Endoscopic repair of congenital ethmoidal meningoencephalocele in a 17-month-old child: A case report

Background: Congenital meningoencephaloceles are rare malformations involving the herniation of intracranial contents through skull base defects. Endoscopic endonasal surgery (EES) is now standard, although transnasal repair is particularly challenging in infants due to small nasal cavities and immature skull-base anatomy. This case highlights early endoscopic repair of a congenital meningoencephalocele in an infant, contributing to the limited pediatric literature. Case Description: A 17-month-old girl with extreme prematurity presented with noisy breathing and persistent clear rhinorrhea, later confirmed as a cerebrospinal fluid leakage. Imaging identified a right ethmoidal meningoencephalocele originating from a cribriform plate defect, confirmed on computed tomography (CT) and magnetic resonance imaging (MRI). She underwent endoscopic resection and multilayer skull base repair using a fat graft as a plug, reinforced with oxidized regenerated cellulose, a right nasoseptal mucosal flap, and fibrin glue. Recovery was uneventful, and follow-up MRI confirmed closure without recurrence. Surgical planning involved coordination among neurosurgery, otolaryngology, and neuroradiology teams to optimize access and repair strategy. Conclusion: EES is considered the gold-standard approach for anterior skull base meningoencephaloceles, although anatomical constraints make the procedure challenging in infants. In this patient, EES was successfully performed using tailored techniques and materials, illustrating that the approach can be reproduced in other young children. Transcranial approaches remain an alternative when endonasal access is limited. Early surgery in symptomatic cases prevents complications such as meningitis. Careful planning and coordination among specialties support optimal outcomes in complex pediatric skull base surgery.