Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair.

Heidekrueger, Paul I; Thu, Myat; Mühlbauer, Wolfgang; Holm-Mühlbauer, Charlotte; Schucht, Philippe; Anderl, Hans; Schoeneich, Heinrich; Aung, Kyawzwa; Mg Ag, Mg; Thu Soe Myint, Ag; Juran, Sabrina; Aung, Thiha; Ehrl, Denis; Ninkovic, Milomir; Broer, P Niclas (2017). Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair. Journal of neurosurgery - pediatrics, 20(4), pp. 334-340. American Association of Neurological Surgeons 10.3171/2017.5.PEDS1762

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OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
UniBE Contributor:	Schucht, Philippe
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1933-0707
Publisher:	American Association of Neurological Surgeons
Language:	English
Submitter:	Nicole Söll
Date Deposited:	26 Feb 2018 08:32
Last Modified:	05 Dec 2022 15:08
Publisher DOI:	10.3171/2017.5.PEDS1762
PubMed ID:	28731403
Uncontrolled Keywords:	CSF = cerebrospinal fluid NGO NGO = nongovernmental organization craniofacial frontoethmoidal meningoencephalocele humanitarian mission meningocele neural tube defects surgical mission sustainability
URI:	https://boris.unibe.ch/id/eprint/107939