title: Ethmoidal meningoencephalocele and CSF leak after posthaemorrhagic ventricular dilatation in a newborn child.
abstract: BACKGROUND
  Rhinoliquorrhoea suggests a communication between the subarachnoid space and the sinonasal tract. Clinical presentation includes clear nasal discharge, headache, pneumocephalus, meningitis or brain abscess. Cerebrospinal fluid (CSF) leaks are mostly of traumatic origin (skull base fractures), iatrogenic (secondary to endoscopic endonasal surgery) or associated with tumour aetiology. Occasionally, hydrocephalus has been the cause of rhinoliquorrhoea in adults, presumably secondary to the chronically raised intracranial pressure with skull base erosion and meningocele. To our knowledge, the association of hydrocephalus and ethmoid meningoencephalocele/CSF leak has not been previously reported in a newborn child.
  
  
  METHODS
  We present the case of a 9-month-old girl who was referred for rhinorrhoea. She had a history of posthaemorrhagic ventricular dilatation. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed a left ethmoidal meningoencephalocele and small ventricular size. The meningoencephalocele was surgically repaired using an intradural subfrontal approach. During the postoperative period, after the transient lumbar drain was withdrawn, she developed symptomatic hydrocephalus. Ventriculoperitoneal shunting was required.
  
  
  CONCLUSIONS
  Progressive ventricular dilatation may arise from a meningoencephalocele/CSF leak in paediatric patients. Early identification and repair of the meningoencephalocele are critical to avoid development of complications.
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Avenida Carlos Haya s/n, 29010, Málaga, Spain. gonzalezgarcialaura@hotmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: González-García
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Avenida Carlos Haya s/n, 29010, Málaga, Spain. broslopez@yahoo.es.
authors.forename: Bienvenido
authors.initials: B
authors.lastname: Ros-López
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Avenida Carlos Haya s/n, 29010, Málaga, Spain. siglesias95@yahoo.es.
authors.forename: Sara
authors.initials: S
authors.lastname: Iglesias-Moroño
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Avenida Carlos Haya s/n, 29010, Málaga, Spain. alvaro1710@hotmail.com.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Martín-Gallego
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Avenida Carlos Haya s/n, 29010, Málaga, Spain. antoniocarrasco87@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carrasco-Brenes
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Avenida Carlos Haya s/n, 29010, Málaga, Spain. msfn27@gmail.com.
authors.forename: Miguel Segura
authors.initials: MS
authors.lastname: Fernández-Nogueras
authors.affiliation: Department of Neurosurgery, HRU Carlos Haya, Avenida Carlos Haya s/n, 29010, Málaga, Spain. marraezs@commalaga.com.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Arráez-Sánchez
mesh_terms: D002552:Cerebral Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000209:etiology; D004453:Echoencephalography; D004677:Encephalocele / Q000175:diagnosis* / Q000209:etiology; D005004:Ethmoid Bone / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000209:etiology; D007223:Infant; D020300:Intracranial Hemorrhages / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008588:Meningocele / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed
keywords: CSF leak; Hydrocephalus; Meningoencephalocele; Posthaemorrhagic ventricular dilatation; Ventriculoperitoneal shunt