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    Encephalocele is the consequence of an incomplete closure of the cranial cavity. The prognosis depends on the topography and volume of the lesio

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    Encephalocele is the consequence of an incomplete closure of the cranial cavity. The prognosis depends on the topography and volume of the lesio

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    © All Rights Reserved
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    27 views3 pages

    Encephalocele Prenatal Diagnosis About A Case

    Uploaded by

    International Journal of Innovative Science and Research Technology
    Encephalocele is the consequence of an incomplete closure of the cranial cavity. The prognosis depends on the topography and volume of the lesio

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    © All Rights Reserved
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    Volume 6, Issue 4, April – 2021 International Journal of Innovative Science and Research Technology

    ISSN No:-2456-2165

    Encephalocele Prenatal Diagnosis: About a Case


    Meimouna Mohamed Lemine, Ezza Lemrabot, Karam Mouhammed Saoud,
    Nessrine Mamouni, Senae Errarhay ; Chahrazad Bouchikhi ; Abdelaziz Banani

    Department of Obstetric and Gynecology I .Uhc Hassan II of Fes, Marocco


    Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fes.
    Corresponding Author : Meimouna Mohamed Lemine

    Abstract:- Encephalocele is the consequence of an Case 1:


    incomplete closure of the cranial cavity. The prognosis Patient aged 45 years, large multiparous, without
    depends on the topography and volume of the lesion. The notable pathological history, admitted in labor on a
    antenatal diagnosis is made during the first trimester pregnancy estimated at 38SA + 5 days, the pregnancy was
    ultrasound in 80% of cases. We report two cases of followed at the health center, without notion of
    encephalocele diagnosed antenatally by ultrasound in morphological ultrasound. An ultrasound scan was
    our department and managed immediately at birth by performed, showing a severe hydrocephalus (figure 1), with
    pediatric surgeons and neonatologists. a bi-parietal diameter of 118mm, with a brain parenchyma
    of 9mm, associated with a parietal encephalocele (figure 2),
    I. INTRODUCTION hence the indication for a caesarean delivery. Extraction of a
    male neonate, Abgard 10/10, birth weight 3300g, with
    Encephalocele is defined as the exteriorization of brain presence of a macrocrania and an intact parietal
    tissue and/or meninges outside the skull cavity through a encephalocele of 14cm (figure 3), neonate with good
    congenital bony defect. The detection rate of cephaloceles in adaptation to the extrauterine life, neurological examination
    the first trimester has been estimated at 80% and it does not reveal any other abnormality, entrusted to the
    constitutes 5% of all severe structural abnormalities of the pediatric surgeon for an eventual cure of encephalocele.
    central nervous system (CNS)[1].

    Figure 1, 2 : ultrasound images of a mass in the parietal bone, heterogeneous and predominantly anechogenic, evoking an
    encephalocele, and a severe hydrocephalus

    Figure 3 : aspect of the parietal encephalocele after delivery

    IJISRT21APR435 www.ijisrt.com 869


    Volume 6, Issue 4, April – 2021 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165
    Case 2: occipital encephalocele (figure 4) making 3cm, without
    Patient aged 27 years, with no notable pathological other associated signs, notably no hydrocephalus or other
    history; second action; without notion of consanguinity, neural tube closure anomalies, vaginal delivery was
    current pregnancy not followed (contracted in the period of accepted, expulsion of a male newborn; the clinical
    pandemic Covid 19), admitted in active phase of labor on a examination confirmed the presence of an occipital
    pregnancy which is said to be at term, an obstetrical encephalocele (figure 5) with a scalloped sac; with a normal
    ultrasound was made before entering the delivery room and neurological examination and good adaptation to extra
    which objectified an evolutive mono-fetal pregnancy with uterine life. He was subsequently referred to the pediatric
    presence of an anechne occipital mass in favor of an surgery department for management.

    4 5
    Figure 4 : a heterogeneous occipital mass, with an anechogenic component, suggesting an occipital encephalocele.
    Figure 5 : aspect of the occipital encephalocele after delivery.

    II. DISCUSSION encephaloceles, with diagnosis usually made in the second


    trimester. [5]
    Encephalocele affects 0.8 to 5 in 10,000 live births, [2]
    with marked geographic and ethnic variations. While the Although the onset of cephaloceles apparently occurs
    prevalence of neural tube defects has decreased significantly between 25 and 50 days of gestation (for lesions located
    since the folic acid fortification that was recommended in anteriorly) and up to 60 days (for posterior defects), but the
    the early 1990s, this question has been controversial with median GA of diagnosis is approximately 18 weeks of
    respect to the development of cephaloceles [3, 4]. gestation according to the literature [8].

    For both patients folic acid supplementation was not for our two patients the diagnosis was late because
    taken nor were other supplements taken during their they were not followed up; their pregnancies occurred at the
    pregnancy. same time as the pandemic period of COVID 19

    with prognosis dependent on the amount of herniated The etiology of cranial hernias is not fully understood,
    brain tissue and other associated malformations. [5] More but includes ethnic, genetic, and environmental factors. It is
    than 75% of encephalocele cases are occipital in location, simply a failure of separation of the neural ectoderm from
    while others may be frontal or parietal. [7] Prenatal the surface ectoderm after closure of the rostral neuropore
    diagnosis is usually made by ultrasound (US). during the four weeks of gestation. [9].

    Schoner K, et all reported on a study done on neural Weichert J and all [10] have reported, 80% of defects
    tube defects; they found 17.7% of meningo-encephaloceles are occipital versus 6% parietal. It is interesting to note that
    represent. [6] for our reported cases one is occipital of small the latter are discussed as not constituting a genuine form of
    size and was not associated with other malformation; and in neural tube defect, but rather an origin of the defect
    the other case the encephalocele is of parietal localization stemming rather from environmental influences (e.g.,
    which is a rare form of the encephalocele, and is associated reduced folic acid consumption) ; and It has recently been
    with severe hydrocephalus and in any case the diagnosis is established that maternal passive smoking is an independent
    made by ultrasound. risk factor for three subtypes of NTDs (anencephaly, spina
    bifida and more strongly encephalocele) [11, 12].
    Prenatal ultrasound to assess fetal morphology is
    usually performed early in pregnancy, between 11 and 14 In terms of management, a neurosurgical opinion is
    weeks' gestation, and can detect a wide range of congenital warranted. In a previous study published by Kiymaz et al,
    anomalies, including neural tube defects. [7] Two- [13] factors such as lesion size, amount of neural tissue
    dimensional ultrasound can detect approximately 80% of contained, ventriculomegaly, and other accompanying
    abnormalities negatively affected the prognosis of these

    IJISRT21APR435 www.ijisrt.com 870


    Volume 6, Issue 4, April – 2021 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165
    patients. The amount of neural tissue involved is associated [11]. Wang M, Wang ZP, Zhang M, Zhao ZT (2014)
    with the severity of subsequent neurodevelopmental delays. Maternal passive smoking during pregnancy and
    It has also been reported that only about 17% of patients neural tube defects in offspring: a meta-analysis. Arch
    with encephaloceles had normal development, whereas 83% Gynecol Obstet 289:513–521
    of patients had severe psychomotor developmental [12]. Suarez L, Ramadhani T, Felkner M, Canfield M,
    delays[14] Although the treatment is surgical correction, Hendricks K (2011) Maternal smoking, passive
    encephalocele remains a disorder with very high morbidity tobacco smoke, and neural tube defects. Birth Defects
    and mortality rates despite appropriate treatment. Res A Clin Mol Teratol 91:29–33
    [13]. Kiymaz N, Yilmaz N, Demir I, Keskin S. Prognostic
    III. CONCLUSION factors in patients with occipital encephalocele. Pediatr
    Neurosurg 2010; 46:6–11
    Encephalocele can appear isolated or as part of a [14]. French BN. Midline fusion defects and defects of
    polymalformative pattern. The antenatal diagnosis is mainly formation. In: Youmans JR (ed). Neurological
    based on ultrasound. Advice to parents must be tailored Surgery. Philadelphia, PA: WB Saunders Co;
    individually and on a case-by-case basis; in a 1990:1164–1169.
    multidisciplinary approach with neuropediatricians,
    geneticists and neurosurgeons.

    REFERENCES

    [1]. Cameron M, Moran P (2009) Prenatal screening and


    diagnosis of neural tube defects. Prenat Diagn 29:402–
    411
    [2]. Siffel C, Wong LY, Olney RS, Correa A. Survival of
    infants diagnosed with encephalocele in Atlanta,
    1979–98. Paediatr Perinat Epidemiol 2003; 17:40–48
    [3]. Rowland CA, Correa A, Cragan JD, Alverson CJ
    (2006) Are encephaloceles neural tube defects?
    Pediatrics 118:916–923
    [4]. Thompson DN (2009) Postnatal management and
    outcome for neural tube defects including spina bifida
    and encephalocoeles. Prenat Diagn 29:412–419
    [5]. Liao S, Tsai PY, Chen YC, Chang CH, Ko HC, Chang
    FM. Prenatal diagnosis of fetal encephalocele using
    three-dimensional ultrasound. J Med Ultrasound 2012;
    20:150–154
    [6]. Schoner K, Axt-Fliedner R, Bald R, Fritz B, Kohlhase
    J, Kohl T, Rehder H. Fetal Pathology of Neural Tube
    Defects - An Overview of 68 Cases. Geburtshilfe
    Frauenheilkd. 2017 May;77(5):495-507. doi:
    10.1055/s-0043-103459. Epub 2017 May 24. PMID:
    28579621; PMCID: PMC5444532.
    [7]. Fong KW, Toi A, Salem S, et al. Detection of fetal
    structural abnormalities with US during early
    pregnancy. Radiographics 2004; 24:157–174
    [8]. Bannister CM, Russell SA, Rimmer S, Thorne JA,
    Hellings S (2000) Can prognostic indicators be
    identified in a fetus with an encephalocele? Eur J
    Pediatr Surg 10(Suppl 1):20–23
    [9]. ten Donkelaar HJ, Bekker M, Renier WO, Hori A,
    Shiota K (2014) Neurulation and neural tube defects.
    In: ten Donkelaar HJ (ed) Clinical neuroembryology,
    2nd edn. Springer, Heidelberg, pp 165–217
    [10]. Weichert J, Hoellen F, Krapp M, Germer U, Axt-
    Fliedner R, Kempe A, Geipel A, Berg C, Gembruch U.
    Fetal cephaloceles: prenatal diagnosis and course of
    pregnancy in 65 consecutive cases. Arch Gynecol
    Obstet. 2017 Sep;296(3):455-463. doi:
    10.1007/s00404-017-4424-7. Epub 2017 Jun 20.
    PMID: 28634753.

    IJISRT21APR435 www.ijisrt.com 871

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