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Posterior Skull Base

Thomas Coquet, Michel Lefranc, Louis Chenin, Pascal Foulon, Éric Havet, Johann Peltier
In this anatomy report, we describe the first case of abducens nerve duplication limited to the sphenopetroclival venous gulf and the cavernous sinus. The objective point of division of the two duplicated roots was localized at the gulfar face of the dural porus, just distal to the unique cisternal trunk of the abducens nerve, as it pierced the petroclival dural mater. In the gulfar segment, both roots traveled through a variant of Dorello's canal called the "petrosphenoidal canal" and remained separated through the posterior half of the cavernous sinus...
March 15, 2018: Surgical and Radiologic Anatomy: SRA
Rubens Spin-Neto, Louise H Matzen, Lars W Schropp, Thomas S Sørensen, Ann Wenzel
OBJECTIVES: To assess the impact of head motion artefacts and an automated artefact-correction system on CBCT image quality and interpretability for simulated diagnostic tasks. METHODS: A partially dentate human skull was mounted on a robot simulating four types of head movement (antero-posterior translation, nodding, lateral rotation, and tremor), at three distances (0.75, 1.5, and 3 mm) based on two movement patterns (skull returning/not returning to the initial position)...
March 14, 2018: Dento Maxillo Facial Radiology
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
Alexandre Bossi Todeschini, Alaa S Montaser, Douglas A Hardesty, Ricardo L Carrau, Daniel M Prevedello
Endoscopic endonasal approaches (EEA) have gained popularity and acceptance in skull base surgery over the last two decades. So-called expanded EEA allow access in the sagittal plane from the frontal sinus to the odontoid process. The endoscopic endonasal transclival approach allows a unique trajectory into the midline clivus and skull base that is unachievable from traditional craniotomy approaches to lesions such as chondrosarcomas, chordomas, and posterior fossa meningiomas. In this review, we will assess the benefits and drawbacks to using an endoscopic endonasal approach versus transcranial approach to these challenging lesions, assess the anatomical limits of endoscopic endonasal transclival surgery, and discuss the published literature on the topic...
March 8, 2018: Journal of Neurosurgical Sciences
James Barger, Matthew Siow, Michael Kader, Katherine Phillips, Girish Fatterpekar, David Kleinberg, David Zagzag, Chandranath Sen, John G Golfinos, Richard Lebowitz, Dimitris G Placantonakis
Background: While effective for the repair of large skull base defects, the Hadad-Bassagasteguy nasoseptal flap increases operative time and can result in a several-week period of postoperative crusting during re-mucosalization of the denuded nasal septum. Endoscopic transsphenoidal surgery for pituitary adenoma resection is generally not associated with large dural defects and high-flow cerebrospinal fluid (CSF) leaks requiring extensive reconstruction. Here, we present the posterior nasoseptal flap as a novel technique for closure of skull defects following endoscopic resection of pituitary adenomas...
2018: Surgical Neurology International
Jéssica Araújo Figueira, Fábio Roberto de Souza Batista, Karina Rosso, Vanessa Cristina Veltrini, Angelo José Pavan
Gorlin-Goltz syndrome (GGS), also known as nevoid basal cell carcinoma syndrome, is an autosomal dominant inherited disorder with high penetrance and variable expressivity. The classic triad originally described by Gorlin and Goltz in 1960 is composed of multiple nevoid basal cell carcinomas (NBCCs), odontogenic keratocysts (OKCs) in the jaws and bifid ribs. in 1977, this triad was modified by Rayner et al, and to GGS diagnosis, the OKCs had to appear in combination with calcification of the cerebellar falx or palmar and plantar pits...
March 8, 2018: Journal of Craniofacial 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
Rodrigo Fernandez-Gajardo, Joao Paulo Almeida, Suganth Suppiah, Ian Witterick, Gelareh Zadeh
BACKGROUND: Skull base meningoencephaloceles are a rare condition, frequently secondary to traumatic or iatrogenic causes. Cerebrofacial arteriovenous metameric syndrome (CAMS) is characterized by the presence of retinal, facial and cerebral arteriovenous malformations (AVMs) with metameric distribution. To the best of our knowledge, this is the first reported case associating these two conditions. CASE DESCRIPTION: A 45 years old female previously diagnosed with CAMS type 2 presented with a long history of cerebrospinal fluid (CSF) rhinorrhea...
March 3, 2018: World Neurosurgery
Marc Valera-Melé, Anna Puigdellívol-Sánchez, Marija Mavar-Haramija, Juan A Juanes-Méndez, Luis San-Román, Matteo de Notaris, Alberto Prats-Galino
We describe a new and freely available 3D interactive model of the intracranial internal carotid artery (ICA) and the skull base that also allows to display and compare its main segment classifications. High-resolution 3D human angiography (isometric voxel's size 0.36 mm) and Computed Tomography angiography images were exported to Virtual Reality Modeling Language (VRML) format for processing in a 3D software platform and embedding in a 3D Portable Document Format (PDF) document that can be freely downloaded at http://diposit...
March 5, 2018: Journal of Medical Systems
Hyun-Tai Chung, Jeong Hun Kim, Jin Wook Kim, Sun Ha Paek, Dong Gyu Kim, Kook Jin Chun, Tae Hoon Kim, Yong Kyun Kim
Image co-registration is used in frameless gamma knife radiosurgery (GKSRS) to assign a stereotactic coordinate system and verify patient setup before irradiation. The accuracy of co-registration with cone beam computed tomography (CBCT) images of a Gamma Knife IconTM (GK Icon) was assessed, and the effects of the region of co-registration (ROC) were studied. CBCT-to-CBCT co-registration is used for patient setup verification, and its accuracy was examined by co-registering CBCT images taken at various configurations with a reference CBCT series...
2018: PloS One
Heinz Arnold, Maximilian Schulze, Stephan Wolpert, Bernhard Hirt, Anke Tropitzsch, Rainer Zimmermann, Andreas Radeloff, Hubert Löwenheim, Katrin Reimann
HYPOTHESIS: Anatomical and radiological evaluation improves safety and accuracy of the retrosigmoid approach for positioning a transcutaneous bone conduction implant and provides anatomical reference data for standardized, landmark-based implantation at this alternative site. BACKGROUND: The primary implantation site for the floating mass transducer of a novel bone conduction hearing implant is the mastoid. However, anatomical limitations or previous mastoid surgery may prevent mastoid implantation...
February 28, 2018: Otology & Neurotology
Asha Karadwal, Shailja Chatterjee
Chondrosarcoma is a rare malignant cartilaginous tumor of the head and neck region. It is a slow-growing tumor and is mostly detected in the anterior maxilla and the base of the skull. We report a case of "Grade II Chondrosarcoma" of the posterior right side of the palate invading maxillary sinus and perforating the floor of the orbit.
January 2018: Journal of Oral and Maxillofacial Pathology: JOMFP
Vadim Gospodarev, Vikram Chakravarthy, Casey Harms, Hannah Myers, Brett Kaplan, Esther Kim, Matthew Pond, Kenneth De Los Reyes
BACKGROUND: Trigeminal neuralgia (TGN) causes severe unilateral facial pain. The etiology is hypothesized to be segmental demyelination of the trigeminal nerve root via compression by the superior cerebellar artery (SCA). Microvascular decompression (MVD) allows immediate and long-term pain relief. Preoperative evaluation includes MRI (magnetic resonance imaging) and/or MRA (magnetic resonance angiography) of the brain. Having a pacemaker is a contraindication for MRI. There have been isolated reports of using computed tomography (CT) cisternography scans for radiation planning for TGN...
February 21, 2018: World Neurosurgery
E-B Luna, M Janini, F Lima, R-A Pontes, F Guedes, M Geller, L da Silva, A Motta, K Cunha
BACKGROUND: Oral manifestations are common in neurofibromatosis 1 (NF1), and include jaws and teeth alterations. Our aim was to investigate the craniomaxillofacial morphology of Brazilian children, adolescents and adults with NF1 using cone beam computed tomography. MATERIAL AND METHODS: This study was conducted with 36 Brazilian individuals with NF1 with ages ranging from 4 to 75. The participants were submitted to anamnesis, extra and intraoral exam and cephalometric analysis using cone beam computed tomography...
February 24, 2018: Medicina Oral, Patología Oral y Cirugía Bucal
Giandomenico Maggiore, Maria Silvia Lazio, Oreste Gallo
Olfactory neuroblastoma is a rare malignant tumor of neuroectodermal origin and represents the most common cancer of the nasal cavity in pediatric age. The gold standard of treatment consists of en bloc resection, numerous studies have shown as the endoscopic approaches permit good control of the disease improving the quality of life after the treatment. Herein we describe the case of a 13-year-old patient referred to our outpatient clinic with a polypoid multi-lobed lesion occupying the left nasal cavity and imaging that confirmed a left-sided nasal mass without cribriform plate involvement (Kadish B)...
February 20, 2018: Auris, Nasus, Larynx
Ali Tayebi Meybodi, Michael T Lawton, Sonia Yousef, Xiaoming Guo, Jose Juan González Sánchez, Halima Tabani, Sergio García, Jan-Karl Burkhardt, Arnau Benet
Anterior clinoidectomy is a difficult yet essential technique in skull base surgery. Two main techniques (extradural and intradural) with multiple modifications have been proposed to increase efficiency and avoid complications. In this study, the authors sought to develop a hybrid technique based on localization of the optic strut (OS) to combine the advantages and avoid the disadvantages of both techniques. Ten cadaveric specimens were prepared for surgical simulation. After a standard pterional craniotomy, the anterior clinoid process (ACP) was resected in 2 steps...
February 23, 2018: Journal of Neurosurgery
Reshma Munbodh, Jonathan P S Knisely, David A Jaffray, Douglas J Moseley
PURPOSE: We present and evaluate a fully automated 2D-3D intensity-based registration framework using a single limited field-of-view (FOV) 2D kV radiograph and a 3D kV CBCT for 3D estimation of patient setup errors during brain radiotherapy. METHODS: We evaluated two similarity measures, the Pearson correlation coefficient on image intensity values (ICC) and maximum likelihood measure with Gaussian noise (MLG), derived from the statistics of transmission images...
February 22, 2018: Medical Physics
Laura Holtmann, Kerstin Stähr, Julian Kirchner, Stephan Lang, Stefan Mattheis
INTRODUCTION:  Choanal atresia is a rare abnormality. As neonates depend on transnasal respiration, bilateral choanal atresia causes an acute emergency. Transnasal endoscopic resection of congenital choanal atresia is a well-established therapy. However, the surgical technique has not yet been standardized. METHODS:  A retrospective chart review was performed with a follow-up examination between 9 to 87 months after surgery. 11 patients (7 with unilateral atresia, 4 with bilateral atresia) were included...
February 8, 2018: Laryngo- Rhino- Otologie
James K Liu, Zachary S Mendelson, Gurkirat Kohli, Jean Anderson Eloy
BACKGROUND: Reconstruction of large anterior skull base (ASB) defects after an endoscopic endonasal transcribriform approach (EEA-TC) remains a challenge despite the advent of the vascularized pedicled nasoseptal flap (PNSF). OBJECTIVE: We describe a relaxing PNSF slit incision that extends the anterior and posterior reach of the PNSF to maximize tensionless flap coverage of transcribriform ASB defects. METHODS: A retrospective chart review was conducted on 20 consecutive patients who underwent EEA-TC and subsequent PNSF reconstruction with a relaxing slit incision...
February 5, 2018: World Neurosurgery
V Hellstern, M Aguilar-Pérez, S Schob, P Bhogal, M AlMatter, P Kurucz, A Grimm, H Henkes
Dural arteriovenous fistulas (DAVF) involving the anterior and posterior condylar vein at the skull base are rare but important to recognize. Due to the highly variable anatomy of the venous system of the skull base, detailed anatomical knowledge is essential for correct diagnosis and appropriate treatment of these lesions. In this report we review the normal anatomy of the condylar veins and describe rare and, to our knowledge, not previously reported anatomical variants. We also highlight the treatment modalities for these lesions with focus on the endovascular transvenous occlusion based on four consecutive cases from our center...
February 5, 2018: Clinical Neuroradiology
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