Endoscopic management of congenital nasal meningoencephaloceles: a short series of 15 paediatric cases
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ORIGINAL ARTICLE
Endoscopic management of congenital nasal meningoencephaloceles: a short series of 15 paediatric cases Satyawati Mohindra 1 & Sandeep Mohindra 2 & Shaurya Mahendru 3 & Ninad R. Patil 2 Received: 4 November 2019 / Accepted: 27 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To retrospectively analyse surgical management of clinico-radiologically proven nasal meningoencephalocele amongst children and results of repair with single-layer septo-mucosal flap at a tertiary skull base surgery centre in north India. Methods Fifteen children with clinic-radiological nasal meningoencephaloceles with or without CSF rhinorrhoea were included. Radiological scans included CT scans and MRI scans for all cases to delineate soft tissue and bony architecture. All children underwent endoscopic excision of encephaloceles and repair of the skull base defect. Results The authors were successful in fourteen cases. Successful cases included 4 children less than 6 months of age who underwent single-layer rotated septo-mucosal flaps, thereby avoiding donor site morbidity. Conclusion As endoscopic excision of nasal encephalocele is an established management approach, the authors take the concept of minimally invasive surgery a step further by successfully managing these lesions with single-layer repair. Vascularized septomucosal flap seems to be the only determining factor for a successful repair for congenital meningoencephalocele. However, a prospective study comprising a larger subset of patients would substantiate the assumption. Keywords Single layer . Encephalocele . Endoscope . Children
Presentation at a meeting nil
Introduction A nasal meningoencephalocele is a congenital herniation of meningeal tissue along with brain parenchyma through a defect in the skull base and may present as a mass or polyp-like lesion in the nasal cavity. If ruptured, it may present as CSF rhinorrhoea. Congenital meningoencephalocele is a rare lesion and affects 1 in 35,000 live births [1], though commoner amongst Asians (1 in 6000 live births) [2]. Surgical repair remains the management of choice and endoscopic route is the preferred option, thus avoiding complications of
* Sandeep Mohindra [email protected] 1
Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3
Dayanand Medical College and Hospital, Ludhiana, Punjab, India
craniotomy, inherent blood loss and facial incisions [3–7]. Endoscopic approach also avoids interference with the growth centres as there is no manipulation of facial bones [8, 9]. The present communication includes a series of 15 children with congenital nasal meningoencephaloceles, managed endoscopically.
Subjects and methods Over a period of 6 years (from January 2013 to January 2019), a u t h o r s d i a g no s e d 15 c a s e s o f c o n g e ni t al n as a l meningoencephaloceles
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