Perioperative Management of Children With Encephalocele

Mahajan, Charu; Rath, Girija Prasad; Dash, Hari H.; Bithal, Parmod K.

doi:10.1097/ana.0b013e31821f93dc

Cited by 65 publications

(67 citation statements)

References 21 publications

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“…4,16,27,34 A significant proportion of these children lack normal developmental milestones and may have neurological problems such as ataxia, visual impairment, mental and growth retardation, and seizures. 22 Previous studies report that prognosis for patients with occipital and parietal encephaloceles is directly related to the presence of neural tissue, hydrocephalus, microcephaly, and accompanying cerebral malformations. 6,10,14,20 Hydrocephalus carries a significant morbidity in these children, reported to occur in as many as 60%-90% of patients with posterior encephaloceles, in contrast to a much lower incidence of 10%-15% in anterior encephaloceles.…”

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confidence: 99%

“…3,5,17,22,27,34 The prognosis for a newborn with an encephalocele depends on a number of factors and includes the location, size, and contents of the encephalocele, along with microcephaly and associated anomalies. 4,16,27,34 A significant proportion of these children lack normal developmental milestones and may have neurological problems such as ataxia, visual impairment, mental and growth retardation, and seizures.…”

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Risk factors for hydrocephalus and neurological deficit in children born with an encephalocele

Silva

Jeelani

Dang

et al. 2015

PED

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OBJECT There is a known association of hydrocephalus with encephaloceles. Risk factors for hydrocephalus and neurological deficit were ascertained in a series of patients born with an encephalocele. METHODS A retrospective analysis was undertaken of patients treated for encephaloceles at Children's Hospital Los Angeles between 1994 and 2012. The following factors were evaluated for their prognostic value: age at presentation, sex, location of encephalocele, size, contents, microcephaly, presence of hydrocephalus, CSF leak, associated cranial anomalies, and neurological outcome. RESULTS Seventy children were identified, including 38 girls and 32 boys. The median age at presentation was 2 months. The mean follow-up duration was 3.7 years. Encephalocele location was classified as anterior (n = 14) or posterior (n = 56) to the coronal suture. The average maximum encephalocele diameter was 4 cm (range 0.5–23 cm). Forty-seven encephaloceles contained neural tissue. Eight infants presented at birth with CSF leaking from the encephalocele, with 1 being infected. Six patients presented with hydrocephalus, while 11 developed progressive hydrocephalus postoperatively. On univariate analysis, the presence of neural tissue, cranial anomalies, encephalocele size of at least 2 cm, seizure disorder, and microcephaly were each positively associated with hydrocephalus. On multivariate logistic regression modeling, the single prognostic factor for hydrocephalus of borderline statistical significance was the presence of neural tissue (odds ratio [OR] = 5.8, 95% confidence interval [CI] = 0.8–74.0). Fourteen patients had severe developmental delay, 28 had mild/moderate delay, and 28 were neurologically normal. On univariate analysis, the presence of cranial anomalies, larger size of encephalocele, hydrocephalus, and microcephaly were positively associated with neurological deficit. In the multivariable model, the only statistically significant prognostic factor for neurological deficit was presence of hydrocephalus (OR 17.2, 95% CI 1.7–infinity). CONCLUSIONS In multivariate models, the presence of neural tissue was borderline significantly associated with hydrocephalus and the presence of hydrocephalus was significantly associated with neurological deficit. The location of the encephalocele did not have a statistically significant association with incidence of hydrocephalus or neurological deficit. In contrast to modestly good/fair neurological outcome in children with an encephalocele without hydrocephalus, the presence of hydrocephalus resulted in a far worse neurological outcome.

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confidence: 99%

mentioning

confidence: 99%

Risk factors for hydrocephalus and neurological deficit in children born with an encephalocele

Silva

Jeelani

Dang

et al. 2015

PED

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“…[4][5][6] Bazı olgularda başı supin pozisyonda tutmak için "donut ring" denilen ortası boşluklu geniş baş yastıkları kullanılmış, bazı olgularda baş ameliyat masasının ucuna getirilerek kese masadan aşağıya sarkıtılmış, baş ve kese asistanlar tarafından desteklenmiş, bazı olgularda ise bu olguda olduğu gibi baş lateral pozisyonda entübasyon yapılmıştır. [4][5][6] Bu tür hastalar için diğer perioperatif problemler elektrolit dengesizliği (BOS aspirasyonuna bağlı), hipotermi ve kan kaybıdır. 4,6 Kan kaybı ve buna bağlı hemodinamik değişiklikler sebebiyle kan transfüzyonu ihtiyacı olabilir.…”

Section: Discussionunclassified

“…[4][5][6] Bu tür hastalar için diğer perioperatif problemler elektrolit dengesizliği (BOS aspirasyonuna bağlı), hipotermi ve kan kaybıdır. 4,6 Kan kaybı ve buna bağlı hemodinamik değişiklikler sebebiyle kan transfüzyonu ihtiyacı olabilir. 6 Ayrıca ensefalosel kesesi açılırken, BOS drenajı esnasında, drenajın hızlı olması sebebiyle bradikardi hatta kardiyak arreste sebep olabilecek hemodinamik bozukluklar oluşabilir.…”

Section: Discussionunclassified

Anesthetic Management of A Patient with Giant Encephalocele: Case Report

Uzun¹,

Akaycan²,

Işıkay³

et al. 2015

Turkiye Klinikleri J Case Rep

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efalosel, intrakraniyal yapıların kafatasındaki bir defektten protrüz-yonudur. Sefaloseller, lezyonun yerine göre oksipital, pariyetal ve anterior (frontal ve bazal) olarak sınıflandırılırken; içeriğine göre meningosel, ensefalosel, ensefalomeningosel ve ensefalomeningosistosel olarak sınıflandırılır.1 Posterior yerleşimleri anterior yerleşime göre daha sık-tır. 2 Ensefaloseller glial doku içeren nadir lezyonlardır. Fiziksel etki ve belli bir cinsiyet bağımlılığı yoktur. 3 Tedavileri cerrahidir. Ensefalosel köken al- A An na ah ht ta ar r K Ke el li im me el le er r: : Ansefalosel; anestezi, genel A AB BS ST TR RA AC CT T Cephalocele is the protrusion of intracranial structures from a defect on the cranium. Encephalocele are rare lesions with glial tissue. The patient was the child of a 26-year-old mother's first pregnancy. She was born with cesarian section after the diaognosis of the encephalocele during prenatal ultrasound examinations. When the patient was 9 week old and 7 kg weight she was admitted for encephalocele surgery. The mask ventilation was easy despite it was though that intubation and mask would be difficult. The patient's head could not be positionned in the supine position and the face was supported with a cloth for raising the head. The patient was intubated easily in the lateral position with Miller 1 blade. A central venous catheter was attached in case of need for blood transfusion. During the drainage of cerebrospinal fluid, invasive blood pressure monitoring was performed. The surgery was lasted for 135 minutes and there wasn't any complication and the infant was extubated and transferred to the neurosurgical intensive care unit.K Ke ey y W Wo or rd ds s: : Encephalocele; anesthesia, general T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J C Ca as se e R Re ep p 2 20 01 15 5; ;2 23 3( (2 2) ): :1 10 05 5--9 9Şennur UZUN, OLGU SUNUMUYirmi altı yaşındaki annenin ilk gebeliğinden olan hasta, prenatal ultrasonografi incelemeleri esnasında ensefalosel tespit edilmesi üzerine 37. haftasında C/S ile doğurtulmuştur. Olgu dokuz haftalık, 7 kilogram olduğunda ensefalosel operasyonuna alındı. Yapılan ekokardiyografisinde patent duktus arteriosus (PDA) ve patent foramen ovale (PFO) tespit edilen hastanın preoperatif bilinen başka ek hastalığı yoktu. Oksipital bölgede dev ensefalosel sebebiyle zor maske ve entübasyon olabileceği ön-görüldü (Resim 1). Bunun için pediatrik fiberoptik ameliyat odasında hazır bulunduruldu. Hasta dört saatlik açlık sonrasında ameliyathaneye alındığında periferik damar yolu yoktu. Rutin EKG, kan basıncı, SpO 2 , ETCO 2 ve nazal ısı monitörizasyonu yapıldı. Hipotermiyi önlemek amacıyla gövdesi ve ensefalosel kesesi sıcak örtülerle örtüldü, operasyon süresince eksternal ısıtıcı ile olgu ısıtıldı. Hastaya %100 O 2 ile sevofluran indüksiyonu uygulandı. Maske ile ventilasyonu rahattı (Resim 2).Öncelikle ekstremitelerinden intravenöz yol arandı, ancak bulunamayınca skalpten 24G kanül ile damar yolu açıldı. Periferik damar yolu cerrahi alanda olduğu için sağ internal jugu...

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“…12 Another study on 118 children of encephalocoel shows difficulty during endotracheal intubation in 19.5% cases. 13 Airway management of occipital encephalocele children were explained by various authors. Quezado et al described a foam-cushion device to prevent pressure on encephalocele sac.…”

Section: Discussionmentioning

confidence: 99%