The false fontanel

1984 ◽  
Vol 61 (1) ◽  
pp. 71-75 ◽  
Author(s):  
Robert E. Harbaugh ◽  
Richard L. Saunders
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Illustrative Case ◽  
Anterior Fontanel ◽  
Brain Herniation ◽  
Content Type ◽  
Cranial Window ◽  
The Right ◽  
Fluid Leak ◽  
The Brain ◽  
Infants And Young Children

✓ In the neonate, palpation of the anterior fontanel is recognized as a simple and reliable means for estimating intracranial pressure. With closure of the fontanel this aspect of the clinical examination is lost. The authors report a series of 15 shunted infants and children in whom a false fontanel was created by making a 2-cm craniectomy in the right parietal region and excising the underlying internal pericranium. This produces a cranial opening which, like the anterior fontanel, can be used for palpation and real-time ultrasound imaging of the brain. By removing the internal pericranium, reossification of the defect is delayed by more than 12 months. Sparing the dura propria avoids the risks of cerebrospinal fluid leak or brain herniation into the cranial window. This procedure is reported to be simple, reliable, and of value in assessing shunt function in hydrocephalic infants and young children. An illustrative case report is presented.

A Novel Technique for Endoscopic Repair of Large Anterior Skull Base Defects: The PDS Wrap

2019 ◽  
Vol 34 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Karan Jolly ◽  
Okechukwu Okonkwo ◽  
Georgios Tsermoulas ◽  
Shahzada K. Ahmed
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Skull Base ◽  
Brain Herniation ◽  
Novel Technique ◽  
Endoscopic Skull Base Surgery ◽  
Fluid Leak ◽  
The Brain

Background Endoscopic skull base surgery continues to push boundaries with increased complexity of work and subsequently larger defects requiring repair. Robust repair following endoscopic skull base surgery is essential to reduce significant postoperative complications such as cerebrospinal fluid leak, meningitis, and pneumocephalus. Objective To describe and further validate our novel technique of using a polydioxanone plate wrap used in large anterior skull base resections where brain herniation can be of concern. Method After large resections where there is obvious brain herniation, our PDS (polydioxanone) wrap can be deployed to provide rigid support to the brain. The PDS plate is wrapped in a dural graft material and sutured closed in order to allow deployment by releasing the sutures when in position under the bony ridge of the defect. Conclusion Till date we have successfully used this technique in 3 patients following large skull base resections of olfactory meningiomas, where there was herniation of the brain. Postoperatively, there was no evidence of cerebrospinal fluid leak. We therefore recommend the use of the PDS wrap to prevent brain herniation and provide additional support to the repair.

Transesophageal echocardiography: a simple method for monitoring the patency of ventriculoatrial shunts

1991 ◽  
Vol 74 (6) ◽  
pp. 1018-1020 ◽  
Author(s):  
Luc Calliauw ◽  
Johan Vandenbogaerde ◽  
Okito Kalala ◽  
Jacques Caemaert ◽  
Frédéric Martens ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Cerebrospinal Fluid Leak ◽  
Early Experience ◽  
Accurate Assessment ◽  
Ventriculoatrial Shunt ◽  
Simple Method ◽  
Content Type ◽  
Incidental Discovery ◽  
The Right ◽  
Fluid Leak

✓ A new method for evaluating the patency of a ventriculoatrial shunt is described, and early experience with it is reported. Transesophageal echocardiography can demonstrate a cerebrospinal fluid leak in the right atrium through the atrial tip of a shunting device. This capability was an incidental discovery, and since then the accuracy of the technique in evaluating the patency of a ventriculoatrial shunt has been prospectively studied in 20 observations of 16 patients. The method proved to be accurate in 90% to 100% of cases. It is concluded that transesophageal echocardiography offers a rapid and accurate assessment of ventriculoatrial shunt function, is well tolerated, and is easy to perform.

scholarly journals Crayon in the Orbit and Sinuses in a Pediatric Patient

2021 ◽  
pp. 014556132110185
Author(s):  
Michela Borrelli ◽  
Kristen A. Echanique ◽  
Jeffrey Koempel ◽  
Elisabeth H. Ference
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Patient ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Rare Occurrence ◽  
Lamina Papyracea ◽  
The Right ◽  
Fluid Leak ◽  
Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

How to build a business

2015 ◽  
Vol 31 (11) ◽  
pp. 33-36
Keyword(s):  
Firm Performance ◽  
Business Model ◽  
Illustrative Case ◽  
Conceptual Approach ◽  
Model Framework ◽  
Content Type ◽  
The Right ◽  
Entrepreneurial Activities ◽  
The Relationship ◽  
Practical Implications

Purpose – This paper aims to deconstruct entrepreneurial orientation (EO) using a business model framework. Design/methodology/approach – Develops a conceptual approach supported by illustrative case studies that show how five Swedish small-to-medium-sized enterprises identified entrepreneurial opportunities and how they then modified their business model to exploit them. Findings – What makes an enterprise enterprising? What distinguishes these firms from the conservative, steady-as-she-goes, take-no-risks company quietly supplying its chosen market and expecting to do so for many more? Intuitively you might expect that entrepreneurial activities would be better rewarded – but researchers evaluating the link between EO and firm performance have found ambiguous results. So are we asking the right questions? And are we measuring the right things? Practical implications – Shows that companies can be entrepreneurial in some parts of their business model and more cautious in their approach to other activities. Social implications – Draws attention to the way that differences in entrepreneurs’ background, skills and growth ambitions affect their firm’s activities. Originality/value – Highlights opportunities for further research clarifying the relationship between EO and firm performance.

Management of Brain Herniation and Cerebrospinal Fluid Leak in Revision Chronic Ear Surgery

2005 ◽  
Vol 115 (7) ◽  
pp. 1256-1261 ◽  
Author(s):  
Christopher T. Wootten ◽  
David M. Kaylie ◽  
Frank M. Warren ◽  
C Gary Jackson
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Brain Herniation ◽  
Ear Surgery ◽  
Fluid Leak

scholarly journals Fonsecaea pugnacius, a Novel Agent of Disseminated Chromoblastomycosis

2015 ◽  
Vol 53 (8) ◽  
pp. 2674-2685 ◽  
Author(s):  
Conceição M. P. S. de Azevedo ◽  
Renata R. Gomes ◽  
Vania A. Vicente ◽  
Daniel W. C. L. Santos ◽  
Sirlei G. Marques ◽  
...  
Keyword(s):  
Internal Transcribed Spacer ◽  
Novel Species ◽  
Large Subunit ◽  
Fatal Case ◽  
Content Type ◽  
History Of ◽  
Brain Abscesses ◽  
The Right ◽  
The Brain ◽  
Novel Agent

We report a fatal case of a chromoblastomycosis-like infection caused by a novel species ofFonsecaeain a 52-year-old immunocompetent Caucasian male from an area of chromoblastomycosis endemicity in Brazil. The patient had a 30-year history of slowly evolving, verrucous lesions on the right upper arm which gradually affected the entire arm, the left hemifacial area, and the nose. Subsequent dissemination to the brain was observed, which led to death of the patient. The internal transcribed spacer (ITS) and partial large subunit (LSU),BT2, andCDC42genes of the isolates recovered from skin and brain were sequenced, confirming the novelty of the species. The species is clinically unique in causing brain abscesses secondary to chromoblastomycosis lesions despite the apparent intact immunity of the patient. Histopathologic appearances were very different, showing muriform cells in skin and hyphae in brain.

Hospital-acquired bacterial meningitis in neurosurgical patients

1977 ◽  
Vol 46 (4) ◽  
pp. 494-500 ◽  
Author(s):  
Frederick J. Buckwold ◽  
Roger Hand ◽  
Robert R. Hansebout
Keyword(s):  
Staphylococcus Epidermidis ◽  
Skull Fracture ◽  
Cerebrospinal Fluid Leak ◽  
Enteric Bacteria ◽  
Gram Negative ◽  
Content Type ◽  
Etiologic Agents ◽  
Neurosurgical Patients ◽  
Fluid Leak ◽  
Hospital Acquired

✓ The authors review 23 cases of hospital-acquired meningitis occurring over a 15-year period in neurosurgical patients. Factors associated with the development of meningitis include recent craniotomy, cerebrospinal fluid leak, the presence of ventricular or lumbar drainage tubes, and skull fracture. Four cases were caused by Staphylococcus epidermidis; one of these patients died. In 19 cases, Gram-negative enteric bacteria were the etiologic agents, most commonly members of the Klebsiella-Enterobacter-Serratia group. Eleven of these patients died. The particular antibiotic or group of antibiotics used and the route of administration made no difference in the outcome of Gram-negative bacillary meningitis.

Biologically inert synthetic dural substitutes

1990 ◽  
Vol 73 (6) ◽  
pp. 936-941 ◽  
Author(s):  
Damianos E. Sakas ◽  
Komporn Charnvises ◽  
Lawrence F. Borges ◽  
Nicholas T. Zervas
Keyword(s):  
Foreign Body ◽  
Cerebrospinal Fluid Leak ◽  
Dural Defect ◽  
Artificial Membranes ◽  
Content Type ◽  
Dural Graft ◽  
Polyurethane Film ◽  
Foreign Body Reactions ◽  
Fluid Leak ◽  
Carbonate Film

✓ Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.

Management of temporal bone meningo-encephalocoele

2008 ◽  
Vol 122 (11) ◽  
pp. 1168-1174 ◽  
Author(s):  
K K Ramalingam ◽  
R Ramalingam ◽  
T M SreenivasaMurthy ◽  
G R Chandrakala
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Otitis Media ◽  
Cerebrospinal Fluid Leak ◽  
Ossicular Chain ◽  
Brain Herniation ◽  
Suppurative Otitis Media ◽  
Ossicular Chain Reconstruction ◽  
Fluid Leak ◽  
Mastoid Surgery

AbstractMeningo-encephalocoele of the temporal bone, also known as fungus cerebri, is a rare occurrence in clinical practice. We present a series of 13 patients with chronic otitis media who suffered brain herniation into the mastoid cavity. We also discuss the presentation and management of brain herniation with or without cerebrospinal fluid leak.Study design:Retrospective.Methods:Among 963 cases undergoing revision mastoid surgery, 13 patients suffered brain herniation. These cases were identified and analysed.Results:All 13 patients' initial diagnosis was chronic suppurative otitis media with cholesteatoma, and all had undergone previous mastoid surgery resulting in a defect in the tegmen and weakening of the dura mater. The revision procedures performed included 10 (76.9 per cent) modified radical mastoidectomies without ossicular chain reconstruction and one (7.6 per cent) modified radical mastoidectomy with ossicular chain reconstruction; two (15.3 per cent) patients required a blind sac closure. Brain herniation and/or cerebrospinal fluid leak were repaired by a transmastoid ± minicraniotomy procedure.Conclusions:Injury to the tegmen and dura should be avoided during surgery for chronic middle-ear disease. Cerebrospinal fluid leaks, if encountered, should be managed in the same surgical session. The transmastoid approach is helpful in repairing defects smaller than 1 cm in diameter, whereas the combined transmastoid-minicraniotomy approach provides good access when closing defects larger than 1 cm in diameter and also enables auto-calvarial grafting.

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