Perioperative management for surgical correction of frontoethmoidal encephalomeningocele in children: a review of 102 cases.
BACKGROUND
Frontoethmoidal encephalomeningocele (FEEM) is a congenital neural tube defect characterized by herniation of brain and meninges through an anterior skull defect. The extruding mass results in a cutaneous expanding lesion and facial deformity. The objective of this study was to review perioperative management for surgical correction of this condition.


METHODS
We reviewed the charts of FEEM children who were treated by surgical correction in King Chulalongkorn Memorial Hospital during 1995-2005. The collected data were categorized into preoperative, intraoperative and postoperative data. In addition, average blood loss was calculated.


RESULTS
A total of 102 charts were reviewed. Preoperative data: The mean age of the patients was 4.62 years. Forty-six patients (45%) were smaller than average weight or height. Preoperative-associated abnormal conditions were found in 69 cases (68%). Intraoperative data: The mean duration of the anesthesia and surgery were 6.35 h and 5.51 h, respectively. The estimated mean red cell mass loss was 13.04 ml.kg(-1). There is one case of difficult intubation. No major anesthetic complication was found. Postoperative data: The average intensive care unit stay and hospital stay were 1.55 days and 11.51 days, respectively. The main postoperative complications were tonic-clonic seizure and serious infection including septic shock from wound infection and meningitis.


CONCLUSIONS
We reported perioperative management in 102 FEEM children. Comprehensive care during preoperative, intraoperative and postoperative period is essential for successful outcome.
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. fmedrll@md2.md.chula.ac.th
Ruenreong
R
Leelanukrom
Petch
P
Wacharasint
Areerat
A
Kaewanuchit
D000293:Adolescent; D000465:Algorithms; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D004677:Encephalocele / Q000601:surgery*; D004906:Erythrocyte Count; D005004:Ethmoid Bone / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe / Q000601:surgery*; D006400:Hematocrit; D006801:Humans; D007530:Isoflurane; D008297:Male; D008588:Meningocele / Q000601:surgery*; D019635:Neurosurgical Procedures; D009609:Nitrous Oxide; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
D018685:Anesthetics, Inhalation; D007530:Isoflurane; D009609:Nitrous Oxide