Tropical Doctor, January 1992
44
CASE REPORTS
An unusual orbital swelling N K Sharma MCh P Garg MS Department of Neurosurgery Medical College & Hospital, Rohtak-124001 Haryana, India TROPICAL DOCTOR,
1992, 22, 44
Figures 1 and 2 show orbital swellings which might cause confusion when encountered in a busy district clinic, In a series of five cases seen in our hospital (3 female, 2 male; age range 1-3 years) all presented with swelling around the nasal bridge since birth. The medial canthus of the eye was involved in two cases (Figures 1 and 2). One of the latter had excessive watering from eye and the other recurrent swelling of the lower eyelid. The average diameter of the swelling was 3 em. A cough impulse was present in all. Transillumination was positive in only one. None had neurological symptoms.
Figure I. Sincipital encephalocele (front view)
Figure 2. Sincipital encephalocele (side view) These are presentations of anterior encephalocele. All five cases revealed a midline skull defect on xray. The incidence of anterior encephalocele is between I per 4000 births and 1 per 6000 births (about 10 times as common as posterior encephalocele). Geographical influences, genetic abnormalities, and ethnographic factors have been proposed to account for the condition. The anatomical features suggest that anterior encephalocele is an early developmental anomaly', The nomenclature and classification of this entity are not uniform in the literature. However the lesions are broadly grouped into three categories: sincipital, basal and occipital. Sincipital meningocele is a cosmetic challenge for the neurosurgeon. The diagnosis is usually established by simple X-rays (CT and MRI are required for more detailed information). Pre-operative assessment of surrounding bones is mandatory in formulating reconstruction. Four of our cases were operated by an intracranial approach while one was by the extra-cranial route. The prognosis is good. Hydrocephalus, raised intracranial tension and major neurological defects may create problems at times. One of our patients has developed seizures and is on drug therapy. REFERENCES
I
Rapport RL, Dunn RC, Alhady F. Anterior encephalocele. J Neurosurg 1981;54:213-9
Correspondence to Dr Pradeep Garg, 687/27 opp. Medical Crossing, Model Town, Rohtak 124001, India
2 Younus M, Coode PE. Nasal glioma and encephalocele:two separate entities. J Neurosurg 1986;64:516-19
44
CASE REPORTS
An unusual orbital swelling N K Sharma MCh P Garg MS Department of Neurosurgery Medical College & Hospital, Rohtak-124001 Haryana, India TROPICAL DOCTOR,
1992, 22, 44
Figures 1 and 2 show orbital swellings which might cause confusion when encountered in a busy district clinic, In a series of five cases seen in our hospital (3 female, 2 male; age range 1-3 years) all presented with swelling around the nasal bridge since birth. The medial canthus of the eye was involved in two cases (Figures 1 and 2). One of the latter had excessive watering from eye and the other recurrent swelling of the lower eyelid. The average diameter of the swelling was 3 em. A cough impulse was present in all. Transillumination was positive in only one. None had neurological symptoms.
Figure I. Sincipital encephalocele (front view)
Figure 2. Sincipital encephalocele (side view) These are presentations of anterior encephalocele. All five cases revealed a midline skull defect on xray. The incidence of anterior encephalocele is between I per 4000 births and 1 per 6000 births (about 10 times as common as posterior encephalocele). Geographical influences, genetic abnormalities, and ethnographic factors have been proposed to account for the condition. The anatomical features suggest that anterior encephalocele is an early developmental anomaly', The nomenclature and classification of this entity are not uniform in the literature. However the lesions are broadly grouped into three categories: sincipital, basal and occipital. Sincipital meningocele is a cosmetic challenge for the neurosurgeon. The diagnosis is usually established by simple X-rays (CT and MRI are required for more detailed information). Pre-operative assessment of surrounding bones is mandatory in formulating reconstruction. Four of our cases were operated by an intracranial approach while one was by the extra-cranial route. The prognosis is good. Hydrocephalus, raised intracranial tension and major neurological defects may create problems at times. One of our patients has developed seizures and is on drug therapy. REFERENCES
I
Rapport RL, Dunn RC, Alhady F. Anterior encephalocele. J Neurosurg 1981;54:213-9
Correspondence to Dr Pradeep Garg, 687/27 opp. Medical Crossing, Model Town, Rohtak 124001, India
2 Younus M, Coode PE. Nasal glioma and encephalocele:two separate entities. J Neurosurg 1986;64:516-19
