Abstract
Introduction
Congenital meningoencephaloceles represent a rare clinical entity, with its frequency being around 1 out of 4000–5000 live births. They usually present as a midline mass and the differential diagnosis includes dermoids, encephaloceles, and gliomas. Although the standard coronal approach with frontal craniotomy and pericranial flap has been considered the preferred method for several years, it is associated with risks and prolonged hospitalization. The endoscopic procedure is gaining ground and we are aiming to present our experience from five cases that were treated endoscopically.
Materials and methods
Five cases of paediatric meningoencephaloceles (age ranging from 2.5 to 10 years) were treated in our department between the years 2007–2017. Four children had a congenital and one child a post-traumatic meningoencephalocele. The presenting symptoms included nasal obstruction, meningitis and CSF leak. All patients had pre-operative imaging with CT and MRI scans and the preferred method of repair was multi-layered closure.
Results
All our patients had uneventful recovery, without any post-operative complications. The follow-up period ranges from 39 to 98 months. All five patients remain asymptomatic and recurrence-free.
Conclusion
Endoscopic management of paediatric meningoencephaloceles is a reliable and safe approach and it is known to have no adverse effects on facial growth. It carries a satisfactory success rate, reduces the in-hospital stay with lower cost of treatment, better cosmesis and lower morbidity than external procedures. It requires multidisciplinary team setting in a tertiary centre with experienced endoscopic anterior skull base surgeons. Pre-operative assessment and post-operative care are of paramount importance and larger series need to be studied to reach safe conclusions and establish management guidelines.
Similar content being viewed by others
References
Blumenfeld R, Skolnik EM (1965) Intranasal encephaloceles. Arch Otolaryngol 82(5):527–531
Suwanwela C, Suwanwela N (1972) A morphological classification of sincipital encephalomeningoceles. J Neurosurg 36(2):201–211 (Journal of Neurosurgery Publishing Group)
Kanowitz SJ, Bernstein JM (2006) Pediatric meningoencephaloceles and nasal obstruction: a case for endoscopic repair. Int J Pediatr Otorhinolaryngol 70(12):2087–2092 (Elsevier)
Rahbar R, Resto VA, Robson CD, Perez-Atayde AR, Goumnerova LC, McGill TJ et al (2003) Nasal glioma and encephalocele: diagnosis and management. Laryngoscope 113(12):2069–2077 (Wiley Online Library)
Hughes GB, Sharpino G, Hunt W, Tucker HM (1980) Management of the congenital midline nasal mass: a review. Head Neck 2(3):222–233 (Wiley Online Library)
Castelnuovo P, Bignami M, Pistochini A, Battaglia P, Locatelli D, Dallan I (2009) Endoscopic endonasal management of encephaloceles in children: an eight-year experience. Int J Pediatr Otorhinolaryngol 73(8):1132–1136 (Elsevier)
McCormack B, Cooper PR, Persky M, Rothstein S (1990) Extracranial repair of cerebrospinal fluid fistulas: technique and results in 37 patients. Neurosurgery 27(3):412–417 (Oxford University Press)
Skedros DG, Cass SP, Hirsch BE, Kelly RH (1993) Beta-2 transferrin assay in clinical management of cerebral spinal fluid and perilymphatic fluid leaks. J Otolaryngol 22(5):341–344
Schick B, Draf W, Kahle G, Weber R, Wallenfang T (1997) Occult malformations of the skull base. Arch Otolaryngol Neck Surg 123(1):77–82
Woodworth B, Schlosser RJ (2005) Endoscopic repair of a congenital intranasal encephalocele in a 23 months old infant. Int J Pediatr Otorhinolaryngol 69(7):1007–1009 (Elsevier)
Bothwell MR, Piccirillo JF, Lusk RP, Ridenour BD (2002) Long-term outcome of facial growth after functional endoscopic sinus surgery. Otolaryngol Neck Surg 126(6):628–634 (SAGE Publications Sage CA: Los Angeles, CA)
Castelnuovo P, Dallan I, Pistochini A, Battaglia P, Locatelli D, Bignami M (2007) Endonasal endoscopic repair of Sternberg’s canal cerebrospinal fluid leaks. Laryngoscope 117(2):345–349 (Wiley Online Library)
Kassam A, Thomas AJ, Snyderman C, Carrau R, Gardner P, Mintz A et al (2007) Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 106(2):75–86 (Pediatr American Association of Neurological Surgeons)
Locatelli D, Rampa F, Acchiardi I, Bignami M, Pistochini A, Castelnuovo P (2006) Endoscopic endonasal approaches to anterior skull base defects in pediatric patients. Child’s Nerv Syst 22(11):1411–1418 (Springer)
Van Den Abbeele T, Elmaleh M, Herman P, François M, Narcy P (1999) Transnasal endoscopic repair of congenital defects of the skull base in children. Arch Otolaryngol Head Neck Surg 125(5):580–584 (American Medical Association)
Casiano RR, Jassir D (1999) Endoscopic cerebrospinal fluid rhinorrhea repair: is a lumbar drain necessary? Otolaryngol Neck Surg 121(6):745–750 (Elsevier)
Senior BA, Jafri K, Benninger M (2001) Safety and efficacy of endoscopic repair of CSF leaks and encephaloceles: a survey of the members of the American Rhinologic Society. Am J Rhinol 15(1):21–25 (OceanSide Publications, Inc)
Fyrmpas G, Konstantinidis I, Selviaridis P, Constantinidis J (2014) Management of spontaneous cerebrospinal fluid leaks of the sphenoid sinus: our experience. J Laryngol Otol 128(9):797–802 (Cambridge University Press)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Stavrakas, M., Karkos, P.D., Triaridis, S. et al. Endoscopic management of paediatric meningoencephaloceles: a case series. Eur Arch Otorhinolaryngol 275, 2727–2731 (2018). https://doi.org/10.1007/s00405-018-5116-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-018-5116-z