The Repair of Frontal Encephaloceles in Papua New Guinea

Jacob, Ollapallil J.; Rosenfeld, J. V.; Waiters, D.A.K.

doi:10.1111/j.1445-2197.1994.tb04564.x

Cited by 23 publications

(13 citation statements)

References 10 publications

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“…2,9 If not treated prior to definitive surgery for encephalocele, the risk of postoperative CSF leak is very high. 2,6,18 Thirteen of our patients with significant hydrocephalus underwent ventriculoperitoneal shunt placement prior to craniofacial surgery.…”

Section: Discussionmentioning

confidence: 99%

Anterior encephaloceles: A series of 103 cases over 32 years

Mahapatra

Agrawal

2006

Journal of Clinical Neuroscience

102

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Section: Discussionmentioning

confidence: 99%

Anterior encephaloceles: A series of 103 cases over 32 years

Mahapatra

Agrawal

2006

Journal of Clinical Neuroscience

102

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“…14 The condition is also found in India 19 and Australia in the aboriginal population. 35 This specific and unique geographical distribution of fMEC may provide clues in the investigation of its etiology, with respect to genetic/racial or environmental factors, although the matter is complicated by the occasional discovery of fMECs in ethnically diverse groups-for example, in various African countries, 6,17 Mexico, 9 and Turkey.…”

Section: Geographical Distribution and Etiologymentioning

confidence: 94%

“…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. 11,13,14 Each method has its own value in certain situations, but we prefer a combined procedure (Fig.…”

Section: Surgical Issuesmentioning

confidence: 99%

“…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. 11,13,14 Each method has its own value in certain situations, but we prefer a combined procedure (Fig. 1) which has, in our opinion, 3 major advantages: 1) it allows a better fMEC closure, 2) a better telecanthus correction can be achieved, and 3) it can reduce and sometimes avoid facial scars.…”

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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“…The extracranial technique which was used in 28 out of the 29 patients in our series was the treatment of choice for economic and logistical reasons. Although ex tracranial excision may give satisfactory results in some cases [42], the optimal surgical treatment requires a transcranial approach and a multidisciplinary team [22,[43][44][45][46][47][48]. The internal skull defect should be closed at the inter nal orifice in order to prevent recurrent herniation.…”

Section: Therapeutic Consequencesmentioning

confidence: 99%

Frontoethmoidal Encephaloceles, a Study of Their Pathogenesis

Hoving¹,

Vermeij‐Keers

1997

Pediatr Neurosurg

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A prospective clinical study of 30 patients with frontoethmoidal encephaloceles was performed in order to find support for a proposed theory concerning its pathogenesis, based on a previously performed embryological study and relevant findings in the literature. According to this proposed theory the pathogenesis of frontoethmoidal encephaloceles is primarily based on a disturbance in separation of neural and surface ectoderm at the site of final closure of the rostral neuropore during the final phase of neurulation in the 4th week of gestation. An insufficient occurrence of apoptosis might cause this disturbance in separation. The nonseparation of neural and surface ectoderm will result secondarily in a midline mesodermal defect. This mesodermal defect is reflected in the median skull defect at the site of the foramen caecum. The outgrowth of the nasal septum with the concomitant forward displacement of epidermis (surface ectoderm) and attached brain tissue (neural ectoderm) may act as herniating force. The patient study consisted of a clinical investigation, radiological investigations (X skull and CT scans), and surgical treatment in order to obtain specimens which were examined histologically. Clinical findings supportive of the proposed hypothesis are (1) the consistency in the location of the internal skull defect, (2) the close relationship between epidermal structures and glial tissue in 15 out of 29 specimens, and (3) the presence of a normally developed nose in combination with interorbital hypertelorism in all patients. A discussion of these findings is presented with special reference to the embryological aspects.

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The Repair of Frontal Encephaloceles in Papua New Guinea

Cited by 23 publications

References 10 publications

Anterior encephaloceles: A series of 103 cases over 32 years

Anterior encephaloceles: A series of 103 cases over 32 years

Frontoethmoidal meningoencephalocele: appraisal of 200 operated cases

Frontoethmoidal Encephaloceles, a Study of Their Pathogenesis

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