Endoscopic Endonasal Surgery for Pediatric Meningoencephalocele: A Case Series from a Single Center

Introduction: Pediatric meningoencephalocele is herniation of brain and meningeal tissue through a skull base defect. Meningoencephaloceles of the ventral skull base are readily treated via endoscopic endonasal surgery (EES).

Objective: Examine the safety and effectiveness of EES for meningoencephalocele in pediatric patients.

Methods: Retrospective review of pediatric patients treated with EES for meningoencephalocele from 2000 to 2022.

Results: Twenty-two patients with a median age of 6.3 years (range: 2–17.1) and a male predominance (n = 15, 68%) underwent EES for ventral meningoencephaloceles. Two (9%) were recurrent. Median clinical follow-up was 21.5 months (range: 0–156) and median radiographic was 18 months (range: 0–154).

Meningoencephaloceles were most often located in the anterior cranial fossa (n = 18, 82%), middle and infratemporal fossae (n = 3, 14%), and sella (n = 1, 5%). Most cases were congenital (n = 15, 68%) while some were associated with trauma (n = 7, 32%). Almost all were repaired with EES alone (n = 21, 95%). One patient underwent initial bicoronal craniotomy and pericranial flap for repair of two defects in the orbital roof and ethmoid before EES (n = 1, 5%). Ten patients underwent perioperative lumbar or ventricular drain (48%) and two required long-term CSF diversion (n = 2, 9%). Reconstruction included free mucosal graft (n = 12, 54%) nasoseptal flap (n = 7, 32%), dural substitute (n = 2, 9%), or fascial graft (n = 14%). Median length of stay was 3 days (1–10).

Four patients (18%) had recurrent postoperative CSF leak requiring repeat repair (1 early to < 30 days; 3 delayed), 2 of which were at a separate site than the original repair. At the time of last follow-up, one patient had chronic rhinitis (n = 1, 4.5%) and two had frequent bouts of sinusitis (9%). No patient suffered a decline in vision, cranial neuropathy, or hormone dysfunction.

Conclusion: This single-center case series demonstrates the safety and effectiveness of EES for treating pediatric meningoencephalocele with favorable neurological outcomes. These findings underscore the utility of EES as a viable treatment option in pediatric patients with meningoencephalocele. Long-term follow-up for delayed recurrence is recommended with special attention to sites outside the original repair.

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Artikel online veröffentlicht:
07. Februar 2025