Surgical Technique and Review of Management of Frontoethmoidal Encephalocoele - A Case Report

The Rationale

Encephalocoele is a herniation of the brain formed during embryonic development, because of the incomplete closure of Neural Tube. It is a rare skull defect and most cases are located in the occipital bone. Frontal encephalocoeles are very rare and they may involve the ethmoid bone, nasal bones and/or the orbits. Surgical repair is complex and usually requires a multidisciplinary approach.

Patient Concerns

We present a case of a 6-month-old baby girl with a congenital frontoethmoidal encephalocoele.

Diagnosis

The diagnosis was made by computed tomography scan that showed a defect on the frontoethmoidal zone.

Treatment

Cranial approach was employed using standard bicoronal access. The malformation was removed and the defect was repaired by using an autologous parietal bone graft, without any complication in the follow-up.

Outcomes and Take-away Lessons

The goal of the surgery is to reconstruct the normal anatomy, to achieve a good cosmetic repair, and to avoid a cerebrospinal fluid leak. A description of the case and the surgical technique is presented with a review of literature.

Neuroprotective effect of magnesium supplementation on cerebral ischemic diseases

Ischemic encephalopathy is associated with a high mortality and rate of disability. The most common type of ischemic encephalopathy, ischemic stroke, is the second leading cause of death in the world. At present, the main treatment for ischemic stroke is to reopen blocked blood vessels. However, despite revascularization, many patients are not able to achieve good functional results. At the same time, the strict time window (<4.5 h) of thrombolytic therapy limits clinical application. Therefore, it is important to explore effective neuroprotective drugs for the treatment of ischemic stroke. Magnesium is a natural calcium antagonist, which exerts neuroprotective effects through various mechanisms. However, while most basic studies have shown that magnesium supplementation can help treat cerebral ischemia, intravenous magnesium supplementation in large clinical trials has failed to improve prognosis of ischemic patients. Therefore, we review the basic and clinical studies of magnesium supplementation for cerebral ischemia. According to the route of administration, treatment can be divided into intraperitoneal magnesium supplementation, intravenous magnesium supplementation, arterial magnesium supplementation and intracranial magnesium supplementation. We also summarized the potential influencing factors of magnesium ion intervention in cerebral ischemia injury. Finally, in combination with influencing factors derived from basic research, this article proposes three future research directions, including magnesium supplementation into the circulatory system combined with magnesium supplementation in the lateral ventricle, magnesium supplementation in the lateral ventricle combined with hypothermia therapy, and lateral ventricle magnesium supplementation combined with intracarotid magnesium supplementation combined with selective hypothermia.

Persisting Embryonal Infundibular Recess Masquerading as a Nasal Mass

Persisting embryonal infundibular recess (PEIR) is a rare anomaly of the development of the posterior pituitary wherein there is a defect in the third ventricular floor. Earlier reports have found PEIR descending only up to the sella. However, this is the first case of PEIR presenting as a pulsatile nasal mass. A 35-year-old female presented to the otorhinolaryngologist with hyposmia. Diagnostic nasal endoscopy revealed a pulsatile nasal mass. Magnetic resonance imaging revealed a cystic lesion extending from the third ventricular floor to the nasal cavity. There was no associated hydrocephalus or empty sella. The case was successfully managed by the endoscopic endonasal transsphenoidal approach.

Occult temporal lobe encephalocoele into the transverse sinus

In this article we present a case of an incidental encephalocoele protruding through a dural defect into the transverse sinus. Encephalocoeles are usually described as a herniation of the meninges and brain parenchyma through a bony defect of the cranium or base of skull. To our knowledge, there are only a few patients reported in the literature of occult encephalocoeles through dural defects. Our case study highlights that encephalocoele should be a differential diagnosis for a filling defect in this location.

Encephalocoele as a complication of intranasal surgery

Intranasal encephalocoele can be congenital or acquired as a consequence of injury to the floor of anterior cranial fossa disrupting dura resulting in herniation of brain tissue in the nasal cavity. Authors came across a case of encephalocoele as a complication of intranasal polypectoury. We are reporting this case due to its rareness.