Primary Closure and Local Flap Reconstruction in a Neonate with Giant Meningoencephalocele: A Case Report and Technical Considerations
- Plastic Reconstructive and Aesthetic Surgery Resident, Plastic Surgery Subdivision, Department of Surgery, Medical Faculty of Universitas Syiah Kuala / Zainoel Abidin General Hospital
- Neuro Surgery Subdivision, Department of Surgery, Medical Faculty of Universitas Syiah Kuala / Zainoel Abidin General Hospital
- Plastic Reconstructive and Aesthetic Surgeon, Plastic Surgery Subdivision, Department of Surgery, Medical Faculty of Universitas Syiah Kuala / Zainoel Abidin General Hospital
Abstract
Background: Meningoencephalocele is a rare congenital neural tube defect with herniation of meninges and brain tissue through a skull defect. Large occipital meningoencephaloceles in neonates pose surgical challenges due to fragile tissues, limited physiological reserve, and high risk of CSF leakage and infection. While neurosurgical principles are established, optimal soft-tissue reconstruction in neonates is underreported. Objective: This case report describes a multidisciplinary surgical approach and reconstructive strategy for a neonatal occipital meningoencephalocele, emphasizing plastic and reconstructive considerations supporting neurosurgical objectives.
Method: An 11-day-old female neonate presented with a large midline occipital mass noted since birth. Examination revealed a soft, fluctuant, skin-covered lesion without neurological deficit or infection. Imaging showed an occipital skull defect with herniation of meninges and brain tissue, consistent with occipital meningoencephalocele. After evaluation, staged surgical management was performed. Neurosurgical excision of non-functional herniated tissue and watertight dural closure was followed by scalp reconstruction using a local occipital flap for tension-free coverage.
Result: The patient underwent staged neurosurgical excision and watertight dural repair followed by tension-free scalp reconstruction using a local occipital rotation flap. The post-excisional soft-tissue defect measured approximately 8 × 6 cm. Total operative time was about 180 minutes. No intraoperative complications occurred. Postoperatively, the neonate showed stable wound healing without CSF leakage, wound dehiscence, infection, or neurological deterioration during early follow-up.
Conclusion: A staged, multidisciplinary approach combining precise neurosurgical repair with local flap reconstruction can achieve safe closure, protect neural structures, and provide durable functional and aesthetic outcomes in neonatal occipital meningoencephalocele.
Keywords: Meningoencephalocele, Neonate, Occipital Defect, Scalp Reconstruction, Plastic And Reconstructive Surgery, Multidisciplinary Approach
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- Madaree A, Morris WMM. A Clinicopathological Classification Of Encephalocoeles Based On 207 Patients. JPRAS open. 2023 Jun;36:8–18.PubMedGoogle Scholar
- Padmanabhan R. Etiology, pathogenesis and prevention of neural tube defects. Congenital anomalies. 2006 Jun;46(2):55–67.PubMedGoogle Scholar
- Perrotta M, Gasparroni G, Chiavaroli V, Massimi L, Cognigni R, Sabatini L, et al. A case report of confusing meningoencephalocele. Clinical case reports. 2021 Jan;9(1):109–12.PubMedGoogle Scholar
- Thompson HM, Schlosser RJ, McCarty Walsh E, Cho DY, Grayson JW, Karnezis TT, et al. Current management of congenital anterior cranial base encephaloceles. International journal of pediatric otorhinolaryngology. 2020 Apr;131:109868.PubMedGoogle Scholar
- Hallak B, Kurzbuch AR, Fournier JY, Bouayed S. Spontaneous transethmoidal meningoencephalocele presenting in the form of recurrent unilateral nasal discharge: discussion of the diagnosis and endoscopic surgical management. BMJ Case Reports CP. 2020;13(5).PubMedGoogle Scholar
- Kushida-contreras BH, Gaxiola-garcía MA, Gaxiola-garcía MA. Myelomeningocele defect reconstruction with keystone flaps : vascular rationale for the design and operative technique. 2022;PubMedGoogle Scholar
- Fluss R, Lally A, Kim J, Kobets AJ. Multispecialty view on the management of basal transethmoidal encephaloceles and meningoceles in the neonate. Interdisciplinary Neurosurgery. 2025;40:102006.PubMedGoogle Scholar
- Ramasastry SS, Cohen M. Soft tissue closure and plastic surgical aspects of large open myelomeningoceles. Operative Techniques in Plastic and Reconstructive Surgery. 2000;7(2):68–76.PubMedGoogle Scholar
- AlEnezi AY, Aljawad M, Baltoyour AW, Alotaibi SA, Alzahri MS. Frontal Meningoencephalocele With Cerebrospinal Fluid Rhinorrhea: A Case Report. Cureus. 2023;15(10):e46343.PubMedGoogle Scholar
- Visscher MO, Carr AN, Winget J, Huggins T, Bascom CC, Isfort R, et al. Biomarkers of neonatal skin barrier adaptation reveal substantial differences compared to adult skin. Pediatric Research. 2021;89(5):1208–15.PubMedGoogle Scholar
- Ciprandi G, Crucianelli S, Grussu F, Spuntarelli G, Faustino S, Marino M, et al. Meeting the Challenges in Pediatric Wound Care : Our 15-Year Experience with Dialkylcarbamoyl Chloride-Coated Dressing Technology in Acute and Chronic Wounds. (November 2022):23–33.PubMedGoogle Scholar
- Mathew-Steiner SS, Roy S, Sen CK. Collagen in Wound Healing. Bioengineering (Basel, Switzerland). 2021 May;8(5).PubMedGoogle Scholar
- Yates CC, Hebda P, Wells A. Skin wound healing and scarring: fetal wounds and regenerative restitution. Birth defects research Part C, Embryo today : reviews. 2012 Dec;96(4):325–33.PubMedGoogle Scholar
- Fideler F. Anaesthesia for premature infants and newborns – what ’ s important ? Anästh Intensivmed. 2022;(63):199–216.PubMedGoogle Scholar
- Waldron S, Mackinnon R. Neonatal thermoregulation. T H E R M O R E G U L A T I O N. 2007;3(3):25–7.PubMedGoogle Scholar
- Henry BM, Borasino S, Ortmann L, Figueroa M, Rahman AKMF, Hock KristalM, et al. Perioperative serum albumin and its influence on clinical outcomes in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass : A multi-centre retrospective study Please let us know how this document benefits you . Cardiology in the Young. 2019;29(6):761–7.PubMedGoogle Scholar
- Yuki K, Matsunami E, Tazawa K, Wang W, DiNardo JA, Koutsogiannaki S. Pediatric Perioperative Stress Responses and Anesthesia. Translational perioperative and pain medicine. 2017;2(1):1–12.PubMedGoogle Scholar
- Gong F, Wan B, Qi P, Wei Z. Biomechanical mechanism and clinical management progress of surgical wound tension. Frontiers in surgery. 2025;12:1674382.PubMedGoogle Scholar
- Barber SM, Fridley JS, Konakondla S, Nakhla J, Oyelese AA, Telfeian AE, et al. Cerebrospinal fluid leaks after spine tumor resection: avoidance, recognition and management. Annals of translational medicine. 2019 May;7(10):217.PubMedGoogle Scholar
- Putri NM, Tunjung Narottama, Sadikin. Closure of meningomyelocele defects using various types of keystone-design perforator island flaps. Archives of Plastic Surgery. 2021;48(3):261--268.PubMedGoogle Scholar
- Shim JH, Hwang NH, Yoon ES, Dhong ES, Kim DW, Kim SD. Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair. Archives of plastic surgery. 2016 Jan;43(1):26–31.PubMedGoogle Scholar
- Hantash SA, El-ghazaly MH, Mahmoud WH, Khedr MM. Keystone Flap for Coverage of Myelomeningocele Defects : A Simple Solution to Complex Reconstructive Problem. 2025;15(4):124–36.PubMedGoogle Scholar
- Obande JO, Bitrus PT, Obande EI. The Timing of Primary Neurosurgical Repair and Wound-Site Infection in Children with Myelomeningocele. 2024;137–48.PubMedGoogle Scholar
- Bhatia V, Kalra D, Singh M, Bodra C, Joshi H, Gohil R, et al. Clinical Studies & Medical Case Reports Case Report Rapid Intraoperative Tissue Expansion for Closure of Lumbosacral Meningomyelocele. 2024;1–4.PubMedGoogle Scholar
- Lobo GJ, Nayak M. V-Y Plasty or Primary Repair Closure of Myelomeningocele: Our Experience. Journal of pediatric neurosciences. 2018;13(4):398–403.PubMedGoogle Scholar
- Goktekin T, TASDELEN B. Comparison of Dorsal Intercostal Artery Perforator Propeller Flaps and Bilateral Rotation Flaps in Reconstruction of Myelomeningocele Defects. Turkish Neurosurgery. 2019;29(1):83–9.PubMedGoogle Scholar
- Sultana M, Sultana N, Mostafa B, Khair AB, Islam S. Association of Serum Albumin Level with Wound Healing after Caesarean Section. 2024;8235:263–72.PubMedGoogle Scholar
- Li Z, Tang X, Fu J, Pan D, Wang T, Zhang Z. Case Report: A Complex Multidisciplinary Surgical Approach for a Pediatric Patient With Congenital Meningoencephalocele. The Journal of craniofacial surgery. 2025 Sep;36(6):e796–9.PubMedGoogle Scholar
