For many parents, the most emotionally difficult question is whether surgery will remove brain tissue. This article addresses that question honestly and gently.
The guiding principle: protect function
The surgeon's guiding principle is to protect functional brain tissue while safely closing the defect. What happens to the tissue in the sac depends on what that tissue is:
- Functional brain tissue is protected and, where possible, returned within the skull during the repair.
- Tissue that is clearly non-functional — often malformed tissue that isn't contributing to brain function — may be removed to allow a safe, watertight closure.
Why some tissue is removed
In some encephaloceles, the tissue that herniated into the sac is malformed and does not function as normal brain. In those cases, removing it does not take away functional ability, and it allows the surgeon to close the dura and skull properly. The decision is based on careful assessment, including imaging and the appearance and behavior of the tissue at surgery.
How surgeons decide
Surgeons use several inputs:
- Pre-operative MRI, which shows how much tissue is in the sac and how it connects to the rest of the brain.
- Intra-operative assessment of the tissue's appearance and viability.
- Experience and judgment, prioritizing the protection of anything functional.
This is one reason an experienced pediatric neurosurgical team is so important — these are nuanced, high-stakes judgments.
Talking with your surgeon
It's completely appropriate to ask your surgeon directly:
- "Based on imaging, how much brain tissue is in the sac?"
- "Do you expect to return tissue within the skull, remove tissue, or both?"
- "Is the tissue in the sac thought to be functional?"
- "How will this affect my child?"
A good surgeon will answer honestly, including acknowledging uncertainty until they can see the tissue directly.
Sources
- StatPearls (NCBI Bookshelf) — Encephalocele (removing nonfunctional tissue, protecting function)
- Journal of Integrative Neuroscience — craniofacial encephalocele management
- Cleveland Clinic — Encephalocele
- CHOP — Encephalocele