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The extracranial versus intracranial approach In frontoethmoidal encephalocele corrective surgery: a meta-analysis. Neurosurg Rev 2021; 45:125-137. [PMID: 34120254 DOI: 10.1007/s10143-021-01582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/01/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
The debate between the extracranial and the intracranial approach for frontoethmoidal (FEE) encephalocele corrective surgery was not summarized yet. The extracranial approach is traditionally believed being inferior to the intracranial approach, but convincing evidence was missing. To provide robust evidence, we conducted a meta-analysis on the incidence of cerebrospinal fluid (CSF) leakage, its progression to infection, the reoperation to treat the leakage, and the recurrence rate between the two techniques. We performed a meta-proportion pooled analysis and meta-analysis on eligible literature following the recommendation of PRISMA guidelines. The outcome of interest was the incidence of CSF leakage, the CSF leakage that progressed into an infection, the reoperation rate to treat the leakage, and the recurrence rate. We included 28 studies comprising 1793 patients in the pooled prevalence calculations. Of the 28 studies, nine studies describing 730 patients were eligible for meta-analysis. The prevalence of CSF leakage was 8% (95% CI, 0.04-0.12) in the intracranial approach and 10% (95% CI, 0.01-0.23) in the extracranial approach The subgroup analysis of the intracranial approach showed higher CSF leakage prevalence in the frontal craniotomy approach (9%; 95% CI, 0.03-0.16) than the subfrontal osteotomy (6%; 95% CI, 0.03-0.12). Meta-analysis study revealed a significantly higher risk of CSF leakage (OR 2.82; 95% CI, 1.03-7.72), a higher reoperation rate (OR 5.38; 95% CI: 1.13 - 25.76), and the recurrence rate (RR 4.63; 95% CI, 1.51-14.20) for the extracranial approach. The event of infected CSF leakage (OR 3.69; 95% CI, 0.52-26.37) was higher in the extracranial than intracranial approach without any statistical significance. The extracranial approach was associated with a higher risk of CSF leakage, reoperation rate to treat the CSF leakage, and the recurrence rates. The infected CSF leakage between the extracranial and intracranial approaches showed no significant difference.
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Thompson HM, Schlosser RJ, McCarty Walsh E, Cho DY, Grayson JW, Karnezis TT, Miller PL, Woodworth BA. Current management of congenital anterior cranial base encephaloceles. Int J Pediatr Otorhinolaryngol 2020; 131:109868. [PMID: 31931391 DOI: 10.1016/j.ijporl.2020.109868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Congenital encephaloceles provide unique diagnostic and reconstructive challenges for the pediatric rhinologist. The objectives of the current study were to evaluate contemporary treatment strategies for congenital encephaloceles focusing on presentation, surgical technique, and outcomes. METHODS Multi-institutional retrospective chart review of congenital encephaloceles (2003-2019). Data regarding demographics, presenting symptoms, associated abnormalities, surgical technique, size, location, and complications were collected. RESULTS Fourteen patients with 15 congenital encephaloceles were treated using endoscopic techniques (avg 6.0 years, range 2 months-22 years) with mean follow up of 23 months. The majority presented with nasal obstruction (n = 13); only one child had cerebrospinal fluid (CSF) rhinorrhea. Associated anomalies included nasal deformities, congenital hypopituitarism, and Morning Glory syndrome. Average encephalocele size was 2.44 cm (range 0.5-3.6 cm) with mean skull base defect size of 8.6 x 7.7 mm. Locations included the foramen cecum (n = 9), central sphenoid (n = 3), midline anterior cranial fossa (n = 1), orbital plate of frontal bone (n = 1), and ethmoid roof (n = 1). Because of favorable expansion from encephaloceles, it was unnecessary to postpone surgeries to allow nasal cavity growth. Three individuals had prior operations, including surgeries for "nasal polyp" or "adenoid cyst". Two patients had post-operative complications (meningitis and CSF leak) effectively treated with no further sequelae. CONCLUSIONS In the current study, congenital encephaloceles in children as young as 2 months were successfully repaired using endoscopic techniques. Endoscopic approaches remain a safe and effective intervention for management of these lesions.
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Affiliation(s)
- Harrison M Thompson
- Departments of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Erika McCarty Walsh
- Departments of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Do-Yeon Cho
- Departments of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica W Grayson
- Departments of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Peter L Miller
- Departments of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bradford A Woodworth
- Departments of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Wang T, Uddin A, Mobarakai N, Gilad R, Raden M, Motivala S. Secondary encephalocele in an adult leading to subdural empyema. IDCases 2020; 21:e00916. [PMID: 32775205 PMCID: PMC7398933 DOI: 10.1016/j.idcr.2020.e00916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/06/2022] Open
Abstract
Brain abscesses are an uncommon but potentially fatal infection. They can spread directly from an adjacent source or hematogenously from a distant source. Encephaloceles represent a rare form of neural tube defects that can potentially be complicated by the development of meningitis or brain abscess. We report a case of a 63-year-old female who presented with bilateral lower extremity weakness and was ultimately found to have a Streptococcus pneumoniae subdural empyema and an associated frontal lobe encephalocele extending through the left frontal sinus. She was treated with surgical drainage, intravenous antimicrobials, and ultimately surgical repair of the encephalocele. This report highlights a unique presentation of brain abscess. Clinicians should be aware of this potential infectious complication of a neural tube defect.
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Dutta HK, Khangkeo CW, Baruah K, Borbora D. Growth and Psychological Development in Postoperative Patients With Anterior Encephaloceles. Pediatr Neurol 2017; 71:29-34. [PMID: 28499675 DOI: 10.1016/j.pediatrneurol.2017.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/28/2016] [Accepted: 01/29/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Anterior encephaloceles are rare malformations that are frequently associated with other brain anomalies. This study evaluates the growth and psychological development of children following encephalocele repair. MATERIALS & METHODS Growth and psychological assessment was done in 24 children with only encephalocele (group I); nine children with encephalocele and hydrocephalus (group II); seven children with encephalocele, hydrocephalus, and secondary malformations (group III); and 40 apparently healthy control subjects. Psychological assessment was done by evaluating intelligence and temperament. RESULTS Single-stage repair was performed in 38 children, and two underwent multistage repair. Major postoperative complications were noted in three individuals. The follow-up period ranged from 12 to 168 months, and during this time the growth velocity declined significantly among group II and group III patients when compared with control subjects. After adjusting the body mass index for age, our data revealed that group III participants had a significantly (P = 0.02) lower body mass index than the control group. Group III also had poor indices for intelligence quotient (P ≤ 0.01) and temperament (P ≤ 0.01). Female patients had lower temperament indices when compared with unaffected females with regard to approach withdrawal (P ≤ 0.01), mood (P = 0.026), and intensity (P = 0.03). Overall, increased disease severity adversely affected the psychological indices. CONCLUSION Individuals with anterior encephalocele without associated intracranial defects had excellent postoperative outcomes in terms of growth and psychological developments. Hydrocephalus and agenesis of corpus callosum had the least impact on psychological development. However, the presence of secondary brain defects led to developmental delays. Gender differences in temperament may suggest a need for distinct treatment regimens to assess psychosocial well-being for males and females.
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Affiliation(s)
- Hemonta Kumar Dutta
- Department of Pediatric Surgery, Assam Medical College & Hospital, Dibrugarh, Assam, India.
| | - Chow Wachana Khangkeo
- Department of Pediatric Surgery, Assam Medical College & Hospital, Dibrugarh, Assam, India
| | - Kaberi Baruah
- Department of Psychiatry, Assam Medical College & Hospital, Dibrugarh, Assam, India
| | - Debasish Borbora
- Department of Biotechnology, Gauhati University, Guwahati, Assam, India
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Lazzerini K, Gutierrez-Quintana R, José-López R, McConnell F, Gonçalves R, McMurrough J, De Decker S, Muir C, Priestnall SL, Mari L, Stabile F, De Risio L, Loeffler C, Tauro A, Rusbridge C, Rodenas S, Añor S, de la Fuente C, Fischer A, Bruehschwein A, Penderis J, Guevar J. Clinical Features, Imaging Characteristics, and Long-term Outcome of Dogs with Cranial Meningocele or Meningoencephalocele. J Vet Intern Med 2017; 31:505-512. [PMID: 28247440 PMCID: PMC5354015 DOI: 10.1111/jvim.14638] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/27/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022] Open
Abstract
Background The term meningoencephalocele (MEC) describes a herniation of cerebral tissue and meninges through a defect in the cranium, whereas a meningocele (MC) is a herniation of the meninges alone. Hypothesis/Objectives To describe the clinical features, magnetic resonance imaging (MRI) characteristics, and outcomes of dogs with cranial MC and MEC. Animals Twenty‐two client‐owned dogs diagnosed with cranial MC or MEC. Methods Multicentric retrospective descriptive study. Clinical records of 13 institutions were reviewed. Signalment, clinical history, neurologic findings and MRI characteristics as well as treatment and outcome were recorded and evaluated. Results Most affected dogs were presented at a young age (median, 6.5 months; range, 1 month – 8 years). The most common presenting complaints were seizures and behavioral abnormalities. Intranasal MEC was more common than parietal MC. Magnetic resonance imaging identified meningeal enhancement of the protruded tissue in 77% of the cases. Porencephaly was seen in all cases with parietal MC. Cerebrospinal fluid (CSF) analysis identified mild abnormalities in 4 of 11 cases. Surgery was not performed in any affected dog. Seventeen patients were treated medically, and seizures were adequately controlled with anti‐epileptic drugs in 10 dogs. Dogs with intranasal MEC and mild neurologic signs had a fair prognosis with medical treatment. Conclusion and clinical importance Although uncommon, MC and MEC should be considered as a differential diagnosis in young dogs presenting with seizures or alterations in behavior. Medical treatment is a valid option with a fair prognosis when the neurologic signs are mild.
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Affiliation(s)
- K Lazzerini
- Small Animal Hospital, University of Glasgow, Glasgow, UK
| | | | - R José-López
- Small Animal Hospital, University of Glasgow, Glasgow, UK
| | - F McConnell
- Small Animal Teaching Hospital, University of Liverpool, Liverpool, UK
| | - R Gonçalves
- Small Animal Teaching Hospital, University of Liverpool, Liverpool, UK
| | | | - S De Decker
- Queen Mother Hospital for Animals, Royal Veterinary College, London, UK
| | - C Muir
- Pathology and Pathogen Biology, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - S L Priestnall
- Pathology and Pathogen Biology, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - L Mari
- Animal Health Trust, Newmarket, UK
| | | | | | - C Loeffler
- Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - A Tauro
- Fitzpatrick Referrals, Eashing, Surrey, UK
| | | | - S Rodenas
- Hospital Veterinario Valencia Sur, Valencia, Spain
| | - S Añor
- Fundació Hospital Clínic Veterinari, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - C de la Fuente
- Fundació Hospital Clínic Veterinari, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - A Fischer
- Ludwig-Maximilian University Munich, Munchen, Germany
| | | | - J Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Stirling, UK
| | - J Guevar
- Small Animal Hospital, University of Glasgow, Glasgow, UK
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Naidich T, Braffam B, Altman N, Birchansky S. Congenital Malformations Involving the Anterior Cranial Fossa. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099400700304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - B.H. Braffam
- Department of Radiology, Memorial Hospital; Hollywood FL
| | - N. Altman
- Department of Radiology, Miami Children's Hospital
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Achar SV, Dutta HK. Sincipital Encephaloceles: A Study of Associated Brain Malformations. J Clin Imaging Sci 2016; 6:20. [PMID: 27313974 PMCID: PMC4901838 DOI: 10.4103/2156-7514.183040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/23/2016] [Indexed: 11/18/2022] Open
Abstract
Objective: The aim of this study was to evaluate the associated intracranial malformations in patients with sincipital encephaloceles. Materials and Methods: A hospital-based cross-sectional study was conducted over 8 years from June 2007 to May 2015 on 28 patients. The patients were evaluated by either computed tomography or magnetic resonance imaging whichever was feasible. Encephaloceles were described with respect to their types, contents, and extensions. A note was made on the associated malformations with sincipital encephaloceles. Results: Fifty percent of the patients presented before the age of 3 years and both the sexes were affected equally. Nasofrontal encephalocele was the most common type seen in 13 patients (46.4%), and corpus callosal agenesis (12 patients) was the most common associated malformation. Other malformations noted were arachnoid cyst (10 patients), hydrocephalus (7 patients), and agyria-pachygyria complex (2 patients). Conclusion: Capital Brain malformations are frequently encountered in children with sincipital encephaloceles. Detail radiological evaluation is necessary to plan treatment and also to prognosticate such rare malformations.
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Affiliation(s)
| | - Hemonta Kumar Dutta
- Department of Pediatric Surgery, Assam Medical College and Hospital, Dibrugarh, Assam, India
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8
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Rawal RB, Sreenath SB, Ebert CS, Huang BY, Dugar DR, Ewend MG, Sasaki-Adams D, Senior BA, Zanation AM. Endoscopic sinonasal meningoencephalocele repair: a 13-year experience with stratification by defect and reconstruction type. Otolaryngol Head Neck Surg 2015; 152:361-8. [PMID: 25645526 DOI: 10.1177/0194599814561437] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Sinonasal meningoencephalocele is a rare defect, with varying etiologies and treatment strategies. Here we present the largest published series from a single institution of patients with endoscopic repair. The primary goal is to examine rates of success with consideration to accompanying patient demographic data. The secondary goal is to report the results stratified by defect and reconstruction type. DESIGN Retrospective consecutive case series. SETTING Tertiary care academic center. SUBJECTS AND METHODS Consecutive patients with CPT codes for skull base meningoencephalocele repair between May 2000 and March 2013 were reviewed. Patients who specifically had sinonasal defects were included. RESULTS During the study period, 149 cases of sinonasal meningoencephaloceles were managed in 133 patients. Mean follow-up was 21.3 months (range, 0-116). There was a success rate of 88% for initial repair, with mean recurrence time of 8.3 months (range, 0-38), and a success rate of 93.8% for initial recurrence surgery, with 99.3% of ultimate successful repair. All cases were repaired endoscopically. Recurrence rate was not significantly related to location of defect (P = .682), size of defect (P = .434), particular reconstruction technique (P = .163), or etiology (trauma, P = .070). Overall complication rate was 11.3%. CONCLUSION Endoscopic sinonasal meningoencephalocele repair has excellent long-term results and may be considered as a primary approach. Surgeon comfort with a particular technique should be the most important factor used to guide choice of reconstruction.
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Affiliation(s)
- Rounak B Rawal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin Y Huang
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Deepak R Dugar
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew G Ewend
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Deanna Sasaki-Adams
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Secci F, Consales A, Merciadri P, Ravegnani GM, Piatelli G, Pavanello M, Cama A. Naso-ethmoidal encephalocele with bilateral orbital extension: report of a case in a western country. Childs Nerv Syst 2013; 29:1947-52. [PMID: 23780401 DOI: 10.1007/s00381-013-2125-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Encephalocele is a rare congenital malformation of the central nervous system with protrusion of cranial content (meninges, brain, and ventricles in different combinations) beyond the normal confines of the skull. Anterior encephaloceles occur with a high frequency in Southeast Asia, while in the Western countries occipital encephaloceles prevail. The treatment of an anterior (naso-ethmoidal) encephalocele involves a neurosurgeon or a multidisciplinary team (neurosurgeon, maxillofacial surgeon, plastic surgeon, and ENT surgeon) dealing with craniofacial surgery. Goals of surgery include removal or repositioning of nonfunctional cerebral tissue, closure of the dura, and reconstruction of skeletal and cutaneous structures. The prognosis depends from the anatomical site, volume of neural contents, and the presence of coexisting malformations. CASE REPORT We report the case of an Italian child suffering from a naso-ethmoidal encephalocele with bilateral orbital extension. The surgical treatment was performed in two steps. CONCLUSION Sincipital encephalocele is a complex pathology without a unique standardized surgical treatment. Its low incidence in Western countries can make its management particularly tricky.
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Affiliation(s)
- Francesca Secci
- Department of Neurosurgery, Giannina Gaslini Children's Research Hospital (IRCSS), Largo Gerolamo Gaslini 5, Genoa, Italy
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10
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Chaudhary N, Gupta N, Gudwani S, Safaya A. Nasal encephalocoele -an atypical case. Indian J Otolaryngol Head Neck Surg 2012; 56:51-3. [PMID: 23120030 DOI: 10.1007/bf02968776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nasal encephalocoele present at birth as a characteristic swelling over the nose and widening of intracanthal distance. Atypical nasal encephalocoeles are usually missed at birth due to absence of any external swelling and they present with diagnostic difficulties. These are very rare and present with only an intranasal mass. We report a case of an atypical nasal encephalocnele in a 8 year old boy who presented with a unilateral intranasal mass and cerebrospinal fluid rhinorrhoea.
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Affiliation(s)
- N Chaudhary
- Department of Otolaryngology, Safdarjang Hospital, 241, Laxmi Bai Nagar, 110 023 New Delhi
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11
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Colon atresia and frontal encephalocele: a rare association. J Pediatr Surg 2011; 46:e25-8. [PMID: 22152902 DOI: 10.1016/j.jpedsurg.2011.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/18/2011] [Accepted: 09/01/2011] [Indexed: 11/22/2022]
Abstract
The association of colonic atresia with craniofacial anomalies has been well described and probably represents a malformative event that occurs in the early embryonal period. We present a case of an infant with colonic atresia and a frontal encephalocele and believe this to be a newly reported association. We review possible pathogenic mechanisms.
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12
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König M, Due-Tønnessen B, Osnes T, Haugstvedt JR, Meling TR. Median facial cleft with a frontoethmoidal encephalocele treated with craniofacial bipartition and free radial forearm flap: a case report. Skull Base 2010; 20:119-23. [PMID: 20808538 DOI: 10.1055/s-0029-1238216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We describe a patient with a median facial cleft with a frontoethmoidal encephalocele, hypertelorism, hydrocephalus, and cerebrospinal fluid (CSF) leakage referred to our department due to numerous complications after previous surgical treatments. An 8-year-old girl, born with median cleft syndrome, underwent neurosurgical repair of the encephalocele at another hospital and cleft lip/palate repair later in the same year. Her hydrocephalus was treated with a ventriculoperitoneal shunt, but she underwent numerous shunt revisions due to recurrent intracerebral infections. In 2008, she was rehospitalized due to a gram-negative meningitis and cerebral abscess. She underwent surgery where part of her frontal bone was removed due to osteomyelitis. She was referred to our department due to persistent CSF leakage, recurrent infections, and significant dura defect. In addition, she had hypertelorism and a strongly reduced vision. We performed a monobloc and facial bipartition osteotomy where 15 mm of her frontal and nasal bone was removed after facial bipartiton. The dura defect was closed using a free fasciocutanous flap. The patient had no CSF leakage or infections postoperatively, and her hypertelorism was reduced. The case represents the first monobloc and facial bipartition osteotomy performed in Norway as a part of the treatment of median cleft syndrome with a nasoethmoidal encephalocele.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, The National Hospital, Oslo, Norway
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13
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Abstract
OBJECT Anterior encephaloceles are rare congenital malformations. Most of the cases in the literature are reported from Southeast Asia. In India it is seen more frequently among manual laborers in the tea gardens of Assam. A brief background of the patients, clinical presentation, operative treatment, and outcome are discussed, with a review of the relevant literature. The causes and pathogenesis of anterior encephaloceles are discussed. The authors' surgical approach to repair of the defect, postoperative complications, and results are described. METHODS Twenty-eight patients (mean age 38 months, range 1 month-12 years) with anterior encephaloceles who presented between 1998 and 2007 are included in the study. Patients were assessed for physical and psychological growth and development; any associated anomalies were noted. A detailed history of the patient's family, including the prenatal history, was obtained. Lesions were classified with the help of neuroimaging studies (skull x-ray, CT, ultrasonography, and MR imaging studies) and confirmed at surgery. RESULTS Sixteen patients had nasofrontal, 9 had nasoethmoidal, and 3 had nasoorbital encephaloceles, and 12 patients had associated hydrocephalus. The modes of presentation were nasofrontal swelling, watering from the eyes, CSF leakage, fever, and vomiting. Parents of all the patients were ethnic tea garden workers. The average parental age at the time of marriage was 24 years for men and 18 years for women. Consanguinity was present in 6 patients. Alcohol consumption and tobacco chewing were a common practice in both parents. A total of 42 surgical procedures were done in 16 patients, one of whom died of postoperative meningitis. The mean follow-up duration was 38 months (1-92 months). CONCLUSIONS Anterior encephaloceles are rare in Western countries and other states in India, but this defect is more commonly seen among the ethnic tea garden workers in Assam. Transcranial repair is the treatment of choice. Unlike encephaloceles in other locations, anterior encephaloceles have a better clinical outcome after surgery.
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Affiliation(s)
- Hemonta K Dutta
- Department of Pediatric Surgery, Assam Medical College & Hospital, Assam, India.
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14
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Spacca B, Amasio ME, Giordano F, Mussa F, Busca G, Donati P, Genitori L. SURGICAL MANAGEMENT OF CONGENITAL MEDIAN PERISELLAR TRANSSPHENOIDAL ENCEPHALOCELES WITH AN EXTRACRANIAL APPROACH. Neurosurgery 2009; 65:1140-5; discussion 1145-6. [DOI: 10.1227/01.neu.0000351780.23357.f5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Median perisellar congenital transsphenoidal encephalocele (CTE) is a rare entity associated with multiple endocrine, visual, and respiratory deficits. The most likely causative factor for these pathological alterations is distension of neural structures (hypothalamic-pituitary system, optic pathway), resulting in protrusion of the dural sac through a sphenoid bone defect into the pharynx. The continuity with the extracranial space can be associated with an increased risk of tearing of the sac, with consequent cerebrospinal fluid leakage and subsequent increase in the risk of infection. We retrospectively reviewed the surgical treatment of CTE in our hospital using either an extracranial transoral or transnasal approach.
METHODS
We retrospectively reviewed our database. Between July 1994 and June 2005, CTE we identified 6 patients. Five of them were treated by a surgical intervention. The first patient was treated via a transcranial approach but had a relapse of the prolapse 11 years later. The relapse was treated with an extracranial transpalatal approach. Four patients were treated with an extracranial surgical approach: an extracranial transoral approach was performed in 2 cases, and an extracranial transnasal approach was used in the other 2 cases. Surgery was not performed in 1 patient because the parents refused to consent to the procedure.
RESULTS
Preoperative symptoms remained stable or improved in all of the patients after the surgical procedure and worsened in the patient who did not have a surgical intervention. Two patients experienced a palatal dehiscence. No mortality was recorded in this series of patients.
CONCLUSION
The surgical treatment of CTE is indicated to stop the progression or improve symptoms related to this disease entity. If approached correctly, the extracranial approach is a safe procedure with subsequent low morbidity.
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Affiliation(s)
- Barbara Spacca
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
| | | | - Flavio Giordano
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
| | - Federico Mussa
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
| | - Gianpaolo Busca
- Department of Otorhinolaryngology, Ospedale Maria Vittoria, Turin, Italy
| | - Pierarturo Donati
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
| | - Lorenzo Genitori
- Department of Pediatric Neurosurgery, “Anna Meyer” Children's Hospital, Florence, Italy
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Telecanthus and hypertelorism in frontoethmoidal meningoencephaloceles and the surgical correction of these conditions: Part II. A novel surgical approach in the treatment of telecanthus. J Craniofac Surg 2008; 19:148-55. [PMID: 18216680 DOI: 10.1097/scs.0b013e3180f610f9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Frontoethmoidal meningoencephaloceles (MEC) are frequently associated with telecanthus (TC) and seldom with hypertelorism (HT). The correction of these orbital dysmorphisms are undertaken in the same setting as the surgical treatment of MEC. During several charity missions to Phnom Penh, Cambodia, the authors developed a simple surgical technique for the correction of TC that has not been described before. The results of this technique was evaluated as follows: in 58 patients, who underwent surgical treatment of MEC, the pre and postoperative inner canthal (ICD) and outer canthal distances (OCD) were measured; the interpupillary distance (IPD) was measured in 50 patients. Forty five (78%) out of the 58 patients showed a telecanthus before surgery; 39 (87%) of these 45 showed normal values after surgery, in the rest 6 (13%) the ICD could be decreased after surgery, however the values did not reach a normal range.A HT (including TC) was found in 10 patients presenting with MEC (17%) before surgery. Five (50%) of these patients did not show a HT in post surgical follow-up. In 3 (30%) of the remaining 5 patients showing persistent HT, the ICD alone could be decreased to a normal value (no TC), whereas in 2 (20%) others a TC was unchanged. Three patients with MEC had shown normal preoperative orbital morphometry. The mean follow-up was 9 months (range: 5-16 months). The reader is further referred to our previous paper for interpreting the orbital measurement values in Khmer Cambodians as pertinent to TC or HT.
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Leelanukrom R, Wacharasint P, Kaewanuchit A. Perioperative management for surgical correction of frontoethmoidal encephalomeningocele in children: a review of 102 cases. Paediatr Anaesth 2007; 17:856-62. [PMID: 17683404 DOI: 10.1111/j.1460-9592.2007.02216.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frontoethmoidal encephalomeningocele (FEEM) is a congenital neural tube defect characterized by herniation of brain and meninges through an anterior skull defect. The extruding mass results in a cutaneous expanding lesion and facial deformity. The objective of this study was to review perioperative management for surgical correction of this condition. METHODS We reviewed the charts of FEEM children who were treated by surgical correction in King Chulalongkorn Memorial Hospital during 1995-2005. The collected data were categorized into preoperative, intraoperative and postoperative data. In addition, average blood loss was calculated. RESULTS A total of 102 charts were reviewed. Preoperative data: The mean age of the patients was 4.62 years. Forty-six patients (45%) were smaller than average weight or height. Preoperative-associated abnormal conditions were found in 69 cases (68%). Intraoperative data: The mean duration of the anesthesia and surgery were 6.35 h and 5.51 h, respectively. The estimated mean red cell mass loss was 13.04 ml.kg(-1). There is one case of difficult intubation. No major anesthetic complication was found. Postoperative data: The average intensive care unit stay and hospital stay were 1.55 days and 11.51 days, respectively. The main postoperative complications were tonic-clonic seizure and serious infection including septic shock from wound infection and meningitis. CONCLUSIONS We reported perioperative management in 102 FEEM children. Comprehensive care during preoperative, intraoperative and postoperative period is essential for successful outcome.
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Affiliation(s)
- Ruenreong Leelanukrom
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Roux FE, Lauwers F, Oucheng N, Say B, Joly B, Gollogly J. Treatment of frontoethmoidal meningoencephalocele in Cambodia: a low-cost procedure for developing countries. J Neurosurg 2007; 107:11-21. [PMID: 17644915 DOI: 10.3171/ped-07/07/011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Frontoethmoidal meningoencephaloceles (MECs) are a relatively common abnormality in southeast Asia, with disastrous consequences for the sufferer. In Cambodia, a lack of skilled neuro- and craniofacial surgeons, and the cost of surgery limit the possibilities for appropriate treatment of patients with these lesions. The authors developed a low-cost humanitarian program with the goals of treating frontoethmoidal MECs, ensuring careful postoperative follow-up, and teaching Khmer surgeons how to treat these malformations. METHODS This program was facilitated by two nongovernmental organizations: Rose Charities Cambodia provided the facilities, patients, and local staff, and "Médecins du Monde" provided visiting surgeons and anesthesiologists. All operations were free of charge for all patients. A strict follow-up program was organized to evaluate the surgical results, the social impact of the surgery, and the satisfaction levels of the children and their parents. RESULTS Forty-five children and seven young adults with MECs were treated using a rather simple surgical technique. Of the three types of MECs encountered, the most frequent was the nasoethmoidal type (43 cases). The most common postoperative issue was a temporary CSF leak (in 16 patients). Cosmetic results were considered excellent or good in 40 patients, average in nine, and poor in one; two patients were lost to follow-up. The overall cost of each operation was estimated to be $380 (US dollars), far less than a standard MEC operation would cost in a more developed country. At the end of this humanitarian program, Khmer surgeons were able to treat standard cases of frontoethmoidal MECs without the help of foreigners. CONCLUSIONS Patients in developing nations who have limited access to standard neurosurgical care can be treated for frontoethmoidal MECs with few complications and a satisfactory cost-to-benefit ratio.
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HASEGAWA S, HAYASHI N, KUBO M, HAMADA H, KUWAYAMA N, SHOJAKU H, AKAI T, ENDO S. Basal Encephalocele Associated With Hypoplasia of the Internal Carotid Artery -Case Report-. Neurol Med Chir (Tokyo) 2007; 47:572-5. [DOI: 10.2176/nmc.47.572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shinsaku HASEGAWA
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Nakamasa HAYASHI
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Michiya KUBO
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Hideo HAMADA
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Naoya KUWAYAMA
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
| | - Hideo SHOJAKU
- Department of Otolaryngology, University of Toyama, Faculty of Medicine
| | - Takuya AKAI
- Department of Neurosurgery, Kanazawa Medical University
| | - Shunro ENDO
- Department of Neurosurgery, University of Toyama, Faculty of Medicine
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Hedlund G. Congenital frontonasal masses: developmental anatomy, malformations, and MR imaging. Pediatr Radiol 2006; 36:647-62; quiz 726-7. [PMID: 16532348 DOI: 10.1007/s00247-005-0100-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Revised: 12/06/2005] [Accepted: 12/12/2005] [Indexed: 10/24/2022]
Abstract
The newborn, infant, or young child who presents with a midline frontonasal mass often poses a diagnostic challenge to the clinician. The most pressing issue is whether the mass extends intracranially. The development of the frontonasal region or anterior neuropore is complex. Aberrant embryogenesis leads to three main types of anomalies: nasal dermal sinus, anterior cephalocele, and nasal glioma. Understanding the developmental anatomy of the anterior neuropore and postnatal maturation will serve the radiologist well when it comes to imaging frontonasal masses. Pitfalls particularly common to CT imaging interpretation include the evolving ossification of the frontal, nasal and ethmoid bones in the first year of life, morphology and size of the foramen cecum, and the natural intumescence of the anterior nasal septum. Determination of the presence of a connection between the frontonasal mass and the anterior cranial fossae is crucial in the imaging assessment and clinical management. In the case of the nasal dermal sinus, failure to appreciate the intracranial components of the malformation can lead to fatal meningitis. MR imaging is the modality of choice for assessing the pediatric frontonasal region. Its advantages include multiplanar imaging, distinguishing the interface among cartilage, bone, brain and fluid, diffusion imaging to detect epidermoid tumors, and the capacity to evaluate the brain for associated cerebral anomalies.
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Affiliation(s)
- Gary Hedlund
- Department of Medical Imaging, Primary Children's Medical Center, Salt Lake City, UT 84113, USA.
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Abstract
Clinical assessment of olfactory dysfunction can be challenging. Because olfactory disturbances comprise most chemosensory abnormalities with imaging findings, this article focuses on the imaging of smell disorders. This article reviews the normal imaging appearance of the olfactory apparatus, discusses the respective roles of CT and MRI, provides illustrative imaging of typical pathologic lesions, and discusses a clinically based imaging strategy.
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Affiliation(s)
- Bronwyn E Hamilton
- Department of Radiology and Otolaryngology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA
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21
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Dehdashti AR, Abouzeid H, Momjian S, Delavelle J, Rilliet B. Occipital extra- and intracranial lipoencephalocele associated with tectocerebellar dysraphia. Childs Nerv Syst 2004; 20:225-8; discussion 229-38. [PMID: 14986040 DOI: 10.1007/s00381-003-0867-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2003] [Indexed: 11/24/2022]
Abstract
OBJECTS Tectocerebellar dysraphism was first described by Padget and Lindenberg, together with occipital encephaloceles, cerebellar midline defects, tectal beaking, posterior kinked and displaced brainstem, and inverted cerebellum. We present a unique case of lipoencephalocele associated with tectocerebellar dysraphia and discuss the etiologies of both pathologies. The importance of the developmental comprehension of posterior fossa malformations is stressed. CASE REPORT A 9-month-old girl in good health was referred for a huge occipital mass. On local examination, the patient had a rounded mass about 10 x 12 cm in size, covered by alopecic skin, with a small eccentric dimple without any discharge. Magnetic resonance imaging revealed a lipoencephalocele with an intra- and an extracranial part, associated with tectocerebellar dysraphia with no aspect of inverted cerebellum as originally described in the tectocerebellar dysraphia. Resection of the extracranial part of the lipoma was performed for esthetic reasons. The intracranial part remained in situ. CONCLUSION The association of lipoencephalocele and tectocerebellar dysraphia is extremely rare. The functional prognosis seems to be less severe for this combination than for the isolated tectocerebellar dysraphia. This association favors the dysraphic theory for the embryogenesis of the lipoma. It seems safe to restrict the surgery of this bizarre malformation to its external part.
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Affiliation(s)
- Amir R Dehdashti
- Department of Neurosurgery, Geneva University Hospital, Rue Micheli-du-Crest 24, 1211 Genève 14, Switzerland.
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22
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Huisman TAGM, Schneider JFL, Kellenberger CJ, Martin-Fiori E, Willi UV, Holzmann D. Developmental nasal midline masses in children: neuroradiological evaluation. Eur Radiol 2004; 14:243-9. [PMID: 12904880 DOI: 10.1007/s00330-003-2008-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2002] [Revised: 05/27/2003] [Accepted: 06/20/2003] [Indexed: 12/14/2022]
Abstract
Developmental nasal midline masses in children are rare lesions. Neuroimaging is essential to characterise these lesions, to determine the exact location of the lesion and most importantly to exclude a possible intracranial extension or connection. Our objective was to evaluate CT and MRI in the diagnosis of developmental nasal midline masses. Eleven patients (mean age 4.5 years) with nasal midline masses were examined by CT and MRI. Neuroimaging was evaluated for (a) lesion location/size, (b) indirect (bifid or deformed crista galli, widened foramen caecum, defect of the cribriform plate) and direct (identification of intracranially located lesion components or signal alterations) imaging signs of intracranial extension, (c) secondary complications and (d) associated malformations. Surgical and histological findings served as gold standard. Nasal dermoid sinus cysts were diagnosed in 9 patients. One patient was diagnosed with an meningocele and another patient with a nasal glioma. Indirect CT and MRI signs correlated with the surgical results in 10 of 11 patients. Direct CT findings correlated with surgery in all patients, whereas the direct MRI signs correlated in 9 of 11 patients. In 2 patients MRI showed an intracranial signal alteration not seen on CT. Neuroimaging corrected the clinical diagnosis in 1 patient. One child presented with a meningitis. In none of the patients was an associated malformation diagnosed. Intracranial extension is equally well detected by CT and MRI using indirect imaging signs. Evaluating the direct imaging signs, MRI suspected intracranial components in 2 patients without a correlate on CT. This could represent an isolated intracranial component that got undetected on CT and surgery. In 9 patients CT and MRI matched the surgical findings. The MRI did not show any false-negative results. These results in combination with the multiplanar MRI capabilities, the different image contrasts that can be generated by MRI and the lack of radiation favour the use of MRI as primary imaging tool in these young patients in which the region of imaging is usually centred on the radiosensitive eye lenses.
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Affiliation(s)
- Thierry A G M Huisman
- Department of Radiology and Magnetic Resonance, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
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Martínez-Lage J, Casas Fernández C, López Hernández F. Rinorrea espontánea por encefalocele basal. An Pediatr (Barc) 2001. [DOI: 10.1016/s1695-4033(01)77724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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24
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Kennedy EM, Gruber DP, Billmire DA, Crone KR. Transpalatal approach for the extracranial surgical repair of transsphenoidal cephaloceles in children. J Neurosurg 1997; 87:677-81. [PMID: 9347974 DOI: 10.3171/jns.1997.87.5.0677] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The surgical treatment of transsphenoidal cephaloceles in children is controversial. Reduction and repair via a transcranial approach are associated with high postoperative rates of morbidity, mortality, and hypothalamic dysfunction. In this study, four patients, aged 3 to 35 months at surgery, underwent successful transpalatal repair of two encephaloceles and two meningoceles. Two patients presented with nasal obstruction in infancy, one presented with unexplained meningitis, and in one patient the lesion was found incidentally during evaluation for seizures. Two children had median cleft face syndrome, another had an associated Arnold-Chiari type I malformation, and the fourth had no other cranial abnormalities. All patients underwent preoperative evaluation including magnetic resonance (MR) imaging. Auditory, ophthalmological, genetic, endocrinological, or other evaluation was undertaken as indicated. Lesions were approached through the median raphe of the hard and soft palates. All cephaloceles were easily visualized and dissected after division of the nasal palatal mucosa. The dural sac and its contents were reduced by surface coagulation after division and dissection of the overlying mucosa. Once reduced, the bone defect was obliterated in three of four patients. The dura was not opened and anomalous neural elements were not resected. At follow-up evaluation, all patients demonstrated resolution of preoperative symptoms without evidence of infection or lasting morbidity. Follow-up MR imaging showed reduction in all cases. The authors conclude that this transpalatal approach is safe and reliable for the treatment of transsphenoidal cephaloceles in young children.
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Affiliation(s)
- E M Kennedy
- Department of Plastic Surgery, University of Cincinnati, Children's Hospital Medical Center, and the Mayfield Clinic, Ohio, USA
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25
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Parízek J, Mĕrićka P, Nĕmecek S, Nĕmecková J, Zemánková M, Sercl M, Häringová M. Allogeneic cartilage used for skull base plasty in children with primary intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea. Childs Nerv Syst 1996; 12:136-41. [PMID: 8697455 DOI: 10.1007/bf00266815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Three children with primary intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea were operated on at the Department of Neurosurgery, Hradec Králové. In two children, aged 4 and 9.5 years, freeze-dried allogeneic costal cartilage was glued into the skull base defect. This plugging was covered up with deep frozen allogeneic fascia lata. In the third child, an only 1-year-old boy, after transection of the neck of the encephalomeningocele freeze-dried allogeneic dura mater was glued on extradurally and deep-frozen allogeneic fascia lata applied intradurally. The cerebrospinal fluid rhinorrhea ceased immediately after surgery. Spontaneous atrophy of the intranasal portion of the encephalomeningocele was demonstrated respectively 11, 1, and 7 years postoperatively on computed tomography. To evaluate cartilage healing histologically, the extracted allogeneic cartilage used for orbital roof plasty after 4 months was examined. The extent of spotty regressions represented about 7% of the tissue volume. It is stressed that, once diagnosed, intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea should be operated on for prevention of meningitis as soon as possible.
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Affiliation(s)
- J Parízek
- Department of Neurosurgery, Medical Faculty, Charles University, Hradec Králové, Czech Republic
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26
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Czech T, Reinprecht A, Matula C, Svoboda H, Vorkapic P. Cephaloceles - experience with 42 patients. Acta Neurochir (Wien) 1995; 134:125-9. [PMID: 8748770 DOI: 10.1007/bf01417678] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Forty-two patients with 44 cephaloceles treated between 1966 and 1993 are presented. Eighteen lesions were occipital, 2 parietal, 1 at the anterior fontanelle, 11 sincipital, and 12 basal. In recent years computerized tomography (CT) and magnetic resonance imaging (MRI) provided better information on the site and nature of the lesion as well as on associated malformations. Different malformations were associated more frequently with the cranial vault lesions. Cerebrospinal fluid (CSF)-rhinorrhea was the most frequent clinical sign in the basal lesions. Excision of the cele was performed in all but one case. The age at the time of surgical treatment ranged from 1 day to 11 years. Seven patients were shunted. Post-operative complications were persisting CSF-leaks in 5 patients needing operative revision and 2 infections. The outcome was good in the anterior lesions and in the occipital meningoceles.
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Affiliation(s)
- T Czech
- Department of Neurosurgery, Nordstadtkrankenhaus, Hannover, Federal Republic of Germany
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27
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Turgut M, Ozcan OE, Benli K, Ozgen T, Gürçay O, Sağlam S, Bertan V, Erbengi A. Congenital nasal encephalocele: a review of 35 cases. J Craniomaxillofac Surg 1995; 23:1-5. [PMID: 7699076 DOI: 10.1016/s1010-5182(05)80246-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Congenital encephaloceles are rare lesions which are usually seen in the occipital region, in the West. They may rarely be seen in the frontal region and they have distinct diagnostic features, together with several other pathological conditions occurring in this region. In order to emphasize these points, a retrospective analysis of 35 cases which have been operated on in our clinic, is made in this study. The findings are compared with the data obtained from the literature.
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Affiliation(s)
- M Turgut
- Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey
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28
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Jacob OJ, Rosenfeld JV, Watters DA. The repair of frontal encephaloceles in Papua New Guinea. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1994; 64:856-60. [PMID: 7980262 DOI: 10.1111/j.1445-2197.1994.tb04564.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Frontal encephaloceles are common in Papua New Guinea (PNG). Seventeen cases collected over 7 years are reported. Eleven frontal (sincipital) encephaloceles were repaired successfully via an extracranial approach. One of these patients with a frontonasal encephalocele developed a recurrence following the extracranial approach, which was subsequently repaired intracranially. Three patients with small naso-ethmoidal encephaloceles were repaired intracranially via an extradural approach. The other three cases have not yet had surgical correction. Complex craniofacial surgery which corrects hypertelorism as well as the encephalocele is unavailable in the developing world. For the general surgeon in the developing world, the extracranial approach is recommended for the frontonasal encephaloceles, and the intracranial approach for the naso-ethmoidal and naso-orbital encephaloceles. Hydrocephalus and epilepsy have not developed in the patients.
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Affiliation(s)
- O J Jacob
- Department of Surgery, University of Papua New Guinea, Boroko
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29
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Sharma NK, Garg P. An unusual orbital swelling. Trop Doct 1992; 22:44. [PMID: 1542959 DOI: 10.1177/004947559202200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- N K Sharma
- Department of Neurosurgery Medical College & Hospital, Rohtak, Haryana, India
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30
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Akdemir H, Paşaoğlu A, Ekinciler OF, Selçuklu A, Karaküçük S, Oktem IS. Unilateral naso-orbital meningocele and bilateral congenital fistulae of the lacrimal passages. Acta Ophthalmol 1991; 69:680-3. [PMID: 1776427 DOI: 10.1111/j.1755-3768.1991.tb04861.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Orbital meningocele is the protrusion of a sac containing cerebrospinal fluid into the orbit, through a defect called cranium bifidum. Although the occipital and frontal basis of the cranial cavity constitute the two most frequent localizations, this pathology may rarely be located in the naso-orbital region. Other developmental anomalies of the eyes may accompany the anomalies of the bony orbit. The case described in the present paper had a right naso-orbital meningocele associated with bilateral fistulae of the lacrimal passages which represents a very rare condition.
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Affiliation(s)
- H Akdemir
- Department of Neurosurgery, Erciyes University Medical School, Kayseri, Turkey
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31
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Miller JD, Middleton TH, Haines DE. Presentation of a frontal sinus encephalomeningocele in an adult. Clin Anat 1991. [DOI: 10.1002/ca.980040402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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32
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Lello GE, Sparrow OC, Gopal R. The surgical correction of fronto-ethmoidal meningo-encephaloceles. J Craniomaxillofac Surg 1989; 17:293-8. [PMID: 2808707 DOI: 10.1016/s1010-5182(89)80056-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
One-stage correction of fronto-ethmoidal meningo-encephaloceles and related stigmata, via an orbito-cranial approach, is recommended. A bifrontal craniotomy is only required when simultaneous correction of hypertelorism is to be undertaken. A combined intra- and extracranial approach is essential. The possibility of a high relapse rate for repaired fronto-ethmoidal meningo-encephaloceles, together with the possibility of prolonged postsurgical cerebrospinal fluid leakage, meningitis and other complications is invited when either a transcranial bifrontal craniotomy surgical approach, or an extracranial approach via the facial lesion, is undertaken alone. Modification of existing craniofacial surgical approaches in order to avoid a frontal craniotomy, allowed for good repair of the encephalocele together with significant benefits in terms of simplification of the surgical procedure, operating time, blood loss, frontal lobe retraction and complications.
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Affiliation(s)
- G E Lello
- Dept. of Maxillofacial and Oral Surgery, Medical University of Southern Africa, Pretoria
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33
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Jaw SJ, Yen M, Wu JS. Orbital cephaloceles. Neuroophthalmology 1989. [DOI: 10.3109/01658108909010469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gussack GS, Schlitt M, Hurley D. Craniofacial approach for the neonatal management of frontonasal encephalocoeles. Int J Pediatr Otorhinolaryngol 1988; 16:225-35. [PMID: 3235288 DOI: 10.1016/0165-5876(88)90034-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Three nasofrontal encephalocoeles managed at the University of South Alabama Medical Center are presented. Each consisted of abnormal brain originating from one frontal lobe, although the amount of cerebral tissue and the accompanying skin and meningeal layers varied. The encephalocoeles protruded through a defect in the anterior skull base near the cribiform plate. Repair in the neonatal period was required in two of the infants because of the size of the lesion and obstruction of the nasal airway. The operative approach utilized a bifrontal craniotomy with resection of the encephalocoele intradurally, repair of the anterior cranial fossa dura and osteoplastic repair of the foramen cecum defect. The closure of the facial defect depended upon the nature of the skin covering the herniation; either absence or excess of skin occurred. The preoperative evaluation disclosed associated congenital deformities in 2 of 3 patients in this series. Computerized tomographic scanning was of importance in preoperative planning. The operative technique can be modified to allow for each child's unique anatomy. Repair of nasofrontal encephalocoeles in the neonatal period may simplify the required operative procedures.
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Affiliation(s)
- G S Gussack
- Department of Surgery, University of South Alabama Medical Center, Mobile 36617
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35
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Shokunbi MT, Olumide AA, Adeloye A. Sincipital encephalocoeles: a review of clinical presentations and methods of surgical repair in Ibadan, Nigeria. Br J Neurosurg 1988; 2:497-501. [PMID: 3267333 DOI: 10.3109/02688698809029604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Between January 1972 and September 1987, 10 sincipital (fronto-ethmoidal) encephalocoeles were encountered at the neurosurgical unit of the University College Hospital, Ibadan, Nigeria. Seven of the eight patients whose clinical records were available for study were females. The age at presentation varied from 7 days to 5 years. All patients exhibited a mass at the root of the nose. An increase in the size of the lesion was noted, prior to surgery. Clinically, there was no hydrocephalus. Associated birth defects were minor. Five patients underwent intracranial repair. One patient's lesion was excised extracranially. In all these patients, a lump remained or recurred after surgery. Only one patient returned for a recommended second stage of repair at which the residual mass was completely excised. The default rate from follow-up was high. A combined intracranial and extracranial repair during the same hospital admission may offer the best chance for cure.
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Affiliation(s)
- M T Shokunbi
- Department of Surgery, University of Ibadan, Nigeria
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36
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Abstract
We report a case of ectopic brain tissue in the orbit associated with a bony defect of the orbit and the presence of skeletal muscle. Previous reports of orbital ectopic brain and related lesions in the orbit and at other sites are reviewed.
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Smith DE, Murphy MJ, Hitchon PW, Babin RW, Abu-Yousef MM. Transsphenoidal encephaloceles. SURGICAL NEUROLOGY 1983; 20:471-80. [PMID: 6648786 DOI: 10.1016/0090-3019(83)90030-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Transsphenoidal encephaloceles are rare congenital anomalies that may be immediately apparent in infants that present with multiple cranial midline defects. They should also be suspected in patients presenting with cerebrospinal fluid rhinorrhea, an epipharyngeal soft tissue mass, a visual defect, or an endocrinologic disturbance, especially when associated with midfacial and optic nerve anomalies. Plain x-ray films of the skull may show absence of the sellar floor and a soft tissue mass; the diagnosis is confirmed by computed tomography scanning. Surgical therapy may be indicated for persistent cerebrospinal fluid rhinorrhea, symptomatic epipharyngeal respiratory distress, or progression of neurological deficits. Two cases of transsphenoidal encephalocele are reported.
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Abstract
Four patients are presented with the Goldenhar syndrome (GS) and cranial defects consisting of plagiocephaly, microcephaly, skull defects, or intracranial dermoid cysts. Twelve cases from the literature add hydrocephalus, encephalocele, and arhinencephaly to a growing list of brain anomalies in GS. As a group, these patients emphasize the variability of GS and the increased risk for developmental retardation with multiple, severe, or unusual manifestations. The temporal relation of proposed teratogenic events in GS provides an opportunity to reconstruct biological relationships within the 3-5-week human embryo.
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