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. 2024 Feb 12;7(7):CASE23700.
doi: 10.3171/CASE23700. Print 2024 Feb 12.

Spontaneous sphenoid sinus meningocele with associated amenorrhea and headache: illustrative case

Deveney Franklin  1 , Ali S Yamani  2 , Andre E Boyke  3 , Simon A Menaker  3 , Dennis Tang  4 , Adam N Mamelak  3
Affiliations

Spontaneous sphenoid sinus meningocele with associated amenorrhea and headache: illustrative case

Deveney Franklin et al. J Neurosurg Case Lessons. .

Abstract

Background: Developmental meningoceles of the sphenoid sinus are uncommon. When encountered, they are often associated with cerebrospinal fluid (CSF) rhinorrhea.

Observations: The authors present the case of a 27-year-old female with a large meningocele eroding through the sella turcica and sphenoid sinus into the nasopharynx. The patient presented with intractable headaches and amenorrhea without CSF rhinorrhea.

Lessons: The patient underwent an endoscopic endonasal transsphenoidal reduction of the meningocele with reelevation of the pituitary gland and skull base reconstruction with abdominal fat graft and nasoseptal flap.

Keywords: congenital; endocrinopathy; meningocele; skull base.

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Figures

FIG. 1
FIG. 1
Original coronal (left) and sagittal (right) MRI from 2013 showing a cystic lesion.
FIG. 2
FIG. 2
A: Cystic lesion with extension through the floor of the sella turcica and filling the sphenoid sinus. B: Downward traction of the cyst caused inferior retraction of the optic chiasm, stretching of the pituitary stalk, and flattening of the pituitary gland at the base of the sphenoid. C: Signal intensity within the cystic lesion was consistent with CSF.
FIG. 3
FIG. 3
Intraoperative endoscopic images of the meningocele and final repair. A: Meningocele after the sphenoid roof was removed (prior to opening). B: Meningocele cavity after the pituitary gland was freed up and elevated. C: Fat graft placed to obliterate the meningocele. D: Nasoseptal flap covering the meningocele.
FIG. 4
FIG. 4
Postoperative axial (A), coronal (B), and sagittal (C) T2-weighted MRI sequences showed a reduction of the meningocele with the fat graft in place obliterating much of the sphenoid sinus.
See this image and copyright information in PMC

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