Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 482
Filtrar
1.
No Shinkei Geka ; 49(4): 909-913, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34376623

RESUMO

In this case report, we describe a rare case of anterior cranial fossa dural arteriovenous fistula(ACF-dAVF)that had drained into the fronto-basal vein and refluxed to the superficial middle cerebral vein(SMCV). A 45-year-old man presented with aphasia and swelling of the left eye after head trauma. MRI detected a flow void in the left frontal basal area, and digital subtraction angiography revealed ACF-dAVF, which was fed from the ophthalmic arteries on both sides and had a shunt point within the left front basal dura. It drained into the left front basal vein and refluxed to the left SMCV via the cavernous sinus. Aphasia occurred due to the reflux of the SMCV. We treated the patient with transcatheter arterial embolization(TAE)by injecting n-butyl-2-cyanoacrylate(NBCA)into the shunt point. Immediately after TAE, the aphasia and swelling of the left eye of the patient improved. Cases of ACF-dAVF that drain not into the frontal cortical veins but into the fronto-basal vein and SMCV are relatively rare. As ACF-dAVF occasionally causes frontal symptoms such as aphasia, we should carefully investigate such patients and consider the presence of ACF-dAVF.


Assuntos
Afasia , Malformações Vasculares do Sistema Nervoso Central , Traumatismos Craniocerebrais , Afasia/etiologia , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Fossa Craniana Anterior , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade
3.
J Neurol Surg A Cent Eur Neurosurg ; 82(6): 585-593, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34384130

RESUMO

BACKGROUND: Different surgical approaches have been developed to manage lesions of the anterior and middle skull base areas. Frontal, pterional, bifrontal, and fronto-orbito-zygomatic approaches are traditionally used to reach these regions. With advancements in the neurosurgical field, skull opening should be simple and as minimally invasive as possible, tailored on the surgical corridor to the target. The supraorbital approach and the "keyhole" concept have been introduced and popularized by Axel Perneczky starting from 1998 and are now considered a part of everyday practice. The extended possibilities of this surgical route, considering the reachable targets and surgical limits, are described and systematically analyzed, including a description of the salient surgical anatomy, presenting different illustrative cases. METHODS AND RESULTS: Different illustrative cases are presented and discussed to underline the potentials and limits of the minimally invasive subfrontal approach (MISFA) and the possibilities to tailoring the craniotomy on the basis of the targets: extra-axial lesions with different localizations (anterior roof of the orbit, olfactory groove, tuberculum sellae, medial third of the sphenoid wing, anterior and posterior clinoid process), deeper intra-axial lesions (gyrus rectus, medial temporal lobe-uncus-amygdala-anterior hippocampus), and vascular lesions (anterior communicating aneurysm). Each case has been preoperatively planned considering the anatomical and radiologic features and using virtual simulation software to tailor the best possible corridor to reach the surgical target. CONCLUSIONS: The MISFA is a safe multicorridor approach that can be used efficiently to manage lesions of the anterior and middle skull base areas with extremely low approach-related morbidity.


Assuntos
Fossa Craniana Anterior , Procedimentos Neurocirúrgicos , Craniotomia , Humanos , Órbita/cirurgia , Lobo Temporal/cirurgia
4.
Oper Neurosurg (Hagerstown) ; 21(4): 207-216, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34245152

RESUMO

BACKGROUND: Endoscopic endonasal approaches (EEAs) to anterior skull base meningiomas have grown in popularity, though anatomic limitations remain unclear. OBJECTIVE: To show the anatomic limits of EEA for meningiomas. METHODS: Retrospective chart review for all patients that underwent EEA for anterior skull base meningiomas from 2005 to 2014. RESULTS: A total of 100 patients averaged follow-up of 46.9 mo (24-100 mo). A total of 35 patients (35%) had olfactory groove, 33 planum sphenoidale (33%), and 32 tuberculum sella (32%) meningiomas. The average diameter was 2.9 cm (0.5-8.1 cm). Vascular encasement was seen in 11 patients (11%) and calcification in 20 (20%). Simpson Grade 1 (SG1) resection was achieved in 64 patients (64%). Only calcification impacted degree of resection (40% SG1, P = .012). The most common residual was on the anterior clinoid dura (11 patients [11%]). Six (6%) had residual superior/lateral to the optic nerve. Residual tumor was adherent to the optic apparatus or arteries in 5 patients (5%) each, and 3 patients (3%) had residual lateral to the mid-orbit. Rates of residual decreased over time. A total of 11 patients (11%) had tumor recurrence (mean of 40 mo): 4 (4%) on the anterior clinoid, 2 (2%) each on the lateral orbital roof, adherent to optic apparatus and superolateral to the optic nerve, and 1 (1%) was at the anterior falx. CONCLUSION: Anterior skull base meningiomas can effectively be approached via EEA in most patients; tumors extending to the anterior clinoid, anterior falx, or superolateral to the optic nerve or orbital roof, especially if calcified, may be difficult to reach via EEA.


Assuntos
Neoplasias Meníngeas , Meningioma , Fossa Craniana Anterior/cirurgia , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Resultado do Tratamento
5.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116999

RESUMO

We report a case of a 30-year-old man who presented with altered mental status, fever, headache and vomiting for 3 days. An initial CT scan of the brain revealed the presence of pneumocephalus with a bony defect in the anterior cranial fossa. The pneumocephalus was not explained initially and the patient was re-examined for any signs of trauma to the face, and a review of the history revealed a series of three traumatic events months prior to this illness. Further laboratory studies revealed Streptococcus pneumoniae in the blood and bacterial meningitis. He was treated with antibiotics and was later taken up for endoscopic repair of the skull base defect. This case highlights the importance of recognising post-traumatic pneumocephalus with superimposed meningitis and sepsis months after a traumatic event to the skull base.


Assuntos
Meningites Bacterianas , Pneumocefalia , Adulto , Fossa Craniana Anterior , Humanos , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
World Neurosurg ; 152: e241-e249, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34058363

RESUMO

OBJECTIVE: The objective of the present study was to describe and evaluate the feasibility, mobility, and surface area provided by the simple and extended transorbital pericranial flap (TOPF). Furthermore, we compared this novel technique with the current practice of pericranial flap harvesting and insetting techniques. We also studied the adequacy of the TOPF in the reconstruction of postoperative anterior cranial fossa (ACF) defects. METHODS: The TOPF was performed bilaterally in 5 alcohol-preserved, latex-injected human cadaveric specimens. The TOPF was harvested in 2 stages: the orbitonasal stage and the cranial stage. For the orbitonasal stage, a transorbital superior eyelid approach was used. We have described 2 harvesting techniques for creating 2 distinct TOPF types (simple and extended) according to the main vascular pedicle. The superficial flap areas offered by the simple and extended TOPF and the traditional bicoronal pericranial flap were calculated and compared. The distances from the supratrochlear and supraorbital arteries to specified anatomical landmarks were also measured. Additionally, the ACF defect area of relevant surgical cases performed using endoscopic transcribriform approaches were measured on immediate postoperative computed tomography head scans using radiological imaging software. RESULTS: The harvest of both the simple and the extended TOPFs was efficient. As expected, the areas offered by simple and extended TOPFs were smaller than that offered by the traditional bicoronal flap. However, the surface area offered by either the simple or extended TOPF provides sufficient coverage for most ACF defects. A high spatial distribution was observed between the vascular pedicles and their respective foramen or notch. CONCLUSIONS: The TOPF represents a novel harvesting, tunneling, and insetting technique that offers a large, versatile, pedicled flap for coverage of most standard ACF defects after endoscopic surgery.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Órbita/cirurgia , Retalhos Cirúrgicos , Adulto , Pontos de Referência Anatômicos , Cadáver , Fossa Craniana Anterior/cirurgia , Endoscopia/métodos , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Órbita/anatomia & histologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Base do Crânio/anatomia & histologia , Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X , Transplante Autólogo
7.
J Craniofac Surg ; 32(2): 581-586, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33704985

RESUMO

BACKGROUND: Pfeiffer syndrome is a rare syndromic craniosynostosis disorder, with a wide range of clinical manifestations. This study aims to investigate the structural abnormalities of cranial fossa and skull base development in Pfeiffer patients, to provide an anatomic basis for surgical interventions. METHOD: Thirty preoperative CT scans of Pfeiffer syndrome patients were compared to 35 normal controls. Subgroup comparisons, related to differing suture synostosis, were performed. RESULTS: Overall, the volume of anterior and middle cranial fossae in Pfeiffer patients were increased by 31% (P < 0.001) and 19% (P = 0.004), versus controls. Volume of the posterior fossa in Pfeiffer patients was reduced by 14% (P = 0.026). When only associated with bicoronal synostosis, Pfeiffer syndrome patients developed enlarged anterior (68%, P = 0.001) and middle (40%, P = 0.031) fossae. However, sagittal synostosis cases only developed an enlarged anterior fossa (47%, P < 0.001). The patients with solely bilateral squamosal synostosis, developed simultaneous reduced anterior, middle and posterior cranial fossae volume (all P ≤ 0.002). The overall skull base angulation, measured on both intracranial and subcranial surfaces, grew normally. CONCLUSION: Enlarged anterior cranial fossae in Pfeiffer syndrome children is evident, except for the squamosal synostosis cases which developed reduced volume in all fossae. Volume of the middle cranial fossa is influenced by associated cranial vault suture synostosis, specifically, sagittal synostosis cases develop normal middle fossa volume, while the bicoronal cases develop increased middle fossa volume. Posterior cranial fossa development is restricted by shortened posterior cranial base length. Surgical intervention in Pfeiffer syndrome patients optimally should be indexed to different suture synostosis.


Assuntos
Acrocefalossindactilia , Craniossinostoses , Acrocefalossindactilia/diagnóstico por imagem , Criança , Fossa Craniana Anterior , Fossa Craniana Posterior/diagnóstico por imagem , Suturas Cranianas/diagnóstico por imagem , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/cirurgia , Humanos , Lactente , Crânio , Base do Crânio/diagnóstico por imagem
8.
World Neurosurg ; 150: e74-e80, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33647487

RESUMO

BACKGROUND: Among the new perspectives to revolutionize skull base surgery, there are the transorbital neuroendoscopic (TONES) approaches to reach the anterior and middle cranial fossa (ACF and MCF). We conceived to explore the potentialities of a modified superiorly and medially extended lateral retrocanthal (LRC) approach. METHODS: Six head specimens were dissected. Applying the established conic model and the key surgical landmark of sphenofrontal suture, we tested the feasibility of a modified LRC to reach ACF and MCF; computed tomography (CT) scans were performed before and after dissection to obtain a morphometric analysis of the surgical corridors using a polygonal surfaces model. RESULTS: Through our anatomical study, we were able to identify and explore 3 different surgical corridors to reach the ACF and MCF: the superomedial, the superolateral, and the inferolateral. The superomedial corridor appeared most suitable to reach the medial part of the ACF and the optic-carotid region, whereas through the superolateral and inferolateral corridors it was possible to reach and explore the lateral part of ACF and MCF. The mean volumes of the 3 surgical corridors calculated on post-dissection CT scans were: 12.72 ± 1.99, 5.69 ± 0.34, and 6.24 ± 0.47 cm3, respectively. CONCLUSIONS: The development of TONES approaches has not replaced the traditional open or endoscopic approach; nonetheless, identification of surgical corridors and the possibility to combine them represent a major breakthrough. Clinical studies are necessary to demonstrate their validity and test the effectiveness, safety, and reproducibility of TONES approaches in managing lesions harboring in the ACF and MCF.


Assuntos
Fossa Craniana Anterior/cirurgia , Fossa Craniana Média/cirurgia , Neuroendoscopia/métodos , Órbita/anatomia & histologia , Cadáver , Fossa Craniana Anterior/anatomia & histologia , Fossa Craniana Anterior/diagnóstico por imagem , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/diagnóstico por imagem , Humanos , Órbita/diagnóstico por imagem
9.
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
10.
Int J Oral Maxillofac Surg ; 50(8): 1040-1046, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33483210

RESUMO

The decision about which metopic synostosis patients should undergo surgery remains controversial. Multiple measures for radiographic severity have been developed in order to determine the optimal criteria for treatment. The aim of this study was to perform an extensive craniomorphometric analysis of patients who underwent surgery for metopic synostosis to validate and compare the various severity scales developed for this non-syndromic craniosynostosis. A comparative morphometric analysis was performed using computed tomography scans of preoperative metopic synostosis patients (n=167) and normal controls (n=44). Measurements included previous and newly developed metopic severity indices. Volumetric and area analyses were used to determine the degree of anterior cranial area and potential volume restrictions. Of the severity indices measured, the frontal angle, endocranial bifrontal angle (EBF), adjusted EBF (aEBF), anterior cranial fossa angle, horizontal cone angle, and bitemporal/biparietal distance ratio were significantly different in the metopic subjects relative to controls overall. However, metopic index, orbital rim angle, foramen ovale distance, and cranial volume exhibited no significant difference from controls. Only the frontal angle and aEBF correlated with the changes in anterior cranial dimensions observed in metopic synostosis. In conclusion, the frontal angle and aEBF provide the most accurate measures of severity in metopic synostosis.


Assuntos
Craniossinostoses , Fossa Craniana Anterior , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/cirurgia , Humanos , Lactente , Crânio , Tomografia Computadorizada por Raios X
11.
Neurosurg Rev ; 44(2): 1141-1150, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32394302

RESUMO

The supraorbital eyebrow approach (SEa) has been commonly used as a straightforward route to reach lesions located in the anterior cranial fossa. The reduced surgical exposure provided by this approach limits its applicability. A modification of the SEa, the extended supraorbital eyebrow approach (X-SEa), allows use of the transylvian corridor to approach parasellar lesions, while maintaining most of the aesthetic advantages of the SEa. To quantify the surgical exposure and maneuverability provided by the X-SEa using a cadaveric study. Eleven heads were used to obtain all stereotactic measurements. Surgical exposure and maneuverability were measured by means of the area of exposure and the angles of attack along key representative points in the anterior circulation. The horizontal angle of attack at the middle cerebral artery provided by the X-SEa was larger than that provided by the SEa (32.6 vs 18.4°, p = 0.009). The X-SEa afforded broader vertical angles of attack at all targets in the anterior circulation (p < 0.05). The total area of exposure provided by the X-SEa was significantly larger than that provided by the SEa (1272 vs 978 ± 156 mm2, p = 0.003). The area of exposure in the ipsilateral trigon and in the midline quadrangle was also significantly larger for the X-SEa (paramedian 195 vs 121 mm2, p = 0.01; midline 1310 vs 778 mm2, p = 0.002). The X-SEa increases the exposure and surgical maneuverability along the anterior and middle cranial fossa when compared to the standard SEa.


Assuntos
Craniotomia/métodos , Sobrancelhas , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Órbita/cirurgia , Cadáver , Fossa Craniana Anterior/patologia , Fossa Craniana Anterior/cirurgia , Fossa Craniana Média/patologia , Fossa Craniana Média/cirurgia , Sobrancelhas/patologia , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Órbita/patologia
12.
Neuroradiology ; 63(2): 259-266, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32840681

RESUMO

PURPOSE: We report a multicenter experience using endovascular embolization as the first line approach for treatment of anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF). METHODS: All patients with DAVFs located in the anterior cranial fossa who were treated with endovascular technique as a first line approach were included. Demographics, clinical presentation, angioarchitecture, strategy, complications, immediate angiographic, and follow-up results were included in the analysis. RESULTS: Twenty-three patients met the inclusion criteria (18 male and 5 female). Age ranged from 14 to 79 years (mean 53 years). Twelve patients presented with hemorrhage. Twenty-eight endovascular procedures were performed. The overall immediate angiographic cure rate after endovascular treatment was 82.6% (19/23 patients). The angiographic cure rate of the transvenous strategy was significantly superior to the transarterial strategy (p ≤ 0.001). There was 1 complication in 28 total procedures (3.6%). Angiographic follow-up was available in 21 out of the 23 patients with a mean of 25 months (range 2 to 108 months). In these 21 patients, the DAVF was completely cured in 20 (95%). At last follow-up, all patients had a modified Rankin scale (mRS) 0 to 2. CONCLUSION: Our experience suggests that endovascular treatment for ACF DAVFs has an acceptable safety profile with high rates of complete occlusion, particularly with transvenous approach. Whenever possible, transvenous approach should be preferred over transarterial approach as first line strategy.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Procedimentos Endovasculares , Adolescente , Adulto , Idoso , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Fossa Craniana Anterior , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Curr Opin Otolaryngol Head Neck Surg ; 29(1): 53-58, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33278134

RESUMO

PURPOSE OF REVIEW: To give an overview of recently published literature on the indications and use of cranialization of the frontal sinuses. RECENT FINDINGS: Recent studies on cranialization have evaluated its role in frontal sinus fractures, inflammatory disease, and tumors involving both the frontal sinus and anterior cranial fossa. Currently, a more conservative approach is favored with traumatic injury to the frontal sinus outflow tract, with multiple studies demonstrating outflow recanalization with observation alone. Similarly, advancements in endoscopic sinus surgical approaches allow the many posterior table fractures to be managed without cranialization. Severe inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression have successfully been managed without cranialization in multiple studies suggesting an endoscopic surgical approach can be favored in these settings. Both benign and malignant tumors of the frontal sinus are managed without cranialization with select cases favoring an open approach with cranialization depending on tumor location. Malignant tumors of the frontal sinus are more likely to require cranialization as oncologic resection including margins can lead to large dural defects with significant tissue loss, which is unfavorable for more conservative reconstructive options. SUMMARY: Cranialization remains a necessary and indicated procedure in the appropriate clinical circumstances. A more conservative approach to frontal sinus fractures is warranted, with recent literature supporting similar outcomes and less morbidity. Inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression can be managed without cranialization. Although most benign tumors can be resected via endoscopic approaches, cranialization remains a mainstay as part of the reconstructive plan after oncologic resection of malignant tumors involving the frontal sinus.


Assuntos
Fossa Craniana Anterior/cirurgia , Seio Frontal/cirurgia , Doenças dos Seios Paranasais/cirurgia , Craniotomia/métodos , Humanos
14.
J Neurosurg Sci ; 65(2): 118-132, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33245219

RESUMO

Meningiomas along the anterior skull base arise from the midline but have historically been resected via open cranial approaches with lateral to medial trajectories. The endoscopic endonasal approach (EEA) offers a direct, inferomedial approach which has demonstrated several superior qualities for their resection. These meningiomas include tuberculum sellae, planum sphenoidale, and olfactory groove meningiomas. While early gross total resection (GTR) was lower than open approaches, EEA has currently achieved comparable rates of GTR and significantly improved postoperative visual outcomes. Rate of cerebrospinal fluid (CSF) leak was one of the early complicating features preventing widespread use of EEA. However, CSF leak rates have dramatically fallen into a tolerable range with introduction of the vascularized nasoseptal flap. Olfactory groove meningiomas often present with anosmia which is persistent after endonasal approach. Rates of other complications have proven similar between EEA and open approaches and include: vascular injury, infection, morbidity, and mortality. With the appropriate team and experience, EEA for anterior skull base meningiomas is increasingly becoming the standard for resection of these lesions. However, there are certain anatomic considerations, patient features, and other aspects which may favor the open approach over EEA, and vice versa; these must be carefully and judiciously evaluated preoperatively. Overall, resection and recurrence rates are comparable, complication rates fall within a very acceptable range, and patients experience superior cosmesis and improved visual outcome with this approach.


Assuntos
Neoplasias Meníngeas , Meningioma , Neoplasias da Base do Crânio , Fossa Craniana Anterior/cirurgia , Humanos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Neoplasias da Base do Crânio/cirurgia , Resultado do Tratamento
15.
J Neurosurg Sci ; 65(2): 103-117, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33245220

RESUMO

Endoscopic endonasal approaches (EEA) to the skull base have significantly impacted the management of lesions located in the cranial base. Specifically, lesions arising from the anterior cranial fossa, such as pituitary macroadenomas, craniopharyngiomas meningiomas and craniofacial malignancies have benefited from the development of such approaches. Understanding of the anatomy of the anterior fossa is of utmost importance for the successful selection of the approach and application of surgical techniques in EEA. In the current manuscript, we review the most relevant points of surgical anatomy and nuances of the surgical technique of EEA to the anterior fossa. Anatomical landmarks for the transtuberculum transplanum and transcribriform approaches are discussed and a step-by-step description for those approaches is presented. We reinforce that safe and effective application of such techniques follow the same principles of other skull base surgery techniques: mastering of surgical anatomy, adequate case selection, correct instrumentation and surgical experience.


Assuntos
Neoplasias Meníngeas , Neoplasias da Base do Crânio , Fossa Craniana Anterior/cirurgia , Humanos , Neoplasias Meníngeas/cirurgia , Procedimentos Neurocirúrgicos , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/cirurgia
16.
J Craniofac Surg ; 32(5): 1673-1678, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33208698

RESUMO

ABSTRACT: Anterior cranial fossa intra- and extracranial tumors arise from the anterior cranial fossa and invade the orbit and nose. Anterior cranial fossa tumor resection and skull base reconstruction are challenging for neurosurgeons due to the complex anatomy, leakage of cerebrospinal fluid, and critical neurovasculature involvement. The authors report a case series of cranio-orbital communicating tumors and cranionasal-orbital communicating tumors. All patients underwent a modified Derome approach or transfrontal basal approach, and all tumor resections were satisfactory. Skull base reconstruction for small defects (<1.5 cm) can be performed with autogenous fascia, muscle, and fat. Large defects (≥1.5 cm) require autogenous fascia, muscle, and fat combined with osseous reconstruction (autogenous bone, titanium mesh, and polyetheretherketone). The techniques and treatments were successful, and only 1 patient experienced mild cerebrospinal fluid leak but no intracranial infection, pneumocrania or intracranial hemorrhage. Additionally, long-term follow-up demonstrated that the outcomes remain favorable. According to a literature review, this technique might be an alternative strategy for treating anterior cranial fossa intra- and extracranial tumors, and better skull base reconstruction can prevent many postoperative complications.


Assuntos
Implantes Dentários , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Base do Crânio , Fossa Craniana Anterior/cirurgia , Humanos , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/cirurgia
17.
J Clin Neurosci ; 81: 1-5, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33222894

RESUMO

Intracranial schwannomas not originating from cranial nerves are rare. In this paper, we report a case of a 50-year-old male who presented with worsening headaches, diplopia and nausea over two years. Radiological imaging revealed a large tumour arising from the olfactory groove region with a preoperative diagnosis of olfactory groove meningioma (OGM). Intraoperatively, the tumour originated from the region of the attachment of the falx to the crista galli. The patient recovered without complication and histopathology reported an unexpected diagnosis of WHO Grade 1 schwannoma. However, as olfactory groove schwannomas (OGSs) cannot be distinguished from olfactory ensheathing cell tumours (OECTs), it is possible that the tumour could have been either an OGS or an OECT. Distinguishing between OGSs, OECTs and OGMs preoperatively is difficult. OGMs exhibit distinct histopathological features from OGSs/OECTs, however, OGSs and OECTs currently cannot be distinguished from each other. Here, we review the literature to discuss the differentiating features and cellular origins of these three tumours.


Assuntos
Fossa Craniana Anterior/patologia , Neurilemoma/diagnóstico , Neoplasias da Base do Crânio/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Neurilemoma/cirurgia , Neoplasias da Base do Crânio/cirurgia
18.
Int J Med Sci ; 17(13): 1974-1983, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32788876

RESUMO

Unlike its parietal, temporal, and occipital counterparts, the frontal lobe has a broad basal surface directly facing the anterior cranial fossa dura mater which could permit establishment of transdural collaterals (TDCs) with the frontal lobe. Studies on the TDCs from the anterior cranial fossa in moyamoya disease (MMD) are scarce and inadequately investigated. A retrospective study of 100 hemispheres in 50 patients who were diagnosed with MMD by catheter angiography between January 2015 and June 2019 was performed in our institution. TDCs through the anterior ethmoid artery (AEA) or posterior ethmoid artery (PEA) were divided into 3 types respectively based on their respective angioarchitecture. Furthermore, we also studied TDCs to the temporal, parietal, and occipital lobes and collaterals from the posterior circulation to the territory of the anterior cerebral artery. TDCs through the AEA and PEA were identified in 89 (89/100, 89%) and 73 (73/100, 73%) of the hemispheres. The vascularization state of the frontal lobe was good in 89 (89/100, 89%) hemispheres. Rete mirabile and TDCs through the PEA were statistically different among patients with different Suzuki stages. No statistical difference was noted in TDCs through the AEA, frontal TDCs from other sources, and the vascularization state of the frontal lobe with regard to different Suzuki stages. TDCs through the AEA and PEA at the anterior cranial fossa play a very important role in compensating the ischemic frontal lobe. The frontal lobe could be well compensated in most of the patients with TDCs at the anterior cranial fossa.


Assuntos
Angiografia/métodos , Fossa Craniana Anterior/diagnóstico por imagem , Doença de Moyamoya/diagnóstico por imagem , Adulto , Artérias , Circulação Colateral , Fossa Craniana Anterior/irrigação sanguínea , Seio Etmoidal/irrigação sanguínea , Feminino , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
No Shinkei Geka ; 48(8): 691-697, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32830133

RESUMO

The formation of symptomatic intradural mucocele associated with a paranasal osteoma is rare, and no standard treatment has been established. Here, we present a case of intradural mucocele in a 27-year-old man complaining of headache and generalized convulsion. Cranial CT and brain MRI showed a left frontoethmoidal osteoma extending into the left anterior cranial fossa and orbit along with a mass in the left frontal lobe. He underwent resection of both intracranial osteomas and the mass through left frontal craniotomy. Histological findings were consistent with a mucocele, and the diagnosis of an intradural mucocele associated with a frontoethmoidal osteoma was confirmed. The postoperative course was uneventful. Although both osteoma and mucocele are benign, they may cause life-threatening symptoms by expanding intracranially. A tailored treatment considering the invasiveness and postoperative long-term follow-up of the patient is essential for this uncommon condition.


Assuntos
Seio Frontal , Mucocele , Osteoma , Neoplasias dos Seios Paranasais , Adulto , Fossa Craniana Anterior , Humanos , Masculino
20.
Clin Neurol Neurosurg ; 196: 106041, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32604034

RESUMO

INTRODUCTION: Olfactory groove meningiomas (OGMs) account for 8-13 % of all intracranial meningiomas. The gold standard of treatment is generally surgery, however various approaches have been used and the literature is still uncertain about the superiority of one treatment over the others. The most debated techniques are traditional microscopic open approaches versus the endoscopic endonasal ones. The aim of this paper is to prove a valid surgical route that gathers the benefits of both endoscopic and transcranial routes. METHODS: Fifty consecutive patients underwent trans-frontal sinus surgical removal of an OGM between January 2000 and January 2019 at the Neurosurgical Departments in Torino, Brescia and Legnano (Italy). The clinical features were collected in a database and compared with neuroimaging and outcomes. All patients were investigated with neuroimaging techniques. Clinical evaluations were performed 3-4 months and 1 year after surgery, together with neuroradiological follow-up. RESULTS: All patients with OGM underwent Simpson grade I resection. The most common neurological symptom leading to neuroradiological evaluations were headaches (36 %), followed by behavioural changes (30 %), hyposmia/anosmia (12 %), visual impairments (6%) and focal deficits (6%). At 3-4 months follow-up 48 patients underwent a brain MRI (2 patients underwent a brain CT), and a complete resection was confirmed in 45 patients (94 %). CONCLUSIONS: Despite different techniques and studies supported by good evidence, there is no consensus on the best surgical approach for OGMs. The data shown in this article suggests that the trans-frontal sinus approach is a valid alternative to an endoscopic approach and the classical transcranial routes, collecting benefits from both approaches.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Fossa Craniana Anterior/patologia , Fossa Craniana Anterior/cirurgia , Feminino , Seio Frontal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...