Singh Gurmeet, Pandey Anand, Verma Ajay Kumar, Gupta Archika, Rawat Jiledar, Wakhlu Ashish, Kureel Shiv Narain
Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India.
J Indian Assoc Pediatr Surg. 2020 Nov-Dec;25(6):385-389. doi: 10.4103/jiaps.JIAPS_101_18. Epub 2020 Oct 27.
Giant occipital encephalocele (GOE) is a term used when the size of the OE is greater than or equal to the size of the head. It has been limited to case reports, with only sporadic exclusive series. This is a series of GOE managed at our center over time with emphasis on practical problems faced in management.
This was a retrospective observational study. The patients were evaluated for the age of presentation, sex, and head size. Any associated neural tube defect was also looked for. Imaging was used for associated brain anomalies and to plan the surgical procedure. The requirement of ventriculoperitoneal (VP) shunt was also assessed.
During the study period of 7 years, 11 patients of GOE were admitted. Apart from one, all other patients were <1 year of age. Nine patients underwent surgical intervention, which included excision and repair of swelling with or without VP shunt placement. The content of the sac was only cerebrospinal fluid (CSF) in six patients and CSF and gliotic brain tissue in remaining patients. The attendants of two patients did not give consent for surgery and left against medical advice.
GOE is an uncommon entity with limited information about management. Careful evaluation, proper imaging of patient, and care during intraoperative and postoperative periods with emphasis of factors determining the prognosis may provide satisfactory results.
巨大枕部脑膨出（GOE）是指枕部脑膨出（OE）的大小大于或等于头部大小的情况。此前相关报道仅限于病例报告，仅有零星的独立系列报道。本文介绍了我们中心长期以来对一系列巨大枕部脑膨出病例的治疗情况，重点关注治疗过程中遇到的实际问题。
这是一项回顾性观察研究。对患者的就诊年龄、性别和头围进行评估。同时检查是否存在任何相关的神经管缺陷。利用影像学检查来发现相关的脑部异常情况，并规划手术方案。还评估了脑室腹腔（VP）分流术的必要性。
在为期7年的研究期间，共收治了11例巨大枕部脑膨出患者。除1例患者外，其他所有患者年龄均小于1岁。9例患者接受了手术干预，包括切除并修复肿物，部分患者同时进行了VP分流术。6例患者囊内仅含脑脊液（CSF），其余患者囊内含有脑脊液和胶质化脑组织。2例患者的家属未同意手术，自行离院。
巨大枕部脑膨出是一种罕见疾病，关于其治疗的信息有限。仔细评估、对患者进行恰当的影像学检查以及在术中和术后给予精心护理，同时着重考虑决定预后的因素，可能会取得满意的治疗效果。
