Refaee Ehab Ahmed El, Refaat Mohamed Ibrahim, Reda Mohamed
Department of Neurosurgery, Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Germany.
Department of Neurosurgery, Faculty of Medicine, Cairo University Hospitals Kasr Al Ainy-El Manial Hospital 26, Cairo, Egypt.
J Neurol Surg A Cent Eur Neurosurg. 2018 Jan;79(1):15-18. doi: 10.1055/s-0036-1597548. Epub 2017 Feb 1.
Encephaloceles presents as a protrusion of the cranial contents through a defect in the cranium. The most common sites of occurrence are the occipital and frontonasal regions. The surgical outcome is reported to be satisfactory; however, the incidence of hydrocephalus in patients with encephaloceles is variable in the literature. This study investigated the relationship between the size of the encephaloceles and the occurrence of hydrocephalus.
Data of all neonates with encephaloceles who presented to our institution from September 2012 to September 2014 were collected. Surgery was performed during the first 2 weeks of age. Encephaloceles with a maximal diameter > 10 cm were included in the study, and the clinical picture, surgical technique, pre- and postoperative imaging, and follow-up were analyzed.
Nineteen cases were included in this study. The mean follow-up period was 7 months. Sixteen cases were occipital; three were frontal. In all patients the maximum diameter was > 10 cm. However, in four patients it was > 18 cm. Postoperative ventriculomegaly occurred in seven cases. Of these, four patients needed a permanent ventriculoperitoneal shunt implantation (21%). Wound dehiscence occurred in two patients who required secondary sutures with a favorable outcome. One patient died 2 weeks after the surgery due to a poor general condition and wound infection.
Early surgical excision provides effective treatment of huge encephaloceles. Overall, 21% of cases require cerebrospinal fluid (CSF) diversion afterward depending on associated anomalies. Despite their size, giant encephaloceles can have an excellent prognosis with no need for further treatment or CSF diversion.
脑膨出表现为颅骨内容物通过颅骨缺损处突出。最常见的发生部位是枕部和鼻额部。据报道手术效果令人满意；然而，文献中脑膨出患者脑积水的发生率各不相同。本研究调查了脑膨出大小与脑积水发生之间的关系。
收集了2012年9月至2014年9月在我院就诊的所有脑膨出新生儿的数据。在出生后2周内进行手术。最大直径>10 cm的脑膨出纳入研究，并对临床表现、手术技术、术前和术后影像学检查以及随访情况进行分析。
本研究纳入19例患者。平均随访期为7个月。16例为枕部脑膨出；3例为额部脑膨出。所有患者的最大直径均>10 cm。然而，4例患者的最大直径>18 cm。7例患者术后出现脑室扩大。其中，4例患者需要永久性脑室腹腔分流术植入（21%）。2例患者发生伤口裂开，需要二次缝合，预后良好。1例患者术后2周因全身状况差和伤口感染死亡。
早期手术切除可有效治疗巨大脑膨出。总体而言，21%的病例术后需要根据相关异常情况进行脑脊液分流。尽管脑膨出体积巨大，但无需进一步治疗或脑脊液分流也可获得良好预后。
