Radiologic and endoscopic assessment of the skull base in children with recurrent meningitis

ABSTRACT

Meningitis is a potentially fatal disease. Recurrence of the attacks should alert the physician to the possibility of an underlying cause. Six children who had between 2 to 6 episodes of meningitis were investigated by computed tomography, magnetic resonance imaging, fluorescein endoscopy and cisternography in order to find the cause of recurrence. Cerebrospinal fluid rhinorrhea was confirmed in three patients. Cerebrospinal fluid otorrhea was confirmed in one patient. Streptococcus pneumonia was isolated from the CSF of four patients. The following findings were found [1] bone defect and CSF fistula in the region of the cribriform plate; [2] CSF fistula in the region of the sphenoid sinus; [3] bone defect and encephalocele in the region of the cribriform plate/glabella; [4] bone defect in the roof of the ethmoid sinus; [5] bone defect and CSF fistula in the region of the tegmen antri; [6] one patient did not have any congenital defects in the skull base, but had complement defects and immunoglobulin subclass defects. Duraplasty was done for the patients by using endonasal, transfacial, trans- frontal and transmastoid approaches. In patients with recurrent meningitis, modern diagnosis methods should be used to search for congenital defects of the skull base. The necessary surgical repair should be performed to prevent the further occurrence of potentially fatal attacks of meningitis