Anaesthetic management of a huge occipital meningoencephalocele in a 14 days old neonate
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Meningoencephalocele is a skull defect that includes herniation of the cerebrospinal fluid and the brain tissue, and of meninges through it.
We report the anaesthetic management in a case of a 14-day-old neonate with a huge occipital meningoencephalocele referred for surgical excision and repair. The major anaesthetic challenges encountered in the management of occipital meningoencephalocele were to maintain adequate positioning of the neonate on the operation theatre table during induction and securing the airway thereafter.
The anaesthetic management of an occipital meningoencephalocele poses challenges for an anaesthesiologist in terms of positioning, difficulty encountered in securing airway particularly in the lateral position, blood loss and perioperative care; thus, attention should always be paid for proper positioning and perfect handling of airways along with replacement of blood loss intraoperatively.
KeywordsLateral position intubation Meningoencephalocele Occipital
The term encephalocele represents the herniation of cranial contents through a defect in the skull. If herniation of only cerebrospinal fluid and meninges exists, it is termed as meningocele. The herniation of the cerebrospinal fluid and meninges, along with the brain tissue, is termed as meningoencephalocele (Cote and Miller 2010). In Southeast Asia, the incidence of meningoencephalocele is one in 5000 live births (Creighton et al. 1974). The anaesthetic management of the airway may be challenging in neonates and young infants with large neck mass such as a huge occipital meningoencephalocele. Occipital meningoencephalocele poses challenges to an anaesthesiologist because of inadequate extension of the neck and inability to lay down the neonate in the supine position on the table, which makes the optimal position for intubation difficult.
So, in conclusion, the perioperative management of a case of occipital meningoencephalocele may pose challenges both for an anaesthesiologist and a neurosurgeon. In our case, a neonate with a huge occipital meningoencephalocele, the problems encountered were essentially because of its large size, positioning during induction and intubation and blood loss during resection of large amount of redundant skin. Thus, added attention should be paid to look for other congenital abnormalities along with proper positioning, perfect handling of airways and replacement of blood loss intraoperatively.
The consent form is attached separately (signed by parent–mother) for the reproduction of images of child as a purpose of publication in a journal.
Availability of data and materials
The data is extracted from the medical records file of the patient through medical record department of our hospital and the materials are being used which were available in our set up with valid reasons.
KJ and SKS have reviewed the available literature and participated in the data acquisition and analysis. SKS prepared the primary manuscript. SKS, KJ, NJ, and VP reviewed and edited final manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate
Although this is not a study, the permission for sending a case report was taken from the local institutional ethical committee after obtaining a valid consent from the patient’s mother.
Consent for publication
Written permission/consent for reproduction of images of the patient for the purpose of publication in an educational medical journal was obtained from the parents (mother) of the patient.
The authors declare that they have no competing interests.
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