scholarly journals The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications

2015 ◽  
Vol 15 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Brian J. Dlouhy ◽  
Michael P. Chae ◽  
Charles Teo
Keyword(s):  
Frontal Sinus ◽  
Medial Temporal Lobe ◽  
Skin Incision ◽  
Senior Author ◽  
Csf Leak ◽  
Cosmetic Results ◽  
Working Space ◽  
Operative Outcomes ◽  
Endoscopic Assistance ◽  
A Minor

OBJECT The supraorbital eyebrow approach utilizes an eyebrow skin incision to fashion a supraorbital craniotomy for exposure of the subfrontal corridor. This provides anterolateral access to surgical lesions in the anterior cranial fossa, parasellar regions, brainstem, and medial temporal lobe. With use of the endoscope, further areas can be accessed. This approach has been applied effectively in adults, but questions remain about its use in children—specifically with regard to adequate working space, effectiveness for achieving the desired results, cosmesis, and complications. METHODS The authors conducted a retrospective review of more than 450 cases involving patients of all ages who had undergone a supraorbital eyebrow approach performed by the senior author (C.T.) from 1995 to 2013. Only cases involving patients younger than 18 years with a minimum follow-up of 6 weeks were included in this study. All inpatient and outpatient records were retrospectively reviewed and clinical/operative outcomes, cosmetic results, and complications were recorded. In the present article, the authors briefly describe the surgical approach and highlight any differences in applying it in children. RESULTS Fifty-four pediatric patients who had undergone a supraorbital eyebrow approach met inclusion criteria. The pathological conditions consisted mostly of tumors or other resectable lesions. In a total of 51 resectable lesions, 44 surgeries resulted in a gross-total (100%) resection and 7 cases resulted in subtotal (50%–99%) resection. The endoscope assisted and expanded visualization or provided access to areas not reached by standard microscopic visualization in all cases. Cosmetic outcomes were excellent. In all cases, the incisional scar was barely visible at 6 weeks. In 3 cases a minor bone defect was observed on the forehead. Given the small size of the frontal sinus in children, no frontal sinus breaches occurred. Additionally, no CSF leak or wound infection was identified. CONCLUSIONS The supraorbital eyebrow approach is extremely effective in achieving desired results in properly selected cases in patients of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal.

Cerebellopontine Angle Epidermoids: Comparative Results of Microscopic and Endoscopic Excision Using the Retromastoid Approach”

2021 ◽  
Author(s):  
Suyash Singh ◽  
Kuntal Kanti Das ◽  
Krishna Kumar ◽  
Kamlesh Rangari ◽  
Priyadarshi Dikshit ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Surgical Excision ◽  
Csf Leak ◽  
Tumor Extension ◽  
Endoscopic Excision ◽  
Endoscopic Assistance ◽  
Comparative Results ◽  
Neurovascular Structures

Abstract Background Densely packed neurovascular structures, often times inseparable capsular adhesions and sometimes a multicompartmental tumor extension, make surgical excision of cerebellopontine angle epidermoids (CPEs) a challenging task. A simultaneous or an exclusive endoscopic visualization has added a new dimension to the classical microscopic approaches to these tumors recently. Method Eighty-six patients (age: 31.6 ± 11.7 years, M:F = 1:1) were included. Nineteen patients (22.1%) had a multicompartmental tumor. Tumor extension was classified into five subtypes. Sixty-two patients underwent a pure microscopic approach (72%) out of which 10 patients (16%) underwent an endoscope-assisted surgery (11.6%) and 24 patients (28%) underwent an endoscope-controlled excision. Surgical outcomes were retrospectively analyzed. Results Headache (53.4%), hearing loss (46.5%), and trigeminal neuralgia (41.8%) were the leading symptoms. Interestingly, 21% of the patients had at least one preexisting cranial nerve deficit. Endoscopic assistance helped in removing an unseen tumor lobule in 3 of 10 patients (30%). Pure endoscopic approach significantly reduced the hospital stay from 9.2 to 7.3 days (p = 0.012), and had a statistically insignificant yet a clearly noticeable lesser incidence of subtotal tumor excision (0 vs. 10%, p = 0.18) with comparable cranial nerve deficits but with a higher postoperative cerebrospinal fluid (CSF) leak rate (29% vs. 4.8%, p = 0.004). Conclusion Endoscope assistance in CPE surgery is a useful addition to conventional microscopic retromastoid approach. Pure endoscopic excision in CPE is feasible, associated with a lesser duration of hospital stay, better extent of excision in selected cases, and it has a comparable cranial nerve morbidity profile albeit with a higher rate of CSF leak.

Epidural abscess treated with a medial supraorbital craniotomy through an incision in the eyebrow

2008 ◽  
Vol 1 (2) ◽  
pp. 145-147 ◽  
Author(s):  
David S. Rosen ◽  
Stephen Shafizadeh ◽  
Fuad M. Baroody ◽  
Bakhtiar Yamini
Keyword(s):  
Frontal Sinus ◽  
Epidural Abscess ◽  
Fluid Collection ◽  
Skin Incision ◽  
Frontalis Muscle ◽  
Supraorbital Nerve ◽  
Facial Swelling ◽  
Anterior Fossa ◽  
Supraorbital Craniotomy

✓The authors describe a medial supraorbital craniotomy performed through a medial eyebrow skin incision to approach an epidural abscess located in the medial anterior fossa of the skull. An 8-year-old boy presented with fevers and facial swelling. Imaging demonstrated pansinusitis and an epidural fluid collection adjacent to the frontal sinus. A medial supraorbital craniotomy was performed to access and drain the epidural abscess. The supraorbital nerve laterally and the supratrochlear nerve medially were preserved by incising the frontalis muscle vertically, parallel to the course of the nerves, and dissecting the subperiosteal plane to mobilize the nerves. This approach may be a useful access corridor for other lesions located near the medial anterior fossa.

scholarly journals Instruments Used in Skin Incision

2018 ◽  
Vol 2 (3) ◽  
pp. 557-561
Author(s):  
Bárbara Cartes ◽  
Leonardo Brito ◽  
Juan Alister ◽  
Francisca Uribe ◽  
Sergio Olate
Keyword(s):  
Postoperative Infection ◽  
Surgical Intervention ◽  
Skin Incision ◽  
Repair Time ◽  
Surrounding Tissue ◽  
Cosmetic Results ◽  
Conventional Instrumentation

The incision is the beginning of every surgical intervention, where separation of the tissues occurs. The uses of thermal mechanisms in skin incisions have been controversial due to higher repair time, necrosis of surrounding tissue, postoperative infection, and poor cosmetic results. The purpose of this study was to determine the evolution of the various types cutting systems and compare the tissue’s response on the use of conventional instrumentation versus diathermy

Simple Decompression with Small Skin Incision for Cubital Tunnel Syndrome

2002 ◽  
Vol 27 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Y. TANIGUCHI ◽  
M. TAKAMI ◽  
T. TAMAKI ◽  
M. YOSHIDA
Keyword(s):  
Clinical Results ◽  
Skin Incision ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Endoscopic Assistance ◽  
Tunnel Syndrome ◽  
Grade Ii ◽  
The Mean ◽  
Simple Decompression

Eighteen elbows in 17patients with cubital tunnel syndrome were treated by simple decompression using only a 1.5–2.5 cm skin incision with no endoscopic assistance. According to McGowan’s criteria, three elbows were classified preoperatively as grade I, six as grade II and nine as grade III. The mean follow-up period was 14 months (range 3–25). Clinical results were evaluated as excellent for four elbows, good for ten and fair for four. Improvement of symptoms occurred in all patients and dislocation of the ulnar nerve was not observed. Simple decompression through a small skin incision can be recommended for the treatment of cubital tunnel syndrome, if the indication is appropriate.

Tension pneumocephalus with cerebrospinal fluid rhinorrhoea in a post craniotomy patient

2010 ◽  
Vol 9 (1) ◽  
pp. 13-14
Author(s):  
Nicholas H Smallwood ◽  
◽  
Sreenivasan Shiva ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Features ◽  
Frontal Sinus ◽  
Surgical Intervention ◽  
Csf Leak ◽  
Dural Tear ◽  
Tension Pneumocephalus ◽  
Neurological Signs ◽  
Important Complication ◽  
Csf Rhinorrhoea

Tension pneumocephalus is an uncommon but important complication of neurosurgery, often requiring urgent surgical intervention. It should be considered in any patient presenting with neurological symptoms after recent craniotomy, particularly if they also have clinical features consistent with cerebrospinal fluid (CSF) leak. We describe a patient who presented four weeks post-craniotomy with fluctuating neurological signs and CSF rhinorrhoea, who made a full recovery following repair of a frontal sinus defect and dural tear.

scholarly journals Autologous cervical fascia duraplasty in 123 children and adults with Chiari malformation type I: surgical technique and complications

2018 ◽  
Vol 22 (3) ◽  
pp. 297-305 ◽  
Author(s):  
Brian J. Dlouhy ◽  
Arnold H. Menezes
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Aseptic Meningitis ◽  
Chiari Malformation ◽  
Senior Author ◽  
Csf Leak ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Fascia Graft ◽  
Prospective Database

OBJECTTechniques for combined extradural and intradural decompression with expansile duraplasty for Chiari malformation type I (CM-I) have been well described, with various allogenic and autologous materials used for duraplasty. However, the approach and surgical technique used for duraplasty in our treatment of CM-I and developed by the senior author in the 1990s has not been described.METHODSA prospective database was initiated in March 2003 to denote the use of cervical fascia for duraplasty and incorporate an ongoing detailed record of complications during the surgical treatment of children and adults with CM-I with and without syringomyelia. A total of 389 surgeries for CM-I were performed on 379 patients from March 2003 to June 2016. A total of 123 posterior procedures were performed on 123 patients in which both a posterior fossa extradural and intradural decompression with duraplasty (extra-intradural) was performed. In this paper the authors describe the surgical technique for harvesting and using cervical fascia for duraplasty in the surgical treatment of CM-I and analyze and discuss complications from a prospective database spanning 2003–2016.RESULTSThe authors found that cervical fascia can be harvested in patients of all ages (2–61 years old) without difficulty, and it provides a good substitute for dura in creating an expansile duraplasty in patients with CM-I. Cervical fascia is an elastic-like material with a consistency that allows for a strong watertight closure. Harvesting the cervical fascia graft does not require any further extension of the incision superiorly or inferiorly to obtain the graft. Complications were uncommon in this study of 123 children and adults. The risk of any type of complication (aseptic meningitis, CSF leak, pseudomeningocele, infection, development of hydrocephalus, and need for ventriculoperitoneal shunt) for the 78 patients in the pediatric age group was 0%. The risk of complication in the adult group was 6.7% (1 patient with aseptic meningitis and 2 patients with CSF leak).CONCLUSIONSAutologous cervical fascia is easy to obtain in patients of all ages and provides an effective material for duraplasty in the treatment of CM-I. Complications from the combination of both an extradural and intradural decompression with autologous cervical fascia duraplasty are uncommon.

Significance of Empty Sella in Cerebrospinal Fluid Leaks

2003 ◽  
Vol 128 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Sella Turcica ◽  
Radiographic Finding ◽  
Empty Sella ◽  
Senior Author ◽  
Csf Leak ◽  
Benign Intracranial Hypertension ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Leaks

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group. METHODS: We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author. RESULTS: Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant ( P = 0.01). The spontaneous group consisted primarily of obese, middle-aged females (13 of 16 patients). CONCLUSION: Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.

scholarly journals Left Transperitoneal Adrenalectomy with a Laparoendoscopic Single-Site Surgery Combined Technique: Initial Case Reports

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Yasuhiro Sumino ◽  
Daisaku Nakano ◽  
Ken-Ichi Mori ◽  
Takeo Nomura ◽  
Fuminori Sato ◽  
...  
Keyword(s):  
Case Reports ◽  
Laparoscopic Approach ◽  
Skin Incision ◽  
Single Site ◽  
Laparoendoscopic Single Site ◽  
Limited Experience ◽  
A Minor ◽  
Laparoendoscopic Single Site Surgery ◽  
Combined Technique ◽  
Single Site Surgery

Laparoendoscopic single-site surgery (LESS) is a step toward the development of minimally invasive surgery. It is initially difficult for surgeons with limited experience to perform the surgery. We describe two cases of left adrenalectomy with a LESS combined with the addition of an accessory port. After a 2.5-cm skin incision was made at the level of the paraumbilicus to insert the primary 12-mm trocar for the laparoscope, a 5-mm nonbladed trocar was placed through the skin incision side-by-side with the primary trocar. A second 3-mm nonbladed trocar was then placed along the anterior axillary line; a multichannel trocar was not used as a single port. Both adrenalectomies were completed successfully. In patients with a minor adrenal tumor, a combined technique using LESS and an additional port is easier than LESS alone and may, therefore, be a bridge between the conventional laparoscopic approach and LESS.

Sign in / Sign up

Export Citation Format

Share Document