Research Article Spontaneous Transethmoidal Meningoceles in Adults: Case Series with Emphasis on Surgical Management G. Ziade, A. L. Hamdan, M. T. Homsi, I. Kazan, and U. Hadi Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Phase I, 6th Floor, Room C-638, Bliss Street, P.O. Box 11-0236, Beirut, Lebanon Correspondence should be addressed to U. Hadi; uhadi@dm.net.lb Received 8 October 2015; Accepted 24 January 2016 Academic Editor: Andreas Prescher Copyright © 2016 G. Ziade et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Spontaneous onset transethmoidal meningocele is a rare entity among the adult population. Methods. A retrospective chart review was performed and cases of adults diagnosed with spontaneous transethmoidal meningoceles from November 2000 till February 2014 were reported. Data collected included demographics, clinical presentation, diagnostic modalities, and results. Intraoperative fndings, the type of surgical reconstruction performed, and the percentage of recurrence, if present, were also reported. Results. Ten cases of spontaneous transethmoidal meningoceles in adults were diagnosed. Eight were females and two males with a mean age of 47.5 years. All patients presented with CSF leakage with or without meningitis. Tey underwent a reconstruction of the base of skull defect using the temporalis fascia graf in addition to fbrin glue (Tissucol) and Surgicel (Ethicon). In two cases with a larger defect, a piece of septal bone and turbinate mucosa were applied achieving a watertight seal in all cases. Conclusion. Spontaneous transethmoidal meningocele in adults is a rare condition. It usually presents with clear rhinorrhea with or without meningitis and an endoscopic multilayer reconstruction is advocated for treatment of such conditions. 1. Introduction A cephalocele is a herniation of cranial content through a defect in the skull base. It can consist of meninges alone and would be referred to as meningocele or it can also include brain tissue and in that case it would be described as a menin- goencephalocele [1]. Tese herniations can occur at diferent locations at the level of the calvaria or the skull base, and many classifcations were proposed for the skull base cephalo- celes [2–6]. Sincipital cephaloceles are the anterior hernia- tions that always present with an external mass whereas basal cephaloceles, which include the transethmoidal subcategory, are located at the level of the anterior and middle skull base and do not present with an external mass [4, 6]. Many hypotheses have been postulated on the origin of the defect; it is believed that in childhood the most common etiology is a congenital defect, while in adulthood it is mainly due to traumatic or iatrogenic causes. Terefore, spontaneous herniations in adults rarely occur [1, 5]. Diferent presenta- tions have been described in the literature for spontaneous onset transethmoidal cephaloceles in the adult population such as CSF leaks, meningitis, seizures, and nasal mass [7–16]. Many endoscopic transnasal techniques for reconstruction of the skull base defect were described and all are presented as safe techniques [12, 17–28]. Spontaneous onset transethmoidal meningocele in adults is a rare condition. Kubo et al. published the largest case series on 19 cases where 17 of them had a transcranial repair of the defect [8]. Te aim of this study is to list a series of spontaneous transethmoidal meningoceles among the adult population, describe their presentation and assessment, and evaluate the transnasal endoscopic management. 2. Methods Tis study was approved by the Institutional Review Board of the American University of Beirut. Tis is a retrospective review of all adult patients at the American University of Beirut Medical Center and its afliated hospitals from November 2000 through February 2014 who were diagnosed with spontaneous transethmoidal meningoencephalocele or meningocele. Hindawi Publishing Corporation e Scientific World Journal Volume 2016, Article ID 3238297, 5 pages http://dx.doi.org/10.1155/2016/3238297