Author(s)
Brooke Su, MD, MPH
David Hsu, MD
Alisha N. West, MD
Jeffrey D. Suh, MD
Affiliation(s)
Department of Head and Neck Surgery, UCLA David Geffen School of Medicine
Abstract:
Introduction: Endoscopic repair of anterior skull base defects can be accomplished successfully in adult patients using a variety of techniques and grafts. While use of vascularized flaps and multi-layer approaches are well-described, experience with single layer repairs using biomaterials is still controversial. We present a case of a frontal sinus encephalocele and cerebrospinal fluid (CSF) leak repaired successfully utilizing a single layer onlay graft in a pediatric patient. Methods: Case report of a pediatric patient with an encephalocele secondary to trauma, treated at a tertiary academic medical center.Results: An 11-year old girl presented with a right frontoethmoidal encephalocele (13mm by 11mm by 19mm) found on imaging after an episode of meningitis preceded by clear rhinorrhea. She did have a history of remote head trauma and prior frontal bone fracture. An endonasal endoscopic approach was performed with a Draf III to provide exposure to the skull base defect and encephalocele. The defect extended superiorly and laterally over the orbit, which limited the choice of reconstructive options. The defect was repaired successfully with a single layer onlay graft of bovine collagen matrix. After 4 months of follow-up, the graft site has healed with no evidence of meningitis or recurrent CSF leak.Conclusions: Reconstructive options for skull base defects are determined by size, location, and complexity of the defect. Single layer repairs using commercially available biomaterials should be considered in both adults and pediatric patients where multilayer closure or use vascularized flaps may not be possible or optimal.