Intrasphenoidal Meningo-encephalocele: Report of two rare cases and review of literature
A 45-year-old female was admitted complaining of refractory headache and recent CSF rhinorrhea. She had no history of head trauma, meningitis or previous surgical operation. In physical exam, cranial nerves were intact and laboratory tests including hormonal studies were all normal. In MRI, the sella was enlarged and filled with CSF compatible with the pattern of empty sella [Figure –, , and ]. There was another mass with signal intensity compatible with mixed CSF and glial tissue, protruding into the sella from the lateral recess of the sphenoid sinus. This mass contained tissue resembling extension of glial tissue of the temporal lobe extending into the cyst [Figure – and ]. Metrizamide CT cisternography identified an intrasphenoidal meningocele located in the left side of the sinus resembling persistence of open Sternberg’ canal connecting the subarachnoid cistern of the medial temporal region into the cyst []. Endoscopic endonasal approach to the sella revealed the CSF containing cyst hanging into the sphenoid sinus and fibr-oglial tissue remnants within it. The overlying fibrous tissue, resembling the dura was coagulated and removed little by little along with the neurovascular glial tissue within it. At the end, there was an orifice located in the left lateral side of the sphenoid cavity. There was no communication between the cyst cavity and the sella tursica. The orifice could be packed with autogenous fat and covered by a pediculate mucosal flap. In the postoperative course, she was suffering from dry left eye. Rhinorrhea recurred a week after surgery. Lumbar drainage was established for 5 days and rhinorrhea stopped. She was asymptomatic during the first 6 months after surgery but CSF leakage recurred after 1 year. A lumbo-peritoneal shunt was placed and there has been no CSF leakage during the next 10 months follow up.