Features of the use of vascularized flaps for plastics of skull base defects after removal of meningoencephalocele in children

Abstract

Basal meningoencephalocele is a rare pathology that occurs due to the prolapse of meninges and brain tissues through a bone defect in the skull base. Treatment of patients with this pathology consists in the removal of the meningoencephalocele, followed by plasty of the skull base defect. One of the ways to close defects of the skull base is to use vascularized flaps. Vascularized flaps are the method of choice of plastic material in adults, however, in pediatric practice, there is insufficient data on the effectiveness and safety of their use. Purpose: to assess the effectiveness and safety of the use of vascularized flaps in the removal of meningoencephalocele, as well as to clarify the indications for their use in pediatric practice Material and methods. A retrospective analysis of a series of patients with basal meningoencephalocele aged 0 to 18 years, operated from 2008 to 2020. Comparison of two groups, divided according to the types of methods used for plastics of skull base defects, has been carried out. Results. There was a statistically significant difference in the groups for the localization of defects (p = 0.048), complaints in the postoperative period for pain in the wound on the left hip (p < 0.001). There was no statistically significant difference in the groups in terms of the size of the defect (p = 1), the frequency of using lumbar drainage (p = 0.141), the duration of surgery (p = 0.2), and blood loss (p = 0.248). Conclusions. Vascularized flaps are effective for plasty of the skull base defect in children in the removal of meningoencephalocele. The safety of using flaps intraoperatively and in the early postoperative period has been proved. The question of the long-term results and the influence of the formation of a vascularized flap on the structures of the facial skeleton remains unstudied. When planning the elimination of meningoencephalocele in children and the choice of plastic material, it is necessary to take into account the localization of the fistula.