Abstract
Meningoencephalocele refers to herniation of the intracranial tissue, including the brain and/or meninges, through a defect in the skull base. Cranial meningoencephalocele is classified into occipital, frontal, ethmoidal, nasoorbital, and transsphenoidal types, according to the location of the defect. Transsphenoidal meningocele is rarely encountered. The patient was a 22-year-old man, with no previous history of nasal surgery or head trauma, who presented with a headache and underwent brain MRI. The MRI findings led to the suspicion of a sphenoidal pyocele. CT revealed a bone defect in the lateral wall of the sphenoidal sinus. We performed endoscopic sinus surgery to drain the pyocele and provide relief from the headache. However, after the operation, the patient developed high fever and developed a serous discharge from the sphenoid sinus. We corrected our diagnosis to transsphenoidal meningocele and performed reoperation. It was difficult to detect the point of the CSF leakage. We covered the defect in the sphenoid sinus with a fat graft obtained from the lower abdomen. A free mucus graft from the inferior turbinate was used to cover the fat graft. After 7 months, a brain MRI confirmed that the fat graft had not shrunk. Until the last follow-up at 3 years after the surgery, the patient had not developed any recurrence of the CSF leakage.
