Asunto(s)
Neoplasias Encefálicas/cirugía , Glioblastoma/cirugía , Recurrencia Local de Neoplasia/etiología , Neoplasias Encefálicas/diagnóstico por imagen , Craneotomía/efectos adversos , Progresión de la Enfermedad , Glioblastoma/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagenRESUMEN
A case of the syndrome of the trephined progressing to paradoxical herniation is presented in a patient with a penetrating brain injury, postdecompressive craniectomy, and a delayed cerebral spinal fluid leak from a skull base defect. The patient had a penetrating head trauma from a high-velocity ballistic projectile during military wartime operations. The patient's clinical course, which demonstrates a rare presentation of central sleep apnea syndrome or Ondine's curse, is reviewed. Radiographic imaging includes sequential computed tomography (CT) scans with and without intrathecal contrast. Medical management was directed at increasing the intracranial pressures (ICPs) by placing the patient into Trendelenburg position and increasing hydration. Surgical intervention involved correction of the skull base defect by intranasal endoscopic repair. A literature review of paradoxical herniation and delayed neurologic decline in postcraniectomy patients is conducted, and the surgical and neurocritical care management is discussed.
Asunto(s)
Endoscopía/métodos , Traumatismos Penetrantes de la Cabeza/cirugía , Base del Cráneo/lesiones , Base del Cráneo/cirugía , Fracturas Craneales/cirugía , Heridas por Arma de Fuego/cirugía , Campaña Afgana 2001- , Descompresión Quirúrgica , Progresión de la Enfermedad , Traumatismos Penetrantes de la Cabeza/diagnóstico por imagen , Traumatismos Penetrantes de la Cabeza/etiología , Traumatismos Penetrantes de la Cabeza/fisiopatología , Humanos , Presión Intracraneal , Masculino , Posicionamiento del Paciente , Base del Cráneo/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Fracturas Craneales/etiología , Fracturas Craneales/fisiopatología , Trastornos Intrínsecos del Sueño/diagnóstico por imagen , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/fisiopatología , Trastornos Intrínsecos del Sueño/terapia , Punción Espinal , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/fisiopatología , Adulto JovenRESUMEN
Authors of this report describe a Fukushima Type D(b) or Kawase Type ME2 trigeminal schwannoma involving the right maxillary division in a 59-year-old woman who presented with intermittent right-sided facial numbness and pain. This tumor was successfully resected via a right lateral orbitotomy without the need for craniotomy. This novel approach to a lesion of this type has not yet been described in the scientific literature. The outcome in this case was good, and the patient's intra- and postoperative courses proceeded without complication. The epidemiology of trigeminal schwannomas and some technical aspects of lateral orbitotomy, including potential advantages of this approach over traditional transcranial as well as fully endoscopic dissections in appropriately selected cases, are also briefly discussed.