Medical Case Reports

Spontaneous Pseudomeningocele of a Sphenoid Sinus: An Case Report

Introduction: A spontaneous pseudomeningocele (PMC) (e.g.without previous surgery or injury) is a rare pathology that may be mimicked as an unilateral polypoid mass in endoscopy or as a mucocele on CT /MRI, which only very exceptionaly doesn’t present with rhinoliquorhea. PMC develops when cerebrospinal fluid (CSF) becomes trapped behind the paranasal sinus mucosa or extracranial soft tissues, and may be associated with bony erosion.

Case presentation: We present an exceptional case of a 47-year-old man with a rare spontaneus pseudomeningocele of the sphenoid sinus without any obvious clinical symptoms, which resembles a mucocele on CT and MRI scans and which was first correctly diagnosed after an exploratory sphenoidotomy. Due to postsurgical complications (a significant rhinoliquorhea), an endoscopic obliteration of the sphenoid cavity was necessary.

Conclusion: In the report we intend to stress the pitfalls of an exceptional skull base pathology and its surgical complications in patients with atypical manifestations. For successful treatment, a wide exposure to address all potential skull base defects and following duroplasty is recommended.The biggest challenge of spontaneous PMC is a correct diagnosis, especially when typical symptoms are absent. In the case report we want to point out the pitfalls of an endonasal surgery, which may result in another surgical revision after futher investigation.

Author(s):

Zuzana Horakova and Hana Binkova

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