scholarly journals Preventing Surgical Complications During Microscopic Fenestration in Middle Fossa Arachnoid Cysts: A Retrospective Study for 38 Cases and Literature Review

2021 ◽  
Author(s):  
Zheng LU ◽  
Wen jian ZHENG ◽  
Xu HAN ◽  
Jian Gong
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Postoperative Hemorrhage ◽  
Csf Leak ◽  
Middle Fossa ◽  
Short Term

Abstract Purpose Middle fossa arachnoid cyst (MFAC) is one of the most common cranial cysts in children. The various postoperative complications following cyst fenestration are still the major concern for most surgeons. We systemically review the short-term postoperative complications in the literature and introduce our experience in preventing these complications.Methods A retrospective survey was conducted on the 38 cases of patients having MFAC (<14 years old) who underwent microscopic fenestration from January 2019 to December 2020. Short-term postoperative complications including postoperative hemorrhage/hematoma, subdural hygroma (SH), cranial nerve palsy, and central nervous system infection (PCNSI), and cerebrospinal fluid (CSF) leak were collected. A systematic PubMed search for cohort studies of surgically treated MFAC published from 2000 was performed. The short-term postoperative complications in the included studies were illustrated.Results The overall complication rate in our series is 5.2%. Eight patients (21.1%) developed postoperative SH. One of them required reoperation. Patients who developed SH were significantly younger (4.1±1.6 versus 6.2±3.4 y.o., p=0.018). Binary logistic analysis showed that a lower age could be a risk factor for developing SH (P=0.115). No postoperative hemorrhage, cranial nerve palsy, or CSF leak was observed. In the systemic review, eighteen studies were included, comprising 649 cases of MFAC. The most common complication was SH (4.9%). The short-term postoperative complication rate between microscopic and endoscopic techniques was similar.Conclusion The complication rate in MFAC fenestration is low in children. SH is the most common postoperative complication, and it is prone to occur in young children.

scholarly journals Combined petrosal approach for resection of petroclival chondrosarcoma: Microsurgical 2-D video

2020 ◽  
Vol 11 ◽  
pp. 102
Author(s):  
Miguel Angel Lopez-Gonzalez ◽  
Timothy Marc Eastin ◽  
Dinesh Ramanathan ◽  
Song Minwoo ◽  
Baishakhi Choudhury
Keyword(s):  
Posterior Fossa ◽  
Tumor Size ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Low Grade ◽  
Middle Fossa ◽  
Petroclival Region ◽  
Lumbar Drain

Background: Petroclival lesions pose a significant neurosurgical challenge due to involvement or close proximity to important neurovascular structures. Chondrosarcomas are rare lesions that can affect these areas. Case Description: A 24-year-old male with 3 months history of poor coordination, imbalance, left-sided face hypoesthesia, facial palsy House-Brackmann Grade 2, and 6th cranial nerve palsy with diplopia. Hearing was preserved. Preoperative images showed a 5.5 cm multilobulated enhancing extra-axial mass centered in the left petroclival region with extension into middle and posterior fossa causing severe (Stage 3) brainstem compression.[1] After a lengthy discussion of treatment options, the patient consented for the procedure. We performed a presigmoid retrolabyrinthine combined petrosal approach. We used cranial nerves monitoring (VII, VIII, IX, X, XI, XII), frameless stereotaxy, and a lumbar drain. Due to the tumor size and location (petroclival region with extension into the posterior and middle cranial fossa), we chose this approach to achieve a maximal safe resection of the tumor and preserve hearing. Alternative approaches of use are expanded middle fossa with transcavernous extension or expanded endonasal approach. The selected approach achieved wide exposure of the tumor which was highly vascular. The tumor was carefully dissected off the brainstem, cranial nerves (IV, V, VI, VII, VIII), and basilar artery trunk. A gross total resection was achieved (Multimedia 1). The patient did well after surgery and was extubated on postoperative day (POD) 1 and the lumbar drain removed on POD 5. Pathology reported low-grade chondrosarcoma (WHO grade I). At 3 months follow-up, the patient improved neurologically, including facial nerve weakness (House-Brackmann Grade 1) except for his left 6th cranial nerve palsy which mildly improved. Conclusion: Petroclival chondrosarcomas are rare tumors that are usually treated with surgical resection followed by stereotactic radiosurgery. The tumor size, location, and extension dictate approach selection. For lesions involving the petroclival region with extension into the middle fossa and posterior fossa, the combined petrosal approach is reasonable.

scholarly journals 18 Lyme disease as an emerging cause of Seventh Cranial Nerve Palsy (“Bell’s palsy”) in Nova Scotia

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e7-e7
Author(s):  
Julia LeBlanc ◽  
Michael Young ◽  
Ellen Wood ◽  
Donna MacKinnon-Cameron ◽  
Joanne Langley
Keyword(s):  
Emergency Department ◽  
Lyme Disease ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Complete Resolution ◽  
Nerve Palsy ◽  
Health Centre ◽  
Bell’S Palsy ◽  
Bell's Palsy ◽  
Seventh Cranial Nerve

Abstract Introduction/Background Lyme disease, a tick-borne zoonosis caused by the bacterium Borrelia burgdorferi, has emerged in Nova Scotia (NS) as a common illness. Since 2002 when Lyme disease was first diagnosed in NS, &gt;1000 cases have been reported. Seventh cranial nerve palsy (CNP-7) is said to be the most common presentation of early disseminated Lyme disease in children in endemic areas. Objectives We aimed to determine the frequency of CNP-7 in NS and if physicians are considering Lyme disease as an etiology. Design/Methods A retrospective review of health records of children seen at the IWK Health Centre from 2000-2018 who were ≤18 years of age with an ICD-9 or 10 diagnosis of Bell’s palsy (CNP-7) was conducted. CNP-7 due to local infection, trauma, malignancy, or systemic neurologic disease was excluded. Results Of 237 ICD “Bell’s palsy” diagnoses, 66 cases were eligible, of which 60.6 % (n=40) were female. The median age was 10 years (range 0-16). Five cases of Lyme disease-associated CNP-7 were recognized (7.6%), all since 2013. No bilateral CNP-7 occurred; 59.1% of cases were on the left. Most children presented within 3 days of symptom onset (84.8%) to the emergency department (95.4%), and 56.1% subsequently saw a pediatric neurologist. The most common associated symptom with CNP-7 was headache (22.7%). Lyme disease was considered in the differential diagnosis in 34.8 % (n=23) of cases, and only since 2012. Systemic steroids were prescribed to 51.5 % (34/66) of children in the emergency department, for durations varying from 1 to 10 days. The most common steroid course length was 5 days. Antimicrobials were prescribed for 18 (27.3%) children including acyclovir, beta lactams and tetracyclines. Resolution of the facial palsy findings was documented in 45 children, of whom 36 (54.5%) had complete resolution and 9 (13.6%) had partial resolution. Four children with Lyme disease associated CNP-7 had complete resolution, and one had partial resolution. Conclusion There does not appear to be a standard approach to diagnosis and management of CNP-7 in this pediatric health centre. Lyme disease is not regularly considered in the differential diagnosis, which is surprising given the high incidence of Lyme disease in NS. These findings will be shared with health care providers most likely to see CNP-7 in order to develop a standard algorithm to the initial presentation of 7th cranial nerve palsy in children.

scholarly journals Aseptic Meningitis and Cranial Nerve Palsy Revealing Adult‐Onset Still's Disease

1999 ◽  
Vol 29 (1) ◽  
pp. 220-221 ◽  
Author(s):  
I. Marie ◽  
H. Levesque ◽  
N. Perraudin ◽  
N. Cailleux ◽  
F. Lecomte ◽  
...  
Keyword(s):  
Aseptic Meningitis ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Adult Onset Still’S Disease ◽  
Adult Onset ◽  
Still’S Disease ◽  
Still's Disease ◽  
Adult Onset Still's Disease

Ischemic stroke presenting with bilateral 6th cranial nerve palsy, nausea and vomiting

2015 ◽  
Vol 357 ◽  
pp. e415
Author(s):  
H. Akgun ◽  
S. Tasdemir ◽  
Z. Ozkan ◽  
A. Cetiz ◽  
M. Yucel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Nausea And Vomiting

scholarly journals ‘Man-in-the-Barrel’ Syndrome with Bilateral 6th Cranial Nerve Palsy

2012 ◽  
Vol 68 (6) ◽  
pp. 367-367 ◽  
Author(s):  
Ivan Rocha Ferreira Da Silva
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy

1239 Postoperative Complication Rate of Facial Injury Repairs Treated by Maxillofacial On-Call Team: Surgical Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Dhanjal ◽  
M Ghouri ◽  
S Crank
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Maxillofacial Surgery ◽  
General Anaesthetic ◽  
Facial Injury ◽  
Postoperative Complication Rate ◽  
Female Ratio ◽  
Facial Injuries

Abstract Introduction A significant aspect of Oral and Maxillofacial Surgery workload relates to trauma, particularly soft-tissue injuries. Contingent on the aetiology of injury, facial wounds require debridement and rapid closure to reduce risk of infection and degree of scarring. The aim was to identify possible risks and frequency of postoperative complications, including problems identified by patients following treatment of facial injuries by the Maxillofacial on-call team. Method Data was retrospectively collected from patients who sustained soft-tissue facial injuries treated by the Maxillofacial team and provided with follow-up appointments from January to August 2020. Computerised clinical notes were accessed to determine patient demographics, mechanism and site of injury, location and time of repair, operator grade and postoperative complications (if any). Results 153 patients required debridement and suturing of a facial injury under local or general anaesthetic. Among these, the male to female ratio was 65:35. 47% of facial injuries resulted from mechanical fall. Lips were found to be the most common site (31%) of injury. Postoperative complication rate was 8% within the 8-month period, with reports of infection, wound dehiscence and haematoma requiring further treatment. 58% of complications resulted from treatment carried out between 5pm-5am with a sole operator (DCT/SHO). 83% of complications followed treatment carried out within the Emergency Department rather than Maxillofacial clinical setting. Conclusion Following facial injury repair, just less than 8% of patients experienced complications, which required corrective treatment. Although facial injuries require immediate care, careful planning and performing treatment in a specialised setup may improve perioperative care, thus clinical outcomes.

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