Abstract
A newly-born infant with a congenital dural and bony defect and an associated short-segmented duplication of the superior sagittal sinus suffered from herniation and infarction of parietal brain tissue secondary to vacuum extraction. This ultimately led to the formation of a subgaleal cerebrospinal fluid (CSF) collection. Initial operative closure of the encephalocele was performed by attaching a galeal flap to the periostium surrounding the congenital defect. As the bony defect developed characteristics of a growing fracture later on, dural repair, transplantation of a split-bone flap and, finally, the insertion of a ventriculoperitoneal shunt became necessary. This case affirms that stringent indication and cautious usage of vacuum-assisted delivery is strongly recommended, especially in view of the possibility that undetected congenital cranial, vascular and/or cerebral alterations may be present.
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Neumann and colleagues describe an interesting and well-documented case involving the surgical treatment of a newborn with congenital parietal skull defect associated with fenestration of the superior sagittal sinus and a related complication of instrumental delivery, namely parietal encephalocele after vacuum extraction. Interestingly, the encephalocele developed through the gap between both arms of the superior sagittal sinus. So far this has only been described in a case with a teratoma mimicking a parietal encephalocele [1]. For obstetricians and pediatricians the case is important, because it illustrates that even early MRI in cases with subgaleal hematomas may not be sufficient to understand the underlying pathology properly. From the obstetric standpoint, further improvements of fetal imaging, like three-dimensional ultrasound which would allow offline analysis of volume datasets [2], are desirable to identify fetuses with skull abnormalities and to select them for Caesarean section.
References
1. Baykaner MK, Ergun E, Cemil B, Bayik P, Emmez H (2007) A mature cystic teratoma in pineal region mimicking parietal encephalocele in a newborn. Childs Nerv Syst 23:573–576
2. Chaoui R, Heling KS (2006) Three-dimensional ultrasound in prenatal diagnosis. Curr Opin Obstet Gynecol 18:192-202
Ulrich J. Knappe, Neurosurgeon
Bernhard Erdlenbruch, Pediatrician
Ulrich Cirkel, Gynaecologist and Obstetrician,
Minden, Germany
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Neumann, JO., Herweh, C. & Halatsch, ME. Congenital duplication of the superior sagittal sinus and parietal encephalocele after vacuum extraction delivery. Acta Neurochir 152, 713–716 (2010). https://doi.org/10.1007/s00701-009-0470-7
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DOI: https://doi.org/10.1007/s00701-009-0470-7