Anaesthetic managements of 16 days’ neonate with large occipital meningeoencephalocele in a resource-limited setting, Ethiopia: a clinical case report and review of literature

Abstract

Introduction: Meningoencephalocele is a rare congenital neural tube defect that results in herniation of brain tissue, necessitating surgical treatment. However, anesthetic management of meningoencephalocele is challenging because of the giant occipital mass in airway management, particularly for anesthetists working in resource-limited settings. Therefore, this case report aimed to share the challenges encountered during the perioperative anesthesia management of a giant occipital meningoencephalocele in Ethiopia. Case presentation: A 16-day-old female neonate was referred from a health center in Ethiopia for surgical excision and repair of a giant occipital meningoencephalocele (GOM). The main challenges were hemodynamic instability and airway management due to the giant mass on neck movement and inability to achieve the optimal position for intubation. Methods: A single clinical case report discussed challenges encountered during perioperative anesthesia management of GOM in a resource-limited setting in Ethiopia, and this work has been reported in line with the SCARE 2023 criteria. Conclusion: Anesthesia management in neonates with GOM is challenging for anesthetists in resource-limited settings because of the scarcity of different airway equipment and large masses. Another concern was to avoid pressure on the GOM due to rupture, which may result in hemodynamic instability and hypothermia. Therefore, attention should be paid to proper handling of the airway, hypothermia, and fluid loss. Generally, managing an occipital meningoencephalocele poses challenges for anesthetists, particularly in terms of securing the airway. Despite these challenges, we managed with locally available resources.