title: Pseudomeningoceles of the sphenoid sinus masquerading as sinus pathology.
abstract: OBJECTIVE
  To describe the clinical presentation, pathophysiology, and treatment of spontaneous cerebrospinal fluid (CSF) leaks of the sphenoid bone, with an emphasis on a previously undescribed form in this location, in which CSF is trapped under the mucosa of the sinonasal cavity or in the soft tissue of the skull base.
  
  
  METHODS
  Case series and literature review.
  
  
  METHODS
  Analysis of cases through medical records and literature review.
  
  
  RESULTS
  Four examples of unusual spontaneous CSF leaks of the skull base are presented. In each case, a CSF collection was contained behind the sinonasal mucosa of the sphenoid sinus, resembling a nasal polyp or mucocele on exam or imaging. In one case, the fluid collection was also associated with significant bone resorption and extravasation into the soft tissue of the infratemporal fossa. In each case, small defects of the ventral skull base (sphenoid bone) were the source of the CSF leaks. Successful treatment was achieved after transnasal endoscopic repair of the skull base defects using a combination of free abdominal fat grafts, free fascial grafts, and pedicled nasoseptal flaps. Postoperatively, a ventriculoperitoneal shunt was placed if the intracranial pressure was elevated.
  
  
  CONCLUSIONS
  Spontaneous CSF leaks arising in the sphenoid sinus may not always present with overt CSF rhinorrhea but with a submucosal fluid collection (pseudomeningocele) that may mimic a mucocele or nasal polyp. These bona fide pseudomeningoceles of the skull base may be associated with elevated intracranial pressure and can be managed using endoscopic endonasal surgery.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors: Alec
authors: A
authors: Vaezi
authors: Carl H
authors: CH
authors: Snyderman
authors: Hesham A
authors: HA
authors: Saleh
authors: Ricardo L
authors: RL
authors: Carrau
authors: Adam
authors: A
authors: Zanation
authors: Paul
authors: P
authors: Gardner
mesh_terms: D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008588:Meningocele / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000175:diagnosis* / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D019291:Skull Base / Q000601:surgery; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome