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Endonasal Management of Pediatric Congenital Transsphenoidal Encephaloceles: Nuances of a Modified Reconstruction Technique. Technical Note and Report of 3 Cases Publisher Pubmed



Zeinalizadeh M1, 2 ; Sadrehosseini SM3 ; Habibi Z4 ; Nejat F4 ; Da Silva HB5 ; Singh H6
Authors
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Authors Affiliations
  1. 1. Brain and Spinal Cord Injuries Repair and Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Otolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Neurological Surgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA, United States
  6. 6. Department of Neurological Surgery, Stanford University School of Medicine, Stanford, CA, United States

Source: Journal of Neurosurgery: Pediatrics Published:2017


Abstract

OBJECTIVE: Congenital transsphenoidal encephaloceles are rare malformations, and their surgical treatment remains challenging. This paper reports 3 cases of transsphenoidal encephalocele in 8- to 24-month-old infants, who presented mainly with airway obstruction, respiratory distress, and failure to thrive. METHODS: The authors discuss the surgical management of these lesions via a minimally invasive endoscopic endonasal approach, as compared with the traditional transcranial and transpalatal approaches. A unique endonasal management algorithm for these lesions is outlined. The lesions were repaired with no resection of the encephalocele sac, and the cranial base defects were reconstructed with titanium mesh plates and vascular nasoseptal flaps. RESULTS: Reduction of the encephalocele and reconstruction of the skull base was successfully accomplished in all 3 cases, with favorable results. CONCLUSIONS: The described endonasal management algorithm for congenital transsphenoidal encephaloceles is a safe, viable alternative to traditional transcranial and transpalatal approaches, and avoids much of the morbidity associated with these open techniques. ©AANS, 2017.