{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T22:49:57Z","timestamp":1794005397688,"version":"4.8.0"},"reference-count":33,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,2,4]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>Spontaneous meningoencephaloceles (MECs) are sparsely documented in the literature. Those occurring in the frontal sinus are an exceedingly rare entity. MECs are commonly associated with cerebrospinal fluid (CSF) rhinorrhoea. CSF rhinorrhoea is frequently misdiagnosed, causing delays in diagnosis and management. The subsequently increased risk of bacterial meningitis can be life-threatening to patients. We report the case of a woman in her late 70s with a spontaneous frontal sinus MEC, presenting with a 6-month history of CSF rhinorrhoea. The patient was successfully treated using the novel Carolyn\u2019s window approach endoscopically; 9-month follow-up revealed no skull-base breach. Our case emphasises the importance of considering MEC as a differential diagnosis for clear rhinorrhoea and demonstrates successful repair through a novel surgical approach.<\/jats:p>","DOI":"10.1136\/bcr-2023-258886","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T12:35:28Z","timestamp":1707914128000},"page":"e258886","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Carolyn\u2019s window approach for spontaneous frontal sinus meningoencephalocele"],"prefix":"10.1136","volume":"17","author":[{"given":"Arshia","family":"Akhavan-Mofrad","sequence":"first","affiliation":[{"name":"College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8155-0001","authenticated-orcid":false,"given":"Keshav Kumar","family":"Gupta","sequence":"additional","affiliation":[{"name":"ENT and Skull Base Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karan","family":"Jolly","sequence":"additional","affiliation":[{"name":"ENT and Skull Base Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,14]]},"reference":[{"key":"2025082710295808000_17.2.e258886.1","doi-asserted-by":"crossref","first-page":"100353","DOI":"10.1016\/j.xocr.2021.100353","article-title":"Frontal sinus meningoencephalocele presenting with spontaneous cerebrospinal fluid leak","volume":"21","author":"Knappe","year":"2021","journal-title":"Otolaryngology Case Reports"},{"key":"2025082710295808000_17.2.e258886.2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3744"},{"key":"2025082710295808000_17.2.e258886.3","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2020-234703","article-title":"Spontaneous transethmoidal meningoencephalocele presenting in the form of recurrent unilateral nasal discharge: discussion of the diagnosis and endoscopic surgical management","volume":"13","author":"Hallak","year":"2020","journal-title":"BMJ Case Rep"},{"key":"2025082710295808000_17.2.e258886.4","doi-asserted-by":"crossref","first-page":"e574","DOI":"10.1016\/j.wneu.2023.01.083","article-title":"The need for emphasis on intracranial hypertension management in spontaneous skull base meningoencephaloceles","volume":"172","author":"Poczos","year":"2023","journal-title":"World Neurosurgery"},{"key":"2025082710295808000_17.2.e258886.5","doi-asserted-by":"crossref","first-page":"151594","DOI":"10.1016\/j.anndiagpath.2020.151594","article-title":"Nasal meningoencephalocele: a retrospective study of clinicopathological features and diagnosis of 16 patients","volume":"49","author":"Xue","year":"2020","journal-title":"Ann Diagn Pathol"},{"key":"2025082710295808000_17.2.e258886.6","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1007\/s00405-014-3049-8","article-title":"Lateral sphenoid sinus recess cerebrospinal fluid leak: a case series","volume":"271","author":"Almeida d\u2019\u00c1vila Melo","year":"2014","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2025082710295808000_17.2.e258886.7","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200206000-00008"},{"key":"2025082710295808000_17.2.e258886.8","doi-asserted-by":"crossref","unstructured":"Hernandez JG , Garcia CF , Pardo-sanz MS , et al . 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