J Neurol Surg Rep 2013; 74(02): 081-087
DOI: 10.1055/s-0033-1348955
Georg Thieme Verlag KG Stuttgart · New York

Pathophysiology and Treatment Options in Trigeminal Meningoceles

Matthias Preuss
1   Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany
,
Alexander Steinhoff
2   Department of Neurosurgery, University Leipzig, Leipzig, Germany
,
Constantin J. Zühlke
3   Department of Neuroradiology, Justus-Liebig-University, Giessen, Germany
,
Dirk Schulz
1   Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany
,
Marco Stein
1   Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany
,
Ulf Nestler
1   Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany
,
Petros Christophis
1   Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany
› Author Affiliations
Further Information

Publication History

14 December 2012

13 April 2013

Publication Date:
12 July 2013 (online)

Abstract

Trigeminal meningoceles, lateral to the maxillary nerve (V2), have seldom been reported as underlying pathology for spontaneous rhinoliquorrhea. In contrast to sphenoid meningoceles arising from a persistent lateral craniopharyngeal canal (Sternberg–Cruveilhier, medial to V2), their occurrence seems to be generated by addition of erosive processes to the constitutively thin bony shell underneath the semilunar ganglion, lateral to the round foramen (and V2).

The developmental and anatomical relationships of trigeminal meningoceles to the sphenoid bone are depicted, and in a review of the literature we present the different surgical approaches employed for sealing the dura leak. In view of these techniques we discuss an unusual case of therapy-resistant rhinoliquorrhea with left-sided trigeminal meningocele involving the Meckel cave at the lateral sphenoid and reaching the superior orbital fissure and the medial orbital space.

In contrast to patients who have lateral sphenoidal meningoceles with a persistent lateral craniopharyngeal canal (Sternberg–Cruveilhier), who can be treated successfully using an endoscopic transsphenoidal approach (recurrence rate 13.7%), the recurrence rate of cerebrospinal fluid (CSF) efflux for trigeminal meningoceles lies much higher (endoscopically 66%, open craniotomy 33%). The surgical strategy thus has to be chosen individually, taking into account specific anatomical situations and eventually preceding operations.

 
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