Transnasal endoscopic repair of pediatric meningoencephalocele

Keshri, Amit; Shah, Saurin; Patadia, Simple; Sahu, Rabi Narayan; Behari, Sanjay

doi:10.4103/1817-1745.181249

Cited by 35 publications

(18 citation statements)

References 8 publications

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“…Pure endoscopic repair of anterior skull base defects in children has been previously described 23 ; however, with such large bony defects as seen in our cases, a purely endoscopic approach in children this young would be difficult, particularly in the case of the nasofrontal encephalocele (case 2). Additionally, small nares in babies in the first days of life create technical challenges regarding purely endoscopic repair.…”

Section: Discussionmentioning

confidence: 74%

Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele

Das

Lacey

Guillaume

2020

J Neurol Surg B Skull Base

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Objectives Congenital frontoethmoidal encephaloceles are associated with a shallow sloping forehead. We (1) sought to determine if early repair reverses abnormal forehead slope, and (2) assessed a modification of the fetal profile (FP) line to assess results. Design Study of two cases. Participants Newborns with frontoethmoidal encephaloceles repaired prior to the age of 4 months with cranial base bone grafting. Main Outcome Measures Forehead slope was assessed using a modification of the FP line, defined as the line that passes through the anterior border of the mandible and nasion, on pre and postoperative magnetic resonance imaging (MRI) in the midsagittal plane. A modified FP (mFP) line anterior to the forehead was “ − ”, while a posterior (normal) mFP line was “ + .” The largest distance from the mFP line to the forehead was measured. Results Both infants underwent bifrontal craniotomy, excision of encephalocele, and repair of cribriform plate defect using full-thickness autologous parietal bone before the age of 4 months. Preoperatively, the mFP line was −20.6 mm in case 1, and −9.8 mm in case 2. In both cases, follow-up MRI showed excellent reversal of forehead slope and normal calvarium development. The mFP line improved to +7.4 (age = 16 months) in case 1, and +7.6 (age = 11 months) in case 2. The parietal bone donor site ossified completely within 3 months in both cases. Conclusion Early repair with bone grafting can promote normal frontal bone development and improve forehead slope. The mFP line is a useful method to measure degree of forehead slope.

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Section: Discussionmentioning

confidence: 74%

Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele

Das

Lacey

Guillaume

2020

J Neurol Surg B Skull Base

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“…This pathology is described as an encephalocele when the sac contains neural elements and as a meningocele when no recognizable brain tissue is present within the sac. 34,35 Patients with a history of rhinorrhea or meningitis were selected for surgery. Before surgery, CT was performed to determine the bony defect and MRI was conducted to identify the contents and size of the meningocele.…”

Section: Discussionmentioning

confidence: 99%

“…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

Kahiloğulları

Meço

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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“…EES avoids the additional morbidity of open approaches and is effective in long-term follow-up. 13,27 The goals of surgery are to resect the encephalocele, minimize any injury to normal brain tissue and vessels, and provide a watertight seal to divide the sinonasal and intracranial contents.…”

Section: Encephalocelementioning

confidence: 99%

Endoscopic Management of Developmental Anomalies of the Skull Base

Wilson

Snyderman

2018

J Neurol Surg B

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Developmental anomalies of the skull base may present in childhood or as an adult. The most common pathologies include dermoid, encephalocele, and glioma. Encephaloceles may present as part of a syndrome. Other entities include infantile hemangiomas and teratoma. Endoscopic techniques provide a less invasive and morbid option for treatment. Proper evaluation and treatment is necessary to prevent complications such as meningitis.

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Transnasal endoscopic repair of pediatric meningoencephalocele

Cited by 35 publications

References 8 publications

Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele

Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele

Endoscopic Transnasal Skull Base Surgery in Pediatric Patients

Endoscopic Management of Developmental Anomalies of the Skull Base

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