Spontaneous external rupture of hydrocephalus after fontanelle closure: a case report and review of literature
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CASE REPORT
Spontaneous external rupture of hydrocephalus after fontanelle closure: a case report and review of literature Varidh Katiyar 1 & Kanwaljeet Garg 1 P. Sarat Chandra 1
&
Ramesh Doddamani 1 & Pankaj Kumar Singh 1 & Manmohan Singh 1 &
Received: 15 April 2020 / Accepted: 1 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract We report a 2-year-old child with congenital hydrocephalus who presented with a frontal meningocoele due to ventriculosubgaleal fistula secondary to hydrocephalus (internal rupture), which gradually ruptured spontaneously through the skin. This case is unique given its association with occipital encephalocele and is only the second case to present with external rupture beyond the age of 1 year. Further, the ventricles have ruptured through the skull, after the closure of anterior fontanelle, into the subgaleal space. It challenges the present understanding that external rupture occurs only through an open anterior fontanelle. Keywords Spontaneous rupture . External rupture . Hydrocephalus . Fontanelle closure . Subgaleal space
Background Hydrocephalus is one of the most common causes of neurosurgical consultation in the pediatric age group. The spectrum of cases of hydrocephalus differs widely among the populations with different socio-cultural and economic backgrounds. In developing countries with more influence of alternative medical practices and poverty resulting in unaffordability, adequate intervention is usually delayed. This results in some bizarre complications, unheard in the developed countries in present times. Few cases with spontaneous external rupture through the open
* Kanwaljeet Garg [email protected] Varidh Katiyar [email protected] Ramesh Doddamani [email protected] Pankaj Kumar Singh [email protected] Manmohan Singh [email protected] P. Sarat Chandra [email protected] 1
Department of Neurosurgery, All India Institute of Medical Sciences, 720, CNC, AIIMS, New Delhi 110029, India
anterior fontanelle have been reported in the literature [1–4]. We report a child with congenital hydrocephalus who presented with a frontal meningocele due to ventriculo-subgaleal fistula secondary to hydrocephalus (internal rupture), which gradually ruptured spontaneously through the skin.
Case A 2-year-old boy born at full term by normal vaginal delivery presented to our outdoor clinic with complaints of a cystic swelling in the right frontal region and occipital region since birth. Though he had no focal neurological deficits, but the developmental milestones were delayed for age in all domains. At presentation, he was able to speak only monosyllables and was able to walk with support. There was bony deformity in the right frontal region as well, with scalloping of the skull and everted bony edges around the skull defect. He was diagnosed with multiple cranial meningocoeles including one in the occipital region and frontal region. He also had a swelling in the occipital region that was soft and around 4 × 4 cm in siz
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