Endoscopic endonasal approaches to anterior skull base defects in pediatric patients.

INTRODUCTION: We studied 12 pediatric patients with congenital or acquired anterior skull base defects. All subjects underwent surgery owing to progressive symptoms. The endoscopic endonasal approach is a new method in the treatment of this pathology in children. MATERIALS AND METHODS: Twelve children had surgery to correct anterior skull base defects: seven patients with a spontaneous anterior basal meningoencephalocele and five with posttraumatic cerebrospinal fluid (CSF) leakage. The defects were repaired using the endoscopic endonasal approach, which combined with the fluorescein diagnostic test, detects the exact location of the skull base defect. Different closure techniques were used to obtain a permanent graft, depending on the type, location, and size of the defect. An intraoperative fluorescein test confirmed the absence of CSF leakage after surgery. RESULTS: The follow-up period ranged from 3 to 72 months. Symptoms resolved in all patients after surgery and none of them experienced complications or recurrence of CSF leakage. Postoperative magnetic resonance scans showed that the defect had successfully been repaired in all patients. DISCUSSION: The surgical treatment of skull base defects in children reduces life-threatening risks, which include infections, CSF leaks, and enlargement or trauma of the sac. The endoscopic technique minimizes surgical scars and has little impact on brain tissue. The endoscopic endonasal approach to the anterior skull base helps to preserve the physiology of the nose and sinuses and reduces the impact on the still developing splanchnocranium in pediatric patients. It ensures a definitive repair of the defect and requires a very short inpatient period.

Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience.

OBJECTIVE: To describe surgical endoscopic experience in the repair of cerebrospinal fluid leaks treated by transnasal approaches. METHODS: Different surgical approaches and techniques in the repair of cranial base defects are reviewed in a series of 135 patients. RESULTS: Success rate at first attempt was 93.3%. Only 9 patients (6.7%) needed a second surgical repair, and in one patient, a coronal approach with frontal craniotomy was necessary. In the other eight cases, an endoscopic procedure was chosen. Two patients needed a third endonasal endoscopic surgical repair, with successful outcome. CONCLUSION: The target of endoscopic endonasal technique in the repair of cerebrospinal fluid leaks is to ensure a stable duraplasty with the least invasive approach avoiding craniotomy. A correct diagnosis surely allows the choice of the best treatment, surgical approach, graft, and technique. Our multidisciplinary approach to this pathology during these years has been essential to gain our challenging results.