Seasonal variations in frontoethmoidal meningoencephalocele births in Cambodia

Clinical article

Restricted access


Frontoethmoidal meningoencephalocele (fMEC) is relatively common in many Southeast Asian countries, with devastating aesthetic and social consequences for affected children. No cause has been detected to date. Among other factors, the authors of this paper attempt to identify a statistically significant difference in the spread of fMEC births throughout the year compared with other births. This seasonal variation in the incidence of fMEC births may provide clues to the causes of this condition.


From a group of 175 children with fMEC who underwent surgery at the authors' humanitarian institution (Children's Surgical Centre) in Phnom Penh between 2004 and 2008, 86 children were studied. These children were born at full term and had an accurately recorded date of birth. The birth dates of this fMEC group were compared with a group of > 15,000 other live births at one of the main maternity units in Phnom Penh in 2005 and 2006.


Seasonal variation in incidence of fMEC by month of birth was highly statistically significant (p < 0.001), with the peak of births occurring in the dry season (between March and May). This is in contrast to the control group, in which there was an equal distribution of births throughout the year. More than 85% of the parents of children with fMEC who the authors treated were farmers, but this figure reflects the composition of the Cambodian population.


Uneven spread in the incidence of fMEC births throughout the year suggests that a seasonal factor during the wet season may be suspected in the pathogenesis of fMEC in Cambodia.

Abbreviation used in this paper: fMEC = frontoethmoidal meningoencephalocele.

Article Information

Address correspondence to: Franck-Emmanuel Roux, M.D., Ph.D., INSERM 825 et Service de Neurochirurgie, Hôpital Purpan, F-31059 Toulouse, France. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Data of the birth dates from 86 children born with fMEC and from a control group of > 15,000 children born in the main maternity unit in Phnom Penh between 2005 and 2006. A: Photographs of 2 children suffering from fMEC. B: Graph showing the birth dates of the children affected with fMEC. A large group of children with fMEC were born during the dry season in Cambodia (March–May). C: Graph showing the birth dates of > 15,000 children (2005 and 2006 data) born in the main maternity unit of Phnom Penh. The number of births per month is almost stable with no seasonal variations.


  • 1

    Amaratunga NA: A study of etiologic factors for cleft lip and palate in Sri Lanka. J Oral Maxillofac Surg 47:7101989

  • 2

    De la Vega AMartinez E: Seasonal variation in the incidence of cleft lip and palate based on the age of conception. P R Health Sci J 25:3433462006

    • Search Google Scholar
    • Export Citation
  • 3

    De Vries HRMaxwell SMHendrickse RG: Foetal and neonatal exposure to aflatoxins. Acta Paediatr Scand 78:3733781989

  • 4

    Flatz G: Fronto-ethmoidal encephalomeningoceles in the population of northern Thailand. Humangenetik 11:181970

  • 5

    Hoving EWVermeij-Keers CMommaas-Kienhuis AMHartwig NG: Separation of neural and surface extoderm after closure of the rostral neuropore. Anat Embryol (Berl) 182:4554631990

    • Search Google Scholar
    • Export Citation
  • 6

    Huber SFieder M: Strong association between birth month and reproductive performance of Vietnamese women. Am J Hum Biol 21:25352009

    • Search Google Scholar
    • Export Citation
  • 7

    National Institute of Statistics Ministry of Planning Ministry of Health: Cambodia Demographic and Health Survey 2000. Preliminary Report Phnom Penh, CambodiaNational Institute of Statistics2000. ( [Accessed 24 July 2009]

    • Search Google Scholar
    • Export Citation
  • 8

    Roux FELauwers FOucheng NSay BJoly BGollogly J: Treatment of frontoethmoidal meningoencephalocele in Cambodia: a low-cost procedure for developing countries. J Neurosurg 107:11212007

    • Search Google Scholar
    • Export Citation
  • 9

    Suwanwela CSuwanwela N: A morphological classification of sincipital encephalomeningoceles. J Neurosurg 36:2012111972

  • 10

    Thu AKyu H: Epidemiology of frontoethmoidal encephalomeningocoele in Burma. J Epidemiol Community Health 38:89981984

  • 11

    Wang SLHuang CSChen YRNoordhoff MS: [Cleft lip and cleft palate in the Craniofacial Center, Chang Gung Memorial Hospital: incidence, sex, seasonality and topographic distribution.]. Changgeng Yi Xue Za Zhi 12:2152241989. (Chinese)

    • Search Google Scholar
    • Export Citation
  • 12

    Wangikar PBDwivedi PSharma AKSinha N: Effect in rats of simultaneous prenatal exposure to ochratoxin A and aflatoxin B1. II. Histopathological features of teratological anomalies induced in fetuses. Birth Defects Res B Dev Reprod Toxicol 71:3523582004

    • Search Google Scholar
    • Export Citation
  • 13

    Whatmore WJ: Sincipital encephaloceles. Br J Surg 60:2612701973

  • 14

    Wie XSulik KK: Pathogenesis of craniofacial and body wall malformations induced by ochratoxin A in mice. Am J Med Genet 47:8628711993

    • Search Google Scholar
    • Export Citation
  • 15

    Wilcox AJLie RTSolvoll KTaylor JMcConnaughey DRAbyholm F: Folic acid supplements and risk of facial clefts: national population based case-control study. BMJ 334:4642007

    • Search Google Scholar
    • Export Citation




All Time Past Year Past 30 Days
Abstract Views 139 139 43
Full Text Views 51 51 0
PDF Downloads 64 64 0
EPUB Downloads 0 0 0


Google Scholar