Endoscopic repair of a rare basioccipital meningocele associated with recurrent meningitis.

Anatomical variants of the basiocciput are uncommon and usually clinically benign. While the majority remain undetected, these anomalies rarely manifest as CSF rhinorrhea or recurrent meningitis associated with meningocele. Compromise of the leptomeninges provides an avenue of ingress for pathological organisms and can lead to recurrent meningitis, necessitating operative repair of the defect to prevent infection. A review of the literature reveals only 3 cases in which a congenital basioccipital defect has been associated with a meningocele requiring surgical repair. The authors present a case of recurrent meningitis in an infant with a congenital basioccipital meningocele treated with a minimally invasive endoscopic technique. At the 2-year follow-up the repair remained successful, with no evidence of recurrence of the meningocele or CSF infection. The literature regarding the etiology and treatment of these lesions was reviewed, with an emphasis on the safety and efficacy of the endoscopic approach. Note that recurrent meningitis in the setting of a skull base defect may indicate the presence of other congenital anomalies that will necessitate multidisciplinary care for a patient's long-term well-being.

Pediatric skull base surgery. 1. Embryology and developmental anatomy.

Surgical pathology of the pediatric cranial base is uncommon, but in affected children, traditional operative techniques and management philosophies predominate. While the creation of multidisciplinary skull base teams synergistically pools the talents of individual specialties, a better understanding of the developmental anatomy of the cranial base becomes essential in order for such teams to safely implement these approaches in children. The extant neurosurgical literature lacks a comprehensive review of this anatomy. This report discusses the developmental anatomy and embryology of the cranial base within the context of specific surgical approaches. Detailed development of the calvaria, midface skeleton and orbit is excluded.

Pediatric skull base surgery. 2. Experience and outcomes in 55 patients.

In the second of these two articles, we will discuss our clinical experience with skull base surgery in the pediatric population. We present a retrospective analysis of 55 patients less than 16 years of age who underwent skull base surgical approaches at the Primary Children's Medical Center or the University of Utah Medical Center between January 1992 and April 1999. There were 30 boys and 25 girls (mean age 9.8 years). Patient follow-up averaged 58 months. Most patients had pathology that required either an anterior or anterolateral approach; 6 patients underwent a far-lateral or a transpetrosal exposure. Thirty-five procedures were performed by a neurosurgeon, a pediatric otolaryngologist performed 11 procedures, and 10 procedures were performed by both services together. Ninety-six percent of patients (n = 53) had a Glasgow Outcome Score of 4 or 5. Complications included 4 sustained cranial nerve palsies and 2 hemipareses. There were no CSF leaks, infections or deaths. Patients with sellar region pathology had a disproportionately higher incidence of postoperative morbidity. We conclude that in selected pediatric cases, skull base surgical techniques can be performed effectively and safely with the use of multidisciplinary teams. To implement these techniques, knowledge of their limitations and of the anatomical differences between the adult and pediatric cranial base is essential.