J Korean Neurosurg Soc.  2012 Dec;52(6):555-557. 10.3340/jkns.2012.52.6.555.

Endoscope-Assisted Trans-Sphenoidal Approach for Treatment of Sternberg's Canal

• Maselli G
• Ricci A
• Galzio RJ

• KMID: 1426267
• DOI: http://doi.org/10.3340/jkns.2012.52.6.555

Abstract

We report an uncommon case of a 45-year-old woman who presented with spontaneous rhinorrhea. A computed tomography (CT) scan of the head revealed an abnormally large sphenoid sinus associated with a parasellar bony defect (Sternberg's canal) through which magnetic resonance imaging could detect an encephalocele of the right temporal lobe. An endoscope-assisted trans-sphenoidal approach was performed and, with the aid of image guided surgery, reduction of the encephalocele was obtained and followed by surgical repair of the dural and bony defects. The postoperative course was uneventful and the cerebrospinal fluid fistula was closed as confirmed by the postoperative CT scan and by the absence of rhinorrhea. After three years of monitoring the patient remained asymptomatic.

Keyword

Cerebrospinal fluid; Endoscope-assisted procedures; Sternberg's canal

MeSH Terms

Encephalocele
Female
Fistula
Head
Humans
Magnetic Resonance Imaging
Sphenoid Sinus
Surgery, Computer-Assisted
Temporal Lobe

Figure

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  Fig. 1 A : High resolution computed tomography of facial massix revealing an accessory cell posterior to the right maxillary sinus. B : Magnetic resonance imaging with contrast medium demonstrating peripheral enhancement of the right sphenoidal encephalocele.

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  Fig. 2 A : High resolution computed tomography of facial massix; coronal reconstruction scan revealing the persistent Sternberg's canal. B : Magnetic resonance imaging with contrast medium coronal scan demonstrating peripheral enhancement of the right sphenoidal encephalocele.

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  Fig. 3 A : Endoscope-assisted trans-sphenoidal approach. B : Neuronavigation image confirms the bony defect.

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  Fig. 4 A : Endoscopic image of the right sphenoidal encephalocele with cerebrospinal fluid fistula in the endoscopic-assisted trans-sphenoidal approach. B : Endoscopic-assisted trans-sphenoidal approach : a particular of the cerebrospinal liquor outflow under brain pulsation.

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  Fig. 5 A : Postoperative high resolution computed tomography of facial massix demonstrating the reduction of the encephalocele and the complete closure of the defect by duroplasty. B : Postoperative high resolution computed tomography of facial massix; coronal reconstruction scan demonstrating the complete reconstruction by a duroplasty.

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