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Case report
Transnasal transpterygoid resection of meningoencephalocoele with abolition of seizures
  1. Dimitrios Spinos1,
  2. Samit Unadkat1,
  3. Ramesh Nair2 and
  4. William Grant1
  1. 1 Department of Otolaryngology, Charing Cross Hospital, London, UK
  2. 2 Department of Neurosurgery, Charing Cross Hospital, London, UK
  1. Correspondence to Samit Unadkat, s.unadkat{at}


Meningoencephalocoeles are herniations of intracranial contents through skull base defects. Patients may present with a plethora of symptoms ranging from cerebrospinal fluid (CSF) rhinorrhoea to epileptic convulsions, or indeed may be asymptomatic. We present a case of a 24-year-old man suffering from new onset, drug-resistant tonic–clonic seizures. Imaging studies revealed neural tissue and meninges protruding through the pterygoid portion of the sphenoid bone, into the anteromedial aspect of the middle cranial fossa. An image-guided endoscopic transnasal transpterygoid approach was carried out as a joint otolaryngological and neurosurgical procedure, resulting in the patient being seizure-free for over 12 months postoperatively. There is a paucity of literature supporting such an endoscopic approach to treat epilepsy secondary to a meningoencephalocoele. We illustrate that this is a safe and minimally invasive treatment option which ultimately rendered the patient free of all anticonvulsants.

  • neurology (drugs and medicines)
  • ear, nose and throat/otolaryngology
  • epilepsy and seizures
  • otolaryngology/ENT

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  • Contributors DS wrote the main manuscript. SU co-wrote and edited the manuscript. RN revised the manuscript and was the consultant neurosurgeon who operated on the patient. WG provided the images and revised the manuscript and operated on the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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