Related Experiment Video
Updated: Jan 13, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Orbital Apex Syndrome Secondary to Middle Cranial Fossa Meningocele: A Rare Pediatric Case
Konstantin Gushansky1, Mohamad Zaghal1
1Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Orbital apex syndrome (OAS) in a child was successfully treated. A rare middle cranial fossa meningocele compressing orbital structures was identified and surgically repaired, restoring vision and eye movement.
Area of Science:
- Neuro-ophthalmology
- Pediatric Neurology
- Radiology
Background:
- Orbital apex syndrome (OAS) is a rare condition affecting neurovascular structures.
- It can cause sight-threatening and potentially life-threatening complications.
- Prompt diagnosis and intervention are crucial for preserving vision.
Purpose of the Study:
- To report a pediatric case of OAS.
- To highlight a rare etiology: middle cranial fossa meningocele (MEC).
- To emphasize multidisciplinary management and outcomes.
Main Methods:
- Case report of a 10-year-old child with acute OAS symptoms.
- Diagnostic imaging (CT/MRI) to identify MEC and associated sinusitis/meningitis.
- Multidisciplinary team approach involving ophthalmology, neurology, ENT, and radiology.
- Treatment with intravenous antibiotics followed by surgical repair (cranial osteoplasty).
Main Results:
- The patient presented with proptosis, ophthalmoplegia, and optic disc edema.
- Imaging confirmed MEC extending into the orbital apex.
- Intravenous antibiotics led to rapid systemic and ocular improvement.
- Surgical repair resulted in normal visual acuity and largely recovered extraocular movements at follow-up.
Conclusions:
- Middle cranial fossa meningoceles are a rare but important cause of OAS.
- Early recognition and collaborative, multidisciplinary management are key.
- Successful outcomes are achievable with timely intervention and surgical repair.
Background:
Orbital apex syndrome (OAS) is a rare, sight-threatening condition caused by injury or compression of neurovascular structures in the orbital apex, which, depending on the underlying etiology, may even pose a life-threatening risk. Prompt recognition and intervention are essential to prevent permanent visual loss and systemic complications.
Case Presentation:
We report a 10-year-old child presenting with acute left-sided proptosis, eyelid edema, ophthalmoplegia, and optic disc edema, following a history of orbital cellulitis and meningitis in early childhood. Imaging revealed a middle cranial fossa meningocele (MEC) extending into the orbital apex, associated with sinusitis and purulent meningitis. Ophthalmic examination demonstrated severe restriction of left-eye movements, proptosis, and a relative afferent pupillary defect. A multidisciplinary team - including ophthalmology, neurology, ENT, and radiology - initiated urgent intravenous antibiotics, resulting in rapid systemic and ocular improvement. The patient subsequently underwent cranial osteoplasty to repair the skull base defect. At discharge and four-month follow-up, visual acuity was normal, extraocular movements had largely recovered, and imaging showed intact retinal nerve fiber layers.
Conclusion:
This case underscores the importance of early recognition and collaborative management in OAS. Middle cranial fossa meningoceles, though rare, should be considered among potential structural causes of orbital apex compression.
Related Concept Videos
01:27Cranial Bones: Lateral View
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...
01:19Cranial and Spinal Meninges
Cranial Meninges
These meningeal layers cover the cranium. The dura mater is the outermost layer of cranial meninges. It is a thick and durable membrane of dense...
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:12General Case of Eccentric Axial Loading
Consider a member subjected to equal and opposite forces that are applied along a line that does not coincide with the member's neutral axis. In unsymmetrical...