Endoscopic Sinonasal Meningoencephalocele Repair

Rawal, Rounak B.; Sreenath, Satyan B.; Ebert, Charles S.; Huang, Benjamin; Dugar, Deepak R.; Ewend, Matthew G.; Sasaki‐Adams, Deanna; Senior, Brent A.; Zanation, Adam M.

doi:10.1177/0194599814561437

Cited by 22 publications

(16 citation statements)

References 59 publications

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“…Characteristically, if meningoencephaloceles present with CSF leaks, they should be emergently managed to reduce the incidence of meningitis and seizures. 5 The mainstay operative management of meningoencephaloceles includes an open craniotomy with a pericranial flap or an alternative approach using a nasal septal flap via an endoscopic endonasal method. 5 Although open craniotomy is the traditional management of this condition, it is associated with over a 20% complication rate to the anterior skull base, including CSF leak, meningitis, intracranial hemorrhage, and pneumocephalus.…”

Section: Discussionmentioning

confidence: 99%

“…5 The mainstay operative management of meningoencephaloceles includes an open craniotomy with a pericranial flap or an alternative approach using a nasal septal flap via an endoscopic endonasal method. 5 Although open craniotomy is the traditional management of this condition, it is associated with over a 20% complication rate to the anterior skull base, including CSF leak, meningitis, intracranial hemorrhage, and pneumocephalus. 4 In adults, an endoscopic endonasal approach has been widely adopted, with successful closure rates of over 90%.…”

Section: Discussionmentioning

confidence: 99%

“…4 Accordingly, a study by Rawal et al found that an endoscopic method had an 11.3% complication rate, with the most common manifestation being meningitis in 3% of their patients. 5 Yet, the researchers still believe that an endoscopic endonasal approach is an excellent method that provides a less invasive solution and can be considered a primary treatment approach.…”

Section: Discussionmentioning

confidence: 99%

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An Endoscopic Endonasal Attempt at Pediatric Meningoencephalocele Repair

2023

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Meningoencephalocele is an abnormal skull base protrusion of fluid, brain tissue, and meninges that can lead to nasal obstruction, meningitis, and Cerebrospinal Fluid (CSF) rhinorrhea. This condition can be managed operatively through an open craniotomy or a less invasive endoscopic approach. Here, we report a case of an 18-month-old female who presented with a meningoencephalocele that was part of the Sakoda complex, a rare neurosurgical phenomenon consisting of meningoencephalocele, agenesis of the corpus callosum, and cleft lip/palate. The patient was initially treated with the endoscopic transsphenoidal approach with subsequent open craniotomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Endoscopic Endonasal Attempt at Pediatric Meningoencephalocele Repair

2023

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“…The success rate for endoscopic repair of lateral recess leaks varies between 60% and 100% [6,[12][13][14]. Recurrence of these defects has been estimated to occur in 20% of the cases [15]. Therefore, follow-up is critical to detect recurrent leakage.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal Numbness After Intracranial Repair of a Spontaneous Meningoencephalocele of the Lateral Wall of the Sphenoid Sinus

Jesús¹,

Pagán-Rodríguez²,

Quiñones³

et al. 2021

Cureus

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A 58-year-old female with an eight-year history of rhinorrhea and a two-day history of subjective fever, chills, and vomiting presented to the emergency department for neurosurgical evaluation. Brain MRI demonstrated herniation of the meninges and portions of the inferomedial right temporal lobe through a defect of the lateral wall of the right sphenoid sinus, extending to the sphenoethmoidal recess and posterior right ethmoid air cells. A right pterional craniotomy was performed where the herniated part of the right temporal lobe, and its associated meninges, were excised. After surgery, she had hypoesthesia at the right maxillary division of the trigeminal nerve. This finding was caused by the proximity of the trigeminal nerve to the dural dissection that we performed at the bone defect. This rare complication has never been described after intracranial surgery. Only eight literature reports have described hypoesthesia or paresthesia of the trigeminal nerve after endoscopic resection of a sphenoid sinus meningoencephalocele. The patient has not had any recurrence of rhinorrhea after a six-month follow-up period.

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“…Имеются публикации, в которых проанализированы серии случаев лечения назальной ликвореи разной этиологии. Авторы этих публикаций приводят данные о размерах дефектов, но не анализируют отдельно эффективность пластики крупных дефектов (только серии в целом) [23,24]. Мы представляем ретроспективный анализ 30 случаев пластики именно крупных дефектов (>15 мм) различной этиологии.…”

Section: таблица 1 клинико-демографическая характеристика пациентов перенесших пластику крупных дефектов основания черепаunclassified

Endoscopic skull base reconstruction of large defects: retrospective analysis of 30 cases

Shelesko

Chernikova

Кравчук

et al. 2021

Nejrohirurgiâ (Mosk.)

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Background. Endoscopic skull base reconstruction of large defects is a difficult issue in neurosurgery, as there are problems associated with a wide dural resection, intra-arachnoid dissection (due to removal of the meningocele or resection of an intracranially spreading tumor), and exposure to high-flow cerebrospinal fluid within the cisterns. But perhaps the most significant influence is the larger nonvascularized reconstructive bed – cerebrospinal fluid on one side and sinus cavity (air) on the other.The study objective is to analyze our own experience in treating patients with large defects of the skull base and, based on the results obtained, to optimize the method of reconstruction.Materials and methods. A retrospective analysis of 30 cases of reconstruction of large defects of skull base of various etiologies. The results of surgery in the early and late postoperative period were evaluated. Statistical analysis was carried out using the exact Fisher criterion and the analysis of arbitrary contingency tables using the chi-square criterion. A literature review was conducted to compare the data obtained with the results of other studies.Results. In the group of patients (n = 16) for whom reconstruction was performed only with free transplants the effectiveness of reconstruction was 75 %. In the group of patients (n = 14) who underwent the last stage of reconstruction using a vascularized pedicled nasoseptal flap, the plastic surgery efficiency was 100 %. According to statistical analysis, there is a relationship between the choice of transplant type and the multilayer technique (p <0.05). The use of lumbar drainage did not affect the recurrence of cerebrospinal fluid leak in the postoperative period (p >0.05).Conclusion. Endoscopic skull base reconstruction can be effectively used for defects of the skull base >1.5 cm. When choosing the technique of reconstruction of large defects of the skull base, preference should be given to multilayer plastic using vascularized flaps. The use of lumbar drainage for reconstruction of large defects is a justified method in the case of a clear definition of indications for its use, based on a comparison of the possible benefits and risks associated with the invasiveness of the method.

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Endoscopic Sinonasal Meningoencephalocele Repair

Abstract: Endoscopic sinonasal meningoencephalocele repair has excellent long-term results and may be considered as a primary approach. Surgeon comfort with a particular technique should be the most important factor used to guide choice of reconstruction.

Cited by 22 publications

References 59 publications

An Endoscopic Endonasal Attempt at Pediatric Meningoencephalocele Repair

An Endoscopic Endonasal Attempt at Pediatric Meningoencephalocele Repair

Trigeminal Numbness After Intracranial Repair of a Spontaneous Meningoencephalocele of the Lateral Wall of the Sphenoid Sinus

Endoscopic skull base reconstruction of large defects: retrospective analysis of 30 cases

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