title: Atretic cephaloceles: a comprehensive analysis of historical cohort.
abstract: OBJECTIVE
  This study aims to analyze the historical cohort of patients with atretic cephaloceles (ACs) comprehensively, since the literature regarding ACs is limited by small case series or case reports and to report a new venous anomaly concomitant with a parietal AC in our exemplary case.
  
  
  METHODS
  After a PubMed/Medline search with "atretic cephalocele" in April 2016, we retrieved 42 articles, 41 of which were relevant with the topic. Full texts of accessible articles and abstracts of inaccessible articles were read comprehensively. References of retrieved articles were manually searched. Additional 29 articles reporting the cases of atretic, rudimentary, occult, or sequestered cephaloceles were accessed, since these terms have been used interchangeably in the literature.
  
  
  RESULTS
  Median age and mean age of the patients were 1 and 6.69 years, respectively. Female/male ratio was 1.03:1. Atretic cephaloceles were located in different regions, in decreasing order of frequency: parietal (55 %; n = 105), occipital (37 %; n = 71), parieto-occipital (n = 8), frontal (n = 4), asterion (n = 1), and sincipital (n = 1). Concomitant central nervous system (CNS) anomalies were present in 73.3 % of patients with parietal atretic cephaloceles and in 32.4 % of patients with occipital atretic cephaloceles (p < 0.0001). We realized that all patients with worse outcomes had concomitant CNS anomalies (100 %), whereas only 48 % of those with good clinical outcomes had concomitant anomalies (p = 0.0248).
  
  
  CONCLUSIONS
  Atretic cephaloceles present as nodular extrusions on the parietal and occipital regions. Concomitant CNS anomalies, which impair the clinical outcomes, are more common in patients with parietal ACs. Observation-only approach is enough in patients with asymptomatic ACs. However, life-long follow-ups are required, because of recurrence after the surgery.
authors.affiliation: Department of Radiology, Medical School, Bahçeşehir University, Istanbul, Turkey.
authors.forename: Mustafa Kemal
authors.initials: MK
authors.lastname: Demir
authors.affiliation: Department of Neurosurgery, Elazığ Medical Park, Elazığ, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Çolak
authors.affiliation: Department of Orthopedic Surgery-Spine Center, University of California at San Francisco, 500 Parnassus Avenue MU320 West, San Francisco, CA, 94143-0728, USA. muratsakireksi@gmail.com.
authors.forename: Murat Şakir
authors.initials: MŞ
authors.lastname: Ekşi
authors.affiliation: Department of Physical Medicine and Rehabilitation, Antalya Atatürk State Hospital, Antalya, Turkey.
authors.forename: Emel Ece
authors.initials: EE
authors.lastname: Özcan-Ekşi
authors.affiliation: Department of Neurosurgery, Medical School, Bahçeşehir University, Istanbul, Turkey.
authors.forename: Akın
authors.initials: A
authors.lastname: Akakın
authors.affiliation: Department of Neurosurgery, Medical School, Bahçeşehir University, Istanbul, Turkey.
authors.forename: Baran
authors.initials: B
authors.lastname: Yılmaz
mesh_terms: D002648:Child; D002675:Child, Preschool; D004677:Encephalocele / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male
keywords: Atretic cephalocele; Headache; Superior sagittal sinus; Varicose vein