Objectives: To define a diagnostic strategy of a sphenoid sinus lesion and the management of CSF fluid leak in the case of a sphenoid arachnoidocele.
Materials and methods: A 70-year-old woman exhibited a sphenoidal sinus opacity which was discovered on the assessment of chronic headaches. It was labelled sphenoid mucocele. A cerebrospinal fluid leak occurred when the marsupialization was made. After an assessment of additional imaging (MRI, CTscan), the diagnosis of sphenoid arachnoidocele was retained.
Results: The leak was repaired by navigated endoscopic endonasal surgery. We used a multilayer reconstructive technique with autologous materials (abdominal fat, fascia of muscle, middle turbinate) and fibrin glue. With a decline of eighteen months no rhinorrhea was noted.
Conclusion: Sphenoid arachnoidocele is a rare disease. This case shows that it's essential to know the differential diagnosis sphenoid sinus lesions and how to repair an osteomeningeal leak.