Encephalocoele - middle cranial fossa
Trauma with left orbital fracture at age 15. Intermittent headaches / migraines and fluid discharge from nose for the last 20 years.
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A defect is present in the medial aspect of the left middle cranial fossa leading into the the left sphenoid sinus. Through the defect the anterior most part of the left inferior temporal gyrus has herniated, with resultant distortion of the temporal pole. The sinus appears partially opacified by fluid without a convincing air-fluid level. The pituitary fossa is enlarged and empty.
Features are those of an internal encephalocoele.
Encephaloceles are most frequently congenital due to failure of normal skull formation and are thus most frequently in the midline. Acquired encephaloceles are more frequently due to trauma (as in this case) or prior surgery. When they occur through the base of skull they are usually externally occult, although they can present as nasopharyngeal or paranasal sinus 'lumps'. If there is an associated dural defect then rhinorrhea and meningitis can occur. This can be intermittent.