CIRCULATORY AND RESPIRATORY DISTURBANCES DURING POSTERIOR CRANIAL FOSSA SURGERY

OBJECTIVE Posterior vault distraction osteogenesis (PVDO) is an effective tool to increase intracranial volume and expand the posterior cranial fossa. During PVDO, the authors extended osteotomy posterior to the foramen magnum to fully expand the posterior cranial fossa. The aim of this study was to investigate the efficacy of complete PVDO in posterior fossa expansion and treatment of Chiari malformation type I (CM-I) in patients with craniosynostosis. METHODS Patients with craniosynostosis who had undergone complete PVDO between January 2012 and May 2020 were reviewed retrospectively. A coronal osteotomy extending to the foramen magnum was performed and the foramen magnum was decompressed by removing its posterior rim with a 1-mm Kerrison rongeur. Four distractor devices were placed and the vector of distraction was controlled from the posterior to the inferior-posterior direction, depending on the deformity. Changes in the intracranial volume, posterior cranial fossa area, and cerebellar tonsillar descent were measured after complete PVDO by using CT and MRI. RESULTS A total of 11 patients with craniosynostosis and concurrent CM-I were included in the study. The mean age was 34.6 ± 24.0 months (continuous variables are expressed as the mean ± SD throughout). One patient had sleep apnea, which was consistent with CM-I, and another patient had a headache, which was nonspecific. The intracranial volume increased from 1179.6 ± 180.2 cm3 to 1440.6 ± 251.5 cm3 (p = 0.003; 24.5% increase compared to the preoperative volume). The posterior skull base area increased from 44.9 ± 19.3 cm2 to 72.7 ± 18.1 cm2 (p = 0.004). Cerebellar tonsillar descent decreased in all 11 patients after complete PVDO (preoperative: 10.8 ± 3.7 mm, postoperative: 2.7 ± 3.0 mm; p = 0.003). Among the 11 patients, 5 showed complete resolution of cerebellar tonsillar herniation. CONCLUSIONS Complete PVDO can more efficiently expand the posterior cranial fossa, unlike conventional methods. Moreover, it helps to relieve cerebellar tonsillar herniation. Complete PVDO is a powerful tool to increase the intracranial and posterior fossa volumes in patients with craniosynostosis and concurrent CM-I.

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Meningioma in Lateral Cerebellomedullary Cistern without Dural Attachment

Indian Journal of Neurosurgery ◽

10.1055/s-0037-1602754 ◽

2017 ◽

Vol 06 (02) ◽

pp. 144-148

Author(s):

Prithvi Varghese ◽

Julio Kandathil ◽

Jayasree Govindan ◽

Rashmi R. ◽

Muhammed Jalal

Keyword(s):

Soft Tissue ◽

Soft Tissue Mass ◽

Imaging Modality ◽

Posterior Cranial Fossa ◽

Tissue Mass ◽

Tela Choroidea ◽

Dural Tail ◽

Dural Attachment ◽

Cranial Fossa ◽

Space Occupying Lesion

AbstractIntracranial meningiomas without dural attachment are rare and posterior cranial fossa meningiomas without dural attachment are rarer. Such meningiomas are thought to arise from arachnoid cap cells in pial membrane, tela choroidea, or choroid plexus. MRI is the best imaging modality for the diagnosis of meningiomas and typically shows an enhancing, dural based, extra-axial soft tissue mass with a characteristic dural tail. Meningioma without dural attachment should be suspected if the MRI shows a space-occupying lesion having features of a meningioma but without a dural base and dural tail. We report a case of meningioma in the lateral cerebellomedullary cistern without dural attachment.

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Human Foramen Magnum Area and Posterior Cranial Fossa Volume Growth in Relation to Cranial Base Synchondrosis Closure in the Course of Child Development

Neurosurgery ◽

10.1227/neu.0000000000001309 ◽

2016 ◽

Vol 79 (5) ◽

pp. 722-735 ◽

Cited By ~ 8

Author(s):

Guillaume Coll ◽

Jean-Jacques Lemaire ◽

Federico Di Rocco ◽

Isabelle Barthélémy ◽

Jean-Marc Garcier ◽

...

Keyword(s):

Rapid Growth ◽

Slow Growth ◽

Volume Growth ◽

Cranial Base ◽

Foramen Magnum ◽

Posterior Cranial Fossa ◽

Healthy Children ◽

Cranial Fossa ◽

The Mean ◽

Tomography Scan

Abstract BACKGROUND: To date, no study has compared the evolution of the foramen magnum area (FMA) and the posterior cranial fossa volume (PCFV) with the degree of cranial base synchondrosis ossification. OBJECTIVE: To illustrate these features in healthy children. METHODS: The FMA, the PCFV, and the ossification of 12 synchondroses according to the Madeline and Elster scale were retrospectively analyzed in 235 healthy children using millimeter slices on a computed tomography scan. RESULTS: The mean FMA of 6.49 cm2 in girls was significantly inferior to the FMA of 7.67 cm2 in boys (P <.001). In both sexes, the growth evolved in a 2-phase process, with a phase of rapid growth from birth to 3.75 years old (yo) followed by a phase of stabilization. In girls, the first phase was shorter (ending at 2.6 yo) than in boys (ending at 4.33 yo) and proceeded at a higher rate. PCFV was smaller in girls (P <.001) and displayed a biphasic pattern in the whole population, with a phase of rapid growth from birth to 3.58 yo followed by a phase of slow growth until 16 yo. In girls, the first phase was more active and shorter (ending at 2.67 yo) than in boys (ending at 4.5 yo). The posterior interoccipital synchondroses close first, followed by the anterior interoccipital and occipitomastoidal synchondroses, the lambdoid sutures simultaneously, then the petro-occipital and spheno-occipital synchondroses simultaneously. CONCLUSION: The data provide a chronology of synchondrosis closure. We showed that FMA and PCFV are constitutionally smaller in girls at birth (P ⩽.02) and suggest that a sex-related difference in the FMA is related to earlier closure of anterior interoccipital synchondroses in girls (P =.01).

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