encephalocele
Introduction
Introduction to brain swelling Brain bulging is a congenital skull defect in which part of the central nervous system is excised out of the skull. If the intracranial sputum only includes cerebrospinal fluid and meninges, it is called meningocele. If the contents are brain tissue and meninges, it is called meningeal bulging. If the sputum has brain tissue, meninges and ventricles, it is called Brain swelling of the meninges for hydrocephalus. basic knowledge The proportion of sickness: 0.00001% Susceptible people: no special people Mode of infection: non-infectious Complications: hydrocephalus, epilepsy
Cause
Brain swelling cause
Causes:
Most cases of brain swelling are sporadic, and only a few patients have a family history. The remaining factors such as nutrition, folic acid deficiency, and elevated maternal temperature are still unclear. The reason is that the incidence of this disease is low and it is not easy to obtain appropriate Epidemiological data.
Pathogenesis:
Embryology proves that when the human embryo develops in the uterus to the 4th to 6th week, the primitive neural tube is closed at the midline. If the original neural tube is incomplete, the brain will bulge, and the cranial nerve can not be closed. In addition to affecting the skull and meninges. In addition to defects, often accompanied by cerebral dysplasia, such as hydrocephalus, cerebellar malformation, corpus callosum dysplasia, etc., because most brain bulging contains mature neural tissue, such as the cerebral cortex or cerebellum, both in the nerve After the tube is closed, it is speculated that brain swelling occurs in connection with abnormal development of the surface mesenchymal tissue. The latter causes skull defects, which usually occur in the embryo for 8 to 12 weeks, without congenital defects of the scalp or skull. It may happen at a later time.
Prevention
Brain swelling prevention
With the routine application of fetal ultrasound and alpha-fetoprotein detection in maternal blood, brain bulging can be diagnosed in the uterus, which is important for determining whether to terminate the pregnancy. Fetal ultrasound can reveal large brain bulging. It is also easy to detect the presence or absence of substantial tissue in the sac. Hydrocephalus is not often found in prenatal ultrasound. In fact, hydrocephalus is rarely present at birth, usually after repair of the posterior cranial brain. In the ultrasound examination, attention is paid to the identification of brain swelling in the skull, scalp or high neck segment. These lesions are less common than brain swelling. The necessary conditions for producing abnormal alpha-fetoprotein are tissue fluid and cerebrospinal fluid. Leakage occurs. If the lesion is completely epithelialized, even if the skin is poorly developed, the alpha-fetoprotein levels in maternal blood and amniotic fluid are normal.
Complication
Brain swelling complications Complications hydrocephalus epilepsy
If surgery is performed, the following complications may occur
1. Local effusion: If the cerebrospinal fluid is dysfunctional, the fluid will accumulate at the repair site, affecting the healing of the incision, which can be controlled by intermittent pumping and pressure dressing.
2. Hydrocephalus: The performance of the child's head circumference is enlarged, the front sputum is full, and the transcranial ultrasound examination shows that the ventricle is progressively enlarged. At this time, the ventricle peritoneal shunt can be placed for treatment. If infection occurs in the cerebrospinal fluid pathway, it must be given first. The child was placed outside the brain for drainage, and the wound was healed. After the infection was cured, the hydrocephalus was performed again. Although the incidence of hydrocephalus in the meningeal brain was much higher than that of the meninges, the treatment of hydrocephalus The method is the same.
3. Epilepsy: The relationship between the occurrence of epilepsy and central nervous system hypoplasia is greater than the relationship between brain swelling and repair.
Symptom
Symptoms of brain swelling Common symptoms Repeated infections, convulsions, reflexes, increased intracranial pressure, abnormal hair, meningitis, eyeball, olfactory loss
Local symptoms
Generally, they are mostly round or elliptical cystic bulging masses. For example, they are mostly flat-shaped masses at the base of the nose. The sizes are different. The larger ones are similar to the heads. The smaller ones can be several centimeters in diameter, and some are born after birth. Larger, some gradually grow up, covering the soft tissue, the degree of thickness is very different, individual can be thin and transparent even to break the cerebrospinal fluid and cause repeated infection, leading to purulent meningitis, thick soft tissue is full, soft touch The elastic feeling, some surfaces seem to be scar-like and hard, the base part can be thin pedicle or broad base, and some can touch the edge of the bone defect, the cystic mass is generally soft and elastic, touch pressure There may be fluctuations and increased intracranial pressure. When the child is crying, the mass increases and the tension increases. The light transmission test is positive, and the bulging brain tissue shadow may be seen when the meningeal brain bulges.
2. Nervous system symptoms
Lighter patients have no obvious neurological symptoms. The severe ones are related to the location of the lesions and the extent of the damage. They may show mental retardation, convulsions and varying degrees of convulsions, hyperreflexia, and non-constant pathological reflexes, such as when occurring at the base of the nose. Loss of one or both sides of the olfactory, such as bulging into the sputum, may have II, III, IV, VI cranial nerves and the first involvement of the V-brain nerve, such as meningococcal bulging in the occipital region, There are cortical visual disorders and manifestations of cerebellar damage.
3. Pressure performance of adjacent organs
Bulging in the base of the nose, often cause facial deformity, widened nose, increased eye distance, small cavity, sometimes the eye is triangular, the eyeball is squeezed to the outside, can involve the lacrimal gland to cause lacrimal sac, can protrude into the nasal cavity When breathing or lying on the side, the breathing is smooth. When the bulge protrudes into the sac, it can cause the eyeball to protrude and shift. The sacral cavity is enlarged, and the bulging occurs in different parts. There may be different changes in the shape of the head, such as huge swelling of the occiput. Out, due to the long-term lateral position, the anteroposterior diameter of the head is obviously increased to form a scaphoid head, and sometimes there may be local hair abnormalities.
Examine
Examination of brain swelling
1. CT can not only display the shape of the skull defect, but also show whether the bulged soft tissue contains cerebrospinal fluid or brain tissue. For example, if the brain membrane bulge is combined, the same density of the brain can be seen, and the size, displacement and deformation of the ventricle can be seen. Etc., for the anterior cranial bulge of the skull, CT examination, especially the application of three-dimensional reconstruction technology, is helpful for deciding whether or not to require craniofacial reconstruction and selection of reconstruction methods. For skull base bulging, coronary CT scan shows more it is good.
2. Magnetic resonance imaging (MRI) can be seen in the skull defect and the bulging cerebrospinal fluid, brain tissue, cerebrovascular and dural tissue signal mass, the resolution of the skull defect is not as clear as CT, but the content of the bulging The rate is higher.
3. If you need to understand the blood supply, you can choose magnetic resonance angiography.
4. The size and extent of the hole can be found in the flat slice of the skull.
5. After repairing the posterior cerebral bulge of the skull, craniocerebral ultrasound is an effective means of tracking the size of the ventricle and the formation of hydrocephalus. Once hydrocephalus is formed, cerebrospinal fluid shunt surgery is required.
Diagnosis
Diagnosis of brain swelling
diagnosis
According to the medical history and clinical manifestations, the location, nature, appearance, and light transmission test of the tumor are positive, and it is not difficult to make a correct diagnosis.
Differential diagnosis
The occipital brain bulge is mainly differentiated from the benign mass of the scalp and the cranial sinus. The benign scalp is usually not in the midline. The mass does not change when crying. The X-ray or CT shows the tumor outside the skull. There is no defect in the skull. Sinus or hemangioma and intracranial venous sinus traffic, with the change of head position, the size of the mass changes obviously, the puncture can draw blood, and the injection of contrast agent may develop the intracranial venous sinus.
Brain skull meningocele should be differentiated from nasal polyps and nasopharyngeal tumors, especially in children before nasopharyngeal biopsy, the possibility of meningeal bulging should be considered to avoid cerebrospinal fluid leakage and craniotomy. Internal infection.
