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Management of cerebrospinal-fluid-related intracranial abnormalities in frontoethmoidal encephalocele using “Shunt algorithm for frontoethmoidal encephalocele” (SAFE)

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Abstract

A cerebrospinal-fluid-related (CSF-related) problem occurred in 25-30% of frontoethmoidal encephalocele (FEE) cases. Since there was no algorithm or guideline, the judgment to treat the CSF-related problem often relies upon the surgeon's experience. In our institution, the early shunt was preferable to treat the problem, but it added risks to the children. We developed an algorithm, "Shunt Algorithm for Frontoethmoidal Encephalocele" (SAFE), to guide the surgeon in making the most reasonable decision. To evaluate the SAFE's efficacy in reducing unnecessary early shunting for FEE with CSF-related intracranial abnormality. Medical records of FEE patients with CSF-related abnormalities treated from January 2007 to December 2019 were reviewed. The patients were divided into two groups: before the SAFE group as group 1 (2007 – 2011) and after the SAFE group as group 2 (2012 – 2019). We excluded FEE patients without CSF-related abnormalities. We compared the number of shunts and the complications between the two groups. One hundred and twenty-nine patient's medical records were reviewed. The males were predominating (79 versus 50 patients) with an average age of 58.2±7.1 months old (6 to 276 months old). Ventriculomegaly was found in 18 cases, arachnoid cysts in 46 cases, porencephalic cysts in 19 cases, and ventricular malformation in 46 cases. Group 1, with a score of 4 to 7 (19 cases), received an early shunt along with the FEE repair. Complications occurred in 7 patients of this group. Group 2, with a score of 4-7, received shunts only after the complication occurred in 3 cases (pseudomeningocele unresponsive with conservative treatment and re-operation in 2 cases; a sign of intracranial hypertension in 1 case). No complication occurred in this group. Groups 1 and 2, with scores of 8 or higher (6 and 8 cases, respectively), underwent direct shunt, with one complication (exposed shunt) in each group. The SAFE decision algorithm for FEE with CSF-related intracranial abnormalities has proven effective in reducing unnecessary shunting and the rate of shunt complications.

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Authors and Affiliations

  1. Department of Neurosurgery, Universitas Airlangga Faculty of Medicine– Dr. Soetomo General Academic Hospital, Gedung Pusat Diagnostik Terpadu (GDC), Lantai 5, Surabaya, Indonesia

    Muhammad Arifin Parenrengi & Wihasto Suryaningtyas

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  1. Muhammad Arifin Parenrengi
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  2. Wihasto Suryaningtyas
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Contributions

MAP and WS wrote the main manuscript text and prepared all the figures. All authors reviewed the manuscript.

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Correspondence to Muhammad Arifin Parenrengi.

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The authors declare no competing interests.

Ethical approval

The Ethical Committee In Health Research Dr. Soetomo General Hospital Surabaya reviewed and approved the study (Ethical Clearance No. 457/Panke.KKE/VII/2017; date: August 9, 2017). The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Parenrengi, M.A., Suryaningtyas, W. Management of cerebrospinal-fluid-related intracranial abnormalities in frontoethmoidal encephalocele using “Shunt algorithm for frontoethmoidal encephalocele” (SAFE). Neurosurg Rev 47, 110 (2024). https://doi.org/10.1007/s10143-024-02342-y

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