title: Endoscopic sinonasal meningoencephalocele repair: a 13-year experience with stratification by defect and reconstruction type.
abstract: OBJECTIVE
  Sinonasal meningoencephalocele is a rare defect, with varying etiologies and treatment strategies. Here we present the largest published series from a single institution of patients with endoscopic repair. The primary goal is to examine rates of success with consideration to accompanying patient demographic data. The secondary goal is to report the results stratified by defect and reconstruction type.
  
  
  METHODS
  Retrospective consecutive case series.
  
  
  METHODS
  Tertiary care academic center.
  
  
  METHODS
  Consecutive patients with CPT codes for skull base meningoencephalocele repair between May 2000 and March 2013 were reviewed. Patients who specifically had sinonasal defects were included.
  
  
  RESULTS
  During the study period, 149 cases of sinonasal meningoencephaloceles were managed in 133 patients. Mean follow-up was 21.3 months (range, 0-116). There was a success rate of 88% for initial repair, with mean recurrence time of 8.3 months (range, 0-38), and a success rate of 93.8% for initial recurrence surgery, with 99.3% of ultimate successful repair. All cases were repaired endoscopically. Recurrence rate was not significantly related to location of defect (P = .682), size of defect (P = .434), particular reconstruction technique (P = .163), or etiology (trauma, P = .070). Overall complication rate was 11.3%.
  
  
  CONCLUSIONS
  Endoscopic sinonasal meningoencephalocele repair has excellent long-term results and may be considered as a primary approach. Surgeon comfort with a particular technique should be the most important factor used to guide choice of reconstruction.
authors: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina adam_zanation@med.unc.edu.
authors: Rounak B
authors: RB
authors: Rawal
authors: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Satyan B
authors: SB
authors: Sreenath
authors: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Charles S
authors: CS
authors: Ebert
authors: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Benjamin Y
authors: BY
authors: Huang
authors: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Deepak R
authors: DR
authors: Dugar
authors: Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Matthew G
authors: MG
authors: Ewend
authors: Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Deanna
authors: D
authors: Sasaki-Adams
authors: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Brent A
authors: BA
authors: Senior
authors: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Adam M
authors: AM
authors: Zanation
mesh_terms: D015897:Comorbidity; D004677:Encephalocele / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008588:Meningocele / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D016896:Treatment Outcome
keywords: cerebrospinal fluid leak; encephalocele; ethmoid; flaps; frontal; grafts; lumbar drain; meningoencephalocele; skull base; sphenoid; vascularized flap