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Surgical management of encephalocoele in tertiary care center: Ca | 50283

Journal of Neurology & Neurophysiology

ISSN - 2155-9562

Surgical management of encephalocoele in tertiary care center: Case series

Joint Event on 23rd International Conference on Neurology & Neurophysiology & 24th International Conference on Neurosurgery and Neuroscience

March 18-19, 2019 Edinburgh, Scotland

B V S Raman, K S V Prasad and B Hayagriva Rao

King George Hospital, India

Posters & Accepted Abstracts: J Neurol Neurophysiol

Abstract :

Introduction: Encephalomeningocele is a congenital malformation characterized by protrusion of meninges and/or brain tissue due to a skull defect. It is one form of neural tube defects as the other two, anencephaly and spina bifida. Despite the higher incidence of this congenital defect in this area, little is known about its etiology and pathogenesis. Some evidence from previous studies suggest environmental factors as potential causes. So far, only aflatoxin has been proposed to be a teratogenic agent for this anomaly. Indirect evidences from its closely related anomaly, spina bifida, may suggest the role of folate deficiency in encephalomeningocele. Here, we report 10 cases of encephaloceles in and review their epidemiological, clinical, imaging characteristics, as well as analyze the surgical results.

Material & Methods: The study was carried at Department of Neurosurgery, King George Hospital, Visakhapatnam during year 2016 to 2018. Patients with encephalocele (occipital, Scincipital, parietal) admitted during year 2016 to 2018 were evaluated for their clinical features. Complete base line investigations were performed including ultrasound, CT scan and MRI of brain. Other congenital anomalies were also noted in record. Written consent was taken. Operative and postoperative records were maintained. Statistics in King George Hospital: 10 children with encephalocele were selected during the years 2016-2018. Out of these 6 were male and 4 were female. Age range was 06 days to 2 years. Most common type of encephalocele was Frontal encephalocele. All patients underwent surgery. Out of 10 only two patients died. Postoperative follow up showed uneventful results. Two of our cases required postoperative VP shunt in addition to the repair of the sac. The immediate outcome was good in all except in 2 patients. Both presented with ruptured encephalocele and succumbed to meningitis. CSF leak and wound infection observed in two cases improved on conservative

Discussion: Encephaloceles represents a congenital defect of the cranium which are common congenital problem in the practice of neurosurgery worldwide. The contents of the sac vary from small dysplastic diverticulum to a large amount of degenerative brain tissue with variable amount of CSF fluid. The bony defect can vary in size. Elective surgery provides time for the patients to gain weight and strength and allows the surgeon to select the best technique. Most large encephaloceles required urgent surgical treatment to avoid damage to sac. In all the occipital, parietal and nasal encephaloceles there was dysplastic brain tissue which was removed safely. Postoperative hydrocephalus should be managed. Through ventriculoperitoneal (VP) shunts as one or two-stage procedures.

Conclusion: Early surgical management of encephalocele is not only for cosmetic reasons but also to prevent tethering, rupture, and future neurological deficits. Complications like hydrocephalus may need to be managed with shunt surgery. Endoscopic procedures play an important role in fronto-naso-ethmoidal encephaloceles.

Biography :

E-mail: ramanbhavana@gmail.com

 

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