Brain Tumor Res Treat.  2022 Jan;10(1):38-42. 10.14791/btrt.2022.10.e20.

Intradiploic Encephalocele at the Parietal Bone: A Case Report and Literature Review

• Jeong DJ
• Lee B
• Yang K

• KMID: 2525301
• DOI: http://doi.org/10.14791/btrt.2022.10.e20

Abstract

Intradiploic encephalocele is a rare condition of herniation of the brain parenchyma through the diploic space. A 52-year-old man presented with a parietal intradiploic encephalocele manifesting as an intermittent headache for 7 months. CT revealed an osteolytic lesion involving the right parietal bone. MRI demonstrated brain herniation within the diploic space. Surgery may be unnecessary in the absence of concurrent symptoms or neurological deficits. After 2 years of follow-up, symptoms were improved without neurological deficits and CT findings. We report the X-ray, CT, and MRI findings of an extremely rare case of parietal intradiploic encephalocele in adulthood.

Keyword

Encephalocele; Skull; Osteolysis; Adult

Figure

• 

  Fig. 1 Initial MR image. A: T2-weighted axial MR image showing a parietal osteolytic lesion, confirming the presence of a herniated brain cortex within the diploe. B: Magnified the white square of T2-weighted axial image. C: T2-weighted coronal MR image. D: Magnified the white square of T2-weighted coronal image. E: Gadolinium (Gd)-enhanced T1-weighted axial MR image. F: Magnified the white square of Gd-enhanced T1-weighted axial image reveal no enhancement of lesion.

• 

  Fig. 2 Skull X-ray and CT findings. A: Initial skull X-ray showing an osteolytic lesion (white arrow heads) in the right parietal bone. B: Initial CT scan showing intradiploic herniation of brain parenchyma. C: Initial CT scan (bone window) reveal skull osteolytic lesion confined to inner table. D: Two-year follow up CT scan shows no change of the lesion.

Reference

1. Valci L, Dalolio M, Kuhlen D, Pravatà E, Gobbi C, Reinert M. Intradiploic encephalocele of the primary motor cortex in an adult patient: electrophysiological implications during surgery. J Neurosurg. 2018; 128:871–874. PMID: 28452617.

2. Arevalo-Perez J, Millán-Juncos JM. Parietal intradiploic encephalocele: report of a case and review of the literature. Neuroradiol J. 2015; 28:264–267. PMID: 26246093.

3. Mealey J Jr, Dzenitis AJ, Hockey AA. The prognosis of encephaloceles. J Neurosurg. 1970; 32:209–218. PMID: 5411997.

4. Martínez-Lage JF, Poza M, Sola J, Soler CL, Montalvo CG, Domingo R, et al. The child with a cephalocele: etiology, neuroimaging, and outcome. Childs Nerv Syst. 1996; 12:540–550. PMID: 8906370.

5. Matson DD. Neurosurgery of infancy and childhood. 2nd ed. Springfield: Charles C Thomas;1969.

6. Tsuboi Y, Hayashi N, Noguchi K, Kurimoto M, Nagai S, Endo S. Parietal intradiploic encephalocele--case report. Neurol Med Chir (Tokyo). 2007; 47:240–241. PMID: 17527054.

7. Kosnik EJ, Meagher JN, Quenemoen LR. Parietal intradiploic encephalocele. Case report. J Neurosurg. 1976; 44:617–619. PMID: 1262923.

8. Naidich TP, Altman NR, Braffman BH, McLone DG, Zimmerman RA. Cephaloceles and related malformations. AJNR Am J Neuroradiol. 1992; 13:655–690. PMID: 1566723.

9. Battal B. Letter to the editor. Brain herniation with surrounding CSF into the skull. J Neurosurg. 2018; 128:949–951. PMID: 29271708.

10. Roy S, Sarkar C, Tandon PN, Banerji AK. Cranio-cerebral erosion (growing fracture of the skull in children). Part I. Pathology. Acta Neurochir (Wien). 1987; 87:112–118. PMID: 3673689.

11. Chakkalakkoombil SV, Venkatesh M, Nair PP, Sowkar UB. Intradiploic cephalocele: a rare entity at a rare site. BMJ Case Rep. 2018; 2018:bcr2017223262.

12. Winston K, Beatty RM, Fischer EG. Consequences of dural defects acquired in infancy. J Neurosurg. 1983; 59:839–846. PMID: 6619936.

13. Martínez-Lage JF, López F, Piqueras C, Poza M. Iatrogenic intradiploic meningoencephalocele. Case report. J Neurosurg. 1997; 87:468–471. PMID: 9285618.

14. Patil AA, Etemadrezaie H. Posttraumatic intradiploic meningoencephalocele. Case report. J Neurosurg. 1996; 84:284–287. PMID: 8592236.

15. Menkü A, Koç RK, Tucer B, Akdemir H. Is skull fracture necessary for developing an intradiploic pseudomeningocele as a complication of head injury in adulthood? Acta Neurochir (Wien). 2004; 146:623–627. discussion 627. PMID: 15168231.

16. Kandemirli SG, Candan S, Bilgin C. Post-traumatic occipital intradiploic encephalocele. World Neurosurg. 2019; 129:9–12. PMID: 31150845.

17. Shi C, Flores B, Fisher S, Barnett SL. Symptomatic parietal intradiploic encephalocele—a case report and literature review. J Neurol Surg Rep. 2017; 78:e40–e45. PMID: 28299248.

18. McPheeters MJ, Kainth DS, Lam CH. Spontaneous frontal intradiploic meningoencephalocele. Surg Neurol Int. 2015; 6:S651–S654. PMID: 26713172.

19. Loumiotis I, Jones L, Diehn F, Lanzino G. Symptomatic left intradiploic encephalocele. Neurology. 2010; 75:1027. PMID: 20837973.

20. Mazzucchi E, Bianchi F, Vigo V, Anile C, Frassanito P. Parietal intradiploic encephalocele in an adult: a delayed complication of pediatric head injury? Childs Nerv Syst. 2017; 33:217–219. PMID: 28005171.

21. Peters J, Raab P, Marquardt G, Zanella FE. Intradiploic meningoencephalocele. Eur Radiol. 2002; 12 Suppl 3:S25–S27.

22. Chen X, Dai H. Intradiploic encephalocele following linear skull fracture: a rare evolution of growing skull fracture. Childs Nerv Syst. 2021; 37:3967–3971. PMID: 33715079.

23. Byrne JV, Britten JA, Kaar G. Chronic post-traumatic erosion of the skull base. Neuroradiology. 1992; 34:528–531. PMID: 1436467.