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Li AY, Gaebe K, Quon JL, Vescan A, James AL, Wolter NE. Endoscopic Transnasal Management of Meningoceles and Encephaloceles in Children: A Systematic Review. Otolaryngol Head Neck Surg 2024. [PMID: 38494838 DOI: 10.1002/ohn.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/28/2023] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To review surgical techniques used in the endoscopic transnasal repair of pediatric basal meningoencephaloceles and compare perioperative outcomes in children <2 and ≥2 years old. DATA SOURCES MEDLINE, EMBASE, and CENTRAL. REVIEW METHODS Data sources were searched from inception to August 22, 2022, using search terms relevant to endoscopic transnasal meningoencephalocele repair in children. Reviews and Meta-analyses were excluded. Primary outcomes were the incidence of intraoperative and postoperative complications, including cerebrospinal fluid leak, recurrence, and reintervention. Quality assessments were performed using Newcastle-Ottawa Scale, ROBIN-I, and NIH. RESULTS Overall, 217 patients across 61 studies were identified. The median age at surgery was 4 years (0-18 years). Fifty percent were female; 31% were <2 years. Most defects were meningoencephaloceles (56%), located transethmoidal (80%), and of congenital origin (83%). Seventy-five percent of repairs were multilayered. Children ≥2 years underwent multilayer repairs more frequently than those <2 years (P = 0.004). Children <2 years more frequently experienced postoperative cerebrospinal fluid leaks (P = 0.02), meningoencephalocele recurrence (P < 0.0001), and surgical reintervention (P = 0.005). Following multilayer repair, children <2 years were more likely to experience recurrence (P = 0.0001) and reintervention (P = 0.006). CONCLUSION Younger children with basal meningoencephaloceles appear to be at greater risk of postoperative complications following endoscopic endonasal repair, although the quality of available evidence is weakened by incomplete reporting. In the absence of preoperative cerebrospinal fluid leak or meningitis, it may be preferable to delay surgery as access is more conducive to successful repair in older children.
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Affiliation(s)
- Alyssa Y Li
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karolina Gaebe
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer L Quon
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Mercea PA, Gadenstaetter AJ, Matula C, Arnoldner C. Combined Open Surgical and Endoscopic Approach for Management of a Meningoencephalocele After Iatrogenic Perforation of the Anterior Skull Base in a Young Infant. Cureus 2022; 14:e24797. [PMID: 35686256 PMCID: PMC9170422 DOI: 10.7759/cureus.24797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Traumatic iatrogenic perforation of the anterior skull base is a rare complication following endonasal intubation in preterm infants. Subsequent meningoencephaloceles with concomitant cerebrospinal fluid (CSF) fistulas bear the risk of severe complications, therefore early diagnosis and closure of the skull defect are crucial. However, there is no consensus on the management of such cases of meningoencephaloceles. This case report presents a sophisticated approach of open brain surgery in combination with endonasal endoscopy. A 15-month-old girl presented with a meningoencephalocele and a CSF fistula due to iatrogenic perforation of the left anterior skull base during attempted endonasal intubation after birth. Difficult nasal breathing and an increasing diameter of the skull base defect on imaging controls indicated surgical management. Close multidisciplinary collaboration was essential for diagnosis and decision upon treatment. Open neurosurgical resection and CSF fistula closure combined with endonasal endoscopic removal of the excised meningoencephalocele was performed. Our case report shows that this combined open surgical and endonasal endoscopic approach is a safe procedure in favor of the postoperative outcome and follow-up of the patient.
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Alokby G, Albathi A, Alshurafa Z, AlQahtani A. Endoscopic endonasal repair of a temporal lobe meningoencephalocele in the pterygoid fossa: A case report and literature review. Int J Surg Case Rep 2021; 83:105963. [PMID: 34022760 PMCID: PMC8164042 DOI: 10.1016/j.ijscr.2021.105963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Meningoceles are defined as herniation of the meninges through a skull base defect. If brain tissue is herniated as well, then it is called meningoencephalocele. The most common locations of meningoceles are the cribriform plate and the lateral recess of the sphenoid sinus, with the most common presentation being CSF leakage. We present a case of temporal lobe meningocele that herniated through a defect in the greater wing of the sphenoid bone to the pterygoid fossa and that was diagnosed incidentally while evaluating the patient for seizures. Methodology Case report and literature review. Conclusion The endonasal endoscopic approach is a suitable minimally invasive approach for the management of pterygoid fossa lesions, including meningoceles. In this case, the patient had epilepsy with the surgery resulting in the resolution of the seizures. Endonasal approach can be considered as a minimally invasive approach for lesions in the pterygoid fossa. Meningocele are to be considered as a possible etiology for pterygoid fossa masses connected with the middle cranial fossa. Surgical resection of encephalomeningocele should be considered for the management of intractable seizures.
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Affiliation(s)
- Ghassan Alokby
- Department of Otolaryngology, Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Otolaryngology, Head and Neck Surgeery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; AlFaisal University, Riyadh, Saudi Arabia.
| | - Abeer Albathi
- Department of Otolaryngology, Head and Neck Surgeery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Abdulaziz AlQahtani
- Department of Otolaryngology, Head and Neck Surgeery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; Department of Otolaryngology, Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
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Mohindra S, Mohindra S, Mahendru S, Patil NR. Endoscopic management of congenital nasal meningoencephaloceles: a short series of 15 paediatric cases. Childs Nerv Syst 2020; 36:3059-3062. [PMID: 32382868 DOI: 10.1007/s00381-020-04649-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To retrospectively analyse surgical management of clinico-radiologically proven nasal meningoencephalocele amongst children and results of repair with single-layer septo-mucosal flap at a tertiary skull base surgery centre in north India. METHODS Fifteen children with clinic-radiological nasal meningoencephaloceles with or without CSF rhinorrhoea were included. Radiological scans included CT scans and MRI scans for all cases to delineate soft tissue and bony architecture. All children underwent endoscopic excision of encephaloceles and repair of the skull base defect. RESULTS The authors were successful in fourteen cases. Successful cases included 4 children less than 6 months of age who underwent single-layer rotated septo-mucosal flaps, thereby avoiding donor site morbidity. CONCLUSION As endoscopic excision of nasal encephalocele is an established management approach, the authors take the concept of minimally invasive surgery a step further by successfully managing these lesions with single-layer repair. Vascularized septo-mucosal flap seems to be the only determining factor for a successful repair for congenital meningoencephalocele. However, a prospective study comprising a larger subset of patients would substantiate the assumption.
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Affiliation(s)
- Satyawati Mohindra
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | - Ninad R Patil
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Başak H, Kahiloğulları G, Güler TM, Sayacı EY, Etuş V, Meço C. Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant. Childs Nerv Syst 2020; 36:2883-2886. [PMID: 32270272 DOI: 10.1007/s00381-020-04602-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022]
Abstract
Endonasal endoscopic approach (EEA) has become a routine and effective method for the management of large skull base defects in adults and increasingly in older pediatric populations despite their challenging narrow transnasal corridors. To our knowledge, this is the first report in the literature of a large craniopharyngeal canal (CC) meningoencephalocele in a 6-month-old infant managed purely through EEA, also by utilizing a pedicled nasoseptal flap (PNF).
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Affiliation(s)
- Hazan Başak
- Department of Otolaryngology, Head and Neck Surgery, Ankara University, Sihhiye, Ankara, Turkey
| | | | | | - Emre Yağız Sayacı
- Department of Neurosurgery, Ankara University, Sihhiye, 06100, Ankara, Turkey
| | - Volkan Etuş
- Department of Neurosurgery, Kocaeli University, Kocaeli, Turkey
| | - Cem Meço
- Department of Otolaryngology, Head and Neck Surgery, Ankara University, Sihhiye, Ankara, Turkey.,Department of Otolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
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Endonasal endoscopic surgery for pediatric anterior cranial fossa encephaloceles: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 132:109919. [PMID: 32036168 DOI: 10.1016/j.ijporl.2020.109919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic endonasal skull base surgery (ESBS) is a well-established management strategy for anterior cranial fossa (ACF) encephaloceles in adults. However, its application to the pediatric population has not been evaluated in large-scale studies. This study systematically reviews the safety of ESBS for pediatric ACF encephaloceles. METHODS Articles reporting on pediatric patients undergoing purely ESBS for encephaloceles were reviewed from three databases (PubMed, Scopus, and Cochrane Library). Main outcomes were post-operative cerebrospinal fluid (CSF) leak and other surgical complications. RESULTS Twenty-three articles provided data on 110 eligible patients with a mean age of 4.3 years (range birth - 18 years). Intraoperative CSF leaks occurred in 18.5% of children while post-operative CSF leaks developed in 6.0% of cases. Rates of meningitis and hydrocephalus were each 3.7%. Other complications included alar collapse, nasal stenosis, transient diabetes insipidus, pneumonia, and neurologic injury, collectively occurring in 7.0% of cases. The rate of death was 4.8%. The average duration of follow-up was 25.3 months. Encephaloceles recurred in 5.2% of patients. CONCLUSIONS ESBS for pediatric ACF encephaloceles provides a relatively favorable risk-benefit profile, with a low rate of post-operative CSF leak, other surgical complications, and disease recurrence.
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Alshamrani A, Habalrih F, Altweijri I, Alsaleh S, Ajlan A. Endoscopic trans-nasal repair of basal encephalocele associated with morning glory syndrome. Br J Neurosurg 2018; 36:108-110. [PMID: 30095018 DOI: 10.1080/02688697.2018.1494264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ali Alshamrani
- a Department of Radiology & Medical Imaging, King Saud University Medical City , Riyadh , Kingdom of Saudi Arabia
| | - Fehid Habalrih
- b Department of Neurosurgery , Prince Sultan Military Medical City , Riyadh , Kingdom of Saudi Arabia
| | - Ikhlass Altweijri
- c Division of Neurosurgery, Department of Surgery, College of Medicine , King Saud University , Riyadh , Kingdom of Saudi Arabia
| | - Saad Alsaleh
- d Otolaryngology-Head & Neck Surgery Department, College of Medicine , King Saud University , Riyadh , Kingdom of Saudi Arabia
| | - Abdulrazag Ajlan
- c Division of Neurosurgery, Department of Surgery, College of Medicine , King Saud University , Riyadh , Kingdom of Saudi Arabia
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Khandelwal G, Sharma M, Gupta P. Endoscopic Management of Congenital Intranasal Meningocele in 3-Month Old Infant. Indian J Otolaryngol Head Neck Surg 2016; 68:544-546. [PMID: 27833887 PMCID: PMC5083653 DOI: 10.1007/s12070-016-1017-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/17/2016] [Indexed: 11/28/2022] Open
Abstract
Fronto-ethmoidal meningocoele is a rare congenital condition with protrusion of meninges through anterior cranial fossa into the facial skeleton, surgical repair should be done in order to resolve nasal obstruction, provide a watertight division between sino-nasal and intra-cranial cavities and minimise injury to any CNS contents (Maddalozzo in Issue Otolaryngol Clin N Am 2015). Open approaches may be required but endoscopic endo-nasal repairs can be done in paediatric skull-base defects. A 3 month-old infant with fronto-ethmoidal meningocele operated with endo-nasal approach. In regular follow up and there is no recurrence reported till now. Recent techniques and skills will increase the use of endo-nasal approaches in paediatric skull-base surgery without complications associated with external approaches.
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Affiliation(s)
- Gaurav Khandelwal
- Department of Otorhinolaryngology, Sarojini Naidu Medical College, Agra, India
| | - Manoj Sharma
- Department of Otorhinolaryngology, Sarojini Naidu Medical College, Agra, India
| | - Priyanka Gupta
- Department of Otorhinolaryngology, Sarojini Naidu Medical College, Agra, India
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