Surgical nuances giant encephalocele

GIANT OCCIPITAL ENCEPHALOCELE

•FTNVD MALE CHILD

•PRESENTED AT 15 DAYS OF AGE

•O/E: Head Circumference: 31cmEncephalocele circumference:

56cm

ANESTHETIST’S CONSIDERATIONS

• Difficult intubation

• Hypothermia (maintenance of temp)

• Fluid/Blood loss

INTRAOPERATIVE POSITIONING

ASPIRATION OF THE ENCEPHALOCELE

SAC DISSECTION

CLOSUREMultilayer closure

Arachnoid

Dura (Double breasting)

Cranioplasty

Two layer muscle closure

CRANIOTOMY FOR ASSOC

CRANIOSYNOSTOSIS

POSTOPERATIVE COURSE

•Pt shifted to ICU intubated, in incubater

•Had severe hypothermia(29.C)-Warmed

•Cyanosed-no peripheral pulse & low BP

•Extubated 12 hours later

•Further recovery uneventful

GIANT ENCEPHALOCELE

COMPLICATIONS

Postoperative hydrocephalus requiring shunt 4

Postoperative meningitis 4

POST OPERATIVE MORTALITY:

• Fulminant meningitis 2

• Postoperative brain abscess 1

• Post operative hypothermia 1