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A 3-mm (A, B) coronal and (C) axial reformats in both (A) brain and (B) bone windows on (D) CT and coronal MRI showing herniated brain parenchyma. CT, computed tomography; MRI, magnetic resonance imaging.
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He was initially seen in the ED where a magnetic resonance imaging (MRI) showed IE of the right parasagittal parietal bone containing portions of the right precentral gyrus and surrounding brain parenchyma (Fig. 1D). Noncontrasted computed Tomography (CT) demonstrated a well-circumscribed, 4.3 x 3.7 cm area of osteolysis in the right parasagittal parietal bone, with internal soft tissue attenuation (Fig. 1A-C), complete erosion of the inner table, and noncontiguous lytic changes of the outer table (Fig. 1B, C). MRI with and without gadolinium contrast administration demonstrated a right parasagittal dural defect with intradiploic herniation of the right precentral gyrus (Fig. 1D).
(A) Axial 5 mm SE) T2 images, (B) axial 5 mm blood suppressed SE T1 images, (C) axial 5 mm FLAIR images, and (D) axial 5 mm postcontrast SE T1 images (12 mm Gadavist). CT, computed tomography; MRI, magnetic resonance imaging; SE, spin echo
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There was no restricted diffusion to suggest acute infarction (Fig. 2A-D).
(A) Intraoperative picture showing large craniotomy incorporating the bone defect. The pial-arachnoid plane surrounding that area was very sclerotic and firmly adherent to the encephalocele pedicle. The defect was shown in (B) and (C) for dorsal and ventral side, respectively.
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Once the margins of the encephalocele were completely identified and dissected, a large craniotomy incorporating the bone defect was completed using high-speed craniotome (Fig. 3).
(C) A 3-mm axial bone window and coronal reformats in both (B) brain and (A) bone windows on postoperative CT. CT, computed tomography
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Postoperative noncontrasted CT head revealed no ischemic changes on the surrounding parenchyma and adequate reduction of the encephalocele (Fig. 4A-C).