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One type of congenital intrasphenoidal meningoencephalocele is remnant of lateral craniopharyngeal (Sternberg's) canal. We present a case of a 23-year girl with 10-month history of right side CSF rhinorrhea. CT scan, MRI revealed congenital meningoencephalocele and CSF leak from middle fossa to right side of sphenoid sinus, and there were bony defects at the floor of the anterior aspect of the right middle fossa. Transcranial repair was performed with right side pterional craniotomy. Careful preoperative evaluation and localization of the sphenoid defect are essential for selection of the best possible surgical approach and skull base reconstruction for repair of sphenoid sinus CSF leaks and meningoencephaloceles. In this case, an endoscopic technique was not successful so, transcranial repair was performed with right side pterional craniotomy. KeywOrds: Meningoencephalocele, Rhinorrhea, Transcranial repair ÖZSfenoid kanat içine yerleşmiş meningoensephalosel, lateral kraniofarengial kanalın (Stenberg'in kanalı) artığından meydana gelen bir konjenital anomalidir. Sağ burun deliğinden 10 aydan beri BOS gelen 23 yaşında kadın olgu olarak sunulmuştur. Bilgisayarlı tomografi ve manyetik rezonans görüntülemede; sağ orta fossa tabanının anterior yüzündeki kemik defekti ile sfeneoid sinüsün sağ tarafı arasında ilişki bulunmuştur. Sağ piterional kraniotomi yapılarak; kranial yoldan kemik defekti onarıldı. Sfenoid sinüsden BOS kaçağı olan ve meningoensefeloseli olan hastalarda ameliyat öncesi dönemde detaylı görüntüleme çalışmaları ile defekt ortaya konmalı ve en iyi cerrahi yaklaşım yolu bu görüntüleme çalışmalarına göre belirlenmelidir. Olgumuzda endoskopik girişimin başarısız olması nedeni ile sağ piterional kraniotomi yapılarak defekt onarımı yapılmıştır.

Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, and new strategies are needed to help these patients. Vagus nerve stimulation (VNS) therapy is the most frequently used neurostimulation modality for patients with drug-resistant epilepsy who are not eligible for seizure surgery. In this study, we aimed to evaluate the efficacy and adverse effects of VNS in patients with drug-resistant epilepsy in an open-label, prospective, long-term study in Iran. We selected 48 patients with partial-onset drug-resistant epilepsy. Implantations were performed in the neurosurgery department of Loghman Hospital, Tehran, Iran. Follow-up visits were done on monthly bases for 5 years. Forty-four patients completed the study. Mean age of patients was 24.4 years. Mean years of epilepsy history was 14 years. The mean number of anti-epileptic drugs did not significantly change over five years (p = 0.15). There was no exacerbation of epilepsy; however, one patient discontinued his therapy due to unsatisfactory results. Five patient had more than 50 %, and 26 patients (59 %) had 25-49 % reduction in the frequency of monthly seizures persistently. Overall mean frequency of monthly seizures decreased by 57.8, 59.6, 65, 65.9, and 67 %, in 1st, 2nd, 3rd, 4th, and 5th years of follow-up, respectively. Most common side effects were as follows: hoarseness (25 %) and throat discomfort (10 %). We found VNS as a safe and effective therapy for drug-resistant epilepsy, with an approximate long-term decrease in mean seizure frequency of 57.8-67 %. Thus, VNS is recommended for suitable patients in developing countries.

Acquired non-traumatic transethmoidal encephaloceles are very infrequent lesions that are generally caused by a tumor or hydrocephalus. As far as we know, there is no reported case of encephalocele after CSF diversion in the literature.We present a 25-year-old woman with hydrocephalus due to aquiductal stenosis who was treated with endoscopic third ventriculostomy. Nine months later, she had developed rhinorrhea and on imaging she had a transethmoidal encephalocele. She underwent endonasal endoscopic repair of the defect and removal of herniated parenchyma.CSF diversion to parasellar cisterns is not a known iatrogenic cause of basal encephalocele and is not noted elsewhere as a complication of third ventriculostomy. However, as third ventriculostomy is performed usually for intracranial hypertension treatment and intracranial hypertension itself is a known but rare cause of lacunar skull defect and encephalocele, this co-incidence may occur. KeywOrds: Encephalocele, Rhinorrhea, Hydrocephalus, Stenosis ÖZAkkiz non-travmatik transetmoidal ensefaloseller genel olarak bir tümör veya hidrosefali nedeniyle gelişen çok nadir lezyonlardır. Bildiğimiz kadarıyla literatürde BOS diversiyonu sonrasında bildirilen ensefalosel olgusu yoktur.Akuedukt stenozu nedeniyle hidrosefalisi olan ve endoskopik üçüncü ventrikülostomi ile tedavi edilmiş 25 yaşında bir kadını bildiriyoruz. Dokuz ay önce rinore gelişmiş ve görüntülemede transetmoidal ensefalosel bulunmuştu. Endonazal endoskopik yolla defekt tamir edilip herniye parankim çıkarıldı. Parasellar sisternlere BOS diversiyonu bazal ensefaloselin bilinen bir iatrojenik nedeni değildir ve üçüncü ventrikülostominin bir komplikasyonu olarak başka yerde bahsedilmemiştir. Ancak üçüncü ventrikülostomi genellikle intrakraniyal hipertansiyon tedavisi için yapıldığından ve intrakraniyal hipertansiyonun kendisi laküner kafatası defekti ve ensefaloselin bilinen ama nadir bir nedeni olduğundan birlikte görülme mümkündür.

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