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NEURORADIOLOGY Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 4  |  Page : 379-381
Fronto ethmoidal meningocele


Department of Radiodiagnosis & Imaging, Gandhi Medical College & Associated Hamidia Hospital, Bhopal, India

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Keywords: Cephelocele, Meningocele, Encephalocele

How to cite this article:
Malik R, Pandya V K, Parteki S. Fronto ethmoidal meningocele. Indian J Radiol Imaging 2004;14:379-81

How to cite this URL:
Malik R, Pandya V K, Parteki S. Fronto ethmoidal meningocele. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Nov 15];14:379-81. Available from: http://www.ijri.org/text.asp?2004/14/4/379/28676

   Introductions Top


A skull defect in association with herniated intracranial content is termed as cephalocele. If the herniation contains solely leptomeninges and CSF it is termed a meningocele. Cephaloceles in which the protruding structure consists of leptomeninges, CSF and brain are termed meningoencephalocele.


   Case Report Top


A 18 years old man presented with progressively enlarging swelling at nasion since birth.[Figure - 1] On examination the swelling was expansile on valsalva, giving positive Furstenbery sign and transillumination. A non contrast head C. T. was performed which revealed a large frontoethmoidal meningocele, [Figure - 2],[Figure - 3] unilateral left side colpocephaly [Figure - 4],[Figure - 5].


   Discussion Top


Encephaloceles signify the herniation of neural tissue through defect in the skull [1]. They may contain meninges (meningocele) or brain matter and meninges (encephalomeningocele) or they may communicate with a ventricle (encephalomeningocystocele). No familial pattern has been demonstrated with these lesions. Association with other diseases (e.g.  Ehlers-Danlos syndrome More Details, frontonasal dysplasia), however, may suggest a genetic component[2],[3].

Twenty percent of all encephaloceles occur in the cranium. Of these, 15% are nasal. Nasal encephaloceles can be divided into 2 types : sincipital (60%) and basal (40%)

Further, the sincipital form is divided into sub types as follows: (1) The nasofrontal (40%), which exits the cranium between the nasal and frontal bones; (2) The nasoethmoidal (40%), which exits between the nasal bone and nasal cartilages; and, (3) The nasoorbital (20%), which exits, through a defect in the maxillary frontal process. Sincipital encephaloceles typically present as soft compressible masses over the glabella [3],[4],[5].

The basal form is divided into two subtypes as follows: (1) The transethmoidal, which exits through the cribriform plate into the superior meatus, extending medial to the middle turbinate; (2) the sphenoethmoidal, which exits through the cribriform plate [5], between the posterior ethmoid cells and sphenoid, to present in the nasopharynx; (3) the sphenoorbital, which enters the orbit via the superior orbital fissure and may produce exophthalmos; and; (4) the transsphenoidal which herniates in the nasopharynx via defect posterior to the cribriform plate. Basal encephaloceles may remain hidden (clinically) for years.

There has been an association of cranial meningocele with obstructive Hydrocephalus and Colpocephaly due to obstruction at foramen of Monro or Luschka and Magendie [4].

Both CT scan and MRI are useful in diagnosis, the former for degree of bony defect and the latter for degree of soft tissue herniation.

Further Associated Anomalies :

Occular hypertelorism, nasal widening, complex facial malformations and median nasal fissure, spina bifida, agenesis of the corpus callosum, ocular malformation & microcephaly.

In these cases biopsy is strongly contraindicated due to risk of infection and meningitis. The treatment involving surgical excision with repair of bony defect, often a craniotomy is necessary to approach the encephalocele.[6]

 
   References Top

1.Diebler C, Dulac O : Cephaloceles : clinical and neuroradiological appreance, Neuroadiology.  Back to cited text no. 1    
2.Soyar P, Dobbelaere P, Benoit S: Case report : Transalar sphenoidal encephalocele, radiologic findings. Clin Radiol 43:65-67, 1991.  Back to cited text no. 2    
3.Humphreys RP. Encephalocele and Dermal sinus Chapter 5. In Pediatric Neurosurgery Ed. Cheek WR. Saunders, Philadelphia, 1994.  Back to cited text no. 3    
4.Kollias SS, Ball WS, Congenital Malformation of Brain Chapter 5. In Pediatric Neuroradiology Ed. Ball WS. Lippincott. Raven, Philadelphia, 1997.  Back to cited text no. 4    
5.Mewborne JD, Williams DW, Elster AD Frontal Sinus Cephelocele associated with hydrocephalus J. Comput Assist Tomogr; 1997; 21:840 - 841,  Back to cited text no. 5    
6.Goelz (1999) Neurology, Saunders, P 515 - 16.  Back to cited text no. 6    

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Correspondence Address:
R Malik
Department of Radiodiagnosis & Imaging, Gandhi Medical College & Associated Hamidia Hospital, Bhopal
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]



 

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    Introductions
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    References
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