Skull Base 2002; 12(3): 133-140
DOI: 10.1055/s-2002-33459
ORIGINAL ARTICLE

Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Endoscopic Repair of Acquired Encephaloceles, Meningoceles, and Meningo-Encephaloceles: Predictors of Success

Julie L. Zweig1 , Ricardo L. Carrau1 , Scott E. Celin1 , Carl H. Snyderman1 , Amin Kassam1 , Hassan Hegazy1
  • 1Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania
Further Information

Publication History

Publication Date:
21 August 2002 (online)

ABSTRACT

Meningoceles, encephaloceles, and meningo-encephaloceles may develop through defects associated with congenital anomalies or through defects produced by tumor, trauma, or surgery. Their initial management, surgical indications, and repair techniques are not universally accepted. We undertook this study to compare the contributions of different surgical techniques and materials to the success of endoscopic repairs of acquired meningo-encephaloceles. We also examined whether characteristics of the patient, the meningo-encephalocele, or the adjunctive treatment influenced the outcome of the repair.

We retrospectively reviewed the clinical charts of all patients undergoing transnasal endoscopic repair of acquired meningo-encephaloceles at our academic hospitals. We encountered 17 patients with meningo-encephaloceles of the anterior fossa and parasellar area; 15 were repaired immediately using transnasal endoscopic techniques. Two persistent leaks associated with hydrocephalus were repaired during a second endoscopic attempt, which was rapidly followed by ventriculoperitoneal shunting. Location and size of the skull base defect, its etiology, and the technique and choice of material used for repair did not significantly affect surgical outcomes. However, the presence of hydrocephalus was significantly related to poor surgical outcomes.

REFERENCES

  • 1 Celin S. Contemporary diagnosis and management of anterior skull base cephalocele and cerebrospinal fluid leaks. In: Arriaga M, Diaz-Day J, eds. Neurosurgical Issues in Otolaryngology Philadelphia, PA: Lippincott Williams Wilkins; 1999
  • 2 Buchman C A, Civantos F J, Casiano R R. Skull base cerebrospinal fluid leaks and encephaloceles. In: Advances in Otolaryngology-Head and Neck Surgery Vol 13. St. Louis, MO: Mosby Inc; 1999
  • 3 Aarabi B, Leibrock L G. Neurosurgical approaches to cerebrospinal fluid rhinorrhea.  Ear Nose Throat . 1992;  71 300-305
  • 4 Hughes R, Jones N S, Roberton I J. The endoscopic treatment of cerebrospinal fluid rhinorrhea: the Nottingham experience.  J Laryngol Otol . 1977;  111 125-128
  • 5 Bernal-Sprekelsen M, Bleda-Vazquez C, Carrau R. Ascending meningitis secondary to traumatic cerebrospinal fluid leaks.  Am J Rhinol . 2000;  14 257-259
  • 6 Anand V, Murali R K, Glasgold M J. Surgical decisions in the management of cerebrospinal fluid rhinorrhea.  Am J Rhinol . 1995;  33 212-218
  • 7 Stankiewicz J. Cerebrospinal fluid fistula and endoscopic sinus surgery.  Laryngoscope . 1991;  101 250-256
  • 8 Shetty P, Shroff M M, Sahani D V. Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula.  Am J Neuroradiol . 1998;  19 633-639
  • 9 Park J I, Nakamura G R, Griesemer E C, Noguchi T T. Current management of cerebrospinal fluid rhinorrhea.  Laryngoscope . 1983;  83 1294-1300
  • 10 Hirsch O. Successful closure of cerebrospinal fluid rhinorrhea by endonasal surgery.  Arch Otolaryngol . 1952;  56 1-13
  • 11 McCabe B F. The osteomucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea.  Laryngoscope . 1976;  86 537-539
  • 12 Yessenow R S, McCabe B F. The osteomucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea: a 20-year experience.  Otolaryngol Head Neck Surg . 1989;  101 555-558
  • 13 Wigand M E. Transnasal ethmoidectomy under endoscopic control.  Rhinology . 1981;  19 7-15
  • 14 Weber R, Keerl R, Drat W. Management of dural lesions occurring during endonasal sinus surgery.  Arch Otolaryngol Head Neck Surg . 1996;  122 732-736
  • 15 Papay F, Maggiano H, Dominquez S. Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistulas.  Laryngoscope . 1989;  99 1195-1201
  • 16 Lanza D C, O'Brian D A, Kennedy D W. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles.  Laryngoscope . 1996;  106 1119-1125
  • 17 Burns J, Dodson E, Gross C. Transnasal endoscopic repair of cranionasal fistulae: a refined technique with long-term follow-up.  Laryngoscope . 1996;  106 1080-1083
  • 18 Hegazy H M, Carrau R L, Snyderman C H, Kassam A, Zweig J. Transnasal-endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis.  Laryngoscope . 2000;  110 1166-1172
  • 19 Casiano R R, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair: is a lumbar drain necessary?.  Otolaryngol Head Neck Surg . 1999;  121 745-750
  • 20 Zweig J L, Carrau R L, Celin S E. Endoscopic repair of CSF leaks to the sinonasal tract: predictors of success.  Otolaryngol Head Neck Surg . 2000;  123 195-201
  • 21 Mattox D, Kennedy D. Endoscopic management of cerebrospinal fluid leaks and cephaloceles.  Laryngoscope . 1990;  100 857-862
    >