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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Current management of congenital anterior cranial base encephaloceles
Harrison M Thompson1, Rodney J Schlosser2, Erika McCarty Walsh1
1Departments of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Endoscopic surgery effectively treats congenital encephaloceles in children, even those as young as two months. This minimally invasive approach offers a safe and successful option for managing these complex nasal and skull base abnormalities.
Area of Science:
- Pediatric Otolaryngology
- Neurosurgery
- Congenital Abnormalities
Background:
- Congenital encephaloceles present significant diagnostic and surgical challenges in pediatric patients.
- Effective management requires a thorough understanding of presentation, surgical techniques, and outcomes.
Purpose of the Study:
- To evaluate contemporary endoscopic treatment strategies for congenital encephaloceles.
- To analyze presentation, surgical techniques, and patient outcomes.
Main Methods:
- Retrospective chart review of 14 patients with 15 congenital encephaloceles treated between 2003 and 2019.
- Data collected included demographics, symptoms, associated anomalies, surgical details, and complications.
Main Results:
- Endoscopic repair was performed on patients aged 2 months to 22 years, with a mean follow-up of 23 months.
- Nasal obstruction was the most common presentation; cerebrospinal fluid (CSF) leak was rare.
- Average encephalocele size was 2.44 cm with a mean skull base defect of 8.6 x 7.7 mm.
Conclusions:
- Endoscopic techniques are safe and effective for repairing congenital encephaloceles in pediatric patients.
- Early intervention is feasible, with successful repairs in infants as young as two months.
- Endoscopic approaches provide a viable alternative to traditional open surgeries.
Objectives:
Congenital encephaloceles provide unique diagnostic and reconstructive challenges for the pediatric rhinologist. The objectives of the current study were to evaluate contemporary treatment strategies for congenital encephaloceles focusing on presentation, surgical technique, and outcomes.
Methods:
Multi-institutional retrospective chart review of congenital encephaloceles (2003-2019). Data regarding demographics, presenting symptoms, associated abnormalities, surgical technique, size, location, and complications were collected.
Results:
Fourteen patients with 15 congenital encephaloceles were treated using endoscopic techniques (avg 6.0 years, range 2 months-22 years) with mean follow up of 23 months. The majority presented with nasal obstruction (n = 13); only one child had cerebrospinal fluid (CSF) rhinorrhea. Associated anomalies included nasal deformities, congenital hypopituitarism, and Morning Glory syndrome. Average encephalocele size was 2.44 cm (range 0.5-3.6 cm) with mean skull base defect size of 8.6 x 7.7 mm. Locations included the foramen cecum (n = 9), central sphenoid (n = 3), midline anterior cranial fossa (n = 1), orbital plate of frontal bone (n = 1), and ethmoid roof (n = 1). Because of favorable expansion from encephaloceles, it was unnecessary to postpone surgeries to allow nasal cavity growth. Three individuals had prior operations, including surgeries for "nasal polyp" or "adenoid cyst". Two patients had post-operative complications (meningitis and CSF leak) effectively treated with no further sequelae.
Conclusions:
In the current study, congenital encephaloceles in children as young as 2 months were successfully repaired using endoscopic techniques. Endoscopic approaches remain a safe and effective intervention for management of these lesions.
