{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T16:10:42Z","timestamp":1681575042824},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2011,7]]},"abstract":"<jats:p>Tuberous sclerosis complex (TSC) is a genetic neurocutaneous disorder that commonly affects the CNS. The most commonly associated brain tumors include cortical tubers, subependymal nodules, and subependymal giant cell astrocytomas (SEGAs). The authors report an unusual case of recurrent meningitis due to a tuber-containing encephalocele via the posterior wall of the frontal sinus.<\/jats:p>\n<jats:p>An 11-year-old girl presented with a history of TSC and previous SEGA resection via interhemispheric approach. She presented twice within 4 months with classic bacterial meningitis. Cerebrospinal fluid cultures revealed <jats:italic>Streptococcus pneumoniae<\/jats:italic>. Computed tomography and MR imaging of the brain showed a right frontal sinus encephalocele via a posterior frontal sinus wall defect. Both episodes of meningitis were treated successfully with standard regimens of intravenous antibiotics. The neurosurgical service was consulted to discuss surgical options.<\/jats:p>\n<jats:p>Via a bicoronal incision, a right basal frontal craniotomy was performed. A large frontal encephalocele was encountered in the frontal sinus. The encephalocele was herniating through a bony defect of the posterior sinus wall. The encephalocele was ligated and resected followed by removing frontal sinus mucosa and complete cranialization of frontal sinus. Repair of the sinus floor was conducted with fat and pericranial grafts followed by CSF diversion via lumbar drain. Histopathology of the resected encephalocele showed a TSC tuber covered with respiratory (frontal sinus) mucosa. Tuber cells were diffusely positive for GFAP. The patient underwent follow-up for 2 years without evidence of recurrent meningitis or CSF rhinorrhea.<\/jats:p>\n<jats:p>This report demonstrates that frontal tubers of TSC can protrude into the frontal sinus as acquired encephaloceles and present with recurrent meningitis. To the authors' knowledge, recurrent meningitis is not known to coincide with TSC. Careful clinical and radiographic follow-up for frontal tubers in patients with TSC is recommended.<\/jats:p>","DOI":"10.3171\/2011.4.peds10308","type":"journal-article","created":{"date-parts":[[2011,7,1]],"date-time":"2011-07-01T14:03:40Z","timestamp":1309529020000},"page":"103-106","source":"Crossref","is-referenced-by-count":2,"title":["Recurrent meningitis associated with frontal sinus tuber encephalocele in a patient with tuberous sclerosis"],"prefix":"10.3171","volume":"8","author":[{"given":"Samer K.","family":"Elbabaa","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela D.","family":"Riggs","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali G.","family":"Saad","sequence":"additional","affiliation":[{"name":"Pathology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1-0080103","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E13","DOI":"10.3171\/FOC\/2008\/25\/9\/E13","article-title":"Epilepsy surgery and tuberous sclerosis complex: special considerations","volume":"25","author":"Bollo","year":"2008"},{"key":"b2-0080103","series-title":"Surg Neurol","first-page":"49","article-title":"Intranasal meningoencephalocele with recurrent meningitis","volume":"12","author":"Copty","year":"1979"},{"key":"b3-0080103","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1056\/NEJMra055323","article-title":"The tuberous sclerosis complex","volume":"355","author":"Crino","year":"2006"},{"key":"b4-0080103","series-title":"Am J Med Genet","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1002\/ajmg.1320370402","article-title":"Incidence of tuberous sclerosis in patients with cardiac rhabdomyoma","volume":"37","author":"Harding","year":"1990"},{"key":"b5-0080103","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1227\/00006123-198503000-00006","article-title":"Spontaneous cerebrospinal fluid rhinorrhea: evolving concepts in diagnosis and surgical management based on the Mayo Clinic experience from 1970 through 1981","volume":"16","author":"Hubbard","year":"1985"},{"key":"b6-0080103","series-title":"Am J Hum Genet","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1086\/302381","article-title":"Comprehensive mutation analysis of TSC1 and TSC2-and phenotypic correlations in 150 families with tuberous sclerosis","volume":"64","author":"Jones","year":"1999"},{"key":"b7-0080103","series-title":"Pediatr Infect Dis J","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1097\/00006454-198909000-00013","article-title":"Review of recurrent bacterial meningitis","volume":"8","author":"Kline","year":"1989"},{"key":"b8-0080103","series-title":"J Neurol","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1007\/s00415-006-0354-1","article-title":"Nasal meningoencephalocele, an unusual cause for recurrent meningitis. 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