Anaesthetic Management of a Giant Encephalocele: Size Does Matter

Abstract

Encephalocele is a form of neural tube defect, characterized by protrusion out of the meninges and brain tissue through a bony skull defect. As per the site of origin, these encephaloceles have been classified into different types, out of which the frontoethmoidal one is exclusively common in Southeast Asia with a reported incidence of 1 in 5,000. Neurological outcome of such malformations depends on the size of the sac, neural tissue content, hydrocephalus, associated infection, and other pathologies that accompany this condition. Here we describe the anaesthetic concerns and perioperative management of a giant occipital encephalocele.

Anaesthetic Management of an Infant with a Giant Inter-Parietal Meningoencephalocele

“…Other potential complications include cranial nerve palsy which may result in inspiratory stridor [4], lack of pharyngeal coordination, poor suckling reflex, absent gag reflex, aspiration complications, or derangement in pontomedullary respiratory control center leading to inadequate spontaneous respiration even after complete reversal of muscle relaxation [1]. Overall prognosis of MEC cases is poor and depends on contents, sac size, operability, hydrocephalus and other associated malformations [3,4,8].…”

“…The size of a MEC may be variable and has a bearing with its successful anesthetic management [2,3]. A giant MEC, which may be even larger than the head from which it arises can pose several anesthetic challenges including proper securing of airway, prone position for surgery, accurate assessment of CSF and blood loss, etc.…”

Giant meningoencephalocele with Arnold-Chiari type III malformation and anaesthetic challenges: A rare case report

“…[ 3 ] Gender difference is seen as anterior encephaloceles are more common in males while 70% of posterior or occipital encephaloceles occur in females Neurological outcome of such malformations depends on the size of the sac, neural tissue content, hydrocephalus, associated infection and other pathologies that accompany this condition. [ 4 ] Due to presence of huge congenital swelling, increasing in size, the child came for consultation. Here we want to discuss successful anaesthesia management of giant meningoencephalocele with Arnold-Chiari type III (ACM type III) with presence of atrial septal defect (ASD).…”

Anaesthetic management of neonate with giant occipital Meningoencephalocele .

“…1 In Southeast Asia, the incidence is approximately 1 in 5000 live births. 2 The occipital bone is the most common location for cephalocele. Neurological outcome of such malformations depends on the size of the sac, neural tissue content, hydrocephalus, associated infection, and other pathologies that accompany this condition.…”