Perioperative and airway management of a giant occipital encephalocele in a neonate: A case report

Giant occipital encephalocele is a rare congenital neural-tube defect characterized by herniation of brain tissue and meninges through a large cranial defect, often exceeding the size of the cranium itself. Such lesions present formidable anesthetic and surgical challenges due to difficult airway access, positioning limitations, risk of cerebrospinal-fluid loss, and potential hemodynamic instability. We describe the perioperative management of a 3-day-old female neonate weighing 2.5 kg who presented with a massive occipital swelling measuring approximately 24 × 15 × 10 cm. Computed tomography of the head revealed a large occipital bone defect containing dysplastic neural tissue and cerebrospinal fluid. Anticipating airway compromise, anesthesia was induced in the lateral position using a videolaryngoscope. Careful padding and support were applied to prevent pressure on the sac. The intraoperative course was uneventful; blood loss was minimal and compensated with crystalloid and packed-cell transfusion. Thermoregulation and fluid balance were meticulously maintained. The infant was kept intubated postoperatively for observation, extubated on the second postoperative day, and discharged on day 3 with an intact neurological status. This case highlights the importance of meticulous preoperative planning, innovative airway management strategies, and vigilant perioperative monitoring in neonates with giant encephalocele. Close coordination between anesthesiology, neurosurgery, and neonatology teams is essential to optimize outcomes and minimize perioperative morbidity.