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Pediatric Otolaryngology

(174) Endoscopic Endonasal Management of Meningoencephaloceles in Children: A Systematic Review

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Nikolaus E. Wolter, MD, MSc, FRCSC, FACS

    Otolaryngologist
    Department of Otolaryngology – Head and Neck Surgery, Hospital for Sick Children, University of Toronto
    Toronto, ON, Canada

    • Co-Author(s)

  • Alyssa Y. Li, BA

    Medical Student
    Department of Otolaryngology – Head and Neck Surgery, Hospital for Sick Children, University of Toronto
    Toronto, Ontario, Canada

    • Co-Author(s)

  • KG

    Karolina Gaebe, BMath

    Medical Student
    University of Toronto
    Toronto, Ontario, Canada

  • AV

    Allan Vescan, MD, MSc

    Department of Otolaryngology – Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, USA

  • AJ

    Adrian L. James, MA, DM

    Professor
    Department of Otolaryngology – Head and Neck Surgery, Hospital for Sick Children, University of Toronto
    Toronto, Ontario, Canada

    • Senior Author(s)

  • Nikolaus E. Wolter, MD, MSc, FRCSC, FACS

    Otolaryngologist
    Department of Otolaryngology – Head and Neck Surgery, Hospital for Sick Children, University of Toronto
    Toronto, ON, Canada

Disclosure(s):
Karolina Gaebe, BMath: No relevant relationships to disclose.
Adrian L. James, MA, DM: No relevant relationships to disclose.


Introduction: Basal meningoencephaloceles are rare skull base defects with herniation of meninges, cerebrospinal fluid (CSF), and brain tissue that manifest with serious complications, including meningitis, CSF rhinorrhea, and nasal obstruction. This systematic review aims to describe the landscape of pediatric endoscopic meningoencephalocele repair, which has emerged as a less morbid alternative to open surgical approaches, and illustrate some of the unique peri-/postoperative challenges encountered in caring for children with meningoencephaloceles.

Methods: Records were identified in MEDLINE, EMBASE, CENTRAL, and grey literature from database inception to August 1, 2022. Studies describing operative techniques and peri-/postoperative outcomes of endoscopic endonasal basal meningoencephalocele repair in children were selected. Study type, patient demographics, and surgical interventions were extracted and summarized in narrative descriptions. Outcomes of interest included the incidence of peri-/postoperative complications, meningoencephalocele recurrence, and revision surgery.

Results: Overall, 89 patients (67 with meningoencephaloceles, 22 with meningoceles) across 33 studies underwent endoscopic endonasal repair. Median age was 5.0 years. 32% of patients underwent surgery below age 2. Median postoperative follow-up was 10.0 months. 68% of patients underwent multilayer closure. Lumbar drains were inserted in 13% of patients. Nasal packing and postoperative antibiotics were used in 83% and 38% of patients, respectively. 2.2% of patients experienced significant postoperative complications, and an additional 2.2% developed recurrent meningoencephaloceles.

Conclusions: This systematic review demonstrates the significant variability in surgical techniques and postoperative outcomes in the repair of meningoencephaloceles in children. While endoscopic repair of meningoencephaloceles is feasible in children, ongoing studies with meaningful, long-term follow-up data are required to help guide clinical decision-making.