title: Meningocele and Meningoencephalocele of the Lateral Wall of Sphenoidal Sinus: The Role of the Endoscopic Endonasal Surgery.
abstract: BACKGROUND
  Meningocele and meningoencephalocele of the lateral wall of the sphenoidal sinus (LWSS) are rare lesions, crossing the borders of multiple disciplines such as ear-nose-throat, maxillofacial, and neurologic surgery. We reviewed our surgical experience to analyze the role of the endoscopic endonasal approach and consider these pathologies from different perspectives.
  
  
  METHODS
  All consecutive cases of meningocele and meningoencephalocele of LWSS operated through an endoscopic endonasal approach from 1998 to 2015 in our institutions were collected. Medical history, focusing on previous episodes of cerebrospinal fluid leak, meningitis or seizures, was considered. The outcome was assessed considering the medical condition and the postoperative neuroimaging.
  
  
  RESULTS
  The series includes 23 patients (7 male, 16 female). Mean age was 52 years (26-73 years). Eleven cases were meningoencephaloceles and 12 meningoceles. A clear cerebrospinal fluid leak occurred on in 19 patients and was associated with meningitis in 3. Two were presenting a history of epilepsy. No complications were observed, but 1 case presented seizures on waking. At follow-up (mean 84 months, 4-167) each patient is in good clinical condition with no further episodes of leaking or seizures.
  
  
  CONCLUSIONS
  Endoscopic endonasal surgery is a safe and effective approach for meningocele and meningoencephalocele of LWSS; it allows resection of herniated tissue and repair of the osteodural defect. The favorable clinical outcome and the possible effectiveness on seizures lead us to support this approach as first minimally invasive treatment also in presence of epilepsy, as a first low risk epilepsy surgical procedure.
authors.affiliation: Center of Pituitary and Endoscopic Skull Base Surgery, Bologna, Italy. Electronic address: matteo.zoli4@unibo.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Zoli
authors.affiliation: ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Farneti
authors.affiliation: ENT Department, Bellaria Hospital, Bologna, Italy.
authors.forename: Michael
authors.initials: M
authors.lastname: Ghirelli
authors.affiliation: Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Giulioni
authors.affiliation: Center of Pituitary and Endoscopic Skull Base Surgery, Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Frank
authors.affiliation: Center of Pituitary and Endoscopic Skull Base Surgery, Bologna, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Mazzatenta
authors.affiliation: ENT Department, Bellaria Hospital, Bologna, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Pasquini
mesh_terms: D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D004677:Encephalocele / Q000150:complications / Q000601:surgery*; D004827:Epilepsy / Q000150:complications / Q000601:surgery; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000150:complications; D008588:Meningocele / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods; D009666:Nose; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: CSF leak; Endoscopic endonasal approach; Epileptic surgery; Meningocele; Meningoencephalocele; Sphenoidal sinus; epilepsy