Management of the Fallopian Canal Meningocele: A Case Series and Literature Review
Introduction: The herniation of intracranial contents through the temporal bone is rare in the absence of associated trauma or a destructive process such as infection or neoplasm. In previous reports of meningoencephaloceles of the temporal bone, spontaneous fallopian canal meningoceles were found to be particularly rare and were frequently associated with CSF leaks and meningitis. We present a case series of fallopian canal meningoceles and review the relevant literature to discuss trends in diagnosis and management.
Methods: A retrospective analysis was performed using patient data from the experience of a single academic institution between January 1998 and December 2012 and all relevant cases from the English-language literature. Demographic information, presenting symptoms and treatment outcomes from these two series of patients were compared with each other and analyzed in aggregate.
Results: Seven patients were identified from our experience and six patients from previous case reports with an average of 45.2 months of follow-up after diagnosis. Seventeen meningoceles were identified in total. Significant differences existed between the two groups with regards to the age at presentation (p < 0.01), the incidence of obesity (p = 0.04), the presence of other meningoceles or encephaloceles (p < 0.01), the incidence of an associated cerebrospinal fluid leak (p < 0.01), and the rate of surgical intervention (p < 0.01). Additionally, patients experiencing an associated CSF leak, meningitis, or facial nerve dysfunction were significantly younger (p = 0.01), were likely to be obese (p < 0.01) and were less likely to have another, separate meningocele (p < 0.01).
Conclusion: This report describes a series of acquired FCMs likely developing in association with elevated intracranial pressure, which appears to be a distinct population when compared with previously reported cases. Our patients are older and typically obese. They may also have other meningoceles and few clinical symptoms. Our experience with acquired FCMs argues for clinical observation with management of elevated ICP for asymptomatic lesions.