Endoscopic Endonasal Management of Pediatric Congenital Transsphenoidal Encephalocele: A Case Report
Bibliographic record
Abstract
Congenital transsphenoidal encephaloceles are rare and typically observed only in very young children. The surgical management of these patients remains challenging. Here we describe the case of a 15-month-old female child with a large trans-sphenoidal encephalocele that was managed purely with the endonasal endoscopic approach (EEA). The child was born with a large nasal mass that caused respiratory distress and feeding difficulty, and she required a tracheostomy and G-tube placement. Imaging studies showed a large left middle cranial fossa arachnoid cyst and a midline naso-oropharyngeal encephalocele extending from the sella through the defect in the sphenoid bone. A cystoperitoneal shunt was inserted for the arachnoid cyst at the age of three months. The patient developed bacterial meningitis twice, one month after shunt placement, and at the age of 14 months. Due to her recurrent infections, we decided to proceed with surgical repair. We felt that a transcranial approach will be limited by the location of the anterior cerebral arteries. Therefore, the patient underwent EEA with insertion of a lumbar drain (LD) to repair the encephalocele sac and bony defect. Cerebrospinal fluid (CSF) drainage from the LD continued at a rate of approximately 10 mL/hour. On postoperative day 5, a CSF leak was noted that required a repeat EEA. Further dissection of the encephalocele sac was performed up to the layer of the dural ring. The dural ring was exposed anteriorly and laterally on both sides. We then proceeded with the multilayered reconstruction of the defect. The patient recovered after the surgery with no signs of a CSF leak and was discharged home. At the four month follow-up, she had no further respiratory distress and was decannulated. To our knowledge, EEA for the repair of trans-sphenoidal encephalocele has been performed in only four children ≤18 months, and a postoperative CSF leak occurred in one of them. The EEA is a safe and feasible alternative to transcranial and transpalatal approaches. Fig. 1 Publication History Article published online: 15 February 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".