Chondro-osseous respiratory epithelial adenomatoid hamartoma of the nasal cavity (COREAH): A case report

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Objective: Determine the efficacy of the anterior skull base reconstruction in adult patients with intranasal meningoceles and meningoencephaloceles treated by endoscopic endonasal approach. Study design: Retrospective observational study of adult patients admitted to a tertiary hospital. Materials and methods: Intranasal meningocele was defined as a protrusion of meninges through a defect in the skull base forming a cyst filled with cerebrospinal fluid in the nasal cavity or paranasal sinuses. If the cyst had brain tissue it was called meningoencephalocele. The electronic clinical records of patients admitted with suspected of intranasal MC or MEC between January 2010 and December 2018 were reviewed. All patients treated by endoscopic endonasal approach were included. We excluded those cases with anterior skull base previous surgeries (iatrogenic or following tumoral resections), reconstruction with external surgical approaches and those who were less than 18 years old. Results: Intranasal MC was the most frequent lesion (6/5) and there was one patient with MEC (1/6). 5 cases were idiopathic and one patient had history of transnasal surgery. A total of 83,3% of the cases were primary surgeries and one patient had 3 prior MC surgeries. Only in four of them (66,6%) the lesion location was detected by at least one of the studies (CT, MRI and/or endoscopy). We performed a multilayer closure technique in all patients. During the immediate postoperative period, one patient had acute meningitis. One patient had a CSF leak recurrence 4 months after surgery. The success rate of the reconstructions performed by endonasal approach was 83.33% (5/6). The average follow-up of the patients was 15 months. Conclusion: The effectiveness of the anterior skull base reconstruction in adult patients with meningoceles and meningoencephaloceles performed by endoscopic endonasal approach in our series was 83.33% (5/6). This procedure is currently the gold standard due to its high efficacy and low morbidity. According to current studies, it is recommended to perform the reconstruction with a multilayer technique.