Mann Prachi, Gajbhiye Sanjog S, Sarjare Deoyani, Anand Aarti, Kalbagwar Shrikant, Giri Pramod
Department of Radiodiagnosis, Government Medical College, Nagpur, India.
Department of Neurosurgery, Government Medical College and Superspeciality Hospital, Nagpur, India.
SA J Radiol. 2024 May 10;28(1):2829. doi: 10.4102/sajr.v28i1.2829. eCollection 2024.
Intrasphenoidal encephalocoeles are acquired or congenital herniations of meninges and brain parenchyma through a structural sphenoid bone defect. Acquired causes are most common, either iatrogenic, post-traumatic, or spontaneous. However, defects in the lateral wall of the sphenoid sinus are uncommon and cephalocoeles through them relatively underexplored in current literature, warranting dedicated attention to unravel their complexities. Congenital causes such as persistence of Sternberg's canal, which can lead to lateral cephalocoeles, is a rare entity, seen in two of the presented cases, based on the location of the defect with respect to the line connecting the foramen rotundum and the vidian canal (VR line). Three cases of intrasphenoidal cephalocoeles are presented; two patients presented with watery nasal discharge without prior trauma or surgery and the third case was incidentally detected in an elderly patient with intraparenchymal haemorrhage. Imaging with CT cisternography and brain MR were performed to ascertain the exact location of the leak and confirm the presence of herniated brain tissue via the defects. Patients were evaluated by otolaryngology for transnasal endoscopic repair, which was deemed unfeasible, and referred to neurosurgery for transcranial duroplasty.
These cases provide crucial insights into the aetiology of lateral intrasphenoidal cephalocoeles, offering a practical system to classify cerebrospinal fluid (CSF) leaks based on the bony defect location. The three illustrative cases and emphasis on advanced imaging modalities refine the knowledge of their aetiology, clinical presentation and management, which hold direct clinical relevance for accurate diagnosis and tailored management of these rare anomalies.
蝶窦内脑膨出是指脑膜和脑实质通过蝶骨结构缺损形成的后天性或先天性疝出。后天性病因最为常见，包括医源性、创伤后或自发性病因。然而，蝶窦外侧壁缺损并不常见，目前文献中对通过这些缺损形成的脑膨出研究相对较少，因此需要专门关注以揭示其复杂性。先天性病因如施特恩贝格管持续存在可导致外侧脑膨出，这是一种罕见情况，在所呈现的两例病例中可见，其依据缺损相对于连接圆孔和翼管的线（VR线）的位置而定。本文呈现了三例蝶窦内脑膨出病例；两例患者表现为水样鼻溢液，无既往创伤或手术史，第三例在一名老年脑实质内出血患者中偶然发现。进行了CT脑池造影和脑部磁共振成像以确定漏口的确切位置，并通过缺损确认疝出脑组织的存在。患者接受了耳鼻喉科评估以进行经鼻内镜修复，但认为不可行，随后转诊至神经外科进行经颅硬脑膜成形术。
这些病例为蝶窦内外侧脑膨出的病因提供了关键见解，提供了一个基于骨缺损位置对脑脊液（CSF）漏进行分类的实用系统。这三例说明性病例以及对先进成像方式的强调完善了对其病因、临床表现和治疗的认识，这对于准确诊断和针对性治疗这些罕见异常具有直接临床意义。
