• Ricky Ma, Jason Brown, and Matthew Careskey.
• From the John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
• A A Pract. 2024 Jul 1; 18 (7): e01809e01809.

AbstractAnterior encephaloceles are rare neural tube defects posing anesthetic challenges. While anterior encephaloceles can cause airway obstruction at birth, this presentation is very rare and to our knowledge not reported in the literature. This case report describes a 34 weeks +0 days gestation, 2.6 kg, newborn with a massive nasoethmoidal anterior encephalocele creating significant external airway obstruction, necessitating emergent and thoughtful airway management and anesthetic care. Our most important perioperative considerations for this newborn included spontaneous ventilation using awake fiberoptic bronchoscopic intubation with lidocaine airway topicalization, secure endotracheal tube attachment, and avoiding noninvasive positive airway pressure postoperatively to avoid pneumocephalus.Copyright © 2024 International Anesthesia Research Society.

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