Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair

J Neurosurg Pediatr. 2017 Oct;20(4):334-340. doi: 10.3171/2017.5.PEDS1762. Epub 2017 Jul 21.

Abstract

OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.

Keywords: CSF = cerebrospinal fluid; NGO; NGO = nongovernmental organization; craniofacial; frontoethmoidal meningoencephalocele; humanitarian mission; meningocele; neural tube defects; surgical mission; sustainability.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Decompression, Surgical / methods*
  • Encephalocele / surgery*
  • Female
  • Frontal Bone / surgery*
  • Humans
  • Infant
  • Male
  • Meningocele / surgery*
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult