Purpose or Case Report: Meningoceles in the cranium occur when an osseous defect in the skull base allows for the protrusion or herniation of the meninges into the extracranial compartment. Meningoceles vary in severity and may be asymptomatic or complicated by meningitis, brain abscess, pneumocephalus, or cerebrospinal fluid leak. Meningoceles can be congenital, traumatic, iatrogenic (such as in sinus or craniofacial surgery), spontaneous (due to increased intracranial pressure) or idiopathic. The most common sites of meningoceles in the skull base are the cribriform plate, sphenoid sinus, perisellar region, and tegmen tympani or mastoideum. Accurate and timely detection is essential for avoiding complications of meningoceles. Localization of the site of the meningoceles and assessment of their size and composition is accomplished through a variety of imaging techniques, such as with CT or MR myelography. Surgical repair of meningoceles may be accomplished through both open and endoscopic approaches.
A 2-year-old male patient with a past medical history of febrile seizures and postinfectious hydrocephalus requiring ventriculoperitoneal shunt placement and multiple shunt revisions initially presented with emesis and lethargy concerning for shunt malfunction. MRI showed a fluid-signal intensity located adjacent to the petrous portion of the right temporal bone, extending caudally to the right upper neck, which raised concern for cerebrospinal fluid (CSF) leak. Lumbar puncture was notable for an elevated CSF opening pressure of 40 cm H2O. CT myelogram confirmed a small (7mm) meningocele protruding through an osseous defect in the right jugular foramen, which completely opacified with intrathecally-injected contrast. Delayed images obtained following two hours further demonstrated subtle contrast enhancement surrounding the right jugular vein in the upper neck, raising concern for a slow CSF leak from the meningocele. Due to elevated CSF opening pressure, shunt malfunction was theorized to be the cause of the patient’s emesis and lethargy. Shunt was revised and patient was subsequently able to be discharged. Repeat follow up imaging demonstrated stabile size of patient’s meningocele. Due to small size, and resolution of patient’s symptoms following shunt revision, patient’s meningocele will be followed with recurrent MR imaging.
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