OBJECTIVES: To describe surgical experience in the repair of anterior skull base defects, we studied patients with congenital or acquired defects. According to a multidisciplinary evaluation, all subjects underwent surgery performed by an ENT surgeon in order to avoid craniotomy. DESIGN: Retrospective study of patients who were treated for an anterior skull base defect between 2000 and 2005 at a tertiary referral centre. MATERIALS AND METHODS: Twelve patients had surgery to correct anterior skull base defects. Four patients had spontaneous anterior basal defect and eight had a post-traumatic cerebrospinal fluid (CSF) leakage. The diagnosis was made with imaging studies: Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans, possibly supplemented by a cisternography. The defects were repaired using the endoscopic endonasal approach excepted in frontal sinus location. RESULTS: CT and MRI scans demonstrated the defect in all but two cases. In one of them, MR cisternography showed the intranasal sac and in the other CT cisternography demonstrated a CSF fistula without any bone defect at the ethmoid roof. After surgery, the follow-up period was at least 16 months (mean 26 months). Success rate at first attempt was 83%. Two adults needed a second surgical repair with successful outcome in one, increasing the success rate to 92% after the second attempt. One female patient, obese with a body mass index > 30 and hydrocephaly, had a recurrence of CSF leakage despite surgical revision. Postoperative imaging studies, CT scan or MRI, showed that the defect had successfully been repaired in 11 patients. CONCLUSION: High-resolution CT scan, MRI with or without cisternography, should investigate osteo-meningeal defect. Our report confirms that endonasal surgical techniques are useful for treating meningoceles and meningo-encephaloceles. The external route is to be preferred when the lesion is located in the apex of the frontal sinus.
Cerebrospinal Fluid , Skull Base/abnormalities , Skull Base/injuries , Adolescent , Adult , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Retrospective Studies , Skull Base/surgery , Young Adult
UNLABELLED: Neurofibromatosis 1 (NF1) is a frequent genetic disease. Diagnostic criterias were established in 1988. The patients can exhibit various and unpredictable complications. OBJECTIVES: To check the efficiency of a coordinated follow-up in specialized multidisciplinary centers providing a higher quality of management and to have a better knowledge of the complications including their true frequencies. POPULATION AND METHODS: We report a serie of 100 NF1 children who were followed-up during 4 years in a specialized center at the Tours University Hospital. Three hospital check-up at 2-5, 6-7, 14-15 years of age were performed as well as an annual physical examination. RESULTS: In our serie, the mean age was 7.8 years old with a sex ratio of 1. The mean age at diagnosis was 3.8 years old and the main diagnosis criteria were the café-au-lait spots and the family history for 80% of the patients. The optic nerve glioma has a low frequency of 5%. Learning disabilities clearly represent the most frequent complication (46% of the patients). CONCLUSION: An early detection of these difficulties is a priority for the appropriate management of these children.
Neurofibromatosis 1/complications , Neurofibromatosis 1/diagnosis , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Learning Disabilities/etiology , Male
Many women with cerebrospinal fluid shunts are now reaching reproductive age. Clinical management of pregnant patients with hydrocephalus should include preconception counseling and CT scan or MRI. A family pedigree should also be established for counseling on the risk of recurrence of the woman's condition or another neural tube defect. Electrophoresis of acetylcholinesterase in the amniotic fluid can provide the diagnosis of open neural tube defect between 13 and 24 weeks gestation. Shunt malfunction may occur during pregnancy in 50 % of cases. Management requires well-planned, a combined neurosurgical and obstetrical approach. Vaginal delivery is possible in asymptomatic mothers. Cesarean section is recommended for neurologically unstable patients. Prophylactic antibiotics are recommended for labor and delivery to avoid shunt infection. Epidural analgesia is contraindicated in patients with intracranial hypertension. Some complications of complementary treatment for cerebral tumors in childhood are briefly reported.
Hydrocephalus/surgery , Pregnancy Complications , Ventriculoperitoneal Shunt , Epilepsy/diagnosis , Female , Humans , Neoplasms/therapy , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Prenatal Diagnosis , Risk Factors
Ultrasonography can identify agenesis of the corpus callosum (excluding holoprosencephaly which an be detected earlier on) in the second trimester of pregnancy (18-20 weeks gestation). Diagnosis of corpus callosum agenesis is difficult but is important as a risk factor for neurological or genetic malformations. The characteristic signs suggestive of corpus callosum agenesis are: moderate distension of the occipital ventricle and the ventricular communications; absence of the spectrum giving rise to an upward displacement of the third ventricle shown in the anterior coronal section (especially in transvaginal ultrasonography); radial position of the fissures on the internal side of the cerebral hemisphere seen on the sagittal section; the absence in color coded Doppler of the pericallosal artery normally characterised by a semicircular vessel observable on the median sagittal section. At present, color coded Doppler should give the diagnosis of corpus callosum agenesis. MRI can provide further information especially in case of late detection around 28-30 weeks gestation as is most frequently the case. The development of 3D echographic imaging should allow an even more sophisticated approach to this diagnosis giving even more precise prognosis. Isolated corpus callosum agenesis is compatible with normal intellectual development an raises an important problem with regard to pregnancy continuation and infant development. Each individual case should be discussed during the pluridisciplinary prenatal diagnostic discussion.
Brain Diseases/diagnosis , Corpus Callosum/diagnostic imaging , Ultrasonography, Prenatal/methods , Agenesis of Corpus Callosum , Brain Diseases/diagnostic imaging , Female , Humans , Pregnancy
We report a case of radiation-induced meningioma that appeared 12 years after the discovery and treatment of a posterior fossa medulloblastoma. The features of the case that support the diagnosis of radiation-induced meningioma are discussed.
Brain Neoplasms/radiotherapy , Medulloblastoma/radiotherapy , Meningioma/diagnosis , Neoplasms, Radiation-Induced/diagnosis , Radiotherapy/adverse effects , Adolescent , Brain/pathology , Brain/radiation effects , Brain/surgery , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Combined Modality Therapy , Fatal Outcome , Female , Humans , Medulloblastoma/pathology , Medulloblastoma/surgery , Meningioma/etiology , Neoplasm Recurrence, Local , Neoplasms, Radiation-Induced/etiology , Tomography, X-Ray Computed
BACKGROUND: Transient cortical blindness is a rare complication of mild head trauma in children. This spectacular manifestation always has a benign outcome. CASE REPORT: A five-year-old girl was admitted for bilateral blindness immediately following a fall with frontal head injury. Neurological examinations and ophthalmological investigations showed no abnormalities. The electroencephalogram showed slow waves in the left occipital area. The blindness resolved completely within 3 hours. CONCLUSION: This bilateral blindness was similar to that of the 40 cases reported since 1964, including a rapid and benign outcome. Its mechanism is not clear, although some suggest a cerebral vasospasm. Our patient's mother has a history of migraine.
Blindness/etiology , Craniocerebral Trauma/complications , Child, Preschool , Female , Humans , Time Factors
The authors report the case of 30 years old patient presenting with an hydrocephalus responsible for high intracranial pressure and cerebellar ataxia. The fourth ventricle dilatation was predominant and there was no passage of the contrast media in the cisterna magna during ventriculography. For lack of neonatal antecedents and neurological pathology a congenital origin was evoked. The obstruction of the foramina of Luschka and Magendie with an hydraulic stability in the ventricles during the life before decompensation was likely. A ventriculo-peritoneal shunt, seemed to be the better treatment with regard to the permeability of the aqueduct.
Cerebral Ventricles/pathology , Hydrocephalus/etiology , Adult , Dilatation, Pathologic/congenital , Dilatation, Pathologic/etiology , Humans , Magnetic Resonance Imaging , Male , Tomography, X-Ray Computed
