Intrasphenoidal encephalocele associated with cerebrospinal fluid fistula and subdural hematomas: technical case report.
OBJECTIVE
Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported.


METHODS
A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele.


METHODS
A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure.


CONCLUSIONS
The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.
Fraioli
Bernardo
B
Department of Neuroscience, Neurosurgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy. Lunardi@med.uniroma2.it
Conti
Carlo
C
Lunardi
Pierpaolo
P
Liccardo
Giovanni
G
Fraioli
Mario Francesco
MF
Pastore
Francesco Saverio
FS
D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D004677:Encephalocele / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005402:Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006408:Hematoma, Subdural / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013100:Sphenoid Bone / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed