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Middle Skull Base

Konstantinos Natsis, Maria Piagkou, Nikolaos Lazaridis, Trifon Totlis, Nikolaos Anastasopoulos, Jannis Constantinidis
PURPOSE: The current study investigated the incidence, morphology and morphometry of the ossified ligaments expanding between petrous bone and posterior clinoid processes and in between the anterior, middle and posterior clinoid processes. Side symmetry, gender dimorphism and age influence were also studied. MATERIALS AND METHODS: A total of 123 adult Greek dry skulls were observed. RESULTS: A caroticoclinoid bar (CCB) was found in 60.2%. Partial CCBs appeared more commonly (36...
February 10, 2018: Journal of Cranio-maxillo-facial Surgery
Rosalinda Calandrelli, Fabio Pilato, Luca Massimi, Marco Panfili, Gabriella D'Apolito, Simona Gaudino, Cesare Colosimo
PURPOSE: Craniosynostostic syndromes are due to multisuture synostoses and affect the entire craniofacial skeleton. This study analyzed the facial complex and airways to quantify the relationship between insufficient facial growth, airways obstruction, and the sutural pattern of the splanchnocranium and cranial fossae. METHODS: Preoperative high-resolution CT images in 19 infants with syndromic craniosynostosis were quantitatively analyzed. Because all children showed involvement of minor sutures/synchondroses coursing in the posterior cranial fossa, they were divided into three groups according to the synostotic involvement of "minor" sutures/synchondroses coursing in anterior (ACF) and middle (MCF) cranial fossae: group 1 (ACF), group 2 (MCF), and group 3 (ACF-MCF)...
March 8, 2018: Neuroradiology
Daniele Marchioni, Angelo Musumeci, Cristoforo Fabbris, Stefano De Rossi, Davide Soloperto
BACKGROUND: The clivus is a region characterized by complex anatomy, with vascular and neural structures that are located in close proximity. Different pathologies can affect this area, and traditional surgical approaches were open approaches. Recently, the endoscopic transnasal technique has been introduced, and currently represents a good alternative for the surgical management of these lesions. This is a preliminary report on patients treated endoscopically for clival lesions by the authors' Skull Base Team...
March 8, 2018: European Archives of Oto-rhino-laryngology
Brandon Lucke-Wold, Erik C Brown, Justin S Cetas, Aclan Dogan, Sachin Gupta, Timothy E Hullar, Timothy L Smith, Jeremy N Ciporen
Cerebrospinal fluid (CSF) leaks occur in approximately 10% of patients undergoing a translabyrinthine, retrosigmoid, or middle fossa approach for vestibular schwannoma resection. Cerebrospinal fluid rhinorrhea also results from trauma, neoplasms, and congenital defects. A high degree of difficulty in repair sometimes requires repetitive microsurgical revisions-a rate of 10% of cases is often cited. This can not only lead to morbidity but is also costly and burdensome to the health care system. In this case-based theoretical analysis, the authors summarize the literature regarding endoscopic endonasal techniques to obliterate the eustachian tube (ET) as well as compare endoscopic endonasal versus open approaches for repair...
March 2018: Neurosurgical Focus
Melissa M Stamates, John M Lee, Ryan T Merrell, Michael J Shinners, Ricky H Wong
In the absence of significant extracranial disease, patients with solitary brain metastases have shown benefit with resection. Brain lesions due to endometrial cancer are uncommon, and the only described skull base involvement is limited to the pituitary gland. We report the case of a 60-year-old female with endometrial cancer who presented with weeks of right cheek pain and numbness that was accompanied by headaches. We describe the magnetic resonance imaging (MRI) findings and surgical resection of a solitary endometrial metastasis involving the infratemporal fossa, middle fossa, cavernous sinus, trigeminal nerve, and nasal sinuses...
January 2018: Journal of Neurological Surgery Reports
Paul J Plummer, Jan K Shearer, Katie E Kleinhenz, Leslie C Shearer
OBJECTIVE To determine the optimal anatomic site and directional aim of a penetrating captive bolt (PCB) for euthanasia of goats. SAMPLE 8 skulls from horned and polled goat cadavers and 10 anesthetized horned and polled goats scheduled to be euthanized at the end of a teaching laboratory. PROCEDURES Sagittal sections of cadaver skulls from 8 horned and polled goats were used to determine the ideal anatomic site and aiming of a PCB to maximize damage to the midbrain region of the brainstem for euthanasia. Anatomic sites for ideal placement and directional aiming were confirmed by use of 10 anesthetized horned and polled goats...
March 2018: American Journal of Veterinary Research
Liang Wang, Xun Ye, Qiang Hao, Li Ma, Xiaolin Chen, Hao Wang, Yuanli Zhao
To develop a realistic model of middle cerebral artery (MCA) aneurysms using three-dimensional (3D) printing for surgical planning, research, and training of neurosurgical residents. This study included eight MCA aneurysm cases. The aneurysm together with the adjacent arteries and skull base were printed based on raw computed tomography angiography (CTA) data using a 3D printer with acrylonitrile-butadiene-styrene as the model material. The aneurysm models were used for surgical planning, and craniotomy and clipping practice by neurosurgical residents...
February 10, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Neil Saez, Giriraj K Sharma, Christian H Barnes, Yuxin Lu, Frank P Hsu, Kevin C Huoh, Hamid R Djalilian, Harrison W Lin
OBJECTIVES: Aneurysmal bone cysts (ABC) are benign, rapidly growing osteolytic lesions. Solid variant of ABC (SVABC) is a rare subtype of ABC that has not been reported in the temporal bone. METHODS: We report the case of a 6-year-old boy presenting with a slowly enlarging bony protuberance over the right zygomatic/malar eminence region. Computed tomography and magnetic resonance imaging demonstrated a 2.6 × 5.8 × 5.1 cm temporal bone mass involving the right mastoid, petrous, and temporal squamosal calvarium, with extradural intracranial extension to the middle cranial fossa...
February 1, 2018: Annals of Otology, Rhinology, and Laryngology
Golda Grinblat, Manjunath Dandinarasaiah, Sampath Chandra Prasad, Gianluca Piras, Enrico Piccirillo, Andrea Fulcheri, Mario Sanna
OBJECTIVE: To study the clinical presentation, intraoperative findings and surgical management in meningo-encephalic-herniation (MEH) based on the etiology. STUDY DESIGN: A retrospective clinical study and is a follow-up on the previously published report in 2009. SETTING: A quaternary referral otology and skull base center PATIENTS AND METHODS:: The inclusion criteria were intraoperatively verified MEH in patients with a minimum follow-up of 12 months, which yielded 262 operated ears...
March 2018: Otology & Neurotology
Ricky H Wong
OBJECT: Middle fossa floor access can be challenging. Open skull base approaches have associated morbidity and yield suboptimal working angles around temporal lobe. Endoscopic endonasal approaches to the middle fossa are poorly described, but provide an improved angle. The author hypothesized that the length of the maxillary nerve can be transposed out of foramen rotundum in order to provide a path to expose the full width of the middle fossa floor through the anterolateral and anteromedial triangle...
February 1, 2018: World Neurosurgery
Daniele Marchioni, Marco Carner, Davide Soloperto, Luca Bianconi, Andrea Sacchetto, Luca Sacchetto, Barbara Masotto, Livio Presutti
Objective Vestibular schwannoma (VS) is a benign tumor of the lateral skull base. Different microscopic surgical techniques are described in literature: the retrosigmoid and translabyrinthine approaches are used to treat big tumors located in the cerebellopontine angle, and the middle cranial fossa approach is utilized for small tumors with good hearing preservation. The expanded transcanal transpromontorial (ExpTT) approach is a combined microscopic-endoscopic technique previously indicated for Koos stage I and II VS and now proposed for larger VS, up to 3 cm in diameter, with linear progression into the cerebellopontine angle and touching the brainstem...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Mahmoud Messerer, Rodolfo Maduri, Roy Thomas Daniel
Objective  Endoscopic transsphenoidal extended endoscopic approach (EEA) represents a valid alternative to microsurgery for craniopharyngiomas removal, especially for retrochiasmatic lesions without large parasellar extension. The present video illustrates the salient surgical steps of the EEA for craniopahryngioma removal. Patient  A 52-year-old man presented with a bitemporal hemianopia and a bilateral decreased visual acuity. MRI showed a Kassam type III cystic craniopharyngioma with a solid component ( Fig...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Michael Groth, Käthe Greta Barthe, Martin Riemer, Marielle Ernst, Jochen Herrmann, Jens Fiehler, Jan-Hendrik Buhk
PURPOSE:  To compare the learning benefit of three different teaching strategies on the interpretation of emergency cerebral computed tomography (CT) pathologies by medical students. MATERIALS AND METHODS:  Three groups of students with different types of teaching (e-learning, interactive teaching, and standard curricular education in neuroradiology) were tested with respect to the detection of seven CT pathologies. The test results of each group were compared for each CT pathology using the chi-square test...
February 1, 2018: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Nishanth Sadashiva, Rajalakshmi Poyuran, Anita Mahadevan, Dhananjaya I Bhat, Sampath Somanna, Bhagavatula Indira Devi
Chordoid meningioma is a rare variant of meningioma, with a higher incidence in the young and a supposed association with Castleman's syndrome. They have an aggressive clinical course, and are assigned as WHO grade II meningiomas. To the best of our knowledge, 284 chordoid meningiomas have been reported in the literature. This series reporting 33 cases is the third largest series in published literature from a single Institution. We reviewed Clinico-pathological characteristics of 33 patients diagnosed with chordoid meningioma between 2001 and 2015 in our institution...
January 27, 2018: Journal of Neuro-oncology
Lu Yang, Li Hu, Weidong Zhao, Huankang Zhang, Quan Liu, Dehui Wang
BACKGROUND: The anatomical locations involved in trigeminal schwannomas (TSs) are quite complex. The endoscopic endonasal approach provides a minimal damage access corridor to both anterior and middle skull base for surgery. Given the nerve function recovery and postoperative neurological deterioration varied in different reports, the author demonstrates his surgery tips and the functional outcomes under endoscopic surgery in one single institution. METHODS: A retrospective review of patients with TSs was undertaken to assess the outcome of endoscopic surgery from 2006 to 2016...
March 2018: European Archives of Oto-rhino-laryngology
Masahiro Shin, Masaaki Shojima, Kenji Kondo, Hirotaka Hasegawa, Shunya Hanakita, Akihiro Ito, Taichi Kin, Nobuhito Saito
OBJECTIVE: Skull base meningiomas carry a nonnegligible risk of recurrence. In particular, those arising from the sphenoid wings or middle cranial fossa penetrate into extracranial regions, uncommonly showing massive expansion into the craniofacial regions on recurrence. The role of endoscopic endonasal surgery for those intractable lesions remains unclear. METHODS: We performed endoscopic endonasal craniofacial surgery for 8 recurrent meningiomas invading into the pterygopalatine fossa, infratemporal fossa, nasopharynx, paranasal sinus, or orbit, comprising 2 meningothelial and 1 fibrous meningiomas (World Health Organization [WHO] grade I), 3 atypical and 1 clear cell meningiomas (grade II), and 1 anaplastic meningioma (grade III)...
January 12, 2018: World Neurosurgery
Stephen Monteith, Oded Goren, Ragu Sampath, Eric Lehr, Akshal Patel, Paul J Choi, Joe Iwanaga, Marios Loukas, R Shane Tubbs
BACKGROUND: A few options of extracranial donor vessels exist for utilization in intracranial vascular bypass procedures. To our knowledge, the use of an internal thoracic artery for cerebral revascularization has not been studied previously. Hence, this cadaveric feasibility study was performed. METHODS: The internal thoracic artery was dissected in five adult cadaveric specimens. The proximal diameter, distal diameter, and the length of the vessel were measured and recorded...
January 12, 2018: World Neurosurgery
Bin Yang, Jian Ni, Binghang Li
PURPOSE: This study aims to comprehensively evaluate the deformation of the skull base and fronto-temporal soft tissue in the patients with anterior plagiocephaly over 1 year of age by three-dimensional (3D) imaging after fronto-orbital advancement (FOA). METHODS: We quantitatively analyzed the surgical results and outcome of FOA performed in 10 patients with anterior plagiocephaly. The measurements of the skull base and fronto-temporal soft tissue were performed based on 3D computed tomography (CT) scan...
January 15, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Ashwin Kumaria, Harshal A Ingale, Donald C Macarthur
We present the case of a 58 year old lady with a large middle cranial fossa meningioma (5 cm × 4 cm in maximal dimensions) which has considerably regressed without any treatment during seven years of follow up. While the tumour had remained radiologically static for the first three years, scans from year five post-diagnosis onwards have shown shrinkage of the meningioma from a calculated volume of 36 cm3 to 11.2 cm3. There has been no intratumoral haemorrhage or infarction and no medication or exogenous hormonal effect that could account for this effect...
January 15, 2018: British Journal of Neurosurgery
Guichen Li, Xuan Zhai, Yang Zhang, Ping Liang, Xuanxuan Wu, Kun Hou
BACKGROUND: Intracranial (cavernous malformations) CMs are usually located at the cerebral parenchyma, dural-based CMs outside the middle fossa are rarely reported. To our knowledge, dural-based CMs located at the cerebral convexity are even rarer that only two pediatric cases were ever reported. In this report, we present two extremely rare cases of dural-based CMs at the cerebral convexity in pediatric patients. The clinical course, radiological and pathological features, treatment, and follow-up are described...
January 10, 2018: World Neurosurgery
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