Spontaneous Meningoencephalocele Perioperative Management Survey How do you image these patients in routine cases (check all that apply)? CT sinus/temporal bone MRI Cisternogram (CT or MRI) Lumbar Drain: Do you routinely place a lumbar drain in the OR? No, almost never Yes, in specific cases only (e.g. larger or multiple defects, or suspected IIH) Yes, routinely If you place a lumbar drain how long do you use it? N/A- almost never place a LD Leave it clamped in place for <48 hours, only open if there is a leak Leave it open for <24 hours and then clamp, remove in <4 days Leave it open for <48 hours and then clamp, remove in <4 days Leave it open for <72 hours and then clamp, remove in <4 days When do you measure spinal fluid pressure for idiopathic intracranial hypertension? Non-routine, on case-by-case basis Routine preoperative spinal fluid pressure Routine intraoperative spinal fluid pressure Routine post-repair spinal fluid pressure Multiple time points (e.g. intraop and postop) Do you inject fluorescein dye in to the spinal fluid in surgery to aid in identification? Never Always Only for anterior skull base meningocele/meningoencephaloceles Only for lateral skull base meningocele/meningoencephaloceles Only in patients with indeterminate leak location Do you routinely use acetazolamide? No In some patients Routinely in almost all patients If you use acetazolamide, how long do you use it for? N/A, I do not use Immediately postop for up to 2 weeks Immediately post-op and until re-evaluated Immediately post-op and indefinitely When would you generally consider permanent CSF diversion/shunting? Based on perioperative CSF pressures, pressure >20cmH20 Based on perioperative CSF pressures, pressure >30cmH20 Based on perioperative CSF pressures, pressure >40cmH20 Decision for shunting not based on pressures, but other clinical or surgical factors For routine (<1cm) ANTERIOR skull base meningocele/meningoencephaloceles, what material/layers do you most commonly use (check all that apply)? Synthetic dural graft Autologous graft (e.g. fat, fascia) Free mucosal graft Pedicled flap Dural Sealant For routine (<1cm) LATERAL skull base meningocele/meningoencephaloceles, what material/layers do you most commonly use (check all that apply)? Synthetic dural graft Autologous graft (e.g. fat, fascia, pericranium) Dural Sealant Bone cement Bone graft Do you use anti-seizure prophylaxis for meningoencephalocele repair? No Yes, in some cases (higher risk or larger defects) Yes, in almost all cases Please describe your routine post-operative activity progression: Mobilize ad lib with CSF leak precautions (e.g. nose blowing, bending, weight restrictions) Bedrest for <24hr and then mobilize ad lib with CSF leak precautions Progression: Bedrest for <24hr, then sitting, then walking with CSF leak precautions Duration of CSF leak precautions: <2 weeks 2-4 weeks >4 weeks Duration off CPAP: Start right way <1 week 1-2 weeks 2-4 weeks >4 weeks PhoneThis field is for validation purposes and should be left unchanged.
