The Transpalatal Approach to Repair of Congenital Basal Sphenoethmoidal Meningoceles

Objective: The purpose of this study is to provide an in-depth discussion of the transpalatal approach for resection of basal sphenoethmoidal meningoceles, including high-definition videos, images, and illustrations.

Methods: Two cases are described of infants with a midline skull base defect and associated basal sphenoethmoidal meningocele, with a focus on surgical technique of the transpalatal repair.

Results: Two infants presented to the otolaryngology service with basal sphenoethmoidal meningocele. The first patient had a midline skull base defect with meningocele bulging into the nasopharynx with an intact palate, requiring intubation at birth for airway obstruction. In the first week of life, he underwent a transoral, transpalatal approach to resection of the meningocele. The second patient had the Sakoda complex, including a midline meningocele and midline cleft palate. At 7 months, a transoral resection of the meningocele was performed through his preexisting cleft palate, with repair of the skull base defect with calvarial bone graft.

Conclusion: Basal sphenoethmoidal meningoceles and encephaloceles are extremely rare entities. The traditional approach has been a transcranial subfrontal repair, which puts the olfactory bulbs, optic chiasm, and pituitary at risk. An alternative is the transoral transpalatal approach to repair of the meningocele and skull base defect, which spares the morbidity of a craniotomy. The transpalatal approach has been reported in only three previous cases; we present two additional—one that required a palatal split and one that was done through a preexisting cleft palate. Emphasis will be on diagnosis, management options, and surgical technique, with the use of high-definition videos, images, and illustrations.