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Two occult skull base malformations causing recurrent meningitis in a child: a case report.
Bernhard Schick1, Andreas Prescher, Erich Hofmann
1Department of Otolaryngology and Head and Neck Surgery, University of Homburg-Saar, Kirrberger Str, 66421 Homburg, Germany. bernhard.schick@uniklinik-saarland.de
Summary
Occult skull base defects can lead to recurrent meningitis. Early and thorough radiological evaluation, including the clivus, is crucial for detecting these rare congenital anomalies and preventing serious infections.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Occult skull base malformations are rare but can cause severe complications like meningitis.
- Investigations for cerebrospinal fluid (CSF) fistulas or meningoceles are often delayed until recurrent meningitis occurs.
Observation:
- A child with recurrent meningitis since childhood underwent surgery for chronic sinusitis, revealing an olfactory groove bony defect.
- Despite initial surgery, meningitis recurred, prompting further imaging.
- Repeat imaging identified a transclival bony defect with a meningocele, suggestive of a canalis basilaris medianus.
Findings:
- Endonasal surgery successfully closed the transclival defect and meningocele.
- The patient has remained meningitis-free for 2 years post-surgery without antibiotics.
Implications:
- Congenital skull base defects can be challenging to diagnose and may involve multiple sites.
- Comprehensive radiological assessment, including the clivus, is essential for identifying these defects.
- Prompt surgical closure of identified defects is mandatory to prevent infectious endocranial complications.