CSF fistula secondary to sphenoid meningoencephalocele.A 40-year-old woman developed spontaneous cerebrospinal fluid (CSF) rhinorrhea, possibly as a result of a significant remote cranial trauma. Magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. (MRI) revealed a nonspecific fluid intensity in a space-occupying lesion in the sphenoid sinus; the lesion extended into the left lateral recess (figure 1). Magnetic resonance cisternography revealed fluid intensity and a meningoencephalocele with bulging meninges meninges (mĭnĭn`jēz), three membranous layers of connective tissue that envelop the brain and spinal cord (see nervous system). The outermost layer, or dura mater, is extremely tough and is fused with the membranous lining of the skull. in the left lateral sphenoid sphenoid /sphe·noid/ (sfe´noid) 1. wedge-shaped. 2. sphenoid bone. sphenoi´dal sphe·noid n. The sphenoid bone. adj. 1. recess (figure 2). In order to confirm the suspected cranial trauma, conventional contrast cisternography with computed tomography (CT) was performed (figure 3). CT cisternography identified dehiscence dehiscence /de·his·cence/ (de-his´ins) a splitting open. wound dehiscence separation of the layers of a surgical wound. de·his·cence n. of the left lateral sphenoid recess, which contained contrast medium that had drained into the nasal cavity (figure 3). [FIGURES 1-3 OMITTED] Trans-sphenoidal meningoencephaloceles are usually congenital anomalies, although cranial trauma as a cause has been reported. (1) The trans-sphenoidal type is the least common type of encephalocele, accounting for 5% of encephaloceles that are seen in the base of the skull The base of the skull (lat. basis cranii) is the most inferior area of the skull. Structures Structures found at the base of the skull are for example:
Surgical treatment of CSF rhinorrhea secondary to a middle fossa fossa /fos·sa/ (fos´ah) pl. fos´sae [L.] a trench or channel; in anatomy, a hollow or depressed area. acetabular fossa a nonarticular area in the floor of the acetabulum. encephalocele that extends into the lateral recess of the sphenoid sinus differs from the surgical strategy followed for more medial sphenoid fistulae. Fistulae that involve the lateral recess of the sphenoid sinus require a transcranial approach for direct visualization and obliteration of the bone defect, whereas fistulae that involve the central portion of the sphenoid sinus can be successfully obliterated via a trans-sphenoidal approach. (3) References (1.) Jabre A. Tabaddor R, Samarawerra R. Transsphenoidal meningoencephalocele in adults. Surg Neurol 2000;54:183-7: discussion 187-8. (2.) Schick B, Draf W, Kahle G, et al. Occult malformations of the skull base. Arch Otolaryngol Head Neck Surg 1997:123:77-80. (3.) Landreneau FE, Mickey B, Coimbra C. Surgical treatment of cerebrospinal fluid fistulae involving lateral extension of the sphenoid sinus. Neurosurgery 1998;42: 1101-4; discussion 1104-5. From the Department of Radiology, Louisiana State University Louisiana State University and Agricultural and Mechanical College, generally known as Louisiana State University or LSU, is a public, coeducational university located in Baton Rouge, Louisiana and the main campus of the Louisiana State University System. Health Sciences Center, New Orleans. |
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