[Meningoencephalocele as rhinosurgical problem].

Cephalocele is a rare lesion mainly of congenital or traumatic origin. The lesion occurs as an extracranial hernia of dura mater that consists of cerebrospinal fluid only (meningocele) or cerebellar tissue (encephalocele). Some cephaloceles concern anterior cranial fossa and then are observed as hernias in nasal cavity or in paranasal sinuses. Three patients are presented. In 52 year woman, who was admitted due to idiopathic rhinorrhea (persisting 16 years) with periodical headache, the meningocele in right ethmoid sinus was diagnosed. The lesion was removed with the rhinosurgical approach and the defect in anterior cranial fossa was repaired with the free cartilaginous flap. 12 year boy was admitted due to the nasal tumor diagnosed by CT and MRI. The lesion was removed with the combined access: firstly the hernia sac was cut intracranially with the frontal craniotomy and then encephalocele was removed with lateral rhinotomy. Cranial fossa defect was repaired by the periosteum flap. In third case (8 year boy) encephalocele caused 5 incidences of purulent meningitis. CT and MRI showed the lesion in frontal sinus. Encephalocele was removed with rhinosurgical approach and the defect in posterior frontal wall was repaired with free cartilaginous and mucosal flaps. In all patients long term result of operations was good. Anatomic and pathologic conditions that influence on the choice of rhinosurgical or combined access to nasal and sinusal encephaloceles are presented and discussed.