Cent Eur Neurosurg 2009; 70(1): 43-47
DOI: 10.1055/s-0028-1082321
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

A Non-midline Spheno-orbital Encephalocele in a Newborn

Eine laterale spheno-orbitale Encephalocele bei einem NeugeborenenU. Knopp 1 , A. Knopp 2 , F. Stellmacher 3 , E. Reusche 3 , M. Löning 4 , S. R. Kantelhardt 6 , H. von Domarus 5 , H. Arnold 5 , A. Giese 6
  • 1Department of Neurosurgery, University Hospital Lübeck, Lübeck, Germany
  • 2Department of Pediatrics, University Hospital Lübeck, Lübeck, Germany
  • 3Department of Pathology, University Hospital Lübeck, Lübeck, Germany
  • 4Department of Obstetrics and Gynecology, MHH, Hannover, Germany
  • 5Department of Craniofacial and Maxillary Surgery, University Hospital of Lübeck, Lübeck, Germany
  • 6Department of Neurosurgery, University of Goettingen, Goettingen, Germany
Further Information

Publication History

Publication Date:
03 February 2009 (online)

Abstract

Basal encephaloceles in western countries occur in 1 of every 35 000–40 000 live births; with an incidence of less than 10% they are the least common of all encephaloceles. Certain subtypes such as transsphenoidal variants may be as rare as 1 in 700 000 live births. These rare encephaloceles are classified into five anatomic types: spheno-ethmodial, transsphenoidal, spheno-orbital, transethmoidal, and spheno-maxillary. Here we present an exceedingly rare variant of a non-midline basal encephalocele of the spheno-orbital type, which was treated by resection of the encephalocele, which contained dysplastic central nervous system tissue, on day four post partum. The patient had no neurological deficits and a six year follow-up showed a normal intellect and a good cosmetic result.

Zusammenfassung

Basale Encephalocelen treten in Europa oder Nordamerika bei einer von 35 000 bis 40 000 Geburten auf und stellen mit 10% die seltensten Encephalocelen dar. Bestimmte Typen, wie die transsphenoidalen Varianten, sind besonders selten und haben eine Häufigkeit von 1 auf 700 000 Lebendgeburten. Diese seltenen transsphenoidalen Varianten werden in fünf anatomische Typen klassifiziert, die spheno-ethmoidalen, transsphenoidalen, spheno-orbitalen, transethmoidalen und spheno-maxillären Encephalocelen. Hier stellen wir eine außerordentlich seltene Nicht-Mittellinien-Variante einer basalen Encephalocele des spheno-orbitalen Typs vor, die am vierten Tag post partum durch Resektion der Encephalocele und dysplastischen zentralnervösen Gewebes behandelt wurde. Bei exzellentem kosmetischem Ergebnis fanden sich keine neurologischen Defekte bei einer normalen kindlichen Entwicklung und normalem Intellekt über einen sechsjährigen Verlauf.

References

  • 1 Abe T, Ludecke DK, Wada A. et al . Transsphenoidal cephaloceles in adults. A report of two cases and review of the literature.  Acta Neurochir (Wien). 2000;  142 397-400
  • 2 Allen WP, Stevenson RE, Thompson SJ. et al . The impact of prenatal diagnosis on NTD surveillance.  Prenat Diagn. 1996;  16 531-535
  • 3 Blustajn J, Netchine I, Fredy D. et al . Dysgenesis of the internal carotid artery associated with transsphenoidal encephalocele: a neural crest syndrome?.  Am J Neuroradiol. 1999;  20 1154-1157
  • 4 Boonvisut S, Ladpli S, Sujatanond M. et al . Morphologic study of 120 skull base defects in frontoethmoidal encephalomeningoceles.  Plast Reconstr Surg. 1998;  101 1784-1795
  • 5 Botto LD, Moore CA, Khoury MJ. et al . Neural-tube defects.  N Engl J Med. 1999;  341 1509-1519
  • 6 Brown MS, Sheridan-Pereira M. Outlook for the child with a cephalocele.  Pediatrics. 1992;  90 914-919
  • 7 Chen CS, David D, Hanieh A. Morning glory syndrome and basal encephalocele.  Childs Nerv Syst. 2004;  20 87-90
  • 8 David DJ, Sheffield L, Simpson D. et al . Fronto-ethmoidal meningoencephaloceles: morphology and treatment.  Br J Plast Surg. 1984;  37 271-284
  • 9 David DJ. New perspectives in the management of severe cranio-facial deformity.  Ann R Coll Surg Engl. 1984;  66 270-279
  • 10 David DJ. Cephaloceles: classification, pathology, and management – a review.  J Craniofac Surg. 1993;  4 192-202
  • 11 Dhawan IK, Tandon PN. Excision, repair and corrective surgery for fronto-ethmoidal meningocoele.  Childs Brain. 1982;  9 126-136
  • 12 EUROCAT Working Group . Prevalence of neural tube defects in 20 regions of Europe and the impact of prenatal diagnosis, 1980–1986.  J Epidemiol Community Health. 1991;  45 52-58
  • 13 Formica F, Iannelli A, Paludetti G. et al . Transsphenoidal meningoencephalocele.  Childs Nerv Syst. 2002;  18 295-298
  • 14 French BN. Midline fusion defects and defects of formation. In: Youmans JR, ed. Neurosurgical Surgery. Vol. 3. Philadelphia: Saunders 1982: 1236-1380
  • 15 Golden JA, Chernoff GF. Multiple sites of anterior neural tube closure in humans: evidence from anterior neural tube defects (anencephaly).  Pediatrics. 1995;  95 506-510
  • 16 Honein MA, Paulozzi LJ, Mathews TJ. et al . Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects.  JAMA. 2001;  285 2981-2986
  • 17 Khoury MJ, Erickson JD, Cordero JF. et al . Congenital malformations and intrauterine growth retardation: a population study.  Pediatrics. 1988;  82 83-90
  • 18 Mahapatra AK. Anterior encephaloceles.  Indian J Pediatr. 1997;  64 699-704
  • 19 Mahapatra AK, Suri A. Anterior encephaloceles: a study of 92 cases.  Pediatr Neurosurg. 2002;  36 113-118
  • 20 Martinez-Lage JF, Poza M, Sola J. et al . The child with a cephalocele: etiology, neuroimaging, and outcome.  Childs Nerv Syst. 1996;  12 540-550
  • 21 MacComb JG. Encephaloceles. In: Youmans JR, ed. Neurosurgical Surgery. Vol. 2. Philadelphia: Saunders 1996: 829-842
  • 22 MacComb JG. Spinal and cranial neural tube defects.  Semin Pediatr Neurol. 1997;  4 156-166
  • 23 MacLaurin RL. Encephalocele and related anomalies. In: Hoffmann HJ, ed. Disorder of the developing nervous system: diagnosis and treatment. St Louis: Blackwell Scientific 1986: 153-171
  • 24 Mealey Jr J, Dzenitis AJ, Hockey AA. The prognosis of encephaloceles.  J Neurosurg. 1970;  32 209-218
  • 25 Penner CR, Thompson L. Nasal glial heterotopica: a clinical and immunophenotypic analysis of 10 cases with review of the literature.  Ann Diagn Pathol. 2003;  7 354-359
  • 26 Peter JC, Fieggen G. Congenital malformations of the brain – a neurosurgical perspective at the close of the twentieth century.  Childs Nerv Syst. 1999;  15 635-645
  • 27 Pollock JA, Newton TH, Hoyt WF. Transsphenoidal and transethmoidal encephaloceles. A review of clinical and roentgen features in 8 cases.  Radiology. 1968;  90 442-453
  • 28 Richards CG. Frontoethmoidal meningoencephalocele: a common and severe congenital abnormality in South East Asia.  Arch Dis Child. 1992;  67 717-719
  • 29 Shimizu T, Kitamura S, Kinouchi K. et al . A rare case of upper airway obstruction in an infant caused by basal encephalocele complicating facial midline deformity.  Paediatr Anaesth. 1999;  9 73-76
  • 30 Siffel C, Wong LY, Olney RS. et al . Survival of infants diagnosed with encephalocele in Atlanta, 1979–98.  Paediatr Perinat Epidemiol. 2003;  17 40-48
  • 31 Simpson DA, David DJ, White J. Cephaloceles: treatment, outcome, and antenatal diagnosis.  Neurosurgery. 1984;  15 14-21
  • 32 Stevenson RE, Allen WP, Pai GS. et al . Decline in prevalence of neural tube defects in a high-risk region of the United States.  Pediatrics. 2000;  106 677-683
  • 33 Suwanwela C, Hongsaprabhas C. Fronto-ethmoidal encephalomeningiocele.  J Neurosurg. 1966;  25 172-182
  • 34 Suwanwela C, Sukabote C, Suwanwela N. Frontoethmoidal encephalomeningocele.  Surgery. 1971;  69 617-625
  • 35 Allen MI Van, Kalousek DK, Chernoff GF. et al . Evidence for multi-site closure of the neural tube in humans.  Am J Med Genet. 1993;  47 723-743
  • 36 Wiswell TE, Tuttle DJ, Northam RS. et al . Major congenital neurologic malformations. A 17-year survey.  Am J Dis Child. 1990;  144 61-67
  • 37 Yokota A, Matsukado Y, Fuwa I. et al . Anterior basal encephalocele of the neonatal and infantile period.  Neurosurgery. 1986;  19 468-478

Correspondence

Prof. A. GieseMD 

Department of Neurosurgery

Georg-August-University

Robert-Koch-Str. 40

37075 Goettingen

Germany

Phone: +49/551/39 60 33

Fax: +49/551/39 87 94

Email: alf.giese@med.uni-goettingen.de

    >