Nerve-Sparing Approach to the Lateral Sphenoid Sinus Recess in a Patient With Multiple Sphenoid Encephaloceles

We present a case of an encephalocele of the lateral recess of the sphenoid sinus and detail the utilization of a nerve-sparing, windowed, pterygopalatine fossa approach to the lateral sphenoid sinus recess in a 37 year-old patient. The patient presented with 15 years of headaches that worsened with stress and head position and 2 weeks onset of unilateral clear rhinorrhea that was similarly worsened by head position. Collected rhinorrhea was positive for β-2 transferrin, and computed tomography was notable for erosion of the roof of the sphenoid sinus at the lateral recess with soft tissue extending into the sphenoid sinus. Magnetic resonance imaging confirmed the presence of a sphenoid encephalocele. The patient underwent a nerve-sparing windowed transpterygoid approach to the skull-base defect. Intraoperatively, 2 discreet skull-base defects were encountered, each with exposed dural tissue that were then repaired with septal cartilage underlay grafts and overlay mucosal grafts. The patient started acetazolamide in the postoperative period and recovered without the recurrence of cerebrospinal fluid leak.