Correction of the Frontoethmoidal Encephalomeningocele with Minimal Facial Incision

Abstract

At present all surgical techniques to correct the frontoethmoidal encephalomeningocele require extensive incisions over the mass and perinasal area, thus adding scars to the already-disfigured faces. This study demonstrates a possibility of doing definitive surgery with minimal facial incision. The technique follows the principles of the "Chula technique," which is the one-stage definitive technique without formal frontal craniotomy. However facial incision was kept to minimum, or even avoided, while amputation of the herniation, dural repair, skull defect closure, and repositioning of the medial canthal ligaments were performed mainly via the coronal incision. There were 20 patients operated on using this modified Chula technique. No perinasal incision was needed at all in three patients (15%) with F1 masses (small- and medium-sized masses according to the "FEEM classification"). Three patients with F1 masses had only small stab incisions just medial to the medial canthus for medial canthopexy. The rest (70%) consisting of two F2 (large-sized) masses and twelve F1 masses had limited nasal incisions just to help removing the facial masses and correcting facial deformity. With an average of 287 days of follow-up period (14-997 days), there had been no cerebrospinal fluid leakage or disease recurrence. Correction of the frontoethmoidal encephalomeningocele can be done safely via the coronal incision alone while facial incision can be omitted or, if necessary, kept to minimum.