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Unusual presentation of an asymptomatic pseudomeningocele within the sphenoid sinus

Published online by Cambridge University Press:  15 October 2013

K J McNamara ,
R P Exley ,
S Khwaja  and
R K Bhalla
K J McNamara
Affiliation:
Department of Otolaryngology, Tameside Hospital, Ashton-Under-Lyne, UK
R P Exley
Affiliation:
Department of Otolaryngology, Tameside Hospital, Ashton-Under-Lyne, UK
S Khwaja
Affiliation:
Department of Rhinology, Central Manchester Foundation Trust, UK
R K Bhalla*
Affiliation:
Department of ENT, University of Manchester, Manchester Academic Health Science Centre, Central Manchester University Foundation Trust, UK
*
Address for correspondence: Mr R K Bhalla, Department of Otolaryngology – Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK Fax: +44 (0)161 276 5003 E-mail: [email protected]
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Abstract

Objective:

We report the rare case of a 55-year-old woman with an asymptomatic left sphenoid sinus pseudomeningocele mimicking a mucocele.

Case report:

A 55-year-old woman was found to have an incidental mass in the left sphenoid sinus on computed tomography. Magnetic resonance imaging confirmed the presence of a mucocele. A left endoscopic sphenoidotomy was performed to drain the mucocele. Despite an anatomical puncture through a stenosed sphenoid ostium, alarmingly, the opening leaked cerebrospinal fluid. A dehiscent lateral wall was identified with a dural opening communicating with the sphenoid sinus. This was immediately repaired with a free nasal septal mucosal graft. Six months post-operatively, the patient remained free from cerebrospinal fluid leakage.

Conclusion:

Pseudomeningoceles are extremely rare in the absence of trauma or iatrogenic injury. Surgeons should be alert to their presence as they can mimic a unilateral mucocele or nasal polyp. Endoscopic management lends itself to a single-stage repair.

Keywords

Sphenoid SinusMucoceleSkull BaseMeningocele
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 12 , December 2013 , pp. 1238 - 1241
Copyright
Copyright © JLO (1984) Limited 2013 

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References

1Gutiérrez-González, R, Boto, G, Pérez-Zamarrón, A, Rivero-Garvía, M. Retropharyngeal pseudomeningocele formation as a traumatic atlanto-occipital dislocation complication: case report and review. Eur Spine J 2007;17:859–63Google ScholarPubMed
2Vaezi, A, Snyderman, CH, Saleh, HA, Carrau, RL, Zanation, A, Gardner, P. Pseudomeningoceles of the sphenoid sinus masquerading as sinus pathology. Laryngoscope 2011;121:2507–13CrossRefGoogle ScholarPubMed
3Smith, D, El Sayed, I, Pafundi, E, Dolan, R. Presentation and treatment of a posttraumatic pseudomeningocele of the superior orbit. Am J Otolaryngol 2000;21:219–21CrossRefGoogle ScholarPubMed
4Tóth, M, Selivanova, O, Schaefer, S, Mann, W. Spontaneous cerebrospinal fluid rhinorrhea: a clinical and anatomical study. Laryngoscope 2010;120:1724–9CrossRefGoogle ScholarPubMed
5Badia, L, Loughran, S, Lund, V. Primary spontaneous cerebrospinal fluid rhinorrhea and obesity. Am J Rhinol 2001;15:117–9CrossRefGoogle ScholarPubMed
6Dunn, CJ, Alaani, A, Johnson, AP. Study on spontaneous fluid rhinorrhea: its etiology and management. J Laryngol Otol 2005;119:12–5CrossRefGoogle Scholar
7Sugerman, HJ, DeMaria, EJ, Felton, WL 3rd, Nakatuska, M, Sismanis, A. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology 1997;49:507–11CrossRefGoogle ScholarPubMed
8Shetty, G, Shoff, MM, Fatterpekar, GM, Sahani, DV, Kirtane, MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. Am J Neuroradiology 2000;21:337–42Google ScholarPubMed
9Blaivie, C, Lequeux, T, Kampouridis, S, Louryan, S, Saussez, S. Congenital transsphenoidal meningocele: case report and review of the literature. Am J Otolaryngol 2006;27:422–44CrossRefGoogle ScholarPubMed
10Schick, B, Brors, D, Prescher, A. Sternberg's canal – cause of congenital sphenoidal meningocele. Eur Arch Otorhinolaryngol 2000;257:430–2CrossRefGoogle ScholarPubMed
11Castelnuovo, P, Dallan, I, Pistochini, A, Battaglia, P, Locatelli, D, Bignami, M. Endonasal endoscopic repair of Sternberg's canal cerebrospinal fluid leaks. Laryngoscope 2007;117:345–9CrossRefGoogle ScholarPubMed
12Tomazic, PV, Stammberger, H. Spontaneous CSF-leaks and meningoencephaloceles in sphenoid sinus by persisting Sternberg's canal. Rhinology 2009;47:369–74CrossRefGoogle ScholarPubMed
13Bendersky, DC, Landriel, FA, Ajler, PM, Hem, SM, Carrizo, AG. 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;2:171CrossRefGoogle Scholar
14Barañano, CF, Curé, J, Palmer, JN, Woodworth, BA. Sternberg's canal: fact or fiction? Am J Rhinol Allergy 2009;23:167–71CrossRefGoogle ScholarPubMed
15Sautter, NB, Batra, PS, Citardi, MJ. Endoscopic management of sphenoid sinus cerebrospinal fluid leaks. Ann Otol Rhinol Laryngol 2008;117:32–9CrossRefGoogle ScholarPubMed
16Al-Nasher, IS, Carrau, RL, Herrera, A, Snyderman, CH. Endoscopic transnasal transpterygopalatine fossa approach to the lateral recess of the sphenoid sinus. Laryngoscope 2004;114:528–32CrossRefGoogle Scholar
17Tosun, F, Carrau, RL, Snyderman, CH, Kassam, A, Celin, S, Schaitkin, B. Endonasal endoscopic repair of cerebrospinal fluid leaks of the sphenoid sinus. Arch Otolaryngol Head Neck Surg 2003;129:859–63CrossRefGoogle ScholarPubMed