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Anterior encephaloceles
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi.
Insights
This study reviewed 65 children with anterior encephaloceles, finding the naso-ethmoid type most common. It highlights rare nasopharyngeal encephaloceles and advocates for one-stage repair for better outcomes.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Radiology
Background:
- Anterior encephaloceles are congenital herniations of brain tissue through skull defects.
- Naso-ethmoid and nasopharyngeal encephaloceles present unique diagnostic and surgical challenges.
- Long-term outcomes and optimal management strategies require further investigation.
Purpose of the Study:
- To retrospectively analyze the clinical presentation, radiological findings, surgical management, and outcomes of anterior encephaloceles in children.
- To identify the prevalence of different encephalocele types, including rare variants like nasopharyngeal encephaloceles.
- To evaluate the efficacy of one-stage surgical repair for encephalocele and associated hypertelorism.
Main Methods:
- Retrospective case series of 65 children with anterior encephaloceles over a 22-year period (1973-1994).
- Review of clinical data, radiological imaging (including CT scans), surgical procedures, and patient outcomes.
- Analysis of specific subtypes, associated anomalies, and complications such as CSF rhinorrhoea.
Main Results:
- The naso-ethmoid type was most frequent (45 patients), with 6 rare cases of nasopharyngeal encephalocele observed.
- Common findings included nasal swelling (53 patients) and hypertelorism (50 patients).
- One-stage repair of encephalocele and hypertelorism was performed in 59 patients, with one postoperative mortality and 10 cases of CSF rhinorrhoea.
Conclusions:
- Anterior encephaloceles predominantly affect young children, with the naso-ethmoid type being most common.
- Rare nasopharyngeal encephaloceles require specific consideration, and one-stage repair appears effective for managing encephalocele and hypertelorism.
- Management of complications like CSF rhinorrhoea may necessitate further interventions, such as shunts.
Abstract:
Sixty five children with anterior encephaloceles were retrospectively studied for clinical presentation, radiological findings, surgery and outcome. They were sampled over a 22 years period (Jan 1973-Dec 1994). Only 6 children were above 10 years of age. Naso-ethmoid type was the most frequent type, encountered in 45 patients. Surprisingly, nasopharyngeal type was observed in 6 children. Swelling over the nose and hypertelorism were usual findings, recorded in 53 and 50 patients respectively. Ten patients, each, had CSF rhinorrhoea and proptosis. In fifty four patients CT scans were performed and bony defect could be demonstrated in 45 of them. Three each had agenesis of corpus callosum and porencphalic cysts. Six patients with hydrocephalus underwent ventricul operitoneal shunt, prior to surgical repair of the encephaloceles. In fifty nine patients, one stage repair of encephalocele and hpertelorism was carried out. There was one postoperative mortality. Ten patients developed postoperative CSF rhinorrhoea, among them 6 required percutaneous lumbo-peritoneal shunt. This study brings out the rare cases of nasopharyngeal encephaloceles and highlights the need for one stage repair in these patients.