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J Neurosurg Pediatr. 2017 Oct;20(4):334-340. doi: 10.3171/2017.5.PEDS1762. Epub 2017 Jul 21.

Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair.

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Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital, Technical University Munich.
Center of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany.
Department of Neurosurgery, Yangon General Hospital, Yangon.
Department of Plastic and Aesthetic Surgery, ATOS Clinic.
Department of Neurosurgery, University Hospital Inselspital and University of Bern, Switzerland.
Department of Plastic and Reconstructive Surgery, Innsbruck University Hospital, Innsbruck, Austria; and.
Department of Plastic and Reconstructive Surgery, Interplast Germany, Section Munich.
Department of Neurosurgery, Mandalay University Hospital, Mandalay, Myanmar.
Population and Development Branch, Technical Division, United Nations Population Fund, New York, New York.


OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.


CSF = cerebrospinal fluid; NGO; NGO = nongovernmental organization; craniofacial; frontoethmoidal meningoencephalocele; humanitarian mission; meningocele; neural tube defects; surgical mission; sustainability

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