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Child's Nervous System
Published in: Child's Nervous System 2/2016

01-02-2016 | Case Report

Ethmoidal meningoencephalocele and CSF leak after posthaemorrhagic ventricular dilatation in a newborn child

Authors: Laura González-García, Bienvenido Ros-López, Sara Iglesias-Moroño, Álvaro Martín-Gallego, Antonio Carrasco-Brenes, Miguel Segura Fernández-Nogueras, Miguel Ángel Arráez-Sánchez

Published in: Child's Nervous System | Issue 2/2016

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Abstract

Background

Rhinoliquorrhoea suggests a communication between the subarachnoid space and the sinonasal tract. Clinical presentation includes clear nasal discharge, headache, pneumocephalus, meningitis or brain abscess. Cerebrospinal fluid (CSF) leaks are mostly of traumatic origin (skull base fractures), iatrogenic (secondary to endoscopic endonasal surgery) or associated with tumour aetiology. Occasionally, hydrocephalus has been the cause of rhinoliquorrhoea in adults, presumably secondary to the chronically raised intracranial pressure with skull base erosion and meningocele. To our knowledge, the association of hydrocephalus and ethmoid meningoencephalocele/CSF leak has not been previously reported in a newborn child.

Case presentation

We present the case of a 9-month-old girl who was referred for rhinorrhoea. She had a history of posthaemorrhagic ventricular dilatation. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed a left ethmoidal meningoencephalocele and small ventricular size. The meningoencephalocele was surgically repaired using an intradural subfrontal approach. During the postoperative period, after the transient lumbar drain was withdrawn, she developed symptomatic hydrocephalus. Ventriculoperitoneal shunting was required.

Conclusion

Progressive ventricular dilatation may arise from a meningoencephalocele/CSF leak in paediatric patients. Early identification and repair of the meningoencephalocele are critical to avoid development of complications.
Literature
1.
Bret P, Hor F, Huppert J, Lapras C, Fischer G (1985) Treatment of cerebrospinal fluid rhinorrhea by percutaneous lumboperitoneal shunting: review of 15 cases. Neurosurgery 16(1):44–47CrossRefPubMed
2.
Cabezudo JM, Vaquero J, Garcia-de-Sola R, Areitio E, Martinez R (1981) Direct communication between the lateral ventricle and the frontal sinus as the cause of CSF rhinorrhea in aqueductal stenosis. Acta Neurochir 57:95–98CrossRefPubMed
3.
Cantisani PL, Cancelliere M, Armenise B, Lupo F (1999) Hypertensive pneumocephalus and nasal fistula in ventriculoperitoneal shunt: case report and review of literature. J Neurosurg Sci 43(2):153–157PubMed
4.
Carrau RL, Snyderman CH, Kassam AB (2005) The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope 15(2):205–212CrossRef
5.
Conboy PJ, Johnson IJ, Jaspan T, Jones NS (1998) Idiopathic diffuse erosion of the skull base presenting as cerebrospinal fluid rhinorrhoea. J Laryngol Otol 112:679–681CrossRefPubMed
6.
Costa H, Cunha C, Conde A, Cerejo A, Baptista A, Vaz R, Goncalves M (1997) Reconstruction of the anterior cranial base with a frontal muscle flap in cerebrospinal fluid fistulae. Acta Med Port 10:19–26(Pol, with Eng abstract)PubMed
7.
Gallia GL, Teo C (2008) Spontaneous third ventriculocisternostomy in an infant with obstructive hydrocephalus. J Neurosurg Pediatr 1(6):477–480CrossRefPubMed
8.
Gharzouli I, Verillaud B, Tran H, Blancal JP, Sauvaget E, Kania R, Guichard JP, Herman P (2015) Value of systematic analysis of the olfactory cleft in case of cerebrospinal rhinorrhea: incidence of olfactory arachnoid dilatation. Eur Arch Otorhinolaryngol 18 [Epub ahead of print]
9.
Honarmand A, Pasternak-Wise O, Alden T, Bowman R, Hurley M, Ansari S, Shaibani A (2014) E-004 vascular causes of pediatric intracranial hypertension. J Neurointerv Surg 6(Suppl 1):A39
10.
Iffenecker C, Benoudiba F, Parker F, Fuerxer F, David P, Tadié M, Bobin S, Doyon D (1999) The place of MRI in the study of cerebrospinal fluid fistulas. J Radiol 80(1):37–43PubMed
11.
Locke CE (1926) The spontaneous escape of cerebrospinal fluid through the nose: its occurrence with brain tumors. Arch Neurol Psychiatr 15:309CrossRef
12.
Marston AP, Van Gompel JJ, Carlson ML, O’Brien EK (2015) A unique case of bilateral recurrent sphenoid sinus cerebrospinal fluid leaks: primary acquired leak within the lateral sphenoid sinus recess, Followed by a Leak via Sternberg’s Canal. Ann Otol Rhinol Laryngol [Epub ahead of print]
13.
Martín-Martín C, Martínez-Capoccioni G, Serramito-García R, Espinosa-Restrepo F (2012) Surgical challenge: endoscopic repair of cerebrospinal fluid leak. BMC Res Notes 27:5–459
14.
Muzumdar D, Nadkarni T, Goel A (2003) Spontaneous cerebrospinal fluid rhinorrhea as a presenting symptom of aqueductal stenosis—case report. Neurol Med Chir (Tokyo) 43(12):626–629CrossRef
15.
16.
Ommaya AK. Cerebrospinal fluid fistula, in Wilkins S, Rengachary SS (eds): Neurosurgery. New York, McGraw-Hill, 1985, pp 1637–1647
17.
Perani D, Scotti G, Colombo N, Sterzi R, Castelli A (1984) Spontaneous CSF rhinorrhea through the lamina cribrosa associated with primary empty sella. Ital J Neurol Sci 5:167–172CrossRefPubMed
18.
Psaltis AJ, Overton LJ, Thomas 3rd WW, Fox NF, Banks CA, Schlosser RJ (2014) Differences in skull base thickness in patients with spontaneous cerebrospinal fluid leaks. Am J Rhinol Allergy 28(1):e73–e79CrossRefPubMed
19.
Raghavan U, Majumdar S, Jones NS (2002) Spontaneous CSF rhinorrhoea from separate defects of the anterior and middle cranial fossa. J Laryngol Otol 116:546–547CrossRefPubMed
20.
Ramsden JD, Corbridge R, Bates G (2000) Bilateral cerebrospinal fluid rhinorrhoea. J Laryngol Otol 114:137–138PubMed
21.
Romero L, Ros B, Ríus F, González L, Medina JM, Martín A (2014) Ventriculoperitoneal shunt as a primary neurosurgical procedure in newborn posthemorrhagic hydrocephalus: report of a series of 47 shunted patients. Childs Nerv Syst 30(1):91–97CrossRefPubMed
22.
Ros-López B, Jaramillo-Dallimonti AM, De Miguel-Pueyo LS, Rodríguez-Barceló S, Domínguez-Páez M, Ibáñez-Botella G, Márquez-Márquez B, Arráez-Sánchez MA (2009) Ventricular haemorrhage in preterm neonates and posthemorrhagic hydrocephalus. Proposal of a management protocol based on early ventriculo-peritoneal shunt. Neurocirugia (Astur) 20(1):15–24CrossRef
23.
Rovit RL, Schechter MM, Nelson K (1969) Spontaneous “high-pressure cerebrospinal rhinorrhea” due to lesions obstructing flow of cerebrospinal fluid. J Neurosurg 30:406–412CrossRefPubMed
24.
Schechter MM, Rovit RL, Nelson K (1969) Spontaneous “high pressure CSF rhinorrhoea”. cerebrospinal fluid leakage caused by long-standing increased intracranial pressure. Br J Radiol 42(500):619–622CrossRefPubMed
25.
Senior BA, Jafri K, Benninger M (2001) Safety and efficacy of endoscopic repair of CSF leaks and encephaloceles: a survey of the members of the American Rhinologic Society. Am J Rhinol 15:21–25CrossRefPubMed
26.
Symss NP, Prasad AN, Vasudevan MC, Ramamurthi R (2009) Exophytic choroid plexus papilloma of the fourth ventricle presenting with cerebrospinal fluid rhinorrhea: a case report. Surg Neurol 71(6):705–708CrossRefPubMed
27.
Tokuno T, Ban S, Nakazawa K, Yoshida S, Matsumoto S, Shingu T, Sato S, Yamamoto T (1995) Non-traumatic cerebrospinal fluid rhinorrhea associated with hydrocephalus: a case report. No Shinkei Geka 23:265–269(Jpn, with Eng abstract)PubMed
28.
Woodworth BA, Prince A, Chiu AG, Cohen NA, Schlosser RJ, Bolger WE, Kennedy DW, Palmer JN (2008) Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg 138(6):715–720CrossRefPubMed
29.
Gosepath J, Santamaria VE, Lippert BM, Mann WJ (2007) Forty-one cases of congenital choanal atresia over 26 years—retrospective analysis of outcome and technique. Rhinology 45(2):158–163PubMed
30.
Ma J, Huang Q, Li X, Huang D, Xian J, Cui S, Li Y, Zhou B (2015) Endoscopic endonasal repair of cerebrospinal fluid leaks with and without an encephalocele in pediatric patients: from infants to children. Childs Nerv Syst May 15 [Epub ahead of print]
Metadata
Title
Ethmoidal meningoencephalocele and CSF leak after posthaemorrhagic ventricular dilatation in a newborn child
Authors
Laura González-García
Bienvenido Ros-López
Sara Iglesias-Moroño
Álvaro Martín-Gallego
Antonio Carrasco-Brenes
Miguel Segura Fernández-Nogueras
Miguel Ángel Arráez-Sánchez
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 2/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-015-2828-x

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