2026 Poster Presentations
P250: TRAUMATIC SKULL BASE ENCEPHALOCELES: OUTCOMES AND MANAGEMENT OF A RARE PHENOMENON
Manasi Prashant, BS; Christopher Z Wen, MD; Pharibe Pope, MD; Benjamin Shuster, MS; Faye Zhang, MD; Natalie S Justicz, MD; Andrea M Hebert, MD; Adam C Kaufman, MD; University of Maryland School of Medicine
Background: Traumatic skull base fractures occur in approximately one in five head injuries, and traumatic encephaloceles are a rare yet significant complication of these fractures. Despite this, the natural history, management, and long-term outcomes of traumatic encephaloceles remain poorly understood, limited primarily by a lack of data to guide clinical decision making. Thus far, literature on this topic has been limited to one systematic review of case reports and small case series. Our single-center cohort represents the largest described and highlights the heterogeneity in presentation of both anterior and lateral traumatic encephaloceles.
Methods: A single-center retrospective review of traumatic skull base encephaloceles at high-volume trauma center between 2015 and 2025 was performed. Electronic medical record data collected included demographics, injury etiology and characteristics, associated otolaryngologic and neurologic symptoms, and operative details if applicable. Patients with past congenital encephaloceles, other brain malformations, post-surgical encephaloceles, and those who died in the acute setting were excluded.
Results: A total of 22 patients with 23 radiographically confirmed encephaloceles were included. The mean patient age was 33.27 years (SD 11.1), and 86% of patients were male. 65% (15/23) of traumatic encephaloceles were diagnosed within one week of initial injury, with 9 cases diagnosed on the day of admission. For patients diagnosed in a delayed manner, the mean time to presentation was 160.5 days (SD 280). The most common mechanisms of injury were gunshot wound (8/22), motor vehicle accident (6/22), and fall (5/22). Anterior skull base encephaloceles comprised 83% (19/23) of cases while 17% (4/23) were lateral. Within the anterior group, the most common encephalocele location was the ethmoid bone (7/19), followed by the orbital roof (n=6), sphenoid bone (4) and frontal sinus (2). All lateral encephalocele cases (4/23) were associated with a temporal bone fracture (2 tegmen mastoideum, 1 tegmen tympani, and 1 combined). Pneumocephalus occurred significantly more often in patients with anterior encephaloceles compared to lateral encephaloceles (p = 0.0026; OR 86, 95% CI 2.9-2582). There was no difference in rates of CSF leak between anterior (78%) and lateral (75%) encephaloceles. Vision changes occurred in 61% (11/18) of patients with anterior encephaloceles, while hearing loss occurred in all patients with lateral encephaloceles. Operative management was pursued in 74% (17/23) of cases. Non-operative management was pursued in 26% (6/23) of cases due to no active clinical concerns (n=3), stable head CT (2), and management with external ventricular drain (1). Recurrence was observed in 2 operative patients (22 and 805 days post-surgery).
Conclusion: This study represents the largest series of traumatic skull base encephaloceles to date, highlighting the heterogeneity between anterior and lateral lesions in fracture patterns, symptoms, and complications. These findings provide important insight into the outcomes of this rare but serious complication, offering guidance for clinical care.