Emergency repair of neonatal frontoethmoidal encephalocele: controlled mobilization of neonatal frontal bone flaps

Abstract

Background

Frontoethmoidal encephalomeningocele (FEEM) is a rare congenital malformation characterized by herniation of intracranial structures through a defect in the anterior skull base. Surgical management in the neonatal period is particularly challenging due to physiological fragility, limited surgical exposure, and the risk of cerebrospinal fluid (CSF) leakage and infection.

Case report

We report a female neonate born at 37 weeks of gestation with a large FEEM involving the anterior horns of the lateral ventricles and frontobasal parenchyma herniating through the anterior skull base. Active CSF leakage developed on the first day of life, necessitating urgent surgical intervention. A bicoronal incision and bifrontal craniotomy with inferior frontal bone mobilization were performed. Taking advantage of the elasticity of neonatal bone, the frontal bone flaps were mobilized without segmentation, allowing adequate exposure of the defect. The postoperative course was uneventful, although progressive hydrocephalus required external ventricular drainage followed by ventriculoperitoneal shunt placement. At follow-up, wound healing was complete and the cosmetic outcome was satisfactory.

Conclusion

This case highlights that controlled mobilization of elastic frontal bone flaps may provide adequate surgical exposure in neonatal patients requiring urgent repair and may reduce the need for additional bone segmentation.

Keywords Frontoethmoidal encephalocele · Skull base surgery · Congenital cranial malformation · Bifrontal approach · Neonatal skull elasticity