Correction of Frontonasoethmoidal Encephalocele: The HULA Procedure

Kumar, Anand; Helling, Eric R.; Guenther, D.A.; Crabtree, Tom; Wexler, Andrew W.; Bradley, James P.

doi:10.1097/prs.0b013e3181956633

Cited by 26 publications

(13 citation statements)

References 10 publications

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“…22 Neurological complications and congenital brain anomalies are uncommon in fMEC, 28,38 and a majority of affected children are mentally normal. 15 Some of our parents reported that their child's malformation did not grow at all with time, whereas others (as reported by other authors) noted that their child's malformation became progressively larger. 9,38 Some authors therefore recommend early surgical correction to minimize the pressure effect of the mass on facial growth.…”

Section: Pathogenesis and Natural Historymentioning

confidence: 48%

“…More refined classifications based on CT findings can also be used. 15,24 However, when CT is not readily available, we think that the anatomical classification of Suwanwela and Suwanwela, although less accurate, is more practical.…”

Section: Classification Of Fmecsmentioning

confidence: 99%

“…Most authors consider that the best method is a "combined" procedure: bicoronal insicion, nasofrontal bone flap, and facial reconstruction. 2,5,15,18,20 Others used either bicoronal, transfacial approaches, or combined procedures according to the patient malformation pattern. 9 Some claim that fMEC can be corrected only by an extracranial procedure; 11,14,30 this could be more appropriate in some developing countries where neurosurgical expertise is lacking.…”

Section: Surgical Issuesmentioning

confidence: 99%

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Frontoethmoidal meningoencephalocele: appraisal of 200 operated cases

Oucheng

Lauwers

Gollogly

et al. 2010

PED

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Object Frontoethmoidal mengingoencephaloceles (fMECs) are frequently observed in Cambodia, especially in poor families. The authors describe issues related to the surgical treatment of fMECs in Cambodia at the end of a humanitarian program that provided surgery free of charge to patients and their families. Methods The authors reviewed 257 cases of fMEC involving patients who presented to their institution, the Children's Surgical Center in Phnom Penh, between 2004 and 2009. They treated 200 of these patients surgically (108 males, 92 females; 89% younger than 18 years) using a “low-cost” management plan with no routine pre- or postoperative investigations. Initially, surgery was performed by visiting foreign surgeons who taught the procedures to resident surgeons. Patients were not charged for consultations or treatment and received at least 1 follow-up examination 6 months postoperatively. Results The nasoethmoidal type was the most frequent fMEC encountered (69%). Many patients had associated ophthalmological issues (46% of cases). Only 1 familial case was detected. Combined neurosurgical and facial procedures were successfully standardized and learned by surgeons initially unfamiliar with fMEC management. A neurosurgical approach avoided the need for a facial incision in 42 cases, improving cosmetic results. The most common postoperative issues were a temporary CSF leak (24 cases [12%]) and/or infection (28 cases [14%]). There were 3 deaths directly related to the operations. Cosmetic results were good in 145 cases, average in 27, poor in 7, and worse than preoperative appearance in 6 patients. Fifteen patients were lost to follow-up. The parents of 87% of the children were rice farmers. Questionnaire results confirmed that fMEC has important social and educational consequences for the affected children and that these consequences can be partially improved by fMEC correction. Conclusions This experience in fMEC management demonstrates that local surgeons can treat these malformations with limited surgical materials and in a nonspecialized infrastructure after principles of treatment have been learned and if they are carefully respected. Surgery for fMEC can thus be more accessible to a larger number of patients in developing countries. Moreover, local treatment facilitates better postoperative and follow-up care.

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Section: Pathogenesis and Natural Historymentioning

confidence: 48%

Section: Classification Of Fmecsmentioning

confidence: 99%

Section: Surgical Issuesmentioning

confidence: 99%

See 1 more Smart Citation

Frontoethmoidal meningoencephalocele: appraisal of 200 operated cases

Oucheng

Lauwers

Gollogly

et al. 2010

PED

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“…Because of the rare opportunity for surgical correction of these cases within the equine field, a human neurosurgeon (Pittman, MD, University of Kentucky College of Medicine, Lexington, Kentucky) was consulted to help with the procedure. Common techniques were followed, including excision of the herniated sac with preservation of as much normal‐appearing brain tissue as possible, bony reconstruction, and an emphasis on a tight dural closure . It has been recommended that these cases be treated before full bone development so that the skull has time to develop .…”

Section: Discussionmentioning

confidence: 99%

Surgical correction of a meningoencephalocele in a thoroughbred filly

Buck

Hunt

2019

Veterinary Surgery

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Objective To describe the surgical correction of a closed meningoencephalocele in a thoroughbred filly. Study design Case report. Animal One thoroughbred filly, 1.5 months old at the time of surgery. Methods A meningoencephalocele was identified at birth and diagnosed with radiography and MRI. The abnormal tissue was excised and submitted for histopathology, the dura was closed, and the defect in the skull was corrected with a titanium mesh. Results Histopathology confirmed the presence of neural parenchyma consisting of neurons and glial cells. The filly remained without neurologic deficits 7 months after surgery. Conclusion Surgical correction of a meningoencephalocele was performed and considered successful, with no long‐term neurologic deficits postoperatively. Clinical significance Given the paucity of neural tube defect cases in the equine population, no surgical corrective techniques have been reported in the literature. This Case Report describes the first successful surgical treatment of a meningoencephalocele in a horse.

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“…Patient surveys were modified for this specific patient group based on a focus group interview survey of 10 Romberg patients and their parents. 8,13 Additionally, the survey had been validated for intrarater and interrater reliability. 14 Physician and patient outcome satisfaction was based on symmetry, volume, and overall appearance in both the perioperative and follow-up periods as a 5-point scale (0 through 4).…”

Section: Methodsmentioning

confidence: 99%