Nasofrontal Encephaloceles

I’m learning operations that I’ve never seen before. Some of the problems that I’m operating on, I’ve never even heard of before I arrived here. One of them is nasofrontal encephaloceles. For some reason, they are relatively common here. A child is born with a defect in the bone right between the eyes. This provides an opening in the skull for the fluid inside and brain itself to start bulging out. These kids come to me with a soft mass growing out between their eyes that has been growing ever since they were born. With each of the families, I try to get them to go to Namibia, but none have had the resources to get treatment at a specialty center. I encourage them to go because I’m teaching myself how to do these operations & the first little boy I operated on died after surgery. The 1 or 2 other nasofrontal encephaloceles operated on at our hospital before I arrived had also died. A 100% death rate is not an encouraging statistic when you get ready for your next operation. These are the tough decisions here. When should you attempt things that you’ve never done before? When should you refer? Is there anywhere to refer the patient? Can they afford to go see experts? Is the patient better off without any operation? Everyday these are the questions that I face as I see my patients.

Thankfully, my second child and third child with nasofrontal encephaloceles survived! Now I’ve got a 66% survival rate.