A ten year retrospective study on encephaloceles as seen and managed at Kenyatta National Hospital (January 1992-December 2001)

Abstract

This is a retrospective study of patients with cranial encephaloceles seen at the Kenyatta National Hospital over a period of ten years from 1st January 1992 to 31st December 2001. Eighty-nine patients with cranial encephaloceles were treated at the Kenyatta National Hospital during that period. There were 31 males (34.8%) and 58 females(65.2%). Seventy-one patients (79.8%) were referrals from other health care providing services. District hospitals contributed the most, 38.2% of the patients. The youngest patient was 1 day old and the oldest was 10 years with a mean age distribution of 5.25 months and a median of l.5 months. The commonest age group to be operated on was between 1 month to 6 months (39.3%) with the mode being 3 months (16.9%). The Kikuyu with 4l.6% and Kamba with 14.6% were the commonest tribes followed by the Luhya 11.2%, Meru 9.0%, Kalenjin 6.7%, Luo 4.5% and all the remaining other tribes accounting for 16.9%. Eight percent of the patients presented with leakage of cerebrospinal fluid (CSF) from the encephalocele and seventeen percent of all patients had ulceration of the lesion. The commonest associated congenital malformation was hydrocephalus which was observed in 19% of the patients. Other associated congenital malformations of the eNS were cranio vertebral junction anomalies, Dandy walker cyst and microcephaly.Fifty seven percent of the patients did not have any obvious associated congenital malformations. Computerized Tomography (CT Scan) of the head was the commonest imaging study done (42.7%), followed by ultrasonography (15.7%) and radiography (14.6%). Sixty one percent of the study cases had posterior encephaloceles with anterior lesions accounting for 39%. All the patients with posterior encephaloceles underwent excision and repair of the lesion, while 69% of the patients with anteriorencephaloceles underwent extracranial excision and repair. Thirty one percent of the patients with anterior encephaloceles underwent intracranial excision and repair of the lesion. VP shunting alone without excision of the lesionwas performed on one patient with anterior encephaloceles. Thirty three percent of those with posterior encephaloceles had surgery for insertion of VP shunts while for anterior lesions it was 34.4%. The commonest complications seen m patients who underwent surgery for cranial encephaloceles were wound infection (19.1 %), intra-operative hemorrhage (18%) and recurrence of the lesion (12%). Eight patients (9%) died following surgery, with four (4) of these dying within 6 weeks of surgery. The average duration of hospital stay was 46 days although the average postoperative hospital stay was 14 days. Most of the patients (76.4%) attended the outpatient clinic regularly for review for at least 12 months.