Recurrent meningitis in a child with bilateral cochlear implantation associated with a petrous apex encephalocele: a case report and literature review

Abstract

To report a case of pediatric recurrent meningitis that is associated with an underlying petrous apex encephalocele in a patient with bilateral cochlear implants and reviews the literature of similar petrous apex lesions. A 5-year-old girl presented during her third episode of meningitis. Her first episode of meningitis left her with profound bilateral sensorineural hearing loss for which she received cochlear implants. During her assessment, she was found to have a petrous apex encephalocele, which was successfully repaired via a middle cranial fossa approach. Literature review demonstrates that petrous apex cephaloceles (PAC) are associated with meningitis, particularly in children. No previous reports exist of PAC in patients with cochlear implants. This case illustrates the importance of identifying an underlying anatomic abnormality in recurrent meningitis. PAC are rare abnormalities that can cause cerebrospinal fluid leaks leading to intracranial hypotension, cranial neuropathies, and infectious complications.

Petrous Apex Cephaloceles: Radiology Features and Surgical Management of a Rare Entity

“…To date, there have been several cases of CSF leak in the context of children, often presenting with symptoms of infection (1,17,18). Warade et al (7) provided the first and only case report of an adult presenting with CSF leak in the setting of PAC, in a man that was misdiagnosed and operated on unsuccessfully via endonasal route.…”