A case of sphenoid sinus meningoencephalocele repaired by an image-guided endoscopic endonasal approach

We report a Japanese patient with a complaint of unilateral watery nasal discharge. Analysis of the nasal discharge showed it to contain high levels of sugar and transferrin, which indicated cerebrospinal fluid (CSF) rhinorrhea. A diagnosis of sphenoid sinus meningoencephalocelewas easilymadeonthebasisoftheCT,MRIandnasaldischargefindings.Weperformedsurgerybyanimage-guidedendoscopicendonasalapproach (IGEEA).Animageguidancesystem(IGS)wasusedtoconfirmthepositionofthebonedefectandtheprolapsedbrainlobe.Weresectedthebrain lobe, and used fat tissue and fascia to create an extracranial‐intracranial blockade. As of 18 months after the operation, there is no evidence of infectionorCSFleakage.TheIGEEAenabledustosuccessfullyrepairthemiddleskullbaseusingamulti-layersealingtechnique,whiletheIGS allowedustoconfirmtheanatomicalstructuresandsuccessfullyavoidcausingcollateraldamagetothesurroundingtissues.Thiscaseexemplifies the beneficial effect that of the development of surgical support equipment on the operative approach that is now indicated for sphenoid sinus meningoencephaloceles: the endonasal approach has largely replaced other approaches, such as lateral rhinotomy. # 2011 Elsevier Ireland Ltd. All rights reserved.