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External Auditory Atresia
Joseph Junewick, MD FACR
over 8 years ago
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Petrous Apex Cephalocele

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: 7 months ago
Updated: 7 months ago
Tags: PEDS
Modality/Study Types: MR CT FL
Activities:
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History

3 year old female with hearing loss


Case Images


Diagnosis

Petrous Apex Cephalocele

Clinical Notes

Historiy of Dandy-Walker spectrum and compensated hydrocephalus.

Findings

MR – Symmetric fluid collections in Meckel’s caves surrounding trigeminal nerve fibers; no restricted diffusion or abnormal enhancement. Note partial empty sella and stigmata of Dandy-Walker spectrum (vermian hypoplasia, enlarged retrocerebellar fluid collection and ventriculomegaly).

Discussion

Sometimes referred to as a meningocele or an arachnoid cyst, petrous apex cephaloceles are rare lesions that originate in Meckel’s cave and erode into the petrous apex of the temporal bone. Petrous apex cephaloceles can be easily differentiated from other apex lesions in that they originate from the ipsilateral Meckel’s cave. There are instances of both congenital and acquired petrous apex cephaloceles; congenital are idiopathic and acquired are probably related to increased intracranial pressure transmitted or herniation of arachnoid mater through a patent porus trigeminus; occasionally associated with Usher syndrome. Additionally, these lesions can be asymptomatic or symptomatic. Patients may experience headache, neuralgia, palsy of the cranial nerves, or cerebrospinal fluid otorrhea. In instances of symptomatic petrous apex cephaloceles, surgical intervention (filling the cavity with fat or muscle) may be considered. Differential diagnoses include cholesterol granuloma, mucocele, inflammatory cysts, cholesteatoma, and petrous apex effusion.

Reference

Moore KR, Fischbein, NJ, Harnsberger HR, Shelton C, Glastonbury CM, White DK, & Dillon WP. 2001. American Journal of Neuroradiology. 22(10): 1867-1871.

Contributor

Abigail Rossman



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