Complex Therapy of Frontoethmoidal Meningoencephaloceles in Conditions of a Developing Country-Neurosurgical Aspects

Introduction: Meningoceles and meningoencephaloceles (MEC) are congenital malformations with a high incidence in Southeast Asia. The most frequent frontoethmoidal MEC needs surgical treatment applying craniofacial techniques. To our knowledge this is the first report of operating a series of MEC not in an established craniofacial center, but under tropical conditions, with limited hygiene and limited technical apparative medical support. The operative approach and the results are presented highlighting the neurosurgical aspects.

Material and Methods: Fourteen patients (5 female, 9 male, ages 5-22 years) were operated on within 2 weeks in the ROSE Charities Surgical Rehabilitation Center Kien Khleang, Phnom Penh, Cambodia. Eight patients suffered from combined nasoethmoidal–naso-orbital MEC. Six patients had previous surgery through a nasal incision. Six patients had associated malformations. Only plain x-ray films were available for radiographic imaging; no preoperative blood tests were taken. Furthermore, neither postoperative intensive care nor blood for transfusion was available. This type of operation had not been performed in this hospital before. A modified surgical procedure was employed: frontobasal closure of the cele, the bone defect, and corrective maneuvers of the orbital and nasal skeleton were successfully performed through a bicoronal approach.

Results: Satisfactory to good esthetic results of the frontal, orbital, and nasal areas could be achieved in all patients. No meningitis, no CSF leakage (also not temporary), and no MEC relapse were observed in the follow-up of up to 9 months. One patient developed an inflammatory frontal fistula. Surgical revision revealed granulation tissue around the fixing dura sutures and around the osteosynthesis wires; but no CSF leakage. After revision, the fistula healed uneventfully.

Conclusions: The selected simple combined neurosurgical and craniomaxillofacial operation technique—which had not yet been described—proved to be reliable even under the limited conditions of a Third World hospital. The costs of these operations are by far below the costs of similar surgery in centers abroad, thus enabling the treatment of very poor people in the Third World

This study was supported by Médécins du Monde.