Anaesthetic management of neonate with giant occipital Meningoencephalocele .

Abstract

Meningoencephalocele is herniation of cerebrospinal fluid, brain tissue and meninges through the skull defect. The anaesthetic management of occipital meningoencephalocele is challenging because of the difficulty in securing airway, prone position, blood loss and, perioperative care. The two major aims of the anaesthesiologists while caring for children with occipital encephalocoele intraoperatively are to avoid premature rupture of the encephalocoele and to manage a possible difficult airway due to restricted neck movement and inability to achieve optimal position for intubation of the trachea. We report a case of giant occipital meningoencephalocele presented for surgical excision. Perioperative management of patients with giant meningoencephalocele may be challenging for both anaesthesiologist and neurosurgeon. These patients must be managed closely with an interdisciplinary approach.

Giant occipital encephalocele: a case report, surgical and anesthetic challenge and review of literature

“…Preoperative neurological status of the patients and the cranial contents herniating into the sac remain the vital factors in deciding the long-term prognosis. The anesthetic management of occipital meningoencephalocele presents a challenge due to apparent difficulty in satisfactorily establishing the airway while being in a prone position, blood loss, and perioperative care [3].…”

Giant Occipital Encephalocele: A Case Report, Surgical & Anesthetic Challenge

“…Infants with encephalocele can develop sudden hypothermia due to dysfunction of autonomic control below the present defect. [3] Thus immediate consideration and management has to be given to hypothermia, blood loss, and its associated complications. The surgery is advised to be done as soon as possible to avoid life threatening complications such as Central Nervous System (CNS) infections, respiratory distress, aspiration pneumonia, irreversible impairment of vagus nerve and hypothermia.…”

“…[5] The table below, comprises all the reported cases to the author's knowledge. (Table 1) [3,4,[9][10][11][12][13][14][15][16][17][18][19][20][21] The main aim is to portray the different and most commonly used surgical procedures in the management of giant occipital encephaloceles. The most frequently used method is simple resection and dural repair.…”

“…This further leads to an inability of having an optimal tracheal intubation position. [3] The operative procedure also includes the management of possible loss of large quantities of CSF causing superimposed electrolyte imbalance. Infants with encephalocele can develop sudden hypothermia due to dysfunction of autonomic control below the present defect.…”

“…The anaesthetic management of occipital meningoencephalocele presents a challenge due to di culty in securing the airway while being in a prone position, blood loss and perioperative care. [3] Case Presentation: A 4-month-old baby boy presented to us through the pediatric emergency department with the history of a fall from his mother's lap. This baby boy had a huge swelling on the back of his head since birth and it increased in size over the period of time.…”