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Published on: June 20, 2018
Pediatric meningoencephaloceles and nasal obstruction: a case for endoscopic repair
Seth J Kanowitz1, Joseph M Bernstein
1Head & Neck Institute, Section of Nasal & Sinus Disorders, Cleveland Clinic, Cleveland, OH, United States.
Insights
Endoscopic repair of congenital pediatric skull base defects causing nasal obstruction is effective. This minimally invasive technique avoids complications associated with traditional craniotomy in children.
Area of Science:
- Pediatric Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Congenital anterior skull base defects with meningoencephaloceles are rare causes of pediatric nasal obstruction.
- Diagnosis can be challenging due to overlapping symptoms with common pediatric nasal and allergic conditions.
- Traditional surgical repair involved bifrontal craniotomy, a procedure with significant associated morbidity.
Observation:
- This study reviewed two pediatric cases of anterior skull base defects with meningoencephalocele.
- Both patients underwent transnasal endoscopic repair.
- The patients were aged 15 months and 6 years.
Findings:
- Successful endoscopic closure of skull base defects and resection of intranasal meningoencephaloceles were achieved in both pediatric patients.
- Postoperative resolution of nasal obstruction and cerebrospinal fluid rhinorrhea was observed.
- The transnasal endoscopic approach proved effective even in the infant population.
Implications:
- Endoscopic techniques offer a less invasive alternative to craniotomy for pediatric skull base defects.
- Minimally invasive surgery reduces complications related to frontal lobe retraction.
- Advanced imaging (triplanar CT and MRI) is crucial for surgical planning, assessing defect size, herniated content characteristics, and vascular anatomy.
Objectives:
Congenital anterior skull base defects with meningoencephaloceles causing nasal obstruction are rare clinical entities. Nasal obstruction in children may also be a symptom of multiple benign nasal and allergic disorders, making the initial diagnosis of meningoencephalocele difficult. Traditionally, skull base defects have been repaired via a bifrontal craniotomy approach. With the advent of pediatric endoscopic instrumentation, more of these lesions are accessible via an intranasal endoscopic approach, even in the infant population. However, owing to the rarity of these lesions, there is a paucity of data demonstrating successful adaptation of endoscopic skull base techniques to the pediatric population.
Methods:
Retrospective review of two cases of endoscopic repair of anterior skull base defects with meningoencephaloceles at a tertiary care medical center.
Results:
Two children, ages 15 months and 6 years, underwent successful endoscopic closure of their anterior skull base defects and resection of their intranasal meningoencephalocele with resolution of their nasal obstruction and cerebrospinal fluid rhinorrhea.
Conclusions:
Pediatric nasal meningoencephaloceles with anterior skull base defects can be successfully repaired via a transnasal endoscopic technique, thus minimizing the complications associated with craniotomy and frontal lobe retraction. Triplanar computed tomographic and magnetic resonance imaging is paramount to evaluate the caliber of the skull base defect, consistency of the herniated intracranial contents, as well as the presence of cerebral vasculature.
