Leaking Encephaloceles-Strategies in Management Based on 27 Patients

Craniofacial surgeons are sometimes referred patients with an encephalocele that is leaking and ulcerated. The management of such cases is sparse in the literature. If early surgery is not performed, these patients usually demise.

The charts in the Craniofacial Unit of the Nelson R. Mandela School of Medicine, University of KwaZulu-Natal were reviewed from 1990 to 2024. All patients that were referred to the unit with a leaking or imminently leaking encephalocele were reviewed. There were 27 patients of which 14 were male and 13 were female. There were 22 patients with a frank leak with ulceration and 4 with an imminent leak because of the tenuous skin and meningeal cover. Early surgery was performed on these patients with almost half of them requiring a local flap.

There were 3 postoperative mortalities and 1 before surgery could be performed (14.8%). There was a high complication rate of 63%. The mean follow-up period was 44.3 months. As regards the neurological outcome, 7 (26%) attended a normal school, 6 (22%) were delayed but not dependent, 6 (22%) were delayed and dependent, and 4 (18%) did not return for a follow-up.