Abstract
Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of brain tissue and meninges through a defect in the cranium, in frontal, orbital, nasal and ethmoidal regions. The management of this complex congenital malformation is controversial according to whether use, an intracranial, extra-cranial or combined approach. This is the first largest series published in Africa, in which we present our experience in the operative management of AME; we share our recommendation in technical consideration for surgical approach with review of the literature. All patients beneficed of neuro-radiological investigations including Plan X rays, Spiral Three dimensional CT scan and MRI. Ophthalmologic and maxillo-facial evaluations were done in all the cases. MEA are surgically approached in various ways, mainly on the basis of its location and type, by cranio-facial approach in one-step, or in two stages by intracranial approach followed by facial approach, only by cranial approach or facial approach. The surgical results were evaluated in the follow up on the basis of disappearance of cranio-facial tumefaction with correction of hypertelorism. 60 children with AME were treated in our department between January 1992 and December 2012. The mean age at time of surgery was 14 months (20 days to 18 years) with slight men predominance (28 females/32 males). Cranio-facial team operated 21 patients, 16 were operated in two stages by intracranial approach followed by facial approach, 20 cases beneficed the neurosurgical approach and three only the facial approach Some post operative complications were observed: 2 cases of post operative hydrocephalus underwent shunt; CSF fistulas in three cases cured by spinal drainage, one death due to per operative hypothermia, 3 cases of recurrence how needed second surgery. After mean follow up for 80 months (1 year to 19 years) theses techniques permitted a good cosmetics results in 42 cases, average cosmetics results in 8 cases, poor results in 5 cases and worse cosmetics results in 4 cases, The AME are rare conditions we used the multiples approach first intracranial approach followed by facial approach, but after 1998 we used one-step correction by combined approach, only cranial approach when needed or facial correction.
Highlights
In 1855, Finnish physician Karl Benedikt Mesterton described a congenital malformation characterized by the herniation of the mining's and cerebral tissue through a defect in the anterior cranium
This is the first largest series published in Africa, in which we present our experience in the operative management of MEA; we share our recommendation in technical consideration for surgical approach with review of the literature
The number of cases has remained similar over the last twenty years ranging from two to three cases on the average per years. This number is higher than the posterior meningo-encephaloceles how is 27cases received in the same period
Summary
In 1855, Finnish physician Karl Benedikt Mesterton described a congenital malformation characterized by the herniation of the mining's and cerebral tissue through a defect in the anterior cranium He classified this pathological entity, known as frontoethmoidal meningo-encephaloceles (MEC) into three types according to its location: nasofrontal, nasoethmoidal and naso-orbital. In the same time spring in 1854 wrote an excellent monograph on the subject, which was probably the first major work about this condition He made a distinction between a meningocele and cerebral hernia. In our department we have operated them in different techniques with cranial or facial approaches depending on the type of the meningo- encephalocele This is the first largest series published in Africa, in which we present our experience in the operative management of MEA; we share our recommendation in technical consideration for surgical approach with review of the literature
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