A case of meningoencephalocele in the nasal cavity 6 years after skull base fracture

Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)

Download Full-text

High-grade glioma with anterior skull base erosion and intranasal extension: case report

Journal of Neurosurgery ◽

10.3171/2016.4.jns151724 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1484-1487 ◽

Cited By ~ 1

Author(s):

Matthew T. Stib ◽

Michael Johnson ◽

Alan Siu ◽

M. Isabel Almira-Suarez ◽

Zachary Litvack ◽

...

Keyword(s):

Nasal Cavity ◽

Skull Base ◽

Radiation Treatment ◽

High Grade Glioma ◽

Brain Parenchyma ◽

Anterior Skull Base ◽

High Grade ◽

Who Grade ◽

Who Grade Iii ◽

Grade Iii

The authors describe the case of a large WHO Grade III anaplastic oligoastrocytoma extending through the anterior skull base and into the right nasal cavity and sinuses. Glial neoplasms are typically confined to the intracranial compartment within the brain parenchyma and rarely extend into the nasal cavity without prior surgical or radiation therapy. This 42-year-old woman presented with progressive headaches and sinus congestion. MR imaging findings revealed a large intracranial lesion with intranasal extension. Endoscopic nasal biopsy revealed pathology consistent with an infiltrating glioma. The patient subsequently underwent a combined transcranial/endonasal endoscopic approach for resection of this lesion. Pathological diagnosis revealed a WHO Grade III oligoastrocytoma. This report reviews the mechanisms of extradural glioma extension. To the authors' knowledge, it is the second report of a high-grade glioma exhibiting nasal extension without prior surgical or radiation treatment.

Download Full-text

The orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus

Journal of Neurosurgery ◽

10.3171/2020.3.jns2022 ◽

2020 ◽

pp. 1-10

Author(s):

Kenichi Oyama ◽

Kentaro Watanabe ◽

Shunya Hanakita ◽

Pierre-Olivier Champagne ◽

Thibault Passeri ◽

...

Keyword(s):

Nasal Cavity ◽

Skull Base ◽

Paranasal Sinuses ◽

Middle Cranial Fossa ◽

The Body ◽

Middle Fossa Approach ◽

Alternative Approach ◽

Endoscopic Assistance ◽

Skull Base Lesions ◽

Cranial Fossa

OBJECTIVEThe anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity.METHODSFive formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the inferior orbital fissure, between the orbit and the PPF, by transposing the PPF inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article.RESULTSVia the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2).CONCLUSIONSOpening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.

Download Full-text

Three-dimensional Computed Tomography Imaging of a Frontal Skull Base Fracture —Case Report—

Neurologia medico-chirurgica ◽

10.2176/nmc.37.838 ◽

1997 ◽

Vol 37 (11) ◽

pp. 838-840 ◽

Cited By ~ 6

Author(s):

Koh YANG ◽

Tatsuya KURODA ◽

Yusuke TANABE ◽

Akira TAKAO ◽

Noboru SAKAI

Keyword(s):

Computed Tomography ◽

Case Report ◽

Skull Base ◽

Three Dimensional ◽

Computed Tomography Imaging ◽

Skull Base Fracture ◽

Tomography Imaging ◽

Frontal Skull Base

Download Full-text

Huge Anterior Skull Base Defect Reconstruction on Communicating Between Cranium and Nasal Cavity

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000006221 ◽

2020 ◽

Vol 31 (2) ◽

pp. 436-439

Author(s):

Dongwoo Shin ◽

Chae Eun Yang ◽

Yong Ook Kim ◽

Jong Won Hong ◽

Won Jai Lee ◽

...

Keyword(s):

Nasal Cavity ◽

Skull Base ◽

Anterior Skull Base ◽

Defect Reconstruction ◽

Skull Base Defect

Download Full-text

Surgically repaired posttraumatic CSF rhinorrhea: An institutional experience and review of literature

Indian Journal of Neurosurgery ◽

10.4103/2277-9167.94366 ◽

2012 ◽

Vol 01 (01) ◽

pp. 023-027

Author(s):

Brijesh Kumar ◽

Rabinarayan Sahu ◽

A.K. Srivastava ◽

Anup Nair ◽

Anant Mehrotra ◽

...

Keyword(s):

Skull Base ◽

Early Onset ◽

Review Of Literature ◽

Endoscopic Repair ◽

Csf Rhinorrhea ◽

Skull Base Fracture ◽

Institutional Experience ◽

History Of ◽

Extradural Approach ◽

Better Than

AbstractPosttraumatic cerebrospinal fluid (CSF) rhinorrhea frequently complicates anterior skull base fracture. Although skull base fracture is present in only about 7% cases of head injury, CSF rhinorrhea develops in 30% of cases with basal fracture.A total of 43 cases admitted in our Institute (SGPGI Lucknow) from January 2000 to June 2011with history of head trauma followed by CSF rhinorrhea. Forty one cases were included in this study as two patients refused surgery.Out of forty one cases, 26 cases (63%) were admitted with history of recurrent meningitis, 21 cases (51%) with loss of smell, 26 cases (63%) with delayed onset CSF rhinorrhea, 3 cases (7%) with early onset rhinorrhea which did not improve after trauma, 12 cases (30%) with early onset rhinorrhea which improved but reappeared after some time. Twenty cases (48.8%) were repaired by extradural approach, 10 cases (24.4%) were repaired by intradural approach and 11 cases (26.8%) were repaired by endoscopic approach. 12 cases (29.0%) required re-surgery for persistent or recurrence of CSF rhinorrhea.Although posttraumatic CSF rhinorrhea usually resolves with conservative management, its persistence makes an individual prone for further complications like meningitis, brain abscess and septicaemia. Timely surgical intervention usually gives promising results. Endoscopic repair was better than transcranial repair.

Download Full-text