Surgical Management of Spontaneous and Traumatic Anterior Skull Base Meningoceles: Technique and Pitfalls

Abstract

Objectives:

A majority of anterior skull base meningoceles are often managed via the endoscopic endonasal approach (EEA) for the excision and repair of the cerebrospinal fluid (CSF) leak, in addition to the reconstruction of the skull base defect. The aim of the study was evaluation of an institutional case series to identify specific risks and strategies for successful management of anterior skull base meningoceles.

Methods:

Case series review of all surgical cases involving repair of any anterior skull base meningocele spanning 3 years.

Results:

A total of 18 patients were managed surgically for repair of meningocele with or without CSF rhinorrhea. All patients had postoperative follow-up to one year. EEA was used in 17 patients, and one had a combined transcranial with endoscopic approach. Four patients had meningoceles with a larger than 1.0-cm bony skull base defect. Large spontaneous meningoceles along the ethmoid were likely to include cerebrovascular structures within their intranasal component. Nasal airway obstruction was the initial presenting symptom in all large spontaneous ethmoid meningoceles, rather than CSF rhinorrhea (present in all large traumatic ones).

Conclusions:

The endoscopic technique is a safe and effective approach to repair of anterior skull base defects involving both ethmoid and sphenoid regions. Successful repair of lateral sphenoid wall defects depends on gaining sufficient access via incorporating extended approaches, such as trans-pterygopalatine approach. Preoperative angiography may be warranted, especially in spontaneously appearing anterior skull base meningoceles with a bony defect larger than 1.0 cm.