Parietal Intradiploic Encephalocele-Case Report-

Epilepsy Surgery Outcome of Traumatic Intradiploic Meningoencephalocele: A Case Report and Literature Review

We highlight an under-recognized epileptic pathology in a 56-year-old left-handed female with progressive right facial numbness and weekly focal seizures characterized by episodic aphasia. She was found to have a left frontoparietal intradiploic meningoencephalocele (IDME). Her only epilepsy risk factor was minor head trauma 10 years prior to presentation. She underwent craniotomy for encephalocele resection and mesh cranioplasty without residual neurological deficits and excellent seizure outcome: at 3-year follow-up, she was still seizure-free since surgery, except for an isolated breakthrough seizure at 7 postoperative months when she discontinued her preoperative regimen of Lacosamide monotherapy. Traumatic IDME is a rare condition and rarely presents with seizures. Symptoms may arise up to decades following minor head trauma and are progressive in nature. The likely definitive treatment is cranioplasty and dural repair with or without resecting the protruding parenchyma.

Frontal intradiploic encephalocele in a 44-year-old male patient: illustrative case

BACKGROUND

Encephaloceles are protrusions of the cerebral tissue through a skull defect. They occur mostly in children and very rarely in adults.

OBSERVATIONS

The authors present a case of a 44-year-old man presenting with a first-time generalized seizure. Computed tomography of the head showed bone destruction associated with a right frontal lesion. Magnetic resonance imaging scans demonstrated a largely isointense lesion in the intradiploic space that contained small, hyperintense nodular components and showed a low to moderate contrast agent enhancement.

LESSONS

The patient underwent resection, during which the histological examination found the lesion to be an intradiploic encephalocele. The patient had an uneventful postoperative course with a cessation of seizures. The imaging and neuropathological findings as well as a literature review, together with a discussion on the etiology of intradiploic encephaloceles, are contained in this report.

Intradiploic Encephalocele at the Parietal Bone: A Case Report and Literature Review

Intradiploic encephalocele is a rare condition of herniation of the brain parenchyma through the diploic space. A 52-year-old man presented with a parietal intradiploic encephalocele manifesting as an intermittent headache for 7 months. CT revealed an osteolytic lesion involving the right parietal bone. MRI demonstrated brain herniation within the diploic space. Surgery may be unnecessary in the absence of concurrent symptoms or neurological deficits. After 2 years of follow-up, symptoms were improved without neurological deficits and CT findings. We report the X-ray, CT, and MRI findings of an extremely rare case of parietal intradiploic encephalocele in adulthood.

Trigeminal Neuralgia Caused by Vascular Compression from the Petrous Carotid Artery with Bony Erosion and Meckel Cave Encephalocele: Clinical Imaging with Surgical Video

Trigeminal neuralgia (TN) is most commonly caused by neurovascular compression of the superior cerebellar artery. We present the first reported TN case where nerve compression was caused by the petrous internal carotid artery in the vicinity of a Meckel cave (MC) encephalocele. The patient underwent a pterional craniotomy for decompression of the gasserian ganglion and trigeminal nerve branches. All symptoms were resolved post surgery. We surmise that the principal cause of the TN was vascular compression from an exposed petrous internal carotid artery in the presence of an encephalocele. Causation was irrespective of whether the dehiscence in the petrous apex was a congenital defect or associated with destruction from the encephalocele. Based on this observation, we recommend that surgeons carefully consider all possible causes of patient symptoms as they prepare a meticulous dissection plan to avoid damage to surrounding neurovascular structures.

Post-Traumatic Occipital Intradiploic Encephalocele

BACKGROUND

Brain parenchyma herniation through a disrupted inner table into an enlarged diploic cavity with an intact outer table is described as intradiploic encephalocele. Intradiploic encephaloceles share common morphologic characteristics with expanding skull fractures and intradiploic arachnoid cysts. Herein, we describe a case of traumatic occipital intradiploic encephalocele.

CASE DESCRIPTION

Cranial computed tomography of an 11-year-old boy revealed erosion of the inner table of the left side of occipital bone and expansion of the cranial diploë by a soft-tissue density with a gyral pattern. His medical history was positive for head trauma at the age of 3 years to the same region. Magnetic resonance imaging showed herniation of left occipital parenchyma with cystic encephalomalacic changes into the diploë.

CONCLUSIONS

Intradiploic encephaloceles have different features compared with the classic encephalocele and can be considered as a variant of expanding skull fracture and intradiploic arachnoid cyst.

Symptomatic Parietal Intradiploic Encephalocele-A Case Report and Literature Review

Encephalocele is a rare condition that consists of herniation of cerebral matter through openings of dura and skull. A majority of encephaloceles are congenital and manifest in childhood. We present a case of a 45-year-old man presenting with contralateral hemiparesis and found to have an extremely rare phenomenon of a symptomatic posttraumatic parietal intradiploic encephalocele (IE) manifesting 36 years following pediatric traumatic head injury. Computed tomography and magnetic resonance imaging confirmed herniation of brain tissue into the intradiploic space. Surgical treatment with reduction of the encephalocele achieved near resolution of preoperative hemiparesis on follow-up. The pathogenesis and a literature review of IE are discussed.

Spontaneous frontal intradiploic meningoencephalocele

Background:

Since 1976, 10 cases of intradiploic encephaloceles have been reported in the literature. This case is the first report of a spontaneous intradiploic meningoencephalocele of the frontal bone hypothesized to be secondary to distant head trauma.

Case Description:

A 60-year-old female with a history of multiple traumatic head injuries as a child presenting with new onset generalized tonic-clonic seizures. Work-up revealed a right frontal epileptic focus. Imaging showed a right frontal intradiploic lesion. The patient underwent surgical resection, which during exploration was found to be an intradiploic encephalocele. She had an uneventful postoperative course with a resolution of seizures.

Conclusions:

The authors hypothesize that the rare nature of posttraumatic frontal intradiploic encephaloceles is due to the increased thickness of the frontal bone compared to the parietal bone.

Parietal intradiploic encephalocele: Report of a case and review of the literature

Encephaloceles consist of brain tissue and meninges that has herniated through a skull defect, usually located in the midline. They are seen more commonly in children and very rarely in adults. We present a case of an 84-year-old patient who was incidentally diagnosed with a lytic bone lesion in the right parietal intradiploic space, after computed tomography of the head was performed. A magnetic resonance imaging scan of the brain showed herniation of brain tissue through the defect. Magnetic resonance imaging was crucial in demonstrating the presence of parenchyma and its continuity with the rest of the brain, consequently distinguishing it from other entities. We report the imaging findings of a parietal indradiploic encephalocele with its differential diagnosis and a review of the relevant literature.