Temporosphenoidal (Sternberg) Meningoceles: Value of the Ipsilateral Nasoseptal Flap

Objectives: The endoscopic approach is the procedure of choice for the treatment of anterior skull base defects. Success rate after primary surgery stands between 90% and 95%. However, defects located in the sphenoid sinus seem to have a lower rate of success. Difficulty in exposing the defect, the size of the defect, and impaired mucosal healing may contribute to failures. The goal of this study is to review the surgical tricks that lead to success.

Methods: Retrospective study of patients with temporosphenoidal meningoencephaloceles who were operated on during the last 10 years in our institution. Approaches, methods of closure, and failure rate are described.

Results: Eleven cases were operated on (9 males, 2 females). Nine cases could not be related to persistence of Sternberg's canal because they were lateral to the foramen rotundum. In all cases, a large sphenoidotomy combined with a transpterygoid approach was performed. The approaches were either ipsilateral combined with a medial maxillectomy or contralateral. Bone defects were electively plugged after meningocele resection. The secondary layer consisted in a large fascia lata graft covering the whole cavity (Draf's tobacco pouch) or in a nasoseptal flap from the contra (n = 1) or ipsilateral side (n = 2).

Conclusions: Transpterygoid procedure eventually performed from the contralateral side provides adequate exposure for the elective treatment of temporosphenoidal meningoceles. After primary closure of the bone defect, the ipsilateral nasoseptal flap, elevated with gentle dissection of the pterygopalatine fissure, is the best option for complete coverage of the pterygoid recess and a rapid mucosal healing.