The Transoral Approach for the Management of Intradural Lesions at the Craniovertebral Junction: Review of 7 Cases

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 88-98 ◽  
Author(s):  
Alan H. Crockard ◽  
Chandra N. Sen
Keyword(s):  
Cerebrospinal Fluid ◽  
Cranial Nerves ◽  
Craniovertebral Junction ◽  
Transoral Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Main Difficulty ◽  
Fibrin Adhesive ◽  
Vertebral Arteries ◽  
Brain Retraction ◽  
The Brain

Abstract The main difficulty in dealing with intradural lesions located ventrally in the region of the craniovertebral junction (CVJ) is related to their relative inaccessibility. Posterolateral approaches involve some manipulation of the brain stem and provide limited access because of the necessity of working between the cranial nerves. Even then, the view of the ventral midline and across is limited. The transoral approach, which has been widely used for the management of extradural lesions in this area, is also useful for the treatment of intradural lesions. It provides an unimpeded although somewhat restricted, view of the ventral aspect of the CVJ without the need for brain retraction. The cranial nerves and vertebral arteries are not interposed between the surgeon and the lesion. The risks of cerebrospinal fluid leakage and infection are greatly diminished by the use of fibrin adhesive and prolonged diversion of the cerebrospinal fluid. The use of this approach, together with its technical difficulties and results, in the management of seven purely intradural lesions located ventrally at the CVJ, is discussed.

Monitoring retraction pressure on the brain

1987 ◽  
Vol 66 (2) ◽  
pp. 270-275 ◽  
Author(s):  
Kazuhiro Hongo ◽  
Shigeaki Kobayashi ◽  
Akira Yokoh ◽  
Kenichiro Sugita
Keyword(s):  
Cerebrospinal Fluid ◽  
Strain Gauge ◽  
Cranial Nerves ◽  
Head Position ◽  
Cerebrospinal Fluid Drainage ◽  
Content Type ◽  
Attenuation Rate ◽  
Brain Retraction ◽  
The Brain ◽  
Fine Print

✓ The problem of minimizing tissue damage during brain retraction was studied both experimentally in dogs and clinically with the aid of newly designed strain-gauge retractor. The pressure required to obtain a specific exposure decreased gradually with time. The average time for a 50% reduction in retraction pressure was 6.6 minutes in the earlier trials of repeated retraction. The attenuation rate of retraction pressure gradually decreased when retraction of the same area was repeated. The lower the head position of the dog, the larger was the amplitude of brain retraction pressure. Clinical studies demonstrated that: 1) cerebrospinal fluid drainage was effective in decreasing the retraction pressure required; 2) use of multiple retractors reduced the pressure applied by each retractor; and 3) retraction pressure could be monitored when the strain-gauge retractors were applied to arteries and cranial nerves.

Unknown fatal encephalomyelopolyradiculoneuritis in a child. A case report

2021 ◽  
Vol 2 (2) ◽  
pp. 100-106
Author(s):  
Aleksandra I. Pavlyuchkova ◽  
Aleksey S. Kotov
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Genetic Diseases ◽  
Cranial Nerves ◽  
Unknown Etiology ◽  
Active Therapy ◽  
Nerve Roots ◽  
Child Patient ◽  
Brain And Spinal Cord ◽  
The Brain

In childhood, various infectious, autoimmune, genetic diseases can manifest. We present a case of fatal encephalomyelopolyradiculoneuritis of unknown etiology in a 9-year-old child. Patient N.K. in February 2019, noted an increase in temperature to subfebrile values, received symptomatic and antibiotic therapy without effect. An increase in protein and lymphocytes was found in the cerebrospinal fluid. According to MRI data, the emergence of more and more foci of the pathological signal in the brain and spinal cord, cranial nerves and nerve roots of the lumbar plexus was noted. Known infectious and autoimmune diseases were excluded. Despite active therapy with glucocorticoids, antibiotics, antiviral drugs, immunoglobulin, the disease continued to progress, and the patient died in April 2020.

The role of the perforated segment of the ventricular catheter in cerebrospinal fluid leakage into the brain

1991 ◽  
Vol 5 (3) ◽  
pp. 299-302 ◽  
Author(s):  
Avinash Prasad ◽  
Vijay S. Madan ◽  
Tarvinder B. S. Buxi ◽  
Pushpendra N. Renjen ◽  
Rakesh Vohra
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leakage ◽  
Ventricular Catheter ◽  
Fluid Leakage ◽  
The Brain

scholarly journals The Brain-Nose Interface: A Potential Cerebrospinal Fluid Clearance Site in Humans

2022 ◽  
Vol 12 ◽  
Author(s):  
Neel H. Mehta ◽  
Jonah Sherbansky ◽  
Angela R. Kamer ◽  
Roxana O. Carare ◽  
Tracy Butler ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Animal Species ◽  
Immune Surveillance ◽  
Cranial Nerves ◽  
Extracellular Fluid ◽  
Olfactory Nerve ◽  
Brain Functions ◽  
Treatment Considerations ◽  
Physiological Homeostasis ◽  
The Brain

The human brain functions at the center of a network of systems aimed at providing a structural and immunological layer of protection. The cerebrospinal fluid (CSF) maintains a physiological homeostasis that is of paramount importance to proper neurological activity. CSF is largely produced in the choroid plexus where it is continuous with the brain extracellular fluid and circulates through the ventricles. CSF movement through the central nervous system has been extensively explored. Across numerous animal species, the involvement of various drainage pathways in CSF, including arachnoid granulations, cranial nerves, perivascular pathways, and meningeal lymphatics, has been studied. Among these, there is a proposed CSF clearance route spanning the olfactory nerve and exiting the brain at the cribriform plate and entering lymphatics. While this pathway has been demonstrated in multiple animal species, evidence of a similar CSF egress mechanism involving the nasal cavity in humans remains poorly consolidated. This review will synthesize contemporary evidence surrounding CSF clearance at the nose-brain interface, examining across species this anatomical pathway, and its possible significance to human neurodegenerative disease. Our discussion of a bidirectional nasal pathway includes examination of the immune surveillance in the olfactory region protecting the brain. Overall, we expect that an expanded discussion of the brain-nose pathway and interactions with the environment will contribute to an improved understanding of neurodegenerative and infectious diseases, and potentially to novel prevention and treatment considerations.

Basilar aneurysms: a new transclival approach via maxillotomy

1987 ◽  
Vol 67 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Daniel J. Archer ◽  
Steven Young ◽  
David Uttley
Keyword(s):  
Cranial Nerves ◽  
Neurological Complications ◽  
Fibrin Adhesive ◽  
Dural Repair ◽  
Content Type ◽  
Le Fort ◽  
Maxillary Osteotomy ◽  
Le Fort I ◽  
Vertebrobasilar Aneurysms ◽  
The Brain

✓ A transoral transclival approach to vertebrobasilar aneurysms, using a Le Fort I maxillary osteotomy rather than splitting the soft and hard palates, was employed successfully in three patients. This technique gave much improved access to the clivus, and eased exposure of the aneurysms without the need for traction on the brain stem or cranial nerves. There were no postoperative cerebrospinal fluid fistulae and no neurological complications. In one patient, a human-derived fibrin adhesive was used for dural repair. The postoperative cosmetic results were excellent and no problems relating to malocclusion were reported. This approach may have advantages when dealing with other diseases in or around the clivus.

Recurrence of Olfactory Groove Meningiomas

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 534-543 ◽  
Author(s):  
Fayez Obeid ◽  
Ossama Al-Mefty
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Resection ◽  
Paranasal Sinuses ◽  
Cranial Nerves ◽  
Cranial Base ◽  
Cerebrospinal Fluid Leakage ◽  
Incomplete Resection ◽  
Olfactory Groove ◽  
Fluid Leakage ◽  
Clinical Records

Abstract OBJECTIVE Despite apparent gross total resection, olfactory groove meningiomas have a high rate of late recurrence (average, 23%). In this retrospective study, we confirmed that the sites of these recurrences are the cranial base and paranasal sinuses. We postulated that these recurrences stem from conservative handling of the underlying invaded bone. Therefore, we analyzed patient outcomes according to the radicality of surgical resection. METHODS Fifteen consecutive patients with a diagnosis of olfactory groove meningioma were treated surgically between 1992 and 2001 (nine new cases, six recurrent). Only patients with benign meningiomas were included; atypical and malignant meningiomas were excluded. Surgical resection included the dura and drilling of the underlying bone and resection of involved mucosa. We reviewed each patient's clinical records, radiological studies, sites of recurrence, grade of previous resection, and complications. RESULTS Olfactory groove meningiomas invaded the underlying bone in 13 cases. All patients with recurrence had previously undergone a surgical resection corresponding only to Simpson Grade 2, which does not include the removal of underlying invaded bone. The sites of recurrence were in the cranial base or adjacent paranasal sinuses. The time to recurrence varied from 1 to 12 years (average, 7 yr; mean, 8 yr). Three patients had undergone one previous resection, two had undergone two previous resections, and one had undergone four previous operations. The ethmoid sinus was involved in all cases of recurrence, either with the sphenoid sinus or with an intracranial recurrence. Thirteen patients underwent complete resection of underlying bone and the invaded paranasal sinuses, then reconstruction of the anterior fossa. No patient died. There were three instances of cerebrospinal fluid leakage (one requiring operative repair), one case of delayed worsening vision after initial improvement, and two cases of transient cranial nerve palsy (Cranial Nerves III and IV). There was no recurrence at follow-up (average, 3.7 yr; range, 1–7.3 yr). CONCLUSION The cranial base and paranasal sinuses are sites of predilection for recurrence of olfactory groove meningiomas. Recurrence is the result of a direct extension attributable to incomplete resection of involved bone and regrowth at the edge of a previous surgical field. Extensive resection of all suspicious underlying bone is a complement to radical removal of these lesions. Reconstruction with a vascularized pericranial flap to prevent cerebrospinal fluid leakage is crucial.

Fibrinolytic Activity of Cerebro-Spinal Fluid and the Development of Artificial Cerebral Haematomas in Dogs

1969 ◽  
Vol 21 (02) ◽  
pp. 294-303 ◽  
Author(s):  
H Mihara ◽  
T Fujii ◽  
S Okamoto
Keyword(s):  
Cerebrospinal Fluid ◽  
Carboxylic Acid ◽  
Fibrinolytic Activity ◽  
Clinical Implications ◽  
Trans Form ◽  
Plate Method ◽  
Blood Samples ◽  
Fibrin Plate ◽  
The Brain

SummaryBlood was injected into the brains of dogs to produce artificial haematomas, and paraffin injected to produce intracerebral paraffin masses. Cerebrospinal fluid (CSF) and peripheral blood samples were withdrawn at regular intervals and their fibrinolytic activities estimated by the fibrin plate method. Trans-form aminomethylcyclohexane-carboxylic acid (t-AMCHA) was administered to some individuals. Genera] relationships were found between changes in CSF fibrinolytic activity, area of tissue damage and survival time. t-AMCHA was clearly beneficial to those animals given a programme of administration. Tissue activator was extracted from the brain tissue after death or sacrifice for haematoma examination. The possible role of tissue activator in relation to haematoma development, and clinical implications of the results, are discussed.

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