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Vol. 66. Issue 1.
Pages 1-7 (January - February 2015)
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Vol. 66. Issue 1.
Pages 1-7 (January - February 2015)
Original article
Endoscopic Transpterygoid Approach and Skull Base Repair After Sphenoid Meningoencephalocele Resection. Our Experience
Abordaje endoscópico transpterigoideo y reparación de base de cráneo tras resección de meningoencefalocele esfenoidal. Nuestra experiencia
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Àngels Martínez Ariasa, Manuel Bernal-Sprekelsenb, Elena Riojae, Joaquim Enseñatc, Alberto Prats-Galinod, Isam Alobidb,
Corresponding author
isamalobid@gmail.com

Corresponding author.
a Servicio de Otorrinolaringología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
b Unidad de Base de Cráneo, Servicio de Otorrinolaringología, Hospital Clínic Barcelona, Barcelona, Spain
c Servicio Neurocirugía, Hospital Clínic, Barcelona, Spain
d Laboratorio de Neuroanatomía quirúrgica, Hospital Clínic, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
e Servicio de Otorrinolaringología Althaia Xarxa Assistencial, Manresa, Spain
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Tables (2)
Table 1. Characteristics of Our Series of Meningoencephalocele in Lateral Sphenoid Sinus Recess.
Table 2. Characteristics of the Published Series of Meningoencephaloceles in Lateral Sphenoid Sinus Recess.
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Abstract
Introduction and objectives

Cerebrospinal fluid leaks associated to meningoencephaloceles of the sphenoid lateral recess are rare entities. A congenital bony defect at this level results in the persistence of Sternberg's canal, or a lateral craniopharyngeal canal, which is supposed to be the origin of these lesions. Our objective was to show that the endoscopic transpterygoid approach is an effective technique for their treatment.

Methods

We present a series of 5 cases of meningoencephaloceles of the sphenoid lateral recess treated with endoscopic sinus surgery (4 women and one man; mean age=59, range 37–72 years). Cerebrospinal fluid rhinorrhoea was present in all of them and they all underwent a transpterygoid approach with reconstruction of the skull base. We describe the surgical technique and review the literature.

Results

No complications were observed during surgery or the postoperative period. After a mean follow-up of 81 months, only one recurrence was seen.

Conclusions

The transpterygoid approach has proven to be effective for the treatment of meningoencephaloceles of the sphenoid lateral recess. Providing wide access to identify the defect, followed by meningoencephalocele ablation, is the key for successful surgery.

Keywords:
Skull base
Sternberg's canal
Endoscopic sinus surgery
Cerebrospinal fluid leak
Meningoencephalocele
Sphenoid lateral recess
Transpterygoid
Resumen
Introducción y objetivos

Las fístulas de líquido cefalorraquídeo asociadas a meningoencefaloceles del receso lateral de esfenoides son entidades muy infrecuentes. Un defecto óseo congénito a este nivel da lugar a la persistencia del canal de Sternberg o canal craneofaríngeo lateral, supuesto origen de estas lesiones. Nuestro objetivo es exponer que la cirugía endoscópica nasosinusal con abordaje transpterigoideo es una técnica efectiva para su tratamiento.

Métodos

Presentamos cinco casos de meningoencefaloceles de receso lateral de esfenoides tratados con cirugía endoscópica (4 mujeres y un hombre, edad media=59, rango 37-72 años). Todos presentaban rinolicuorrea y en todos se realizó un abordaje transpterigoideo con reconstrucción de la base de cráneo. Realizamos una descripción de la técnica quirúrgica y una revisión de la literatura.

Resultados

Ninguno tuvo complicaciones intra o postoperatorias y solo se registró una recidiva, con una media de seguimiento de 81 meses.

Conclusiones

El abordaje transpterigoideo es efectivo para el tratamiento de meningoencefaloceles de receso lateral de esfenoides. Realizar un amplio acceso para identificar el defecto, seguido de la ablación del meningoencefalocele es la clave para una cirugía exitosa.

Palabras clave:
Base del cráneo
Canal de Sternberg
Cirugía endoscópica nasosinusal
Fístula de líquido cefalorraquídeo
Meningoencefalocele
Receso lateral de esfenoides
Transpterigoideo

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