Two years old boy having Swelling at occipital in mid line since birth which is increasing progressively CT scan showed underlying bony defect Diagnosis is meningo encaphalocoele? Problem may be super Sagittarius sinus involvement. Pt is poor can not effort MRI and MRA ,Venogram etc May I go for surgery without venography? How to manage this case?

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MRI is a must as the stakes may be against the patient's life .Consider getting it done in a government institute even after some delay.Do not touch it without a MR.It might risk his life.Depending on MRI-we can decide what defect this is and is there an underlying communication or is there hydrocephalus.also-is there healthy skin cover available.Any difficulty-do consult a plastic surgeon preoperatively only as postoperative CSF leak or meningitis is highly dangerous;not to say costly.child is otherwise normal?Be very careful-else refer to higher centre.

if this area is shaved for surgery,I would actually consider an incision extending in the normal skin and then raise a flap.That way-the sinus would also be safe and the skin sutures will lie in the healthy area. However tempting-do not make a direct incision on it.You can definitely encounter the sinus-but that is just one of the problem.-any doubt-please refer to a higher centre.

Meningocele. Check for cough impulse

A swelling coming from brain . Do ct scan It might be mengocele.

Meningocele Take the help of good Neurologist Surgeon Asir close to superior digital sinus

MRI should be done.Talk to the medical supretendant of any govt. medical college hospital. They can arrange for one ,considering it an academic case to be studied.

Rule out Hydrocephalus first. if +ve then VPShunt first followed by encephalocele decapping & repair

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