Surgical nuances in operating open a giant occipital encephalocele

1. GIANT OCCIPITAL ENCEPHALOCELE
•FTNVD MALE CHILD
•PRESENTED AT 15 DAYS OF AGE
•O/E: Head Circumference: 31cm
Encephalocele circumference: 56cm

3. ANESTHETIST’S
CONSIDERATIONS
•Difficult intubation
•Hypothermia (maintenance of temp)
•Fluid/Blood loss

5. INTRAOPERATIVE
POSITIONING

8. ASPIRATION OF THE
ENCEPHALOCELE

10. SAC DISSECTION

15. CLOSURE
Multilayer closure
Arachnoid
Dura (Double breasting)
Cranioplasty
Two layer muscle closure

18. CRANIOTOMY FOR
ASSOC
CRANIOSYNOSTOSIS

20. POSTOPERATIVE COURSE
•Pt shifted to ICU intubated, in incubater
•Had severe hypothermia(29
.
C)-Warmed
•Cyanosed-no peripheral pulse & low BP
•Extubated 12 hours later
•Further recovery uneventful

21. GIANT ENCEPHALOCELE
COMPLICATIONS
Postoperative hydrocephalus requiring shunt 4
Postoperative meningitis 4
POST OPERATIVE MORTALITY:
•Fulminant meningitis 2
•Postoperative brain abscess 1
•Post operative hypothermia 1