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

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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 During the postoperative period, after the transient lumbar drain was withdrawn, she developed symptomatic hydrocephalus.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.

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Abbreviations

CSF:

Cerebrospinal fluid

CT:

Computed tomography

ICP:

Intracranial pressure

MRI:

Magnetic resonance imaging

PHVD:

Posthaemorrhagic ventricular dilatation

VP shunt:

Ventriculoperitoneal shunt

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Conflict of interest

The authors state that no conflict of interest exists, no funding was provided, and we deny any kind of commercial relationship or financial disclosure.

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Authors and Affiliations

  1. Department of Neurosurgery, HRU Carlos Haya, Avenida Carlos Haya s/n, 29010, Málaga, Spain

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

Authors
  1. Laura González-García
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  2. Bienvenido Ros-López
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  3. Sara Iglesias-Moroño
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  4. Álvaro Martín-Gallego
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  5. Antonio Carrasco-Brenes
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  6. Miguel Segura Fernández-Nogueras
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  7. Miguel Ángel Arráez-Sánchez
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Correspondence to Laura González-García.

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González-García, L., Ros-López, B., Iglesias-Moroño, S. et al. Ethmoidal meningoencephalocele and CSF leak after posthaemorrhagic ventricular dilatation in a newborn child. Childs Nerv Syst 32, 369–375 (2016). https://doi.org/10.1007/s00381-015-2828-x

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  • DOI: https://doi.org/10.1007/s00381-015-2828-x

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