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Published on: June 20, 2018
Transnasal endoscopic repair of pediatric meningoencephalocele
Amit Kumar Keshri1, Saurin R Shah1, Simple D Patadia1
1Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
Endoscopic repair of pediatric intranasal meningoencephaloceles offers a minimally invasive solution. This approach resulted in successful outcomes with minimal complications in a small cohort.
Area of Science:
- Neurosurgery
- Otolaryngology
- Pediatric Surgery
Background:
- Intranasal meningoencephaloceles are rare skull base lesions.
- Congenital forms often present as nasal masses in children, necessitating surgical correction.
Purpose of the Study:
- To evaluate the efficacy of endonasal endoscopic repair for pediatric intranasal meningoencephaloceles.
- To assess outcomes and complications associated with this minimally invasive surgical technique.
Main Methods:
- Retrospective study of 6 pediatric patients (<12 years) with intranasal meningoencephalocele.
- Treatment involved endonasal endoscopic repair using gasket seal or fat plug techniques.
- Follow-up ranged from 6 months to 2 years, with clinical and radiological evaluation.
Main Results:
- The study included 4 post-traumatic and 2 congenital cases.
- All patients remained asymptomatic post-operatively.
- One patient experienced minor nasal alar collapse as a complication.
Conclusions:
- Transnasal endoscopic repair is a minimally invasive, single-stage surgery for anterior skull base meningoencephaloceles.
- Advantages include reduced hospital stay, lower treatment costs, and improved cosmesis.
- Tailoring repair to defect size is crucial for a watertight seal and optimal outcomes.
Introduction:
Encephaloceles in relation to the nose are rare lesions affecting the skull base. In the pediatric population, majority are congenital lesions manifesting as nasal masses requiring surgical intervention.
Materials And Methods:
A retrospective study of 6 consecutive patients below 12 years of age with intranasal meningoencephalocele treated by endonasal endoscopic approach at our tertiary centre was done. The follow up period ranged from 6 months to 2 years. A detailed clinical and radiological evaluation of these cases was done. Endonasal endoscopic repair (gasket seal/fat plug) was carried out in all cases.
Results:
Out of 6 patients, 4 patients had post-traumatic and rest 2 cases had congenital meningo-encephaloceles. All patients were asymptomatic in post-operative follow up period. One patient had minor complication of nasal alar collapse due to intra-operative adherence of encephalocele to cartilaginous framework.
Conclusion:
Transnasal endoscopic repair of anterior skull base meningoencephalocele is a minimally invasive single stage surgery, and has advantage in terms of lesser hospital stay, cost of treatment, and better cosmesis. The repair technique should be tailored to the size of defect to provide a water-tight seal for better outcome.
