4.14\ Cranial Vault Encephalocele

Repair

4.14.1\ Discussion

Traditional management of encephaloceles consists of resecting the abnormal herniated brain tissue and closing the wound via primary intention if there is sufficient skin available (Fig. 4.37), with the goal of avoiding new deficits related to extended surgery. Cranioplasty can be performed at the same time as the primary surgery or at a later time, using materials such as methyl methacrylate, hydroxyapatite bone cement, demineralized bone matrix, and autologous grafts, which can be harvested from the adjacent calvarium, for example (Fig. 4.38). If a substantial amount of functional brain tissue has herniated through the encephalocele sac, expansile cranioplasty can be performed. This technique consists of reconstructing the calvarial defect with autologous bone graft harvested from the adjacent parietal region. This approach effectively enlarges or extends the intracranial cavity to encompass the herniated brain tissue.

a

b

Fig. 4.38  Frontonasal encephalocele repair. Preoperative sagittal (a) and 3D (b) CT images show a frontonasal encephalocele herniating through a midline skull defect.

Postoperative sagittal (c) and 3D (d) CT images show interval resection of the encephalocele and repair of the defect using calvarial bone graft (arrows)