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One-Stage Operation for a Frontoethmoidal Encephalomeningocele Associated with Ventriculomegaly-A Case Report

Encephalomeningoceles, especially in the frontoethmoidal region, are a form of neural tube defect which affect patients in Southeast Asia more commonly than those in Western countries. We performed a 1-stage reconstruction and ventriculoperitoneal (V-P) shunt placement for a frontoethmoidal encephalomeningocele in an 18-year-old male. We used the 3D reformation computed tomography (CT) and magnetic resonance imaging (MRI) to delineate the skull defect and the exit pathway of the herniated brain tissue and to determine the surgical strategy. The frontoethmoidal encephalomeningocele was completely resected via a 1-stage operation. Neither hydrocephalus nor cerebrospinal fluid (CSF) rhinorrhea was noted after the operation. However, Klebsiella pneumoniae meningitis was diagnosed 2 weeks after the operation. The infection was cured by the use of meropenem. A good aesthetic result was achieved. A 1-stage operation is necessary for large frontoethmoidal encephalomeningoceles and should be performed as early as possible in order to resect the mass, to reconstruct the defect, and to restore the aesthetic appearance with assistance of 3D reformation CT and MRI. A V-P shunt or extraventricular drainage (EVD) catheter placement needs to be considered during the operation for large encephalomeningoceles coexisting with hydrocephalus.