# Encephalocele — GCMD Library living collection Everything in the library about encephalocele — built automatically from dossiers that name it. Updated: n/a · 3 episodes · 73 cited statements ## Episodes ### Surgical Management - [Pediatric Endoscopic Skull Base Surgery: Collaborative Approaches and Techniques](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374) — video · 24:46 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374.md) - [Pediatric Endonasal Skull Base Surgery: Pediatric Endoscopic Neurosurgery 2018](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379) — video · 24:46 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379.md) ### Case-Based Learning - [A new face for Zakary | Cincinnati Children's](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199) — video · 3:01 · [machine version](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199.md) ## Chapters - [0:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=0) Introduction and Importance of Collaboration in Pediatric Endoscopic Skull Base Surgery (Ep 1) - [7:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=420) Skull Base Development and Anatomical Considerations (Ep 1) - [12:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=720) Transnasal and Transfrontal Approaches: Encephaloceles and Clival Lesions (Ep 1) - [15:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=900) Transsphenoidal Approaches and Craniopharyngiomas (Ep 1) - [18:20](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1100) Outcomes Data and Additional Approaches (Ep 1) - [21:57](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1317) Q&A: Anatomical Limitations, Encephalocele Management, and Fluorescein Use (Ep 1) - [0:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=0) Introduction and Importance of Collaboration (Ep 2) - [4:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=240) Skull Base Development and Anatomical Considerations (Ep 2) - [8:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=480) Transnasal and Transfrontal Approaches (Ep 2) - [10:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=600) Transsphenoidal Approaches and Sphenoid Drilling Technique (Ep 2) - [15:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=900) Extended Approaches: Transethmoidal and Transmaxillary (Ep 2) - [18:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1100) Craniopharyngioma Management and Outcomes (Ep 2) - [21:57](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1317) Question and Answer Session (Ep 2) - [0:00](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=0) Prenatal diagnosis and initial consultation (Ep 3) - [0:47](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=47) Birth, NICU course, and surgical planning (Ep 3) - [1:45](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=105) Surgical procedure and outcome (Ep 3) - [2:31](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=151) Follow-up and gratitude (Ep 3) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "Endoscopic skull base surgery was slow to propagate into the pediatric world despite evolving as an adult specialty." (clinical) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=0) - "Many pediatric neurosurgeons felt there wasn't enough room and hadn't had enough training in endoscopic skull-based techniques." (opinion) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=180) - "Strong collaboration between pediatric neurosurgery and adult endoscopic skull base surgery is the key to program success." (opinion) [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=240) - "Children are not just little adults - there are unique special things about the pediatric population that adult surgeons may not be aware of or able to manage as well as pediatric neurosurgeons." (clinical) [Ep 1 · 5:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=300) - "Age 4 and above is a comfortable threshold after which most endoscopic skull base procedures can be performed, though younger is possible." (clinical) [Ep 1 · 9:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=540) - "In the pediatric population, the conchal type of sphenoid sinus is most common, and this enlarges over time." (clinical) [Ep 1 · 10:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=600) - "Even with a conchal sphenoid sinus, much of the bone in the middle of the sphenoid is very soft and can be easily drilled out with a diamond drill to create a pneumatized sphenoid sinus." (clinical) [Ep 1 · 11:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=660) - "After age 4, most conchal sphenoid sinuses are eliminated based on radiographic studies." (clinical) [Ep 1 · 12:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=720) - "Inter-carotid distance increases from 12-13 millimeters at age 5 to about 15 millimeters at age 15, but this 2-3 millimeter difference doesn't make a dramatic difference to surgical procedures." (clinical) [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=780) - "100% of encephaloceles are now done using an endonasal approach, even fairly large ones, whereas traditionally these would be removed with a bifrontal craniotomy." (clinical) [Ep 1 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=900) - "For encephalocele repair, intrathecal fluorescein is given, a lumbar drain is placed, and all encephalocele tissue must be resected until gone, with cauterization of the edges." (clinical) [Ep 1 · 16:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=960) - "The closure technique for encephaloceles involves an inlay of Duragard on the inside, then an onlay of fat and a nasal septal flap." (clinical) [Ep 1 · 17:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1020) - "For encephaloceles, a lumbar drain is left in for a couple of days postoperatively because some patients have increased intracranial pressure, allowing pressure decrease while the closure tightens." (clinical) [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080) - "In pediatric patients, a small rim of craniopharyngioma tumor is often intentionally left on the hypothalamus to avoid causing morbid obesity and cognitive maldevelopment." (clinical) [Ep 1 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140) - "The endonasal view for craniopharyngiomas provides better visualization of the stalk, third ventricle, and hypothalamus with less retraction on optic nerves and brain compared to transcranial approaches." (clinical) [Ep 1 · 20:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1200) - "For craniopharyngiomas, the surgical goal is to save the pituitary stalk as long as possible, but if the stalk is completely infiltrated, it will be sacrificed to achieve cure." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "Superior hypophyseal arteries should be preserved during craniopharyngioma surgery because they feed superiorly to the chiasm, and their sacrifice could cause visual loss." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "The endonasal approach for craniopharyngiomas results in no retraction of the brain, so there is no FLAIR signal in the brain after tumor removal." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "Comparing endonasal to transcranial surgery for craniopharyngiomas, the extent of resection for endonasal surgery is greater than for transcranial surgeries." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "Visual outcome after endonasal surgery for craniopharyngiomas is better than after transcranial surgery because the approach is from below without manipulation of optic nerves." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "In a series of 85 craniopharyngioma patients, gross total resection rate was 86%, greater than 95% resection achieved in 95% of patients, visual improvement in 78%, and CSF leak rate 2.4%." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "For craniopharyngiomas, diabetes insipidus and panhypopituitarism are common when pursuing gross total resection." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "In 11 pediatric craniopharyngioma patients (average age 8 years), gross total resection rate was 45%, but intentional subtotal resection is often the goal in the pediatric population." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "In the pediatric craniopharyngioma series, visual function was stable or improved in over 70%, and all children except one returned to an academic environment, with 10 in a grade appropriate for age." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260) - "Craniopharyngiomas in the pediatric age group are mostly adamantinomatous type, more likely in the sella, and more likely calcified, while adults have both adamantinomatous and papillary types." (clinical) [Ep 1 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140) - "Papillary craniopharyngiomas with BRAF mutation are more likely suprasellar and less likely calcified." (clinical) [Ep 1 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140) - "Juvenile nasopharyngeal angiofibromas are very vascular tumors that are typically embolized beforehand but still bleed quite a bit during surgery." (clinical) [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080) - "Most juvenile nasopharyngeal angiofibromas arise from the pterygopalatine fossa, requiring wide exposure of the back wall of the maxillary sinus." (clinical) [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080) - "For encephalocele repair, the approach is to first repair the encephalocele and see if it holds; shunting is only performed for patients with recurrent encephaloceles or clear hydrocephalus." (clinical) [Ep 1 · 23:13](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1393) - "Patients are placed on acetazolamide for about 2 weeks after encephalocele repair to ensure healing." (clinical) [Ep 1 · 23:13](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1393) - "Out of approximately 40 encephalocele cases, 3 or 4 patients required shunting postoperatively." (clinical) [Ep 1 · 23:38](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1418) - "Intrathecal fluorescein protocol uses a low dose of 0.3mL of 10% fluorescein diluted in 10cc of CSF, with pretreatment using Decadron and Benadryl." (clinical) [Ep 1 · 23:58](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1438) - "Literature has shown adverse effects to high doses of intrathecal fluorescein, but with low-dose protocol and steroid pretreatment, no allergic reactions or arachnoiditis have been observed." (clinical) [Ep 1 · 23:58](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1438) - "The same instruments, scope holder, and scopes used in adult endoscopic skull base surgery are used in pediatric cases." (clinical) [Ep 1 · 22:22](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1342) - "When nostril width is a concern, the irrigation sheath can be removed from the scope, reducing its diameter from 4 millimeters to 2.7 millimeters." (clinical) [Ep 1 · 22:22](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1342) - "Other than age less than 4, there are no significant anatomical concerns in the pediatric population for endoscopic skull base surgery beyond the perceived limitations of limited nares size and non-pneumatized sinuses." (clinical) [Ep 1 · 21:57](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1317) - "The long-term implications of arrested skull base growth in a child with lack of pneumatization 10 years down the road are unknown, though followed patients have not shown long-term problems." (clinical) [Ep 1 · 24:20](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1460) - "Age 4 and above is generally a comfortable threshold for pediatric endonasal skull base surgery, though procedures are possible at younger ages." (clinical) [Ep 2 · 4:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=240) - "In pediatric patients, conchral (non-pneumatized) sphenoid sinuses can be converted to pneumatized sinuses by drilling out soft, vascular bone in the middle with a diamond drill until reaching harder bone over the carotid artery and planum." (clinical) [Ep 2 · 6:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=360) - "After age 4, most conchral sphenoid sinuses are eliminated, with progressive pneumatization occurring over time." (clinical) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=420) - "The intercarotid distance increases from approximately 12-13 millimeters at age 5 to about 15 millimeters at age 15, but this 2-3 millimeter difference does not dramatically affect surgical feasibility." (clinical) [Ep 2 · 7:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=450) - "Essentially 100% of encephaloceles are now managed using an endonasal approach rather than bifrontal craniotomy." (clinical) [Ep 2 · 9:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=540) - "For encephalocele repair, intrathecal fluorescein is administered, a lumbar drain is placed, all encephalocele tissue is resected and cauterized back to the edges, and closure is performed with inlay Duragen, onlay fat, and nasal septal flap." (clinical) [Ep 2 · 9:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=560) - "Lumbar drains are left in place for a couple of days after encephalocele repair because some patients have increased intracranial pressure, allowing pressure reduction while the closure tightens." (clinical) [Ep 2 · 9:50](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=590) - "In pediatric craniopharyngioma surgery, a small rim of tumor is often intentionally left on the hypothalamus to avoid causing morbid obesity and cognitive maldevelopment." (clinical) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=720) - "Craniopharyngiomas have two age peaks of presentation; pediatric cases are mostly adamantinomatous type, more likely in the sella, and more likely calcified, while adult cases include both adamantinomatous and papillary types." (clinical) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1100) - "Papillary craniopharyngiomas with BRAF mutation are more likely suprasellar and less likely calcified." (clinical) [Ep 2 · 18:40](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1120) - "The endonasal view for craniopharyngioma provides better visualization of the stalk, third ventricle, and hypothalamus with less retraction on optic nerves and brain compared to transcranial approaches." (clinical) [Ep 2 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1140) - "In craniopharyngioma surgery, the pituitary stalk is preserved when possible, but is sacrificed if completely infiltrated with tumor in favor of achieving a cure." (clinical) [Ep 2 · 20:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1200) - "Superior hypophyseal arteries should be preserved during craniopharyngioma surgery because they feed the chiasm superiorly, which is critical for preventing visual loss." (clinical) [Ep 2 · 20:10](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1210) - "After endonasal craniopharyngioma resection, there is no flare signal in the brain on postoperative imaging because there is no brain retraction during the procedure." (clinical) [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1260) - "In a series of 85 craniopharyngioma patients, gross total resection was achieved in 86%, with greater than 95% resection in 95% of patients." (epidemiological) [Ep 2 · 21:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1290) - "Visual improvement occurred in 78% of craniopharyngioma patients after endonasal surgery." (epidemiological) [Ep 2 · 21:40](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1300) - "The CSF leak rate in the craniopharyngioma series was 2.4%." (epidemiological) [Ep 2 · 21:45](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1305) - "Diabetes insipidus and panhypopituitarism are fairly frequent outcomes when pursuing gross total resection of craniopharyngioma." (clinical) [Ep 2 · 21:50](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1310) - "In 11 pediatric craniopharyngioma patients (average age 8 years), gross total resection rate was 45%, but intentional subtotal resection is often the goal in the pediatric population." (epidemiological) [Ep 2 · 21:57](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1317) - "In the pediatric craniopharyngioma series, only 2 patients had greater than 9% increase in BMI, visual function was stable or improved in over 70%, and all children except one returned to an academic environment with 10 in grade-appropriate settings." (epidemiological) [Ep 2 · 22:10](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1330) - "Complications in the pediatric craniopharyngioma series included 1 CSF leak, 1 visual loss, and 1 abscess." (epidemiological) [Ep 2 · 22:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1350) - "Extent of resection for craniopharyngioma is greater with endonasal surgery compared to transcranial approaches." (epidemiological) [Ep 2 · 21:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1280) - "Visual outcomes after endonasal craniopharyngioma surgery are better than after transcranial surgery because the approach is from below without manipulation of the optic nerves." (clinical) [Ep 2 · 21:25](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1285) - "Juvenile nasopharyngeal angiofibromas are very vascular tumors that are typically embolized beforehand but still bleed quite a bit during surgery." (clinical) [Ep 2 · 14:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=870) - "Most juvenile nasopharyngeal angiofibromas arise from the pterygopalatine fossa, requiring wide exposure of the back wall of the maxillary sinus." (clinical) [Ep 2 · 14:50](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=890) - "For encephaloceles associated with intracranial hypertension, the approach is to first repair the encephalocele and see if it holds, placing patients on acetazolamide for about 2 weeks postoperatively." (clinical) [Ep 2 · 23:13](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1393) - "Shunting for encephaloceles is reserved for patients with clearly evident hydrocephalus or those with recurrent encephaloceles after initial repair." (clinical) [Ep 2 · 23:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1400) - "Out of approximately 40 encephalocele cases, shunting was required 3 or 4 times." (epidemiological) [Ep 2 · 23:38](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1418) - "Intrathecal fluorescein is administered at a low dose of 0.3 mL of 10% fluorescein diluted in 10 cc of CSF, with pretreatment using Decadron and Benadryl to prevent adverse effects." (clinical) [Ep 2 · 23:58](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1438) - "Literature has shown adverse effects including allergic reactions and arachnoiditis with high doses of intrathecal fluorescein, but low-dose protocols with steroid pretreatment have not resulted in such problems in the speaker's experience." (clinical) [Ep 2 · 24:05](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1445) - "The same instruments, scopes, and scope holders used in adult endonasal surgery are used in pediatric cases." (clinical) [Ep 2 · 22:40](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1360) - "When nostril width is limiting, the irrigation sheath can be removed from the endoscope, reducing the diameter from 4 millimeters to 2.7 millimeters." (clinical) [Ep 2 · 22:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1350) - "A fetal MRI detected an encephalocele midway through Velika Riegel's pregnancy." (host_summary) [Ep 3 · 0:15](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=15) - "Zachary had a large opening in the bone between his eyes through which tissue escaped." (host_summary) [Ep 3 · 0:28](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=28) - "Until Zachary was born, it was unknown whether the encephalocele was cancerous." (host_summary) [Ep 3 · 0:34](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=34) - "Dr. Charles Stevenson knew following delivery that complex reconstruction of the face and nasal bridge would be required." — Charles Stevenson (clinical) [Ep 3 · 0:47](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=47) - "Dr. Stevenson consulted Dr. Hector Pan because complex facial reconstruction would be needed." — Charles Stevenson (clinical) [Ep 3 · 0:47](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=47) - "The surgeons had seen a case like this only once before." (host_summary) [Ep 3 · 1:12](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=72) - "Zachary was delivered December 29th, 2016." (host_summary) [Ep 3 · 1:18](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=78) - "At birth, the growth covered from Zachary's eyes down to his mouth; only a little mouth was visible." — Velika Riegel (clinical) [Ep 3 · 1:25](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=85) - "Zachary needed a feeding tube and supplemental oxygen." (host_summary) [Ep 3 · 1:34](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=94) - "Zachary spent 4.5 months in newborn intensive care at Cincinnati Children's before he grew enough to have the operation." (host_summary) [Ep 3 · 1:38](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=98) - "The surgical steps involved exposing the forehead, exposing the defect, amputating the tissue, preserving the normal brain, and reconstructing the normal layers or barriers which had not formed." — Charles Stevenson (clinical) [Ep 3 · 1:49](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=109) - "The operation was successful and the tissue was found not to be a cancerous tumor." (host_summary) [Ep 3 · 2:08](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=128) - "Zachary and Velika moved to the area to be closer to Cincinnati Children's." (host_summary) [Ep 3 · 2:31](https://qa.library.globalcastmd.com/watch/a-new-face-for-zakary-cincinnati-children-s-12199?t=151) ## Changelog - Sep 15: 3 items added automatically --- Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai