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Repair of Frontoethmoidal Encephalocele in the Philippines: An Account of 30 Cases Between 2008-2013
Amanda-Lynn Marshall1, Pradeep Setty2, Mark Hnatiuk3
1Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA.
Insights
Surgical mission teams effectively treated frontoethmoidal encephaloceles in the Philippines using a combined approach. This interdisciplinary treatment improved patient appearance and well-being despite resource limitations.
Area of Science:
- Neurosurgery
- Craniofacial Surgery
- Pediatric Congenital Abnormalities
Background:
- Frontoethmoidal encephalocele is a congenital anterior skull base defect.
- Development is linked to foramen cecum patency and multifactorial variables.
- Limited resources and expertise hinder treatment in developing nations.
Purpose of the Study:
- To evaluate the effectiveness of an interdisciplinary surgical approach for frontoethmoidal encephalocele repair.
- To assess treatment outcomes in a resource-limited setting.
Main Methods:
- An interdisciplinary team performed surgical mission trips from 2008-2013 in the Philippines.
- A combined extracranial/intracranial approach was used for encephalocele removal and craniofacial defect reconstruction.
Main Results:
- 30 frontoethmoidal encephaloceles were repaired (18 nasoethmoidal, 9 nasofrontal, 3 naso-orbital).
- Concurrent anomalies included enlarged ventricles, arachnoid cysts, and globe deformities.
- No operative mortalities, neurologic deficits, infections, or hydrocephalus were observed post-operatively.
Conclusions:
- An interdisciplinary surgical approach offers effective treatment for frontoethmoidal encephalocele.
- This method improves physical appearance and psychological well-being in affected patients, even in developing countries.
Background:
Frontoethmoidal encephalocele is a congenital abnormality of the anterior skull base involving herniation of cranial contents through a midline skull defect. Patency of the foramen cecum, along with other multifactorial variables, contributes to the development of frontoethmoidal encephaloceles. Because of limited resources, financial constraints, and lack of surgical expertise, repair of frontoethmoidal encephaloceles is limited in developing countries.
Methods:
Between 2008 and 2013 an interdisciplinary team composed of neurosurgeons, craniofacial surgeons, otolaryngologists, plastic surgeons, and nursing personnel, conducted surgical mission trips to Davao City in Mindanao, Philippines. All patients underwent a combined extracranial/intracranial surgical approach, performed in tandem by a neurosurgeon and a craniofacial surgeon, to detach and remove the encephalocele. This procedure was followed by reconstruction of the craniofacial defects.
Results:
A total of 30 cases of frontoethmoidal encephalocele were repaired between 2008 and 2013 (20 male; 10 female). The average age at operation was 8.7 years, with 7 patients older than 17 years. Of the 3 subtypes, the following breakdown was observed in patients: 18 nasoethmoidal; 9 nasofrontal; and 3 naso-orbital. Several patients showed concurrent including enlarged ventricles, arachnoid cysts (both unilateral and bilateral), and gliotic changes, as well as orbit and bulbus oculi (globe) deformities. There were no operative-associated mortalities or neurologic deficits, infections, or hydrocephalus on follow-up during subsequent trips.
Conclusions:
Despite the limitations of performing advanced surgery in a developing country, the combined interdisciplinary surgical approach has offered effective treatment to improve physical appearance and psychological well-being in afflicted patients.
