2026 Proffered Presentations
S221: ENDOSCOPIC REPAIR OF BASAL ENCEPHALOCELES: A SINGLE-ARM META-ANALYSIS OF SUCCESS RATES AND COMPLICATION PROFILES
Khushal Gupta, MBBS1; Michael Karsy, MD, PhD, MSc, FAANS, FCNS2; 1Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Medical College; 2University of Michigan Health
Introduction: Basal encephaloceles represent rare but clinically significant skull base defects, often presenting with CSF rhinorrhea, meningitis, or visual and neurological disturbances. While endoscopic techniques have increasingly replaced open approaches due to their minimally invasive nature and direct access to the defect, the long-term durability and safety profile of these repairs remain incompletely defined. We conducted a meta-analysis to evaluate success rates, revision requirements, recurrence, and complications following endoscopic repair of basal encephaloceles.
Methods: This meta-analysis was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Embase, and Web of Science was performed through July 2025. Studies were eligible if they reported at least five patients undergoing endoscopic repair of basal encephaloceles with extractable outcomes. Case reports, non-endoscopic techniques, and studies without sufficient data were excluded. Extracted variables included sample size, demographics, follow-up duration, repair success, revision surgeries, recurrence, and complication rates.
All outcomes were pooled using a random-effects model (DerSimonian–Laird method). To stabilize proportions, the Freeman–Tukey double arcsine transformation was applied. Between-study heterogeneity was quantified with τ² and I² statistics, with significance set at p<0.10. Prediction intervals were calculated to reflect the expected range of outcomes in future populations. Statistical analysis was performed using Meta-Analysis Online.
Results: Across 16 eligible studies, a total of 419 patients were analyzed. The overall success rate of endoscopic repair was remarkably high at 97% (95% CI: 93–99%). The prediction interval of 85–100% indicates that most patients, even in diverse clinical settings, achieved durable closure. Heterogeneity for this outcome was mild (I²=33%), underscoring the consistency of results across institutions.
The need for revision surgery was uncommon, with a pooled rate of 3% (95% CI: 0–6%). Similarly, the recurrence rate following initial repair was 3% (95% CI: 0–6%), suggesting that once closure was achieved, long-term durability was the rule rather than the exception. Both revision and recurrence demonstrated moderate heterogeneity (I²≈42%), reflecting some variability in reporting practices and patient selection.
Complications were observed in approximately 10% of cases (95% CI: 3–18%), most commonly postoperative CSF leaks, infections, or graft-related issues. Heterogeneity was more pronounced for this outcome (I²=62%), likely due to differences in reconstruction techniques, perioperative management, and thresholds for reporting adverse events. Importantly, most complications were manageable and did not compromise the overall high rate of successful repair.
Conclusion: This single-arm meta-analysis demonstrates that endoscopic repair of basal encephaloceles is both highly effective and safe, with near-universal success and very low recurrence or revision rates. While complications occurred in about one in ten patients, these were generally manageable. Despite modest heterogeneity across studies, the pooled evidence strongly supports endoscopic repair as the standard of care for basal encephaloceles.
