RESUMO
INTRODUCTION: Anterior cranial fossa (ACF) defects still remains a reconstructive challenge to neurosurgeons due to the difficult location, inaccessibility, and unfavorable vascular anatomy. Usual reconstructive methods reported complications such as recurrent cerebrospinal fluid leak due to bone resorption and tissue breakdown. This is mainly due to the avascularity of the bone graft and inability to provide bony structural support for the skull base. An ideal reconstructive modality should provide a rigid bony support to prevent brain herniation as well as ensure a water tight barrier between sinonasal tract and intracranial compartment. METHODOLOGY: Hence, we thought of a novel technique of taking the outer table of the primary craniotomy flap with its intact myofascial pedicle and moulded it with multiple osteotomies (moulded osteomyofascial pedicled split (MOPS) craniotomy flap) to fit into uneven ACF defects. Advantages of our flap include (1) It is a pedicled vascularized bone flap. (2) It is taken from primary craniotomy flap; hence, no separate craniotomy is required. (3) The inner table is intact and leaves no secondary calvarial bone defect on the donor site. (4) Osteoplastic flap is moulded to fit into the defect, thus providing good contour. RESULTS: MOPS flap was used in five patients with ACF defects due to varied etiologies such as encephalocele defect, frontal mucocele, skull base meningioma, and complex naso ethmoid fracture. Age of the patients included in the study varied from 21 to 60 years. Male:female ratio was 4:1. ACF defects were reconstructed using MOPS flap in all cases. There were no postoperative complications and 1-month postoperative computerized tomography scan showed no evidence of bone resorption with acceptable cosmesis. CONCLUSION: MOPS craniotomy flap provides a novel, easily mastered, and cost-effective technique with minimal complication in reconstruction of complex ACF defects with acceptable esthetic and functional outcome.
RESUMO
INTRODUCTION: Tumours of central nervous system constitute 1%-2% of tumours in adults. The incidence of brain tumours has been reported to be around 3.9 and 3.0/one lac/year in males and females respectively. A few studies are available from India which show a lower incidence of brain tumours compared to the developed countries. Not much is known about the epidemiology of brain tumours in the population from South India. AIM: To identify the age groups, gender distribution, topography and different histological types of brain tumours. MATERIALS AND METHODS: A total of 510 cases of brain tumours were identified over a period of seven years which were included in the present study. We retrieved the slides of these cases and reviewed them. Immunohistochemistry in required cases were done. Age and gender distribution, clinical presentation, site of tumour and histopathologic patterns with grade were noted and the data was analysed with SPSS software version 17.0. RESULTS: Our analysis showed that most of the brain tumours occur between 40-60 years of age, with a male to female ratio of 0.9:1. Majority of cases involved dura and cerebral lobes except for the occipital lobe, and meningioma and glial tumours were the most common broad histological types. WHO grade IV tumours and metastasis were common in males compared to females. CONCLUSION: This study revealed the distribution of brain tumours in patients attending our institution. The results obtained were comparable with available worldwide data.
