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Incidence of Secondary Hydrocephalus after Excision of Huge Encephaloceles in Neonates: Case Study
Ehab Ahmed El Refaee1,2, Mohamed Ibrahim Refaat3, Mohamed Reda3
1Department of Neurosurgery, Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Germany.
Insights
Early surgery for large encephaloceles is effective. While 21% of patients required cerebrospinal fluid diversion, giant encephaloceles can have an excellent prognosis.
Area of Science:
- Pediatric Neurosurgery
- Cranial Malformations
- Surgical Outcomes
Background:
- Encephaloceles are cranial content protrusions through skull defects, commonly in occipital and frontonasal areas.
- Surgical outcomes for encephaloceles are generally good, but hydrocephalus incidence varies.
- This study examines the link between encephalocele size and hydrocephalus development.
Purpose of the Study:
- To investigate the relationship between encephalocele size and the occurrence of hydrocephalus.
- To evaluate the effectiveness of early surgical intervention for large encephaloceles.
- To assess the long-term prognosis of giant encephaloceles.
Main Methods:
- Retrospective analysis of neonates with encephaloceles (maximal diameter >10 cm) from 2012-2014.
- Surgical intervention within the first two weeks of life.
- Analysis of clinical data, surgical techniques, imaging, and follow-up outcomes.
Main Results:
- Nineteen neonates with large encephaloceles (>10 cm) were included; 16 occipital, 3 frontal.
- Postoperative ventriculomegaly occurred in 7 cases, with 4 (21%) requiring permanent cerebrospinal fluid diversion.
- Two cases of wound dehiscence and one mortality due to poor condition and infection were reported.
Conclusions:
- Early surgical excision is an effective treatment for huge encephaloceles.
- Approximately 21% of cases may require cerebrospinal fluid diversion, influenced by associated anomalies.
- Giant encephaloceles can achieve excellent prognoses without the need for further intervention.
Background:
Encephaloceles presents as a protrusion of the cranial contents through a defect in the cranium. The most common sites of occurrence are the occipital and frontonasal regions. The surgical outcome is reported to be satisfactory; however, the incidence of hydrocephalus in patients with encephaloceles is variable in the literature. This study investigated the relationship between the size of the encephaloceles and the occurrence of hydrocephalus.
Patient And Methods:
Data of all neonates with encephaloceles who presented to our institution from September 2012 to September 2014 were collected. Surgery was performed during the first 2 weeks of age. Encephaloceles with a maximal diameter > 10 cm were included in the study, and the clinical picture, surgical technique, pre- and postoperative imaging, and follow-up were analyzed.
Results:
Nineteen cases were included in this study. The mean follow-up period was 7 months. Sixteen cases were occipital; three were frontal. In all patients the maximum diameter was > 10 cm. However, in four patients it was > 18 cm. Postoperative ventriculomegaly occurred in seven cases. Of these, four patients needed a permanent ventriculoperitoneal shunt implantation (21%). Wound dehiscence occurred in two patients who required secondary sutures with a favorable outcome. One patient died 2 weeks after the surgery due to a poor general condition and wound infection.
Conclusion:
Early surgical excision provides effective treatment of huge encephaloceles. Overall, 21% of cases require cerebrospinal fluid (CSF) diversion afterward depending on associated anomalies. Despite their size, giant encephaloceles can have an excellent prognosis with no need for further treatment or CSF diversion.
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