Treatment of anterior skull base defects by a transnasal endoscopic approach in children

Journal of Neurosurgery: Pediatrics, Volume 6, Issue 5, Page 459-463, November 2010.

Federico Di Rocco, M.D., Vincent Couloigner, M.D., Patricia Dastoli, M.D., Christian Sainte-Rose, M.D., Michel Zerah, M.D., and Gilles Roger, M.D.

Object

The object of this study was to assess the efficacy and complications of endoscopic management of anterior skull base defects.

Method

The authors reviewed the medical records of 28 children (20 boys and 8 girls) undergoing endoscopic repair of anterior skull base defects in their tertiary referral center between 2001 and 2008; 18 cases were congenital and 10 cases posttraumatic. During the endoscopic procedure, rigid telescopes—2.7 or 4 mm in diameter, with 0° or 30° lenses—were used. In 23 patients the anterior skull base defect was sealed with fragments of middle turbinate (bone and mucosa). In the remaining 5 patients it was sealed with cartilage harvested from the nasal septum (3 cases) or from the auricle (2 cases), fibrin glue, and oxidized cellulose. A combined external and endoscopic approach was required in 3 cases because of the size and extensions of the encephalocele. Outcome was primarily assessed by means of clinical examination, nasal fibroscopy, and imaging.

Results

The mean duration of follow-up was 26.7 months (range 9–57 months). One patient treated by a combined approach died of meningitis 2 years after surgery. In the remaining 27 patients, there was no recurrence of CSF leak, meningitis, or encephalocele. An iatrogenic frontal or ethmoidal mucocele was observed in 4 cases.

Conclusions

The endoscopic approach is a minimally invasive, safe, and efficient technique for removing nasal encephaloceles in children.