Frontonasoethmoidal Encephalocele

Frontonasoethmoidal Encephaloceles are rare herniations of neurologic tissue through the upper face that occur at birth and cause malformations between the eyes. Specifically, this involves the supraorbital, medial canthal, and nasal bones. The skeletal malformation is caused by the ‘pushing’ out of the brain lining and brain-like tissues is analogous to a flower opening up (where the bones are like pedals moving out of anatomic place).


-To rid the central face of the malformation so there is a normal appearance.

-To reduce the chance of infection (meningitis) spread from the contaminated nasal sinus mucosa.


  • Bradley devised the ‘HULA’ procedure from cases he performed in Hawaii. This is aimed at obtaining the best functional and cosmetic result.
  • Both intra and extracranial approaches are used to safely gain a full correction.
  • The abnormal neurologic tissues are removed, brain is safely sealed off, and orbital/canthal/nasal bones are placed or grafted into normal locations.


  • Do all encephaloceles need the same type of surgery?

No, there are variations in types of encephaloceles based on location and severity. Dr. Bradley has designed procedures for each of these variations.

  • How many surgical procedures will it take?

It may only take one procedure to correct the encephalocele if performed at the optimal time between ages 3 and 12 years. However, small revision procedures are sometimes necessary.