Primary Closure and Local Flap Reconstruction in a Neonate with Giant Meningoencephalocele: A Case Report and Technical Considerations

Abstract

Introduction: Meningoencephalocele is a rare congenital neural tube defect characterized by herniation of the meninges and brain tissue through a skull defect. Giant occipital lesions in neonates pose major surgical and reconstructive challenges owing to fragile tissues, limited physiological reserve, and a high risk of cerebrospinal fluid (CSF) leakage and infection. Although neurosurgical principles are well established, optimal soft-tissue reconstruction in neonates remains underreported. We describe a multidisciplinary, reconstruction-focused approach to neonatal occipital meningoencephalocele. Case Description: An 11-day-old female neonate presented with a large midline occipital mass noted since birth—soft, fluctuant, and skin-covered, without neurological deficit or infection. Imaging confirmed an occipital skull defect with herniation of the meninges and brain tissue. After multidisciplinary evaluation, staged surgery was performed: neurosurgical excision of non-functional herniated tissue with watertight dural closure, followed by scalp reconstruction using a local occipital rotation flap for tension-free coverage. The post-excisional defect measured approximately 8 × 6 cm and the total operative time was approximately 180 minutes. No intraoperative complications occurred, and the neonate showed stable wound healing without CSF leakage, dehiscence, infection, or neurological deterioration during early follow-up. Conclusion: A staged, multidisciplinary strategy combining precise neurosurgical repair with appropriate local flap reconstruction can achieve safe closure, protect neural structures, and provide durable functional and aesthetic outcomes in neonates with occipital meningoencephalocele. Early integration of plastic surgery for tension-free, well-vascularized coverage is central to preventing wound and CSF complications.