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Intrasphenoidal encephalocele associated with cerebrospinal fluid fistula and subdural hematomas: technical case
Bernardo Fraioli1, Carlo Conti, Pierpaolo Lunardi
1Department of Neuroscience, Neurosurgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy. Lunardi@med.uniroma2.it
Objective And Importance:
Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported.
Clinical Presentation:
A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele.
Intervention:
A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure.
Conclusion:
The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.