MISDIAGNOSED POST-TRAUMATIC TRANSETHMOIDAL MENINGOENCEPHALOCELE OPERATED BY ENDOSCOPIC ENDONASAL APPROACH

Abstract

A n t e r i o r s k u l l b a s e
Meningoencephalocoeles (ME) following trauma are rare
surgical challenges to Neurosurgeons and
otorhinolaryngologists. They can be miss diagnosed by
general practitioners or even surgeons. When they
occur, Endoscopic approach (which is just evolving in our
environment is now the favoured approach.
Case Report: Herein, a case of a 9-year-old patient, who
presented with progressively worsening right sided
cerebrospinal fluid (CSF) rhinorrhoea of 4 years'
duration. There was a background history of cranial
trauma with transient CSF rhinorrhoea for a few days,
when she was 2-year-old, 3 years prior to the onset of the
recurrence of the symptom. Though the CSF fistula had
been on and of for 4 years prior to surgical intervention,
the referring doctors did not consider CSF leak until the
onset of seizures which necessitated a cranial
neuroimaging. Neuroimaging revealed anterior skull
base ME. The patient subsequently had an uneventful
repair by endoscopic endonasal approach.
Conclusions: Acquired anterior cranial base CSF fistula
with ME can still occur 3 years after cranial base trauma.
To prevent a belated diagnosis of posttraumatic ME, the
presence of uncontrollable unilateral clear watery fluid
dripping from the nose, positive reservoir sign, prior
rhinologic/cranial base surgery, and or antecedent cranial
trauma should arouse the suspicion of CSF rhinorrhoea
and possibly ME. In addition, EEA should be considered
as a low morbidity approach to treat post-traumatic ME.