Management of cerebral vascular structures during endoscopic treatment of encephaloceles: a clinical report.
OBJECTIVE
Otolaryngologists are increasingly being called upon to treat patients with cerebrospinal fluid leak and encephaloceles. The endoscopic approach to the skull base through the nose and paranasal sinuses has proven effective and is well tolerated by patients. With its more widespread and frequent use, unusual cases and potential complications are becoming more apparent.


METHODS
Treatment of two clinical cases in which a cerebral vascular structure was encountered during endoscopic treatment of an encephalocele is presented, and the condition is reviewed.


RESULTS
Two patients presented after a skull base injury that occurred during endoscopic sinus surgery. In each case the initial treating surgeon attempted endoscopic repair of a cerebrospinal fluid leak, but the repair failed and the leak persisted. Upon referral to the author, in each case, a traumatic encephalocele with an active leak was apparent, and during repair a cerebral vessel was encountered. It appeared that the vessel had been "pulled down" into the skull base defect with the encephalocele's migration into the sinonasal cavity.


CONCLUSIONS
This unusual clinical condition is discussed along with the potential complications that can result from it. Otolaryngologists who treat encephaloceles should be aware of the possibility of encountering a cerebral vessel and should understand the potential complications and management options.
Department of Surgery, Division of Otolaryngology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
William E
WE
Bolger
D016025:Bone Transplantation; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D002648:Child; D006259:Craniocerebral Trauma / Q000150:complications; D004564:Electrocoagulation / Q000379:methods*; D004677:Encephalocele / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019291:Skull Base / Q000293:injuries; D014057:Tomography, X-Ray Computed