Endoscopic endonasal repair of anterior cranial base encephaloceles: A lower cost alternative to open craniofacial approaches

Abstract

Congenital anterior cranial base encephaloceles (ACBEs) are rare anomalies where brain tissue, leptomeninges, and cerebrospinal fluid (CSF) exist outside the skull's normal limits 1,2 and may arise from a patent foramen cecum. 2 The mainstay of treatment is surgical repair, 1 which is traditionally performed through open craniofacial approaches (OCAs). 1 Recent reports suggest endoscopic endonasal approaches (EEAs) for pediatric ACBEs demonstrate low complication rates 3 and may reduce health-care resource utilization (HRU) for anterior cranial base pathologies. 4 Optimal management of ACBEs remains unclear as few studies have directly compared outcomes 3 and none have compared cost differences for OCAs and EEAs. Given the rarity of ACBEs, we sought to utilize nationally representative data from the Kids' Inpatient Database (KID), 5 to compare the HRU of EEAs and the OCAs of ACBE repair. PATIENTS AND METHODS Data sourceGiven that these data are publicly available, this research was exempt from review by the institutional review board of the University of Chicago. A weighted cross-sectional analysis of 4 KID releases (2006, 2009, 2012, and 2016) was performed. National analyses can be performed using the KID, which is the largest publicly available database of pediatric hospitalizations in the United States, 5 and provides information including diagnoses, procedures, and HRU.