Spontaneous Cerebrospinal Fluid Rhinorrhea With Meningoencephalocele Recurrence After Placement of a Lumboperitoneal Shunt: A Case Report

Abstract

Cerebrospinal fluid rhinorrhea associated with meningoencephalocele is usually treated surgically. During the perioperative period, cerebrospinal fluid diversion may be employed to control intracranial pressure, but there are few indications for this method. A 51-year-old female presented with cerebrospinal fluid rhinorrhea associated with meningoencephalocele and underwent surgical repair followed by the placement of a lumboperitoneal shunt. However, cerebrospinal fluid leakage recurred, requiring a second surgery. Lumbar drainage effectively controls intracranial pressure, but it does not cure bone defects. The use of these devices should be carefully considered based on the patient's condition.

Keywords: cerebrospinal fluid diversion; cerebrospinal fluid rhinorrhea; lumbar drainage; lumboperitoneal shunt; meningoencephalocele.

Figure 1. The CT and MRI scans show meningoencephalocele protruding into the left sphenoid sinus through the bone defect and CSF in the sphenoid sinus.

Head CT showing a bone defect (arrowheads, A and B) in the left middle cranial fossa communicating with the sphenoid sinus. MRI showing meningoencephalocele in the sphenoid sinus (arrowhead, C) and accumulated cerebrospinal fluid within the sphenoid sinus. CT: computed tomography; MRI: magnetic resonance imaging; CSF: cerebrospinal fluid

Figure 2. A left frontotemporal craniotomy was performed, and meningoencephalocele was excised approaching the extra dural side.

Multiple bone pores (arrowheads, A) are observed, possibly related to thinning of the middle cranial fossa. Brain tissue is observed deviating from the bone defect and is cauterized (B and C). Repair of the bone defect using surgical bone cement (D).

Figure 3. During the second surgery, residual bone defects and surrounding bone pores were observed and closed.

The previously identified dural defect remained open, allowing the leakage of CSF (A). There were bony pores around the leakage point (arrowheads, B). The dural defect was closed using temporal fascia and fibrin glue (C). The middle cranial fossa was extensively repaired with bone cement while also covering the surrounding bone pores (D). CSF: cerebrospinal fluid.