Presentation
CSF rhinorrhea
Patient Data
A focal bony defect is located on the right side of the sphenoid sinus in the floor of the middle cranial fossa with opacification and fluid level within the sinus.
The left maxillary sinus is also opacified.
A 7mm defect at the medial floor of the right middle cranial fossa with inferomedial herniation of the right fusiform gyrus and underlying meninges is demonstrated. Cystic changes are demonstrated within this herniated part of the brain, most likely secondary to cystic gliosis. The right sphenoid sinus is fluid filled.
There is almost complete opacification of the left maxillary sinus with moderate mucosal thickening, and minor right ethmoidal mucosal thickening.
There are multiple areas of increased T2 signal within the deep white matter and in the periventricular region in keeping with chronic ischemic change. Within some of these lesions, areas of decreased T2 signal is seen within the center and are consistent with old lacunar infarcts.
Conclusion:
Findings are in keeping with a post traumatic encephalomeningocoele through the medial floor of the right middle cranial fossa communicating with the right sphenoid sinus.
Case Discussion
Combination of thin CT of the base of skull and MRI with fat saturated T2 sequence are essential in the diagnosis and characterization of suspected dural defects / encephaloceles.
This patient went on to have surgery (transsphenoidal) with repair of the encephalocoele and resection of the gliotic brain.
Medial sphenoid encephalocoeles are increasingly recognized in patients with preexisting intracranial hypertension, in many instances undiagnosed until post encephalocoele repair.
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