Operative Planning

• Physical examination
  
  
  
  • Basal: Examine nose and mouth to reveal pulsatile mass in epipharynx or nasal cavity between septum and middle turbinate
    
  • Sincipital: Forehead midline (interfrontal, splitting metopic suture), nasion (nasofrontal, through foramen cecum), parasagittal forehead and orbit (na-soethmoidal, through foramen cecum and nasal bone)
    
  • Convexity: Frontal, parietal, or occipital midline (with possible neurovascu-lar elements of the posterior fossa)
  
  
• Counsel family: Review developmental, natural history, and prognosis, and discuss major comorbidity, hydrocephalus
  
• Obtain consultations from plastic surgery/otolaryngologist for basal/sincipital encephaloceles

Imaging

• Radiologic studies
  
  
  
  • In utero ultrasound can allow for diagnosis and preoperative, prenatal counseling
    
  • Magnetic resonance imaging/magnetic resonance angiography
    
    
    
    • Delineates intracranial anatomy and neurovascular structures within encephalocele
      
    • Assess extent of hydrocephalus
    
    
  • Three-dimensional computed tomography: defines extent of bony defect

Special Equipment

• Endoscope: useful in select basal encephaloceles
  
• Lumbar drain, external ventricular drain

Anesthetic Issues