To describe the treatment of lateral sphenoid sinus meningoencephalocoele (LSSE) with Transorbital Neuroendoscopic Surgery (TONES) – The Role of An Oculoplastic Surgeon
Author: YVONNE CHUNG
Base Hospital / Institution: Singapore National Eye Centre
ePoster presentation
Abstract ID: 25-577
Purpose
To describe the treatment of lateral sphenoid sinus meningoencephalocoele (LSSE) with Transorbital Neuroendoscopic Surgery (TONES) – Value of a multidisciplinary approach in Oculoplastics and literature review
Methods
A lady with Marfan’s Syndrome had cerebrospinal (CSF) leakage secondary to bilateral LSSE. Imaging showed lateral pneumatization of the bilateral sphenoid wing (left being worse with extension into sphenoid trigone). Traditional treatment plans ranged from temporal craniotomies to transpterygoid approaches. In recent years, TONES has become a viable consideration due to the ability to access the anterior middle cranial fossa with less morbidity. We treated her left LSSE with TONES and endoscopic endonasal transpterygoid approach on the right.
Oculoplastic surgeon’s role for left TONES was to provide quick access to the sphenoid trigone due to familiarity with lateral bony orbitotomies. Superior lid crease incision with lateral extension was made. Segmental fronto-zygomatic rim removed and bony decompression down to the sphenoid trigone performed. The pnematized space within the trigone was revealed, allowing neuroendoscopic access into her left LSSE. Defect was repaired using Surgicel and abdominal fat pate inlay, reinforced with glued nasal floor mucosal graft onlay. Sphenoid recess dead space was filled with abdominal fat. The reflected lateral orbital rim was reapproximated using sutures and lid crease reformed.
Results
There were no ocular complications nor diplopia post operatively. Vision and extraocular movements were unaffected.
Mild transient left maxillary division of trigeminal nerve numbness, lasting for a month was reported
Lid crease incision healed with good cosmesis. No further CSF rhinorrhea was reported at 3 month follow up
Conclusion
Repair of LSSEs with TONES is a new surgical approach. Only 5 other cases reported in the literature. Multidisciplinary collaborations between neurosurgery, ENT and oculoplastics allow for efficient surgical access and reduced post operative morbidity for patients.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Jia Xu | Lim | Singapore General Hospital |
| Kai Jun | Tay | Singapore General Hospital |
| Isabelle | Jang | Singapore General Hospital |
| Jensen | Ang | Singapore General Hospital |
| Hui Png | Lu | Singapore General Hospital |
| Tze Choong | Charn | Singapore General Hospital |
| Valencia | Foo | Singapore National Eye Centre |
| Licia | Tan | Singapore National Eye Centre |
| Sunny | Shen | Singapore National Eye Centre |
| Neville | Teo | Singapore General Hospital |
| Beng Ti | Ang | Singapore General Hospital |
