Expanding Our Considerations in the Surgical Management of Anterior Skull Base Meningoceles

Introduction: A majority of meningoceles involving the ethmoid and sphenoid regions are often managed via the endoscopic endonasal approach for excision and repair of the CSF leak, including reconstruction of the skull base defect.

Objective: To identify possible risks and considerations in the preoperative evaluation and surgical management of meningoceles involving the anterior skull base.

Results: A total of 11 patients (8 sphenoid, 3 ethmoid) with persistent CSF rhinorrhea were managed surgically for repair of their meningocele. Nine patients had endoscopic endonasal approach only, while two underwent a planned combined open and endoscopic approach. Meningoceles with a larger than 1.5cm bony skull base defect are more likely to have vascular structures in the intranasal component of the mass.

Conclusion: Surgical management of large anterior skull base meningoceles may warrant a combined approach which includes endonasal endoscopic and open craniotomy. Preoperative considerations should include angiography for proper identification of the possible involvement of cerebrovascular structures.