How A Rare Congenital Clival Meningocele Almost Threatened A 50-Year Old’s Life with Recurrent Meningitis

 Meningitis, a serious inflammation of the brain & spine’s protective membranes is a skull base neurological problem that is caused by common issues like viruses, bacteria, fungi or parasites. 

Most physicians may think of it as a sudden immunity-based problem, however when meningitis keep recurring again and again, even after comprehensive treatment, the whole case changes; wherein the culprit lies much deeper, hidden within the architecture of the skull itself. 

This article dives deep into the story of a 50-year-old woman who was suffering from a rare Congenital Clival Meningocele successfully recovered under the care and guidance of Dr. Raghvendra Ramdasi, one of the best skull base and pituitary surgery specialists in Mumbai

Understanding The Case More Deeply 

Rupali (name changed) a 50-year-old residing in the city of Mumbai, India had suffered two severe episodes of meningitis within the span of six months. She also had a history of intermittent clear nasal discharge, which were worse in the mornings. 

When she was referred to of Dr. Raghvendra Ramdasi, she relayed all her health history to him. The most unusual part of her diagnosis was that while she had recurring meningitis, she had no history of sinus or other long-term forms of immunity-based problems like cold or infection. 

To get to the root cause of the issue, Dr. Ramdasi conducted a CT and MR cisternography, which revealed a tiny midline clival defect with CSF signal extending into sphenoid sinus. 

The intra-operative findings showed a balloon-like meningocele sac protruding through the clival defect. However, what stood out the most to Dr.Ramdasi was that the defect was followed by a basilar artery pulsating just behind it - a rare and striking sight.

The results pushed him to dive deep into his analysis and conclude a solid diagnosis. All the signs were pointing to a single problem: A congenital clival meningocele causing meningitis in the skull base. 

 

Relying On the Power Of Modern Medicine: An Endoscopic Surgery

Based on the condition of the skull base, Dr. Ramdasi performed an endoscopic endonasal repair on Rupali by using multilayer fascia lata grafts (inlay + overlay technique). It is a technique that uses instruments inserted through the nose and sinuses to help repair defects, ensuing that the brain and it’s accompanying organs stay safe and functional. For patients, it promises reduced pain and faster recovery as there is no tearing or stitching of the body. 

The surgery was relatively small, yet it left a lasting impact of Rupali. 

The outcome of the surgery showed that she had remained leak-free and meningitis-free within the span of two years, living a normal and active life.

Scientific Insights: Why This Case Matters So Much?

  • Extreme rarity: Congenital clival meningoceles are among the rarest causes of CSF rhinorrhea. Fewer than a dozen cases have been described worldwide Literature reports only a handful of such cases (Lockwood 1980; Akyuz 2008; Van Zele 2013; Zanabria-Ortiz 2015; Panagopoulos 2019).
  • Serious risks: Persistent CSF leakage exposes patients to recurrent meningitis, which can be life-threatening if not identified early.
  • Common misdiagnosis: Many patients with clear nasal discharge are initially told they have allergies, sinusitis, or “low immunity.”
  • Proven treatment: The endoscopic skull base approach with multilayer closure is now the gold standard, offering durable results with minimal recovery time.

 From this case, we can learn that clinicians and healthcare professionals should always consider rare skull base defects when evaluating recurrent meningitis with clear nasal discharge. Also, patients who experience watery nasal leak, especially in the mornings should consult a doctor as soon as possible for early diagnosis, as the symptom can be more than just a sinus, the earlier the diagnosis, the better are chances of healing and living a healthy life.

Conclusion

Whether you have a small neurological problem or a rare neurological disease, it’s always best to consult the best neurosurgeon doctor in Mumbai   

Known as one of the pioneers in the field, Dr. Raghvendra Ramdasi has solved a number of rare neurology cases in his 20+ years of service to his patients. 

If you are looking for an experienced neurosurgeon with specialized focus in pituitary and skull base surgery in Mumbai then you can get in touch with Dr. Ramdasi via his clinic in Mumbai. 

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