Anaesthetic Management of an Infant with a Giant Inter-Parietal Meningoencephalocele

Abstract

Abstract:Meningoencephalocele (MEC) consists of herniation of cerebrospinal fluid (CSF), meninges and brain tissue through a congenital bony defect in the cranium. Anesthetic challenges associated with a giant MEC include proper securing of airway, intra-operative prone position and its complications, accurate assessment of CSF and blood loss, etc. An active, 3 month old, first child from a non-consanguineous marriage with no other congenital anomaly was admitted with a giant inter-parietal MEC. MRI brain revealed a large midline inter-parietal MEC, containing small amount of brain and large volume of CSF. Baby was induced and intubated in supine position and operated upon in prone position. Sudden drainage of large volume of CSF occurred on opening the sac. It was accompanied with bradycardia, which was successfully managed with intravenous injection atropine. Thereafter, intra-operative course remained uneventful. Intraoperative losses were adequately replaced. Recovery from anesthesia was satisfactory and postoperative course was uneventful. After monitoring in ICU for a day, the patient was shifted to the ward and discharged on 10 th post-operative day with advice for regular follow up.