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01-12-2024 | Encephalocele | Research

Management of cerebrospinal-fluid-related intracranial abnormalities in frontoethmoidal encephalocele using “Shunt algorithm for frontoethmoidal encephalocele” (SAFE)

Authors: Muhammad Arifin Parenrengi, Wihasto Suryaningtyas

Published in: Neurosurgical Review | Issue 1/2024

Abstract

A cerebrospinal-fluid-related (CSF-related) problem occurred in 25-30% of frontoethmoidal encephalocele (FEE) cases. Since there was no algorithm or guideline, the judgment to treat the CSF-related problem often relies upon the surgeon's experience. In our institution, the early shunt was preferable to treat the problem, but it added risks to the children. We developed an algorithm, "Shunt Algorithm for Frontoethmoidal Encephalocele" (SAFE), to guide the surgeon in making the most reasonable decision. To evaluate the SAFE's efficacy in reducing unnecessary early shunting for FEE with CSF-related intracranial abnormality. Medical records of FEE patients with CSF-related abnormalities treated from January 2007 to December 2019 were reviewed. The patients were divided into two groups: before the SAFE group as group 1 (2007 – 2011) and after the SAFE group as group 2 (2012 – 2019). We excluded FEE patients without CSF-related abnormalities. We compared the number of shunts and the complications between the two groups. One hundred and twenty-nine patient's medical records were reviewed. The males were predominating (79 versus 50 patients) with an average age of 58.2±7.1 months old (6 to 276 months old). Ventriculomegaly was found in 18 cases, arachnoid cysts in 46 cases, porencephalic cysts in 19 cases, and ventricular malformation in 46 cases. Group 1, with a score of 4 to 7 (19 cases), received an early shunt along with the FEE repair. Complications occurred in 7 patients of this group. Group 2, with a score of 4-7, received shunts only after the complication occurred in 3 cases (pseudomeningocele unresponsive with conservative treatment and re-operation in 2 cases; a sign of intracranial hypertension in 1 case). No complication occurred in this group. Groups 1 and 2, with scores of 8 or higher (6 and 8 cases, respectively), underwent direct shunt, with one complication (exposed shunt) in each group. The SAFE decision algorithm for FEE with CSF-related intracranial abnormalities has proven effective in reducing unnecessary shunting and the rate of shunt complications.

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Title: Management of cerebrospinal-fluid-related intracranial abnormalities in frontoethmoidal encephalocele using “Shunt algorithm for frontoethmoidal encephalocele” (SAFE)
Authors: Muhammad Arifin Parenrengi
Wihasto Suryaningtyas
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keyword: Encephalocele
Published in: Neurosurgical Review / Issue 1/2024
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-024-02342-y

2024 ASCO Annual Meeting

Springer Medicine

Management of cerebrospinal-fluid-related intracranial abnormalities in frontoethmoidal encephalocele using “Shunt algorithm for frontoethmoidal encephalocele” (SAFE)

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

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