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Published on: January 17, 2018
Treatment of anterior skull base defects by a transnasal endoscopic approach in children
Federico Di Rocco1, Vincent Couloigner, Patricia Dastoli
1Department of Pediatric Neurosurgery, Necker–Enfants Malades Hospital, Assistance Public Hôpitaux de Paris (AP-HP), Paris, France.
Insights
Endoscopic repair of anterior skull base defects in children is a safe and effective minimally invasive technique. This study found no recurrence of cerebrospinal fluid leaks or encephaloceles in most patients treated endoscopically.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Otolaryngology
Background:
- Anterior skull base defects pose significant challenges in pediatric management.
- Traditional surgical approaches can be invasive with potential complications.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic management for anterior skull base defects in children.
- To assess the complication rates associated with this minimally invasive technique.
Main Methods:
- Retrospective review of 28 pediatric patients (2001-2008) with anterior skull base defects (18 congenital, 10 posttraumatic).
- Endoscopic repair utilized rigid telescopes and grafts from middle turbinate, nasal septum, or auricle, with fibrin glue and oxidized cellulose in some cases.
- Combined external and endoscopic approaches were used for large encephaloceles; outcomes assessed via clinical exam, fibroscopy, and imaging.
Main Results:
- Mean follow-up was 26.7 months.
- No recurrence of cerebrospinal fluid (CSF) leak, meningitis, or encephalocele in 27 out of 28 patients.
- Four cases of iatrogenic mucocele were observed; one patient died of meningitis after a combined approach surgery.
Conclusions:
- Endoscopic management is a minimally invasive, safe, and efficient method for treating pediatric nasal encephaloceles.
- The technique demonstrates a high success rate with low recurrence of major complications.
Object:
The object of this study was to assess the efficacy and complications of endoscopic management of anterior skull base defects.
Method:
The authors reviewed the medical records of 28 children (20 boys and 8 girls) undergoing endoscopic repair of anterior skull base defects in their tertiary referral center between 2001 and 2008; 18 cases were congenital and 10 cases posttraumatic. During the endoscopic procedure, rigid telescopes--2.7 or 4 mm in diameter, with 0° or 30° lenses--were used. In 23 patients the anterior skull base defect was sealed with fragments of middle turbinate (bone and mucosa). In the remaining 5 patients it was sealed with cartilage harvested from the nasal septum (3 cases) or from the auricle (2 cases), fibrin glue, and oxidized cellulose. A combined external and endoscopic approach was required in 3 cases because of the size and extensions of the encephalocele. Outcome was primarily assessed by means of clinical examination, nasal fibroscopy, and imaging.
Results:
The mean duration of follow-up was 26.7 months (range 9-57 months). One patient treated by a combined approach died of meningitis 2 years after surgery. In the remaining 27 patients, there was no recurrence of CSF leak, meningitis, or encephalocele. An iatrogenic frontal or ethmoidal mucocele was observed in 4 cases.
Conclusions:
The endoscopic approach is a minimally invasive, safe, and efficient technique for removing nasal encephaloceles in children.
