Midline Craniofacial Masses in Children

Abstract

Nasal dermoids, encephaloceles, and gliomas are rare congenital lesions that result from improper embryologic development. The differentiation between them and a firm understanding of their pathology is necessary to avoid unnecessary complications. In view of their potential intracranial connection, prompt diagnosis and treatment are paramount. The authors review the embryology, diagnoses, radiologic work-up, surgical management, and complications of these midline craniofacial masses in children.

Surgical correction of a meningoencephalocele in a thoroughbred filly

“…The filly presented in this Case Report appeared to have a defect solely in the right frontal bone, with no changes observed on results of MRI of the left‐side brain. Because most encephaloceles in man occur on midline, the location of the lesion in this filly prompts the question of whether this was a traumatic lesion or was truly developmental . However, because of the uncomplicated nature of the parturition, a traumatic lesion appears less likely.…”

“…Although the nomenclature for hernia contents is well defined, there are many inconsistencies in the nomenclature used to define location. The contents can be described as meningocele when only meninges are protruding; meningoencephalocele when both meninges and cerebral tissue are protruding; and meningoencephalocystocele when meninges, brain, and ventricle are protruding . In the human literature, the most broadly defined locations are occipital, basal, and anterior .…”

“…Common techniques were followed, including excision of the herniated sac with preservation of as much normal‐appearing brain tissue as possible, bony reconstruction, and an emphasis on a tight dural closure . It has been recommended that these cases be treated before full bone development so that the skull has time to develop . Another consideration of the surgery was the contouring of the equine skull, which is flatter than a human skull.…”

Multidisciplinary approach to children with sinonasal tumors: A review

“…In patients with possible meningoencephalocoeles, digital angiography or magnetic resonance imaging should be performed to evaluate the vascular structures. Biopsy is always contraindicated because of the persistent intracranial connection …”

“…The base most often originates from the lateral wall near the middle turbinate and occasionally from the nasal septum. In contrast, extranasal gliomas present as firm, noncompressible, smooth masses that appear anywhere from the nasal tip to the nasal glabella …”