Repair of Frontoethmoidal Encephalocele in the Philippines: An Account of 30 Cases Between 2008-2013.
BACKGROUND
Frontoethmoidal encephalocele is a congenital abnormality of the anterior skull base involving herniation of cranial contents through a midline skull defect. Patency of the foramen cecum, along with other multifactorial variables, contributes to the development of frontoethmoidal encephaloceles. Because of limited resources, financial constraints, and lack of surgical expertise, repair of frontoethmoidal encephaloceles is limited in developing countries.


METHODS
Between 2008 and 2013 an interdisciplinary team composed of neurosurgeons, craniofacial surgeons, otolaryngologists, plastic surgeons, and nursing personnel, conducted surgical mission trips to Davao City in Mindanao, Philippines. All patients underwent a combined extracranial/intracranial surgical approach, performed in tandem by a neurosurgeon and a craniofacial surgeon, to detach and remove the encephalocele. This procedure was followed by reconstruction of the craniofacial defects.


RESULTS
A total of 30 cases of frontoethmoidal encephalocele were repaired between 2008 and 2013 (20 male; 10 female). The average age at operation was 8.7 years, with 7 patients older than 17 years. Of the 3 subtypes, the following breakdown was observed in patients: 18 nasoethmoidal; 9 nasofrontal; and 3 naso-orbital. Several patients showed concurrent including enlarged ventricles, arachnoid cysts (both unilateral and bilateral), and gliotic changes, as well as orbit and bulbus oculi (globe) deformities. There were no operative-associated mortalities or neurologic deficits, infections, or hydrocephalus on follow-up during subsequent trips.


CONCLUSIONS
Despite the limitations of performing advanced surgery in a developing country, the combined interdisciplinary surgical approach has offered effective treatment to improve physical appearance and psychological well-being in afflicted patients.
Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA. Electronic address: almarsha@oakland.edu.
Amanda-Lynn
AL
Marshall
Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Pradeep
P
Setty
Craniofacial Institute of Michigan, Novi, Michigan, USA.
Mark
M
Hnatiuk
Oakland University William Beaumont School of Medicine, Department of Neurosurgery, Royal Oak, Michigan, USA.
Daniel R
DR
Pieper
D000293:Adolescent; D000328:Adult; D016080:Arachnoid Cysts / Q000453:epidemiology; D001139:Arnold-Chiari Malformation / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004677:Encephalocele / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005004:Ethmoid Bone / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005624:Frontal Bone / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology; D007223:Infant; D008297:Male; D008493:Medical Missions; D009295:Nasal Bone / Q000000981:diagnostic imaging / Q000601:surgery; D000069471:Neurosurgeons; D061646:Operative Time; D000066794:Oral and Maxillofacial Surgeons; D000072220:Otolaryngologists; D010348:Patient Care Team; D010679:Philippines; D011183:Postoperative Complications / Q000453:epidemiology; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000601:surgery; D019651:Plastic Surgery Procedures; D013518:Surgery, Plastic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
Foramen cecum; Frontoethmoidal encephalocele; Neural tube defect; Pediatric craniofacial reconstruction; Skull base