Intrasphenoidal Meningo-encephalocele: Report of two rare cases and review of literature
A 17-year-old boy was referred complaining from headache and intermittent CSF rhinorrhea of 2 years duration. In physical examination, hypertelorism, cleft lip, high arch palate, and see saw nystagmus were detected. Endocrinological examinations showed deficient growth hormone (GH), adrenocorticotropic hormone (ACTH), and luteinizing hormone (LH). Brain magnetic resonance imaging (MRI) revealed intrasphenoidal meningocystocele with infandibular recess descending into the meningocele and no other brain anomaly []. Brain angiography, showed hypoplasia of the left A1 segment. The patient was operated by endoscopic transnasal transsphenoidal approach. Preoperatively, it was planned to pack the epidural space of the floor of the sella. At surgery, epidural packing was impossible because of tight adhesion of the fibrous tissues around the base of the meningocele. The epidural space could not be teased off the surrounding bonystructures, so the cavity of the cyst and the sphenoid sinus were packed with autogenous abdominal fat supported by dural glue. There was no rhinorrhea in 3-and 6-month follow up.