Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-
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CASE REPORT
Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant Hazan Başak 1 & Gökmen Kahiloğulları 2 & Tuğba Moralı Güler 3 & Emre Yağız Sayacı 2 & Volkan Etuş 4 & Cem Meço 1,5 Received: 6 February 2020 / Accepted: 30 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Endonasal endoscopic approach (EEA) has become a routine and effective method for the management of large skull base defects in adults and increasingly in older pediatric populations despite their challenging narrow transnasal corridors. To our knowledge, this is the first report in the literature of a large craniopharyngeal canal (CC) meningoencephalocele in a 6-month-old infant managed purely through EEA, also by utilizing a pedicled nasoseptal flap (PNF). Keywords Endonasal . Endoscopy . Meningoencephalocele . Craniopharygeal canal . Infant
Introduction Congenital meningoencephaloceles are rare malformations, occurring in 1/3000–5000 births. Anterior skull base meningoencephaloceles are basically intracranial content herniations into the nasal cavity through a bony defect [3, 8], which could present with cerebrospinal fluid (CSF) leakagerelated complications, but in large ones the only symptom could be nasal obstruction, snoring, and apnea which requires a detailed examination for early diagnosis [3, 6, 8]. Meningoencephaloceles are classified into two types: frontoethmoidal and basal. Basal meningoencephaloceles are divided into subgroups: frontosphenoidal, transethmoidal, sphenoethmoidal, and transsphenoidal [6]. Craniopharyngeal canal is a rare bone defect in the transsphenoidal region, extending from the sellar floor through the sphenoid bone to the
anterosuperior part of the nasopharyngeal roof. CC defects were classified into three types: type 1, with incidental radiological finding; type 2, with adenohypophysis protruding through the canal; and type 3 was further divided into three subtypes: type 3A, with encephalocele; type 3B, with tumor; and type 3C, with both encephalocele and tumor [1]. Recent studies showed that EEA is an effective and safe method for skull base reconstruction in pediatric populations and some case reports/series even demonstrated successful outcomes of meningoencephaloceles but rather for transethmoidal ones [3, 5, 12]. This case report presents the first case of a 6-month-old infant with type 3A CC meningoencephalocele that was successfully managed purely through EEA with a 4-mm endoscope, which was resected and reconstructed using endoscopic multilayer techniques, among them also utilizing a PNF across the very narrow nasal corridors of the infant.
* Gökmen Kahiloğulları [email protected] 1
Department of Otolaryngology, Head and Neck Surgery, Ankara University, Sihhiye, Ankara, Turkey
2
Department of Neurosurgery, Ankara University, Sihhiye, 06100 Ankara, Turkey
3
Department of Neurosurgery, Karabuk University, Karabuk, Turkey
4
Department of Neurosurgery, Kocaeli University, Kocaeli, Turk
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