case_images: PMC10874506_01
case_images: CT scans and MRI confirm inferolateral sphenoid wall dehiscence and brain herniation.. CT scans (A and B) show a dehiscence of the inferolateral sphenoid wall, establishing communication with the middle cranial fossa (arrowheads). MRI (C and D) shows bone discontinuity in the right lateral wall of the sphenoid sinus and in the ipsilateral petrous apex, crossed by tissue with signal emission characteristics similar to brain parenchyma and CSF, involving the right chamber of the sphenoid sinus, the ipsilateral Meckel cave, and the base of the pterygoid processes bilaterally (arrowheads).
case_images: cureus-0016-00000052555-i01.jpg
case_images: PMC10874506_01_cureus-0016-00000052555-i01.jpg
case_images: FIG1
case_images: The CT scans showed an opacification of the right sphenoid and a possible dehiscence of the inferolateral sphenoid wall, possibly the Stenberg's canal (Figure 1A, 1B). The MRI confirmed the presence of meningoencephalic herniation through the right lateral sphenoid wall and petrous bone involving also the Meckel's cave (Figure 1C, 1D).
case_images: Transpterygoid approach to access sphenoid meningoencephalocele.. The posterior wall of the maxillary sinus was exposed and removed (arrowhead, A). The herniated brain was then exposed (arrowhead, B). The meningoencephalocele was then retracted with bipolar cauterization (arrowhead, C). Following the retraction, no herniated brain tissue was observed in the sphenoid sinus (arrowhead, D).
case_images: cureus-0016-00000052555-i02.jpg
case_images: PMC10874506_01_cureus-0016-00000052555-i02.jpg
case_images: FIG2
case_images: The herniated brain tissue was bipolar retracted, and a multilayer reconstruction was performed with fat tissue, fascia lata, and nasoseptal flap (Figure 2).
case_images: Post-surgical evaluation shows a completely healed nasal cavity.. The maxillary sinus (arrowhead, A) and the sphenoid sinus (arrowhead, B).
case_images: cureus-0016-00000052555-i03.jpg
case_images: PMC10874506_01_cureus-0016-00000052555-i03.jpg
case_images: FIG3
case_images: PMC10874506_02
case_images: CT and MRI show dehiscence of the lateral left sphenoid wall with brain herniation.. CT scans (A and B) show dehiscence of the lateral left sphenoid wall (arrowheads), establishing communication with the middle cranial fossa. MRI (C and D) shows bone discontinuity in the left lateral wall of the sphenoid, crossed by tissue with signal emission characteristics similar to brain parenchyma and CSF to the left chamber of the sphenoid sinus (arrowheads).
case_images: cureus-0016-00000052555-i04.jpg
case_images: PMC10874506_02_cureus-0016-00000052555-i04.jpg
case_images: FIG4
case_images: The CT scan showed an opacification of the left sphenoid sinus and the absence of the left lateral sphenoid wall (Figure 4A, 4B). The imaging study was complemented with an MRI that showed an encephalocele through the left lateral sphenoid wall to the sphenoid sinus (Figure 4C, 4D).
case_images: A transpterygoid endonasal approach with multilayer reconstruction was used.. The pterygoid fossa was exposed maintaining its periosteum (arrowhead, A). Following sphenoidotomy, the meningoencephalocele was exposed (arrowhead, B), and then shrunk with bipolar cauterization (arrowhead, C). The pedicle of the herniated tissue was then sectioned (arrowhead, D). The defect of the lateral wall of the sphenoid sinus was then reconstructed with bone from the middle turbinate (arrowhead) and oxidized regenerated cellulose (E). Finally, a nasoseptal flap was used to cover the sphenoid with another layer of oxidized regenerated cellulose (arrowhead, F).
case_images: cureus-0016-00000052555-i05.jpg
case_images: PMC10874506_02_cureus-0016-00000052555-i05.jpg
case_images: FIG5
case_images: A multilayer reconstruction was done using oxidized regenerated cellulose, a bone from the middle turbinate, a dura substitute, and a nasoseptal flap (Figure 5A-5F).