Neck swelling due to skull base (pseudo)meningocele protruding through a congenital skull base bone defect: a case report.
BACKGROUND
Meningocele is defined as a protrusion of the meninges through an opening in the skull or spinal column, forming a bulge or sac filled with cerebrospinal fluid. A pseudomeningocele is defined as a cerebrospinal fluid (CSF) collection formed due to escape of CSF through a dural defect with trapping of CSF into the surrounding soft tissues. We herby report rare occurrence of a large (pseudo)meningocele in a young patient with congenital skull base defect presenting as upper lateral neck swelling.


METHODS
We present the case of a 17-year-old boy who had painless progressive swelling right side of the upper neck without any history of meningitis or CSF leak. He had a history of undergoing cranioplasty using steel plates for nontraumatic boggy swelling right parieto-occipital region at the age of 5 years at another hospital. Clinical examination showed painless swelling right side of the upper neck, with positive cough impulse and transillumination. CT head with cisternography showed a large right skull base defect through which a large pseudomeningocele was herniating, thus producing upper neck swelling and compressing oral cavity. The neck swelling and intraoral bulge reduced in size after the coperitoneal shunt.


CONCLUSIONS
Differential diagnosis of (pseudo)meningocele should be considered while evaluating a painless progressive upper neck swelling having cough impulse and transillumination in a young patient.
Department of Neurosurgery, AIIMS, New Delhi, 110029, India. rajufbd79@rediffmail.com.
Rajeev
R
Sharma
Department of Neurosurgery, AIIMS, New Delhi, 110029, India.
Bhoopendra
B
Singh
Department of Neurosurgery, AIIMS, New Delhi, 110029, India.
Shweta
S
Kedia
Department of Neurosurgery, AIIMS, New Delhi, 110029, India.
Rajinder Kumar
RK
Laythalling
D000293:Adolescent; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology*; D004487:Edema / Q000209:etiology*; D006801:Humans; D008297:Male; D008588:Meningocele / Q000150:complications* / Q000601:surgery; D009192:Myelography; D009333:Neck / Q000473:pathology*; D019291:Skull Base / Q000000981:diagnostic imaging / Q000473:pathology*; D015898:Tomography Scanners, X-Ray Computed; D014057:Tomography, X-Ray Computed
Congenital; Meningocele; Neck swelling; Pseudomeningocele; Skull base defect