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Spontaneous cerebrospinal fluid (CSF) fistula is a rare entity, most commonly occurs at the ethmoid roof, cribriform plate, or the sphenoid sinus; at the perisella, inferolateral or pterygoid recesses. Imaging plays a major role in diagnosis, thereby guiding the treatment of a spontaneous CSF fistula, evolving multiple modalities. We report a case of a patient with spontaneous Meningio-encephalocele presented as an expansile lytic lesion in the left pterygoid body, this patient was successfully treated surgically.

Incidental spontaneous CSF fistula with pterygoid process meningoencephalocele