LETTER TO THE EDITOR
Year : 2011  |  Volume : 6  |  Issue : 2  |  Page : 155-156

An interesting case of interparietal encephalocele

Rabindranath Mohapatra¹, Manoja K Panigrahi², Pushpa Kumari^3
1 Department of Neurosurgery, Ispat General Hospital, Rourkela, India
² Department of General Surgery, Ispat General Hospital, Rourkela, India
³ Department of Ophthalmology, Ispat General Hospital, Rourkela, India

Date of Web Publication

13-Feb-2012

Correspondence Address:
Rabindranath Mohapatra
Qr. No. C/91, Sector-19, Rourkela - 769 005
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1817-1745.92851

How to cite this article: Mohapatra R, Panigrahi MK, Kumari P. An interesting case of interparietal encephalocele. J Pediatr Neurosci 2011;6:155-6

How to cite this URL: Mohapatra R, Panigrahi MK, Kumari P. An interesting case of interparietal encephalocele. J Pediatr Neurosci [serial online] 2011 [cited 2020 Oct 25];6:155-6. Available from: https://www.pediatricneurosciences.com/text.asp?2011/6/2/155/92851

Dear Sir,

A 15-day-old male child, 2 ^nd sibling of his parents, delivered vaginally in his own home was admitted to neurosurgery department for an ulcerated big swelling on his vertex [Figure 1]. The child was 2.5 kg in weight; swelling was cystic, transilluminant [Figure 2], covered by healthy skin except at the fundus, where it was ulcerated. The child was taken up for surgery after routine screening. He was positioned supine after induction of anesthesia. Initially, the cerebro-spinal fluid (CSF) was allowed to drain through a hypodermic fluid for 15 minutes to avoid sudden decompression of grossly dilated ventricular system [Figure 3]. On the lax swelling, longitudinal elliptical skin incision was planned little away from the neck; dura was easily separated avoiding injury to the vessels run longitudinally and close to neck. Small protrusion of brain parenchyma was seen which was not disturbed [Figure 4]. At the end, dura was closed in two layers followed by scalp closure. Rest of the hospital stay was uneventful. Till the end of 6 months there was no need of CSF drainage procedure, but the patient was lost to follow-up afterward.

Figure 1: Encephalocele showing ulcer at the fundus. Its vertical measurement is 13 cm and circumference is 32 cm Click here to view

Figure 2: Transillumination of the encephalocele showing evidence of CSF and blood vessels Click here to view

Figure 3: CT scan of the brain shows a grossly dilated ventricular system Click here to view

Figure 4: Intraoperative photograph showing protruding brain parenchyma into the herniation Click here to view

Discussion

Several key points are to be addressed during surgery of large encephaloceles of the vertex. Position of the head and swelling should not cause hindrance for airway management nor it should hinder the closure of wound at the end of surgery. CSF from the swelling may be decompressed slowly. ^[1],[2],[3] Major veins should be spared from injury. ^[2] Follow-up is required, as the patient may need ventriculo-peritoneal shunt if CSF flow is blocked. ^[2] Cranial reconstruction may be avoided if bony deficit is small, as brain is yet to grow. Overall prognosis is poor ^[1] and depends on the contents of the sac, operability, hydrocephalus, and other associated malformations. ^[1],[2],[3]

 

References

1.	Mahapatra AK. Management of Encephalocele. In: Ramamurthi R, Sridhar K, Vasudevan MC, editors. Text Book of Operative Neurosurgery. 2 nd ed. New Delhi: B.I. Publications Private Ltd.; 2005. p. 284-5.
2.	Hoving E, Blaser S, Kelly E, Rutka JT. Anatomical and embryological considerations in the repair of a large vertex cephalocele. J Neurosurg 1999;90:537-41.   [PUBMED]  [FULLTEXT]
3.	Walia B, Bhargava P, Sandhu K. Giant occipital encephalocele. Armed Forces Med J India 2005;61:293-4.

Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]