2025 Poster Presentations
P076: A CHALLENGING CASE OF PAEDIATRIC CLIVAL ENCEPHALOCELE
Arshad Zubair, MRCS1; Sameul Leong, FRCS2; Ajay Sinha, FRCS1; Grace Khong, FRCS1; 1Alder Hey Children's Hospital; 2Aintree University Hospital
Introduction: Paediatric clival encephalocele is an exceedingly rare pathology, with handful of cases reported in literature. Basi-occipital clival defects are believed to be caused by persistent notochordal remnants. In adults, clival encephaloceles are commonly repaired via endoscopic endonasal approach. We report a paediatric clival encephalocele repaired via endoscopic endonasal approach and reflect on challenges encountered in this case perioperatively.
Case Report: A 6-year old was referred from an international centre with diagnosis of clival encephalocele. This child has had recurrent episodes of meningitis and has had a previous transoral repair at age of 6 months. There was also history of cyclical vomiting syndrome. Endoscopic endonasal repair was undertaken at our centre. Steps included reduction of the encephalocele with coblation and removal of overlying mucosa to identify the arachnoid layer. Multilayer reconstruction was done with fat, haemopatch onlay graft, middle turbinate free graft and nasoseptal flap(NSF) repair. Foley’s catheter was used for re-inforcement of the reconstruction, along with lumbar drainage. Patient developed stress induced vomiting and meningitis in the immediate postoperative period. CSF leak was identified on post-operative day 10 and patient was returned to theatre for re-exploration. NSF was found to have migrated. Repair was re-inforced with Tachosil, Bioglue and lumbar drain re-insertion. Lumbar drain was removed next week and patient was discharged home 6 weeks from day of initial surgery. This case raised various challenges to management of a paediatric clival encephalocele – 1) chronic stress induced vomiting – leading to raised ICP postoperatively, 2) challenges of use of NSF on a paediatric clivus, 3) tolerability of foley’s catheter in a child and 4) international patient with a prolonged hospital stay. We also discuss advantages of Tachosil and Bioglue in skull base repair.
Conclusion: Endoscopic endonasal repair is an effective management option for the repair of paediatric clival encephalocele. Correct positioning of NSF for repair of clival defects is challenging and reinforcement with Foley catheter may be a useful adjunct.