Trigeminal Numbness After Intracranial Repair of a Spontaneous Meningoencephalocele of the Lateral Wall of the Sphenoid Sinus

Orlando De Jesus,Juan L Pérez-Berenguer,George Santiago Quiñones,Allyson Pagán-Rodríguez

doi:10.7759/cureus.16026

Abstract

A 58-year-old female with an eight-year history of rhinorrhea and a two-day history of subjective fever, chills, and vomiting presented to the emergency department for neurosurgical evaluation. Brain MRI demonstrated herniation of the meninges and portions of the inferomedial right temporal lobe through a defect of the lateral wall of the right sphenoid sinus, extending to the sphenoethmoidal recess and posterior right ethmoid air cells. A right pterional craniotomy was performed where the herniated part of the right temporal lobe, and its associated meninges, were excised. After surgery, she had hypoesthesia at the right maxillary division of the trigeminal nerve. This finding was caused by the proximity of the trigeminal nerve to the dural dissection that we performed at the bone defect. This rare complication has never been described after intracranial surgery. Only eight literature reports have described hypoesthesia or paresthesia of the trigeminal nerve after endoscopic resection of a sphenoid sinus meningoencephalocele. The patient has not had any recurrence of rhinorrhea after a six-month follow-up period.

Highlights

Meningoencephaloceles are herniation of the meninges and parts of the brain through defects in the cranial vault
Postoperative complications directly associated with the resection of the meningoencephalocele are rare; rare cases of trigeminal numbness or paresthesias have been described after endoscopic repair
She has hypoesthesia at the right maxillary divisions of the trigeminal nerve. This finding was caused by the proximity of the trigeminal nerve to the dural dissection that we performed at the bone defect, which was just lateral to the lateral wall of the cavernous sinus wall and foramen rotundum

Summary

Introduction

Meningoencephaloceles are herniation of the meninges and parts of the brain through defects in the cranial vault. A 58-year-old female with no known drug allergies presented to the emergency department with an eightyear history of waxing and waning headaches and rhinorrhea and a two-day history of subjective fever, chills, and vomiting Her past medical history was significant for morbid obesity (body mass index 45.5 kg/m2) and hypertension. She has hypoesthesia at the right maxillary divisions of the trigeminal nerve This finding was caused by the proximity of the trigeminal nerve to the dural dissection that we performed at the bone defect, which was just lateral to the lateral wall of the cavernous sinus wall and foramen rotundum. She did not complain of a dry eye, proving the integrity of the vidian nerve inside the sphenoid sinus

Discussion

Conclusions

Findings

Disclosures

17. Tami TA