Abstract
Purpose
The diagnosis and management of pediatric cerebrospinal fluid (CSF) leak and encephalocele are challenging. The current study aimed to identify patient characteristics, review operative techniques, and evaluate the efficacy and safety of endoscopic endonasal repair in a pediatric population.
Methods
We retrospectively reviewed the records of pediatric patients who underwent transnasal endoscopic repair of CSF leak with or without a meningocele or an encephalocele at Beijing Tongren Hospital, Capital Medical University, between July 2003 and May 2014. All patients had preoperative radiological evaluations and underwent endoscopic endonasal repair of their skull base defects.
Results
Altogether, 23 children (mean age 7.0 years) underwent the procedures. Sixteen cases were congenital, and 7 patients had trauma history. The herniations or defects included meningoencephaloceles in 15 cases, meningoceles in 4 cases, and CSF leak in 4 cases (2 patients had bilateral leaks). The leak or herniation sites were ethmoid roof in 10 patients (one was bilateral), cribriform plate in 5, lateral to the foramen cecum in 3, posterior wall of the frontal sinus in 1, sphenoid sinus in 2, lateral recess of the sphenoid sinus in 1, and sella turcica base in 2. All subjects had favorable clinical outcomes without recurrence during a follow-up of 6–123 months (mean 61.1 months).
Conclusions
The endoscopic endonasal approach was the preferred method for repairing CSF leaks with or without an encephalocele in pediatric patients. Compared to traditional operations, this endoscopic procedure is minimally invasive, efficient, and safe.
Similar content being viewed by others
References
Aarabi B, Leibrock LG (1992) Neurosurgical approaches to cerebrospinal fluid rhinorrhea. Ear Nose Throat J 71:300–305
Abdel-Aziz M, EI-Bosraty H, Qotb M, EI-Sonbaty M, Abdel-Badie H, Zynabdeen M (2010) Nasal encephalocele: endoscopic excision with anesthetic consideration. Int J Pediatr Otorhinolaryngol 74:869–873
Blumenfeld R, Skolnik EM (1965) Intranasal encephaloceles. Arch Otolaryngol 82:527–531
Castelnuovo P, Dallan I, Pistochini A, Battaglia P, Locatelli D, Bignami M (2007) Endonasal endoscopic repair of Sternberg’s canal cerebrospinal fluid leaks. Laryngoscope 117:345–349
Di Rocco F, Couloigner V, Dastoli P, Sainte-Rose C, Zerah M, Roger G (2010) Treatment of anterior skull base defects by a transnasal endoscopic approach in children. J Neurosurg Pediatr 6:459–463
Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1882–1886
Kassam A, Thomas AJ, Snyderman C, Carrau R, Gardner P, Mintz A, Kanaan H, Horowitz M, Pollack IF (2007) Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 106:75–86
Locatelli D, Rampa F, Acchiardi I, Bignami M, Pistochini A, Casteknuovo P (2006) Endoscopic endonasal approaches to anterior skull base defects in pediatric patients. Childs Nerv Syst 22:1411–1418
Mahajan C, Rath GP, Dash HH, Bithal PK (2011) Perioperative management of children with encephalocele: an institutional experience. J Neurosurg Anesthesiol 23:352–356
Martínez-Lage JF, Pérez-Espejo MA, Palaózn JH, López Hernández F, Puerta P (2006) Autologous tissues for dural grafting in children: a report of 56 cases. Childs Nerv Syst 22:139–144
Papay FA, Benninger MS, Levine HL, Lavertu P (1989) Transnasal transseptal endoscopic repair of sphenoidal cerebral spinal fluid fistula. Otolaryngol Head Neck Surg 101:595–597
Prevedello DM, Barges-Coll J, Fernandez-Miranda JC, Morera V, Jacobson D, Madhok R, dos Santos MC, Zanation A, Snyderman CH, Gardner P, Kassam AB, Carrau R (2009) Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. Laryngoscope 119:2094–2098
Sautter NB, Batra PS, Citardi MJ (2008) Endoscopic management of sphenoid sinus cerebrospinal fluid leaks. Ann Otol Rhinol Laryngol 117:32–39
Steven RA, Rothera MP, Tang V, Bruce IA (2011) An unusual cause of nasal airway obstruction in a neonate: trans-sellar, trans-sphenoidal cephalocoele. J Laryngol Otol 125:1075–1078
Suwanwela C, Suwanwela N (1972) A morphological classification of sincipital encephalomeningoceles. J Neurosurg 36:201–211
Wormald PJ (2003) Salvage frontal sinus surgery: the endoscopic modified Lothrop procedure. Laryngoscope 113:276–283
Zhou B, Han DM, Cui SJ, Zhang JL, Huang Q, Xian JF, Zhang L, Wei YX (2007) Endoscopic transpterygoid intervention of meningoencephalocele within lateral recess of sphenoid. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 42:328–333, Chinese)
Conflict of interest
The authors declare that they have no competing interests .
Funding
This study was funded by the Capital Medical Development Foundation of China (No. 2009-1035).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ma, J., Huang, Q., Li, X. et al. Endoscopic transnasal repair of cerebrospinal fluid leaks with and without an encephalocele in pediatric patients: from infants to children. Childs Nerv Syst 31, 1493–1498 (2015). https://doi.org/10.1007/s00381-015-2746-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-015-2746-y