Endonasal Endoscopic Management of a Craniopharyngeal Canal Meningoencephalocele in a 6-Month-Old Patient

Background: Endonasal endoscopic approach (EEA) for managing even large skull base defects have become a routine and effective method in adults and increasingly in older pediatric populations despite their challenging narrow transnasal corridors. For the first time in a six-month-old boy, we report management of a huge craniopharyngeal canal (CC) meningoencephalocele using this minimal invasive approach.

Case: A 6-month-old baby with known intrauterine large arachnoid cyst had nasal breathing difficulties since birth. Neurologic examination was normal. Flexible endoscopic examination revealed a pulsatile mass obliterating the nasopharynx. Various imaging methods showed a bony CC defect at central sphenoid region and a protruded meningoencephalocele through this defect. Using an EEA we first prepared a pedicled nasoseptal mucoperiosteal flap and parked in maxillary sinus at the beginning of the surgery. Since the transnasal working corridor was too narrow, posterior septectomy was performed to enable binostril dissection and visualization of the origin of meningoencephalocele and bony defect at skull base. After careful cauterization and resection of the meningoencephalocele sac, metal clips were used to additionally seal the dura of CC. Then additionally bony defect was closed in a multilayer fashion using cartilage, allograft dura and nasoseptal flap as the last layer. Nasal breathing became normal right after surgery and no recurrence of meningocele or CSF leak was seen during the follow-up period of 10 months.

Conclusion: For the huge CC meningoencephalocele of the 6-month-old baby, EEA achieved a perfect visualization of skull base defect and enabled a watertight closure after resection of the pathology.