scholarly journals Meningiomas of the ventral foramen magnum

1999 ◽  
Vol 6 (6) ◽  
pp. E7 ◽  
Author(s):  
Kenan I. Arnautovic ◽  
Ossama Al-Mefty ◽  
Muhamed Husain
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Foramen Magnum ◽  
Karnofsky Performance Scale ◽  
Recurrent Tumor ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Favorable Influence ◽  
Prolonged Hospital

Meningiomas of the ventral foramen magnum are rare lesions that account for less than 3% of all meningiomas. Their treatment remains one of the most challenging among all meningiomas. The authors comprehensively analyzed multiple features in the series of patients who harbored these lesions. The authors conducted a retrospective study of 18 patients who harbored lesions in the ventral foramen magnum (mean follow up 40 months) in whom surgery was performed via a transcondylar approach. Sixteen patients underwent surgery for the first time: in 12 patients (75%) gross total, in two (12.5%) near total, and in two (12.5%) subtotal tumor removal was achieved. The remaining two patients were treated for a recurrent tumor. Karnofsky Performance Scale (KPS) scores obtained at follow-up review demonstrated statistically significant improvement compared with those obtained preoperatively. The extent of surgical resection and preoperative KPS score were variables that demonstrated statistically significant favorable influence on outcomes. Ninth and 10th cranial nerve palsies were the most common complication that contributed to the prolonged hospital stay; six patients who experienced nerve palsy preoperatively worsened postoperatively, and four other patients developed nerve palsy after surgery. There were no perioperative deaths. Four patients died during the follow-up period. One patient died of multiple myeloma; another, who underwent surgery for a recurrent tumor, died 3 years after this second surgery from new tumor recurrence at 80 years of age; and the remaining two patients died 1.5 and 5 months postsurgery of pulmonary embolus and endocarditis, respectively. Meningioma of the ventral foramen magnum can be radically removed in a majority of patients in whom complications will be frequent but transient, resulting from lower cranial nerve palsies. The radical removal of a recurrent tumor provides for the patient a relatively long, stable follow-up period. Patients presenting with a low KPS score have a poor prognosis. Early diagnosis and treatment are recommended.

Ventral foramen magnum meningiomas

2000 ◽  
Vol 92 (1) ◽  
pp. 71-80 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty ◽  
Muhammad Husain
Keyword(s):  
Cranial Nerve ◽  
Foramen Magnum ◽  
Karnofsky Performance Scale ◽  
Recurrent Tumor ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Extent Of Surgery ◽  
Prolonged Hospital ◽  
Fine Print

Object. Ventral foramen magnum meningiomas (VFMMs) are rare lesions that account for more than 3% of all meningiomas. These are among the most challenging of all meningiomas to treat. The authors comprehensively analyzed multiple features in a series of VFMMs. Methods. A retrospective study was performed of 18 patients who harbored a meningioma in the ventral foramen magnum (mean follow-up period, 40 months) and underwent surgery via a transcondylar approach. Sixteen patients underwent surgery for the first time: 12 underwent gross-total (75%), two near-total (12.5%), and two subtotal (12.5%) tumor removal. The remaining two patients were treated for a recurrent tumor. After obtaining postoperative Karnofsky Performance Scale (KPS) scores at follow up, statistically significant improvement was demonstrated compared with the preoperative scores. The extent of surgery and higher preoperative KPS scores were variables that showed statistically significant favorable influence on outcome. Ninth and 10th cranial nerve deficits were the most common complications contributing to a prolonged hospital stay. There were no perioperative deaths. Four patients died during the follow-up period. The first patient died of multiple myeloma. The second patient, in whom surgery was performed to treat a recurrent tumor, died 3 years after the surgery of new tumor recurrence at the age of 80 years. The remaining two patients died 1.5 and 5 months postsurgery of pulmonary embolus and endocarditis, respectively. Conclusions. Ventral foramen magnum meningiomas can be radically resected in a majority of patients, with frequent but transient morbidity caused by lower cranial nerve deficits. Radical removal of a recurrent tumor provides a relatively long, stable postoperative course. In patients presenting with a low KPS score a poor prognosis is demonstrated, and early diagnosis and treatment are recommended to avoid it.

scholarly journals Lower Cranial Nerve Palsies in the COVID-19 Pandemic: A 10-Case Series of Intensive Care Unit Patients

2021 ◽  
pp. 1-4
Author(s):  
Pierre Decavel ◽  
Olympe Nahmias ◽  
Carine Petit ◽  
Laurent Tatu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prone Position ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
University Hospital ◽  
Cranial Neuropathy ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies

<b><i>Introduction:</i></b> A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. <b><i>Methods:</i></b> We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. <b><i>Results:</i></b> Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. <b><i>Conclusion:</i></b> The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.

scholarly journals The Sitting Position in Neurosurgery: A Clinical Study in 30 Cases

2013 ◽  
Vol 28 (1) ◽  
pp. 45-51
Author(s):  
Shamsul Alam ◽  
ATM Mossaraf Hossain ◽  
Rezaul Amin ◽  
ANM Wakil ◽  
KM Tarikul Islam ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Foramen Magnum ◽  
Pineal Region ◽  
Close Monitoring ◽  
Sitting Position ◽  
Lower Cranial Nerve ◽  
Tumour Removal ◽  
Almost All

Objective: Sitting position for operation of posterior fossa lesions, occipital and posterior parietal lesions, foramen magnum, upper cervical spinal lesions provides an excellent visualization because of slack of brain due to gravity drainage of CSF and blood. Hence gross total tumour removal relatively easy and less complicative.Methods: From January 2008 to march 2010 total 30 cases underwent neurosurgical procedure in sitting position. Physical characteristics including patients age, sex, size of the tumour and histological diagnosis were collected. The post operative image were studied to see the extent of tumour removal and early detection of complications. Almost all patients required peroperative cerebral venous line or peripheral inserted central venous line, precordial doppler sound, ETCO2, O2 saturation and close monitoring of blood pressure.Results: Venous air embolism were detected in two cases (6.6%). Total tumour removal was possible in 17 (56.6%) cases and subtotal in 11 (36.6%) cases. There were 4 (13.33%) mortality in thirty cases, two cases from CP angle tumour and another case from petroclival meningioma and another from pineal region tumour. There was pneumocephalus in almost all cases and post-operative new facial paresis in 10 (33.3%) cases. Fifth cranial nerve palsy developed in 3 (10%) cases. Temporary lower cranial nerve palsy developed in 2 cases. Post-operative tumour bed haematoma developed in 4 (13.33%) cases. Most of the patient had good outcome (GOS 5).Conclusion: Sitting position can be safely done with good preoperative physiological, peroperative close monitoring of the patient regarding blood pressure, ETCO2 and oxygen saturation. However postoperative complication like tumour bed haematoma, pneumocephalus, cranial nerve palsy have to be bring in mind.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 45-51

Two-year-old girl with cervicomedullary junction stenosis and an unknown type of skeletal dysplasia

2008 ◽  
Vol 2 (3) ◽  
pp. 200-202
Author(s):  
Samuel Henry Cheshier ◽  
Mohammad Yashar Sorena Kalani ◽  
Arjun Pendakaur ◽  
Dominique Higgins ◽  
David Kahn ◽  
...  
Keyword(s):  
Skeletal Dysplasia ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Foramen Magnum ◽  
Occipital Bone ◽  
Lower Cranial Nerve ◽  
Unknown Type ◽  
Cervicomedullary Junction ◽  
Lower Cranial Nerve Palsy

The authors present a novel case of skeletal dysplasia in a 2.8-year-old girl. The patient presented with progressive lower cranial nerve palsy and myelopathy due to constriction at the cervicomedullary junction caused by overgrowth of the occipital bone of the foramen magnum and the C-1. She also had prominent bone overgrowth of the superior orbital ridges, resulting in excessive stretching of periorbital skin and an inability to fully close her eyes.

scholarly journals A Case Series of Malignant Otitis Externa Mimicking Malignancy

2021 ◽  
Vol 64 (1) ◽  
pp. 36-41
Author(s):  
Vengathajalam Selvamalar ◽  
Nik Adilah Nik Othman ◽  
Mohd Khairi Daud
Keyword(s):  
Cranial Nerve ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Case Series ◽  
Lower Cranial Nerve ◽  
Cortical Mastoidectomy ◽  
Cranial Nerve Palsies ◽  
Adjacent Structures ◽  
Malignant Otitis Externa

Malignant otitis externa is an inflammation of the external auditory canal with preceding osteomyelitis of the temporal bone and the adjacent structures that could be potentially lethal. Malignant otitis externa may present with cranial nerve involvements and massive spread of disease mimicking nasopharyngeal carcinoma or any other malignancies on imaging. Two elderly patients who presented with severe otalgia and significant facial nerve palsy and lower cranial nerve palsies showing extensive spread of disease are reported in this case series. They both had resolution of disease after a prolonged course of antibiotics and cortical mastoidectomy for disease clearance in one of them.

Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy

2002 ◽  
Vol 116 (7) ◽  
pp. 556-558 ◽  
Author(s):  
R. G. Rowlands ◽  
G. K. Lekakis ◽  
A. E. Hinton
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Jugular Foramen ◽  
Radiological Investigation ◽  
Lower Cranial Nerve ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Focus Of Infection

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.

scholarly journals Vocal Cord Palsy as a Complication of Epidural Anaesthesia

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Laura Mc Loughlin ◽  
Orla Young
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Epidural Anaesthesia ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies

Cranial nerve palsy is a rare but recognised complication of epidural anaesthesia, most commonly presenting as diplopia secondary to abducens nerve palsy. While upper cranial nerve palsies have been documented on numerous occasions, lower cranial nerve palsies, including recurrent laryngeal nerve palsy, are exceedingly rare. This case describes a 37-year-old female who, following epidural anaesthesia for spontaneous vaginal delivery of her first child, presented with dysphonia. Flexible laryngoscopy confirmed a left vocal cord palsy, and computed tomography ruled out any mass lesions along the course of the recurrent laryngeal nerve. Here, we discuss a case of vocal cord palsy secondary to epidural anaesthesia, an extremely rare complication. We also discuss the proposed etiology, treatment, and outcomes in patients with this condition. Cranial nerve palsy should be an important differential in patients presenting with dysphonia following spinal or epidural anaesthesia.

Radiation-induced cranial nerve palsy: hypoglossal nerve and vocal cord palsies

1991 ◽  
Vol 105 (1) ◽  
pp. 44-45 ◽  
Author(s):  
Toru Takimoto ◽  
Yasuo Saito ◽  
Masayuki Suzuki ◽  
Toshirou Nishimura
Keyword(s):  
Vocal Cord ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Hypoglossal Nerve ◽  
Vocal Cord Palsy ◽  
Head And Neck Tumours ◽  
Neurological Improvement ◽  
Cranial Nerve Palsies ◽  
Radiation Induced

AbstractCranial nerve palsies are an unexpected complication of radiotherapy for head and neck tumours. We present a case of this radiation-induced cranial palsy.An 18-year-old female with nasopharyngeal carcinoma developed a right hypoglossal nerve palsy 42 months after cancericidal doses of radiotherapy. In addition, she developed a bilateral vocal cord palsy 62 months after therapy. Follow-up over four years has demonstrated no evidence of tumour recurrence and no sign of neurological improvement.

Endoscopic Endonasal and Transcranial Surgery for Microsurgical Resection of Ventral Foramen Magnum Meningiomas: A Preliminary Experience

2017 ◽  
Vol 14 (5) ◽  
pp. 503-514 ◽  
Author(s):  
Nicolas Khattar ◽  
Maria Koutourousiou ◽  
Joseph D Chabot ◽  
Eric W Wang ◽  
Aaron A Cohen-Gadol ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Tumor Resection ◽  
Cerebrospinal Fluid Leak ◽  
Foramen Magnum ◽  
Gross Total Resection ◽  
Fat Graft ◽  
Karnofsky Performance Scale ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Lower Cranial Nerve

Abstract BACKGROUND Purely ventral foramen magnum meningiomas are challenging tumors to treat given their location, and proximity and relationship to vital neurovascular structures. OBJECTIVE To present endoscopic endonasal surgery (EES) as a complementary approach to the far-lateral suboccipital approach (FLA) for ventral midline tumors. METHODS From May 2008 to October 2013, 5 patients underwent EES and 5 FLA for primary ventral foramen magnum meningiomas. We retrospectively reviewed their records to evaluate outcomes. RESULTS Nine of 10 patients presented with long-tract and lower cranial nerve deficits. All patients who presented with deficits preoperatively completely normalized after tumor resection regardless of approach. Gross total resection was achieved in 2 cases in the EES group and 4 cases in the FLA group (the rest were near total). Vascular encasement was a limitation to gross total resection with both approaches. Preoperative median Karnofsky Performance Scale score was 80 and improved to 100 in both groups. Following EES, 1 patient developed cerebrospinal fluid leak with resultant meningitis. Two patients developed hydrocephalus, one of which developed an epidural abscess following necrosis of the nasoseptal flap, requiring debridement. In the FLA group, 1 patient developed a pseudomeningocele associated with hydrocephalus. One patient developed an abdominal fat graft site hematoma. CONCLUSION Both approaches provide excellent results for resection of ventral foramen magnum meningiomas, with reconstruction and hydrocephalus as the main sources of complication. In our practice, EES is a preferred technique in ventral, purely midline tumors with limited inferior extension and reduced lower cranial nerve manipulation, whereas FLA is preferred in tumors with lateral and caudal extension below the tip of the dens.

Microsurgical resection of foramen magnum meningioma through a transcondylar approach: three-dimensional operative video

2019 ◽  
Vol 1 (2) ◽  
pp. V3
Author(s):  
Guilherme H. W. Ceccato ◽  
Rodolfo F. M. da Rocha ◽  
Duarte N. C. Cândido ◽  
Wladimir O. Melo ◽  
Marcio S. Rassi ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Three Dimensional ◽  
Foramen Magnum ◽  
Complete Resection ◽  
Neurophysiological Monitoring ◽  
Cervical Instability ◽  
Transcondylar Approach ◽  
Postoperative Mri ◽  
Microsurgical Resection

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.

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