Abstract

TRANSPHENOIDAL ENCEPHALOCELE IN AN ADULT: ABOUT A CLINICAL CASE

Willy Francis Rakotondraibe*, Joseph Synese Bemora, Joe Andry Rakotoarivelo, Mijoro Ramarokoto, Ketsia Tsiky Rarimbato Rakotovao, Willy Ratovondrainy, Mamiarisoa Rabarijaona and Clement Andriamamonjy

Abstract

The authors report a rare case of trans-ethmoidal encephalocele in a 24-year-old male with no known history of head injury. Symptoms had been evolving for three years and consisted of frank LCS rhinorrhea, complete anosmia, and urinary incontinence. On examination, there was paraparesis with muscle strength at 2/5 on both sides. The cerebral CT scan found anterior cerebral parenchyma, communicated by bone dehiscence, of the sifted blade of the ethmoid, which extends down into the nasal cavity, along the septum. The surgery confirmed the diagnosis of encephalocele and consisted of resection of the cerebral hernia after a bifrontal approach, with closure by a meningeal and bone-type bone graft plastic surgery at the frontal-parietal part of the skull, allowing reconstruction and filling of the orifice at the base of the skull. In post-operative at 1 month, the patient manages to walk but always with help; at 6 months walks without help; but anosmia and urinary incontinence persist. Nasopharyngeal encephaloceles are rare in adults and pose the problem of their congenital or acquired origin when no trauma is reported or when it has been forgotten.

Keywords: Adult, brain scan, encephalocele, ethmoid sieve blade, surgery.