This review focuses on the surgical techniques for endoscopic transnasal repair of pediatric basal meningoencephaloceles, comparing outcomes between children under 2 years old and those 2 years or older. Analyzing data from 217 patients across 61 studies, it found that children younger than 2 years are more prone to postoperative complications such as cerebrospinal fluid leaks, recurrence of meningoencephaloceles, and the need for surgical reintervention. Specifically, these younger patients had a higher likelihood of experiencing recurrence and reintervention following multilayer repair. The study suggests that, in the absence of preoperative complications like cerebrospinal fluid leak or meningitis, delaying surgery might be beneficial as older children have a more favorable anatomy for successful repair. This highlights the importance of age in surgical planning and suggests a potential strategy to improve outcomes in this vulnerable population. The evidence, however, is limited by incomplete reporting across the reviewed studies.