[Spontaneous temporo-sphenoidal encephalocele. A case report]

A case of anteromedial temporo-sphenoidal meningo-encephalocele in a 43-year-old woman is reported. She was referred to us after a five-year history of rhinorrhea of CSF. Three years ago, she presented an epileptic seizure. CT scan showed an empty sella and an opacity of the right part of the sphenoid sinus. On coronal sections, a defect was visible in the superior wall of the right lateral recess of the sphenoid sinus. The lateral sphenoidal rhinorrhea was confirmed by a CT cisternography. The patient was operated on via a frontotemporal approach with an orbitozygomatic removal. The dural defect was filled by a patch of pericranium. The patient is without evidence of cerebrospinal fluid leak 2.5 years later. Fifteen cases of anteromedial temporosphenoidal meningo-encephaloceles have been reported. They probably are of a developmental origin. Some cases have been successfully treated via a transsphenoidal route. However, surgical failures related to this approach can be due to the lack of control of the lateral recess of the sphenoid sinus. Therefore, the frontotemporal approach seems more adequate.