Intracranial diverticulum of the frontal sinus as a complication of frontal craniotomy

✓ A technique to expose the anterior cranial base is described with entry through the anterior and posterior walls of the frontal sinus. Burr holes are avoided in the visible portion of the forehead. Expansion of the operative field may be accomplished, if necessary, by supplemental superior frontal or supraorbital rim osteotomy. The technique is rapid, safe, and provides excellent operative exposure and superior cosmetic results.

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Temporalis myofascial repair of traumatic defects of the anterior fossa

Journal of Neurosurgery ◽

10.3171/jns.1986.64.6.0977 ◽

1986 ◽

Vol 64 (6) ◽

pp. 977-978 ◽

Cited By ~ 11

Author(s):

Ritchie P. Gillespie ◽

Frank W. Shagets ◽

Raul A. de los Reyes

Keyword(s):

Bone Defects ◽

Anterior Cranial Fossa ◽

Content Type ◽

Anterior Fossa ◽

Cranial Fossa ◽

Dural Defects ◽

Fine Print

✓ Bilateral temporalis myofascial flaps in continuity with frontal periosteum can be used in repairing extensive dural and bone defects of the anterior cranial fossa floor. The technique of preserving and using this flap is described and offers an alternative to the use of frontal pericranial tissue for repair of anterior dural defects.

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Development of anterior cranial fossa dural arteriovenous malformation following head trauma

Journal of Neurosurgery ◽

10.3171/jns.1997.86.2.0291 ◽

1997 ◽

Vol 86 (2) ◽

pp. 291-293 ◽

Cited By ~ 25

Author(s):

Tatsuya Ishikawa ◽

Kiyohiro Houkin ◽

Kouichi Tokuda ◽

Susumu Kawaguchi ◽

Takeshi Kashiwaba

Keyword(s):

Head Trauma ◽

Anterior Cranial Fossa ◽

Content Type ◽

Sagittal Sinus ◽

First Case ◽

History Of ◽

Cranial Fossa ◽

Ethmoidal Arteries ◽

Dural Avm ◽

Fine Print

✓ Dural arteriovenous malformations (AVMs) are considered to be acquired lesions that develop secondary to venous obstruction, which sometimes happens in head trauma. However, there has been a report of an anterior cranial fossa dural AVM that occurred independently of a history of head trauma, and there has been speculation that these malformations are congenital. The authors recount their experience with a patient who had an anterior cranial fossa dural AVM that was discovered incidentally. The lesion was fed by the bilateral anterior ethmoidal arteries and drained into the superior sagittal sinus via frontal cortical veins. The patient had a history of severe head trauma that had occurred 30 years earlier. This is the first case report in which a previous head trauma is strongly believed to be the cause of an anterior cranial fossa dural AVM. The authors postulate that anterior cranial fossa dural AVMs can develop secondary to a head trauma.

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Angiofibroma of the middle cranial fossa

Journal of Neurosurgery ◽

10.3171/jns.1971.35.1.0090 ◽

1971 ◽

Vol 35 (1) ◽

pp. 90-94 ◽

Cited By ~ 8

Author(s):

G. Vasudeva Iyer ◽

N. D. Vaishya ◽

A. Bhaktaviziam ◽

G. M. Taori ◽

Jacob Abraham

Keyword(s):

Young Woman ◽

Middle Cranial Fossa ◽

Intracranial Tumor ◽

Rare Occurrence ◽

Content Type ◽

Cranial Fossa ◽

Primary Intracranial Tumor ◽

Fine Print

✓ The rare occurrence of angiofibroma as a primary intracranial tumor in the middle cranial fossa is reported in a young woman, and related reports are reviewed.

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Refined and Simplified Surgical Landmarks for the MacCarty Keyhole and Orbitozygomatic Craniotomy

Operative Neurosurgery ◽

10.1227/01.neu.0000369650.69583.9c ◽

2010 ◽

Vol 66 (suppl_2) ◽

pp. ons230-ons233 ◽

Cited By ~ 1

Author(s):

R. Shane Tubbs ◽

Marios Loukas ◽

M.M. Shoja ◽

Aaron A. Cohen-Gadol

Keyword(s):

Frontal Sinus ◽

Lateral Wall ◽

Burr Hole ◽

Anterior Cranial Fossa ◽

Orbital Roof ◽

Alternative Method ◽

Lateral Extent ◽

Cranial Fossa ◽

Burr Holes ◽

External Landmark

Abstract BACKGROUND Precise placement of the MacCarty keyhole, a burr hole simultaneously exposing the anterior cranial fossa floor and orbit, provides accurate, efficient entry for orbitozygomatic and supraorbital craniotomies. To locate the optimal keyhole site, previous studies have used superficial landmarks that, in our experience, are not always visible or consistent on older crania. OBJECTIVE Therefore, we present a technique for accurate keyhole placement using landmarks that are easily visible across age ranges. METHODS From inside the cranium, 1-mm burr holes were placed along the anterior junction of the floor and lateral wall of the anterior cranial fossa in 50 adult skulls (100 sides, with calvaria removed). Additionally, from inside the orbit, 1-mm burr holes were placed into the lateral orbital roof. Exit sites of intracranial and intraorbital burr holes were referenced to the frontozygomatic suture. The center of the site between the exiting intracranial and intraorbital holes was deemed the best location for the keyhole. RESULTS The keyhole center was 6.8 mm (mean) superior and 4.5 mm (mean) posterior to the frontozygomatic suture, which was easily identified on all specimens. Although this keyhole center was slightly more superior on right sides than left, this was not statistically significant. In a minority of specimens, the keyhole was located near the meningo-orbital foramen (22%) and the lateral extent of the frontal sinus (2%). CONCLUSIONS We defined an alternative method for locating the MacCarty keyhole, based on a reliable external landmark, approximately 7 mm superior and 5 mm posterior to the frontozygomatic suture.

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Acute subdural hematoma and death following lateral cervical spinal puncture

Journal of Neurosurgery ◽

10.3171/jns.1983.58.2.0284 ◽

1983 ◽

Vol 58 (2) ◽

pp. 284-286 ◽

Cited By ~ 41

Author(s):

Larry A. Rogers

Keyword(s):

Vertebral Artery ◽

Subdural Hematoma ◽

Posterior Cranial Fossa ◽

Acute Subdural Hematoma ◽

Content Type ◽

Spinal Puncture ◽

Cranial Fossa ◽

Fine Print

✓ An acute subdural hematoma dissecting into the posterior cranial fossa and resulting in death is reported. The patient had undergone spinal puncture by the lateral cervical technique prior to development of the hematoma. Autopsy demonstrated that the source of hemorrhage was an anomalous intraspinal vertebral artery.

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Madreporic coral: a new bone graft substitute for cranial surgery

Journal of Neurosurgery ◽

10.3171/jns.1988.69.4.0510 ◽

1988 ◽

Vol 69 (4) ◽

pp. 510-513 ◽

Cited By ~ 70

Author(s):

François X. Roux ◽

Daniel Brasnu ◽

Bernard Loty ◽

Bernard George ◽

Geneviève Guillemin

Keyword(s):

Bone Graft ◽

Reconstructive Surgery ◽

Experimental Studies ◽

Bone Graft Substitute ◽

Biological Properties ◽

Content Type ◽

Skull Defects ◽

Cranial Fossa ◽

Burr Holes ◽

Fine Print

✓ Since 1985, the authors have been using madreporic coral fragments (genera Porites) as a bone graft substitute. Of the 167 coral grafts implanted, 150 were coral “corks” used to obliterate burr holes (diameter 10 mm), five were large implants (length 20 to 40 mm) to repair skull defects, and 12 were coral blocks to reconstruct the floor of the anterior cranial fossa. Previous experimental studies suggested that coral grafts would be well tolerated and become partially reossified as the calcific skeleton was resorbed. The authors describe their experience and detail the main biological properties of these materials, which appear to be very promising for use in cranial reconstructive surgery.

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Evaluation in cats of a new material for cranioplasty: a composite of plaster of Paris and hydroxylapatite

Journal of Neurosurgery ◽

10.3171/jns.1988.69.2.0269 ◽

1988 ◽

Vol 69 (2) ◽

pp. 269-275 ◽

Cited By ~ 45

Author(s):

Charles E. Rawlings ◽

Robert H. Wilkins ◽

Jacob S. Hanker ◽

Nicholas G. Georgiade ◽

John M. Harrelson

Keyword(s):

Bone Formation ◽

Frontal Sinus ◽

Wound Dehiscence ◽

Bone Defects ◽

The Body ◽

New Bone Formation ◽

Content Type ◽

Plaster Of Paris ◽

New Material ◽

Fine Print

✓ The materials ordinarily used to reconstruct bone defects in the calvaria and facial bones either are difficult to shape, are partially resorbed by the body, or are likely to become infected if used near a contaminated area such as the frontal sinus. Calcium sulfate hemihydrate (plaster of Paris) has been known for years to have excellent reparative qualities in bone defects, but ordinarily it is quickly resorbed. Consequently, a new material, a composite of a dense form of plaster of Paris and hydroxylapatite, was devised to provide nonabsorbable hydroxylapatite particles for bone to form around and within during the phase of plaster absorption. Two types of this material were evaluated in cranial defects in cats. Each of the plaster of Paris/hydroxylapatite mixtures was placed into a surgically unroofed frontal sinus and into a contralateral parietal trephine hole in a group of 32 cats. Two cats in each group succumbed to anesthesia, leaving two sets of 30 cats. During the entire follow-up period there was only one other death, with no evidence of wound infection, wound dehiscence, implant rejection, or cerebral dysfunction among the survivors. The cats in each group were sacrificed at 1, 2, 3, 5, 7, 8, 9, 10, or 12 months after operation. Following sacrifice, both the frontal and parietal defects were exposed and examined visually, histologically, and with histomorphometric analysis for new bone formation. New bone formation was present as early as 1 month after operation and continued to increase during the 12 months of the study. Based upon these osteogenic qualities, the ease of shaping the composite, and the lack of infection in the frontal sinus region, it is concluded that this substance could be a valuable new material for human cranioplasty.

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The straight sinus

Journal of Neurosurgery ◽

10.3171/jns.1974.41.6.0724 ◽

1974 ◽

Vol 41 (6) ◽

pp. 724-727 ◽

Cited By ~ 24

Author(s):

R. C. Saxena ◽

M. A. Q. Beg ◽

A. C. Das

Keyword(s):

Dura Mater ◽

Posterior Cranial Fossa ◽

Cerebral Vein ◽

Content Type ◽

Straight Sinus ◽

Sagittal Sinus ◽

India Ink ◽

Human Cadavers ◽

Cranial Fossa ◽

Fine Print

✓ The dura mater of the posterior cranial fossa of 86 adult human cadavers has been examined grossly after the injection of India ink through the confluence of sinuses in order to visualize the extent, communications, and tributaries of the straight sinus. Variations from the textbook description of formation by the union of the inferior sagittal sinus and the great cerebral vein are described and discussed.

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Thickening of sphenoid sinus mucosa during the acute stage of pituitary apoplexy

Journal of Neurosurgery ◽

10.3171/jns.2001.95.5.0897 ◽

2001 ◽

Vol 95 (5) ◽

pp. 897-901 ◽

Cited By ~ 29

Author(s):

Kazunori Arita ◽

Kaoru Kurisu ◽

Atushi Tominaga ◽

Kazuhiko Sugiyama ◽

Fusao Ikawa ◽

...

Keyword(s):

Transsphenoidal Surgery ◽

Sphenoid Sinus ◽

Pituitary Apoplexy ◽

Sella Turcica ◽

Acute Stage ◽

Mr Images ◽

Content Type ◽

Subepithelial Layer ◽

Sinus Mucosa ◽

Fine Print

✓ The authors treated two patients with pituitary apoplexy in whom magnetic resonance (MR) images were obtained before and after the episode. Two days after the apoplectic episodes, MR imaging demonstrated marked thickening of the mucosa of the sphenoid sinus that was absent in the previous studies. The relevance of this change in the sphenoid sinus was investigated. Retrospective evaluations were performed using MR images obtained in 14 consecutive patients with classic pituitary apoplexy characterized by acute onset of severe headache. The mucosa of the sphenoid sinus had thickened predominantly in the compartment just beneath the sella turcica, in nine of 11 patients, as ascertained on MR images obtained within 7 days after the onset of apoplectic symptoms. This condition improved spontaneously in all four patients who did not undergo transsphenoidal surgery. The sphenoid sinus mucosa appeared to be normal on MR images obtained from three patients at the chronic stage (> 3 months after onset). The incidence of sphenoid sinus mucosal thickening during the acute stage was significantly higher in the patients with apoplexy than that in the 100 patients without apoplexy. A histological study conducted in four patients who underwent transsphenoidal surgery during the early stage showed that the subepithelial layer of the sphenoid sinus mucous membrane was obviously swollen. The sphenoid sinus mucosa thickens during the acute stage of pituitary apoplexy. This thickening neither indicates infectious sinusitis nor rules out the choice of the transsphenoidal route for surgery.

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