[PMID]: | 28731403 |
[Au] Autor: | Heidekrueger PI; Thu M; Mühlbauer W; Holm-Mühlbauer C; Schucht P; Anderl H; Schoeneich H; Aung K; Mg Ag M; Thu Soe Myint A; Juran S; Aung T; Ehrl D; Ninkovic M; Broer PN |
[Ad] Endereço: | Department of Plastic, Reconstructive, Hand, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital, Technical University Munich. |
[Ti] Título: | Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair. |
[So] Source: | J Neurosurg Pediatr;20(4):334-340, 2017 Oct. |
[Is] ISSN: | 1933-0715 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | 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. |
[Mh] Termos MeSH primário: |
Descompressão Cirúrgica/métodos Encefalocele/cirurgia Osso Frontal/cirurgia Meningocele/cirurgia Procedimentos Cirúrgicos Reconstrutivos/métodos
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[Mh] Termos MeSH secundário: |
Adolescente Adulto Criança Pré-Escolar Feminino Seres Humanos Lactente Masculino Estudos Retrospectivos Resultado do Tratamento Adulto Jovem
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[Pt] Tipo de publicação: | JOURNAL ARTICLE |
[Em] Mês de entrada: | 1710 |
[Cu] Atualização por classe: | 171006 |
[Lr] Data última revisão:
| 171006 |
[Sb] Subgrupo de revista: | IM |
[Da] Data de entrada para processamento: | 170722 |
[St] Status: | MEDLINE |
[do] DOI: | 10.3171/2017.5.PEDS1762 |
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