What is Your Diagnosis

Nasofrontal encephalocele: An encephalocele is a protuberance of the dural sac that contains CSF and brain tissue. It can be located anywhere along the neuroaxis posteriorly (Fig. 13.2) as well as anteriorly. If it contains no brain tissue, it is also called a meningocele.

Dermoid: A dermoid consists of ectodermal tissue (epidermal and dermal elements) left behind during an embryological migration process. Its facial variety is found at the base of the nasal ridge and expands the bone there (Fig. 13.3). It can also be a component of a nasal CSF fistula.

Nasal glioma: The nasal glioma consists of sequestered brain tissue at the base of the nose (Fig. 13.4). It may have a fibrous connection to the subarachnoid space but lacks a communication to the CSF space.

• Diagnosis: Giufeng has looked for the relevant finding. There is no apparent communication between the tumor and the CSF space. A defect in the bone is not seen.

I Meningocele

Osseous Defects
Fig. 13.2 The axial CT section through the skull base demonstrates a posterior osseous defect through which a dural pouch extends into the subcutaneous tissue. This does not contain any brain tissue.

Agostino's small bulge can be resected in a cosmetically optimal fashion. It is most likely a benign nasal glioma that has no malignant potential and does not tend to recur. Greg, who had been held back by a conversation with the chairman, reviews the case himself and agrees with her conclusions. The Martinez family can calm down again. Pathological examination after resection confirmed the presence of brain tissue in this lesion.

I Dermoid a a

Nasal Dermoid

Fig.13.3a The axial T1-weighted MR image through the nasal base depicts a small tumor (arrow) in the nasal ridge surrounded by signal-free bone. b On the sagittal image obtained after contrast administration, there is a suggestion of a cutaneous fistulous tract (arrow) but no evidence for communication with the CSF space. c The T2-weighted axial image shows a small dorsal dimple of the tumor (arrow), indicating a possible communication with the intracranial space. Histological examination was compatible with a dermoid.

Fig.13.3a The axial T1-weighted MR image through the nasal base depicts a small tumor (arrow) in the nasal ridge surrounded by signal-free bone. b On the sagittal image obtained after contrast administration, there is a suggestion of a cutaneous fistulous tract (arrow) but no evidence for communication with the CSF space. c The T2-weighted axial image shows a small dorsal dimple of the tumor (arrow), indicating a possible communication with the intracranial space. Histological examination was compatible with a dermoid.

I Meningocele

Nasal Meningocele
Fig. 13.4 The Tl-weighted sagittal section after contrast administration demonstrates a tumor at the nasal base. A tract to the CSF space is not present. This is a nasal glioma.
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