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Endoscopic endonasal management of skull base defects in pediatric patients
Arad Iranmehr1, Mehdi Zeinalizadeh1, Mohamad Namvar1
1Neurological Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, IR, Iran.
Insights
Endoscopic endonasal surgery effectively treats pediatric skull base defects, achieving a 97% success rate for cerebrospinal fluid leaks and other related conditions. This minimally invasive approach offers a safe and feasible solution for children.
Area of Science:
- Pediatric Neurosurgery
- Otolaryngology
- Minimally Invasive Surgery
Background:
- Skull base defects in children can stem from congenital issues or trauma, leading to serious complications like cerebrospinal fluid (CSF) leaks, meningitis, and nasal obstruction.
- Surgical repair is the primary treatment for these defects.
Purpose of the Study:
- To evaluate the effectiveness of the endoscopic endonasal approach for treating skull base defects in pediatric patients.
- To assess the safety and feasibility of this minimally invasive technique.
Main Methods:
- A retrospective study reviewed 38 pediatric patients (ages 2 months to 18 years) who underwent endoscopic endonasal repair of skull base defects between March 2010 and February 2020.
- Exclusion criteria included prior tumor resection, loss to follow-up, or lack of consent.
Main Results:
- The primary indications for surgery were trauma (63.1%) and congenital defects (36.9%), including basal meningoencephalocele and frontoethmoidal defects.
- Fat grafting was the most common repair material. The mean follow-up period was 32 months.
- A high success rate of 97% was observed, with most patients becoming symptom-free.
Conclusions:
- Endoscopic endonasal repair is a safe and effective method for addressing cerebrospinal fluid leaks and skull base defects in children.
- The procedure demonstrates a 97% success rate, highlighting its feasibility in pediatric neurosurgery.
Purpose:
Skull base defects in children may be the result of congenital anomalies or trauma. They often present as cerebrospinal fluid (CSF) rhinorrhea, meningitis, brain abscess or nasal obstruction. Surgical intervention is predominantly the treatment of choice. Our goal is to assess the efficacy of endoscopic endonasal approach in treating skull base defects in pediatric patients.
Material And Methods:
In this retrospective study we identified 38 patients (mean age 8.7 ± 5.6 years old, ranging 2 months-18 years) who underwent endoscopic endonasal repair of skull base defects, between March 2010 and February 2020. Patients who had skull base reconstruction after tumor resection, those who were lost to follow-up or did not sign the consent forms were excluded from the study.
Results:
The clinical indications for endoscopic endonasal repair were trauma (n = 24, 63.1%) and congenital defects (n = 14, 36.9%). Congenital skull base defects included basal meningoencephalocele (n = 5, 35.7%) and frontoethmoidal defects (n = 9, 64.3%). Mean follow up time was 32 ± 29.04 months, ranging 2-103 months. Fat graft (alone or in combination) was the most commonly used material to repair the skull base defects. Thirty-seven patients (97%) showed successful results after endoscopic endonasal surgery and were symptom free.
Conclusion:
The endoscopic endonasal repair of CSF leak and skull base defects proved to be safe and feasible with 97% success rate.
