A Rare Case of Giant Occipital Encephalocele With Thoracic Myelomeningocele: An Anesthetic Conundrum

Abstract

Encephalocele and myelomeningocele are congenital defects in the cranium and spine with herniation of contents into an extracranial and extraspinal sac, respectively. The occurrence of encephalocele and myelomeningocele in the same patient has rarely been described in the literature. The anesthetic management of such cases is associated with multiple challenges, which include difficulty in securing the airway, prone positioning, blood loss, electrolyte imbalance, hypothermia, cardiorespiratory disturbances, and perioperative care. The main aims are, to prevent hemodynamic fluctuations and excessive pressure on the sac to avoid premature rupture and manage a possible difficult airway due to the head and neck mass. We report such a rare case to highlight and share our experiences faced during perioperative management of a giant vascular occipital encephalocele with impending rupture and thoracic myelomeningocele requiring surgical excision and repair. Previous similar case reports were also reviewed, and potential perioperative complications were discussed.

Management of giant posterior meningocele lombosacral: about three case report

“…6 However, around 60% of these children may have associated intracranial and/or extra-SNC malformations affecting perioperative management, such as hydrocephalus, microcephaly, micrognathia, Chiari malformation, pulmonary hypoplasia and renal agenesis. 7 Early closure of the meningocele, usually within the first week of life, is recommended to reduce infectious agent contamination of the exposed spinal cord after pouch rupture, which is the leading cause of death in this population during the neonatal period. Anesthesia in prone children, particularly infants, presents the highest risk of complications.…”

“…The main objectives are to prevent hemodynamic and ventilatory fluctuations, and excessive pressure on the bag to avoid premature rupture and manage any difficulty during intraoperative care. 7 Among the complications during intraoperative care, surgical site infections, cerebrospinal fluid leaks and secondary neurological deficits are the most serious to manage.…”