IA. Marzuki, J. Abdullah, A.R.Ariffx, M. Ghazaimie,
Neurosurgical Division, Department of Radiology,
Department of Anesthesiology,
Universiti Sains Malaysia, 16150 Kubang
Kerian, Kelantan, Malaysia.
In the current index medicus, there are only 9 case reports on management of mega-occipital encephaloceles. We report on 2 large occipital encephaloceles presenting with their own preoperative, intraoperative and postoperative problems. In the two cases, a low pressure ventriculoperitoneal shunt was initially inserted to reduce the effects of cerebrospinal fluid compartment loss. When the weigh of these infants were more than 8kg (including encephalocele) referral to the anesthesiologist were done to ascertain difficult intubation problems, intravernous lines and severe hypothermia and hypovolemia fatal to these patients. Patient one underwent successful removal but developed severe hyponatremic cerebral oedema from SIADH eventually sucuuming to cerebral death. Patient two underwent the same procedure and survived.
Conclusion: Mortality of large occipital encephalocele have been reported to be up to 60% in the most experienced centers. Both anatomical mapping of the sagittal sinus must be done via magnetic or Computer Tomography of the brain prior to surgery.
Reference:
1. Adetiloye VA, Dare FO, Oyelamani OA.
A ten year review of encephalocele on a teaching hospital Int.J. gynaecol.
Obstet 1993;41(3):241-9.
2. Chapman PH, Swearingen B, Caviness
VS. Subtorcular occipital encephaloceles. Anatomical consideration relevant
to operative management J Neurosurg 1989;71(3):375-81.