<![CDATA[Background: Meningoencephalocele is a rare congenital neural tube defect with herniation of meninges and brain tissue through a skull defect. Large occipital meningoencephaloceles in neonates pose surgical challenges due to fragile tissues, limited physiological reserve, and high risk of CSF leakage and infection. While neurosurgical principles are established, optimal soft-tissue reconstruction in neonates is underreported. Objective: This case report describes a multidisciplinary surgical approach and reconstructive strategy for a neonatal occipital meningoencephalocele, emphasizing plastic and reconstructive considerations supporting neurosurgical objectives. Method: An 11-day-old female neonate presented with a large midline occipital mass noted since birth. Examination revealed a soft, fluctuant, skin-covered lesion without neurological deficit or infection. Imaging showed an occipital skull defect with herniation of meninges and brain tissue, consistent with occipital meningoencephalocele. After evaluation, staged surgical management was performed. Neurosurgical excision of non-functional herniated tissue and watertight dural closure was followed by scalp reconstruction using a local occipital flap for tension-free coverage. Result: The patient underwent staged neurosurgical excision and watertight dural repair followed by tension-free scalp reconstruction using a local occipital rotation flap. The post-excisional soft-tissue defect measured approximately 8 × 6 cm. Total operative time was about 180 minutes. No intraoperative complications occurred. Postoperatively, the neonate showed stable wound healing without CSF leakage, wound dehiscence, infection, or neurological deterioration during early follow-up. Conclusion: A staged, multidisciplinary approach combining precise neurosurgical repair with local flap reconstruction can achieve safe closure, protect neural structures, and provide durable functional and aesthetic outcomes in neonatal occipital meningoencephalocele.]]>
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