Endonasal management of pediatric congenital transsphenoidal encephaloceles: nuances of a modified reconstruction technique. Technical note and report of 3 cases

Zeinalizadeh, Mehdi; Sadrehosseini, Seyed Mousa; Habibi, Zohreh; Nejat, Farideh; Silva, Harley Brito da; Singh, Harminder

doi:10.3171/2016.10.peds16270

Cited by 21 publications

(16 citation statements)

References 16 publications

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“…Endoscopic repair of the meningocele defect is a minimally invasive procedure and is advised for successful treatment of the lesions. [34][35][36] Keshri et al reported six patients with meningocele who underwent surgery using the transnasal endoscopic approach. 35 Ma et al reported a series of 23 patients who underwent surgery for CSF leak with or without encephalocele, 28 and Marfatia et al reported a series of 19 pediatric patients with meningoencephaloceles who underwent surgery.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Transnasal Skull Base Surgery in Pediatric Patients

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Beton

et al. 2019

J Neurol Surg B Skull Base

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Introduction In pediatric patients, endoscopic transnasal surgery (ETNS) poses challenges because of the small size of the developing skull and narrow endonasal corridors. Objective This study aimed to evaluate the efficacy of ETNS in children by assessing our experience of endoscopic skull base surgery. Materials and Methods All pediatric patients (n = 54) who were eligible for surgery using only the endonasal endoscopic approach at our tertiary center between 2012 and 2018 were included in this study. The surgeries were performed simultaneously by an endoscopic skull base team of neurosurgeons and otolaryngologists. Hormonal analyses were conducted before and after surgery in all patients with sellar/parasellar lesions. Patients older than 8 years underwent smell and visual testing. Results In the 54 patients aged 1 to 17 years who underwent surgery, craniopharyngioma was the most common pathology (29.6%), followed by pituitary adenoma (22.2%). Gross total resection was achieved in 33 (76.7%) of 41 patients who underwent surgery because of the presence of tumors. All visual deficits improved, although one patient sustained olfactory deterioration. Sixteen (29.6%) patients presented with complications such as transient diabetes insipidus and temporary visual loss. Conclusions Despite anatomy-related challenges in children, adequate results can be achieved with high rates of success, and the functional and anatomical integrity of the developing skull and nose of children can be preserved. In pediatric patients, ETNS is a safe and effective option for addressing various lesions along the skull base.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Transnasal Skull Base Surgery in Pediatric Patients

Kahiloğulları

Meço

Beton

et al. 2019

J Neurol Surg B Skull Base

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“…The choice of transpalatal approach was corroborated by the literature that shows high rate of morbidity, mortality, and cerebrospinal fluid fistula in patients operated by cranial and endoscopic access [1,4,[12][13][14].…”

Section: Multidisciplinary Team Simulationmentioning

confidence: 99%

“…A basal encephalocele is defined as a neural element herniation, including the pituitary gland or optic chiasm, through an anatomical defect in the base of the skull [1][2][3][4]. They represent 1.5-5% of all cephaloceles, and the transsphenoidal encephalocele is the rarest form [2,5,6], with an incidence estimate of 1 in 700,000 live births [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, most reports focus on basal encephaloceles in newborns and infants who have a much smaller nasal cavity and more difficult access [7]. In cases of transsphenoidal encephaloceles with significant skull defects, most authors prefer transpalatal approaches to avoid the recurrence of the herniation through safe and wide access [3,4]. However, palatal osteotomies and removing the hard palate may be technically challenging as much as the reconstruction of the skull base and closure of the mucosal layer [4].…”

Section: Introductionmentioning

confidence: 99%

“…During transcranial subfrontal or pterional operations, access to the posterior border adds technical challenges because of the retrochiasmatic location and the proximity of the pituitary stalk and hypothalamus. Therefore, manipulation of the sac is more susceptible to retraction injuries causing subsequent endocrine imbalance; for instance, diabetes insipidus [4,8]. The sublabial transsphenoidal approach is a welldescribed technique in the literature [9,10] but offers a worse exposure to the sac and bone defect, compared to transpalatal, once its access through the soft tissues is longer and with an oblique view of the lesion.…”

Section: Introductionmentioning

confidence: 99%

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A hybrid simulation model for pre-operative planning of transsphenoidal encephalocele

et al. 2020

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Congenital transsphenoidal encephalocele (CTE) surgical correction is a challenging procedure. Although rare, this anomaly, characterized with neural herniation elements, including the pituitary gland or optic pathway through the sphenoid bone with anatomical alteration, can be presented in many different ways and should be individually analyzed. Significant advances in medical technology and the 3D models may simulate the complex anatomical relations of the human body. Nowadays, medical education relies on the availability of standardized materials that can reliably emulate human anatomy. Therefore, realistic anatomical models have become an alternative for cadavers or animal specimens. In this technical note, the authors present a new technique to create personalized models that combine 3D printing, molding, and casting to create an anatomically and tactilely realistic model based on magnetic resonance and computerized tomography images. Produced from different silicon types, the model recreated the anatomic alterations precisely, allowing a multidisciplinary team to determine the adequate surgical approach for this patient. We describe a case of congenital transsphenoidal encephalocele of a 3-year-old boy, whose surgical correction was planned using a hybrid model. The technical description of the model is given in detail. This new hybrid model allowed a detailed discussion of the surgical approach aspects by having tissues of different consistencies and resistances and a very high prediction rate. This approach may allow a reduction in surgery time and possible complications after operative procedures.

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