REVIEW  ENDOSCOPIC ENDONASAL APPROACHES TO THE ANTERIOR FOSSA 

Journal of Neurosurgical Sciences 2021 April;65(2):140-50

DOI: 10.23736/S0390-5616.20.05099-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Management of anterior fossa cephaloceles

Vittorio RAMPINELLI ¹, Davide MATTAVELLI ¹, Marco FERRARI ^{1, 2}, Alberto SCHREIBER ¹, Marco RAVANELLI ³, Davide FARINA ³, Alberto DEGANELLO ¹, Marco M. FONTANELLA ⁴, Francesco DOGLIETTO ⁴ ✉, Piero NICOLAI ²

¹ Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; ² Section of Otorhinolaryngology, Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy; ³ Unit of Radiology, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; ⁴ Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

Skull base cephaloceles (SBCs) are defined as herniation of intracranial content through the skull base and are classified based on composition, etiology, and topographic location. Anterior SBCs frequently protrude in the sinonasal cavity, and consequently are at potential risk of infection. Therefore, the current recommendation is to treat SBCs with the primary intent of preventing meningitis, and surgery represents the mainstay of treatment. Anterior SBCs may display a wide spectrum of severity and complexity, and in each case the risks and benefits of surgical approaches are to be carefully weighted based on thorough assessment of symptoms, age, general conditions, location and size of the lesion, as well as expertise of the surgeon. In the last 30 years, the evolution and diffusion of transnasal endoscopic surgery have substantially changed the surgical management of the majority of SBC. In the past, they were treated exclusively with open transcranial approaches that may be burdened by relevant morbidity and risk for severe complications. The transnasal endoscopic corridor now provides easy access to the lesion and different reconstructive strategies using endonasal pedicled flaps, without any external incision, cranioplasty or brain manipulation. However, there are still scenarios in which an exclusive transnasal endoscopic route is contraindicated. The aim of the present review was to provide an overview on the comprehensive management of anterior SBC, with a particular focus on lesions suitable for endoscopic surgery. Furthermore, special aspects of SBC management in children and adults will be highlighted.

KEY WORDS: Skull base; Encephalocele; Cerebrospinal fluid leak