Greater Sphenoid Wing Reconstruction With 3d Printed Anatomical Intracranial Implant for a Child With Spheno- Orbital Encephalocele

Greater Sphenoid Wing Reconstruction With 3d Printed Anatomical Intracranial Implant for a Child With Spheno- Orbital Encephalocele | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Greater Sphenoid Wing Reconstruction With 3d Printed Anatomical Intracranial Implant for a Child With Spheno- Orbital Encephalocele Abhishek Patel, Alok Ranjan, Murali Krishna, Tarang Kamalkishor Vora This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4596210/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Sep, 2024 Read the published version in Child's Nervous System → Version 1 posted 8 You are reading this latest preprint version Abstract Sphenoid wing dysplasia is a characteristic finding in children with Neurofibromatosis Type 1(NF1). Six years old boy presented to us with painless progressive uni-ocular vision loss and progressive pulsatile proptosis. Imaging revealed spheno-orbital encephalocele into the orbit through the dysplastic posterior orbital wall. 3D printed customized implant was designed and placed to fit the defect and prevent further herniation of temporal lobe in to the orbit. Sphenoid wing dysplasia Spheno-orbital Encephalocele 3D printed titanium mesh Pulsatile Proptosis Figures Figure 1 Figure 2 Introduction Sphenoid wing dysplasia is one of the characteristics of NF1 affecting 5–10% of the cases [ 15 ]. Congenital sphenoid wing dysplasia is one of tenet of the major diagnostic criteria for NF1 [ 7 , 11 ], and is often considered pathognomonic for the disease [ 1 ]. Sequelae of this deficiency include slow expansion of the middle temporal fossa and progressive herniation of the temporal lobe into the orbital cavity [ 11 ], resulting in progressive pulsatile exophthalmos [ 4 – 6 ]. Vision loss has been noted in few of the cases [ 5 , 7 ]. Management includes reconstruction of defect [ 13 , 18 ]. Herein, we report a patient with greater sphenoid wing dysplasia and temporal lobe herniating through defect causing pulsatile exophthalmos and progressive vision loss. Literature review was done on PubMed central with key words ”Reconstruction of Sphenoid wing dysplasia”; “Spheno-orbital Encephalocele”. Less than 11 such case reports were noted in available English literature on PubMed Central. We reviewed the relevant literature on surgical techniques and grafts utilized to separate the middle cranial fossa contents from the orbit. Case Report Six years old Indian male child, a known case of NF1, was referred to us with history of right eye progressive pulsatile proptosis and vision loss since 6 months. Fundus examination revealed primary optic atrophy in the affected eye with decrease in visual acuity. On examination there were multiple cafe-au- lait spots all over body with eight lesions were more than 15mm in size. A plexiform neurofibroma was also present over right eyelid. A computed tomography scan (CT) of head revealed dysplasia of right greater wing of sphenoid with displacement of right temporal lobe into orbit and displacing right orbital contents forward. Arachnoid cyst was also present at the temporal pole. [Figure 1 ] Customized anatomical 3D printed titanium implant was designed for the child considering the contents at the orbital apex. He underwent right pterional craniotomy, marsupialization of the arachnoid cyst and reconstruction of the greater wing of sphenoid with 3D printed anatomical implant. A follow up CT was showing implant in situ with no herniation of middle cranial fossa content. [Figure 2 ] During follow up, the patient was noted to develop contour irregularities of right temporal bone, mild eyelid swelling due to presence of the plexiform neurofibroma, and complete resolution of pulsatile proptosis. His vision showed improvement in acuity post-surgery. [Figure 2 ] Discussion First ever such case was reported in 1995 and since then there were many progression in treatment of sphenoid wing dysplasia using different types of grafts. Encephalocele is a protrusion of cranial content beyond the normal confines of skull due to defect in bone and dura through which cranial content herniates. Sphenoid Encephalocele are often clinically occult and usually become apparent at the end of first decade of life. In our case of child presented with proptosis at the age of 6 years and not since birth. Spheno-orbital Encephalocele are very rare, counting 5% of all basal Encephalocele and is associated with visual disturbances. Encephalocele are definitively diagnosed by radiological evaluation. Computed tomography (CT) with three dimensional reconstruction and MRI provide precise information about the position of cranial bony defect and the content of cystic mass. They are valuable in determining the need for planning the extent of craniofacial reconstruction. Arachnoid cyst represent less than 1% of brain tumor. It can be acquired or congenital. Here we have seen its association with sphenoid wing dysplasia in our case. Upon reviewing of available literature we have detected that 43.75% cases of sphenoid wing dysplasia is associated with temporal arachnoid cyst. In our case also it was associated with temporal arachnoid cyst. After thorough evaluation, the definitive management of sphenoid wing dysplasia is surgical intervention. Various grafts available for closure of bony defect, i.e. Bone graft, non-anatomical titanium mesh and reconstructed 3D graft. Bony graft are associated with resorption with time and recurrence of temporal pole herniation and proptosis. We have reviewed such complication in one case. Non anatomical titanium mesh has advantage over bone graft that it will not resorbed over time but it is associated with difficulty in placing to close bony defect. The advantage of 3D reconstructed implant is that it can fit the defect precisely and without much difficulty. In our study we have done marsupialization of Encephalocele and reduced content from intra-orbital compartment to intracranially and placed 3D reconstructed implant to fit the defect in such a way that it does not compress orbital apex and superior orbital fissure. Approach for such defect can be extra cranial and intracranial. Extra-cranial approaches to these lesions are associated with many problems including method for treatment of these lesions. Intracranial approach is preferred option. Conclusion Sphenoid wing reconstruction seems to be a reasonable surgical technique with low complication rates. It seems to prevent progression of proptosis and vision loss in children with Spheno-orbital Encephalocele. Association of temporal arachnoid cyst in these cases needs more evaluation. Declarations Disclosures and declarations There are no financial disclosures. Patient’s parents’ consent was taken to publish radiological and intraoperative images. Patient’s identity is not revealed in the paper. Author contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr Abhishek Patel. The first draft of the manuscript was written by Dr Abhishek Patel and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Binet EF, Kieffer SA, Martin SH, Peterson HO (1969) Orbital dysplasia in neurofibromatosis. Radiology 93(4):829–833. https://doi.org/10.1148/93.4.829 Dale EL, Strait TA, Sargent LA (2014) Orbital reconstruction for pulsatile exophthalmos secondary to sphenoid wing dysplasia. Ann Plast Surg 72(6):S107–S111. https://doi.org/10.1097/sap.0000000000000090 Di Rocco C, Samii A, Tamburrini G et al (2017) Correction to: Sphenoid dysplasia in neurofibromatosis type 1: a new technique for repair. Childs Nerv Syst 33:2211. https://doi.org/10.1007/s00381-017-3605-9 Friedrich RE (2011) Reconstruction of the sphenoid wing in a case of neurofibromatosis type 1 and complex unilateral orbital dysplasia with pulsating exophthalmos. https://pubmed.ncbi.nlm.nih.gov/21471549 Friedrich RE (2011b) Reconstruction of the sphenoid wing in a case of neurofibromatosis type 1 and complex unilateral orbital dysplasia with pulsating exophthalmos. PubMed 25(2):287–290. https://pubmed.ncbi.nlm.nih.gov/21471549 Friedrich RE, Heiland M, Kehler U, Schmelzle R (2003) Reconstruction of Sphenoid Wing Dysplasia with Pulsating Exophthalmos in a Case of Neurofibromatosis Type 1 Supported by Intraoperative Navigation Using a New Skull Reference System. Skull Base 13(4):211–216. https://doi.org/10.1055/s-2004-817697 Friedrich RE, Stelljes C, Hagel C, Giese M, Scheuer HA (2010) Dysplasia of the orbit and adjacent bone associated with plexiform neurofibroma and ocular disease in 42 NF-1 patients. PubMed 30(5):1751–1764. https://pubmed.ncbi.nlm.nih.gov/20592374 Goddard NV, Dunne J, Ghorbanian S, Eccles S (2022) Reconstruction of sphenoid wing dysplasia in Neurofibromatosis Type-1 patients: an evolving Technique. JPRAS Open 31:67–71. https://doi.org/10.1016/j.jpra.2021.10.002 Havlik RJ, Boaz J (1998) Cranio-Orbital-Temporal neurofibromatosis. J Craniofac Surgery/the J Craniofac Surg 9(6):529–535. https://doi.org/10.1097/00001665-199811000-00007 Knopp U, Knopp A, Stellmacher F, Reusche E, Löning M, Kantelhardt SR, Von Domarus H, Arnold H, Giese A (2009) A non-midline spheno-orbital encephalocele in a newborn. Cent Eur Neurosurg 70(01):43–47. https://doi.org/10.1055/s-0028-1082321 Marchac D (1984) Intracranial enlargement of the orbital cavity and palpebral remodeling for orbitopalpebral neurofibromatosis. Plast Reconstr Surgery/PSEF CD Journals 73(4):534–541. https://doi.org/10.1097/00006534-198404000-00003 Niddam J, Bosc R, Suffee TM, Guerinel CL, Wolkenstein P, Meningaud J (2014) Treatment of sphenoid dysplasia with a titanium-reinforced porous polyethylene implant in orbitofrontal neurofibroma: Report of three cases. Journal of Cranio-maxillofacial Surgery/Journal of Cranio-maxillo-facial Surgery. 42(8):1937–1941. https://doi.org/10.1016/j.jcms.2014.08.004 Poole MD (1989) Experiences in the surgical treatment of cranio-orbital neurofibromatosis. Br J Plast Surg 42(2):155–162. https://doi.org/10.1016/0007-1226(89)90197-5 Prathibha S, Parasar V, Yasmin S, Pramila VVS (2018) A multidisciplinary approach to sphenoid wing dysplasia presenting with pulsatile proptosis in neurofibromatosis Type 1: A rare case report. Indian J Ophthalmology/Indian J Ophthalmol 66(1):157. https://doi.org/10.4103/ijo.ijo_429_17 Qayyum MU, Ehtesham EUH, Kazmi SaM, Zahra R (2022) SPHENOID WING DYSPLASIA: REPORT OF 3 CASES. JAMC. Journal of Ayub Medical College, Abbotabad. Pakistan/Journal Ayub Med Coll 34(4SUPPL 1). https://doi.org/10.55519/jamc-04-s4-9327 Sharma M, Mally R, Velho V, Agarwal V (2014) Spheno-orbital encephalocele: A rare entity - A case report and review of literature. Asian J Neurosurg 9(02):108–111. https://doi.org/10.4103/1793-5482.136728 Sugawara Y, Harii K, Hirabayashi S, Sakurai A, Sasaki T (1996) A Spheno-orbital Encephalocele with Unilateral Exophthalmos. Ann Plast Surg 36(4):410–412. https://doi.org/10.1097/00000637-199604000-00016 Wu C, Lee S, Chen J, Lin K, Yen S (2008) Computer-Aided design for Three-Dimensional titanium mesh used for repairing skull base bone defect in pediatric neurofibromatosis type 1. Pediatr NeuroSurg 44(2):133–139. https://doi.org/10.1159/000113116 Zapatero ZD, Kalmar CL, Kosyk MS, Carlson AR, Bartlett SP (2021) Sphenoid wing dysplasia in the absence of neurofibromatosis: diagnosis and management of a novel phenotype. Plast Reconstr Surg Glob Open 9(3):e3483. https://doi.org/10.1097/gox.0000000000003483 Table Table 1: Review of Literature Sr No. Authors NF1 Vision Arachnoid cyst Graft used for Bony Defect Outcome 1. Sugawara Y et al [17] (1995) + Diminished Present Hydroxyapatite ceramic implant Vision: Status Quo Resolution of Proptosis. 2. U Knopp et al [10] (2009) - Normal Present Bone defect not closed. Vision: Decreased post-surgery, normal at 3months. 3. Mayur Sharma et al [16] (2022) - Diminished vision Present Bone defect not closed. Vision: Status quo. 4. Mr Naveen Virin Goddard et al [8] (2022) +(4) Absent Vision(2) Diminished vision(1) Normal vision(1) Present(2) Absent(2) Non anatomical titanium mesh(2) Customized reconstructed 3D implant (2) Vision: NA. Resolution of Proptosis. 5. Jeremy Niddam et al [12] (2014) +(3) Absent Vision (1) Normal vision(2) Present(1) Absent(2) Customized reconstructed 3D implant Vision: Intact. Resolution of Proptosis. 6. Di Rocco Concezio et al [3] (2017) +(4) Intact vision (1) Vision status NA (3) Present (4) Non anatomical Titanium mesh Vision: Intact (1). Vision: NA (3). Resolution of Proptosis (4). 7. Reinhard E Friedrich[4] (2011) + Impaired vision Absent Non anatomical Titanium mesh Vision: status quo. Resolution of Proptosis. 8. S Prathibha et al [14] (2018) + Intact vision Absent PMMA bone cement Vision: NA Resolution of Proptosis 9. Zachary D. Zapatero et al [19] (2018) - Intact vision Absent Non anatomical Titanium mesh and bone graft Vision: Intact. Resolution of Proptosis. 10. Elizabeth L Dale et al [2] (2014) - Intact vision Absent Non anatomical Titanium mesh and bone graft Vision: Intact. Resolution of Proptosis. 11. Robert J. Havlik et al [9] (1998) + Intact vision Present Bone graft Resorption of bone graft Recurrence of Proptosis 12. Our Case + Diminished Vision Present Customized reconstructed 3D implant Vision: Intact. Resolution of Proptosis Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Sep, 2024 Read the published version in Child's Nervous System → Version 1 posted Editorial decision: Revision requested 17 Jul, 2024 Reviews received at journal 05 Jul, 2024 Reviewers agreed at journal 24 Jun, 2024 Reviewers agreed at journal 23 Jun, 2024 Reviewers invited by journal 22 Jun, 2024 Editor assigned by journal 19 Jun, 2024 Submission checks completed at journal 19 Jun, 2024 First submitted to journal 17 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4596210","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":321512947,"identity":"f981b093-5674-46a1-ab81-bf782de507c9","order_by":0,"name":"Abhishek Patel","email":"","orcid":"","institution":"Apollo Health city","correspondingAuthor":false,"prefix":"","firstName":"Abhishek","middleName":"","lastName":"Patel","suffix":""},{"id":321512949,"identity":"c88ad2ef-36f7-4ec9-bdeb-3d1f2e7dcae6","order_by":1,"name":"Alok Ranjan","email":"","orcid":"","institution":"Apollo Health city","correspondingAuthor":false,"prefix":"","firstName":"Alok","middleName":"","lastName":"Ranjan","suffix":""},{"id":321512951,"identity":"38be97e7-c29d-457e-b8ae-6f893ab658be","order_by":2,"name":"Murali Krishna","email":"","orcid":"","institution":"Amatomize 3D Medtech","correspondingAuthor":false,"prefix":"","firstName":"Murali","middleName":"","lastName":"Krishna","suffix":""},{"id":321512955,"identity":"b93fad46-a08a-4b70-b723-e924daa91e2a","order_by":3,"name":"Tarang Kamalkishor Vora","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDCCAyi8CiBmZm4gpIURScUZkBZkAYJaGNvAJH4tfLcPsD/4uccuTz4i+diHn/Nqo/nbgVp+VGzDqUXyXAJjY8+z5GLDG2nJM3u3Hc+dcZixgbHnzG2cWgzOAN3Bc4A5cWPPGWMG3m3HchuAWpgZ2/BrafxzoB6shfHvnGO584nR0sxz4HDifPYeY2behprcDYS0SJ5hbJwtc+B44gb2tmRmmWMHcjcCtRzE5xe+M8wHPr45UJ04v5n5MOObmrrceecPH3zwowK3FngsGBwAU4fB5AE86hFAHqKzjijFo2AUjIJRMLIAAITzYQOdsXtJAAAAAElFTkSuQmCC","orcid":"","institution":"Apollo Health city","correspondingAuthor":true,"prefix":"","firstName":"Tarang","middleName":"Kamalkishor","lastName":"Vora","suffix":""}],"badges":[],"createdAt":"2024-06-17 22:25:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4596210/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4596210/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00381-024-06587-2","type":"published","date":"2024-09-02T16:05:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60432238,"identity":"64dd04ab-4e0c-457c-8178-49e63d5020a5","added_by":"auto","created_at":"2024-07-16 16:48:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1363429,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePre-operative CT brain showing right spheno-orbital encephalocele(a,b), Clinical picture of proptosis(c) \u0026amp; 3D reconstruction(d,e,f) of the sphenoidal defect, temporal lobe(red) and optic nerve(blue).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4596210/v1/5dcd8bb93f4b81147f082e2f.png"},{"id":60432237,"identity":"f7070460-96bd-41e7-aeab-82a26540279e","added_by":"auto","created_at":"2024-07-16 16:48:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1505680,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePre-operative 3D Planing; implant used for surgery (b); intraoperative photos showing defect(c) and titanium plate in situ (d); post-operative CT scan showing implant plate (round circle) causing closure of the defect (e) \u0026amp; Post-operative clinical picture (f).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4596210/v1/4e756692ce03eb452458be1f.png"},{"id":64185794,"identity":"e60fc5e2-d2c5-4f1d-a5e4-5c942ba41e4f","added_by":"auto","created_at":"2024-09-09 16:21:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5541996,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4596210/v1/50429c24-036a-459b-bebd-3ef2bf224995.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eGreater Sphenoid Wing Reconstruction With 3d Printed Anatomical Intracranial Implant for a Child With Spheno- Orbital Encephalocele\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSphenoid wing dysplasia is one of the characteristics of NF1 affecting 5\u0026ndash;10% of the cases [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Congenital sphenoid wing dysplasia is one of tenet of the major diagnostic criteria for NF1 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and is often considered pathognomonic for the disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Sequelae of this deficiency include slow expansion of the middle temporal fossa and progressive herniation of the temporal lobe into the orbital cavity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], resulting in progressive pulsatile exophthalmos [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Vision loss has been noted in few of the cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Management includes reconstruction of defect [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Herein, we report a patient with greater sphenoid wing dysplasia and temporal lobe herniating through defect causing pulsatile exophthalmos and progressive vision loss.\u003c/p\u003e \u003cp\u003eLiterature review was done on PubMed central with key words \u0026rdquo;Reconstruction of Sphenoid wing dysplasia\u0026rdquo;; \u0026ldquo;Spheno-orbital Encephalocele\u0026rdquo;. Less than 11 such case reports were noted in available English literature on PubMed Central. We reviewed the relevant literature on surgical techniques and grafts utilized to separate the middle cranial fossa contents from the orbit.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eSix years old Indian male child, a known case of NF1, was referred to us with history of right eye progressive pulsatile proptosis and vision loss since 6 months. Fundus examination revealed primary optic atrophy in the affected eye with decrease in visual acuity. On examination there were multiple cafe-au- lait spots all over body with eight lesions were more than 15mm in size. A plexiform neurofibroma was also present over right eyelid. A computed tomography scan (CT) of head revealed dysplasia of right greater wing of sphenoid with displacement of right temporal lobe into orbit and displacing right orbital contents forward. Arachnoid cyst was also present at the temporal pole. [Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e] Customized anatomical 3D printed titanium implant was designed for the child considering the contents at the orbital apex. He underwent right pterional craniotomy, marsupialization of the arachnoid cyst and reconstruction of the greater wing of sphenoid with 3D printed anatomical implant. A follow up CT was showing implant in situ with no herniation of middle cranial fossa content. [Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e] During follow up, the patient was noted to develop contour irregularities of right temporal bone, mild eyelid swelling due to presence of the plexiform neurofibroma, and complete resolution of pulsatile proptosis. His vision showed improvement in acuity post-surgery. [Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFirst ever such case was reported in 1995 and since then there were many progression in treatment of sphenoid wing dysplasia using different types of grafts.\u003c/p\u003e \u003cp\u003eEncephalocele is a protrusion of cranial content beyond the normal confines of skull due to defect in bone and dura through which cranial content herniates.\u003c/p\u003e \u003cp\u003eSphenoid Encephalocele are often clinically occult and usually become apparent at the end of first decade of life. In our case of child presented with proptosis at the age of 6 years and not since birth.\u003c/p\u003e \u003cp\u003eSpheno-orbital Encephalocele are very rare, counting 5% of all basal Encephalocele and is associated with visual disturbances.\u003c/p\u003e \u003cp\u003eEncephalocele are definitively diagnosed by radiological evaluation. Computed tomography (CT) with three dimensional reconstruction and MRI provide precise information about the position of cranial bony defect and the content of cystic mass. They are valuable in determining the need for planning the extent of craniofacial reconstruction.\u003c/p\u003e \u003cp\u003eArachnoid cyst represent less than 1% of brain tumor. It can be acquired or congenital. Here we have seen its association with sphenoid wing dysplasia in our case. Upon reviewing of available literature we have detected that 43.75% cases of sphenoid wing dysplasia is associated with temporal arachnoid cyst. In our case also it was associated with temporal arachnoid cyst.\u003c/p\u003e \u003cp\u003eAfter thorough evaluation, the definitive management of sphenoid wing dysplasia is surgical intervention. Various grafts available for closure of bony defect, i.e. Bone graft, non-anatomical titanium mesh and reconstructed 3D graft. Bony graft are associated with resorption with time and recurrence of temporal pole herniation and proptosis. We have reviewed such complication in one case. Non anatomical titanium mesh has advantage over bone graft that it will not resorbed over time but it is associated with difficulty in placing to close bony defect. The advantage of 3D reconstructed implant is that it can fit the defect precisely and without much difficulty. In our study we have done marsupialization of Encephalocele and reduced content from intra-orbital compartment to intracranially and placed 3D reconstructed implant to fit the defect in such a way that it does not compress orbital apex and superior orbital fissure.\u003c/p\u003e \u003cp\u003eApproach for such defect can be extra cranial and intracranial. Extra-cranial approaches to these lesions are associated with many problems including method for treatment of these lesions. Intracranial approach is preferred option.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSphenoid wing reconstruction seems to be a reasonable surgical technique with low complication rates. It seems to prevent progression of proptosis and vision loss in children with Spheno-orbital Encephalocele. Association of temporal arachnoid cyst in these cases needs more evaluation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosures and declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no financial disclosures. Patient\u0026rsquo;s parents\u0026rsquo; consent was taken to publish radiological and intraoperative images. Patient\u0026rsquo;s identity is not revealed in the paper. \u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eAuthor contributions\u003c/h4\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr Abhishek Patel. The first draft of the manuscript was written by Dr Abhishek Patel and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBinet EF, Kieffer SA, Martin SH, Peterson HO (1969) Orbital dysplasia in neurofibromatosis. Radiology 93(4):829\u0026ndash;833. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1148/93.4.829\u003c/span\u003e\u003cspan address=\"10.1148/93.4.829\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDale EL, Strait TA, Sargent LA (2014) Orbital reconstruction for pulsatile exophthalmos secondary to sphenoid wing dysplasia. 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Pediatr NeuroSurg 44(2):133\u0026ndash;139. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000113116\u003c/span\u003e\u003cspan address=\"10.1159/000113116\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZapatero ZD, Kalmar CL, Kosyk MS, Carlson AR, Bartlett SP (2021) Sphenoid wing dysplasia in the absence of neurofibromatosis: diagnosis and management of a novel phenotype. Plast Reconstr Surg Glob Open 9(3):e3483. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/gox.0000000000003483\u003c/span\u003e\u003cspan address=\"10.1097/gox.0000000000003483\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Review of Literature\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSr No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNF1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eArachnoid cyst\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGraft used for Bony Defect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSugawara Y \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[17]\u003c/p\u003e\n \u003cp\u003e(1995)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiminished\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHydroxyapatite ceramic implant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: Status Quo\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eU Knopp \u003cem\u003eet al\u003c/em\u003e[10]\u003c/p\u003e\n \u003cp\u003e(2009)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBone defect not closed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: Decreased post-surgery, normal at 3months.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMayur Sharma \u003cem\u003eet al\u003c/em\u003e[16]\u003c/p\u003e\n \u003cp\u003e(2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiminished vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBone defect not closed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: Status quo.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMr Naveen Virin Goddard \u003cem\u003eet al\u003c/em\u003e[8]\u003c/p\u003e\n \u003cp\u003e(2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbsent Vision(2)\u003c/p\u003e\n \u003cp\u003eDiminished vision(1)\u003c/p\u003e\n \u003cp\u003eNormal vision(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent(2)\u003c/p\u003e\n \u003cp\u003eAbsent(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon anatomical titanium mesh(2)\u003c/p\u003e\n \u003cp\u003eCustomized reconstructed 3D \u0026nbsp;implant (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: NA.\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJeremy Niddam \u003cem\u003eet al\u003c/em\u003e[12]\u003c/p\u003e\n \u003cp\u003e(2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbsent Vision (1)\u003c/p\u003e\n \u003cp\u003eNormal vision(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent(1)\u003c/p\u003e\n \u003cp\u003eAbsent(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCustomized reconstructed 3D \u0026nbsp;implant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: Intact.\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDi Rocco Concezio \u003cem\u003eet al\u003c/em\u003e[3]\u003c/p\u003e\n \u003cp\u003e(2017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntact vision (1)\u003c/p\u003e\n \u003cp\u003eVision status NA (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon anatomical Titanium mesh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: Intact (1).\u003c/p\u003e\n \u003cp\u003eVision: NA (3).\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis (4).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReinhard E Friedrich[4]\u003c/p\u003e\n \u003cp\u003e(2011)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eImpaired vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon anatomical Titanium mesh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: status quo.\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eS Prathibha\u0026nbsp;\u003cem\u003eet al\u003c/em\u003e[14]\u003c/p\u003e\n \u003cp\u003e(2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntact vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePMMA bone cement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: NA\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eZachary D. Zapatero\u0026nbsp;\u003cem\u003eet al\u003c/em\u003e[19]\u003c/p\u003e\n \u003cp\u003e(2018)\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntact vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon anatomical Titanium mesh and bone graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: Intact.\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eElizabeth L Dale\u0026nbsp;\u003cem\u003eet al\u003c/em\u003e[2]\u003c/p\u003e\n \u003cp\u003e(2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntact vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon anatomical Titanium mesh and bone graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: Intact.\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRobert J. Havlik \u003cem\u003eet al\u003c/em\u003e[9]\u003c/p\u003e\n \u003cp\u003e(1998)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntact vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBone graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResorption of bone graft\u003c/p\u003e\n \u003cp\u003eRecurrence of Proptosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOur Case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiminished Vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCustomized reconstructed 3D \u0026nbsp;implant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVision: Intact.\u003c/p\u003e\n \u003cp\u003eResolution of Proptosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"childs-nervous-system","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cnsy","sideBox":"Learn more about [Child's Nervous System](http://link.springer.com/journal/381)","snPcode":"381","submissionUrl":"https://submission.nature.com/new-submission/381/3","title":"Child's Nervous System","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Sphenoid wing dysplasia, Spheno-orbital Encephalocele, 3D printed titanium mesh, Pulsatile Proptosis","lastPublishedDoi":"10.21203/rs.3.rs-4596210/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4596210/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSphenoid wing dysplasia is a characteristic finding in children with Neurofibromatosis Type 1(NF1). Six years old boy presented to us with painless progressive uni-ocular vision loss and progressive pulsatile proptosis. Imaging revealed spheno-orbital encephalocele into the orbit through the dysplastic posterior orbital wall. 3D printed customized implant was designed and placed to fit the defect and prevent further herniation of temporal lobe in to the orbit.\u003c/p\u003e","manuscriptTitle":"Greater Sphenoid Wing Reconstruction With 3d Printed Anatomical Intracranial Implant for a Child With Spheno- Orbital Encephalocele","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 16:48:08","doi":"10.21203/rs.3.rs-4596210/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-17T08:19:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-05T22:57:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211115149844850390400699917533016436403","date":"2024-06-24T05:27:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303608464400224790412259403097418453616","date":"2024-06-23T12:39:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-22T09:40:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-19T04:46:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-19T04:44:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Child's Nervous System","date":"2024-06-17T22:24:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"childs-nervous-system","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cnsy","sideBox":"Learn more about [Child's Nervous System](http://link.springer.com/journal/381)","snPcode":"381","submissionUrl":"https://submission.nature.com/new-submission/381/3","title":"Child's Nervous System","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9a7d6955-9593-45b6-95e0-15285f7e24e4","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T16:11:39+00:00","versionOfRecord":{"articleIdentity":"rs-4596210","link":"https://doi.org/10.1007/s00381-024-06587-2","journal":{"identity":"childs-nervous-system","isVorOnly":false,"title":"Child's Nervous System"},"publishedOn":"2024-09-02 16:05:17","publishedOnDateReadable":"September 2nd, 2024"},"versionCreatedAt":"2024-07-16 16:48:08","video":"","vorDoi":"10.1007/s00381-024-06587-2","vorDoiUrl":"https://doi.org/10.1007/s00381-024-06587-2","workflowStages":[]},"version":"v1","identity":"rs-4596210","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4596210","identity":"rs-4596210","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}