Management strategies of cranial encephaloceles: A neurosurgical challenge
Background: Encephalocele is defined as herniation of cranial contents beyond the normal confines of the skull through a defect in the calvarium either along the midline or at the base of skull. These anomalies should be repaired in the first few months of life to prevent neurological deficits and f...
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Veröffentlicht in: | Asian journal of neurosurgery 2019-07, Vol.14 (3), p.718-724 |
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creator | Velho, Vernon Naik, Harish Survashe, Pravin Guthe, Sachin Bhide, Anuj Bhople, Laxmikant Guha, Amrita |
description | Background:
Encephalocele is defined as herniation of cranial contents beyond the normal confines of the skull through a defect in the calvarium either along the midline or at the base of skull. These anomalies should be repaired in the first few months of life to prevent neurological deficits and facial disfigurement. The aim of the surgery is water tight dural closure at the level of internal defect, closure of skull defect, and reconstruction of external bony deformity.
Materials and Methods:
Fifty-four cases of encephalocoeles were studied in our hospital over a 6-year period from 2010 to 2016. Computed tomography (CT) and magnetic resonance imaging (MRI) brain were performed to delineate the bony defect and associated anomalies. Reconstruction of the bony defect was done using autologous calvarial bone graft, Osteopore polycaprolactone (PCL) bone scaffold filler and titanium mesh.
Results:
In our study, 54 patients (34 boys and 20 girls) whose age varied between 2 months and 14 years were evaluated. Frontoethmoidal (44.5%) and occipital encephaloceles (25.9%) were the most frequently seen varieties. Repair of the dural defect either primarily or using pericranium was done in all cases. Closure of the bony defect was done using autologous calvarial bone graft in 12 (22.22%) patients. Titanium mesh was used in eight and Osteopore PCL bone scaffold filler in four children. Cranioplasty was not done in remaining thirty children because of the small bone defect. Overall, 80% had no postoperative problem and were discharged between 7 and 10 days of surgery. Cerebrospinal fluid leak was the most frequent postoperative complication, noted in five patients. Re-exploration with repair was done in one and remaining four were managed conservatively. Overall, cosmetic results were acceptably good, with parents judging the cosmetic outcome as good to excellent in 70%, satisfactory in 18%, and poor in 3% at the last follow-up.
Conclusion:
Our study demonstrated that encephaloceles are associated with complex deformities and pose a technical challenge to the neurosurgeon. A multidisciplinary approach is necessary to manage these cases. MRI brain and three dimensional CT aids in evaluating the deformity better and surgical correction should be performed as soon as possible to prevent a further neurological deficit. Repair of dural defect and reconstruction of the skull defect results in a good long-term outcome. We present our experience on 54 cases of cranial encepha |
doi_str_mv | 10.4103/ajns.AJNS_139_17 |
format | Article |
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Encephalocele is defined as herniation of cranial contents beyond the normal confines of the skull through a defect in the calvarium either along the midline or at the base of skull. These anomalies should be repaired in the first few months of life to prevent neurological deficits and facial disfigurement. The aim of the surgery is water tight dural closure at the level of internal defect, closure of skull defect, and reconstruction of external bony deformity.
Materials and Methods:
Fifty-four cases of encephalocoeles were studied in our hospital over a 6-year period from 2010 to 2016. Computed tomography (CT) and magnetic resonance imaging (MRI) brain were performed to delineate the bony defect and associated anomalies. Reconstruction of the bony defect was done using autologous calvarial bone graft, Osteopore polycaprolactone (PCL) bone scaffold filler and titanium mesh.
Results:
In our study, 54 patients (34 boys and 20 girls) whose age varied between 2 months and 14 years were evaluated. Frontoethmoidal (44.5%) and occipital encephaloceles (25.9%) were the most frequently seen varieties. Repair of the dural defect either primarily or using pericranium was done in all cases. Closure of the bony defect was done using autologous calvarial bone graft in 12 (22.22%) patients. Titanium mesh was used in eight and Osteopore PCL bone scaffold filler in four children. Cranioplasty was not done in remaining thirty children because of the small bone defect. Overall, 80% had no postoperative problem and were discharged between 7 and 10 days of surgery. Cerebrospinal fluid leak was the most frequent postoperative complication, noted in five patients. Re-exploration with repair was done in one and remaining four were managed conservatively. Overall, cosmetic results were acceptably good, with parents judging the cosmetic outcome as good to excellent in 70%, satisfactory in 18%, and poor in 3% at the last follow-up.
Conclusion:
Our study demonstrated that encephaloceles are associated with complex deformities and pose a technical challenge to the neurosurgeon. A multidisciplinary approach is necessary to manage these cases. MRI brain and three dimensional CT aids in evaluating the deformity better and surgical correction should be performed as soon as possible to prevent a further neurological deficit. Repair of dural defect and reconstruction of the skull defect results in a good long-term outcome. We present our experience on 54 cases of cranial encephaloceles managed surgically over a period of only 6 years which is one of the largest series reported from Asia.</description><identifier>ISSN: 1793-5482</identifier><identifier>EISSN: 2248-9614</identifier><identifier>DOI: 10.4103/ajns.AJNS_139_17</identifier><identifier>PMID: 31497091</identifier><language>eng</language><publisher>A-12, 2nd Floor, Sector 2, Noida-201301 UP, India: Thieme Medical and Scientific Publishers Pvt. Ltd</publisher><subject>Care and treatment ; Diagnosis ; Encephalocele ; Neurosurgery ; Original ; Original Article ; Patient outcomes ; Strategic planning (Business) ; Surgery</subject><ispartof>Asian journal of neurosurgery, 2019-07, Vol.14 (3), p.718-724</ispartof><rights>Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon.</rights><rights>COPYRIGHT 2019 Medknow Publications and Media Pvt. Ltd.</rights><rights>Copyright: © 2018 Asian Journal of Neurosurgery 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438e-66fa0a536c69dc6c74680cfdb840ed2cdbed3f7d71f9038f79e1aa26c11c6a5b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703041/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703041/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,20891,27924,27925,53791,53793,54587,54615</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31497091$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Velho, Vernon</creatorcontrib><creatorcontrib>Naik, Harish</creatorcontrib><creatorcontrib>Survashe, Pravin</creatorcontrib><creatorcontrib>Guthe, Sachin</creatorcontrib><creatorcontrib>Bhide, Anuj</creatorcontrib><creatorcontrib>Bhople, Laxmikant</creatorcontrib><creatorcontrib>Guha, Amrita</creatorcontrib><title>Management strategies of cranial encephaloceles: A neurosurgical challenge</title><title>Asian journal of neurosurgery</title><addtitle>Asian J Neurosurg</addtitle><description>Background:
Encephalocele is defined as herniation of cranial contents beyond the normal confines of the skull through a defect in the calvarium either along the midline or at the base of skull. These anomalies should be repaired in the first few months of life to prevent neurological deficits and facial disfigurement. The aim of the surgery is water tight dural closure at the level of internal defect, closure of skull defect, and reconstruction of external bony deformity.
Materials and Methods:
Fifty-four cases of encephalocoeles were studied in our hospital over a 6-year period from 2010 to 2016. Computed tomography (CT) and magnetic resonance imaging (MRI) brain were performed to delineate the bony defect and associated anomalies. Reconstruction of the bony defect was done using autologous calvarial bone graft, Osteopore polycaprolactone (PCL) bone scaffold filler and titanium mesh.
Results:
In our study, 54 patients (34 boys and 20 girls) whose age varied between 2 months and 14 years were evaluated. Frontoethmoidal (44.5%) and occipital encephaloceles (25.9%) were the most frequently seen varieties. Repair of the dural defect either primarily or using pericranium was done in all cases. Closure of the bony defect was done using autologous calvarial bone graft in 12 (22.22%) patients. Titanium mesh was used in eight and Osteopore PCL bone scaffold filler in four children. Cranioplasty was not done in remaining thirty children because of the small bone defect. Overall, 80% had no postoperative problem and were discharged between 7 and 10 days of surgery. Cerebrospinal fluid leak was the most frequent postoperative complication, noted in five patients. Re-exploration with repair was done in one and remaining four were managed conservatively. Overall, cosmetic results were acceptably good, with parents judging the cosmetic outcome as good to excellent in 70%, satisfactory in 18%, and poor in 3% at the last follow-up.
Conclusion:
Our study demonstrated that encephaloceles are associated with complex deformities and pose a technical challenge to the neurosurgeon. A multidisciplinary approach is necessary to manage these cases. MRI brain and three dimensional CT aids in evaluating the deformity better and surgical correction should be performed as soon as possible to prevent a further neurological deficit. Repair of dural defect and reconstruction of the skull defect results in a good long-term outcome. We present our experience on 54 cases of cranial encephaloceles managed surgically over a period of only 6 years which is one of the largest series reported from Asia.</description><subject>Care and treatment</subject><subject>Diagnosis</subject><subject>Encephalocele</subject><subject>Neurosurgery</subject><subject>Original</subject><subject>Original Article</subject><subject>Patient outcomes</subject><subject>Strategic planning (Business)</subject><subject>Surgery</subject><issn>1793-5482</issn><issn>2248-9614</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>0U6</sourceid><recordid>eNp1kk1v3CAQhq2qVbNKc--pslSp6sUbMBjsHipto35FaXtoe0YsHmw2GDZgd5V_H1ZOol2pgQOCed5XM8Nk2WuMlhQjci43Li5Xlz9_C0wagfmzbFGWtC4ahunzbIF5Q4qK1uVJdhbjBqVV4apC5cvshGDacNTgRXb5QzrZwQBuzOMY5AidgZh7nasgnZE2B6dg20vrFViIH_JV7mAKPk6hMyrFVYpZcB28yl5oaSOc3Z-n2d8vn_9cfCuufn39frG6KhQlNRSMaYlkRZhiTauY4pTVSOl2XVMEbanaNbRE85Zj3SBSa94AlrJkCmPFZLUmp9nH2Xc7rQdoVUo9SCu2wQwy3AovjTiOONOLzv8TjCOCKE4G7-8Ngr-ZII5iMDFVZ6UDP0VRljWvcIJpQt_OaCctCOO0T45qj4tV1TDCaUmaRC3_Q6XdwmCUd6BNej8SvDsQ9CDt2Edvp9F4F49BNIMqdTwG0I9lYiT2UyD2UyAOpiBJ3hy251Hw8OcJ-DQDO29HCPHaTjsIIrHXzu-eNBYc1-JhWpLJ-Wwy9ibdxcZPwaVffzqvO9pK1Zs</recordid><startdate>20190701</startdate><enddate>20190701</enddate><creator>Velho, Vernon</creator><creator>Naik, Harish</creator><creator>Survashe, Pravin</creator><creator>Guthe, Sachin</creator><creator>Bhide, Anuj</creator><creator>Bhople, Laxmikant</creator><creator>Guha, Amrita</creator><general>Thieme Medical and Scientific Publishers Pvt. Ltd</general><general>Wolters Kluwer India Pvt. Ltd</general><general>Medknow Publications and Media Pvt. Ltd</general><general>Wolters Kluwer - Medknow</general><scope>0U6</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190701</creationdate><title>Management strategies of cranial encephaloceles: A neurosurgical challenge</title><author>Velho, Vernon ; Naik, Harish ; Survashe, Pravin ; Guthe, Sachin ; Bhide, Anuj ; Bhople, Laxmikant ; Guha, Amrita</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438e-66fa0a536c69dc6c74680cfdb840ed2cdbed3f7d71f9038f79e1aa26c11c6a5b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Care and treatment</topic><topic>Diagnosis</topic><topic>Encephalocele</topic><topic>Neurosurgery</topic><topic>Original</topic><topic>Original Article</topic><topic>Patient outcomes</topic><topic>Strategic planning (Business)</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Velho, Vernon</creatorcontrib><creatorcontrib>Naik, Harish</creatorcontrib><creatorcontrib>Survashe, Pravin</creatorcontrib><creatorcontrib>Guthe, Sachin</creatorcontrib><creatorcontrib>Bhide, Anuj</creatorcontrib><creatorcontrib>Bhople, Laxmikant</creatorcontrib><creatorcontrib>Guha, Amrita</creatorcontrib><collection>Thieme Connect Journals Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Asian journal of neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Velho, Vernon</au><au>Naik, Harish</au><au>Survashe, Pravin</au><au>Guthe, Sachin</au><au>Bhide, Anuj</au><au>Bhople, Laxmikant</au><au>Guha, Amrita</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management strategies of cranial encephaloceles: A neurosurgical challenge</atitle><jtitle>Asian journal of neurosurgery</jtitle><addtitle>Asian J Neurosurg</addtitle><date>2019-07-01</date><risdate>2019</risdate><volume>14</volume><issue>3</issue><spage>718</spage><epage>724</epage><pages>718-724</pages><issn>1793-5482</issn><eissn>2248-9614</eissn><abstract>Background:
Encephalocele is defined as herniation of cranial contents beyond the normal confines of the skull through a defect in the calvarium either along the midline or at the base of skull. These anomalies should be repaired in the first few months of life to prevent neurological deficits and facial disfigurement. The aim of the surgery is water tight dural closure at the level of internal defect, closure of skull defect, and reconstruction of external bony deformity.
Materials and Methods:
Fifty-four cases of encephalocoeles were studied in our hospital over a 6-year period from 2010 to 2016. Computed tomography (CT) and magnetic resonance imaging (MRI) brain were performed to delineate the bony defect and associated anomalies. Reconstruction of the bony defect was done using autologous calvarial bone graft, Osteopore polycaprolactone (PCL) bone scaffold filler and titanium mesh.
Results:
In our study, 54 patients (34 boys and 20 girls) whose age varied between 2 months and 14 years were evaluated. Frontoethmoidal (44.5%) and occipital encephaloceles (25.9%) were the most frequently seen varieties. Repair of the dural defect either primarily or using pericranium was done in all cases. Closure of the bony defect was done using autologous calvarial bone graft in 12 (22.22%) patients. Titanium mesh was used in eight and Osteopore PCL bone scaffold filler in four children. Cranioplasty was not done in remaining thirty children because of the small bone defect. Overall, 80% had no postoperative problem and were discharged between 7 and 10 days of surgery. Cerebrospinal fluid leak was the most frequent postoperative complication, noted in five patients. Re-exploration with repair was done in one and remaining four were managed conservatively. Overall, cosmetic results were acceptably good, with parents judging the cosmetic outcome as good to excellent in 70%, satisfactory in 18%, and poor in 3% at the last follow-up.
Conclusion:
Our study demonstrated that encephaloceles are associated with complex deformities and pose a technical challenge to the neurosurgeon. A multidisciplinary approach is necessary to manage these cases. MRI brain and three dimensional CT aids in evaluating the deformity better and surgical correction should be performed as soon as possible to prevent a further neurological deficit. Repair of dural defect and reconstruction of the skull defect results in a good long-term outcome. We present our experience on 54 cases of cranial encephaloceles managed surgically over a period of only 6 years which is one of the largest series reported from Asia.</abstract><cop>A-12, 2nd Floor, Sector 2, Noida-201301 UP, India</cop><pub>Thieme Medical and Scientific Publishers Pvt. Ltd</pub><pmid>31497091</pmid><doi>10.4103/ajns.AJNS_139_17</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Care and treatment Diagnosis Encephalocele Neurosurgery Original Original Article Patient outcomes Strategic planning (Business) Surgery |
title | Management strategies of cranial encephaloceles: A neurosurgical challenge |
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