Endoscopic repair of a rare basioccipital meningocele associated with recurrent meningitis.
Anatomical variants of the basiocciput are uncommon and usually clinically benign. While the majority remain undetected, these anomalies rarely manifest as CSF rhinorrhea or recurrent meningitis associated with meningocele. Compromise of the leptomeninges provides an avenue of ingress for pathological organisms and can lead to recurrent meningitis, necessitating operative repair of the defect to prevent infection. A review of the literature reveals only 3 cases in which a congenital basioccipital defect has been associated with a meningocele requiring surgical repair. The authors present a case of recurrent meningitis in an infant with a congenital basioccipital meningocele treated with a minimally invasive endoscopic technique. At the 2-year follow-up the repair remained successful, with no evidence of recurrence of the meningocele or CSF infection. The literature regarding the etiology and treatment of these lesions was reviewed, with an emphasis on the safety and efficacy of the endoscopic approach. Note that recurrent meningitis in the setting of a skull base defect may indicate the presence of other congenital anomalies that will necessitate multidisciplinary care for a patient's long-term well-being.
Ko
Andrew L
AL
Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington 98105, USA.
Gabikian
Patrik
P
Perkins
Jonathan A
JA
Gruber
David P
DP
Avellino
Anthony M
AM
D000015:Abnormalities, Multiple / Q000175:diagnosis; D002356:Cartilage / Q000637:transplantation; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D004564:Electrocoagulation; D004724:Endoscopy / Q000379:methods*; D015718:Fibrin Tissue Adhesive; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable; D006801:Humans; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000601:surgery*; D008588:Meningocele / Q000175:diagnosis / Q000601:surgery*; D008866:Microsurgery; D009305:Nasopharynx / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D009777:Occipital Bone / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D014014:Tissue Adhesives; D014057:Tomography, X-Ray Computed
D015718:Fibrin Tissue Adhesive; C411004:FloSeal Matrix; D014014:Tissue Adhesives