PMC10316184_01
Case 1 - (a and b) Computed tomography scans showed a defect (white arrow, black arrow) in the lateral wall of the left sphenoid sinus lateral to the foramen rotundum (black arrowhead) and erosion of the dorsum sellae (asterisk). (c and d) Head T2-weighted magnetic resonance (MR) image (c) and MR cisternogram (d) revealed brain parenchyma had herniated into the lateral sphenoid sinus through the defect of the middle cranial fossa (white arrow). (e) Schema of meningoencephalocele and cerebrospinal fluid rhinorrhea associated with Sternberg's canal.
SNI-14-228-g001.jpg
PMC10316184_01_SNI-14-228-g001.jpg
F1
Head computed tomography (CT) showed a defect lateral to the foramen rotundum in the lateral wall of the left sphenoid sinus and erosion of the dorsum sellae [Figures 1a and b]. Head magnetic resonance (MR) imaging and MR cisternogram revealed brain parenchyma had herniated into the lateral sphenoid sinus through the defect of the middle cranial fossa and the empty sella [Figures 1c-e].
Case 1 - Intraoperative photographs showing the left frontotemporal craniotomy with temporal extension. (a) The intradural approach exposing middle cranial dura and brain tissue protruding into the defect in the middle skull base leading to the sphenoid sinus (arrow). (b) Herniated dura (arrow). (c) Dural defect was sutured through the extradural approach (arrow). (d) Defect in the lateral sphenoid sinus was 5 mm in size (arrow). (e-g) Intradural (e) and extradural spaces (f) and bone defect (g) were sealed with abdominal external oblique fascia containing fat, fibrin glue, and biological tissue reinforcement material.
SNI-14-228-g002.jpg
PMC10316184_01_SNI-14-228-g002.jpg
F2
The intradural and extradural spaces and bone defect were sealed with abdominal external oblique fascia containing fat, fibrin glue, and biological tissue reinforcement material through both the intradural and extradural approaches [Figures 2a-g].
PMC10316184_02
Case 2 - (a and b) Sagittal (a) and coronal computed tomography scans (b) showed a defect in the floor of the sella turcica (arrow). (c) Arteriovenous malformations in the right frontal lobe, with nidus of 5 cm (arrow). (d) Magnetic resonance cisternogram revealed abnormal fluid collection in the sphenoid sinus and the empty sella.
SNI-14-228-g003.jpg
PMC10316184_02_SNI-14-228-g003.jpg
F3
CT showed a defect in the floor of the sella turcica and AVMs in the right frontal lobe, with nidus of 5 cm [Figures 3a-c]. MR cisternogram revealed the empty sella with intracranial and abnormal fluid collection in the sphenoid sinus [Figure 3d].
Case 2 - (a and b) Computed tomography scans showed severe pneumocephalus and a defect in the lateral wall of the left sphenoid sinus between the foramen rotundum and foramen ovale (black arrow). (c and d) Axial (c) and coronal (d) magnetic resonance cisternogram showed that brain parenchyma had herniated into the lateral sphenoid sinus through the defect of the middle cranial fossa (white arrow).
SNI-14-228-g004.jpg
PMC10316184_02_SNI-14-228-g004.jpg
F4
Head CT showed severe pneumocephalus and a defect between the foramen rotundum in the lateral wall of the left sphenoid sinus and the foramen ovale, and erosion of the dorsum sellae and many ovoid bony defects in the middle cranial fossa [Figures 4a and b]. Head MR cisternogram revealed that brain parenchyma had herniated into the lateral sphenoid sinus through the defect of the middle cranial fossa [Figures 4c and d].
Case 2 - Intraoperative photographs of the second surgery. (a and b) Intradural (a) and extradural approaches (b) to the Stenberg's canal. The cranial dura involved multiple holes and protruded with brain parenchyma (black arrow) into the skull base defect between the foramen rotundum and foramen ovale in the middle skull base leading to the sphenoid sinus. (c) Herniated dura and meningoencephalocele were cut away and the nasal mucosa (black arrow) exposed. (d) Bone defect was reconstructed with a titanium plate. (e-h) Intradural (e and f) and extradural spaces (g and h) including the bone defect were sealed with temporal fascia, abdominal fat, fibrin glue, and biological tissue reinforcement material.
SNI-14-228-g005.jpg
PMC10316184_02_SNI-14-228-g005.jpg
F5
The intradural and extradural spaces including the bone defect were sealed with temporal fascia, abdominal fat, fibrin glue, and biological tissue reinforcement material [Figures 5a-h].