J Korean Neurosurg Soc.  2015 Apr;57(4):298-302. 10.3340/jkns.2015.57.4.298.

Cerebrospinal Fluid Rhinorrhea and Seizure Caused by Temporo-Sphenoidal Encephalocele

• Hammer A
• Baer I
• Geletneky
• Steiner HH

• KMID: 1956431
• DOI: http://doi.org/10.3340/jkns.2015.57.4.298

Abstract

This case report describes the symptoms and clinical course of a 35-year-old female patient who was diagnosed with a temporo-sphenoidal encephalocele. It is characterized by herniation of cerebral tissue of the temporal lobe through a defect of the skull base localized in the middle fossa. At the time of first presentation the patient complained about recurrent nasal discharge of clear fluid which had begun some weeks earlier. She also reported that three months earlier she had for the first time suffered from a generalized seizure. In a first therapeutic attempt an endoscopic endonasal approach to the sphenoid sinus was performed. An attempt to randomly seal the suspicious area failed. After frontotemporal craniotomy, it was possible to localize the encephalocele and the underlying bone defect. The herniated brain tissue was resected and the dural defect was closed with fascia of the temporalis muscle. In summary, the combination of recurrent rhinorrhea and a first-time seizure should alert specialists of otolaryngology, neurology and neurosurgery of a temporo-sphenoidal encephalocele as a possible cause. Treatment is likely to require a neurosurgical approach.

Keyword

Encephalocele; Cerebrospinal fluid rhinorrhea; Skull base; Encephalitis; Epilepsia

MeSH Terms

Adult
Brain
Cerebrospinal Fluid Rhinorrhea*
Craniotomy
Encephalitis
Encephalocele*
Fascia
Female
Humans
Neurology
Neurosurgery
Otolaryngology
Seizures*
Skull Base
Specialization
Sphenoid Sinus
Temporal Lobe

Figure

• 

  Fig. 1 Sagittal (A) and coronal (B) computed tomography scan of the skull base showing the defect (6.2×6.3×7.2 mm) in the roof of a far lateral recessus of the right sphenoid sinus leading to the middle fossa (arrows).

• 

  Fig. 2 A : Coronal T1-weighted magnetic resonance imaging scan of the head showing a disruption of the skull base in the area of the roof of the right sphenoid sinus where the encephalocele penetrated. A contrast enhancement in terms of an inflammatory area reaching to the fronto-mesial temporal lobe is detectable (arrows). B : Coronal T2-weighted/FLAIR magnetic resonance imaging scan of the head showing a high signal intensity of the right temporal lobe reconcilable with an encephalitis (arrows). FLAIR : fluid attenuated inversion recovery.

• 

  Fig. 3 A : The middle cranial fossa is reached via a fronto-temporal approach. This way, the damaged dura and skull base become visible (arrows). B : Upon resection of the encephalocele, the dura defect is sealed with galea, tachosil, and fibrin glue (arrow).

• 

  Fig. 4 A : Coronal T1-weighted magnetic resonance imaging scan of the head showing no contrast enhancement in terms of an inflammatory area of the fronto-mesial temporal lobe (arrows). B : Coronal T2-weighted/FLAIR magnetic resonance imaging scan of the head. No abnormal signal intensity are detected in the area of the right temporal lobe (arrows). FLAIR : fluid attenuated inversion recovery.

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