Obesity-related Middle Cranial Fossa Encephalocele treated via Middle Cranial Fossa Approach : A Case Report

Abstract

  We report the case of a middle-aged woman with obesity who presented with otitis media with effusion and rhinorrhea. The diagnosis was a spontaneous middle cranial fossa encephalocele. Cerebrospinal fluid leak repair was planned to prevent meningoencephalitis. We resected the encephalocele and repaired the defect of the right pyramidal bone using the fascia temporalis via a trans-middle cranial fossa approach. The symptoms disappeared postoperatively, although otitis media with effusion recurred after several months. Follow-up magnetic resonance imaging showed a pseudomeningocele at the bone defect. The pathophysiology of the patient speculated that the cerebrospinal fluid leak was caused by an occult encephalocele, which exacerbated under intracranial hypertension due to obesity. Surgical procedures should be planned, including rigid reconstruction against intracranial hypertension.