Cerebral hernia, or encephalocele, is a congenital or acquired pathological condition in which brain tissue, meninges, or cerebrospinal fluid protrude through a defect in the skull bones. Treatment is aimed at eliminating the herniation, restoring the anatomical integrity of the skull, and preventing neurological complications.
Causes of cerebral hernia
- Congenital anomalies. Defective neural tube closure during embryonic development.
- Skull trauma. Cranial fractures with bone defects.
- Infections. Bone destruction due to chronic osteomyelitis.
- Surgical interventions. Postoperative skull defects following neurosurgical procedures.
- Increased intracranial pressure (ICP). Associated with hydrocephalus or brain tumors.
Symptoms of cerebral hernia
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External signs. Visible protrusion in the cranial region containing brain tissue or cerebrospinal fluid. Skull deformity.
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Neurological disorders. Seizures. Headaches. Cognitive impairment and reduced intellectual function. Delayed physical or psychomotor development in children.
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Infectious complications. Increased risk of meningitis or brain abscess.
Diagnosis
- Clinical examination. Assessment of the size, location, and characteristics of the protrusion.
- Instrumental investigations. Magnetic resonance imaging (MRI) of the brain to visualize the hernia sac, brain structures, and meninges. Computed tomography (CT) of the skull to identify bone defects. Echoencephalography to assess intracranial pressure.
- Neurophysiological testing. Electroencephalography (EEG) to evaluate epileptic activity.
Treatment of cerebral hernia
Conservative treatment
Used only in limited cases when surgical intervention is not feasible.
Indications:
- Inability to perform surgery at an early age.
- Presence of severe contraindications to surgical treatment.
Methods:
- Reduction of intracranial pressure using pharmacological therapy.
- Infection control with antibiotic therapy.
- Regular monitoring and follow-up diagnostics.
Surgical treatment
The main and definitive method of treatment for cerebral hernia.
Indications:
- Pronounced herniation.
- Neurological symptoms.
- Increased intracranial pressure.
- High risk of infectious complications.
Types of surgical procedures:
- Resection of the hernia sac. Removal of protruding brain tissue when it is necrotic or nonfunctional.
- Reconstruction of the skull defect. Cranioplasty using alloplastic materials (titanium plates, polymers, ceramics) or autologous bone tissue.
- Decompression. Reduction of intracranial pressure in cases of hydrocephalus. Placement of a shunt system to divert cerebrospinal fluid (e.g., ventriculoperitoneal shunt).
- Endoscopic techniques. Minimally invasive correction in cases of small skull defects.
- Management of infectious complications. Surgical drainage and debridement in cases of abscess or meningitis.
Postoperative rehabilitation
- Medication therapy. Analgesics for pain control. Antibiotics to prevent infection. Neuroprotective agents to support recovery of brain function.
- Physiotherapy. To promote healing and strengthen the muscles of the neck and head.
- Therapeutic exercise (physical therapy). Gradual increase in physical activity.
- Neurological follow-up. Regular visits to monitor neurological status.
- Lifestyle management. Avoidance of head trauma and control of intracranial pressure.
Treatment of cerebral hernia in Belarus is a complex but effective process that requires a highly specialized and multidisciplinary approach.
Timely surgical intervention allows elimination of the defect, prevention of serious complications, and restoration of the patient’s quality of life. Regular follow-up and strict adherence to postoperative recommendations are crucial for achieving a successful long-term outcome.
