Endoscope-Assisted Trans-Sphenoidal Approach for Treatment of Sternberg's Canal
A 45-year-old female presented with complaints of intermittent right-sided watery nasal discharge for one year, without headache, nausea or fever. The symptom was worsened by clinostatic position : during the night, the patient referred watering fluid in the pharynx. This was accompanied by confusion sensation and, sometimes, positional headache. There was no history of meningitis or trauma. β2-Transferrin-analysis and albumin/prealbumin tests of the nasal discharge indicated cerebrospinal fluid. The high resolution computed tomography of facial massix scans, including coronal reconstructions, revealed a particularly extended sphenoidal sinus on the right side (, ). Magnetic resonance imaging with contrast medium demonstrated peripheral enhancement of the lesion. We diagnosed the lesion as sphenoidal encephalocele (, ).\nWe decided to approach the lesion by an endoscope-assisted trans-sphenoidal approach, supported by neuronavigation, and the parasellar bony defect was confirmed (). The right temporal lobe pole was herniated into the accessory sphenoidal cell. Furthermore, the endoscope-assisted observation permitted to individuate cerebrospinal liquor outflow, under brain pulsation ().\nThe herniated brain material was removed under endoscopic control, until the individuation the bone defect on anterior wall of accessory cell. After abdominally fat and muscle graft by a right paraombelical incision, under intraoperative microscopic control, a sphenoidal accessory cell duraplasty was accomplished by inserting grafts of abdominal fat into the "bottleneck" of the meningocele. With the aid of neuronavigation, reduction of the right sphenoidal encephalocele was obtained and the persistent canal was sealed with the aid of fat, muscle graft and fibrin glue.\nThe nasal discharge stopped immediately after surgery and postoperative computed tomography demonstrated the complete reconstruction by a duraplasty ().\nThree years later the patient had no evidence of cerebrospinal fluid leakage.