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Vol. 34. Issue 2.
Pages 93-96 (March - April 2023)
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Vol. 34. Issue 2.
Pages 93-96 (March - April 2023)
Case report
Sphenoidal meningoencephalocele associated with CSF fistula and arteriovenous malformation Spetzler-Martin V: A case report
Meningoencefalocele esfenoidal asociado a fístula de líquido cefalorraquídeo y malformación arteriovenosa Spetzler-Martin V: reporte de caso
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Esteban Ramírez-Ferrer, Rafael Aponte-Caballero
Corresponding author
rafael.aponte@urosario.edu.co

Corresponding author.
, Maria Paula Aguilera-Pena, Santiago David Mendoza-Ayús, Luis Alejandro Osorio-Bohorquez, William Mauricio Riveros-Castillo
Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritan University Hospital, Rosario University School of Medicine, Bogotá, Colombia
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Abstract

Cerebral Arteriovenous malformations (AVMs) are presumed congenital anomalies of the blood vessels, which can increase intracranial pressure by uncertain mechanisms.

We report the rare case of a 55-year-old male patient who complained about CSF rhinorrhea. Persisting CSF leakage prompted CT, which evidenced a bone defect in the right middle cranial fossa with protruding brain tissue. The diagnosis of a sphenoidal meningoencephalocele was made. Neuroimaging evidenced an AVM Spetzler Martin V. The lesion was targeted via an endonasal approach with resection of the herniated brain tissue and closure of the bony and dural defects. The postoperative course was uneventful without recurrence of the CSF fistula.

Documentation of these cases is essential to come up with standardized therapeutical protocols and follow-up. Nevertheless, conservative management of the AVM and surgical repair of the bone defects is an appropriate approach in the first instance, depending on the morphology and characterization of the AVM.

Keywords:
Cerebrospinal fluid leak
Encephalocele
Intracranial arteriovenous malformations
Intracranial hypertension
Resumen

Las malformaciones arteriovenosas (MAV) son consideradas anomalías congénitas de los vasos sanguíneos; estas pueden aumentar la presión intracraneal a través de mecanismos inciertos.

Reportamos el caso de un hombre de 55 años con presencia de rinolicuorrea de larga data. Se realizó la toma de una TC de cráneo, evidenciando un defecto óseo en la fosa craneal media derecha con protrusión de tejido cerebral, diagnosticando un meningoencefalocele esfenoidal. Las imágenes complementarias evidenciaron una MAV Spetzler-Martin V. La lesión fue tratada con un abordaje endonasal resecando el tejido cerebral herniado con cierre de los defectos dural y óseo. En el postoperatorio no hubo recurrencia de rinolicuorrea.

La documentación de estos casos es esencial para generar protocolos estandarizados de tratamiento y seguimiento. En nuestra experiencia el manejo conservador de la MAV y el reparo quirúrgico de los defectos es un abordaje adecuado, teniendo en cuenta la morfología y caracterización de la MAV.

Palabras clave:
Líquido cefalorraquídeo
Encefalocele
Malformación arteriovenosa intracraneal
Hipertensión intracraneal

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