Spontaneous Lateral Sphenoid Cephalocele

A 62-year-old woman with chronic headaches presented for the incidental finding of a left sphenoid abnormality on neuroimaging. She denied prior trauma, surgery, mass, or congenital skull base deformity. On CT, (panel A–C) the lesion (arrow) was isolated to the greater sphenoid wing without apparent extension into the sphenoid sinus or surrounding orbital or brain involvement. On MRI, (panel D) the lesion (arrow) did not enhance with contrast and was isointense to cerebrospinal fluid on T1 (panel E) and T2 imaging (panel F). The patient had a partially empty sella (arrow), which supports the theory that altered cerebrospinal fluid dynamics contribute to the development of spontaneous cephaloceles. No intervention was given for this cephalocele, as it was not thought to be causing the patient's headaches.