case_images: PMC9852628_01
case_images: (A) severe encephalocele of the right frontotemporal region was observed. (B) Head CT scan revealed enlargement of the ventricular system. (C-G) Because of severe brain bulging, VP shunt was first implanted to release the CSF. The frontal ventricular puncture at the frontal bone was guided by the neuronavigation system. The parts of shunting devices were connected to the titanium mesh by an improved method. (H) Postoperative head CT showed no subdural/epidural fluid collection or subdural/epidural/cerebral hematoma. (I) The patient recovered rapidly and was discharged a week later. VP, ventriculoperitoneal; CSF, cerebrospinal fluid.
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case_images: PMC9852628_01_fsurg-09-935171-g004.jpg
case_images: F4
case_images: Severe encephalocele of the right frontotemporal region was observed (Figure 4A). Radiological examination showed right skull defect and dilated ventricular system with periventricular edema (Figure 4B). Frontal ventricular puncture to the frontal bone was guided by neuronavigation system (Figures 4C-E). The parts of the shunting device (reservoir, adjustable differential DP unit, gravitational unit, and tube) were connected on the titanium mesh by an improved method (Figure 4F).
case_images: PMC9852628_02
case_images: (A) Presurgical head CT scan demonstrated expansion of ventricular system, which was diagnosed as hydrocephalus. (B-J) Because of the encephalomeningocele, we first identified the entry point on the dura matter just close to the bone margin by the neuronavigation system. Then, ventricular puncture was performed to release the CSF till the titanium mesh could be attached to dura matter adequately, and parts of the shunting devices were further connected. (K) No operation-related complication was shown in the postsurgical radiological examinations. CSF, cerebrospinal fluid.
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case_images: F5
case_images: During the period, serial CT scans revealed expansion of the ventricular system (Figure 5A). Because of the encephalomeningocele, we first identified the entry point on the dura matter just close to the bone margin assisted by the neuronavigation system (Figures 5B,D). Then, ventricular puncture was performed to release the CSF till the titanium mesh could be attached to dura matter adequately, and parts of the shunting devices were connected (Figures 5E-J). No operation-related complication was observed in the postsurgical examinations (Figure 5K).
case_images: PMC9852628_03
case_images: (A) Head CT scan showed right cranial defect and dilation of the ventricle system. (B,C) According to strategy 1, cranioplasty was performed first. Shunt valve pressure was set at 160 mm H2O before the surgery. (D) Potential epidural space disappeared after suspending with silk thread between titanium mesh and dura mater. (E) The entry point was located by the neuronavigation system on the right frontal bone. (F-I) Then, ventricular puncture was implemented and the shunting tube was connected. (J) No subdural/epidural fluid collection or hemorrhage was revealed by postoperative head CT.
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case_images: F6
case_images: Head CT scan showed right cranial defect and dilation of the ventricle system (Figure 6A). According to strategy 1, we performed cranioplasty first (Figures 6B-E). The entry point was located by the neuronavigation system in the dura matter and titanium mesh (Figures 6F,G). Then, ventricular puncture was implemented and the shunting parts were connected (Figures 6H,I). No subdural/epidural fluid collection or hemorrhage was revealed by postoperative head CT (Figure 6J).