Abstract

Background: An occipital encephalocoele possess difficulty in surgical intervention, not only

the sac contains of herniated brain tissue, but the appropriate positioning for successful
intubation. Appropriate administration of antibiotics must be given to prevent complications such
as meningitis and/or encephalitis.
Objective: To present a case of a 2-day-old female neonate diagnosed with ruptured
encephalocoele who underwent emergency encephalocoele repair.
Case: A 2-day-old female neonate presented with fluid leakage coming from swelling in the
back of the head and was planned for emergency surgery. On examination of the baby in
neonatal intensive care unit (NICU), baby was active, positioned supine with the head turned to a
side, baby had swelling arising from the occipital region with no congenital anomalies, had no
neurological deficit, cardiac and respiratory systems examination was within normal limits. After
induction, baby was then brought to the edge of the OR table with the head lying out of the table
but supported by two residents from both sides. Under direct laryngoscopic vision, trachea was
intubated and tube was fixed after confirming adequate bilateral equal air entry. Baby was then
positioned to prone position, with the head turned to side. The head is supported on a donut-
shaped pillow. Baby was extubated once fully awake with spontaneous limb movement.
Discussions:
Cranium bifidum is a defect in the fusion of the cranial bone, it occurs in the midline, and is most
common in the occipital region. If meninges and cerebral tissue protrude, it is called
encephalocoele. Neonates with encephalocoele may have restricted neck extension and difficult
airway, making intubation difficult. One more concern is positioning of the neonate for
intubation and subsequent positioning during the procedure.
Conclusion: Children with encephalocoele are prone to have peri-operative problems which can
be managed by meticulous anaesthetic managenement.

Key Words: encephalocoele, neonate, general anaesthesia, intubation