Endoscopic Transpterygoid Approach to the Lateral Sphenoid Recess

The endoscopic transpterygoid approach appears to be a viable treatment option for selected patients with an encephalocele or cerebrospinal fluid fistulae from the middle cranial fossa into a lateral sphenoid recess. This case report describes a patient with cerebrospinal fluid leak and seizures in whom a large temporal lobe encephalocele was found. The encephalocele entered the sphenoid sinus through a bony defect in the roof of the lateral recess of a widely pneumatized sphenoid. The endoscopic transpterygoid approach was successfully used to repair the skull base defect. The only disappointing result was that the patient had a reduced sense of smell postoperatively.