Ethmoidal encephalocele associated with cerebrospinal fluid fistula: indications and results of mini-invasive transnasal approach

Anterior skull base defects with encephalocele in adults are quite rare and can be a cause of spontaneous rhinoliquorrhea; however, cerebrospinal fluid (CSF) fistula can be not rarely misdiagnosed for several months or years. Five adult patients affected by ethmoidal encephalocele with CSF fistula w...

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Bibliographic Details
Published in:	The Journal of craniofacial surgery Vol. 25; no. 2; pp. 551 - 553
Main Authors:	Fraioli, Mario Francesco, Umana, Giuseppe Emanuele, Fiorucci, Giulia, Fraioli, Chiara
Format:	Journal Article
Language:	English
Published:	United States 01-03-2014
Subjects:	Absorbable Implants Adult Aged Cerebrospinal Fluid Rhinorrhea - diagnosis Cerebrospinal Fluid Rhinorrhea - surgery Dentistry Diagnostic Errors Encephalocele - diagnosis Encephalocele - surgery Ethmoid Bone - abnormalities Ethmoid Bone - pathology Female Follow-Up Studies Hemostatics - therapeutic use Humans Magnetic Resonance Imaging - methods Male Microsurgery - methods Middle Aged Minimally Invasive Surgical Procedures - methods Nasal Cavity - surgery Palmitates - therapeutic use Reconstructive Surgical Procedures - methods Skull Base - abnormalities Skull Base - surgery Tissue Adhesives - therapeutic use Tomography, Spiral Computed - methods Waxes - therapeutic use
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Summary:	Anterior skull base defects with encephalocele in adults are quite rare and can be a cause of spontaneous rhinoliquorrhea; however, cerebrospinal fluid (CSF) fistula can be not rarely misdiagnosed for several months or years. Five adult patients affected by ethmoidal encephalocele with CSF fistula were treated in our institute from 2006 through to 2011. Onset of clinical history was represented by rhinoliquorrhea, which was precociously recognized in only 1 patient; in the other 4, it was misdiagnosed for a period ranging from 11 months to 5 years. After clinical diagnosis of CSF fistula and after brain magnetic resonance imaging, ethmoidal encephalocele was evident in all patients; preoperative study was completed by spiral computed tomography scan, to clearly identify the skull base bone defect. All patients were operated on by transsphenoidal endonasal endoscope-assisted microsurgical approach through 1 nostril. The herniated brain was coagulated and removed, and reconstruction of cranial base was performed. Postoperative rhinoliquorrhea or other complications did not occur in any patient at short and late follow-up. All patients were discharged after a few days. Endonasal endoscope-assisted microsurgical approach was effective in exposing and repairing the ethmoidal bone defect; tridimensional vision and wide lateral and superior exposition of the operative field were possible in each patient, thanks to the use of microscope and angulated endoscope.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1049-2275 1536-3732
DOI:	10.1097/01.scs.0000436738.44795.8f