Artikel
Results of the surgical treatment of frontoethmoidal meningoencephaloceles in Cambodia
Ergebnisse der operativen Versorgung frontoethmoidaler Meningoenzephalozelen in Kambodscha
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Autoren
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T. Pinzer
- Klinik für Neurochirurgie, Universitätsklinikum Dresden
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G. Lauer
- Klinik für Mund,- Kiefer- und Gesichtschirurgie, Universitätsklinikum Dresden
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K. G. Krishnan
- Klinik für Neurochirurgie, Universitätsklinikum Dresden
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G. Schackert
- Klinik für Neurochirurgie, Universitätsklinikum Dresden
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: A frontoethmoidal meningoencephalocele (MEC) may be defined as a congenital protrusion of the intracranial contents into the face at the foramen caecum. The incidence of MEC in Southeast Asia is approximately 10 times higher than in the developed states of Europe and the Americas. Between 2004 and 2007, we operated on this potentially life staking anomaly in 71 patients (29 females, 42 males, Age range: 4.5 months – 23 years) at Phnom Penh.
Methods: A small bifrontobasal craniotomy (53.3%) and/or only a trephination of a frontoorbital T-segment (46.7%) was performed through a bicoronal incision. After a medial orbitotomy and transcaruncular canthopexy, the stump of the resected cele was epidurally closed using a free, doubled-over, as well as a pedicled periosteal flap. The bony defect of the skull base was covered with a bone plate in all cases. Complete resection of the cele was undertaken through the transcranial approach; an incision in the face was deemed necessary (39.4%) only for reducing the skin saculation. The surgical procedures were performed in minimal hygienic and material conditions of a third world country.
Results: The cosmetic results were evaluated to be satisfactory or good. In 93% of the patients, complete healing and social rehabilitation could be achieved. In 7 cases (9.9%), we have minor complications: lagophthalmus (1), inflamed forehead fistula (1), inflammation of the facial wound (1), self-limiting CSF-rhinorrhoea (1), self-limiting subgaleal CSF-accumulation (2) and epileptic seizure (1). Interestingly two of the three patients with the CSF-leak developed a relapse of the cele (2.8%). The mortality rate was 4.2% (asphyxia, sepsis and increased ICP) related to the limited conditions.
Conclusions: The surgical treatment of MEC is also possible in the constrained conditions of a developing country. For this a simple method is required. The formal frontal trephination is principally not necessary and should, if required, be performed as small as possible. The usage of foreign bodies can be completely avoided. The material required for reconstruction can be procured from the surgical site. An incision in the face is necessary to remove redundant skin only in large celes causing sagging. An interdisciplinary team consisting of maxillocraniofacial and neurosurgeons is advantageous.
Supported by Médicins du Monde, Germany
