Transethmoidal encephalocele after reduction of high intracranial pressure in aqueductal stenosis

Abstract

Acquired non-traumatic transethmoidal encephaloceles are very infrequent lesions that are generally caused by a tumor or hydrocephalus. As far as we know, there is no reported case of encephalocele after CSF diversion in the literature.We present a 25-year-old woman with hydrocephalus due to aquiductal stenosis who was treated with endoscopic third ventriculostomy. Nine months later, she had developed rhinorrhea and on imaging she had a transethmoidal encephalocele. She underwent endonasal endoscopic repair of the defect and removal of herniated parenchyma.CSF diversion to parasellar cisterns is not a known iatrogenic cause of basal encephalocele and is not noted elsewhere as a complication of third ventriculostomy. However, as third ventriculostomy is performed usually for intracranial hypertension treatment and intracranial hypertension itself is a known but rare cause of lacunar skull defect and encephalocele, this co-incidence may occur. KeywOrds: Encephalocele, Rhinorrhea, Hydrocephalus, Stenosis ÖZAkkiz non-travmatik transetmoidal ensefaloseller genel olarak bir tümör veya hidrosefali nedeniyle gelişen çok nadir lezyonlardır. Bildiğimiz kadarıyla literatürde BOS diversiyonu sonrasında bildirilen ensefalosel olgusu yoktur.Akuedukt stenozu nedeniyle hidrosefalisi olan ve endoskopik üçüncü ventrikülostomi ile tedavi edilmiş 25 yaşında bir kadını bildiriyoruz. Dokuz ay önce rinore gelişmiş ve görüntülemede transetmoidal ensefalosel bulunmuştu. Endonazal endoskopik yolla defekt tamir edilip herniye parankim çıkarıldı. Parasellar sisternlere BOS diversiyonu bazal ensefaloselin bilinen bir iatrojenik nedeni değildir ve üçüncü ventrikülostominin bir komplikasyonu olarak başka yerde bahsedilmemiştir. Ancak üçüncü ventrikülostomi genellikle intrakraniyal hipertansiyon tedavisi için yapıldığından ve intrakraniyal hipertansiyonun kendisi laküner kafatası defekti ve ensefaloselin bilinen ama nadir bir nedeni olduğundan birlikte görülme mümkündür.

Idiopathic intracranial hypertension presenting as bilateral spontaneous lateral intrasphenoidal and transethmoidal meningoceles: a case report and review of the literature

“…Most cases involve brain tissue and are generally unilateral [2, 5, 6, 9–28]. On the other hand, spontaneous transethmoidal lesions typically involve meningeal tissue, in the form of a meningocele or a meningoencephalocele [10–14, 29] (Table 1).…”

“…Spontaneous cases almost invariably present as CSF rhinorrhea in adult patients [2, 6, 8–14, 16–24, 26, 28, 29]. The mean age of the 15 spontaneous transethmoidal reported cases was 46 at presentation [10–14, 29]. Only one of these patient’s histories did not include CSF rhinorrhea [29].…”

Cerebrospinal Fluid Rhinorrhea due to Transethmoidal Encephalocele Following Occipital Meningioma Resection in an Adult: A Case Report

“…Another described cause is narrowing of the anterior skull base with subsequent brain herniation due to chronic elevation of intracranial pressure (ICP). 8,9 There seems to be an overlap of risk factors between idiopathic intracranial hypertension and spontaneous CSF rhinorrhea, specifically obesity and female sex. The described female predominance is large.…”

“…This indicates decreasing ICP as a possible factor in the origin of the encephalocele, as previously described in cases of endoscopic third ventriculostomy. 8 The patient noted loss of smell 7 years preceding the diagnosis that could be related to the development of the encephalocele. However, it could also be the gradually increasing ICP.…”

Meningoencefalocele Basal: Tratamento e complicações. Revisão de literatura

“…A finalidade consiste em propiciar uma avaliação adequada da patologia para orientar a abordagem cirúrgica, além de detectar outras alterações do sistema nervoso central, colaborando com o diagnóstico diferencial de outras patologias como pólipos nasais, hemangioma e glioma nasal. Ressalta-se que o diagnóstico através destes exames pode ser feito desde o período intrauterino, seja com ultrassonografia, ou, de forma mais detalhada por RM 2,8,11,17,18 .…”