Surgical management and reconstruction of sincipital encephalocele presenting in adulthood

Sincipital encephaloceles presenting in adulthood are misdiagnosed until they present with persistent cerebrospinal fluid (CSF) rhinorrhea or, in extreme cases, meningeal infection. The basic approach to their repair is a frontal craniotomy and bandeau-type removal of the orbital framework, and reconstruction using dural patch for watertight dural closure, split calvarial bone graft fixation for rigid repair of the bony framework, and a vascularized pericranial flap to provide the soft tissue interposition. We emphasize the pitfall of biopsy when encephalocele is included in the differential diagnosis of a nasal mass and include a step-by-step operative technique that ensures safe and effective reconstruction of the skull base defect.