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J Neurol Surg A Cent Eur Neurosurg 2018; 79(01): 015-018
DOI: 10.1055/s-0036-1597548
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Incidence of Secondary Hydrocephalus after Excision of Huge Encephaloceles in Neonates: Case Study

Ehab Ahmed El Refaee
1   Department of Neurosurgery, Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Germany
2   Department of Neurosurgery, Faculty of Medicine, Cairo University Hospitals Kasr Al Ainy-El Manial Hospital 26, Cairo, Egypt
,
Mohamed Ibrahim Refaat
3   Department of Neurosurgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
,
Mohamed Reda
3   Department of Neurosurgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
› Author Affiliations
Further Information

Publication History

14 February 2016

07 June 2016

Publication Date:
01 February 2017 (online)

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Abstract

Background Encephaloceles presents as a protrusion of the cranial contents through a defect in the cranium. The most common sites of occurrence are the occipital and frontonasal regions. The surgical outcome is reported to be satisfactory; however, the incidence of hydrocephalus in patients with encephaloceles is variable in the literature. This study investigated the relationship between the size of the encephaloceles and the occurrence of hydrocephalus.

Patient and Methods Data of all neonates with encephaloceles who presented to our institution from September 2012 to September 2014 were collected. Surgery was performed during the first 2 weeks of age. Encephaloceles with a maximal diameter > 10 cm were included in the study, and the clinical picture, surgical technique, pre- and postoperative imaging, and follow-up were analyzed.

Results Nineteen cases were included in this study. The mean follow-up period was 7 months. Sixteen cases were occipital; three were frontal. In all patients the maximum diameter was > 10 cm. However, in four patients it was > 18 cm. Postoperative ventriculomegaly occurred in seven cases. Of these, four patients needed a permanent ventriculoperitoneal shunt implantation (21%). Wound dehiscence occurred in two patients who required secondary sutures with a favorable outcome. One patient died 2 weeks after the surgery due to a poor general condition and wound infection.

Conclusion Early surgical excision provides effective treatment of huge encephaloceles. Overall, 21% of cases require cerebrospinal fluid (CSF) diversion afterward depending on associated anomalies. Despite their size, giant encephaloceles can have an excellent prognosis with no need for further treatment or CSF diversion.

Keywords

encephalocele - ventriculocele - secondary hydrocephalus
 

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