Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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January 30, 2014
Petrous Apex Cephalocele
- Petrous apex cephaloceles or Meckel cave meningoceles develop secondary to congenital/acquired herniation of posterolateral wall of Meckel's cave into petrous apex.
- Clinical Presentation: Most commonly seen as asymptomatic incidental finding
- Key Diagnostic Features: CSF intensity/density lesion of petrous apex that shows direct communication with Meckel’s cave. Smooth, nonaggressive expansion of the petrous apex. Expansile cystic lesion with benign margins on CT. Nonenhancing on CECT. Usually nonenhancing on MRI, but may show mild rim enhancement.
- DDx: Mucocele in petrous apex; petrous apex cholestrol granulomas; Meckel cave trigeminal schwannoma; epidermoid (congenital cholesteatoma); apical petrositis; trapped fluid in petrous apex
- Rx: No treatment is required in average case. These lesions should be considered as “leave-me-alone” lesion. Treatment should be performed only in complicated cases with recurrent meningitis, persistent CSF leak, or cranial neuropathy.
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