Combined endoscopic-microsurgical approach for transsphenoidal (sphenopalatine) encephalocele with an intralesional pituitary gland. Case report

• Published in: Journal of neurosurgery. Pediatrics Vol. 4; no. 3; p. 262
• Main Authors: Faggin, Roberto, Pentimalli, Luigi, Grazzini, Maurizia, Saetti, Roberto, Drigo, Paola, d'Avella, Domenico
• Format: Journal Article
• Language: English
• Published: United States 01.09.2009
• Subjects: Cleft Palate - complications; Cleft Palate - pathology; Cleft Palate - surgery; Encephalocele - pathology; Encephalocele - surgery; Endoscopy; Female; Humans; Infant, Newborn; Microsurgery; Palate, Hard; Pituitary Gland; Sphenoid Bone
• ISSN: 1933-0707
• DOI: 10.3171/2009.4.PEDS0884

The treatment of the transsphenoidal sphenopalatine encephalocele in infants has not been thoroughly described in the literature. Pterional and subfrontal transbasal approaches have been reported as the advised treatment for transethmoidal encephalocele, but their feasibility for transsphenoidal encephalocele remains controversial, particularly in neonates. The potential harm to vital structures within the herniated tissue and intraoperative bleeding have been considered the major cause of poor postoperative results. The authors present the case of a full-term newborn with a cleft palate and a large transsphenoidal sphenopalatine encephalocele, which filled the nasopharyngeal space and provided MR imaging evidence of an intralesional pituitary gland. The lesion is unusual, and the extracranial intraoral endoscopic approach with an optimal outcome and sparing of the pituitary tissue has never been described in detail in an infant of this age.