Nasal Encephalocoele: An Atypical Case

An encephalocoele is a congenital deformity in which the intracranial contents herniate through a defect in the skull. As the defect is more attributed to embryological development, it most commonly has a mean age of presentation ranging between 15.5 and 21 months.Nasal enchephalocoeles are herniation of cranial content through a bony defect in the anterior skull base into the nasal area. They are anterior encephalocoeles where meningeal herniation occurs through a midline defect in the floor of the anterior cranial fossa. The usual presentation of these cases is with a disfiguring swelling over the nose at the time of birth. When removal is indicated, there are multiple surgical approaches; including lateral rhinotomy, a transnasal approach and a coronal flap approach, involving a multi-disciplinary team of OtoRhinoLaryngology surgeons and Neuro surgeons. Here we report an atypical case of nasal encephalocoele, that presented later than usual age , with no external swelling or features of CSF leak and with a symptom of only unilateral nasal obstruction.The patient was treated successfully using a transnasal endoscopic approach which obviated the possible morbidity associated with other approaches.