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MENINGOENCEPHALOCELE

Meningoencephalocele is a type of neural tube defect that occurs due to the incomplete closure of the neural tube during the third and fourth week of embryonic development. This leads to the herniation of brain tissue and meninges through a skull defect. It’s a serious congenital condition with varying clinical outcomes depending on the location and size of the herniation. Meningoencephalocele are primarily classified by their location. The most common type is the occipital encephalocele, where herniation occurs at the back of the skull, accounting for 75 to 80 percent of cases. In contrast, frontoethmoidal encephaloceles involve herniation through the frontal or ethmoidal bones, often impacting the nasal or orbital region. Less common types include parietal and basal encephaloceles, the latter of which can be difficult to detect externally. In terms of content, we distinguish between meningoceles, which involve only meninges, and meningoencephaloceles, which also include brain tissue. The most severe form, called a meningohydroencephalocele, additionally contains part of the ventricular system. Clinical presentation varies depending on the severity and location of the defect. Typical signs include a visible sac-like protrusion, neurological impairments like seizures or developmental delays, and in some cases, hydrocephalus, or excess fluid accumulation in the brain. Visual and craniofacial abnormalities are common in frontoethmoidal cases. Diagnosis typically begins with prenatal ultrasound and is followed by postnatal imaging like MRI to assess the full extent of the brain and meninges involved. CT scans are also used to evaluate the bony defect in the skull. The primary treatment for meningoencephalocele is surgical repair, which is ideally performed in the neonatal period to prevent complications. The surgery involves reducing the herniated brain tissue, closing the skull defect, and managing any associated hydrocephalus with a ventriculoperitoneal shunt. A multidisciplinary team, including neurosurgeons, plastic surgeons, and pediatric specialists, is critical to ensure comprehensive care. Postoperative management focuses on preventing infections, monitoring for increased intracranial pressure, and supporting developmental outcomes through rehabilitation. Prognosis largely depends on the extent of brain involvement and the presence of associated conditions like hydrocephalus. Occipital encephaloceles tend to have better outcomes, whereas basal and frontal cases may present more complex challenges. Preventive measures include folic acid supplementation during pregnancy, which significantly reduces the risk of neural tube defects. In summary, meningoencephalocele is a challenging congenital condition requiring early diagnosis and a coordinated approach to treatment. With timely intervention and appropriate care, outcomes can improve, although long-term complications such as seizures or developmental delays remain a concern in many cases.”