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1.
Chin J Traumatol ; 24(6): 328-332, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34511323

RESUMO

PURPOSE: Rapid decompressive craniectomy (DC) was the most effective method for the treatment of hypertensive intracerebral hemorrhage (HICH) with cerebral hernia, but the mortality and disability rate is still high. We suspected that hematoma puncture drainage (PD) + DC may improve the therapeutic effect and thus compared the combined surgery with DC alone. METHODS: From December 2013 to July 2019, patients with HICH from Linzhi, Tibet and Honghe, Yunnan Province were retrospectively analyzed. The selection criteria were as follows: (1) altitude ≥1500 m; (2) HICH patients with cerebral hernia; (3) Glascow coma scale score of 4-8 and time from onset to admission ≤3 h; (4) good liver and kidney function; and (5) complete case data. The included patients were divided into DC group and PD + DC group. The patients were followed up for 6 months. The outcome was assessed by Glasgow outcome scale (GOS) score, Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis. A good outcome was defined as independent (GOS score, 4-5) and poor outcome defined as dependent (GOS score, 3-1). All data analyses were performed using SPSS 19, and comparison between two groups was conducted using separate t-tests or Chi-square tests. RESULTS: A total of 65 patients was included. The age ranged 34-90 years (mean, 63.00 ± 14.04 years). Among them, 31 patients had the operation of PD + DC, whereas 34 patients underwent DC. The two groups had no significant difference in the basic characteristics. After 6 months of follow-up, in the PD + DC group there were 8 death, 4 vegetative state, 4 severe disability (GOS score 1-3, poor outcome 51.6 %); 8 moderate disability, and 7 good recovery (GOS score 4-5, good outcome 48.4 %); while in the DC group the result was 15 death, 6 vegetative state, 5 severe disability (poor outcome 76.5 %), 4 moderate disability and 4 good recovery (good outcome 23.5 %). The GOS score and good outcome were significantly less in DC group than in PD + DC group (Z = -1.993, p = 0.046; χ2 = 4.38, p = 0.043). However, there was no significant difference regarding the survival curve between PD + DC group and DC group. The correlation between the time from admission to operation and GOS at 6 months (r = -0.41, R2 = 0.002, p = 0.829) was not significant in the PD + DC group, but significant in the DC group (r = -0.357, R2 = 0.128, p = 0.038). CONCLUSION: PD + DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.


Assuntos
Craniectomia Descompressiva , Hemorragia Intracraniana Hipertensiva , Adulto , Idoso , Idoso de 80 Anos ou mais , Altitude , China , Drenagem , Encefalocele/cirurgia , Hematoma , Humanos , Hemorragia Intracraniana Hipertensiva/cirurgia , Pessoa de Meia-Idade , Prognóstico , Punções , Estudos Retrospectivos , Resultado do Tratamento
2.
Childs Nerv Syst ; 37(11): 3437-3445, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34390379

RESUMO

INTRODUCTION: Encephaloceles are rare congenital malformations of the central nervous system in which brain tissue is extruded from a defect in the skull. Hydrocephalus can occur in 60 to 90% of patients with posterior encephaloceles when compared to other types of this malformation. This article aims to present a series of posterior encephaloceles and its association with hydrocephalus as well as promote a review of the pertinent literature. MATERIAL AND METHODS: A retrospective study of our series based on hospital charts of 50 patients with posterior encephaloceles was performed. Data on sex, location of encephalocele, presence of associated malformations, presence of neural tissue within the malformation, presence of hydrocephalus and microcephaly were recorded. RESULTS: There were 29 females and 21 males. There were 25 (50%) supratorcular, 8 (16%) torcular, and 17 (34%) infratorcular lesions. Mean age of encephalocele primary repair was 8 days (range 2-120 days). Hydrocephalus was diagnosed in 25 (50%) of the cases. Ventriculoperitoneal shunt was inserted in 24 patients. The mean age at VP shunt insertion was 1.3 months (range 0.3-9 months). Endoscopic third ventriculostomy was successfully performed in one patient. Dandy-Walker malformation and ventriculomegaly prior to encephalocele surgical correction were positively associated with hydrocephalus (p values 0.05 and 0.01, respectively). Chiari III malformation was found in 2 cases, both requiring CSF shunt for treatment of hydrocephalus and are stable in follow-up. Microcephaly was present in 9 cases. The known mortality rate was 8%. CONCLUSIONS: Hydrocephalus is common in patients with posterior encephaloceles, being more frequent in the supratorcular type, especially when associated to Dandy-Walker, Chiari III malformation, and pre-existing ventriculomegaly. The severity of giant encephaloceles, when associated to torcular types and microcephaly, is a limiting factor for development of hydrocephalus, due both to the rapid evolution of natural history and the structural changes in microcephaly.


Assuntos
Malformação de Arnold-Chiari , Hidrocefalia , Encefalocele/complicações , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico por imagem , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Derivação Ventriculoperitoneal
3.
Oper Neurosurg (Hagerstown) ; 21(5): 332-342, 2021 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-34382089

RESUMO

BACKGROUND: Middle fossa (MF) encephaloceles are rare lesions resulting from herniation through defects in the tegmen tympani or mastoideum. Underlying etiologies and clinical presentations are variable. Surgical goals include fistula obliteration, resection of nonfunctioning parenchyma, and dehiscence repair. The middle cranial fossa approach (MCFA), transmastoid approach (TMA), and combined (MCFA + TMA) approaches have been described. The minimally invasive TMA provides excellent exposure of the pathology and allows for ample working room to repair the defect. OBJECTIVE: To present short-term follow-up results in patients treated via the TM repair at our institution. METHODS: A retrospective review of patients with symptomatic encephaloceles treated via the TMA by our multidisciplinary team. Patient demographics, clinical presentations, intraoperative findings, repair technique, and outcomes were highlighted. RESULTS: A total of 16 encephaloceles in 13 patients were treated. Defect etiologies included spontaneous (50.0%), secondary to chronic infection (25.0%), or cholesteatoma (18.8%). Defects were most often within the tegmen mastoideum (68.8%). Average length of surgery was 3.3 h (95% CI: 2.86-3.67) and length of stay 3.9 d (95% CI: 3.09-4.79). On short-term follow-up (average 11.5 mo), no patients experienced postoperative cerebrospinal fluid leak or recurrence. The majority of patients (83.3%) experienced confirmed improvement or stabilization of hearing. CONCLUSION: MF encephaloceles present with various clinical manifestations and result from multiple underlying etiologies. The TMA is an alternative to craniotomy and our short-term results suggest that this approach may be utilized effectively in appropriately selected cases.


Assuntos
Encefalocele , Recidiva Local de Neoplasia , Vazamento de Líquido Cefalorraquidiano , Fossa Craniana Média/diagnóstico por imagem , Fossa Craniana Média/cirurgia , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Humanos , Estudos Retrospectivos
4.
Eur Ann Otorhinolaryngol Head Neck Dis ; 138 Suppl 4: 135-136, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34246589

RESUMO

Cerebrospinal fluid (CSF) leak and encephalocele from the middle cranial fossa into the sphenoid sinus lateral recess (SSLR) is a rare condition. It is often associated with obesity, female sex, well-pneumatized sinus, and prolonged intracranial hypertension. Endoscopic repair has emerged as the mainstay treatment with a success rate increasing to over 90% by refining reconstruction methods and controlling intracranial pressure. Here, we describe how a female with SSLR CSF leak and encephalocele successfully managed with endoscopic transpterygoid approach and multilayered repair. The defect was closed using four indifferent tissues, including the duragen patch, sinus mucosal flaps, the middle turbinate bone, and free mucosa flap, from the inside out. The patient had an uneventful postsurgical course and remained disease-free during the 9-month follow-up. To conclude, the technique of using sinus mucosal flaps in the context of multilayered reconstruction might be a useful method to repair CSF leak.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Osso Esfenoide , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Encefalocele/cirurgia , Endoscopia , Feminino , Humanos , Seio Esfenoidal/cirurgia
5.
Laryngoscope ; 131(10): 2224-2230, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34096616

RESUMO

OBJECTIVES: Cerebrospinal fluid (CSF) leaks and meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be challenging. The traditional transpterygoid approach through the pterygopalatine fossa (PPF) is time consuming and places important structures at risk, which can lead to significant morbidity. We report a multi-institutional experience using a simplified, endoscopic modified transpterygoid approach (MTPA), which spares the PPF contents in the management of lateral sphenoid sinus meningoencephaloceles and CSF leaks. STUDY DESIGN: Multi-Institutional, Retrospective Case Series. METHODS: Patients with lateral sphenoid recess CSF leaks and meningoencephaloceles between 2014 and 2020 who underwent the MTPA at two academic medical centers were identified. Repair techniques and outcomes were evaluated. RESULTS: Thirty-three patients underwent the MTPA for management. Skull base reconstruction was performed using a free mucosal graft (24/33, 72.7%), nasoseptal flap (4/33, 12.1%), bone grafts (3/33, 9.1%), and abdominal fat grafts (2/33, 6.1%). Lumbar drains and perioperative intracranial pressure measurements were routinely employed. Postoperative complications were uncommon and included three patients (9.7%) with temporary V2 anesthesia, one patient (3.2%) with prolonged V2 anesthesia, and one patient (3.2%) with subjective dry eye, all of which resolved at 9 months postoperatively. There were no recurrent CSF leaks resulting in a 100% success rate. Average follow-up was 13 months. CONCLUSION: The MTPA reduces morbidity and greatly simplifies access to the lateral sphenoid sinus for the management of CSF leaks and meningoencephaloceles, without compromising exposure. This technique avoids the need for extensive PPF dissection and should be considered for the management of benign lesions involving the lateral sphenoid sinus. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2224-2230, 2021.


Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Encefalocele/cirurgia , Endoscopia/métodos , Meningocele/cirurgia , Osso Esfenoide/cirurgia , Adulto , Idoso , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vazamento de Líquido Cefalorraquidiano/etiologia , Encefalocele/complicações , Encefalocele/diagnóstico , Encefalocele/patologia , Feminino , Seguimentos , Humanos , Masculino , Meningocele/complicações , Meningocele/diagnóstico , Meningocele/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Osso Esfenoide/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia , Seio Esfenoidal/cirurgia , Retalhos Cirúrgicos/transplante , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
J Craniofac Surg ; 32(6): 2078-2081, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34054092

RESUMO

ABSTRACT: Frontoethmoidal encephalomeningocele (FEEM) is a congenital anomaly involving herniation of the glial tissues and the meninges. Our unit implemented single-stage repair in 1996, and this was followed by the introduction of the medial orbital composite-unit translocation (MOCUT) technique for encephalocele repair in 2001. This report describes the long-term outcomes of patients who underwent the MOCUT technique. Data were collected on 32 patients operated on between 2005 and 2018. A full analysis was subsequently made of the data from 4 selected patients who had been monitored for at least 5 years, and their age-related anterior interorbital distances were compared. Two of the patients, who had simple forms of FEEM, demonstrated improvements in their intercanthal and anterior interorbital distances, whereas telecanthus was experienced by the 2 other cases, both of whom had complex FEEM types. We recommend using the MOCUT technique for simple types of FEEM (especially Type IA) and patients whose medial canthal ligaments are still anatomically attached to the medial orbits.


Assuntos
Encefalocele , Meningocele , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Ossos Faciais , Hospitais , Humanos , Meningocele/diagnóstico por imagem , Meningocele/cirurgia , Órbita/cirurgia
7.
World Neurosurg ; 151: 124-131, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33964493

RESUMO

OBJECTIVE: Late surgical correction of meningoencephalocele is a rare scenario that remains challenging for surgeons. Three-dimensional models can mimic the correct anatomical relationships, and technological systems have brought advances to medicine. This study aims to present a novel preoperative planning modality that combines augmented reality with a hybrid model for complex malformation associated with late correction. METHODS: The present report describes a case of frontoethmoidal encephalocele of a 10-year-old girl. Two different methods for planning the approach were developed: 1) a hybrid hands-on model and 2) augmented reality, using a cell phone app and headset display. The customized hybrid model was created based on patient's imaging. The augmented reality app was developed with a real-time interface. RESULTS: The hybrid model recreated anatomic alterations, thereby allowing a multidisciplinary team to determine an appropriate surgical approach. All aspects of the surgical procedure were simulated. A pre- to postoperative comparison was made, which emphasized benefit of tridimensional anatomical relationships using augmented reality tool and its role in preoperative planning. CONCLUSIONS: The authors believe this new multimodality preoperative platform could be a useful method to improve multidisciplinary discussion as well as a powerful tool for teaching and planning.


Assuntos
Simulação por Computador , Encefalocele/cirurgia , Ossos Faciais/cirurgia , Meningocele/cirurgia , Realidade Aumentada , Criança , Encefalocele/diagnóstico , Feminino , Humanos , Imageamento Tridimensional/métodos , Modelos Anatômicos , Procedimentos Neurocirúrgicos/métodos
8.
World Neurosurg ; 151: 91-101, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33964498

RESUMO

Epileptogenic encephaloceles, most frequently located in the temporal lobe, are a known lesional cause of focal epilepsy. Data are limited regarding diagnosis, management, and outcomes of patients with epilepsy in the setting of an encephalocele, because the literature mostly comprises case reports, case series, and retrospective studies. We conducted a broad literature review for articles related to encephaloceles and epilepsy regardless of level of evidence. Hence, this review provides a summary of all available literature related to the topic. Thirty-six scientific reports that fulfilled our inclusion criteria were reviewed. Most reported patients presented with focal impaired awareness seizures and/or generalized tonic-clonic seizures. Although most of the encephaloceles were located in the temporal lobe, we found 5 cases of extratemporal encephaloceles causing epilepsy. More patients who underwent either lesionectomy or lobectomy were seizure free at time of follow-up. In the temporal lobe, there is no clear consensus on the appropriate management for epileptic encephaloceles and further studies are warranted to understand the associated factors and long-term outcomes associated with epilepsy secondary to encephaloceles. Reported data suggest that these patients could be manageable with surgical procedures including lesionectomy or lobectomy. In addition, because of data suggesting similar results between procedures, a more conservative surgery with lesionectomy and defect repair rather than a lobectomy may have lower surgical risks and similar seizure freedom.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Encefalocele/cirurgia , Epilepsias Parciais/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Resultado do Tratamento , Idade de Início , Humanos
9.
Oper Neurosurg (Hagerstown) ; 21(2): 73-80, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-33861350

RESUMO

BACKGROUND: Encephaloceles are herniations of intracranial neural tissue and meninges through defects in the skull. Basal encephaloceles are rare anterior skull base defects incident in 1 in 35,000 live births. Sphenoethmoidal encephaloceles are even more uncommon, with an incidence of 1 in 700,000 live births. Anterior skull base encephaloceles may be life-threatening in infants, presenting as airway obstruction and respiratory compromise. They can also present with cerebrospinal fluid (CSF) rhinorrhea, purulent nasal drainage, or meningitis. OBJECTIVE: To report a novel technique for repairing a giant sphenoethmoidal encephalocele containing eloquent neural tissue. METHODS: A 16-mo-old girl presented with progressive airway obstruction from a giant sphenoethmoidal encephalocele that filled her oral cavity. She had multiple congenital anomalies including agenesis of the corpus callosum and cleft lip and palate. Computed tomography showed complete absence of the bony anterior cranial base, and magnetic resonance imaging demonstrated the presence of the pituitary gland and hypothalamus in the hernia sac. RESULTS: We repaired the encephalocele using a combined microsurgical and endoscopic multidisciplinary approach working through transcranial, transnasal, and transpalatal corridors. The procedure was completed in a single stage, during which the midline cleft lip was also repaired. The child made an excellent neurological and aesthetic recovery with preservation of pituitary and hypothalamic function, without evidence of CSF fistula. CONCLUSION: The authors describe a novel multidisciplinary technique for treating a giant sphenoethmoidal encephalocele containing eloquent brain. The cleft lip was also repaired at the same time. The ability to work through multiple corridors can enhance the safety and efficacy of an often-treacherous operative endeavor.


Assuntos
Fenda Labial , Fissura Palatina , Encéfalo , Criança , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Feminino , Humanos , Lactente , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia
10.
BMJ Case Rep ; 14(4)2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853821

RESUMO

The petrous apex is a pyramidal-shaped structure which is difficult to examine due to difficult anatomical location. Lesions in the petrous apex can be managed surgically or they can be incidental lesions, which are managed conservatively. Petrous apex cephaloceles (PAC) are the cystic lesion due to herniation in the Meckel's cave of temporal bone. Bilateral PAC is a very rare phenomenon with only 21 cases reported in the literature so far. We present here a case of bilateral PAC, who presented with headache and was managed conservatively.


Assuntos
Anormalidades Maxilomandibulares , Osso Petroso , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Osso Petroso/diagnóstico por imagem
11.
Pediatr Neurosurg ; 56(3): 274-278, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33789317

RESUMO

BACKGROUND: Knobloch syndrome (KS) is a rare autosomal recessive disorder associated with multiple ocular and cranial abnormalities. Occult occipital skull defect or encephalocele should raise suspicion of this disease. It is never reported in neurosurgical literature, possibly due to a lack of clinician familiarity, leading to underdiagnosis and inadequate management. Our patient also had seizures, which is a sporadic presentation of this syndrome. CASE DESCRIPTION: Here, we report a clinico-radiologic finding of a 7-year-old boy who presented with seizures, cataracts, and an occipital bone defect along with bilateral subependymal heterotopias and polymicrogyria. CONCLUSIONS: This case highlights the importance of consideration of this syndrome in children with a midline occipital bone defect with or without encephalocele and seizures. Early recognition of this presentation is critical for obtaining access to appropriate genetic counseling and subsequent monitoring and prevention of complications by surgical intervention.


Assuntos
Degeneração Retiniana , Descolamento Retiniano , Criança , Encefalocele/complicações , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Humanos , Masculino , Descolamento Retiniano/congênito , Convulsões/etiologia
12.
Pediatr Neurosurg ; 56(2): 197-202, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33706320

RESUMO

INTRODUCTION: Primary encephalocele is a rare deformity that is challenging for the neurosurgeon. It requires a multidisciplinary team for adequate reconstructive surgery. CASE PRESENTATION: We report the case of a 6-month-old African boy who presented with a frontoethmoidal encephalocele; we present a technical description of the surgical procedure, using no implant. DISCUSSION/CONCLUSION: The postoperative evolution of the boy was uneventful, with a good clinical result at the follow-up.


Assuntos
Encefalocele , Procedimentos Cirúrgicos Reconstrutivos , Benin , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Humanos , Lactente , Masculino , Neurocirurgiões
13.
World Neurosurg ; 149: e828-e835, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33529766

RESUMO

BACKGROUND: With advances in imaging techniques, encephaloceles, meningoceles, and meningoencephaloceles are occasionally discovered incidentally. These can be located in anterior cranial fossa (ACF), mostly protruding into sphenoid and ethmoid sinuses, or middle cranial fossa (MCF), protruding into the temporal bone. We reviewed a large series of cranial computed tomography and magnetic resonance imaging scans to identify the prevalence of asymptomatic encephaloceles, meningoceles, and meningoencephaloceles and describe their outcome. METHODS: We retrospectively reviewed a database of all magnetic resonance imaging and computed tomography scans done at Weill Cornell Medicine for any reason between 2003 and 2018. Encephaloceles, meningoceles, or meningoencephaloceles were confirmed on 72 scans. Of these, chart reviews were performed to identify incidentally discovered cases with symptoms other than cerebrospinal fluid leak, and chart reviews and phone calls were conducted to determine patient demographics, treatment, and outcome. RESULTS: There were 18 incidental cases for a prevalence of 0.0074%, of which 6 were located in ACF, and 12 were located in MCF. The mean age for ACF cases was 39 ± 15.9 years and for MCF cases was 49.5 ± 19.8 years. There were no leaks in any cases after the encephaloceles were discovered. Eleven of 12 (91.6%) MCF cases were treated conservatively, while 3 of 6 (50%; P = 0.083) ACF cases were treated surgically. CONCLUSIONS: This study showed that encephaloceles, meningoceles, and meningoencephaloceles without cerebrospinal fluid leak or meningitis in MCF were more often conservatively managed with observation only, whereas these entities in ACF were often repaired prophylactically. Incidentally discovered encephaloceles have a relatively benign natural history and do not precipitously leak.


Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Encefalocele/epidemiologia , Encefalocele/cirurgia , Meningite/cirurgia , Adulto , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Fossa Craniana Anterior/cirurgia , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Masculino , Meningite/diagnóstico , Meningocele/epidemiologia , Meningocele/cirurgia , Pessoa de Meia-Idade , Prevalência
14.
Childs Nerv Syst ; 37(9): 2943-2947, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33566142

RESUMO

Lesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.


Assuntos
Cistos Aracnóideos , Neoplasias Cerebelares , Ângulo Cerebelopontino/diagnóstico por imagem , Ângulo Cerebelopontino/cirurgia , Criança , Pré-Escolar , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Base do Crânio
15.
Otol Neurotol ; 42(6): 938-944, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625190

RESUMO

OBJECTIVE: To characterize the radiologic findings of petrous apex cephalocele (PAC) in a patient cohort, and report the surgical management for three symptomatic PAC patients and cerebrospinal fluid (CSF) leak via the middle cranial fossa approach. STUDY DESIGN: Retrospective case series. SETTING: Academic center. PATIENTS: Thirty-five patients with PAC were identified by review of the imaging archive between 2008 and 2019 (29 females; mean, 55 yrs; range, 4-86 yrs). All patients underwent magnetic resonance imaging of the skull base and/or computed tomography examination. INTERVENTIONS: Surgical repair of PAC. MAIN OUTCOME MEASURES: Radiologic features of PAC. RESULTS: Radiological features of PAC: 25.7% bilateral; partial or expanded empty sella in 82.9%; arachnoid pits in 14.2%; and enlarged CSF space of optic nerve sheath in 20.0%. Coexisting pathology included temporal, sphenoid, and bilateral jugular foramen meningocele; as well as cribriform, middle crania fossa, and right temporal defect. Three case studies describing the surgical course of spontaneous CSF leak secondary to PAC were managed with the middle cranial fossa approach. CONCLUSIONS: PAC is an exceedingly unusual cause for CSF leak in the adult and pediatric population. A middle fossa approach may be used to treat CSF leak as a result of PAC. Typically, CSF otorrhea originates from an encephalocele that extends via a bony defect in the tegmen tympani or tegmen mastoideum. However, on occasion the source of the CSF otorrhea is not via the tegmen, instead defects in the middle fossa floor, medial to the ridge for the gasserian ganglion (tubercle of Princeteau), need to be considered.


Assuntos
Encefalocele , Radiologia , Adulto , Otorreia de Líquido Cefalorraquidiano , Criança , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Feminino , Humanos , Osso Petroso/diagnóstico por imagem , Osso Petroso/cirurgia , Estudos Retrospectivos
16.
Pediatr Neurosurg ; 56(1): 67-72, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33588414

RESUMO

INTRODUCTION: Cerebrospinal fluid (CSF) oculorrhea is extremely rare, and very few cases have been reported mostly following trauma. There is only 1 case in the published literature where oculorrhea occurred following the repair of fronto-nasal encephalocele. CASE DESCRIPTION: A six-year-old girl presented with gradually increasing fronto-ethmoidal encephalocele with secondary papulo-nodular changes. She underwent bi-frontal craniotomy with excision of encephalocele sac and herniated gliotic brain followed by dural closure using peri-cranial graft. One month later, she presented again with swelling over the operative site and "tearing" from both her eyes. She was diagnosed with CSF oculorrhea. After failing conservative management, lumbar drain was inserted and kept on continuous drainage. Oculorrhea stopped with lumbar drain but restarted with its removal. Therefore, theco-peritoneal shunt was placed, following which oculorrhea stopped. She is doing well at 5 months' follow-up. CONCLUSION: CSF oculorrhea must be considered by the pediatric neurosurgeons in any patient who presents with "tearing" following the repair of an anterior encephalocele.


Assuntos
Encefalocele , Crânio , Criança , Craniotomia , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Feminino , Humanos
17.
World Neurosurg ; 145: 360-362, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33045449

RESUMO

Trigeminal neuralgia (TN) is most commonly caused by neurovascular compression of the superior cerebellar artery. We present the first reported TN case where nerve compression was caused by the petrous internal carotid artery in the vicinity of a Meckel cave (MC) encephalocele. The patient underwent a pterional craniotomy for decompression of the gasserian ganglion and trigeminal nerve branches. All symptoms were resolved post surgery. We surmise that the principal cause of the TN was vascular compression from an exposed petrous internal carotid artery in the presence of an encephalocele. Causation was irrespective of whether the dehiscence in the petrous apex was a congenital defect or associated with destruction from the encephalocele. Based on this observation, we recommend that surgeons carefully consider all possible causes of patient symptoms as they prepare a meticulous dissection plan to avoid damage to surrounding neurovascular structures.


Assuntos
Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Fossa Craniana Média/diagnóstico por imagem , Craniotomia/métodos , Encefalocele/complicações , Encefalocele/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Doenças das Artérias Carótidas/diagnóstico por imagem , Encefalocele/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Cirurgia de Descompressão Microvascular/métodos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
18.
Laryngoscope ; 131(5): 996-1001, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33135787

RESUMO

OBJECTIVE/HYPOTHESIS: To characterize the pathology and outcomes of skull base surgery in the pediatric population by open versus endoscopic surgical approach. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective review of pediatric patients (<18 years) who underwent skull base surgery for nonmalignant disease from May 2000 to August 2019 was performed. Patient demographics, pathology, and operative characteristics by surgical approach were recorded and analyzed. Patients with a combined endoscopic/open approach were classified as open for the analysis. RESULTS: Eighty-two pediatric skull base patients were identified with a mean age of 11.3 years (standard deviation 5.2). A purely endoscopic approach was used in 63 (77%) patients, a purely open approach was used in nine (11%) patients, and a combined open/endoscopic approach was used in 10 (12%) patients. The all-cause complication rate was 9.8%. There was no statistically significant difference in rate of complications between patients with an open versus endoscopic approach for resection (15.8% vs. 7.9%; P = .379). Risk of having a complication did not significantly vary by patient age. The odds of having a complication with an open approach was not statistically significant in a multivariable model adjusted for age, sex, race, intraoperative cerebrospinal fluid leak, tracheostomy requirement, and vascular flap use (odds ratio 2.76, 95% confidence interval 0.28-26.94; P = .383). CONCLUSIONS: Our retrospective study demonstrates a similar risk of complication for open versus endoscopic approach to resection in pediatric skull base patients at our institution. Safety and feasibility of the endoscopic approach has previously been demonstrated in children, and this is the first study to directly compare outcomes with open approaches. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:996-1001, 2021.


Assuntos
Vazamento de Líquido Cefalorraquidiano/epidemiologia , Endoscopia/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Base do Crânio/cirurgia , Adolescente , Fatores Etários , Vazamento de Líquido Cefalorraquidiano/etiologia , Criança , Pré-Escolar , Encefalocele/cirurgia , Endoscopia/métodos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/etiologia , Masculino , Procedimentos Neurocirúrgicos/métodos , Retalho Perfurante/estatística & dados numéricos , Retalho Perfurante/transplante , Doenças da Hipófise/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Base do Crânio/lesões , Base do Crânio/patologia , Neoplasias da Base do Crânio/diagnóstico , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/cirurgia , Traqueostomia/estatística & dados numéricos , Resultado do Tratamento
19.
Laryngoscope ; 131(6): E1750-E1752, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33107603

RESUMO

INTRODUCTION: Reconstruction of skull base defects are determined by size, location, and complexity of the defect. METHODS: Case report. CASE DISCUSSION: An 11-year old girl presented with a right frontoethmoidal encephalocele after an episode of meningitis. An endoscopic approach was performed with a Draf III to provide exposure. The skull base defect extended superolateral over the orbit, which limited the choice of reconstructive options. The defect was successfully repaired with a single layer onlay graft of bovine collagen matrix. CONCLUSIONS: Single layer repairs using commercial biomaterials should be considered where multilayer closure or vascularized flaps may not be possible. Laryngoscope, 131:E1750-E1752, 2021.


Assuntos
Matriz Óssea/transplante , Transplante Ósseo/métodos , Encefalocele/cirurgia , Seio Frontal/cirurgia , Base do Crânio/cirurgia , Criança , Encefalocele/microbiologia , Feminino , Humanos , Meningite/complicações
20.
J Neurosurg Sci ; 65(2): 140-150, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33320465

RESUMO

Skull base cephaloceles (SBCs) are defined as herniation of intracranial content through the skull base and are classified based on composition, etiology, and topographic location. Anterior SBCs frequently protrude in the sinonasal cavity, and consequently are at potential risk of infection. Therefore, the current recommendation is to treat SBCs with the primary intent of preventing meningitis, and surgery represents the mainstay of treatment. Anterior SBCs may display a wide spectrum of severity and complexity, and in each case the risks and benefits of surgical approaches are to be carefully weighted based on thorough assessment of symptoms, age, general conditions, location and size of the lesion, as well as expertise of the surgeon. In the last 30 years, the evolution and diffusion of transnasal endoscopic surgery have substantially changed the surgical management of the majority of SBC. In the past, they were treated exclusively with open transcranial approaches that may be burdened by relevant morbidity and risk for severe complications. The transnasal endoscopic corridor now provides easy access to the lesion and different reconstructive strategies using endonasal pedicled flaps, without any external incision, cranioplasty or brain manipulation. However, there are still scenarios in which an exclusive transnasal endoscopic route is contraindicated. The aim of the present review was to provide an overview on the comprehensive management of anterior SBC, with a particular focus on lesions suitable for endoscopic surgery. Furthermore, special aspects of SBC management in children and adults will be highlighted.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Base do Crânio , Adulto , Criança , Encefalocele/diagnóstico , Encefalocele/cirurgia , Endoscopia , Humanos , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/cirurgia
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