Cranial fissure and occipital meningoencephalocele repair

The occipital cranial fissure is also a congenital skull defect, which is the result of occipital dysplasia at the anterior end of the neural tube during embryonic period, incomplete closure or complete separation from the ectoderm. The occipital cleft lip is a good site for congenital defects of the skull at the top of the skull. Most meningocele or meningococcal bulging, and some cases of cystic bulging. The occipital meningeal bulge is mostly a round or elliptical cystic mass with full (or partial) coverage of the skin. Occasionally, the epithelium is absent and the brain tissue is exposed. The bulging sac is generally larger and its base is pedicled or wider. The masses have varying degrees of tension, and the tension increases significantly when crying or uneasy. Individuals can still see pulsations, indicating that they have a wider connection with the cranial cavity. When the bulging part is pressed, the intracranial pressure may increase, causing discomfort and even epilepsy. If some of the occipital lobe and cerebellum bulge, the corresponding cortical visual impairment and cerebellar signs may occur. Treatment of diseases: skull defects Indication 1. The occipital bulge is larger, which affects the sleeping and head movement of the sick child. 2. The bulging capsule develops rapidly and the volume increases continuously. The operation time is best to be performed 6 to 12 months after birth, but the wall of the capsule is meager and there is a possibility of perforation. Surgical treatment should be performed as soon as possible. Some people advocate that it should be implemented within one week after birth. Contraindications 1. Local skin ulcers, cystic rupture, secondary infection, or suppurative meningitis. 2. Giant brain membrane bulging, there is a large brain parenchyma, causing severe symptoms such as hemiplegia. 3. Patients with severe hydrocephalus (can be treated with hydrocephalus first, then repaired). Preoperative preparation 1. Take the X-ray film of the skull bone pillow to understand the location and size of the bone defect. 2. CT or MRI examination to understand the ventricular system, the tissue contained in the capsule, and the presence or absence of ventricular bulging. Surgical procedure Incision Make a transverse fusiform incision at the base of the sac, paying attention to retain enough skin to prevent the skin from being too tight after bulging. If the bulge in the capsule is complicated, there are cerebrospinal fluid circulation disorders, or other malformations of the posterior cranial fossa, such as Chiari malformation, flat skull base, and posterior cranial fossa and upper arachnoid adhesion, need to be a posterior cranial fossa probe. A straight incision should be used, up to the upper edge of the occipital trochanter, down to the plane of the fourth cervical vertebra. 2. Separating the neck The aponeurotic aponeurosis is cut along the skin incision until the dura mater of the skull periosteum or bulging sac, the bone defect is exposed, and then the neck is separated to dissociate from the edge of the bone defect. 11.3 3. Treatment of intracapsular tissue The wall of the capsule was cut at the top of the capsule to examine the nature of the bulge and its relationship to the wall of the capsule. If only a small amount of brain tissue bulges, and the appearance is relatively normal, it is separated from the wall of the capsule and is also contained in the skull. If the bone hole is too small or the volume of the cranial cavity is limited, it can not be repaid; or the bulging brain tissue has been denatured and the appearance is abnormal. The brain tissue should be removed from the pedicle, and the blood should be properly stopped by bipolar electrocoagulation. 4. Repair the dura mater The excess cyst wall should be removed from the neck of the capsule. The dura mater should be kept in sufficient amount to make the remaining dura mater overlap and strengthen the suture. The suture must be tight to prevent the cerebrospinal fluid from flowing out. If the dura mater is too thin, a periosteum may be taken for reinforcement. The skull defect does not need to be repaired, and the surrounding soft tissue can be used to reinforce the suture and close the bone hole. If there are other deformities in the posterior cranial fossa, expand the bone hole, explore the posterior cranial fossa, and treat according to different types of deformities. 5. Close the incision The cap-like aponeurosis and skin are tightly sewed. complication Intracranial hematoma The main reason is that when the bulged brain tissue is cut off, the hemostasis is not complete, and once it is found, it should be removed in time. 2. Hydrocephalus Postoperative hydrocephalus is more common, occipital meningocele is mostly cystic, cerebrospinal fluid accumulation is more, may occur in the circulation of disorders, postoperative compensatory ventricular enlargement often occurs, the formation of hydrocephalus. In addition, there is hydrocephalus before surgery, and it has not been resolved during the operation. Postoperative hydrocephalus still exists. It can be used for anterior fistula puncture, and the cerebrospinal fluid can be withdrawn. It may be relieved after repeated several times. If it can not be resolved or there is obvious obstructive hydrocephalus, it should be treated according to hydrocephalus treatment. 3. Cerebrospinal fluid leakage If the dural suture is not strict, the cerebrospinal fluid leakage occurs after the incision, and it is not healed by conservative treatment. It is advisable to perform a second operation early, close suture of the mouth, or strengthen the repair suture.