Sphenoethmoidal cephalocele with cleft palate: transpalatal versus transcranial repair

1983 ◽  
Vol 58 (6) ◽  
pp. 924-931 ◽  
Author(s):  
Michael L. Lewin
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cerebral Tissue ◽  
Posterior Portion ◽  
Content Type ◽  
Dural Closure ◽  
Transpalatal Approach ◽  
Pituitary Deficiency ◽  
Median Cleft ◽  
Fine Print

✓ Two cases of sphenoethmoidal encephalocele with cleft palate are reported in detail. The encephaloceles had prolapsed into the nose and nasopharynx, and protruded into the mouth. Previous examples of this entity are reviewed. Such patients have a typical facial appearance: hypertelorism, median cleft lip, and bifid nose of varied severity. Ocular findings include coloboma of the optic nerve or anophthalmia. The prolapsed cerebral tissue varies from nonfunctional glia elements to vital structures of the hypothalamus-pituitary area. Agenesis of the corpus callosum has been reported consistently. Transcranial access to the bone defect, particularly its posterior portion, is difficult because of distorted cerebral anatomy and abnormal vasculature. The fragility of the prolapsed cerebral tissue makes it difficult to preserve the cerebral tissue intact and to reposition it into the cranium. When there is a cleft palate, it is possible to repair the encephalocele extracranially through a transoral, transpalatal approach, preserving and repositioning the content of the sac. Dural closure and obliteration of the bone defects are other essential steps of the operation. Both patients reported here were successfully operated on by the transoral, transpalatal route, at the age of 3 months and 4 years, respectively. They were followed for several years and had comprehensive endocrinological work-ups. One patient exhibited some pituitary deficiency requiring substitution therapy.

Sphenoethmoidal meningoencephalocele associated with agenesis of corpus callosum and median cleft lip and palate

1979 ◽  
Vol 51 (3) ◽  
pp. 397-401 ◽  
Author(s):  
Katsuaki Sakoda ◽  
Susumu Ishikawa ◽  
Tohru Uozumi ◽  
Katsuhiro Hirakawa ◽  
Hideo Okazaki ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Corpus Callosum ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Distinct Type ◽  
Agenesis Of Corpus Callosum ◽  
Content Type ◽  
Median Cleft ◽  
Fine Print

✓ A case of sphenoethmoidal meningoencephalocele associated with agenesis of the corpus callosum and median cleft lip and palate in a baby boy is reported. Two other cases have been reported previously presenting exactly the same findings. It is possible that these malformations constitute a distinct type of congenital anomaly.

Use of ligamentum nuchae graft for dural closure in posterior fossa surgery

1998 ◽  
Vol 89 (1) ◽  
pp. 155-156 ◽  
Author(s):  
Edward J. Kosnik
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leakage ◽  
Posterior Fossa Surgery ◽  
Content Type ◽  
Fluid Leakage ◽  
Dural Closure ◽  
Fine Print

✓ The technique of harvesting the ligamentum nuchae and its use in posterior fossa surgery are discussed. By using this technique the author has avoided postoperative cerebrospinal fluid leakage in more than 200 procedures.

Cerebral anaerobism during experimental incremental oligemic hypotension

1972 ◽  
Vol 36 (3) ◽  
pp. 310-313 ◽  
Author(s):  
David Yashon ◽  
George E. Locke ◽  
William E. Hunt
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Anaerobic Metabolism ◽  
Aerobic Metabolism ◽  
Cerebral Tissue ◽  
Content Type ◽  
Blood Withdrawal ◽  
Canine Brain ◽  
Fine Print

✓ Thirty-seven dogs were studied to establish the level of mean arterial pressure (MAP) causing cerebral tissue lactate (CTL) accumulation as a result of anaerobic metabolism and to assess the extent of preservation of aerobic metabolism afforded by autoregulation during oligemia. Specimens were removed prior to oligemia and at 5, 30, and 60 min following hypotension created by blood withdrawal. In four control animals, CTL averaged 4.83 (range 3.26 to 7.07) mMol/kg. At 60 min after induction of oligemic hypotension, 13 animals with a MAP of 30 and 40 mm Hg showed concentrations of CTL between 16.56 and 20.89. At a MAP of 50 mm Hg six animals showed a CTL concentration between 4.39 and 15.88; at a MAP of 60 mm Hg eight animals showed a CTL between 3.76 and 14.93; and at a MAP of 70 mm Hg six animals had a CTL between 2.43 and 4.27. At 5 min, at all mean arterial pressures the cerebral tissue lactate varied between 2.07 and 5.50. By 30 min the elevations were similar to those at 60 min. CTL elevation was independent of pre-oligemic MAP. In the canine brain there is a uniform incremental elevation of CTL between a MAP of 30 to 50 mm Hg directly related to the time of hypotension; there is variable intolerance to MAP in the range of 50 to 70 when related to a time longer than 5 min.

Ossification of autologous pericranium used in duraplasty

2001 ◽  
Vol 95 (2) ◽  
pp. 350-352 ◽  
Author(s):  
Devon A. Hoover ◽  
Asim Mahmood
Keyword(s):  
Computerized Tomography ◽  
Gunshot Wound ◽  
Osteogenic Potential ◽  
Review Of The Literature ◽  
Content Type ◽  
Dural Closure ◽  
The Many ◽  
Tomography Scanning ◽  
Fine Print

✓ Pericranium is frequently used in duraplasty and is considered superior to the many other alternatives because of its easy availability and because it offers a watertight dural closure while minimizing the problems of adhesion, infection, and rejection. Although the osteogenic potential of all periosteal tissues is recognized, a review of the literature did not reveal a reported case of osseous formation following use of pericranium for duraplasty. The authors report the case of a 17-year-old man who presented with a self-inflicted gunshot wound to the head. He was obtunded, but moving all extremities purposefully. Computerized tomography scanning demonstrated bifrontal injury. A bicoronal craniotomy with debridement was performed on an emergency basis, with vascularized pericranium used for a duraplasty. Follow-up cranioplasty demonstrated significant ossification of the pericranium 5 months after the original surgery. Pericranium is an attractive material for duraplasty; however, its osteogenic potential may interfere with future cranioplasty and cosmesis. This may be especially relevant in young persons.

Cavernous sinus sampling in patients with adrenocorticotrophic hormone—dependent Cushing's syndrome with emphasis on inter- and intracavernous adrenocorticotrophic hormone gradients

1998 ◽  
Vol 89 (5) ◽  
pp. 762-768 ◽  
Author(s):  
Akira Teramoto ◽  
Yoichi Yoshida ◽  
Naoko Sanno ◽  
Shigeru Nemoto
Keyword(s):  
Standard Deviation ◽  
Cavernous Sinus ◽  
Cushing’S Syndrome ◽  
False Negative ◽  
Cushing's Syndrome ◽  
Adrenocorticotrophic Hormone ◽  
Posterior Portion ◽  
Content Type ◽  
Catheterization Technique ◽  
Fine Print

Object. As an alternative method to inferior petrosal sinus sampling with administration of corticotropin-releasing hormone (CRH), the authors have developed a method of selective venous sampling directly from the cavernous sinus, which is performed using a superselective catheterization technique. The goal of this study is to assess this method. Methods. Catheterization to the cavernous sinus was performed in 44 patients with clinical and biochemical features of Cushing's syndrome. Forty of these patients in whom there was a definite clinical and/or histological diagnosis were evaluated. In 35 patients, a pituitary microadenoma was detected on magnetic resonance imaging and/or during surgery. Ectopic lesions were suspected in five patients, who later developed nonpituitary tumors. The central/peripheral (C/P) ratios of adrenocorticotrophic hormone (ACTH) without CRH administration ranged from 5.2 to 448.1 (mean ± standard deviation, 66.7 ± 91.2) in cavernous sinuses and from 1.1 to 52 (mean ± standard deviation, 8.5 ± 9.9) in the inferior petrosal sinuses. The petrosal sinus sampling contained false negative results in eight patients (23%) based on a cutoff point of 2. On the contrary, patients with ectopic lesions did not show any increase in ACTH levels in either sampling portion. The intercavernous gradients of ACTH, ranging from 1.2 to 506.4, indicated the correct lateralization of microadenoma in the lateral wing in all 30 patients. The interpetrosal gradients, ranging from 1 to 31.4, did not give a sufficient value (≥ 1.4) in four patients (13%) with a lateral lesion. In five cases of midline tumors, the intercavernous and interpetrosal gradients indicated false laterality in three and four cases, respectively. The intracavernous (posterior—anterior) gradients, ranging from 1.04 to 60.7 (mean 14.9), showed a higher concentration of ACTH in the posterior portion of the sinus in all patients. Conclusions. These results suggest that 1) cavernous sinus sampling without CRH administration can demonstrate hypersecretion of ACTH from the pitutary gland with a high diagnostic accuracy; 2) intercavernous gradients will indicate the correct lateralization in laterally localized microadenomas; and 3) sampling should be performed from the posterior portion of the cavernous sinus.

Gross pulmonary embolization with cerebral tissue following head trauma

1973 ◽  
Vol 39 (1) ◽  
pp. 109-113 ◽  
Author(s):  
Jacques Legier ◽  
Italo Rinaldi
Keyword(s):  
Brain Tissue ◽  
Head Trauma ◽  
Cerebral Tissue ◽  
Content Type ◽  
Pulmonary Embolization ◽  
Fine Print

✓ A case of gross pulmonary embolization by cortical brain tissue is described. The likelihood of a superimposed coagulating process induced by the thromboplastic effect of cerebral phospholipids is discussed.

Penetrating craniocerebral injuries in the Israeli involvement in the Lebanese conflict, 1982–1985

1990 ◽  
Vol 72 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Benny Brandvold ◽  
Lion Levi ◽  
Moshe Feinsod ◽  
Eugene D. George
Keyword(s):  
Medical Center ◽  
Head Injuries ◽  
Cerebral Tissue ◽  
Content Type ◽  
Craniocerebral Injuries ◽  
Number Of Patients ◽  
Two Factors ◽  
Bone Fragments ◽  
Fine Print

✓ From June, 1982, through June, 1985, 113 patients were evacuated to Rambam Maimonides Medical Center with penetrating craniocerebral injuries sustained in ongoing military hostilities in Lebanon. Two factors distinguished this group of patients from those presenting in earlier conflicts: 1) this was the first large series in which computerized tomography (CT) was routinely used to initially evaluate combat head injuries; and 2) in an effort to preserve maximum cerebral tissue, intracranial debridement was significantly less vigorous than that advocated during the Korean or Vietnam conflicts. No efforts were made to locate or remove indriven bone or metal fragments visualized on CT unless they readily presented themselves on gentle irrigation. In fact, it was elected to treat a number of patients without intracranial hematomas nonoperatively. The acute outcome was quite similar to that reported in Vietnam series in respect to both complications and mortality. Of the 83 survivors, 46 were Israeli citizens and thus were available for follow-up review. These 46 patients were reevaluated in late 1988, a mean follow-up period of 5.9 years. None had died in the interim; 10 had developed chronic seizure disorders, and there was one case of delayed meningitis in a patient with no retained fragments. Repeat CT scans were performed on 43 patients; 22 (51%) were found to have retained intracranial bone fragments. No relationship existed between the presence of retained fragments and the development of either a seizure disorder or an infection of the central nervous system. These findings suggest that not only is it unnecessary to reoperate for retained bone fragments, but it may also be possible to temper the initial debridement in an effort to preserve additional cerebral tissue.

Iatrogenic intradiploic meningoencephalocele

1997 ◽  
Vol 87 (3) ◽  
pp. 468-471 ◽  
Author(s):  
Juan F. Martínez-Lage ◽  
Francisco López ◽  
Claudio Piqueras ◽  
Máximo Poza
Keyword(s):  
Magnetic Resonance Imaging ◽  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Skull Fractures ◽  
Dural Tear ◽  
Resonance Imaging ◽  
Cerebral Tissue ◽  
Content Type ◽  
Unusual Lesion ◽  
Fine Print

✓ The authors present the case of a 6-year-old girl who developed a right frontal intradiploic meningoencephalocele following an accidental dural tear produced during surgery for craniosynostosis. Although rare, growing skull fractures have been described in at least eight cases following the accidental laceration of the dura mater in the course of craniosynostosis repair. These cases closely resemble those produced by accidental trauma to the growing skull. However, the intradiploic location of a meningoencephalocele following surgery for craniosynostosis has not been documented previously. This patient presented with headache and a frontal tumor of bonelike consistency. Radiographs and computerized tomography scans of the skull revealed an intraosseous cyst, whereas magnetic resonance imaging demonstrated cerebral tissue herniation within the intradiploic tumor. Surgical treatment consisted of duraplasty and cranioplasty, which achieved good functional and cosmetic results. The pathogenesis of this unusual lesion is discussed and compared with the hypotheses advanced for explaining posttraumatic intradiploic cysts.

Resection of suprasellar tumors by using a modified transsphenoidal approach

2000 ◽  
Vol 92 (6) ◽  
pp. 1028-1035 ◽  
Author(s):  
Joshua G. Kouri ◽  
Michael Y. Chen ◽  
Joseph C. Watson ◽  
Edward H. Oldfield
Keyword(s):  
Third Ventricle ◽  
Sella Turcica ◽  
Transsphenoidal Approach ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Posterior Portion ◽  
Content Type ◽  
Suprasellar Region ◽  
Adjacent Structures ◽  
Fine Print

✓ Generally accepted contraindications to using a transsphenoidal approach for resection of tumors that arise in or extend into the suprasellar region include a normal-sized sella turcica, normal pituitary function, and adherence of tumor to vital intracranial structures. Thus, the transsphenoidal approach has traditionally been restricted to the removal of tumors involving the pituitary fossa and, occasionally, to suprasellar extensions of such tumors if the sella is enlarged. However, conventional transcranial approaches to the suprasellar region require significant brain retraction and offer limited visualization of contralateral tumor extension and the interface between the tumor and adjacent structures, such as the hypothalamus, third ventricle, optic apparatus, and major arteries. In this paper the authors describe successful removal of suprasellar tumors by using a modified transsphenoidal approach that circumvents some of the traditional contraindications to transsphenoidal surgery, while avoiding some of the disadvantages of transcranial surgery.Four patients harbored tumors (two craniopharyngiomas and two hemangioblastomas) that arose in the suprasellar region and were located either entirely (three patients) or primarily (one patient) within the suprasellar space. All patients had a normal-sized sella turcica. Preoperatively, three of the four patients had significant endocrinological deficits signifying involvement of the hypothalamus, pituitary stalk, or pituitary gland. Two patients exhibited preoperative visual field defects. For tumor excision, a recently described modification of the traditional transsphenoidal approach was used. Using this modification, one removes the posterior portion of the planum sphenoidale, allowing access to the suprasellar region. Total resection of tumor was achieved (including absence of residual tumor on follow-up imaging) in three of the four patients. In the remaining patient, total removal was not possible because of adherence of tumor to the hypothalamus and midbrain. One postoperative cerebrospinal fluid leak occurred. Postoperative endocrinological function was worse than preoperative function in one patient. No other new postoperative endocrinological or neurological deficits were encountered.This study demonstrates the feasibility of using a modified transsphenoidal approach for resection of certain suprasellar, nonpituitary tumors.

Aggravation of vasogenic cerebral edema by multiple-dose mannitol

1992 ◽  
Vol 77 (4) ◽  
pp. 584-589 ◽  
Author(s):  
Anthony M. Kaufmann ◽  
Erico R. Cardoso
Keyword(s):  
Single Dose ◽  
Water Content ◽  
Cerebral Edema ◽  
Plasma Concentrations ◽  
Cerebral Tissue ◽  
Osmotic Concentration ◽  
Content Type ◽  
Treatment Groups ◽  
Intravenous Injections ◽  
Fine Print

✓ The authors investigated the pharmacokinetics of mannitol administered for treatment of vasogenic cerebral edema. A cortical cold injury was produced in 23 cats maintained under general anesthesia for 5 or 21 hours. Control animals received no mannitol, while treatment groups received either a single dose or five doses administered at 4-hour intervals of 0.33 gm/kg radiolabeled mannitol. Liquid scintillation counting was carried out to determine the concentrations of mannitol in the cerebral tissue, cerebrospinal fluid, plasma, and urine. Cerebral water content and linear progression of edema were also measured. Rapid plasma clearance prevented accumulation of mannitol after multiple intravenous injections, as 84% ± 2% (mean ± standard error of the mean) of the infused mannitol was excreted through the urine. However, there was progressive accumulation of mannitol within the cerebral tissue, especially in the edematous white matter where it reached a level of 0.33 ± 0.03 mg/gm after five doses, exceeding the trough plasma concentrations by a ratio of 2.69:1. Water content measurement showed that a single dose of mannitol failed to reduce cerebral water content or edema progression at 4 hours postinjection, while multiple doses produced a 3% increase in water content in edematous regions (p > 0.0003). The results of this study demonstrated a reversal of the osmotic concentration gradient between edematous brain and plasma following multiple mannitol injections, associated with exacerbation of vasogenic cerebral edema.

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