Intrasphenoidal cephalocoeles: Knowing the less known.

Area of Science:

• Neurosurgery
• Otolaryngology
• Radiology

Background:

• Intrasphenoidal encephalocoeles involve brain herniation through sphenoid bone defects, with acquired causes being most common.
• Defects in the lateral sphenoid sinus wall are uncommon, making lateral encephalocoeles rare and underexplored.
• Congenital causes, like persistent Sternberg's canal, can lead to lateral encephalocoeles.

Observation:

• Three cases of intrasphenoidal encephalocoeles are presented.
• Two patients had watery nasal discharge without prior trauma or surgery.
• One case was incidentally found in an elderly patient with intraparenchymal hemorrhage.

Findings:

• Advanced imaging, including CT cisternography and brain MRI, confirmed the location of cerebrospinal fluid (CSF) leaks and herniated brain tissue.
• A classification system for CSF leaks based on bony defect location was proposed.
• Transnasal endoscopic repair was deemed unfeasible for these lateral defects.

Implications:

• These cases enhance understanding of the etiology, presentation, and management of lateral intrasphenoidal encephalocoeles.
• The findings are clinically relevant for accurate diagnosis and tailored treatment of these rare anomalies.
• Referral to neurosurgery for transcranial duroplasty was indicated for repair.