Right Sphenoid Cephalocele

Case History:

A 50 years old male presented with right side rhinorrhea for the last two months. There was no history of surgery or trauma. On clinical examination, the CSF leak was confirmed. CT Cisternography was suggested to localize the site of CSF leak.

Findings:

Cisterongraphy was performed under aseptic conditions. CT images were obtained at 20 minutes & 40 minutes. The study revealed a 3.5 mm bony defect in the lateral wall of the right sphenoid sinus with herniation of the right frontal CSF containing dural outpouching into the right sphenoid sinus (Image 1). There was associated focal herniation of the right frontal medial basal gyrus along with the dural outpouching into the right sphenoid sinus. It was confirmed on MRI images also (Image 2).

IMAGE 1

                                                                                                                                                                             IMAGE 2                                                                     

Discussion:

Review of literature showed two types of spontaneous lateral sphenoid cephaloceles

Type 1 consists of herniation into the pneumatized portion of the sphenoid sinus and clinical presentation includes headache and CSF leak.

Type 2 consists of localization to the greater wing of the sphenoid without extension into the sphenoid sinus and clinical presentation includes headache, fits, meningitis or neuropathy.

Our case belongs to type 1 lateral sphenoid cephalocele.

Case Study Prepared by:

Dr. Deepak Garg
MD ( Radio-Diagnosis)
Fellowship in Body Imaging and Interventions( USA)
Fellowship in Vascular and Interventional Radiology ( USA)
Senior Consultant Diagnostic and Vascular Interventional Radiologist
@ H.O. D, Karkardooma, Delhi