Occipital encephalocele in a neonate: a case successfully managed by excision and formation of a reverse visor scalp flap

Abstract

Encephaloceles are one form of neural tube defect and are associated with partial absence of skull bone fusion, with an incidence of 1–4 cases for every 10 000 live births. We report the case of a neonate born at term, with an antenatal diagnosis of occipital encephalocele, which was successfully managed with excision and formation of a reverse visor scalp flap on day 2 of life.Surgery was performed in a single stage, involving a multidisciplinary approach between neurosurgery and plastic surgery teams, with wider management involving neonatal intensive care, paediatric, obstetric and anaesthetic teams.The patient had no early postoperative complications, and we use this case report to demonstrate that a reverse visor scalp flap is a good option to cover full-thickness defects in patients with encephaloceles.Furthermore, we advocate early repair and a multidisciplinary approach to minimise the morbidity associated with occipital encephaloceles.

Pre-Natal Diagnosis of Occipital Encephalocele: A Rare Case

“…Indeed, it may stop the progression of encephalocele. Furthermore, the outcomes seem better in this case [6].…”

“…Important questions arise after diagnosis [6]: -Is this isolated or are there other associated anomalies.…”

Wound Dehiscence After Occipital Encephalocele Surgical Repair in a Neonate: Management Alternative

“…Encephalocele surgical repair is a procedure that can be challenging for a multidisciplinary team and is related to different complications such as CSF leak, hydrocephalus, meningitis with possible progression to septic shock, and wound dehiscence [ 1 ].…”

“…Occipital encephaloceles are congenital malformations of the neural tube characterized by a fusion defect of the skull bones, resulting in a space through which structures such as meninges, CSF, and brain tissue can herniate. An incidence of 1-4 cases per 10,000 live births is reported, making the occipital defect the most common in the Western world, accounting for up to 85% of reported cases [ 1 , 2 ].…”

“…This results in a late diagnosis with a slight increase in the risk of morbidity and mortality. However, an adequate approach with imaging studies (MRI or CT) and early correction can decrease the incidence of complications such as cognitive impairment [ 1 ].…”