Abstract：
OBJECTIVE: To review surgical techniques used in the endoscopic transnasal repair of pediatric basal meningoencephaloceles and compare perioperative outcomes in children <2 and ≥2 years old.
METHODS: MEDLINE, EMBASE, and CENTRAL.
METHODS: Data sources were searched from inception to August 22, 2022, using search terms relevant to endoscopic transnasal meningoencephalocele repair in children. Reviews and Meta-analyses were excluded. Primary outcomes were the incidence of intraoperative and postoperative complications, including cerebrospinal fluid leak, recurrence, and reintervention. Quality assessments were performed using Newcastle-Ottawa Scale, ROBIN-I, and NIH.
RESULTS: Overall, 217 patients across 61 studies were identified. The median age at surgery was 4 years (0-18 years). Fifty percent were female; 31% were <2 years. Most defects were meningoencephaloceles (56%), located transethmoidal (80%), and of congenital origin (83%). Seventy-five percent of repairs were multilayered. Children ≥2 years underwent multilayer repairs more frequently than those <2 years (P = 0.004). Children <2 years more frequently experienced postoperative cerebrospinal fluid leaks (P = 0.02), meningoencephalocele recurrence (P < 0.0001), and surgical reintervention (P = 0.005). Following multilayer repair, children <2 years were more likely to experience recurrence (P = 0.0001) and reintervention (P = 0.006).
CONCLUSIONS: Younger children with basal meningoencephaloceles appear to be at greater risk of postoperative complications following endoscopic endonasal repair, although the quality of available evidence is weakened by incomplete reporting. In the absence of preoperative cerebrospinal fluid leak or meningitis, it may be preferable to delay surgery as access is more conducive to successful repair in older children.
METHODS: MEDLINE, EMBASE, and CENTRAL.
METHODS: Data sources were searched from inception to August 22, 2022, using search terms relevant to endoscopic transnasal meningoencephalocele repair in children. Reviews and Meta-analyses were excluded. Primary outcomes were the incidence of intraoperative and postoperative complications, including cerebrospinal fluid leak, recurrence, and reintervention. Quality assessments were performed using Newcastle-Ottawa Scale, ROBIN-I, and NIH.
RESULTS: Overall, 217 patients across 61 studies were identified. The median age at surgery was 4 years (0-18 years). Fifty percent were female; 31% were <2 years. Most defects were meningoencephaloceles (56%), located transethmoidal (80%), and of congenital origin (83%). Seventy-five percent of repairs were multilayered. Children ≥2 years underwent multilayer repairs more frequently than those <2 years (P = 0.004). Children <2 years more frequently experienced postoperative cerebrospinal fluid leaks (P = 0.02), meningoencephalocele recurrence (P < 0.0001), and surgical reintervention (P = 0.005). Following multilayer repair, children <2 years were more likely to experience recurrence (P = 0.0001) and reintervention (P = 0.006).
CONCLUSIONS: Younger children with basal meningoencephaloceles appear to be at greater risk of postoperative complications following endoscopic endonasal repair, although the quality of available evidence is weakened by incomplete reporting. In the absence of preoperative cerebrospinal fluid leak or meningitis, it may be preferable to delay surgery as access is more conducive to successful repair in older children.
摘要：
目的：回顾内镜经鼻修复小儿基底脑膜脑囊肿的手术技术，并比较<2岁和≥2岁儿童的围手术期结果。
方法：MEDLINE，EMBASE,中央。
方法：从开始到2022年8月22日，使用与儿童内镜经鼻脑膜脑膨出修复相关的搜索词搜索数据源。排除评论和Meta分析。主要结果是术中和术后并发症的发生率，包括脑脊液漏,复发,和重新干预。使用纽卡斯尔-渥太华量表进行质量评估，Robin-I,和NIH。
结果：总体而言，在61项研究中确定了217名患者。手术年龄中位数为4岁（0-18岁）。50%为女性；31%为<2岁。大多数缺陷是脑膜脑囊肿（56%），位于横流（80%），和先天起源（83％）。百分之七十五的维修是多层的。≥2岁的儿童接受多层修复的频率高于<2岁的儿童（P=0.004）。<2岁的儿童更常发生术后脑脊液漏（P=0.02），脑膜脑膨出复发（P<0.0001），和手术再干预（P=0.005）。多层修复后，<2岁的儿童更有可能经历复发(P=0.0001)和再干预(P=0.006).
结论：患有基底脑膜脑囊肿的年幼儿童在鼻内镜下修复术后并发症的风险更大，尽管现有证据的质量因报告不完整而被削弱。在没有术前脑脊液漏或脑膜炎的情况下，最好推迟手术，因为手术进入更有利于年龄较大的儿童成功修复。
方法：MEDLINE，EMBASE,中央。
方法：从开始到2022年8月22日，使用与儿童内镜经鼻脑膜脑膨出修复相关的搜索词搜索数据源。排除评论和Meta分析。主要结果是术中和术后并发症的发生率，包括脑脊液漏,复发,和重新干预。使用纽卡斯尔-渥太华量表进行质量评估，Robin-I,和NIH。
结果：总体而言，在61项研究中确定了217名患者。手术年龄中位数为4岁（0-18岁）。50%为女性；31%为<2岁。大多数缺陷是脑膜脑囊肿（56%），位于横流（80%），和先天起源（83％）。百分之七十五的维修是多层的。≥2岁的儿童接受多层修复的频率高于<2岁的儿童（P=0.004）。<2岁的儿童更常发生术后脑脊液漏（P=0.02），脑膜脑膨出复发（P<0.0001），和手术再干预（P=0.005）。多层修复后，<2岁的儿童更有可能经历复发(P=0.0001)和再干预(P=0.006).
结论：患有基底脑膜脑囊肿的年幼儿童在鼻内镜下修复术后并发症的风险更大，尽管现有证据的质量因报告不完整而被削弱。在没有术前脑脊液漏或脑膜炎的情况下，最好推迟手术，因为手术进入更有利于年龄较大的儿童成功修复。
