Abstract
Background We report the rare case of an adult transsphenoidal meningoencephalocele and outline
the microneurosurgical strategy. Clinical history, the findings of computerized tomography
(CT) scans and magnetic resonance imaging (MRI), the microsurgical procedure, and
histopathology are reported.
Case Report A 54-year-old female patient complained about cerebrospinal fluid (CSF) rhinorrhea;
a transnasal biopsy of a mass in the maxillar sinus prior to diagnostic work-up was
performed elsewhere. Persisting CSF leakage prompted CT and MRI, which showed brain
tissue extending from the left middle cranial fossa into the left sphenoid sinus through
several bony defects. The diagnosis of a transsphenoidal meningoencephalocele was
made, and the lesion was targeted via a subtemporal intradural approach with resection
of the herniated brain tissue and closure of the bony as well as of dural defects.
The postoperative course was uneventful without recurrence of the CSF fistula.
Conclusion The transsphenoidal subtype of basal meningoencephaloceles is exceedingly rare. Nonetheless,
it has to be considered as a differential diagnosis if a nasal or intrasphenoidal
mass is diagnosed. Otherwise, unjustified biopsy or unsuccessful management of CSF
leakage could not be avoided. The intradural subtemporal approach is effective to
treat the transsphenoidal type of basal meningoencephaloceles.
Keywords
temporobasal - transsphenoidal meningoencephalocele - rhinorrhea - skull base surgery
