Endoscopic Transpterygoid Approach for Spontaneous Meningoencephalocele of the Sphenoid Wing with Lateral Sphenoid Sinus Extension

Background: Spontaneous meningoencephalocele (SME) of the sphenoid wing is a common cause of cerebrospinal fluid (CSF) leaks. The approach used to treat the fistula depends on the anatomical location of the defect and the extension of the meningoencephalocele. The endoscopic transpterygoid approach is a relatively new technique, which can be used to treat these fistulas.

Methods: We prospectively collected the cases of SME at the sphenoid wing over the last 2 years. Cases with lateral sphenoid sinus extension treated endoscopically were selected. We review the imaging evaluation, operative technique, and the operative morbidity. A literature review of similar cases treated endoscopically was also performed.

Results: Three cases were treated endoscopically via a transpterygoid approach. The extent of the pterygopalatine fossa (PPF) exposure depended on the defect site. A complete PPF exposure was done for one patient and a partial PPF exposure in two. Follow-up ranged from 6 to 18 months. Complete sealing of the fistula was achieved on the first attempt in all three cases. One patient experienced transient double vision that fully resolved at 6 months. Another patient had transient facial numbness. No other complications were seen.

Conclusions: Endoscopic transpterygoid repair is a useful alternative to the traditional approaches used in cases of SME of the sphenoid wing. The feasibility of the intervention depends on the defect site, which can be identified by preoperative imaging. The extent of the PPF exposure did not affect the operative morbidity.