surgical nuances giant encephalocele
Post on 31-May-2015
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GIANT OCCIPITAL ENCEPHALOCELE
•FTNVD MALE CHILD
•PRESENTED AT 15 DAYS OF AGE
•O/E: Head Circumference: 31cmEncephalocele circumference:
56cm
ANESTHETIST’S CONSIDERATIONS
• Difficult intubation
• Hypothermia (maintenance of temp)
• Fluid/Blood loss
INTRAOPERATIVE POSITIONING
ASPIRATION OF THE ENCEPHALOCELE
SAC DISSECTION
CLOSUREMultilayer closure
Arachnoid
Dura (Double breasting)
Cranioplasty
Two layer muscle closure
CRANIOTOMY FOR ASSOC
CRANIOSYNOSTOSIS
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
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
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