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Case Reports
. 2020 Aug 31;14(8):1-7.
doi: 10.3941/jrcr.v14i8.3761. eCollection 2020 Aug.

Spontaneous Unilateral Intrasphenoidal Meningocele

Roger Rozzi  1 , Jessica Behringer  1 , Ademola Obajuluwa  1 , Michael Wilczynski  1
Affiliations
Case Reports

Spontaneous Unilateral Intrasphenoidal Meningocele

Roger Rozzi et al. J Radiol Case Rep. .

Abstract

The sphenoid sinus is an uncommon location for protrusion of a meningocele. When this does occur, it nearly always presents with leakage of cerebrospinal fluid through the nasal cavity. We present a case of a 38-year-old female found to have a meningocele protruding into the left sphenoid sinus, who presented with intractable headache but no CSF rhinorrhea. The lesion was discovered on computed tomography angiography, which was performed in order to rule out intracranial pathology as the etiology of her headache. Prior imaging, including pre- and post-contrast MRI, demonstrated the fluid within the sphenoid sinus, but did not reveal the communication through a defect in the base of the skull. Thus, it was assumed to be strictly related to sinus disease in the past. Our case represents a phenomenon whereby meningoceles protruding through the basilar skull into the sphenoid sinus or any other location are potentially misdiagnosed due to poor visualization of the osseous defect and lack of awareness of this entity.

Keywords: Computed Tomography Angiography; Endoscopic Endonasal Repair; Intrasphenoidal; Meningocele; Meningoencephalocele; Sphenoid Sinus; Sternberg Canal.

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Figures

Figure 1
Figure 1
38-year-old female with intrasphenoidal meningocele. FINDINGS: T2-weighted axial MRI shows high T2 signal in the left lateral recess of the sphenoid sinus with extension from the middle cranial fossa. TECHNIQUE: MRI without contrast, performed on a 1.2T Open MRI.
Figure 2
Figure 2
38-year-old female with intrasphenoidal meningocele. FINDINGS: Sagittal T1-weighted MRI shows CSF signal intensity in the sphenoid sinus (red arrow) when compared to the intensity of air in the frontal sinus (yellow arrow). TECHNIQUE: MRI without contrast, performed on a 1.2T Open MRI.
Figure 3
Figure 3
38-year-old female with intrasphenoidal meningocele. FINDINGS: Coronal T1 Post-contrast MRI imaging shows extension of CSF into the sphenoid sinus. TECHNIQUE: MRI with contrast, performed on a 1.2T Open MRI, (20mL of Multihance intravenous contrast).
Figure 4
Figure 4
38-year-old female with intrasphenoidal meningocele. FINDINGS: Sagittal T1-weighted MRI shows extension of the meninges into the sphenoid sinus. TECHNIQUE: MRI without contrast, performed on a 1.2T Open MRI.
Figure 5
Figure 5
38-year-old female with intrasphenoidal meningocele. FINDINGS: Sagittal T1-weighted MRI of the normal right temporal lobe of the same patient for comparison. TECHNIQUE: MRI without contrast, performed on a 1.2T Open MRI.
Figure 6
Figure 6
38-year-old female with intrasphenoidal meningocele. FINDINGS: Magnification and side-by-side for comparison of Figures 4 and 5.
Figure 7
Figure 7
38-year-old female with intrasphenoidal meningocele. FINDINGS: Coronal Computed Tomography Angiogram of the Brain in Bone Window shows osseous dehiscence of the roof of the left lateral sphenoid sinus. TECHNIQUE: CT Angiogram of the Brain, kVP 120, 5.0mm thick slices, 75mL of Isovue 370 intravenous contrast.
Figure 8
Figure 8
38-year-old female with intrasphenoidal meningocele. FINDINGS: Coronal Computed Tomography Angiogram of the Brain in Soft Tissue Window shows protrusion of CSF through the osseous dehiscence. TECHNIQUE: CT Angiogram of the Brain, kVP 120, 5.0mm thick slices, 75mL of Isovue 370 intravenous contrast.
Figure 9
Figure 9
38-year-old female with intrasphenoidal meningocele. FINDINGS: Sagittal Computed Tomography Angiogram of the Brain in Soft Tissue Window shows the clinoid segment of the left internal carotid artery abutting the sphenoid sinus without protrusion. TECHNIQUE: CT Angiogram of the Brain, kVP 120, 5.0mm thick slices, 75mL of Isovue 370 intravenous contrast.
Figure 10
Figure 10
38-year-old female with intrasphenoidal meningocele. FINDINGS: Axial Computed Tomography Angiogram of the Brain in Soft Tissue Window shows slightly hyperdense material protruding into the sphenoid sinus compared to CSF, possibly representing left temporal lobe parenchyma. TECHNIQUE: CT Angiogram of the Brain, kVP 120, 5.0mm thick slices, 75mL of Isovue 370 intravenous contrast.
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