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Updated: Dec 29, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Endonasal endoscopic surgery for pediatric anterior cranial fossa encephaloceles: A systematic review
Joshua A Lee1, Young Jae Byun2, Shaun A Nguyen1
1Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Insights
Endoscopic endonasal skull base surgery (ESBS) is safe for pediatric anterior cranial fossa encephaloceles. This review shows low rates of cerebrospinal fluid leaks and other complications, supporting its use in children.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Skull Base Surgery
Background:
- Endoscopic endonasal skull base surgery (ESBS) is established for adult anterior cranial fossa (ACF) encephaloceles.
- Limited large-scale data exist on ESBS safety in pediatric ACF encephaloceles.
Purpose of the Study:
- To systematically review the safety and efficacy of ESBS for pediatric ACF encephaloceles.
- Evaluate complication rates and recurrence in children undergoing ESBS.
Main Methods:
- Systematic review of articles from PubMed, Scopus, and Cochrane Library.
- Included studies focused on pediatric patients undergoing purely ESBS for encephaloceles.
- Primary outcomes: post-operative cerebrospinal fluid (CSF) leak and surgical complications.
Main Results:
- Data from 23 articles on 110 pediatric patients (mean age 4.3 years).
- Post-operative CSF leak rate: 6.0%; meningitis and hydrocephalus each 3.7%.
- Recurrence rate: 5.2%; mortality rate: 4.8%.
Conclusions:
- ESBS demonstrates a favorable risk-benefit profile for pediatric ACF encephaloceles.
- Low rates of CSF leak, complications, and recurrence support its use.
- Further research may refine outcomes and indications in pediatric populations.
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.
