Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension
Background: Meningoencephalocele is defined as an abnormal sac of brain tissue and meninges extending beyond natural skull margins, often leading to cerebrospinal fluid (CSF) leakage. When this condition arises in the spheno-ethmoidal region, the diagnosis becomes more challenging as it can be mista...
| Egile Nagusiak: | , , , , , , , , , , , , , |
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| Formatua: | Artikulua |
| Hizkuntza: | English |
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Elsevier
2023-01-01
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| Saila: | Brain and Spine |
| Gaiak: | |
| Sarrera elektronikoa: | http://www.sciencedirect.com/science/article/pii/S2772529423009645 |
| _version_ | 1827591503460958208 |
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| author | Giulio Bonomo Gennaro Bussone Alessandro Gans Guglielmo Iess Roberta Bonomo Francesco Restelli Jacopo Falco Elio Mazzapicchi Mario Stanziano Alessia Amato Morgan Broggi Francesco Acerbi Paolo Ferroli Marco Schiariti |
| author_facet | Giulio Bonomo Gennaro Bussone Alessandro Gans Guglielmo Iess Roberta Bonomo Francesco Restelli Jacopo Falco Elio Mazzapicchi Mario Stanziano Alessia Amato Morgan Broggi Francesco Acerbi Paolo Ferroli Marco Schiariti |
| author_sort | Giulio Bonomo |
| collection | DOAJ |
| description | Background: Meningoencephalocele is defined as an abnormal sac of brain tissue and meninges extending beyond natural skull margins, often leading to cerebrospinal fluid (CSF) leakage. When this condition arises in the spheno-ethmoidal region, the diagnosis becomes more challenging as it can be mistaken for other nasal pathologies, such as mucocele. Research question: We show in this case report a non-congenital sphenoethmoidal meningoencephalocele causing rhinoliquoral fistula and spontaneous intracranial hypotension. Results: this 65-year-old woman presented with sporadic rhinoliquorrhoea associated with orthostatic headache, nausea and dizziness. Brain MRI revealed a small lesion of an ethmoidal sinus, which was successfully treated with endoscopic endonasal surgery. Histology confirmed the presence of meningoencephalic tissue positive for S100 protein on immunohistochemistry. Conclusions: When dealing with lesions of the paranasal sinuses in contact with the anterior skull base, rhinoliquorrhoea presence suggests meningoencephalocele. In dubious cases, a proper workup, including a thorough clinical history and neurological examination, specific imaging, and a direct search of CSF-like markers, is essential to support the differential diagnosis. In such cases, a transnasal endoscopic surgical approach is recommended to obtain a final histological diagnosis and to perform eventual dural plastic surgery. |
| first_indexed | 2024-03-09T01:33:36Z |
| format | Article |
| id | doaj.art-d5556e5b23664a428c94a5de24a1e18c |
| institution | Directory Open Access Journal |
| issn | 2772-5294 |
| language | English |
| last_indexed | 2024-03-09T01:33:36Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj.art-d5556e5b23664a428c94a5de24a1e18c2023-12-09T06:09:14ZengElsevierBrain and Spine2772-52942023-01-013102676Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotensionGiulio Bonomo0Gennaro Bussone1Alessandro Gans2Guglielmo Iess3Roberta Bonomo4Francesco Restelli5Jacopo Falco6Elio Mazzapicchi7Mario Stanziano8Alessia Amato9Morgan Broggi10Francesco Acerbi11Paolo Ferroli12Marco Schiariti13Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; University of Milan, Milan, Italy; Department of Neurological Surgery, Policlinico “G. Rodolico-S. Marco” University Hospital, Catania, ItalyDepartment of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; University of Milan, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; University of Milan, Milan, ItalyDepartment of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; School of Medicine and Surgery, Kore University of Enna, Enna, Italy; Corresponding author. Department of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Via Giovanni Celoria 11, 20133, Milan, Italy.Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; University of Milan, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; University of Milan, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; University of Milan, Milan, ItalyNeuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Neurosciences Department “Rita Levi Montalcini”, University of Turin, Turin, ItalyDepartment of Child Neuropsychiatry, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; University of Milan, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, ItalyBackground: Meningoencephalocele is defined as an abnormal sac of brain tissue and meninges extending beyond natural skull margins, often leading to cerebrospinal fluid (CSF) leakage. When this condition arises in the spheno-ethmoidal region, the diagnosis becomes more challenging as it can be mistaken for other nasal pathologies, such as mucocele. Research question: We show in this case report a non-congenital sphenoethmoidal meningoencephalocele causing rhinoliquoral fistula and spontaneous intracranial hypotension. Results: this 65-year-old woman presented with sporadic rhinoliquorrhoea associated with orthostatic headache, nausea and dizziness. Brain MRI revealed a small lesion of an ethmoidal sinus, which was successfully treated with endoscopic endonasal surgery. Histology confirmed the presence of meningoencephalic tissue positive for S100 protein on immunohistochemistry. Conclusions: When dealing with lesions of the paranasal sinuses in contact with the anterior skull base, rhinoliquorrhoea presence suggests meningoencephalocele. In dubious cases, a proper workup, including a thorough clinical history and neurological examination, specific imaging, and a direct search of CSF-like markers, is essential to support the differential diagnosis. In such cases, a transnasal endoscopic surgical approach is recommended to obtain a final histological diagnosis and to perform eventual dural plastic surgery.http://www.sciencedirect.com/science/article/pii/S2772529423009645MeningoencephaloceleMucoceleOrthostatic headacheCerebrospinal fluid leakSpontaneous intracranial hypotensionRhinoliquorrhoea |
| spellingShingle | Giulio Bonomo Gennaro Bussone Alessandro Gans Guglielmo Iess Roberta Bonomo Francesco Restelli Jacopo Falco Elio Mazzapicchi Mario Stanziano Alessia Amato Morgan Broggi Francesco Acerbi Paolo Ferroli Marco Schiariti Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension Brain and Spine Meningoencephalocele Mucocele Orthostatic headache Cerebrospinal fluid leak Spontaneous intracranial hypotension Rhinoliquorrhoea |
| title | Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension |
| title_full | Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension |
| title_fullStr | Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension |
| title_full_unstemmed | Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension |
| title_short | Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension |
| title_sort | small spheno ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension |
| topic | Meningoencephalocele Mucocele Orthostatic headache Cerebrospinal fluid leak Spontaneous intracranial hypotension Rhinoliquorrhoea |
| url | http://www.sciencedirect.com/science/article/pii/S2772529423009645 |
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