title: Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus.
abstract: OBJECTIVE
  Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare lesions that are hypothesized to result from persistence of the lateral craniopharyngeal canal. Prior reports of the management of this lesion have been limited by its relative rarity. The objective of this paper is to report the theoretical etiology, surgical technique, and outcomes in patients undergoing endoscopic repair of spontaneous meningoencephalocele of the sphenoid sinus.
  
  
  METHODS
  The authors conducted a retrospective review of a multiinstitutional series of 13 cases involving patients who underwent endoscopic repair of spontaneous meningoencephalocele of the lateral sphenoid sinus. The surgical technique and pathophysiological considerations are discussed.
  
  
  RESULTS
  The clinical manifestations included CSF rhinorrhea (85%), chronic headache (77%), and a history of meningitis (15%). The endoscopic approaches to the lateral sphenoid sinus were transnasal (39%), transpterygoid (23%), and transethmoid (39%). Two patients (8%) had postoperative CSF leaks, one of which closed spontaneously and one of which required revision endoscopic closure. All patients were free of leak at most recent follow-up. One patient experienced postoperative meningitis in the early postoperative period.
  
  
  CONCLUSIONS
  Endoscopic endonasal closure is an effective modality in the treatment of spontaneous meningoencephaloceles of the lateral sphenoid sinus. If the sphenoid sinus has extensive lateral pneumatization, adequate exposure may require a transpterygoid approach.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA. atabaee@hotmail.com
authors.forename: Abtin
authors.initials: A
authors.lastname: Tabaee
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
authors.forename: Aldo
authors.initials: A
authors.lastname: Stamm
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis; D002908:Chronic Disease; D003937:Diagnosis, Differential; D004677:Encephalocele / Q000473:pathology* / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006261:Headache / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008588:Meningocele / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009296:Nasal Cavity; D011183:Postoperative Complications; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000473:pathology* / Q000601:surgery*