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Updated: Apr 22, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Spontaneous sphenoid wing meningoencephaloceles with lateral sphenoid sinus extension: the endoscopic transpterygoid
Abdulrazag Ajlan1, Achal Achrol2, Ethan Soudry3
1Department of Neurosurgery, Stanford University, Stanford, California, United States ; Department of Neurosurgery, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Abstract:
Spontaneous meningoencephalocele (SME) of the sphenoid wing is a rare cause of cerebrospinal fluid (CSF) leakage. Surgical closure of the fistula is usually required. The approach taken depends on the location of the defect and the extension of the meningoencephalocele. The endoscopic transpterygoid approach may be useful. We prospectively analyzed the three cases of SME of the sphenoid wing with lateral sphenoid sinus extension treated endoscopically at Stanford over the last 3 years with regard to imaging findings, operative technique, and operative morbidity. In our three cases, the extent of pterygopalatine fossa (PPF) exposure undertaken, complete in one and partial in two, depended on the defect site. Follow-up ranged from 17 to 25 months. The fistula was completely closed in all three cases. Extant literature reports a 97% rate of successful closure (N = 65 of 67, with a mean follow-up of 25 months) and no major complications. Endoscopic transpterygoid repair is a useful, safe alternative to traditional approaches for repair of SME of the sphenoid wing. Its feasibility depends on the site of the defect, which can be identified by preoperative imaging. Larger PPF exposure and postoperative lumbar drainage of CSF can be useful and have a low risk of morbidity.
Insights
Spontaneous meningoencephalocele (SME) of the sphenoid wing can be effectively treated with an endoscopic transpterygoid approach. This minimally invasive technique offers a safe and successful alternative for closing cerebrospinal fluid (CSF) fistulas.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Spontaneous meningoencephalocele (SME) of the sphenoid wing is a rare condition causing cerebrospinal fluid (CSF) leakage.
- Surgical intervention is typically necessary to close the resulting fistula.
Purpose of the Study:
- To evaluate the efficacy and safety of the endoscopic transpterygoid approach for treating SME of the sphenoid wing.
- To analyze imaging findings, surgical techniques, and operative morbidity in patients undergoing this endoscopic repair.
Main Methods:
- Prospective analysis of three cases of SME of the sphenoid wing with lateral sphenoid sinus extension treated endoscopically.
- Assessment of pterygopalatine fossa (PPF) exposure extent based on defect location.
- Review of imaging findings, operative details, and patient follow-up (17-25 months).
Main Results:
- Complete fistula closure was achieved in all three treated cases.
- Literature review indicates a 97% success rate for endoscopic closure in 67 reported cases.
- No major complications were reported in the study or the literature review.
Conclusions:
- The endoscopic transpterygoid approach is a viable, safe, and effective alternative for repairing SME of the sphenoid wing.
- Preoperative imaging is crucial for determining the feasibility of the approach based on defect site.
- Consideration of wider PPF exposure and postoperative CSF drainage may enhance outcomes with low morbidity.
