Growth and Psychological Development in Postoperative Patients With Anterior Encephaloceles

Dutta, Hemonta Kumar; Khangkeo, Chow Wachana; Baruah, Kaberi; Borbora, Debasish

doi:10.1016/j.pediatrneurol.2017.01.029

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…A review of 40 anterior encephalocele patients report that these patients that have associated structural abnormalities like corpus callosum agenesis or arachnoid cysts perform poorly in dimensions of intelligence. 11,20 It is not clear if early repair, as we have demonstrated, would improve any of these outcomes. Our reported patients have not undergone long-term neurocognitive assessment.…”

Section: Discussionmentioning

confidence: 83%

“…Multilayer reconstruction is a principal used not just in encephalocele repair but in skull base surgery in general. 10 There are no reports of patients having surgery below 3 months of age like patient 1 11,12 This patient had respiratory difficulties from the nasal mass which is why the surgery was performed as early as possible. Regarding autologous bone graft for repair there are reports of using rib graft 13 , which was not necessary due to the age of the patients.…”

Section: Casementioning

confidence: 99%

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Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele

Das

Lacey

Guillaume

2020

J Neurol Surg B Skull Base

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Objectives Congenital frontoethmoidal encephaloceles are associated with a shallow sloping forehead. We (1) sought to determine if early repair reverses abnormal forehead slope, and (2) assessed a modification of the fetal profile (FP) line to assess results. Design Study of two cases. Participants Newborns with frontoethmoidal encephaloceles repaired prior to the age of 4 months with cranial base bone grafting. Main Outcome Measures Forehead slope was assessed using a modification of the FP line, defined as the line that passes through the anterior border of the mandible and nasion, on pre and postoperative magnetic resonance imaging (MRI) in the midsagittal plane. A modified FP (mFP) line anterior to the forehead was “ − ”, while a posterior (normal) mFP line was “ + .” The largest distance from the mFP line to the forehead was measured. Results Both infants underwent bifrontal craniotomy, excision of encephalocele, and repair of cribriform plate defect using full-thickness autologous parietal bone before the age of 4 months. Preoperatively, the mFP line was −20.6 mm in case 1, and −9.8 mm in case 2. In both cases, follow-up MRI showed excellent reversal of forehead slope and normal calvarium development. The mFP line improved to +7.4 (age = 16 months) in case 1, and +7.6 (age = 11 months) in case 2. The parietal bone donor site ossified completely within 3 months in both cases. Conclusion Early repair with bone grafting can promote normal frontal bone development and improve forehead slope. The mFP line is a useful method to measure degree of forehead slope.

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Section: Discussionmentioning

confidence: 83%

Section: Casementioning

confidence: 99%

Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele

Das

Lacey

Guillaume

2020

J Neurol Surg B Skull Base

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“…Other reports of long-term outcomes after encephalocele repair also note significant developmental delays, particularly in those with occipital location, brain involvement, intracranial abnormalities, hydrocephalus, and seizure disorder. 1,[10][11][12][13] All of the patients in this small series had very large encephaloceles of the occiput/vertex with abnormal brain architecture and thus were anticipated to have generally poor developmental prognosis. However, the 4 patients who underwent operation had all presented for presurgical evaluations in the first few months of life at which time they were largely meeting the developmental milestones at that early stage, posing a challenge when predicting their individual developmental trajectories with or without surgical intervention.…”

Section: Discussionmentioning

confidence: 94%

“…Both patients who completed long-term assessments exhibited delays in adaptive functioning, motility, and overall behavior. Other reports of long-term outcomes after encephalocele repair also note significant developmental delays, particularly in those with occipital location, brain involvement, intracranial abnormalities, hydrocephalus, and seizure disorder 1,10–13…”

Section: Discussionmentioning

confidence: 99%

Large Vertex Encephaloceles: Management and Outcomes

Schneider

Cappitelli

Langa

et al. 2022

Journal of Craniofacial Surgery

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Background: Complex vertex and posterior encephaloceles containing brain tissue have uncertain prognosis and high operative risk. Patients may not be offered operative intervention depending on local and regional specialist expertise. The authors present their experience treating 5 such pediatric patients. Methods: This is a retrospective review of the surgical assessment, planning, and technique of cranial repairs, as well as surgical outcomes and developmental follow-up regarding adaptive functioning for patients presenting for second opinion for encephalocele of the cranial vertex after having been deemed too high risk at another institution. Results: Five consecutive patients presented between January 2014 and June 2016. One patient was not offered repair. Of 4 patients who underwent reconstruction, average age at time of repair was 2.7 months (range, 0.9–6.7). One presented with ruptured encephalocele, whereas the remaining 3 underwent drainage of the encephalocele (average volume of 1200 mL) at time of surgical resection. Operative time averaged 3.7 hours (range, 2.2–5.3). There were no deaths. One patient had a single seizure postoperatively. Two patients required placement of permanent shunt for hydrocephalus. Two patients completed developmental evaluations, both of whom exhibited delays in adaptive functioning relative to same-aged peers. Conclusions: Patients with large, complex encephalocele warrant evaluation by an experienced high-volume tertiary care pediatric craniofacial center. The decision to proceed with surgical management should include an interdisciplinary team of surgeons, anesthesiologists, neurologists, and social work. Further study of developmental outcomes in both operated and unoperated patients is necessary to better understand risks and benefits of reconstruction.

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“…Haja vista a extrema importância deste procedimento para a restauração da proteção craniocerebral e para a autoestima do paciente. (DUTTA et al, 2017).…”

Section: Repercussão Psicológica Da Encefaloceleunclassified

Encefalocele e cirurgia reconstrutiva: uma revisão sistemática

Alves¹,

Garcia²,

Oliveira³

et al. 2022

Braz. J. Hea. Rev.

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Introdução: Os defeitos de fechamento do tubo neural são malformações congênitas consequentes do fechamento incorreto ou incompleto do tubo neural durante o desenvolvimento embrionário. A encefalocele é uma rara anomalia congênita do sistema nervoso central, com incidência de um caso em cada 5.000 nascidos vivos. Tem como fator de risco a deficiência de ácido fólico que parece ter efeito similar na ocorrência de anencefalia e espinha bífida. A encefalocele pode ocorrer de uma forma isolada ou associada a outras malformações como mielomeningocele, holoprosencefalia, hidrocefalia, microcefalia e entre outras. Metodologia: Este estudo é uma revisão sistemática da literatura elaborada por meio da consulta às bases de dados da SciELO (Scientific Electronic Library Online) e PubMed, nos meses de fevereiro a setembro de 2022. Os critérios de inclusão foram: artigos relacionados ao tema com pelo menos duas das palavras-chave, escritos nas línguas portuguesa ou inglesa, disponíveis para a leitura completa e escritos entre 2011 a 2022. Resultados e discussão: Esta revisão contemplou um estudo observacional de coorte retrospectivo com 400 pacientes; uma série de casos e oito relatos de casos. E o pilar da discussão foi a abordagem da encefalocele com enfoque na fisiopatologia, repercussão psicológica da patologia e na cirurgia reconstrutiva nesta condição. Os artigos analisados elucidaram que existem diversas formas neurocirúrgicas para a abordagem da encefalocele e da meningoencefalocele. Conclusão: Em suma, não há um método padrão e perfeito para todos os pacientes. Tudo deve ser analisado de modo minucioso e individual. E uma equipe multidisciplinar, assim como um plano de ação sinérgico entre neurocirurgião e cirurgião plástico são medidas essenciais para um desfecho excelente.

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Growth and Psychological Development in Postoperative Patients With Anterior Encephaloceles

Cited by 5 publications

References 17 publications

Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele

Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele

Large Vertex Encephaloceles: Management and Outcomes

Encefalocele e cirurgia reconstrutiva: uma revisão sistemática

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