Ethmoidal meningoencephalocele and cerebrospinal fluid leak after septoplasty: a rare complication

Abstract

Meningoencephalocele and cerebrospinal fluid (CSF) rhinorrhea of the anterior cranial fossa is a well known entity resulting from iatrogenic and non-iatrogenic causes including congenital malformations and skull base erosion from intracranial tumors. Iatrogenic CSF leaks frequently occur during endonasal transsphenoidal pituitary surgery and functional endoscopic sinus surgery. [1,2] Septoplasty, one of the most common operations performed in otolaryngology, is usually regarded as a relatively safe operation. However, various complications including CSF leak following septoplasty are reported previously. [3,4] Meningoencephalocele formation associated with CSF leak following septoplasty is very rare. [5] In this case report, we present a case of meningoencephalocele associated with CSF leak diagnosed one year after nasal surgery. The probable pathological mechanism and endonasal endoscopic management of this complication were discussed. Özet: Septoplasti sonras›nda etmoidal meningoensefalosel ve serebrospinal s›v› kaça¤›: Nadir görülen bir septoplasti komplikasyonuYirmi dört yafl›nda erkek hasta aral›klarla olan sa¤ tarafl› su gibi burun ak›nt›s› flikayeti ile klini¤imize refere edildi. Hasta 1 y›l önce septoplasti operasyonu olmufl ve operasyondan 2 hafta sonra rinore ortaya ç›km›fl-t›r. Rinore flikayeti ihmal edilen hastada ameliyattan 2 ay sonra da menenjit geliflmifltir. Bunu takiben de meningoensefalosel formasyonu oluflmufltur. Bu olgu sunumunda, septoplasti operasyonundan bir y›l sonra tan› konan meningoensefalosel ve efllik eden serebrospinal s›v› kaça¤› olgusunu sunduk. Septoplasti genellikle güvenli bir operasyon olarak kabul edilmektedir. Bununla birlikte, etmoid kemi¤in perpendiküler laminas›na zorlay›c› kuvvetli manevralar uygulanmas› kafa kaidesi yap›-lar›nda özellikle de kribriform plakan›n horizontal laminas›nda fraktüre neden olabilmektedir. Böyle bir durumda, menenjit, intrakraniyal apse ve pnömosefalus gibi intrakraniyal komplikasyonlar›n geliflmesini önle-mek için hemen tamir edilmesi gerekmektedir. Böyle bir hasarda tan›da gecikme kafa kaidesindeki kemikte erozyona ve zamanla bu defektten intrakraniyal içeri¤in herniye olmas›na neden olabilmektedir.Anahtar sözcükler: Endoskopik onar›m, komplikasyon, meningoensefalosel, septoplasti, serebrospinal s›v› kaça¤›. AbstractA 24-year-old man referred to our clinic with complaint of intermittent right-sided watery rhinorrhea. Patient underwent nasal septoplasty one year ago and rhinorrhea occurred two weeks after the surgery. Rhinorrhea was ignored and then patient developed meningitis two months after the surgery. Subsequently, meningoencephalocele formation developed. In this case report, we present a case of meningoencephalocele associated with cerebrospinal fluid leak diagnosed one year after the septoplasty. Septoplasty is usually regarded as a relatively safe operation. However, forceful maneuvers to perpendicular lamina of the ethmoid bone may cause breakdown of the skull base structures, particularly the horizontal lamella of the cribriform p...