Delayed Cerebrospinal Fluid Rhinorrhea Associated With Ethmoidal Encephalocele After Resection of Remote Meningioma

Abstract

Diagnosis and treatment of neurosurgical pathology present unique challenges in underserved areas, and many conditions may go undiagnosed, misdiagnosed, or untreated for prolonged periods. The development of an unusual complication, seemingly unrelated to an area of neurosurgical intervention, may be particularly perplexing to non-neurosurgical providers, particularly in areas where neurosurgical procedures have not historically been available. A 44year-old male presented with a giant meningioma which was successfully resected. A nasal encephalocele was noted preoperatively but was not addressed due to lack of associated symptoms and distance from the tumor. The patient lived on a remote island and was lost to follow-up. He developed delayed cerebral spinal fluid (CSF) rhinorrhea three months after surgery, which was diagnosed and treated by local providers as allergic rhinitis for 11 months until he presented with new-onset seizure. Imaging demonstrated descent of the lateral ventricle into the encephalocele. The encephalocele was amputated and the skull base defect was repaired successfully. The alteration of ventricular anatomy and CSF fluid dynamics following tumor resection appears to have created an environment where a non-traumatic CSF leak could develop where it had previously shown no signs of developing. It may be prudent to treat skull base defects prophylactically to prevent this type of complication, particularly in patients of remote regions where regular follow-up is difficult.

Polypectomy-induced encephalocele manifested as meningitis and CSF rhinorrhea in a pregnant woman: a case report

“…Clinical manifestations of encephalocele can include mild to severe headaches, neurological symptoms, ataxia, meningitis, CSF rhinorrhea, etc. There is also a possibility of misdiagnosis of the encephalocele symptoms with situations such as allergic rhinitis, nasal polyps, migraines, or benign lid swelling [13] , [14] , [15] , [16] . The most important signs that can bring physicians closer to the diagnosis of encephalocele are spontaneous CSF rhinorrhea and meningitis.…”