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Skull Base 2002; 12(3): 133-140
DOI: 10.1055/s-2002-33459
ORIGINAL ARTICLE

Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Endoscopic Repair of Acquired Encephaloceles, Meningoceles, and Meningo-Encephaloceles: Predictors of Success

Julie L. Zweig1 , Ricardo L. Carrau1 , Scott E. Celin1 , Carl H. Snyderman1 , Amin Kassam1 , Hassan Hegazy1
  • 1Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania
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Publikationsverlauf

Publikationsdatum:
21. August 2002 (online)

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ABSTRACT

Meningoceles, encephaloceles, and meningo-encephaloceles may develop through defects associated with congenital anomalies or through defects produced by tumor, trauma, or surgery. Their initial management, surgical indications, and repair techniques are not universally accepted. We undertook this study to compare the contributions of different surgical techniques and materials to the success of endoscopic repairs of acquired meningo-encephaloceles. We also examined whether characteristics of the patient, the meningo-encephalocele, or the adjunctive treatment influenced the outcome of the repair.

We retrospectively reviewed the clinical charts of all patients undergoing transnasal endoscopic repair of acquired meningo-encephaloceles at our academic hospitals. We encountered 17 patients with meningo-encephaloceles of the anterior fossa and parasellar area; 15 were repaired immediately using transnasal endoscopic techniques. Two persistent leaks associated with hydrocephalus were repaired during a second endoscopic attempt, which was rapidly followed by ventriculoperitoneal shunting. Location and size of the skull base defect, its etiology, and the technique and choice of material used for repair did not significantly affect surgical outcomes. However, the presence of hydrocephalus was significantly related to poor surgical outcomes.

KEYWORDS

Cerebrospinal fluid - endoscopic surgery - meningocele - encephalocele

REFERENCES

  • 1 Celin S. Contemporary diagnosis and management of anterior skull base cephalocele and cerebrospinal fluid leaks. In: Arriaga M, Diaz-Day J, eds. Neurosurgical Issues in Otolaryngology Philadelphia, PA: Lippincott Williams Wilkins; 1999
    Google Scholar
  • 2 Buchman C A, Civantos F J, Casiano R R. Skull base cerebrospinal fluid leaks and encephaloceles. In: Advances in Otolaryngology-Head and Neck Surgery Vol 13. St. Louis, MO: Mosby Inc; 1999
    Google Scholar
  • 3 Aarabi B, Leibrock L G. Neurosurgical approaches to cerebrospinal fluid rhinorrhea.  Ear Nose Throat . 1992;  71 300-305
    PubMedGoogle Scholar
  • 4 Hughes R, Jones N S, Roberton I J. The endoscopic treatment of cerebrospinal fluid rhinorrhea: the Nottingham experience.  J Laryngol Otol . 1977;  111 125-128
    PubMedGoogle Scholar
  • 5 Bernal-Sprekelsen M, Bleda-Vazquez C, Carrau R. Ascending meningitis secondary to traumatic cerebrospinal fluid leaks.  Am J Rhinol . 2000;  14 257-259
    CrossrefPubMedGoogle Scholar
  • 6 Anand V, Murali R K, Glasgold M J. Surgical decisions in the management of cerebrospinal fluid rhinorrhea.  Am J Rhinol . 1995;  33 212-218
    PubMedGoogle Scholar
  • 7 Stankiewicz J. Cerebrospinal fluid fistula and endoscopic sinus surgery.  Laryngoscope . 1991;  101 250-256
    PubMedGoogle Scholar
  • 8 Shetty P, Shroff M M, Sahani D V. Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula.  Am J Neuroradiol . 1998;  19 633-639
    PubMedGoogle Scholar
  • 9 Park J I, Nakamura G R, Griesemer E C, Noguchi T T. Current management of cerebrospinal fluid rhinorrhea.  Laryngoscope . 1983;  83 1294-1300
    PubMedGoogle Scholar
  • 10 Hirsch O. Successful closure of cerebrospinal fluid rhinorrhea by endonasal surgery.  Arch Otolaryngol . 1952;  56 1-13
    CrossrefPubMedGoogle Scholar
  • 11 McCabe B F. The osteomucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea.  Laryngoscope . 1976;  86 537-539
    CrossrefPubMedGoogle Scholar
  • 12 Yessenow R S, McCabe B F. The osteomucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea: a 20-year experience.  Otolaryngol Head Neck Surg . 1989;  101 555-558
    PubMedGoogle Scholar
  • 13 Wigand M E. Transnasal ethmoidectomy under endoscopic control.  Rhinology . 1981;  19 7-15
    PubMedGoogle Scholar
  • 14 Weber R, Keerl R, Drat W. Management of dural lesions occurring during endonasal sinus surgery.  Arch Otolaryngol Head Neck Surg . 1996;  122 732-736
    CrossrefPubMedGoogle Scholar
  • 15 Papay F, Maggiano H, Dominquez S. Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistulas.  Laryngoscope . 1989;  99 1195-1201
    PubMedGoogle Scholar
  • 16 Lanza D C, O'Brian D A, Kennedy D W. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles.  Laryngoscope . 1996;  106 1119-1125
    CrossrefPubMedGoogle Scholar
  • 17 Burns J, Dodson E, Gross C. Transnasal endoscopic repair of cranionasal fistulae: a refined technique with long-term follow-up.  Laryngoscope . 1996;  106 1080-1083
    PubMedGoogle Scholar
  • 18 Hegazy H M, Carrau R L, Snyderman C H, Kassam A, Zweig J. Transnasal-endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis.  Laryngoscope . 2000;  110 1166-1172
    CrossrefPubMedGoogle Scholar
  • 19 Casiano R R, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair: is a lumbar drain necessary?.  Otolaryngol Head Neck Surg . 1999;  121 745-750
    CrossrefPubMedGoogle Scholar
  • 20 Zweig J L, Carrau R L, Celin S E. Endoscopic repair of CSF leaks to the sinonasal tract: predictors of success.  Otolaryngol Head Neck Surg . 2000;  123 195-201
    CrossrefPubMedGoogle Scholar
  • 21 Mattox D, Kennedy D. Endoscopic management of cerebrospinal fluid leaks and cephaloceles.  Laryngoscope . 1990;  100 857-862
    Google Scholar