Reparación endoscópica de encefalocele esfenoidal, secundario a persistencia del canal de Sternberg / Endoscopic repair of sphenoid encephalocele, secondary to persistence of Sternberg's canal

Las fístulas de líquido cefalorraquídeo (FLCR) nasales se producen por la comunicación entre el espacio subaracnoídeo y el tracto aerodigestivo. Pueden ser adquiridas (secundarias a trauma o iatrogenia) o espontáneas. Éstas últimas pueden ser de origen congénito, tumoral o idiopáticas. El canal lateral craneofaríngeo o de Sternberg se produce por la falta de fusión de los puntos de osificación del seno esfenoidal durante el período embrionario. Esta región, ubicada posterolateral a la pared inferior del seno esfenoidal, queda cubierta solamente por tejido conectivo, siendo la zona de menor resistencia de la base de cráneo. La persistencia de este canal puede causar FLCR, especialmente cuando se asocia a elevación de la presión intracraneana y extensa neumatización. La cirugía endoscópica nasal es la técnica de elección para la resolución de estos casos. En el presente artículo se realiza una revisión de la técnica quirúrgica endoscópica nasal para la resolución quirúrgica de encefaloceles secundarios a persistencia del canal de Sternberg, en base a dos casos clínicos que fueron sometidos a cirugía endoscópica nasal.

Nasal cerebrospinal fluid leaks are caused by a nasal communication between the subarachnoid space and the aerodigestive tract. They may be acquired (secondary to trauma or iatrogenic) or spontaneous. The latter can be congenital, tumoral or idiopathic. The lateral craniopharyngeal canal or Sternberg canal is caused by the lack of fusion of the points of ossification of the sphenoid sinus during the embryonic period. This region, located posterolateral to the bottom wall of the sphenoid sinus, is covered only by connective tissue, being the area of least resistance of the skull base. The persistence of this canal can cause cerebrospinal fluid leaks, especially when associated with elevated intracranial pressure and extensive pneumatization. Nasal endoscopic surgery is the technique of choice for solving these cases. This article is a review of the endoscopic surgical technique of encephaloceles secondary to persistence of Sternberg canal, based on two clinical cases.

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

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.