Encephalocoele as a complication of intranasal sinus surgery: optimal evaluation with magnetic resonance imaging

Abstract

We report a case of post-operative frontal basal encephalocoele evaluated using a new magnetic resonance imaging (MRI) sequence, fast inversion recovery for myelin suppression (FIRMS). FIRMS was developed to enhance the differentiation between grey and white matter. In this case, the sequence was beneficial in distinguishing the encephalocoele from adjacent nasal mucosa and secretions.

Brain herniation through the anterior cranial floor in a long-standing frontal falcine meningioma

“…Acquired herniations may be traumatic 1 or iatrogenic. 2 The cribriform plate is an anatomically fragile portion of the anterior skull base that is vulnerable to normal rhythmic variations in CSF pressure. Anatomical studies of embryological variations in the cribriform plate and traversing olfactory fibers have identified incompletely occluded holes along olfactory fibers in the cribriform plate, 3 a persistent cranial pharyngeal canal, 4 fistulae in the retained embryologic lumen of the olfactory bulb, and meningeal dysplasia in the region of the olfactory nerve.…”

Endoscopic treatment of traumatic basal encephaloceles: a report of 8 cases

“…Since then an increasing number of surgeons have used the endoscope to treat encephaloceles with accompanying CSF leakage. 5,20,22,23,25,32,38 The successful outcomes of the endoscopic approach have opened surgeons to an alternative treatment of this skull base lesion without the risk of transcranial morbidity. Note, however, that overlooking an encephalocele on endoscopy can lead to a failure of repair and fatal complications such as delayed meningitis.…”

“…29 Traumatic basal encephaloceles are categorized as lesions due to head injury 20,25 or iatrogenic conditions following sinonasal surgery. 5,14,20,22,25,38 In a literature review, cases of iatrogenic origin were noted to be less common than those caused by head injury ( Table 2). A basal encephalocele is often complicated by CSF rhinorrhea, recurrent meningitis, headaches, and on occasion subdural hematoma (a sequela of loss of suspension from CSF).…”

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

“…Instantaneous fatal bleeding can possibly occur due to an injury of the internal carotid a., the anterior cerebral a. or the anterior communicating a..Serious damage can also be triggered by induced arterial spasms [90]. The defect at the skull base can cause a secondary herniation of brain tissue [518]. An iatrogenic encephalocele can develop slowly within months and might only become apparent though meningitis [200].…”