One-stage Extracranial Repair and Reconstruction for Frontoethmoidal Encephalomeningocele

Mahatumarat, Charan; Taecholarn, Chopoew; Charoonsmith, T

doi:10.1097/00001665-199112000-00003

Cited by 31 publications

(18 citation statements)

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“…11,19,21,31 Based on our experience, CSF leaks were mostly observed during the first postoperative year. Two factors can explain CSF leaks: the transfacial approach, and inadequate base reconstruction with no watertight dura closure.…”

Section: Postoperative Issuesmentioning

confidence: 95%

“…Frontoethmoidal meningoencephalocele has a remarkably specific geographical distribution in many Southeast Asian countries, such as Burma, 11,40 Thailand, 2,3,8,21,[37][38][39] Cambodia, 7,10,31,43 Malaysia, 1 Indonesia, 13,33 and Papua New Guinea. 14 The condition is also found in India 19 and Australia in the aboriginal population.…”

Section: Geographical Distribution and Etiologymentioning

confidence: 99%

“…1) which has, in our opinion, 3 major advantages: 1) it allows a better fMEC closure, 2) a better telecanthus correction can be achieved, and 3) it can reduce and sometimes avoid facial scars. To achieve these aims, we used the modified Chula technique, 21,26,28 trying to avoid large facial scars (Fig. 2).…”

Section: Surgical Issuesmentioning

confidence: 99%

“…The dura of the fMEC is thin, and even with meticulous dissection dural tears are commonplace. Although a certain number of leaks resolve spontaneously, 21,31 others do not, which then predisposes to infection. The risk of CSF leak can be reduced by avoiding a transfacial approach where possible (for example, when the fMEC is small and the facial skin of good quality).…”

Section: Postoperative Issuesmentioning

confidence: 99%

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Frontoethmoidal meningoencephalocele: appraisal of 200 operated cases

Oucheng

Lauwers

Gollogly

et al. 2010

PED

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Object Frontoethmoidal mengingoencephaloceles (fMECs) are frequently observed in Cambodia, especially in poor families. The authors describe issues related to the surgical treatment of fMECs in Cambodia at the end of a humanitarian program that provided surgery free of charge to patients and their families. Methods The authors reviewed 257 cases of fMEC involving patients who presented to their institution, the Children's Surgical Center in Phnom Penh, between 2004 and 2009. They treated 200 of these patients surgically (108 males, 92 females; 89% younger than 18 years) using a “low-cost” management plan with no routine pre- or postoperative investigations. Initially, surgery was performed by visiting foreign surgeons who taught the procedures to resident surgeons. Patients were not charged for consultations or treatment and received at least 1 follow-up examination 6 months postoperatively. Results The nasoethmoidal type was the most frequent fMEC encountered (69%). Many patients had associated ophthalmological issues (46% of cases). Only 1 familial case was detected. Combined neurosurgical and facial procedures were successfully standardized and learned by surgeons initially unfamiliar with fMEC management. A neurosurgical approach avoided the need for a facial incision in 42 cases, improving cosmetic results. The most common postoperative issues were a temporary CSF leak (24 cases [12%]) and/or infection (28 cases [14%]). There were 3 deaths directly related to the operations. Cosmetic results were good in 145 cases, average in 27, poor in 7, and worse than preoperative appearance in 6 patients. Fifteen patients were lost to follow-up. The parents of 87% of the children were rice farmers. Questionnaire results confirmed that fMEC has important social and educational consequences for the affected children and that these consequences can be partially improved by fMEC correction. Conclusions This experience in fMEC management demonstrates that local surgeons can treat these malformations with limited surgical materials and in a nonspecialized infrastructure after principles of treatment have been learned and if they are carefully respected. Surgery for fMEC can thus be more accessible to a larger number of patients in developing countries. Moreover, local treatment facilitates better postoperative and follow-up care.

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Section: Postoperative Issuesmentioning

confidence: 95%

Section: Geographical Distribution and Etiologymentioning

confidence: 99%

Section: Surgical Issuesmentioning

confidence: 99%

Section: Postoperative Issuesmentioning

confidence: 99%

See 2 more Smart Citations

Frontoethmoidal meningoencephalocele: appraisal of 200 operated cases

Oucheng

Lauwers

Gollogly

et al. 2010

PED

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“…If indicated, a reconstruction of the medial orbital walls can be performed during the same session [39,49,50], The nature of interorbital hypertelorism, as found in all pa tients of our series, implies that surgical reconstruction does not require orbital translocation, but only medial replacement of the medial orbital walls [44]. In order to achieve an adequate closure of the skull defect without the necessity of a major transcranial procedure, the subcranial approach has been developed with satisfying results [51]. This alternative surgical technique provides access to the internal orifice of the skull defect in the anterior fossa by resection of the nasoethmoid bones, since the cri briform plate is tilted downwards in patients with frontoethmoidal encephaloceles (= enlarged LO CP ratio).…”

Section: Therapeutic Consequencesmentioning

confidence: 99%

Frontoethmoidal Encephaloceles, a Study of Their Pathogenesis

Hoving¹,

Vermeij‐Keers

1997

Pediatr Neurosurg

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A prospective clinical study of 30 patients with frontoethmoidal encephaloceles was performed in order to find support for a proposed theory concerning its pathogenesis, based on a previously performed embryological study and relevant findings in the literature. According to this proposed theory the pathogenesis of frontoethmoidal encephaloceles is primarily based on a disturbance in separation of neural and surface ectoderm at the site of final closure of the rostral neuropore during the final phase of neurulation in the 4th week of gestation. An insufficient occurrence of apoptosis might cause this disturbance in separation. The nonseparation of neural and surface ectoderm will result secondarily in a midline mesodermal defect. This mesodermal defect is reflected in the median skull defect at the site of the foramen caecum. The outgrowth of the nasal septum with the concomitant forward displacement of epidermis (surface ectoderm) and attached brain tissue (neural ectoderm) may act as herniating force. The patient study consisted of a clinical investigation, radiological investigations (X skull and CT scans), and surgical treatment in order to obtain specimens which were examined histologically. Clinical findings supportive of the proposed hypothesis are (1) the consistency in the location of the internal skull defect, (2) the close relationship between epidermal structures and glial tissue in 15 out of 29 specimens, and (3) the presence of a normally developed nose in combination with interorbital hypertelorism in all patients. A discussion of these findings is presented with special reference to the embryological aspects.

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