Pneumocephalus with meningitis secondary to an old traumatic anterior cranial fossa defect

2021 ◽  
Vol 14 (6) ◽  
pp. e242855
Author(s):  
Freston Marc Sirur ◽  
Akash Daswaney ◽  
Roshini Raghu ◽  
Mohammad Khalid
Keyword(s):  
Skull Base ◽  
Traumatic Event ◽  
Altered Mental Status ◽  
Anterior Cranial Fossa ◽  
Bony Defect ◽  
The Face ◽  
Post Traumatic ◽  
Cranial Fossa ◽  
Skull Base Defect ◽  
The Brain

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.

Maus y la ética de la representación después del Holocausto Narrativas post-traumáticas, elaboración y post-memoria. / Maus and the Ethics of Representation After the Holocaust Post-traumatic narratives, elaboration and post-memory.

2012 ◽  
Vol 1 (01) ◽  
pp. 71-113
Author(s):  
Silvana Vetö
Keyword(s):  
Mass Media ◽  
Traumatic Event ◽  
High Culture ◽  
Ethical Problems ◽  
Theodor Adorno ◽  
The Holocaust ◽  
The Face ◽  
German Philosopher ◽  
Post Traumatic ◽  
Medios De Comunicacion

En este trabajo se examinarán algunos de los problemas éticos que el Holocausto ha planteado a los medios de representación de la historia, para luego ligar las distintas narrativas que resultan de dichas representaciones, con las posibilidades de duelo y elaboración. Se abordarán primero los planteamientos de Theodor Adorno respecto de las posibilidades del arte frente al sufrimiento. Luego se expondrán algunos aspectos del debate surgido al final de la década del 70 a propósito de la representación del Holocausto en medios de comunicación de masa y en la “alta” cultura. Se mostrará como persiste en ese debate una perspectiva dicotómica respecto del trauma, de la cual surgen dos tipos de narrativas post-traumáticas supuestamente irreconciliables, que no permiten una adecuada elaboración y un duelo satisfactorio respecto de las pérdidas implicadas en el acontecimiento traumático. Finalmente, analizaremos en detalle la novela gráfica Maus. Relato de un superviviente, cuya narrativa experimental permite cuestionar y deconstruir la dicotomía redención/aporía de manera novedosa, planteando nuevos problemas vinculados a la memoria del Holocausto y a la posibilidades de duelo. In this work, we will focus on some of the ethical problems that the Holocaust has posed to the representation of historical limit-events. We will then link the different narratives emerging from these representations to the possibilities of mourning and elaboration. First, we will examine the German philosopher Theodor Adorno’s propositions concerning the possibilities of art in the face of suffering. Then, we will present some aspects of the debate that arose in the late 70s regarding the representation of the Holocaust in mass media and in ‘high’ culture. It will be shown how in this debate there persists a dichotomist perspective of trauma, which creates two supposedly irreconcilable types of post-traumatic narratives that do not permit an appropriate elaboration and mourning of losses caused by the traumatic event. Finally, we will analyze the graphic novel Maus. A Survivor’s Tale, whose experimental and open narrative allows an original questioning and deconstruction of the redemption/aporia dichotomy, putting forward new problems related to the memory of the Holocaust and the possibilities of mourning.

Cribriform Adenocarcinoma of the Minor Salivary Gland (CAMSG); A Separate and Malignant Entity

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S24-S24
Author(s):  
H Laharwani ◽  
T Woods ◽  
J Jackson ◽  
V Manucha ◽  
I Velasco
Keyword(s):  
Salivary Gland ◽  
Cell Carcinoma ◽  
Skull Base ◽  
Minor Salivary Gland ◽  
Middle Cranial Fossa ◽  
Salivary Gland Neoplasm ◽  
Left Neck ◽  
S 100 ◽  
The Face ◽  
Cranial Fossa

Abstract Introduction/Objective Cribriform adenocarcinoma of the minor salivary gland (CAMSG) is a recently described salivary gland neoplasm (SGN) that WHO includes under the polymorphous adenocarcinoma (PAC) subheading. CAMSG is reported to occur mostly in the base of the tongue and lingual tonsils. Methods We present a case of CAMSG of buccal mucosa in a 48-year old woman who presented with pain and swelling on the left side of the face that started after tooth extraction. Imaging revealed a large expansile mass (5.8 x 4.3 x 6.1 cm) originating in the left mandibular angle extending into masticator space, maxillary sinus, pterygopalatine fossa, sphenoid, middle cranial fossa, orbit and skull base. Ameloblastoma, primary intraosseous carcinoma, and squamous cell carcinoma were considered. Incisional biopsy revealed a tumor comprised of round to ovoid cells with clear to vesicular nuclei (ground-glass appearance) and occasional mitosis present in irregular solid, cribriform, and microcystic patterns in a hyalinized stroma with the presence of abundant mucin within lobules and stroma. Results Differential diagnosis of secretory carcinoma, hyalinizing clear cell carcinoma, and less likely PAC and mucoepidermoid carcinoma were considered, all inconsistent with the imaging findings. The tumor cells were positive for S100 and negative for CD117, ki67, p63, CD117, and TTF-1. Based on a prominent cribriform pattern, vesicular nuclei, and S-100 expression, a diagnosis of cribriform adenocarcinoma of minor salivary gland origin was rendered. The patient subsequently underwent left partial maxillectomy, left partial mandibulectomy, and resection of the skull base and left neck dissection and was staged as pT4bN0, with negative margins and vascular invasion. The patient underwent radiation therapy and at 6- month follow up was alive and healthy. Clinically and histologically CAMSG overlaps with tumors of both salivary and non-salivary gland origin. Conclusion Recognition of CAMSG as a distinct entity will help in accurate diagnosis and categorization in the WHO classification of SGNs.

Classification and Microvascular Flap Selection for Anterior Cranial Fossa Reconstruction

2018 ◽  
Vol 34 (08) ◽  
pp. 590-600 ◽  
Author(s):  
James Vargo ◽  
Wojciech Przylecki ◽  
Paul Camarata ◽  
Brian Andrews
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Cranial Fossa ◽  
Microvascular Reconstruction ◽  
Autologous Reconstruction ◽  
Muscle Flaps ◽  
Defect Groups ◽  
Microvascular Flap ◽  
Cranial Fossa

Background Microvascular reconstruction of the anterior cranial fossa (ACF) creates difficult challenges. Reconstructive goals and flap selection vary based on the defect location within the ACF. This study evaluates the feasibility and reliability of free tissue transfer for salvage reconstruction of low, middle, and high ACF defects. Methods A retrospective review was performed. Reconstructions were anatomically classified as low (anterior skull base), middle (frontal bar/sinus), and high (frontal bone/soft tissue). Subjects were evaluated based on pathologic indication and goal, type of flap used, and complications observed. Results Eleven flaps in 10 subjects were identified and anatomic sites included: low (n = 5), middle (n = 3), and high (n = 3). Eight of 11 reconstructions utilized osteocutaneous flaps including the osteocutaneous radial forearm free flap (OCRFFF) (n = 7) and fibula (n = 1). Other reconstructions included a split calvarial graft wrapped within a temporoparietal fascia free flap (n = 1), latissimus myocutaneous flap (n = 1), and rectus abdominis myofascial flap (n = 1). All 11 flaps were successful without microvascular compromise. No complications were observed in the high and middle ACF defect groups. Two of five flaps in the low defect group using OCRFFF flaps failed to achieve surgical goals despite demonstrating healthy flaps upon re-exploration. Complications included persistent cerebrospinal fluid leak (n = 1) and pneumocephalus (n = 1), requiring flap repositioning in one subject and a second microvascular flap in the second subject to achieve surgical goals. Conclusion In our experience, osteocutaneous flaps (especially the OCRFFF) are preferred for complete autologous reconstruction of high and middle ACF defects. Low skull base defects are more difficult to reconstruct, and consideration of free muscle flaps (no bone) should be weighed as an option in this anatomic area.

Lateral Skull Base Attenuation in Patients with Anterior Cranial Fossa Spontaneous Cerebrospinal Fluid Leaks

2016 ◽  
Vol 154 (6) ◽  
pp. 1138-1144 ◽  
Author(s):  
Brendan P. O’Connell ◽  
Shawn M. Stevens ◽  
Christopher C. Xiao ◽  
Ted A. Meyer ◽  
Rodney J. Schlosser
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Anterior Cranial Fossa ◽  
Lateral Skull Base ◽  
Cerebrospinal Fluid Leaks ◽  
Cranial Fossa

Eyelid approach to the anterior cranial base

2008 ◽  
Vol 109 (2) ◽  
pp. 341-346 ◽  
Author(s):  
Norberto Andaluz ◽  
Alberto Romano ◽  
Likith V. Reddy ◽  
Mario Zuccarello
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Artery Aneurysm ◽  
Anterior Cranial Fossa ◽  
Anterior Communicating Artery ◽  
Surgical Morbidity ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Anterior Cranial Base ◽  
Cranial Fossa

Skull base approaches play a fundamental role in modern neurosurgery by reducing surgical morbidity. Increasing experience has allowed surgeons to perform minimally invasive approaches without straying from the premises of skull base surgery. The eyelid approach has evolved from the orbitopterional osteotomy into a more effective and targeted approach to disease of the anterior cranial fossa. In this technique, after an incision is made on the supratarsal fold, the orbicularis oculi muscle is incised, and a myocutaneous flap composed of the elements of the anterior lamella is elevated. Subperiosteal dissection is used to expose the superior and lateral walls of the orbit, the superior and lateral orbital rim, and the frontosphenoidal suture. A MacCarty bur hole is drilled, and a frontal osteotomy is fashioned medial to the supraorbital notch and extending through the orbital roof back toward the orbital half of the MacCarty bur hole, exposing the frontobasal brain. A conventional microsurgical technique is used to treat tumors and aneurysms of the anterior cranial fossa under the operative microscope. Five patients were treated for unruptured aneurysms of the anterior circulation (3 anterior communicating artery aneurysms, 1 ophthalmic artery aneurysm, and 1 posterior communicating artery aneurysm) using the eyelid approach. The mean aneurysm size was 5 mm, and all aneurysms were approached from the right side. Three tumors in the anterior fossa (2 suprasellar pituitary adenomas and 1 craniopharyngioma) were also excised using this approach. There was no surgical morbidity. Three months after surgery all patients presented excellent cosmetic results. The eyelid approach may be considered as an effective, cosmetically beneficial, and minimally invasive skull base approach to selected aneurysms and tumors of the anterior circulation.

Endoscopic Endonasal Transethmoidal Transcribriform Transfovea Ethmoidalis Approach to the Anterior Cranial Fossa and Skull Base

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 883-892 ◽  
Author(s):  
Jeffrey P. Greenfield ◽  
Vijay K. Anand ◽  
Ashutosh Kacker ◽  
Michael J. Seibert ◽  
Ameet Singh ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Sphenoid Sinus ◽  
Malignant Tumors ◽  
Anterior Skull Base ◽  
Anterior Cranial Fossa ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Lumbar Drainage ◽  
Cranial Fossa

Abstract OBJECTIVE The anterior skull base, in front of the sphenoid sinus, can be approached using a variety of techniques including extended subfrontal, transfacial, and craniofacial approaches. These methods include risks of brain retraction, contusion, cerebrospinal fluid leak, meningitis, and cosmetic deformity. An alternate and more direct approach is the endonasal, transethmoidal, transcribriform, transfovea ethmoidalis approach. METHODS An endoscopic, endonasal approach was used to treat a variety of conditions of the anterior skull base arising in front of the sphenoid sinus and between the orbits in a series of 44 patients. A prospective database was used to detail the corridor of approach, closure technique, use of intraoperative lumbar drainage, operative time, and postoperative complications. Extent of resection was determined by a radiologist using volumetric analysis. RESULTS Pathology included meningo/encephaloceles (19), benign tumors (14), malignant tumors (9), and infectious lesions (2). Lumbar drains were placed intraoperatively in 20 patients. The CSF leak rate was 6.8% for the whole series and 9% for intradural cases. Leaks were effectively managed with lumbar drainage. Early reoperation for cerebrospinal fluid (CSF) leak occurred in 1 patient (2.2%). There were no intracranial infections. Greater than 98% resection was achieved in 12 of 14 benign and 5 of 9 malignant tumors. CONCLUSION The endoscopic, endonasal, transethmoidal, transcribriform, transfovea ethmoidalis approach is versatile and suitable for managing a variety of pathological entities. This minimal access surgery is a feasible alternative to transcranial, transfacial, or combined craniofacial approaches to the anterior skull base and anterior cranial fossa in front of the sphenoid sinus. The risk of CSF leak and infection are reasonably low and decrease with experience. Longer follow-up and larger series of patients will be required to validate the long-term efficacy of this minimally invasive approach.

The Radiographic Effects of Surgical Approach and Use of Retractors on the Brain After Anterior Cranial Fossa Meningioma Resection

2018 ◽  
Vol 112 ◽  
pp. e505-e513 ◽  
Author(s):  
Kaisorn L. Chaichana ◽  
Tito Vivas-Buitrago ◽  
Christina Jackson ◽  
Jeffrey Ehresman ◽  
Alessandro Olivi ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Anterior Cranial Fossa ◽  
Cranial Fossa ◽  
The Brain

scholarly journals CRANIAL BASE SYMMETRIC AND NORMAL LOWER JAW ROTATION

2015 ◽  
Vol 61 (3) ◽  
pp. 231-237
Author(s):  
Mohamed Khwanda ◽  
◽  
Yazan Jahjah ◽  
Keyword(s):  
Cranial Base ◽  
The Body ◽  
Adult Patients ◽  
Normal Type ◽  
Lower Jaw ◽  
Angular Measurements ◽  
The Face ◽  
Cranial Fossa ◽  
High Level ◽  
The Brain

Understanding the complexities of cranial base development, function, and architecture is important for testing hypotheses about many aspects of craniofacial variation and evolution. Architecturally, the cranial base provides the platform upon which the brain grows and around which the face grows. In addition, the cranial base connects the cranium with the rest of the body: it articulates with the vertebral column and the mandible, provides conduits for all the vital neural and circulatory connections between the brain, the face and the neck, houses and connects the sense organs in the skull, and forms the roof of the nasopharynx. The shape of the cranial base is therefore a multifactorial product of numerous phylogenetic, developmental, and functional interactions. Aim. The aim of this research is to perform a morphometric analysis of the skull base to investigate the symmetry between the two hemibases of the cranial fossa with each other in adult patients with normal type of lower jaw rotation using cone beam copmuted tomography CBCT in transversal plane. Materials and methods. In result of radiographic study, 35 Caucasian adult patients with no prior orthodontics treatment were selected (16 males, 19 females) from 16 to 27 years (mean age of 20.02 years: females average age was 20.15 years; males average age was 21.84 years) of age with normal type of lower jaw rotation according to the sum of Björk. Pearson’s Correlation Coefficient was calculated to investigate the symmetry between the two hemibases of the cranial fossa with each other. Results. A difference was found amongst the two genders of the sample subjects in the strength of the correlation between the CBCT angular measurements evaluating the two hemibases of the cranial base symmetry. Conclusion. A difference was found amongst the two genders. This study found no exact symmetry between the samples, but it was in high level for adult females.

scholarly journals Fulminant presentation of a SMARCB1-deficient, anterior cranial fossa tumor in adult

2020 ◽  
Vol 11 ◽  
pp. 195
Author(s):  
Idan Levitan ◽  
Suzana Fichman ◽  
Yosef Laviv
Keyword(s):  
Skull Base ◽  
Paranasal Sinuses ◽  
Anterior Skull Base ◽  
Anterior Cranial Fossa ◽  
Sinonasal Carcinoma ◽  
Rhabdoid Cells ◽  
Atypical Teratoid ◽  
Cranial Fossa ◽  
Rhabdoid Glioblastoma ◽  
Tumor Debulking

Background: Malignant atypical teratoid rhabdoid tumor (ATRT) usually develops in children. ATRTs are rare in adults, with only one case in the literature describing involvement of the anterior skull base. These primary intracranial tumors are characterized molecularly as SMARCB1 (INI1) deficient. Different types of such SMARCB1-deficient tumors exist in adulthood, usually in the form of extracranial tumors. Very few cases of such a new entity, named SMARCB1-deficient sinonasal carcinoma have been described with intracranial penetration and involvement of the anterior cranial fossa. Case Description: A 36-year-old male presented with acute cognitive deterioration. Over few hours, he developed a fulminant herniation syndrome. Imaging showed a tumor in the anterior cranial fossa surrounded by massive brain edema. The tumor has destroyed the frontal bone with involvement of the nasal cavities and paranasal sinuses. The patient underwent emergent decompressive craniectomy and tumor debulking but could not be saved. Pathological analysis revealed a highly cellular tumor without rhabdoid cells but with areas of necrosis. Further immunohistochemical stains revealed that neoplastic cells were diffusely and strongly positive for epithelial membrane antigen and P63 and negative for SMARCB1 (i.e., loss of expression), confirming the diagnosis of sinonasal carcinoma. Conclusion: To the best of our knowledge, this is the first report of a fulminant presentation of a SMARCB1- deficient tumor in young adult, involving the anterior cranial fossa and the paranasal sinuses. The main differential diagnosis of aggressive, primary, intracranial SMARCB1-deficient tumors in adults includes ATRT, SMARCB1- deficient sinonasal carcinoma, rhabdoid meningioma, and rhabdoid glioblastoma. Atypical tumors involving the anterior skull base without a clear histopathological pattern should therefore be checked for SMARCB1 expression.

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