Article
Safe and sustainable – The extracranial approach toward frontoethmoidal meningoencephalocele repair
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Published: | August 16, 2017 |
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Background: While rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to the neuro- and plastic reconstructive surgeon. Especially when limited by infrastructure and resources, it is paramount to establish reliable and safe surgical techniques. The presented case series aims to evaluate a previously proposed concise approach to encephalocele repair, with a focus on sustainability of internationally driven surgical efforts.
Patients and methods: Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a one-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the General Hospital Yangon, Myanmar, partially assisted by European surgeons. Outcomes and complications were evaluated.
Results: A total of 246 patients (138 males and 108 females) with a mean age of 10.2 years (range: 75 days to 32 years old) were treated. Follow-up varied between 4 weeks and 16 years (mean: 10 months). 18 patients (7.3 percent) showed signs of increased intracerebral pressure post-operatively, and early cerebrospinal rhinorrhea was observed in 27 patients (11 percent), with five (2 percent) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3 percent) due to meningitis. In 15 patients (6.1 percent), a relapse of brain tissue was observed which unfortunately led to blindness in one case. The remaining patients all showed good to very good aesthetic and functional results.
Conclusions: A minimalistic purely extracranial approach towards frontoehtmoidal encephalocele 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 dependency on foreign supporters, can be circumvented by meticulous training of local surgeons.