Figure - available from: Child's Nervous System
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a Encephalocele sac being cauterized at the origin near the roof of the nasal cavity. b Sac being excised, leaving a small stump at the origin. c Excised encephalocele sac. d Right septo-mucosal flap being harvested with the help of a knife. e Rotated septo-mucosal flap covering the excised encephalocele area. White canula is smearing fibrin glue
Source publication
PurposeTo 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 rhinorr...
Citations
... Так, S. Mohindra и соавт. сообщают об успешном удалении ЭЦ эндоскопическим эндоназальным доступом у 15 детей, возраст младшего из которых составлял 21 день [22]. Другие авторы указывают на необходимость отложить оперативное вмешательство на 6-12 мес, чтобы обеспечить достаточный рост ПН [23][24][25]. ...
Encephalocele or craniocerebral hernia is a disease in which there is a prolapse of the meninges and structures of the brain through a skull defect. Clinically, they are manifested by a violation of nasal breathing, deformation of the naso‑ethmoid region, and nasal liquorrhea. Various inflammatory complications (meningitis, meningoencephalitis, ventriculitis, brain abscess) can occur against the background of persistent hernia, while mortality is 8–10 %.
Basal encephalocele is a rare pathology that requires an integrated approach in a specialized hospital using high‑tech equipment. Therapeutic tactics and risks are determined individually based on the patient’s age, current symptoms, size of the nasal cavity, location and size of the skull base defect. In the absence of nasal liquorrhea, it is possible to delay surgical treatment in order to be able to use an autologous bone of the calvarium, to collect a larger periosteal flap, to perform the operation using a combined approach and to minimize surgical complications. With endonasal endoscopic access, it is necessary to separate the encephalocele from the surrounding tissues, completely remove the hernial sac and visualize the bone edges of the defect, and then perform its plastic closure.
Despite the fact that in most cases the existing methods of treatment are very effective, in a number of cases it is not possible to achieve the desired result. This article presents two rare clinical cases in which patients with basal encephalocele required reoperation for herniation and skull base defect repair.
Objective
To review surgical techniques used in the endoscopic transnasal repair of pediatric basal meningoencephaloceles and compare perioperative outcomes in children <2 and ≥2 years old.
Data Sources
MEDLINE, EMBASE, and CENTRAL.
Review Methods
Data sources were searched from inception to August 22, 2022, using search terms relevant to endoscopic transnasal meningoencephalocele repair in children. Reviews and Meta‐analyses were excluded. Primary outcomes were the incidence of intraoperative and postoperative complications, including cerebrospinal fluid leak, recurrence, and reintervention. Quality assessments were performed using Newcastle‐Ottawa Scale, ROBIN‐I, and NIH.
Results
Overall, 217 patients across 61 studies were identified. The median age at surgery was 4 years (0‐18 years). Fifty percent were female; 31% were <2 years. Most defects were meningoencephaloceles (56%), located transethmoidal (80%), and of congenital origin (83%). Seventy‐five percent of repairs were multilayered. Children ≥2 years underwent multilayer repairs more frequently than those <2 years ( P = 0.004). Children <2 years more frequently experienced postoperative cerebrospinal fluid leaks ( P = 0.02), meningoencephalocele recurrence ( P < 0.0001), and surgical reintervention ( P = 0.005). Following multilayer repair, children <2 years were more likely to experience recurrence ( P = 0.0001) and reintervention ( P = 0.006).
Conclusion
Younger children with basal meningoencephaloceles appear to be at greater risk of postoperative complications following endoscopic endonasal repair, although the quality of available evidence is weakened by incomplete reporting. In the absence of preoperative cerebrospinal fluid leak or meningitis, it may be preferable to delay surgery as access is more conducive to successful repair in older children.
Infections, especially those of a viral nature, and allergies are the most prevalent causes of nasal blockage and runny nose in babies and children. Nasal obstruction is often associated with viral upper respiratory tract infections (URTI) in newborns and babies. Nasal saline irrigation is thought to aid with URTI symptoms by clearing out any extra mucus, decreasing congestion, and allowing for easier breathing. According to the available research, nasal saline irrigation is very effective in relieving the symptoms of allergic rhinitis and acute sinusitis in children. Little information is recorded on the use of medical equipment. As compared to a control group treated with physiological saline solution alone, patients who underwent nasal aspiration with a medical device while experiencing viral rhinitis had a significantly reduced chance of developing acute otitis media and rhinosinusitis [1].KeywordsNasal congestionNewbornInfectionAllergyBreathing
Basal meningoencephalocele is a rare pathology that occurs due to the prolapse of meninges and brain tissues through a bone defect in the skull base. Treatment of patients with this pathology consists in the removal of the meningoencephalocele, followed by plasty of the skull base defect. One of the ways to close defects of the skull base is to use vascularized flaps. Vascularized flaps are the method of choice of plastic material in adults, however, in pediatric practice, there is insufficient data on the effectiveness and safety of their use. Purpose: to assess the effectiveness and safety of the use of vascularized flaps in the removal of meningoencephalocele, as well as to clarify the indications for their use in pediatric practice Material and methods. A retrospective analysis of a series of patients with basal meningoencephalocele aged 0 to 18 years, operated from 2008 to 2020. Comparison of two groups, divided according to the types of methods used for plastics of skull base defects, has been carried out. Results. There was a statistically significant difference in the groups for the localization of defects (p = 0.048), complaints in the postoperative period for pain in the wound on the left hip (p < 0.001). There was no statistically significant difference in the groups in terms of the size of the defect (p = 1), the frequency of using lumbar drainage (p = 0.141), the duration of surgery (p = 0.2), and blood loss (p = 0.248). Conclusions. Vascularized flaps are effective for plasty of the skull base defect in children in the removal of meningoencephalocele. The safety of using flaps intraoperatively and in the early postoperative period has been proved. The question of the long-term results and the influence of the formation of a vascularized flap on the structures of the facial skeleton remains unstudied. When planning the elimination of meningoencephalocele in children and the choice of plastic material, it is necessary to take into account the localization of the fistula.
