2025 Proffered Presentations
S281: ENDOSCOPIC ENDONASAL SURGERY FOR PEDIATRIC MENINGOENCEPHALOCELE: A CASE SERIES FROM A SINGLE CENTER
Ali A Alattar, MD, MAS; Madison Remick, MD; Joseph Garcia, MD; Anna Slingerland, BS; David Fernandes-Cabral, MD; Georgios Zenonos, MD; Garret Choby, MD; Amanda Stapleton, MD; Eric W Wang, MD; Carl Snyderman, MD, MBA; Paul Gardner, MD; Michael M McDowell, MD; University of Pittsburgh Medical 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 2000-2022.
Results: Twenty-two patients with a median age of 6.3 years (range 2 to 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- < 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.
Conclusions: 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.