Endonasal Management of Skull Base Defects: Meningoceles and Meningoencephaloceles
Article Sidebar
Main Article Content
Abstract
Introduction
Meningoceles and menigoencephaloceles result from herniation of the meninges, with or without brain tissue, through defects in the skull base.
Objectives: To determine the success rate of skull base repair for meningoceles and menigoencephaloceles using an endonasal approach assisted by endoscopes, and to establish an algorithm for the preoperative topographic diagnosis of these lesions.
Methods: Patients treated for skull base meningoceles and menigoencephaloceles using anendonasal approach assisted by endoscopes between January 2010 and March 2024 wereincluded. Reconstruction of the defect was performed using a multilayer technique withautologous grafts and local flaps.
Results: Ten patients were treated: nine with meningoceles and one with a meningoencephalocele. Three were located in the sphenoid sinus, six in the cribriform plate of the ethmoid bone, and one in the frontal sinus.
The success rate we achieved in repairing the skull base defect was 90%.
Conclusions: The success rate we achieved in repairing skull base defects caused by meningoceles and meningoencephaloceles using an endonasal approach was
90%.
Computed tomography and contrast-enhanced magnetic resonance imaging (MRI) with a protocol to visualize the olfactory bulb were very useful in diagnosing the site of the lesions at the level of the cribriform plate of the ethmoid bone.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
How to Cite
References
Chan JW. Current concepts and strategies in the diagnosis and management of idiopathic intracranial hypertension in adults. J Neurol. 2017;264(8):1622-1633. DOI: https://doi.org/10.1007/s00415-017-8401-7
Berdahl JP, Fleischman D, Zaydlarova J, et al. Body mass index has a linear relationship with cerebrospinal fluid pressure. Invest Ophthalmol Vis Sci. 2012;53(3):1422-1427. DOI: https://doi.org/10.1167/iovs.11-8220
Bakhsheshian J, Hwang MS, Friedman M. Association between obstructive sleep apnea and spontaneous cerebrospinal fluid leaks: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2015;141(8):733-788. DOI: https://doi.org/10.1001/jamaoto.2015.1128
Satti SR, Leishangthem L, Chaudry MI. Meta-analysis of CSF diversion procedures and dural venous sinus stenting in the setting of medically refractory idiopathic intracranial hypertension. AJNR Am J Neuroradiol. 2015;36(10):1899-1904. DOI: https://doi.org/10.3174/ajnr.A4377
Englhard AS, Volgger V, Leunig A, et al. Spontaneous nasal cerebrospinal fluid leaks: management of 24 patients over 11 years. Eur Arch Otorhinolaryngol. 2018;275(10):2487-2494. DOI: https://doi.org/10.1007/s00405-018-5089-y
Barañano CF, Curé J, Palmer JN, et al. Sternberg’s canal: fact or fiction? Am J Rhinol Allergy. 2009;23:167-171. DOI: https://doi.org/10.2500/ajra.2009.23.3290
Illing E, Schlosser RJ, Palmer JN, et al. Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg's canal. Int Forum Allergy Rhinol. 2014;4(3):246-250. DOI: https://doi.org/10.1002/alr.21262
Dallan I, Cambi C, Emanuelli E, et al. Multiple spontaneous skull base cerebrospinal fluid leaks: some insights from an international retrospective collaborative study. Eur Arch Otorhinolaryngol. 2020;277(12):3357-3363. Errata en: Eur Arch Otorhinolaryngol. 2020;277(12):3365. DOI: https://doi.org/10.1007/s00405-020-06227-w
Cárdenas Fernández MC, Gimeno Hernández J, Lombardía González C, et al. Utilidad de la β2-transferrina y la proteína β-traza en el diagnóstico de fístula de líquido cefalorraquídeo. Rev Lab Clín. 2017;10(2):173-179. DOI: https://doi.org/10.1016/j.labcli.2017.06.006
Georgalas C, Oostra A, Ahmed S, et al. International consensus statement: spontaneous cerebrospinal fluid rhinorrhea. Int Forum Allergy Rhinol. 2021;11(4):794-803. DOI: https://doi.org/10.1002/alr.22704
Risch L, Lisec I, Jutzi M, et al. Rapid, accurate and non-invasive detection of cerebrospinal fluid leakage using combined determination of beta-trace protein in secretion and serum. Clin Chim Acta. 2005;351(1-2):169-176. DOI: https://doi.org/10.1016/j.cccn.2004.09.008
Yasuda E, González Abbati S, Recalde R, et al. ¿Es posible diferenciar líquido cefalorraquídeo de otras secreciones? Utilidad de la proteína Beta Trace como biomarcador de fístulas de líquido. Rev Argent Neuroc. 2018;32(4):217-221.
Pool CD, Patel VA, Schilling A, et al. Economic implications of localization strategies for cerebrospinal fluid rhinorrhea. Int Forum Allergy Rhinol.2020;10:419-425. DOI: https://doi.org/10.1002/alr.22501
Oakley GM, Alt JA, Schlosser RJ, et al. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2016;6(1):8-16. DOI: https://doi.org/10.1002/alr.21637
Kwee RM, Kwee TC. Systematic review and meta-analysis of MRI signs for diagnosis of idiopathic intracranial hypertension. Eur J Radiol. 2019;116:106-115. DOI: https://doi.org/10.1016/j.ejrad.2019.04.023
Allensworth JJ, Rowan NR, Storck KA, et al. Endoscopic repair of spontaneous skull base defects decreases the incidence rate of intracranial complications. Int Forum Allergy Rhinol. 2019;9(10):1089-1096. DOI: https://doi.org/10.1002/alr.22399
Locatelli D, Rampa F, Acchiardi I, et al. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience. Neurosurgery. 2006;58(4 Suppl 2):ONS-246-56; discussion ONS-256-7. DOI: https://doi.org/10.1227/01.NEU.0000193924.65297.3F
Mughal Z, Martinez-Devesa P, Boukas A, et al. Contemporary management of cerebrospinal fluid rhinorrhoea: a review of the literature. J Clin Med. 2025;14(3):995. DOI: https://doi.org/10.3390/jcm14030995
Albu S, Emanuelli E, Trombitas V, et al. Effectiveness of lumbar drains on recurrence rates in endoscopic surgery of cerebrospinal fluid leaks. Am J Rhinol Allergy. 2013;27(6):e190-194. DOI: https://doi.org/10.2500/ajra.2013.27.3986
Adams AS, Russell PT, Duncavage JA, et al. Outcomes of endoscopic repair of cerebrospinal fluid rhinorrhea without lumbar drains. Am J Rhinol Allergy. 2016;30(6):424-429. DOI: https://doi.org/10.2500/ajra.2016.30.4371
Ahmed OH, Marcus S, Tauber JR, et al. Efficacy of perioperative lumbar drainage following endonasal endoscopic cerebrospinal fluid leak repair. Otolaryngol Head Neck Surg. 2017;156(1):52-60. DOI: https://doi.org/10.1177/0194599816670370
Komotar RJ, Starke RM, Raper DM, et al. Endoscopic endonasal versus open repair of anterior skull base CSF leak, meningocele, and encephalocele: a systematic review of outcomes. J Neurol Surg A Cent Eur Neurosurg. 2013;74(4):239-250. DOI: https://doi.org/10.1055/s-0032-1325636
Zweig JL, Carrau RL, Celin SE, et al. Endoscopic repair of acquired encephaloceles, meningoceles, and meningo-encephaloceles: predictors of success. Skull Base. 2002;12(3):133-139. DOI: https://doi.org/10.1055/s-2002-33459
Kapitanov DN, Shelesko EV, Potapov AA, et al. [Endoscopic endonasal diagnosis and treatment of skull base meningoencephalocele]. Zh Vopr Neirokhir Im N N Burdenko. 2017;81(2):38-47. DOI: https://doi.org/10.17116/neiro201781238-47
Schuman TA, Senior BA. Long-term management and outcomes after repair of cerebrospinal fluid rhinorrhea related to idiopathic intracranial hypertension. Curr Opin Otolaryngol Head Neck Surg. 2018;26(1):46-51. DOI: https://doi.org/10.1097/MOO.0000000000000424