Background: Congenital cranial encephalocele carries significant morbidity. This study aims to analyze the prognostic factors and surgical outcomes of congenital encephaloceles, with a specific focus on validating a hydrocephalus prediction score. This study aimed to improve the outcome of surgical management of congenital cranial encephalocele. Methods: A combined prospective-retrospective observational study was conducted on 72 pediatric patients with congenital cranial encephaloceles treated at a single institution. Data on demographics, clinical presentation, encephalocele morphology, surgical management, and postoperative course were collected. The primary outcomes were neurodevelopmental status and mortality at six months. The Kankam hydrocephalus prediction score was applied to all patients. Results: The cohort had a mean surgical age of 1.5 months and a slight male predominance (56.9%). Key preoperative risk factors included consanguinity (52.8%), lack of folic acid supplementation (55.6%), and low socioeconomic status (93.1%). Associated cranial anomalies were present in 72.2% of patients. The observed incidence of shunt-dependent hydrocephalus was 61.1%, closely aligning with the Kankam score's prediction. At six-month follow-up, 25% of patients had normal development, 54.2% had delayed development, and 20.8% died. Multivariable analysis identified the presence of other cranial anomalies (p<0.001), functioning brain tissue within the sac (p<0.001), large sac size (p<0.001), and ulcerated overlying skin (p<0.001) as significant predictors of poor outcome. Conclusions: The prognosis of posterior encephalocele is determined by a combination of non-modifiable factors and modifiable preoperative, surgical and postoperative factors. The Kankam hydrocephalus prediction score is a valid and useful preoperative tool