Spontaneous Lateral Sphenoid Sinus Meningocele Presenting With Recurrent Meningitis: Surgical Resolution via an Endoscopic Endonasal Transpterygoid Approach.

A 52-year-old woman with a history of recurrent bacterial meningitis and clear nasal discharge was diagnosed with a spontaneous meningocele of the lateral recess of the left sphenoid sinus. Radiological evaluation revealed a bony defect lateral to the vidian rotundum line, consistent with excessive lateral pneumatization and suggestive of a skull base defect. The patient underwent endoscopic endonasal transpterygoid repair, which provided sufficient access to the lateral recess. During surgery, the sphenopalatine artery was transected to achieve full exposure, which precluded the use of an ipsilateral vascularized flap. A multilayer closure was performed by using autologous fascia lata, fat, polyglycolic acid felt (Neoveil®, GUNZE Ltd., Osaka, Japan), and fibrin glue. The surgery was performed as a collaboration between otolaryngologists and neurosurgeons. The postoperative course was uneventful, with neither cerebrospinal fluid (CSF) rhinorrhea nor meningitis recurring during five years of follow-up. This case illustrates the importance of precise anatomical assessment and individualized reconstruction strategies in the endoscopic management of lateral sphenoid sinus meningoceles.　.