MyMedR

Management of sphenoid lateral recess encephalocoeles

Govindaraju R, Tang IP, Prepageran N

Curr Opin Otolaryngol Head Neck Surg, 2019 Feb;27(1):37-46.

PMID: 30507693 DOI: 10.1097/MOO.0000000000000508

PURPOSE OF REVIEW: Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome.

RECENT FINDINGS: Transpetrygoid is the most utilized approach with modifications suggested to limit bone removal, exposure and preservation of the neurovascular structures as dictated by the extent of the lateral recess. As more experience is gained, extended transphenoidal techniques were also successfully used for access. Lateral transorbital is a new approach to the lateral recess investigated in cadavers. IIH treatment is still controversial in the setting of SSLRE, but it appears rationale to evaluate, monitor and treat if necessary.

SUMMARY: SSLRE management should be tailored to the specific anatomical variances and cause. Modifications of techniques have been described giving different options to access the lateral recess. Successful repair for spontaneous SSLRE may require treatment of IIH if present, but the long-term outcome is still unclear.

Matched MeSH terms: Encephalocele/surgery*

Fulltext Two-stage management of mega occipito-encephalocele

Mardzuki AI, Abdullah J, Ghazaime G, Ariff AR, Ghazali M

Med J Malaysia, 2003 Mar;58(1):115-9.

PMID: 14556336 MyJurnal

We report three cases of large occipito-encephaloceles that were managed in the Neurosciences Unit, Hospital Universiti Sains Malaysia over the last 5 years. All patients had pre-operative MRI (magnetic resonance imaging) evolution and mapping of the sagittal sinus tract. The cerebrospinal fluid (CSF) of all three patients were initially diverted by means of ventricular shunt two weeks prior to shunt removal. The slow drainage of CSF prevented electrolyte and volume disturbances due to sudden decompression during their definitive occipital encephalocele operations. After 3 years follow-up, all these patients are progressing well.

Matched MeSH terms: Encephalocele/surgery*

Anterior encephalocele

Rapport RL, Dunn RC, Alhady F

J. Neurosurg., 1981 Feb;54(2):213-9.

PMID: 7452336

Eighteen cases of anterior encephalocele treated at the University of Malaya Hospital between 1970 and 1980 are discussed, and the literature concerning this defect is reviewed. A detailed analysis of the microscopic abnormalities present in the surgical specimens is included, along with the relevant radiographic and demographic data. Anterior encephalocele is more common in Southeast Asia than elsewhere. The possible ethnographic and geographic implications are presented, as well as a discussion of the relevant embryology, in attempting to define possible etiologies for this malformation. The author's surgical approach to the repair of this defect and reasons for preferring a transcranial, intradural approach are described. Potential complications are enumerated.

Matched MeSH terms: Encephalocele/surgery*

Alopecia secondary to repaired occipital encephalocele - role of tissue expander in hair restoration

Ishak A, Mat Saad AZ, Azman WS, Halim AS

Med J Malaysia, 2018 06;73(3):172-174.

PMID: 29962502 MyJurnal

Partial scalp alopecia is a common problem that can lead to severe social and psychological problems. Tissue expansion, although an old concept, provides a surgical alternative to manage areas of alopecia. We describe a case of alopecia secondary to repaired occipital encephalocele that was successfully treated using tissue expansion technique.

Matched MeSH terms: Encephalocele/surgery

Combined transnasal and transoral endoscopic approach to a transsphenoidal encephalocele in an infant

Tan SH, Mun KS, Chandran PA, Manuel AM, Prepageran N, Waran V, et al.

Childs Nerv Syst, 2015 Jul;31(7):1165-9.

PMID: 25712744 DOI: 10.1007/s00381-015-2667-9

This paper reports an unusual case of a transsphenoidal encephalocele and discusses our experience with a minimally invasive management. To the best of our knowledge, we present the first case of a combined endoscopic transnasal and transoral approach to a transsphenoidal encephalocele in an infant.

Matched MeSH terms: Encephalocele/surgery*

Double neural tube defect: a case report and discussions on neural tube development

Vashu R, Liew NS

Childs Nerv Syst, 2010 May;26(5):697-701.

PMID: 20225088 DOI: 10.1007/s00381-010-1093-2

Double neural tube defect is a rare congenital problem. A case illustration and current literatures on neural tube closure theory are discussed. The available theories are summarised and compared with regard to the case report.

Matched MeSH terms: Encephalocele/surgery

Prenatal diagnosis and perinatal management of frontoethmoidal meningoencephalocele

Donnenfeld AE, Hughes H, Weiner S

Am J Perinatol, 1988 Jan;5(1):51-3.

PMID: 3337758

Frontoethmoidal meningoencephaloceles (FEM) are exceedingly rare in the western hemisphere, Australia, and Europe with an estimated frequency of 1 in 40,000 live births. Among the inhabitants of Thailand, Burma, Malaysia, Indonesia, and parts of the Soviet Union, however, the frequency is as high as 1 in 5000, accounting for 15% of all neural tube defects (NTD). Normal maternal serum alpha-fetoprotein (MSAFP) values usually will be found in these cases since most encephaloceles are closed, skin covered defects. Correct interpretation of the sonographic findings is crucial in establishing a diagnosis as well as giving prognostic and recurrence risk information. To our knowledge, this is the first reported case of prenatally diagnosed FEM. Perinatal management, differential diagnosis for disorders associated with this malformation, and epidemiologic information regarding this rare condition are discussed. It is anticipated that the prenatal sonographic findings may be applied to establish this diagnosis in similarly affected fetuses.

Matched MeSH terms: Encephalocele/surgery

Frontoethmoidal encephalocele: treatment and outcome

Arshad AR, Selvapragasam T

J Craniofac Surg, 2008 Jan;19(1):175-83.

PMID: 18216685 DOI: 10.1097/scs.0b013e3181534a77

This is a study on 124 patients who were treated by the authors over a 19-year period. There were 48 male and 76 female patients. The age range of these patients at the time of treatment was between 4 months and 32 years. There was no family history of similar deformity. All of these patients come from a socially low-income group. Fourteen patients had accompanying congenital amputation of fingers, toes, or limbs. Two had oral cleft lip and palate. The surgical treatment was medial orbital wall osteotomy and excision of encephalocele. There were two mortalities and five patients who had complications that needed secondary surgical intervention. Thirty-eight patients are still under follow up without any complaints.

Matched MeSH terms: Encephalocele/surgery*

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