title: Endoscopic endonasal approaches to anterior skull base defects in pediatric patients.
abstract: BACKGROUND
  We studied 12 pediatric patients with congenital or acquired anterior skull base defects. All subjects underwent surgery owing to progressive symptoms. The endoscopic endonasal approach is a new method in the treatment of this pathology in children.
  
  
  METHODS
  Twelve children had surgery to correct anterior skull base defects: seven patients with a spontaneous anterior basal meningoencephalocele and five with posttraumatic cerebrospinal fluid (CSF) leakage. The defects were repaired using the endoscopic endonasal approach, which combined with the fluorescein diagnostic test, detects the exact location of the skull base defect. Different closure techniques were used to obtain a permanent graft, depending on the type, location, and size of the defect. An intraoperative fluorescein test confirmed the absence of CSF leakage after surgery.
  
  
  RESULTS
  The follow-up period ranged from 3 to 72 months. Symptoms resolved in all patients after surgery and none of them experienced complications or recurrence of CSF leakage. Postoperative magnetic resonance scans showed that the defect had successfully been repaired in all patients.
  
  
  CONCLUSIONS
  The surgical treatment of skull base defects in children reduces life-threatening risks, which include infections, CSF leaks, and enlargement or trauma of the sac. The endoscopic technique minimizes surgical scars and has little impact on brain tissue. The endoscopic endonasal approach to the anterior skull base helps to preserve the physiology of the nose and sinuses and reduces the impact on the still developing splanchnocranium in pediatric patients. It ensures a definitive repair of the defect and requires a very short inpatient period.
authors.affiliation: Department of Neurosurgery, IRCCS Policlinico S. Matteo, University of Pavia, 27100, Pavia, Italy. dlocatelli@smatteo.pv.it
authors.forename: Davide
authors.initials: D
authors.lastname: Locatelli
authors.forename: Federico
authors.initials: F
authors.lastname: Rampa
authors.forename: Ilaria
authors.initials: I
authors.lastname: Acchiardi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bignami
authors.forename: Andrea
authors.initials: A
authors.lastname: Pistochini
authors.forename: Paolo
authors.initials: P
authors.lastname: Castelnuovo
mesh_terms: D000293:Adolescent; D002559:Cerebrospinal Fluid Rhinorrhea / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000601:surgery*; D010256:Paranasal Sinuses / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology / Q000601:surgery*