Surgical Technique

Outpatient nasendoscopy and a high-resolution coronal CT scan can help define the site and size of any bony defect. MRI is of particular benefit in defining the contents of the sac and the vascularity of its contents.

The surgical technique is similar to that described previously for the treatment of CSF rhinorrhea. The neck of the encephalocele is identified and any overlying mucosa is removed, although the sac has usually become so distended that the mucosa is not distinguishable from the dura. If the size of the sac limits access to define its neck, the sac can be incised and thereby deflated. It is then possible to resect the sac up to the site of the defect. The encephalocele is then excised and the edges of the bony defect are freshened.

The encephalocele should be excised as the neural tissue within it is redundant, and by reducing it in-tracranially the possibility of a septic focus is introduced (Marshall et al., 2001 b). The remaining dural defect is then repaired exactly as described in repairing a CSF leak (Fig. 15.27 a-c).

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