Abstract
Three children with primary intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea were operated on at the Department of Neurosurgery, Hradec Králové. In two children, aged 4 and 9.5 years, freeze-dried allogeneic costal cartilage was glued into the skull base defect. This plugging was covered up with deepfrozen allogeneic fascia lata. In the third child, an only 1-year-old boy, after transection of the neck of the encephalomeningocele freeze-dried allogeneic dura mater was glued on extradurally and deep-frozen allogeneic fascia lata applied intradurally. The cerebrospinal fluid rhinorrhea ceased immediately after surgery. Spontaneous atrophy of the intranasal portion of the encephalomeningocele was demonstrated respectively 11, 1, and 7 years postoperatively on computed tomography. To evaluate cartilage healing histologically, the extracted allogeneic cartilage used for orbital roof plasty after 4 months was examined. The extent of spotty regressions represented about 7% of the tissue volume. It is stressed that, once diagnosed, intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea should be operated on for prevention of meningitis as soon as possible.
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References
Ammar A (1992) Repair of skull base dural defects: the dura sandwich. Technical note. Acta Neurochir (Wien) 119:174–175
Bagger SD, Bergstrand G, Edner G, Anggard A (1983) Nasal meningoencephalocele. A clinical problem. Clin Otolaryngol 8:329–335
Berlit P, Rakicky J, Tornow K (1992) Primary intranasal encephalocele: a rare cause of bacterial meningitis. Acta Neurol Scand 85:404–407
Choudhury AR, Taylor JC (1982) Primary intranasal encephalocele. Report of four cases. J Neurosurg 57:552–555
Copty M, Verret S, Langelier R, Contreras C (1979) Intranasal meningoen-cephalocele with recurrent meningitis. Surg Neurol 12:49–52
Davis CH Jr, Alexander E Jr (1959) Congenital nasofrontal encephalomeningocele and teratomas. Review of seven cases. J Neurosurg 16:365–377
German DF, Wayman DM, Ward R (1991) Spontaneous cerebrospinal fluid rhinorrhea: a case report. Ann Allergy 66:32–34
Giunta G, Pappagallo G, Piazza I, Cirargi A (1990) Una rara causa di moningiti recidivanti: l'encefalocele intranasale Minerva Med 81:577–581
Izquierdo JM, Gil-Carcedo LM (1988) Recurrent menigitis and transethmoidal intranasal meningoencephalocele. Dev Med Child Neurol 30:245–251
Klen R (1959) Cold shock. Folia Biol 1:82–83
Klen R, Metelka M, Pařízek J (1977) Freeze-dried homogenous grafts of fascia lata in neurosurgery. J Neurosurg Sci 21:247–250
Luyendijk W, Schmidt PH (1983) Primary intranasal encephalocele (letter). J Neurosurg 59:1110–1111
Marsh JL, Marchosky JA (1982) Congenital nasal cerebrospinal fluid fistula. Case report. Plastic Reconstr Surg 69:997–1001
Pařízek J (1978) Fascial grafts in pediatric neurosurgery (in English). Sbor Věd Prací LF UK Hradec Králové 21:437–441
Pařízek J, Měřička P (1990) Duraplasty with pretreated freeze-dried sterilized human dura mater (in English). Sbor Věd Prací LF UK Hradec Králové 33:135–143
Rao BD, Subrahmanyam MV, Chari KVN (1974) Intranasal meningoence-phalocele. Int Surg 59:421–422
Rapport II RL, Dunn RC Jr, Alhady F (1981) Anterior encephalocele. J Neurosurg 54:213–219
Silbert P, Mc Comish M, Chakera T, Surveyor I (1992) Intranasal meningoencephalocele causing recurrent meningitis in a 25-year-old Causasian man. Med J Aust 156:141–142
Villarejo FJ (1985) Atlas of pediatric neurosurgical techniques. Karger, Basel
Vital JP, Penha R, Veiga G, Olias J, Cruz M (1987) Intranasal encephalomeningocele-case report. Rev Laryngol 108:497–499
Volpe JJ (1991) Brain development-normal and abnormal. J Perinat Med 19 [Suppl 1]:29–34
Wakhloo AK, Velthoven V van, Schumacher M, Krauss JK (1991) Evaluation of MR imaging, digital subtraction cisternography, and CT cisternography in diagnosing CSF fistula. Acta Neurochir (Wien) 111:119–127
Yamamoto Y, Minakawa H, Yoshida T, Igawa H, Sugihara T, Ohura T, Nohira K (1993) Role of bone graft in reconstruction of skull base defect: is a bone graft necessary? Skull Base Surg 3:223–229
Zinreich SJ, Borders JC, Eisele DW, Mattox DE, Long DM, Kennedy DW (1992) The utility of magnetic resonance imaging in the diagnosis of intranasal meningoencephaloceles. Arch Otolaryngol Head Neck Surg 118:1253–1256
Žižka J (1994) Diagnostis of syndromes and malformations (in Czech). Galén, Prague
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Pařízek, J., Němečková, J., Měřička, P. et al. Allogeneic cartilage used for skull base plasty in children with primary intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea. Child's Nerv Syst 12, 136–141 (1996). https://doi.org/10.1007/BF00266815
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DOI: https://doi.org/10.1007/BF00266815