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Published on: July 5, 2011
Carolyn's window approach for spontaneous frontal sinus meningoencephalocele
Arshia Akhavan-Mofrad1, Keshav Kumar Gupta2, Karan Jolly3
1College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Abstract:
Spontaneous meningoencephaloceles (MECs) are sparsely documented in the literature. Those occurring in the frontal sinus are an exceedingly rare entity. MECs are commonly associated with cerebrospinal fluid (CSF) rhinorrhoea. CSF rhinorrhoea is frequently misdiagnosed, causing delays in diagnosis and management. The subsequently increased risk of bacterial meningitis can be life-threatening to patients. We report the case of a woman in her late 70s with a spontaneous frontal sinus MEC, presenting with a 6-month history of CSF rhinorrhoea. The patient was successfully treated using the novel Carolyn's window approach endoscopically; 9-month follow-up revealed no skull-base breach. Our case emphasises the importance of considering MEC as a differential diagnosis for clear rhinorrhoea and demonstrates successful repair through a novel surgical approach.
Insights
Spontaneous frontal sinus meningoencephaloceles (MECs) are rare. This case report details successful endoscopic repair of a frontal sinus MEC presenting with cerebrospinal fluid (CSF) rhinorrhoea, highlighting a novel surgical approach.
Area of Science:
- Neurosurgery
- Otolaryngology
Background:
- Spontaneous meningoencephaloceles (MECs) are rare neurological conditions.
- Frontal sinus MECs are exceptionally uncommon, often associated with cerebrospinal fluid (CSF) rhinorrhoea.
- CSF rhinorrhoea can be misdiagnosed, delaying treatment and increasing meningitis risk.
Observation:
- A woman in her late 70s presented with a 6-month history of clear rhinorrhoea.
- The patient was diagnosed with a spontaneous frontal sinus MEC.
Findings:
- The frontal sinus MEC was successfully treated using an endoscopic approach.
- A novel surgical technique, Carolyn's window approach, was employed for the repair.
- Nine-month follow-up confirmed no recurrence or complications, including no skull-base breach.
Implications:
- Highlights the importance of considering MEC in cases of unexplained clear rhinorrhoea.
- Demonstrates the efficacy and safety of the Carolyn's window approach for frontal sinus MEC repair.
- Emphasizes the potential for minimally invasive endoscopic techniques in managing rare skull base defects.
