CT scan of 11/12/15 recommended MRI of skull base/ sinus: Confirmed CSF rhinorrhea with question of cephalocele in right sphenoid and posterior ethmoid sinus. There is herniation of dysplastic brain parenchyma, adhesions, and cerebrospinal fluid into the right sphenoid sinus, posterior ethmoid sinus, and nasal cavity via a 7 mm wide defect in the right planum sphenoidale, which is compatible with an encephalocele. The encephalocele measures up to 3 cm in length. There is associated distortion and encephalomalacia of the right gyrus rectus. Fluid surrounding the encephalocele may represent leakage of cerebrospinal fluid. There are prominent arachnoid granulations in the floor of the middle cranial fossae bilaterally. There is also an enlarged partially-empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is a nonspecific focus of susceptibility effect in the left posterior fossa. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a retention cyst formation within the left maxillary sinus.
1. Encephalocele within the right sphenoid sinus and extending into the posterior ethmoid sinus and nasal cavity via a skull base defect with associated right gyrus rectus encephalomalacia. Fluid in the right sphenoid sinus may represent associated cerebrospinal fluid leakage.2. Prominent arachnoid granulations in the floor of the middle cranial fossae bilaterally and an enlarged partially-empty sella suggest underlying pseudotumor cerebri, which can also predispose to encephalocele formation and cerebrospinal fluid leakage.