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2.
No Shinkei Geka ; 52(2): 320-326, 2024 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-38514121

RESUMO

Preoperative simulation images creates an accurate visualization of a surgical field. The anatomical relationship of the cranial nerves, arteries, brainstem, and related bony protrusions is important in skull base surgery. However, an operator's intention is unclear for a less experienced neurosurgeon. Three-dimensional(3D)fusion images of computed tomography and magnetic resonance imaging created using a workstation aids precise surgical planning and safety management. Since the simulation images allows to perform virtual surgery, a déjà vu effect for the surgeon can be obtained. Additionally, since 3D surgical images can be used for preoperative consideration and postoperative verification, discussion among the team members is effective from the perspective of surgical education for residents and medical students. Significance of preoperative simulation images will increase eventually.


Assuntos
Neoplasias da Base do Crânio , Base do Crânio , Humanos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Base do Crânio/patologia , Imageamento Tridimensional/métodos , Neoplasias da Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X/métodos , Procedimentos Neurocirúrgicos/métodos , Imageamento por Ressonância Magnética/métodos
3.
No Shinkei Geka ; 52(2): 327-334, 2024 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-38514122

RESUMO

With the development of endoscopic and peripheral instruments, endonasal or transcranial endoscopic surgery for skull-base tumors has become more common. Preoperative simulation makes it relatively easy to understand the anatomical relationship between skull base tumors and the surrounding vital structures, which vary with each case. This may lead to the avoidance of complications and an improvement in the removal rate. Especially in cases of skull base tumors where multiple surgical approaches are possible, the three-dimensional model can be used to confirm the surgical field for each approach and consider the most appropriate. With the development of endovascular treatment and radiotherapy, experience in craniotomy has decreased. Young neurosurgeons need to develop skills to learn as efficiently as possible from their limited experience. Therefore, it is extremely useful to provide an environment that allows for easier preoperative simulations.


Assuntos
Neoplasias da Base do Crânio , Humanos , Neoplasias da Base do Crânio/cirurgia , Neoplasias da Base do Crânio/patologia , Endoscopia/métodos , Nariz/cirurgia , Craniotomia , Base do Crânio/cirurgia , Base do Crânio/patologia
4.
Otol Neurotol ; 45(4): e351-e358, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38437814

RESUMO

OBJECTIVE: To characterize the opioid prescribing patterns for and requirements of patients undergoing repair of spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Adults with lateral skull base sCSF leaks who underwent repairs between September 1, 2014, and December 31, 2020. MAIN OUTCOME MEASURE: Mean morphine milligram equivalents (MMEs) of opioids dispensed to inpatients and prescribed at discharge, additional pain control medications dispensed, and outpatient additional opioid requests were compared between groups. RESULTS: Of 78 patients included, 46 (59%) underwent repair via a transmastoid (TM), 6 (7.7%) via a middle cranial fossa (MCF), and 26 (33.3%) via a combined TM-MCF approach. Inpatients received a mean of 21.3, 31.4, and 37.6 MMEs per day during admission for the TM, MCF, and combined TM-MCF approaches, respectively ( p = 0.019, ηp 2 = 0.101). Upon discharge, nearly all patients (n = 74, 94.9%) received opioids; 27.3, 32.5, and 37.6 MMEs per day were prescribed after the TM, MCF, and TM-MCF approaches, respectively ( p = 0.015, ηp 2 = 0.093). Five (6.4%) patients requested additional outpatient pain medication, after which three were prescribed 36.7 MMEs per day. Patients with idiopathic intracranial hypertension required significantly more inpatient MMEs than those without (41.5 versus 25.2, p = 0.02, d = 0.689), as did patients with a history of headaches (39.6 versus 23.6, p = 0.042, d = 0.684). CONCLUSIONS: Patients undergoing sCSF leak repair via the MCF or TM-MCF approaches are prescribed more opioids postoperatively than patients undergoing the TM approach. Patients with a history of headaches or idiopathic intracranial hypertension might require more opioids postoperatively.


Assuntos
Analgésicos Opioides , Pseudotumor Cerebral , Adulto , Humanos , Analgésicos Opioides/uso terapêutico , Estudos Retrospectivos , Pseudotumor Cerebral/tratamento farmacológico , Padrões de Prática Médica , Base do Crânio/cirurgia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Dor , Cefaleia , Dor Pós-Operatória/tratamento farmacológico
5.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 42(1): 104-110, 2024 Feb 01.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-38475958

RESUMO

OBJECTIVES: With the assistance of 3D visualization and real-time navigation technologies, the tumors in the parapharyngeal and lateral skull base should be removed through oral the approach with endoscopy. METHODS: The preoperative CT data of eight patients with parapharyngeal or lateral skull base soft tissue tumors were modeled, and the anatomical position relationship between the tumor and surrounding blood vessels and other important structures was reconstructed using 3D visualization technology, and preoperative design was performed. The intraoperative oral approach and real-time navigation guidance were adopted in the endoscopic resection of soft tissue tumors in the parapharyngeal and lateral skull base, and the clinical application value of this method was evaluated. RESULTS: The blood loss during the operation was controlled within 150 mL, and the average blood loss was approximately 125 mL. The incidence of postoperative complications was low, and patients could recover well through functional training. The oral approach did not leave any wounds nor scars on the patient's facial skin after the operation and had no effect on the patient's appearance. CONCLUSIONS: The combination of 3D visualization technology, intraoperative real-time navigation, and endoscopy provides a beautiful, safe, and minimally invasive surgical method for patients with parapharyngeal or lateral skull base tumors.


Assuntos
Neoplasias da Base do Crânio , Neoplasias de Tecidos Moles , Humanos , Neoplasias da Base do Crânio/cirurgia , Imageamento Tridimensional , Endoscopia/métodos , Base do Crânio/cirurgia
6.
Otol Neurotol ; 45(3): 215-222, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38361289

RESUMO

OBJECTIVES: Describe the diagnosis and management of a spontaneous cerebrospinal fluid leak (sCSF-L) through the facial nerve fallopian canal and determine the role of intracranial hypertension (IH). STUDY DESIGN: Retrospective case study and systematic review of the literature. METHODS: Reviewed patient characteristics, radiographic findings, and management of the facial nerve canal CSF leak and postoperative IH. Conducted systematic literature review according to the PRISMA guidelines for surgical management and rates of IH. RESULTS: A 50-year-old female with bilateral tegmen defects and temporal encephaloceles underwent left middle cranial fossa (MCF) repair. Intraoperative CSF egressed from the temporal bone tegmen defects. Facial nerve decompression revealed CSF leak from the labyrinthine segment. A nonocclusive temporalis muscle plug was placed in the fallopian canal, and tegmen repair was completed with bone cement. A ventriculoperitoneal shunt was placed for IH. Postoperative facial nerve function and hearing were normal. A total of 20 studies met inclusion criteria with a total of 25 unique patients. Of 13 total adult cases of fallopian canal CSF leak, there is a 46% recurrence rate, and 86% of patients had documented IH when tested. CONCLUSIONS: Fallopian canal CSF leaks are rare and challenging to manage. Assessment of intracranial hypertension and CSF diversion is recommended along with MCF skull base repair to preserve facial nerve function and conductive hearing.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Hipertensão Intracraniana , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Vazamento de Líquido Cefalorraquidiano/cirurgia , Vazamento de Líquido Cefalorraquidiano/complicações , Base do Crânio/cirurgia , Fossa Craniana Média/cirurgia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia
8.
Medicina (Kaunas) ; 60(2)2024 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-38399622

RESUMO

Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.


Assuntos
Realidade Aumentada , Neurocirurgia , Cirurgia Assistida por Computador , Humanos , Cirurgia Assistida por Computador/métodos , Neuronavegação/métodos , Base do Crânio/cirurgia
9.
BMJ Case Rep ; 17(2)2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38417939

RESUMO

Skull base osteomyelitis can be more life-threatening in immunocompromised patients and patients with diabetes. Here, we present a case of a petrous internal carotid artery pseudoaneurysm resulting from skull base osteomyelitis in a diabetic male in his 50s. This case report highlights the need to be conscious of the various complications associated with skull base osteomyelitis, be proficient in detecting them and treat them as early as possible for better outcomes. After adequate control of the disease process with medical treatment, immediate management of the aneurysm with balloon angioplasty and stenting was done. Acknowledging the trivial nasal and ear bleed, radiological evaluation is necessary to rule out rare complications like pseudoaneurysms in a diagnosed case of skull base osteomyelitis. In the discussion, we have cited the various treatment methods and similar cases of pseudoaneurysm caused by osteomyelitis. Currently, the patient continues to live a disease and disability-free life.


Assuntos
Falso Aneurisma , Aneurisma , Osteomielite , Humanos , Masculino , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Aneurisma/complicações , Radiografia , Artéria Carótida Interna/cirurgia , Osteomielite/diagnóstico por imagem , Osteomielite/terapia , Osteomielite/complicações
10.
Acta Neurochir (Wien) ; 166(1): 99, 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38388836

RESUMO

BACKGROUND: To treat extradural solid-cystic lesions of the ventral skull base, a pedicled nasoseptal flap (NSF) maintains patency of the marsupialized cavity and prevents restenosis and cyst recurrence. METHODS: The authors provide a step-by-step description of the surgical technique valid in different lesions of the skull base, all treated via the endoscopic endonasal approach (EEA). The application is demonstrated by an operative video. CONCLUSION: In selected lesions, endoscopic marsupialization using an NSF ensures drainage and ventilation of the surgical cavity. Re-epithelialization provided by a pedicled flap is a viable alternative to multilayer skull base reconstruction.


Assuntos
Procedimentos de Cirurgia Plástica , Humanos , Vazamento de Líquido Cefalorraquidiano , Endoscopia/métodos , Nariz/cirurgia , Estudos Retrospectivos , Base do Crânio/cirurgia , Retalhos Cirúrgicos/cirurgia
11.
J Craniomaxillofac Surg ; 52(3): 302-309, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38368207

RESUMO

The present study aimed to investigate outcomes following open surgery for extensive skull base ORN. Open surgery through a personalized sequential approach was employed to deal with five cases of extensive skull base ORN. Two patients with mild cases underwent regional debridement and sequestrectomy, and three patients with severe cases underwent extensive resection with reconstruction using free anterolateral thigh (ALT) flap. Biological glues and vascularized flaps were used for obturation of the skull base bony defect to prevent postoperative cerebrospinal fluid (CSF) leakage. The infections were controlled by antibiotic administrations which strictly followed the principles of antimicrobial stewardship (AMS). As results, both regional debridement plus sequestrectomy and extensive resection achieved satisfied outcomes in all patients. No severe complications and delayed hospitalization occurred. During the follow-up period (8-19 months), all patients were alive, pain free, without crusting or purulent discharge, and no sequestration or CSF leakage occurred. In conclusion, a personalized sequential approach including open surgery, pedicled/vascularized free flap reconstruction and AMS was advocated for patients with extensive skull base ORN.


Assuntos
Retalhos de Tecido Biológico , Osteorradionecrose , Procedimentos de Cirurgia Plástica , Neoplasias da Base do Crânio , Humanos , Osteorradionecrose/cirurgia , Osteorradionecrose/complicações , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/cirurgia , Retalhos de Tecido Biológico/cirurgia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Estudos Retrospectivos , Complicações Pós-Operatórias/cirurgia
12.
J Craniomaxillofac Surg ; 52(3): 385-392, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38369396

RESUMO

This study investigated how the fusion states of the cranial base is related to the degree of increased intracranial pressure (ICP) in patients with Crouzon syndrome. This retrospective cohort study enrolled patients who were diagnosed with Crouzon syndrome between May 2007 and April 2022. We categorized the patients into three groups: A, B, and C, according to the severity of increased ICP and the number of cranial vault remodeling procedures for corrective operation. The preoperative fusion states of the cranial base sutures/synchondroses were examined using facial bone computed tomography and compared between groups. Overall, 22 patients were included in Groups A, B, and C, including 8, 7, and 7 patients, respectively. The preoperative average grades of the total cranial base suture/synchondrosis fusion appeared to significantly increase with severity, except for the frontoethmoidal suture, which showed the opposite tendency. In the subgroup analysis, frontosphenoidal, sphenoparietal, sphenosquamosal, parietomastoid, and occipitomastoid suture and petro-occipital synchondrosis were associated with earlier fusion in the more severe group. Premature closure of the cranial base sutures/synchodroses seems to be associated with increased ICP severity in patients with Crouzon syndrome. Precise evaluation of minor sutures/synchondroses at the first visit might help build subsequent operative plans and predict disease prognosis.


Assuntos
Disostose Craniofacial , Craniossinostoses , Humanos , Estudos Retrospectivos , Pressão Intracraniana , Suturas Cranianas/diagnóstico por imagem , Suturas Cranianas/cirurgia , Disostose Craniofacial/diagnóstico por imagem , Disostose Craniofacial/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Suturas , Craniossinostoses/complicações , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/cirurgia
13.
HNO ; 72(4): 265-271, 2024 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-38393669

RESUMO

BACKGROUND: Extended endoscopic endonasal surgery (EEES) is an essential part of treatment of various pathologies of the anterior skull base. In addition to significant improvements in the quality of life of affected patients and a lower complication profile compared to open skull base surgery, the therapeutic results are comparable if the indications are correct. MATERIALS AND METHODS: Data of all endoscopic endonasal skull base procedures performed at the University Skull Base Center Hamburg under the direction of the Department of Otorhinolaryngology between June 2018 and November 2022 were retrospectively collected. RESULTS: A total of 50 cases were identified. Of these, 56% (28/50) were malignant tumors, 24% (12/50) were benign pathologies with direct skull base involvement, and 20% (10/50) were anterior skull base defects with rhinoliquorrhea. In 96% (48/50) of cases, the preoperatively set goal of surgery (representative biopsy, complete resection, closure of the skull base defect) could be achieved. Complications grade III or higher according to Clavien-Dindo occurred in 4/50 cases. During the observation period, n = 5 olfactory neuroblastomas were diagnosed, all of which were exclusively and successfully operated on endoscopically. CONCLUSION: In recent years, the spectrum of endoscopically resectable pathologies of the anterior skull base has steadily expanded. In particular, midline-related tumors such as olfactory neuroblastoma or iatrogenic/idiopathic skull base defects with cerebrospinal fluid rhinorrhea are treated completely endoscopically with very good results. Nevertheless, there are also limitations to this technique. Due to high variance in the scope of frontobasal surgery, the extent, and the complex anatomy, as well as the overlapping responsibilities of the specialist disciplines, establishment of certified skull base centers and bundling of frontobasal surgery at these centers is highly relevant for quality assurance.


Assuntos
Rinorreia de Líquido Cefalorraquidiano , Qualidade de Vida , Humanos , Estudos Retrospectivos , Base do Crânio/cirurgia , Base do Crânio/patologia , Endoscopia/métodos , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/patologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia
14.
Artigo em Chinês | MEDLINE | ID: mdl-38297858

RESUMO

The application of microscope is a milestone in the history of otosurgery, which makes otologists deal with middle ear lesions more clearly and finely, and helps otologists expand the scope of treatment to the lateral skull base area, which greatly promotes the development of otosurgery. In the past 20 years, with the continuous improvement of endoscopic equipment research and development and the gradual improvement of endoscopic technology, the application of endoscopic technology in China has shown an explosive development, and Chinese otolaryngologists have experienced from the initial attempts of endoscopic technology, to the widespread popularization of innovative and applicable technology, and then to the feasibility of exploring the future innovative concepts. Endoscopic technology is another revolutionary push for the development of otosurgery after the microscope.


Assuntos
Invenções , Procedimentos Cirúrgicos Otológicos , Humanos , Endoscopia , Orelha Média/cirurgia , Base do Crânio/cirurgia
16.
Neuroradiology ; 66(3): 417-425, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38197949

RESUMO

PURPOSE: Although CT-guided biopsies of the calvarium, skull base, and orbit are commonly performed, the best approaches, efficacy, and safety of such procedures remain scantly described in the literature. This retrospective review of percutaneous biopsies illustrates several approaches to challenging biopsy targets and provides a review of procedural planning considerations and histopathologic yield. METHODS: A retrospective review of CT-guided biopsies of the skull base, calvarium, and orbit between 1/1/2010 and 10/30/2020 was conducted. Patient demographics and procedural factors were recorded, including lesion size and location, biopsy approach, and needle gauge. Outcomes were also noted, including CT dose length product, complications, and histopathologic yield. RESULTS: Sixty-one CT-guided biopsies were included in the final analysis: 34 skull base, 23 calvarial, and 4 orbital lesions. The initial diagnostic yield was 32/34 (94%) for skull base lesions, with one false-negative and one non-diagnostic sample. Twenty-one of twenty-three (91%) biopsies in the calvarium were initially diagnostic, with one false-negative and one non-diagnostic sample. In the orbit, 4/4 biopsies were diagnostic. The total complication rate for the cohort was 4/61 (6.6%). Three complications were reported in skull base procedures (2 immediate and 1 delayed). A single complication was reported in a calvarial biopsy, and no complications were reported in orbital biopsies. CONCLUSION: Percutaneous CT-guided core needle biopsies can be performed safely and with a high diagnostic yield for lesions in the skull base, calvarium, and orbit.


Assuntos
Cabeça , Órbita , Humanos , Órbita/diagnóstico por imagem , Base do Crânio/diagnóstico por imagem , Biópsia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X/métodos , Estudos Retrospectivos
17.
Otolaryngol Head Neck Surg ; 170(4): 1140-1146, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38167791

RESUMO

OBJECTIVE: To characterize the short-term outcomes of patients undergoing surgical repair of lateral skull base cerebrospinal fluid (CSF) leaks followed by a shortened length of stay (LOS) protocol. STUDY DESIGN: Retrospective study. SETTING: Tertiary medical center. METHODS: A total of 156 adult patients from July 2016 to December 2022 who underwent repair of CSF leaks via transmastoid (TM), middle cranial fossa (MCF), or combined (TM/MCF) approaches were included. Data collected included: LOS, presentation to the emergency department (ED), need for readmission, major neurologic complications (stroke, seizure, and meningitis), and CSF leak recurrence. RESULTS: Approximately half of patients underwent a TM repair (49.4%), whereas the other half underwent either an MCF (3.8%) or combined TM/MCF repair (46.8%). No peri-/postoperative lumbar drains were used and only 2 (1.3%) patients were admitted to the intensive care unit after surgery. Mean LOS for the cohort was 1.1 ± 0.7 days and was longer for surgeries involving MCF (1.3 ± 0.6) compared to TM (0.8 ± 0.7). Ninety-two percent of TM cases were discharged within 24 hours (32% on the same day) while for cases involving an MCF approach, 72.2% of patients were discharged within 24 hours. Of the patients in the study, 6 (3.8%) presented to an ED for minor complications and no patient required readmission. Revision surgery was required for 3 (1.9%) patients for recurrent CSF leak. CONCLUSION: Our findings suggest that short LOS after surgical repair of lateral skull base defects in the treatment of CSF leak is safe and effective.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Base do Crânio , Adulto , Humanos , Estudos Retrospectivos , Tempo de Internação , Resultado do Tratamento , Vazamento de Líquido Cefalorraquidiano/cirurgia , Vazamento de Líquido Cefalorraquidiano/complicações , Base do Crânio/cirurgia , Complicações Pós-Operatórias/etiologia
18.
Otolaryngol Head Neck Surg ; 170(4): 1190-1194, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38230445

RESUMO

Robotic-assisted surgery has gained popularity for otolaryngology procedures. It provides high-definition images and surgical precision to perform diverse procedures. It is an alternative to the operating microscope, endoscope, or exoscope when reaching hidden anatomical structures in the ear. In this proof-of-concept study, we aim to demonstrate the possibility of using a robotic-assisted device to perform ear surgery in conjunction with the microscope or the endoscope. In total, there were 9 ear and lateral skull base procedures performed with the use of robotic-assisted surgery. All surgeons underwent surveys to assess the performance and workload of the device compared to the microscope or endoscope. There were no postoperative complications. Robotic-assisted surgery was optimal for providing high image quality, ergonomics, and maintaining surgical performance. The size of the device and mental demand were higher compared to the microscope or endoscope. Robotic-assisted surgery can be an adjuvant to perform otologic and neurotologic surgery.


Assuntos
Procedimentos Cirúrgicos Otológicos , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Neurocirúrgicos/métodos , Base do Crânio/cirurgia , Endoscópios , Procedimentos Cirúrgicos Otológicos/métodos
19.
STAR Protoc ; 5(1): 102831, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38277268

RESUMO

We present a protocol for the rapid postmortem bedside procurement of selected tissue samples using an endoscopic endonasal surgical technique that we adapted from skull base surgery. We describe steps for the postmortem collection of blood, cerebrospinal fluid, a nasopharyngeal swab, and tissue samples; the clean-up procedure; and the initial processing and storage of the samples. This protocol was validated with tissue samples procured postmortem from COVID-19 patients and can be applied in another emerging infectious disease. For complete details on the use and execution of this protocol, please refer to Khan et al. (2021)1 and Khan et al. (2022).2.


Assuntos
Procedimentos de Cirurgia Plástica , Humanos , Base do Crânio/cirurgia , Endoscopia/métodos , Mucosa Olfatória/cirurgia , Lobo Frontal/cirurgia
20.
BMJ Case Rep ; 17(1)2024 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-38238161

RESUMO

A man in his 30s, with sinonasal undifferentiated carcinoma status post resection 6 years prior, presented with acute onset of fever, headache and altered mentation. The patient was diagnosed with bacteremia and meningitis due to Streptococcus pneumoniae A standard antibiotic and corticosteroid regimen was started. Brain MRI showed an encephalocele abutting the superolateral nasopharynx mucosa. After several days of clinical improvement, the patient's mental status and headache acutely relapsed. A CT head venogram showed a large volume pneumocephalus originating from the region of a surgical defect. Management included external ventricular drain placement followed by right pterional craniotomy with skull base packing. Skull base defects increase the risk of life-threatening conditions such as bacterial meningitis and pneumocephalus. It is crucial for clinicians to be aware of the possibility of cranial surgical defects developing years after surgery.


Assuntos
Meningites Bacterianas , Pneumocefalia , Masculino , Humanos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Base do Crânio/cirurgia , Antibacterianos/uso terapêutico , Cefaleia/tratamento farmacológico
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