[Therapy problems in sphenoethmoidal meningoceles].

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Craniofacial Surgery

Background:

• Meningoencephaloceles are rare congenital abnormalities involving brain tissue herniation through skull defects.
• Sphenoethmoidal meningocele is a specific subtype presenting significant diagnostic and therapeutic challenges.
• Associated anomalies, such as palate clefts and agenesis of the corpus callosum, suggest a primary central developmental disturbance.

Observation:

• A five-year-old boy presented with a large sphenoethmoidal meningocele (3x3x4 cm).
• The patient also exhibited a wide median palate cleft, agenesis of the corpus callosum, and median cheiloschisis.
• Initial attempts at intracranial occlusion of the skull base defect were unsuccessful.

Findings:

• A successful surgical outcome was achieved using a transpalatinal-transnasal extradural approach.
• This involved repositioning the meningocele, removing epipharyngeal mucosa, and securing the bony defect with a tantalum plate.
• Subsequent closure of the palate cleft was performed by an oral surgeon.

Implications:

• The described transpalatinal-transnasal extradural technique offers a viable alternative for treating complex sphenoethmoidal meningoceles.
• This approach may be beneficial for managing challenging transsphenoidal meningocele cases.
• Multidisciplinary collaboration is crucial for managing these complex congenital anomalies.