Citation Information :
Goel P, Meher R. Intrasphenoidal Meningoencephalocele—Transnasal Transpterygoid Cerebrospinal Fluid Leak Repair: A Case Report. Clin Rhinol An Int J 2024; 15 (2):77-80.
Sternberg canal is a defect in lateral recess of sphenoid sinus (SS) formed from incomplete fusion of greater wing of SS with basisphenoid. It can act as a spot for herniation of temporal lobe of brain with meninges and can present as cerebrospinal fluid (CSF) rhinorrhea. We present a case of intrasphenoidal meningoencephalocele due to persistence of lateral craniopharyngeal canal (Sternberg canal). The case presented with intermittent CSF rhinorrhea. Radiological investigations consisted of computed tomography scan and magnetic resonance cisternography. The imaging studies identified temporal lobe herniating through a defect in lateral recess of SS. The patient underwent transnasal transpterygoid endoscopic repair. There was no complication postoperatively and no recurrence of CSF leak after 18 months of follow-up. Transpterygoid approach identifies skull base entirely and prevents the need for revision transcranial approach, if done meticulously.
Elsolh B, Cook DJ. Sternberg's canal – A rare cause of cerebrospinal fluid rhinorrhea. Am Med Stud Res J 2015;1(2)251–256. DOI: 10.15422/amsrj.2015.03.025.
Adepoju A, Carlstrom LP, Graffeo CS, et al. Sternberg's canal and defect: Is the lateral craniopharyngeal canal a source of spontaneous cerebrospinal fluid leak? Anatomic and radiological analysis in pediatric and adult populations. Oper Neurosurg 2021;20(4):426−432. DOI: 10.1093/ons/opaa446.
Hanz SZ, Arko L 4th, Schmidt F, et al. Low incidence of true Sternberg's canal defects among lateral sphenoid sinus encephaloceles. Acta Neurochir 2020;162(10):2413−2420. DOI: 10.1007/s00701-020-04329-2.
Tam EK, Gilbert AL. Spontaneous cerebrospinal fluid leak and idiopathic intracranial hypertension. Curr Opin Ophthalmol 2019;30(6):467−471. DOI: 10.1097/ICU.0000000000000603.
Markey KA, Mollan SP, Jensen RH, et al. Understanding idiopathic intracranial hypertension: Mechanisms, management, and future directions. Lancet Neurol 2016;15(1):78−91. DOI: 10.1016/S1474-4422(15)00298-7.
Bendersky DC, Landriel FA, Ajler PM, et al. Sternberg's canal as a cause of encephalocele within the lateral recess of the sphenoid sinus: A report of two cases. Surg Neurol Int 2011;2:171. DOI: 10.4103/2152-7806.90034.
Phang SY, Whitehouse K, Lee L, et al. Management of CSF leak in base of skull fractures in adults. Br J Neurosurg 2016;30(6):596−604. DOI: 10.1080/02688697.2016.1229746.
Bidot S, Levy JM, Saindane AM, et al. Do most patients with a spontaneous cerebrospinal fluid leak have idiopathic intracranial hypertension? J Neuroophthalmol 2019;39(4):487−495. DOI: 10.1097/WNO.0000000000000761.
Wang J, Bidari S, Inoue K, et al. Extensions of the sphenoid sinus: A new classification. Neurosurgery 2010;66(4):797−816. DOI: 10.1227/01.NEU.0000367619.24800.B1.
Sanjari R, Mortazavi SA, Amiri RS, et al. Intrasphenoidal meningo-encephalocele: Report of two rare cases and review of literature. Surg Neurol Int 2013;4:5. DOI: 10.4103/2152-7806.106260.
Sasindran V, Mathew N, Shabna AK, et al. Spontaneous medial cribriform CSF leak: Endoscopic surgical repair with free mucosal graft − Our experience. Indian J Otolaryngol Head Neck Surg 2018;70(3):387−391. DOI: 10.1007/s12070-018-1387-3.
Khafagy YW, Abd Elfattah AM, Moneir W, et al. Leukocyte- and platelet-rich fibrin: A new graft material in endoscopic repair of spontaneous CSF leaks. Eur Arch Otorhinolaryngol 2018;275(9):2245−2252. DOI: 10.1007/s00405-018-5048-7.
