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Middle Skull Base

Chai Kobkitsuksakul, Pakorn Jiarakongmun, Ekachat Chanthanaphak, Sirintara Pongpech
PURPOSE: The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinüs with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages...
October 21, 2016: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Cameron C Wick, Daniel E Killeen, Michael Clark, Joe Walter Kutz, Brandon Isaacson
OBJECTIVE: Describe the diagnosis and management of spontaneous lateral skull base cerebrospinal fluid (CSF) leaks that originate from the posterior fossa. STUDY DESIGN: Retrospective case review. SETTING: Tertiary university hospital. PATIENTS: Adult patients from 2005 to 2015 who underwent surgical repair of a spontaneous lateral skull base CSF leak with intraoperative confirmation of a posterior fossa leak source...
October 14, 2016: Otology & Neurotology
Christian Güldner, Isabell Diogo, Eva Bernd, Stephanie Dräger, Magis Mandapathil, Afshin Teymoortash, Hesham Negm, Thomas Wilhelm
Cone beam computed tomography (CBCT, syn. digital volume tomography = DVT) was introduced into ENT imaging more than 10 years ago. The main focus was on imaging of the paranasal sinuses and traumatology of the mid face. In recent years, it has also been used in imaging of chronic ear diseases (especially in visualizing middle and inner ear implants), but an exact description of the advantages and limitations of visualizing precise anatomy in a relevant number of patients is still missing. The data sets of CBCT imaging of the middle and inner ear of 204 patients were analyzed regarding the visualization of 18 different anatomic structures...
October 17, 2016: European Archives of Oto-rhino-laryngology
Sharafine Stephen, Beula Subashini, Regi Thomas, Ajay Philip, Rajan Sundaresan
Malignant otitIs externa (skull base osteomyelitis) is predominantly caused by bacteria while fungal etiology is rare. We report a middle aged diabetic gentleman who succumbed to invasive skull base infection due to Apophysomyces elegans a fungus belonging to Zygomycetes which causes only skin and soft tissue infections. Mortality and invasive infections due to this genus is rarely reported, especially in the ear.
February 2016: Journal of the Association of Physicians of India
Gustaw Wojcik
Arachnoid cysts are intracranial pathologies in the space between the pia mater and the dura mater of the brain and cerebellum. Arachnoid cysts are derived from the arachnoidea mater, which while yielding to germination or splitting creates a space filled with liquid with a composition similar to cerebrospinal fluid. The aim of the study is to present possible clinical symptoms and radiological presentation of intracranial arachnoid cysts. The symptoms of intracranial arachnoid cysts are dependent on its size and location...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Joanne May Jenkins, Joel Norton, Timothy Hampton, Robert Weeks
A 55-year-old man was working in a trench when the wall collapsed in on him, pinning him to the wall. On arrival in the emergency department the patient began reporting of right-sided headache. Neurological examination revealed left-sided reduced sensation with weakness. Whole-body CT scan showed right-sided flail chest and bilateral haemothorax as well as loss of flow and thinning of the distal right internal carotid artery (ICA) and loss of grey white matter differentiation in keeping with traumatic ICA dissection with a right middle cerebral artery (MCA) infarct...
2016: BMJ Case Reports
Alberto Schreiber, Davide Mattavelli, Marco Ferrari, Vittorio Rampinelli, Davide Lancini, Francesco Belotti, Luigi Fabrizio Rodella, Piero Nicolai
BACKGROUND: Over the past decade, the treatment of complex intradural and extradural pathologies via expanded endonasal approaches has been made possible by progresses and refinements in skull base reconstruction techniques. The aim of this anatomic study is to describe a novel endonasal flap, the turbinal flap (TF), based on the middle and superior turbinate mucosa and pedicled on the ethmoidal arteries system. METHODS: Three fresh-frozen (6 sides) cadaver heads previously injected with colored silicone were dissected...
September 21, 2016: International Forum of Allergy & Rhinology
Matthew Bobinski, Peter Y Shen, Arthur B Dublin
Skull base fractures extend through the floor of the anterior, middle, or posterior cranial fossa. They are frequently associated with complex facial fractures and serious complications such as cranial nerve or vascular injury, cerebrospinal fluid leak, or meningitis. Several distinct patterns of skull base fractures have been recognized, each of them associated with different complications. Recognition of, often subtle, skull base fracture is essential to prevent or allow early treatment of these serious complications...
October 2016: Journal of Neurological Surgery. Part B, Skull Base
Martin M Mortazavi, Marcus A Cox, Erfanul Saker, Sanjay Krishnamurthy, Ketan Verma, Christoph J Griessenauer, Marios Loukas, Rod J Oskouian, R Shane Tubbs
The superior petrosal sinus is located between the middle and posterior cranial fossae and is important during many neurosurgical approaches to the skull base. Using standard search engines, the anatomical and clinical importance of the superior petrosal sinus was investigated. The superior petrosal sinus is important in many neurosurgical approaches and pathological entities. Therefore, it is important for those who operate at the skull base or interpret imaging here to have a good working knowledge of its anatomy, development, and pathological involvement...
September 19, 2016: Neurosurgical Review
Michihiro Tanaka
BACKGROUND: The distribution of intracranial dural AVFs (DAVFs) may be affected by the embryological bony structures that consist of membranous bone and endochondral bone. METHODS: We retrospectively analyzed the distribution of the shunt points in 58 consecutive cases of DAVFs. Shunt points were identified with selective digital subtraction angiography, high-resolution cone beam computed tomography (CT), or three-dimensional rotation angiography. All the shunt points were plotted on the map of the skull base in relation to the topography of the endochondral bone and the membranous bone...
2016: Acta Neurochirurgica. Supplement
Serdar Ercan, Alba Scerrati, Phengfei Wu, Jun Zhang, Mario Ammirati
OBJECTIVE The subtemporal approach is one of the surgical routes used to reach the interpeduncular fossa. Keyhole subtemporal approaches and zygomatic arch osteotomy have been proposed in an effort to decrease the amount of temporal lobe retraction. However, the effects of these modified subtemporal approaches on temporal lobe retraction have never been objectively validated. METHODS A keyhole and a classic subtemporal craniotomy were executed in 4 fresh-frozen silicone-injected cadaver heads. The target was defined as the area bordered by the superior cerebellar artery, the anterior clinoid process, supraclinoid internal carotid artery, and the posterior cerebral artery...
September 16, 2016: Journal of Neurosurgery
Rick F Nelson, Joseph P Roche, Bruce J Gantz, Marlan R Hansen
OBJECTIVE: To determine the efficacy and morbidity of repairing spontaneous cerebrospinal fluid (CSF) leaks with the middle cranial fossa (MCF) approach without the use of a lumbar drain (LD), as perioperative use of LD remains controversial. STUDY DESIGN: Retrospective review from 2003 to 2015. SETTING: University of Iowa Hospitals and Clinics and Indiana University Health Center. PATIENTS: Those with a confirmed lateral skull base spontaneous CSF leaks and/or encephaloceles...
September 14, 2016: Otology & Neurotology
Cameron C Wick, Joseph Zachariah, Sunil Manjila, William C Brown, Prerna Malla, Bashar Katirji, Mark Cohen, Cliff A Megerian
IgG4-related disease (IgG4-RD) is increasingly being recognized as an entity effecting the head and neck region. Although most commonly seen with salivary gland or paranasal sinus involvement, IgG4-RD may also involve the temporal bone and skull base. We report a rare care of a 61-year-old female with IgG4-RD presenting as synchronous lesions of the middle ear and middle cranial fossa with polyneuropathy of cranial nerves II, VI, and VII. Initial histopathological evaluation of her resected ear mass suggested a benign inflammatory process but no specific diagnosis...
August 18, 2016: American Journal of Otolaryngology
Kurren S Gill, David Hsu, Patrick Tassone, John Pluta, Gurston Nyquist, Howard Krein, Jurij Bilyk, Ann P Murchison, Alfred Iloreta, James J Evans, Ryan N Heffelfinger, Joseph M Curry
OBJECTIVES: To assess risk factors for cerebrospinal fluid (CSF) leak and complications after microvascular reconstruction of cranio-orbitofacial resection with orbital exenteration (CFOE). STUDY DESIGN: Retrospective case series. METHODS: Seventy consecutive patients at a tertiary hospital underwent 76 procedures with microvascular reconstruction of CFOE defects. Patients were stratified by extent of skull base exposure and presence or absence of dural resection...
September 7, 2016: Laryngoscope
Noritaka Komune, Satoshi Matsuo, Koichi Miki, Albert L Rhoton
OBJECTIVE The application of the endoscope in the lateral skull base increases the importance of the middle ear cavity as the corridor to the skull base. The aim of this study was to define the middle ear as a route to the fundus (lateral end) of the internal acoustic canal and to propose feasible landmarks to the fundus. METHODS This was a cadaveric study; 34 adult cadaveric temporal bones and 2 dry bones were dissected with the aid of the endoscope and microscope to show the anatomy of the transcanal approach to the middle ear and fundus of the internal acoustic canal...
September 2, 2016: Journal of Neurosurgery
Samuel J C Fishpool, Anthony Amato-Watkins, Caroline Hayhurst
The objective is to assess whether free middle turbinate (FMT) graft reconstruction, after endoscopic endonasal pituitary surgery, combines an acceptably low post-operative cerebrospinal fluid (CSF) leak rate with acceptable rhinological morbidity. This study identified 50 patients who underwent endoscopic endonasal pituitary surgery by the senior author in our teaching hospital between May 2011 and June 2012. FMT graft reconstruction was used in 32 cases. 18 patients were judged pre-operatively as not suitable for FMT reconstruction according to a novel skull base reconstructive algorithm...
September 1, 2016: European Archives of Oto-rhino-laryngology
Samantha L Schoell, Ashley A Weaver, Jennifer W Talton, Gretchen Baker, Andrea N Doud, Ryan T Barnard, Joel D Stitzel, Mark R Zonfrillo
OBJECTIVE: The objective of the study was to develop a disability-based metric for motor vehicle crash (MVC) injuries, with a focus on head injuries, and compare the functional outcomes between the pediatric and adult populations. METHODS: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System (NTDB-RDS) for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3, 4, and 5 head injuries in NASS-CDS 2000-2011...
September 2016: Traffic Injury Prevention
Rui Feng, Eric Karl Oermann, Thomas Oxley, Raj Shrivastava
Meningiomas are common intracranial tumors that can have complex arterial supply. A patient with a recurrent large left clinoid aypical grade 2 meningioma was found to have left proximal middle cerebral artery (MCA) occlusion, and reconstitution of her MCA circulation from her left middle meningeal artery on diagnostic angiography. The planned surgical approach consequently adjusted to preserve the left external carotid artery circulation in a difficult meningioma resection. This case illustrates a role for preoperative angiography in surgical planning of patients with complex skull base tumors involving intracranial vascular structures and highlights the unique neovascularization that can often take place as meningiomas parasitize the exracranial blood supply...
August 26, 2016: World Neurosurgery
Kate Miller, Sam Eljamel
INTRODUCTION: Therapeutic decompressive craniectomy (TDC) controls raised intracranial pressure (rICP). Its role remained controversial until its successful introduction to treat malignant middle cerebral artery ischemia. However, standardization of its size and site remain controversial points. This study was designed to evaluate does size and site matter in TDC? METHODS: We used a replica-skull of a patient with refractory rICP and successful TDC. ICP was raised using intracranial balloon modified to monitor ICP and permit progressive ICP-increments...
August 24, 2016: World Neurosurgery
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