Petrous apex cephalocele presenting with cerebrospinal fluid rhinorrhea in an adult

Warade, Abhijit G.; Misra, Basant K.

doi:10.1016/j.jocn.2015.06.022

Cited by 9 publications

(13 citation statements)

References 6 publications

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“…7 However, there is significant discrepancy -a form of an "academic disconnect"-between the otolaryngology, neurosurgical, 1 and neurology literature regarding the management of spontaneous CSF leaks [11][12][13] . A significant number of otolaryngologists and neurosurgeons do not acknowledge the link to IIH, [14][15][16][17][18] hence missing the change of diagnosing and treating IIH early.…”

mentioning

confidence: 99%

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Georgalas

Oostra

Ahmed

et al. 2020

Int Forum Allergy Rhinol

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Background The association between spontaneous cerebrospinal fluid CSF leak/rhinorrhea and idiopathic intracranial hypertension IIH has been increasingly recognized over the last years However considerable variability of opinion regarding the assessment investigations and management of patients with spontaneous CSF rhinorrhea remains Methods A consensus group was formed from experts from Europe Asia Australia South and North America Following literature review and open discussions with members of the panel a set of statements was produced A modified Delphi method was used to refine expert opinion with rounds of questionnaires and a consensus group meeting in Santo-Rhino meeting in September Results Fi y statements of total on spontaneous CSF leak and IIH reached consensus In of statements the median response was strongly agree and in the remaining statements the median response was agree Eleven statements were excluded because they did not reach consensus and one new statement was added during SantoRhino meeting The final statements refer to patient history and clinical examination "History taking should include presence of headache tinnitus and visual defects" investigations role of Thin Slice Computed Tomography and CISS/FLAIR sequences in Magnetic Resonance Imaging principles of management watchful waiting or measures to reduce ICP are supplementary but cannot subsitute surgical closure surgical technique intraoperative early postoperative and long term management Conclusion We present fi y consensus statements on the diagnosis investigation and management of spontaneous CSF rhinorrhea based on the currently available evidence and expert opinion Although by no means comprehensive and final we believe they can contribute to the standardization of clinical practice Early diagnosis prompt surgical closure of the defect assesment for and treatment of potentially co-existing idiopathic intracranial hypertension in a comprehensive multidisciplinary approach are essential in order to successfully manage spontaneous CSF rhinorrhea reduce associated morbidity and prevent recurrence

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mentioning

confidence: 99%

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Georgalas

Oostra

Ahmed

et al. 2020

Int Forum Allergy Rhinol

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“…Among symptomatic cases, headache, trigeminal neuralgia, CSF leak, vertigo, ataxia, facial numbness, hearing loss, diplopia, and other visual disturbances have been described. 3,6,9,10,13 Our patient was referred to us with irritability, failure to thrive, drowsiness, vomiting, and left cranial nerve VI palsy. To our knowledge, he represents the youngest patient diagnosed with CTC to date.…”

Section: Discussion Observationsmentioning

confidence: 97%

“…A thin bony plate covered by a thin dural layer could be the site of dehiscence following intracranial hypertension, also because of the spongy bone configuration, sometimes pneumatized. 1 , 6 Schlosser and Bolger explained skull base erosions as an attempt to alleviate increased ICP in highly pneumatized skull bases. Moreover, our findings of elevated pressure at lumbar puncture are equally consistent.…”

Section: Discussionmentioning

confidence: 99%

“…The most widely accepted theory is that their origin is from increasing intracranial pressure (ICP) causing herniation of the meninges and CSF from the posterolateral region of the Meckel's cave into the petrous apex. 1,[5][6][7] CTCs can be acquired or congenital and either monolateral or bilateral. 8,9 They are occasionally described together with the presence of an empty sella.…”

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confidence: 99%

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Cavum trigeminale cephalocele associated with intracranial hypertension in an 18-month-old child: illustrative case

Miccoli

Cicala

Spennato

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Cavum trigeminale cephaloceles (CTCs) are characterized by a cystic appearance and extension of the posterolateral aspect of Meckel’s cave into the superomedial portion of the petrous apex. A possible mechanism is a transient or sustained increase of intracranial pressure transmitted to Meckel’s cave, leading to its secondary herniation, in the presence of predisposing local factors. The majority of CTCs are incidental findings. Among symptomatic cases, headache, trigeminal neuralgia, cerebrospinal fluid leak, vertigo, ataxia, facial numbness, hearing loss, diplopia, and other visual disturbances have been described. OBSERVATIONS The authors describe a case of an 18-month-old male patient referred to their hospital with drowsiness, vomiting, left cranial nerve VI palsy, and papilledema. Neuroradiological investigation revealed the presence of a CTC with a swollen aspect of the left pontine hemisection and indirect signs of intracranial hypertension. The patient was managed with implantation of a ventriculoperitoneal shunt. LESSONS CTCs are rare lesions that are difficult to recognize on neuroimaging, in which they can be mistaken for tumoral or inflammatory lesions. The most frequent asymptomatic forms should be considered as “leave-me-alone” lesions. In cases of intracranial hypertension, according to a supposed theory on the origin of CTCs, the authors recommend treating only the intracranial hypertension instead of performing more invasive surgical procedures, especially in pediatric patients.

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“…The majority of cases (72%) have been reported in adults with a minority (28%) reported in children. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] 70% of the reported cases of pediatric PACs (including this report) were associated with infectious complications such as meningitis [17][18][19]30] compared to only 12% of adult cases. [14,15,26] This may reflect an increase risk of meningitis in children or possibly difficulty of children to report other symptoms that could present before infectious complications.…”

Section: Discussionmentioning

confidence: 99%

Recurrent meningitis in a child with bilateral cochlear implantation associated with a petrous apex encephalocele: a case report and literature review

Pross

Cardenas

Ahn

et al. 2016

Acta Oto-Laryngologica Case Reports

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To report a case of pediatric recurrent meningitis that is associated with an underlying petrous apex encephalocele in a patient with bilateral cochlear implants and reviews the literature of similar petrous apex lesions. A 5-year-old girl presented during her third episode of meningitis. Her first episode of meningitis left her with profound bilateral sensorineural hearing loss for which she received cochlear implants. During her assessment, she was found to have a petrous apex encephalocele, which was successfully repaired via a middle cranial fossa approach. Literature review demonstrates that petrous apex cephaloceles (PAC) are associated with meningitis, particularly in children. No previous reports exist of PAC in patients with cochlear implants. This case illustrates the importance of identifying an underlying anatomic abnormality in recurrent meningitis. PAC are rare abnormalities that can cause cerebrospinal fluid leaks leading to intracranial hypotension, cranial neuropathies, and infectious complications.

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Petrous apex cephalocele presenting with cerebrospinal fluid rhinorrhea in an adult

Cited by 9 publications

References 6 publications

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Cavum trigeminale cephalocele associated with intracranial hypertension in an 18-month-old child: illustrative case

Recurrent meningitis in a child with bilateral cochlear implantation associated with a petrous apex encephalocele: a case report and literature review

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