Transnasal endoscopic repair of congenital defects of the skull base in children

Objective: To examine imaging findings and methods of endoscopic treatment of congenital skull base defects in children. Design: Retrospective study and case series. Setting: Academic tertiary care center. Patients: Four patients (aged 12 and 14 months and 8 and 13 years) were inc luded from 1995 to 1997. Three presented with a nasal glioma, which was rec urrent in 1 case. The fourth patient presented with bacterial meningitis du e to a spontaneous cerebrospinal fluid leak. Computed tomography and magnet ic resonance imaging were used to locate the defect of the skull base. Intervention: Transnasal endoscopic resection of the glioma or the meningoc ele, with immediate repair of the skull base defects using free mucosal fla ps and/or pediculized mucosal flaps and/or conchal cartilage together with fibrin glue and nasal packing during a 3-week period. Results: None of the 4 patients has experienced recurrent cerebrospinal flu id leaks or postoperative meningitis. Conclusions: The transnasal endoscopic repair of congenital meningoceles is a reliable technique in select pediatric patients. Computed tomography and magnetic resonance imaging provide information that can be used to help th e surgical procedure.