Introduction: Anterior encephaloceles are rare congenital malformations involving herniation of the brain and meninges beyond the cranium. For unknown reasons, anterior encephaloceles are more common in Southeast Asia. Due to their anatomic location, they are accompanied with both physical and psychological disfiguring effects. Accesses to treatment for these lesions are often unavailable in these countries and support from outside international groups is required for definitive care.
Methods: During 2010 and 2011, a group consisting of neurosurgeons, craniofacial surgeons, otolaryngologists, plastic surgeons and critical care nurses visited the Philippine province of Davao City for a combined 4 week surgical mission trip. A simultaneous intracranial and extracranial approach was used consisting of a bicoronal frontal-orbital craniotomy and reconstruction of the anterior nasal bones and cosmetic deformity correction.
Results: A total of 24 anterior encephaloceles were repaired on 10 males and 14 females with an average age of 9. Frontoethmoidal encephaloceles were identified in 9 patients, frontal-nasal in 10 patients and fronto-orbital in 6 patients. The largest defect in sac size in our series was 30x15cm. Bicoronal craniotomy with orbital osteotomy was performed in 22 of 24 patients; pericranial autograft was created in 22 of 24 patients; split-thickness calvarial bone grafting in 20 of 24 and absorbable cranial plating system in 12 of 24 patients. There was one death from respiratory distress in the immediate post-op period. No reports of neurological deficits, hydrocephalus, infection, cerebrospinal leak were reported in up to one year follow-up.
Conclusions: Combined intracranial-extracranial approach for repair of anterior encephaloceles is a safe and effective treatment. It is a challenge when performing this surgery in a third-world country with limited resources. With appropriate organization, operative planning, post-operative care and follow-up care by local neurosurgeons, we believe this to be a safe and worthwhile mission for our international community.
Patient Care: Provide information regarding these rare congenitial malformations as well as discuss their practical treatment options.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the pathophysiology of an encephalocele 2) Define the classification of an encephalocele 3) Discuss the treatment options and 4) Describe the importance of a surgical mission trip for the betterment of our international community.
References: David, D. J. (1972, October). AC, FRCSE, FRACS: Cephaloceles: Classification, pathology and management-A review. Journal of Craniofacial Surgery, 4(4), 192-202.
Greenberg, M. S. (2010). Handbook of neurosurgery (7th ed.). Tampa, FL: Greenberg Graphics.
Hockley, A. D., Golden, J. H., & Eake, M. J. (1960). Management of anterior encephalocele. Child's Nervous System, 6, 444-446.
Suwanwela, C., Sukabote, C., & Suwanwela, N. (1971). Frontal ethmoidal encephalocele. Surgery, 69, 617-625.
Suwanwela, C., & Suwanwela, N. (1972). A morphological classification of sincipital encephalomeningoceles. Journal of Neurosurgery, 36, 201-211.
Thomas, C., Mahapatra, A. K., Joy, M. J., Krishnan, A., & Sharma, R. R. (2001, May). Craniofacial surgery in Oman: A preliminary study of 10 cases. Journal of Craniofacial Surgery, 12(3), 247-252.