Surgical management of frontoethmoidal encephalocele in a 4-month-old infant: An Ethiopian perspective and case report

Introduction: Encephalocele is a herniation of intracranial contents through a defect in the skull bone. It is a distressing condition that poses significant technical challenge to the managing team, especially in a low-resource setting. In this report we present our experience of managing a case of Frontoethmoidal encephalocele in a 4-month-old infant. Case presentation: A 4-month-old infant was referred to our center with progressively enlarging mass over the dorsum of the nose. A diagnosis of frontoethmoidal encephalocele and hydrocephalus was established and subsequently, a multidisciplinary team was formulated for the management. An autologous calvarial bone graft was utilized to reconstruct the defect and the clinical outcomes were satisfactory given the circumstances. Discussion: Frontoethmoidal encephalocele is infrequently encountered in our experience. It poses a technical challenge for reconstruction. Satisfactory outcomes can be obtained by multidisciplinary team approach. The overall goal of the surgery is the reduction of healthy brain tissue, resection of dysplastic tissue and sac, watertight durable dural closure (either primary or with pericranium flap) and reconstruction of skull defect, using either autologous calvarial bone graft or prosthetic materials (such as titanium mesh, or bone filler). Conclusion: Despite its rarity and the technical challenges it poses, frontoethmoidal encephalocele can be successfully managed by a multidisciplinary team in a low-resource setting, even in the absence of prosthetic materials.