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P386: COMBINED TRANSNASAL AND TRANSCRANIAL APPROACH FOR REPAIR OF A MULTIFOCAL MENINGOENCEPHALOCELE
Felix E Fernández-Penny, BS, Rhinology Research Fellow^1,2; Luke M O'Neil, MBBS, Rhinology Fellow²; Hector A Perez, MD, Clinical Instructor³; Jacob J Ruzevick, MD, Assistant Professor⁴; Aria Jafari, MD, Assistant Professor²; ¹University of Chicago - Pritzker School of Medicine; ²University of Washington - Dept. of Otolaryngology Head & Neck Surgery; ³Loma Linda University Health - Rhinology and Skull Base Surgery; ⁴University of Washington - Dept. of Neurological Surgery

This video demonstrates the management of multifocal ethmoid and frontal meningoencephaloceles in a 50-year-old female using combined transcranial and endoscopic endonasal approaches. Lesions were successfully isolated and fulgurated, followed by multilayered reconstruction using a pericranial flap over the skull base, and fascia lata graft and nasoseptal flap over the cribriform plate. Postoperatively, the patient experienced symptom resolution without complications. This case highlights the effectiveness of a tailored multidisciplinary approach for complex anterior skull base defects. 

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