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CSF leak with meningoencephalocele secondary to sphenoid bone defect

Case contributed by Rayyan Mardhiyah
Diagnosis certain

Presentation

Presented with persistent rhinorrhea and pillow is frequently wet in the morning. History of craniectomy for frontal meningioma.

Patient Data

Age: 40 years
Gender: Female

Defect in lateral part of left sphenoid sinus with herniation of temporal horn and antero-inferior pole of left temporal lobe. Grey matter and meningeal layer herniation with CSF like fluid density in the left sphenoid sinus. This is suggestive of left middle cranial fossa defect with left temporal lobe encephalomeningocele lead to CSF leakage.

Evidence of left frontal craniectomy. Fluid density within left sphenoid sinus ( fluid attenuation 5-15HU) with bone defect in lateral roof of left sphenoid sinus. No adjacent dural thickening.

Case Discussion

The patient underwent bilateral function endoscopic sinus surgery and septectomy, left middle turbinectomy and left transsphenoidal CSF leak repair using thigh and fascia lata flap. 

In patients with rhinorrhea and diagnosing CSF leak, the most important sequences would be 3D-CISS with the benefit of multiplanar images capacity, less bony artifacts from bony elements, non-invasive and high soft-tissue contrast, lack of ionizing radiation and contrast medium administration 1.

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