155 Endoscopic Endonasal Surgery for Pediatric Meningoencephalocele: A Single-Center Case Series

INTRODUCTION: Pediatric meningoencephalocele is herniation of brain and meningeal tissue through a skull base defect. Meningoencephaloceles of the ventral skull base are readily treated via endoscopic endonasal surgery (EES). METHODS: Retrospective review of pediatric patients treated with EES for meningoencephalocele from 2000-2022. RESULTS: Eighteen patients with a median age of 6.1 years (range 2.4 to 17.1) and a male predominance (n=12, 66.67%) underwent EES. One (5.56%) had recurrent pathology. Median clinical follow-up was 20.5 months (range 0-216) and median radiographic follow up was 10 months (range 0-154). Meningoencephaloceles were most often located in the anterior cranial fossa (n=14, 78%), middle and infratemporal fossae (n=3, 17%), and sella (n=1, 6%). Most cases were spontaneous (n=13, 72%) while some were associated with trauma (n=5, 28%). Almost all were repaired with EES alone (n=17, 94%). One patient required additional bicoronal craniotomy and pericranial flap for repair of two defects in the orbital roof and ethmoid (n=1, 6%). Eight patients underwent perioperative lumbar or ventricular drain (44%) and two required long-term CSF diversion (n=2, 12%). Reconstruction included free mucosal graft in 8 patients (44%) and nasoseptal flap in 7 (39%). Median length of stay was 2 days (1-10). Three patients (18%) had postoperative CSF leak requiring repair (1 early- < 30 days; 2 delayed). At the time of last follow-up, one patient had chronic rhinitis (n=1, 12.5%) and two had frequent bouts of sinusitis (25%). No patient suffered a decline in vision, cranial neuropathy, or hormone dysfunction. CONCLUSIONS: This single-center case series demonstrates the safety and effectiveness of EES for treating pediatric meningoencephalocele with favorable neurological outcomes. These findings underscore the utility of EES as a viable treatment option in pediatric patients with meningoencephalocele.