Unusual presentation of an asymptomatic pseudomeningocele within the sphenoid sinus

We report the rare case of a 55-year-old woman with an asymptomatic left sphenoid sinus pseudomeningocele mimicking a mucocele. A 55-year-old woman was found to have an incidental mass in the left sphenoid sinus on computed tomography. Magnetic resonance imaging confirmed the presence of a mucocele....

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Bibliographic Details
Published in:Journal of laryngology and otology 2013-12, Vol.127 (12), p.1238-1241
Main Authors: McNamara, K J, Exley, R P, Khwaja, S, Bhalla, R K
Format: Article
Language:English
Subjects:
Asymptomatic
Clinical Records
Contrast Media
Diagnosis, Differential
Drainage - adverse effects
Drainage - methods
Endoscopy
Female
Head injuries
Humans
Incidental Findings
Magnetic Resonance Imaging
Middle Aged
Mucocele - diagnosis
Mucocele - diagnostic imaging
Mucocele - surgery
Natural Orifice Endoscopic Surgery - methods
Otolaryngology
Pathology
Sinuses
Sphenoid Sinus - abnormalities
Sphenoid Sinus - diagnostic imaging
Sphenoid Sinus - surgery
Tomography
Tomography, X-Ray Computed
Treatment Outcome
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Summary:We report the rare case of a 55-year-old woman with an asymptomatic left sphenoid sinus pseudomeningocele mimicking a mucocele. A 55-year-old woman was found to have an incidental mass in the left sphenoid sinus on computed tomography. Magnetic resonance imaging confirmed the presence of a mucocele. A left endoscopic sphenoidotomy was performed to drain the mucocele. Despite an anatomical puncture through a stenosed sphenoid ostium, alarmingly, the opening leaked cerebrospinal fluid. A dehiscent lateral wall was identified with a dural opening communicating with the sphenoid sinus. This was immediately repaired with a free nasal septal mucosal graft. Six months post-operatively, the patient remained free from cerebrospinal fluid leakage. Pseudomeningoceles are extremely rare in the absence of trauma or iatrogenic injury. Surgeons should be alert to their presence as they can mimic a unilateral mucocele or nasal polyp. Endoscopic management lends itself to a single-stage repair.
ISSN:0022-2151
1748-5460
DOI:10.1017/S0022215113002247