Craniopharyngeal duct: a cause of recurrent meningitis

Abstract

Identification of the cause of recurrent meningitis may pose a diagnostic challenge. Evaluation of a patient with recurrent meningitis calls for meticulous review of skull base structures by cross sectional imaging to exclude any underlying anatomical abnormality. Our case highlights the importance of excluding persistent craniopharyngeal duct, a rare but treatable cause of recurrent meningitis. The isolation of Streptococcus pneumoniae in recurrent meningitis may be a clue to the presence of a skull base abnormality. Craniopharyngeal canals have been classified depending on their qualitative and quantitative imaging features. Such imaging based classification is important for identification of patients with associated potential pituitary involvement and also for appropriate surgical planning. Controversy exists as to the approach to surgical treatment of craniopahryngeal duct. The persistent craniopahryngeal duct in our patient was successfully treated by an endoscopic transsphenoidal approach.

Figure 1.

Axial CT scan of the head in bone window showing a round corticated defect (arrow) in the sphenoid body.

Figure 2.

CT scan of the head with sagittal reformat on bone window through the midline shows defect (arrow) in the sphenoid body.

Figure 3.

Preoperative MRI. T ₂ weighted sagittal image through the midline shows cerebrospinal fluid-filled tract (arrow) communicating between the floor of the sella and the nasopharynx.

Figure 4.

Postoperative MRI. T ₂ weighted sagittal image shows obliteration of the tract by soft-tissue material (arrow).