Understanding the general steps of encephalocele repair can make the operation feel less mysterious. Every case is individual, but the core goals are consistent.
The goals of the operation
Whatever the type, surgeons aim to:
- Address the contents of the sac — returning functional brain tissue within the skull when possible, and removing tissue that is clearly non-functional.
- Achieve a watertight closure of the dura (the brain's tough covering) to prevent CSF leaks.
- Repair the bony defect in the skull, sometimes using the child's own bone or, when needed, other materials.
- Reconstruct the area — including the scalp or, for facial types, the forehead, nose, and eye region — for protection and appearance.
The general steps
While details vary by location, a typical repair involves:
- General anesthesia, with careful monitoring tailored to infants.
- An incision over or around the sac (for facial types, incisions are planned to hide scars where possible).
- Careful dissection to separate the sac and identify its contents and the edges of the bony defect.
- Managing the contents: protecting/returning functional tissue and removing non-functional tissue.
- Watertight dural closure, sometimes using a graft to seal the covering.
- Bony reconstruction to close the skull opening.
- Closure of the scalp/soft tissues, often with dissolvable stitches.
A team effort
For many encephaloceles — especially facial ones — repair is a collaboration between pediatric neurosurgery (to handle the brain coverings and protect neural tissue) and craniofacial/plastic surgery (to reconstruct the skull and face). This combined expertise is one reason care at an experienced center matters.
What about hydrocephalus?
If hydrocephalus is present or develops, it may be treated before, during, or after the encephalocele repair — often with a shunt. Untreated pressure can stress the repair, so it's managed as part of the overall plan.
Sources
- StatPearls (NCBI Bookshelf) — Encephalocele (surgical goals and approach)
- Journal of Integrative Neuroscience — craniofacial encephalocele management
- CHOP — Encephalocele (multidisciplinary repair)
- Cleveland Clinic — Encephalocele