Spontaneous transethmoidal meningoencephalocele presenting in the form of recurrent unilateral nasal discharge: discussion of the diagnosis and endoscopic surgical management

Abstract

Meningoencephaloceles of the skull base most commonly occur as a sequela of head trauma or they can more rarely be congenital malformations. Several types of encephalocele exist depending on anatomic features and localisation. Clinical presentation and symptoms can vary. Different methods of management and repair of the concurring skull base defects have been described and ranging vary from endoscopic to open surgical approaches. We report the case of a 56-year-old Caucasian woman with the diagnosis of right sided spontaneous transethmoidal meninoencephalocele. Clinical presentation of this rare pathology, methods of diagnostic and management and its outcome are presented. Spontaneous skull base meningoencephaloceles are rare entities, without clear underlying etiologies. Multidisciplinary management is recommended. The transnasal endoscopic approach provides a wide skull base exposure with more advantages and less morbidity in comparison with the conventional open approach.

Two Uncommon Cases of Pediatric Transethmoidal–Transnasal Encephaloceles with a Review of Literature

“…Emergency surgery is avoided unless there is a leaking encephalocele that can result in meningitis. 5,6…”

Carolyn’s window approach for spontaneous frontal sinus meningoencephalocele

“…Fundamental principles guiding spontaneous cephalocele and CSF leak management include surgical resection of herniated contents, followed by skull base defect reconstruction, to prevent ascending infections 3. Endoscopic sinus surgery has become the gold-standard surgical approach with its use increasing dramatically over the last decade 24.…”

“…Depending on their contents, they may be classified into meningoceles (meninges and cerebrospinal fluid (CSF)), or meningoencephaloceles (MECs; brain parenchyma, meninges and CSF). Anatomically, MEC can be subdivided into frontal, parietal, occipital and basal types 3. While most cephaloceles are congenital, some are acquired, secondary to trauma or surgery, and a much sparser subset are spontaneous 1.…”

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.…”