Computed tomography in the evaluation of encephaloceles in infants and children

Transethmoidal meningoencephalocele involving the olfactory bulb with enlarged foramina of the lamina cribrosa--case report

A 3-year-old girl presented with a transethmoidal meningoencephalocele manifesting as recurrent rhinorrhea. Initially, she developed meningitis, but after treatment she experienced rhinorrhea. Two months later, she again presented with rhinorrhea. Neuroimaging studies revealed a small protrusion (15 mm x 10 mm) at the roof of the ethmoidal sinus. Nasal endoscopy confirmed the diagnosis of meningoencephalocele. The operative findings revealed a small hole in the left olfactory bulb, which had descended into an enlarged foramen along with the arachnoid membrane. The left olfactory bulb was removed, and the enlarged foramina of the lamina cribrosa were covered with a frontal pericranial flap. The defect in the bone was very small, but contributed to the development of meningitis and leakage of the cerebrospinal fluid. Basal cephalocele should be considered in a patient with recurrent rhinorrhea and intracranial infections, even in the absence of any apparent anomaly.

Transethmoidal intranasal meningoencephalocele in an adult with recurrent meningitis

Intranasal meningoencephalocele is a rarely encountered congenital malformation. We report a case of transethmoidal intranasal meningoencephalocele in a 52-year old man with recurrent purulent meningitis. After treatment of the acute meningitis, frontal craniotomy followed by the removal of the stalk of the meningoencephalocele and repair of the bony defect was successfully performed. He has had no further meningitis or CSF rhinorrhea post-operatively. Detailed neuroradiological examination and appropriate surgical treatment are important to prevent fatal neurological complications of intranasal meningoencephalocele.

An unusual presentation of an encephalocele to the otolaryngologist

An unusual case of encephalocele causing obstruction of the upper airway in a neonate is described. The patient presented with a large mass in the neck, which extended from the base of the skull to the level of the larynx. Although there was no evidence of a defect of the skull base, subsequent excision and histological examination confirmed an encephalocele.

Intranasal (transethmoidal) encephalomeningocele. Case report

Intranasal encephaloceles are rarely encountered in pediatric neurosurgery. The symptoms and clinical features may mimic those of nasal polyp. It is important to know the type of basal encephalomeningocele for appropriate surgical intervention. Computed tomographic examination is helpful for differential diagnosis of the encephalocele sac and localization of the cranial bone defect.

The calvarium

The calvarium is a crucial structure that can manifest a great deal of pathology. The plain film remains the main imaging modality, although CT and MRI are becoming increasingly important. We discuss its anatomy, normal variants, congenital and developmental anomalies, hematologic disease, idiopathic disorders, neoplasms, metabolic disease, trauma, and the postoperative skull. Whenever possible, we emphasize CT and MRI.

Coronal CT examination in the evaluation of small frontoethmoidal encephalocoeles

Symptoms producing small front-ethmoidal encephalocoeles are generally identified radiologically. The examination of choice is coronal CT, eventually performed axially with coronal reconstructions, and best with intrathecal contrast material delineating the basal cisterns. Two case reports demonstrate the clinical and radiological problems in identifying small fronto-ethmoidal encephalocoeles.

Transsphenoidal encephaloceles

Transsphenoidal encephaloceles are rare congenital anomalies that may be immediately apparent in infants that present with multiple cranial midline defects. They should also be suspected in patients presenting with cerebrospinal fluid rhinorrhea, an epipharyngeal soft tissue mass, a visual defect, or an endocrinologic disturbance, especially when associated with midfacial and optic nerve anomalies. Plain x-ray films of the skull may show absence of the sellar floor and a soft tissue mass; the diagnosis is confirmed by computed tomography scanning. Surgical therapy may be indicated for persistent cerebrospinal fluid rhinorrhea, symptomatic epipharyngeal respiratory distress, or progression of neurological deficits. Two cases of transsphenoidal encephalocele are reported.

Computed tomography in migratory disorders of human brain development

Computed tomographic findings in developmental brain anomalies are more easily classified when the system used is based on embryogenesis related to morphology. Analysis of computed tomographic findings in a series of 154 patients with brain anomalies (Chiari malformation not included) revealed that specific examples of abnormalities occurring in major stages of brain development may be recognized by computed tomography. This paper deals with a group of patients with abnormalities that reflect a disturbance in neuronal migration.

A large convexity meningioma followed by liquorrhoea from a nasal encephalocele. A case report

A 46-year-old woman was readmitted, two years after removal of a large convexity meningioma, because of cerebrospinal fluid rhinorrhoea from a nasal encephalocele eventually visualized by CT-scan. The encephalocele was extirpated via an intracranial approach, and its histological appearance is described. The aetiology of this extracranial brain tissue protrusion is discussed. It is suggested that the mechanisms behind the formation of this encephalocele are a combination of a congenital malformation and the long term increase of the intracranial pressure due to the meningioma.