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<p>Frontoethmoidal meningoencephalocele (FMEC) is a rare congenital skull base defect prevalent in Southeast Asia, where otolaryngologists play an underrecognized yet important role. This pediatric case series highlights key otolaryngologic contributions using a combined craniofacial and endoscopic endonasal modified Tessier approach. We report two cases: a 7-month-old male with bilateral nasoethmoidal meningoencephalocele and anophthalmia, and a 7-year-old male with proptosis and hydrocephalus. Both underwent single-stage combined craniofacial repair. The otolaryngologist performed preoperative nasal endoscopy, endoscopic-assisted transnasal sac dissection from the ethmoid complex, preservation of the nasolacrimal apparatus, and multilayered skull base reconstruction. The reconstructive technique employed an inlay collagen matrix (DuraGen) placed intradurally, an onlay fascia lata graft positioned over the bony defect extradurally, and a free inferior turbinate mucosal graft applied endonasally to achieve sinonasal separation. Grafts were secured with fibrin sealant (Tisseel) and absorbable nasal packing (Nasopore) for five days. No lumbar drain was used. Concurrently, neurosurgery completed bifrontal craniotomy and dural repair, while plastic surgery managed external reconstruction and medial canthopexy. Three-dimensional CT and MRI guided collaborative planning. Over a six-month follow-up period, no cerebrospinal fluid leakage, meningitis, or sinonasal complications occurred. In this small case series, the otolaryngologist’s role in endoscopic skull base reconstruction appears to be an important component to a successful multidisciplinary approach. Our preliminary experience suggests that this technique may contribute to favorable outcomes, though these findings warrant further investigation in larger cohorts.</p>

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Multidisciplinary management of frontoethmoidal meningoencephalocele: an institutional experience highlighting the role of endoscopic skull base reconstruction

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月28日

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  • Farhad Balafif,
  • Tommy Alfandy Nazwar,
  • Donny Wisnu Wardhana,
  • Fachriy Balafif,
  • Mustofa Mustofa

摘要

Frontoethmoidal meningoencephalocele (FMEC) is a rare congenital skull base defect prevalent in Southeast Asia, where otolaryngologists play an underrecognized yet important role. This pediatric case series highlights key otolaryngologic contributions using a combined craniofacial and endoscopic endonasal modified Tessier approach. We report two cases: a 7-month-old male with bilateral nasoethmoidal meningoencephalocele and anophthalmia, and a 7-year-old male with proptosis and hydrocephalus. Both underwent single-stage combined craniofacial repair. The otolaryngologist performed preoperative nasal endoscopy, endoscopic-assisted transnasal sac dissection from the ethmoid complex, preservation of the nasolacrimal apparatus, and multilayered skull base reconstruction. The reconstructive technique employed an inlay collagen matrix (DuraGen) placed intradurally, an onlay fascia lata graft positioned over the bony defect extradurally, and a free inferior turbinate mucosal graft applied endonasally to achieve sinonasal separation. Grafts were secured with fibrin sealant (Tisseel) and absorbable nasal packing (Nasopore) for five days. No lumbar drain was used. Concurrently, neurosurgery completed bifrontal craniotomy and dural repair, while plastic surgery managed external reconstruction and medial canthopexy. Three-dimensional CT and MRI guided collaborative planning. Over a six-month follow-up period, no cerebrospinal fluid leakage, meningitis, or sinonasal complications occurred. In this small case series, the otolaryngologist’s role in endoscopic skull base reconstruction appears to be an important component to a successful multidisciplinary approach. Our preliminary experience suggests that this technique may contribute to favorable outcomes, though these findings warrant further investigation in larger cohorts.