Obstructing Encephaloceles Presenting as Chronic Rhinosinusitis: Lessons Learned from a Case Series

Abstract

We present a unique anatomic cause of encephalocele, and describe appropriate diagnosis. Two patients underwent stereotactic image-guided sinus surgery for presumed chronic rhinosinusitis with intraoperative findings of a sinus encephalocele. The first patient underwent a conservative 2-stage management that included an initial cerebrospinal fluid (CSF) leak repair followed by encephalocele resection. The second patient underwent a 1-stage encephalocele resection and CSF leak repair with a septal graft. The sinus surgeon needs to consider the possibility of encephalocele when the ethmoid, sphenoid, or, rarely, frontal sinuses present with an isolated opacification that does not improve with conservative medical therapy.

Intranasal meningoencephalocele in a 1‐year‐old Staffordshire Bull Terrier with unilateral destructive rhinitis

“…In people, MEC can present without neurologic signs and with signs of chronic rhinosinusitis alone. 6 Rhinosinusitis in these patients is usually considered secondary to CSF leakage; however, it is rarely destructive and epistaxis has not been described. The phenomenon of CSF rhinorrhea is uncommon, but well documented in humans and it is frequently misdiagnosed as allergic rhinitis.…”

“…The case described here is the first case report of a dog diagnosed with MEC without neurologic changes and with nasal signs alone. In people, MEC can present without neurologic signs and with signs of chronic rhinosinusitis alone 6 . Rhinosinusitis in these patients is usually considered secondary to CSF leakage; however, it is rarely destructive and epistaxis has not been described.…”