Vascularized temporalis muscle flap for the treatment of otorrhea

2003 ◽  
Vol 98 (5) ◽  
pp. 1128-1132 ◽  
Author(s):  
Gabriel C. Tender ◽  
Scott Kutz ◽  
Deepak Awasthi ◽  
Peter Rigby
Keyword(s):  
Intracranial Pressure ◽  
Muscle Flap ◽  
Middle Fossa ◽  
Temporalis Muscle ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Middle Fossa Approach ◽  
Medial Side ◽  
Temporalis Muscle Flap ◽  
Fine Print

✓ The surgical treatment for cerebral spinal fluid (CSF) fistulas provides closure of the bone and dural defects and prevents the recurrence of brain herniation and CSF fistula. The two main approaches used are the transmastoid and middle fossa ones. The authors review the results of performing a modified middle fossa approach with a vascularized temporalis muscle flap to create a barrier between the repaired dural and bone defects. Fifteen consecutive cases of CSF fistulas treated at the authors' institution were retrospectively reviewed. All patients presented with otorrhea. Eleven patients had previously undergone ear surgery. A middle fossa approach was followed in all cases. The authors used a thin but watertight and vascularly preserved temporalis muscle flap that had been dissected from the medial side of the temporalis muscle and was laid intracranially on the floor of the middle fossa, between the repaired dura mater and petrous bone. The median follow-up period was 2.5 years. None of the patients experienced recurrence of otorrhea or meningitis. There was no complication related to the intracranial temporalis muscle flap (for example, seizures or increased intracranial pressure caused by muscle swelling). One patient developed hydrocephalus, which resolved after the placement of a ventriculoperitoneal shunt 2 months later. The thin, vascularized muscle flap created an excellent barrier against the recurrence of CSF fistulas and also avoided the risk of increased intracranial pressure caused by muscle swelling. This technique is particularly useful in refractory cases.

Intracranial xanthogranuloma of the dura in Hand-Schüller-Christian disease

1993 ◽  
Vol 78 (2) ◽  
pp. 297-300 ◽  
Author(s):  
Zain Alabedeen B. Jamjoom ◽  
Vinita Raina ◽  
Abdulfattah Al-Jamali ◽  
Abdulhakim B. Jamjoom ◽  
Basim Yacub ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Clinical Features ◽  
Obstructive Hydrocephalus ◽  
Relevant Literature ◽  
Increased Intracranial Pressure ◽  
Falx Cerebri ◽  
Content Type ◽  
Tentorium Cerebelli ◽  
Ultrastructural Studies ◽  
Fine Print

✓ The authors describe a 37-year-old man with the classic clinical features of Hand-Schüller-Christian disease. He presented with symptoms of increased intracranial pressure due to obstructive hydrocephalus secondary to a huge xanthogranuloma involving falx cerebri and tentorium cerebelli. Immunohistochemical and ultrastructural studies failed to demonstrate Langerhans histiocytes, however. The implication of this finding is discussed in light of the recent relevant literature.

Conray ventriculography in the diagnosis of intraventricular and posterior fossa lesions

1971 ◽  
Vol 34 (3) ◽  
pp. 405-407 ◽  
Author(s):  
Salvador Gonzalez-Cornejo
Keyword(s):  
Intracranial Pressure ◽  
Posterior Fossa ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Conray Ventriculography ◽  
Fine Print

✓ The author reports the safe and satisfactory use of Conray ventriculography in 26 patients with increased intracranial pressure and discusses his technique for this procedure.

Pneumocephalus in patients with CSF shunts

1985 ◽  
Vol 63 (4) ◽  
pp. 532-536 ◽  
Author(s):  
John R. Ruge ◽  
Leonard J. Cerullo ◽  
David G. McLone
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Mental Status ◽  
Aqueductal Stenosis ◽  
Increased Intracranial Pressure ◽  
Csf Shunts ◽  
Content Type ◽  
Presenting Symptoms ◽  
Fine Print

✓ The authors present two cases of pneumocephalus occurring in patients with permanent shunts and review nine previously reported cases. Mental status changes and headache are the most common presenting symptoms. Six of the 11 cases of pneumocephalus occurred in patients with shunt placement for hydrocephalus secondary to aqueductal stenosis. In these patients, thinned cerebrospinal fluid barriers secondary to longstanding increased intracranial pressure may predispose them to pneumocephalus. Temporary extraventricular drainage is an effective method of treatment in this group of patients. Two other etiologies are identified with significance to treatment, and the role of craniotomy is discussed.

Extended middle fossa approach: quantitative analysis of petroclival exposure and surgical freedom as a function of successive temporal bone removal by using frameless stereotaxy

2004 ◽  
Vol 100 (4) ◽  
pp. 695-699 ◽  
Author(s):  
Frank P. K. Hsu ◽  
Gregory J. Anderson ◽  
Aclan Dogan ◽  
Joseph Finizio ◽  
Akio Noguchi ◽  
...  
Keyword(s):  
Temporal Bone ◽  
High Speed ◽  
Internal Auditory Canal ◽  
Frameless Stereotaxy ◽  
Middle Fossa ◽  
Content Type ◽  
Middle Fossa Approach ◽  
Bone Removal ◽  
Stereotactic System ◽  
Fine Print

Object. Conventional wisdom regarding skull base surgery says that more extensive bone removal equals greater exposure. Few researchers have quantitatively examined this assertion, however. In this study the authors used a frameless stereotactic system to measure quantitatively the area of petroclival exposure and surgical freedom for manipulation of instruments with successive steps of temporal bone removal. Methods. With the aid of high-power magnification and a high-speed drill, 12 cadaveric specimens were dissected in four predetermined, successive bone removal steps: 1) removal of the Kawase triangle; 2) removal of the Glasscock triangle; 3) removal of the cochlea together with skeletonization of the anterior internal auditory canal; and 4) inferior displacement of the zygoma. Step 1 offered 62 ± 43 mm2 of exposed petroclival area, with 84 ± 69 mm2 of surgical freedom; Step 2, 61 ± 22 and 76 ± 58 mm2; Step 3, 128 ± 47 and 109 ± 87 mm2; and Step 4, 135 ± 38 and 102 ± 69 mm2, respectively. Conclusions. The middle fossa approach provided a means surgically to expose the petroclival area. When examined quantitatively by using a frameless stereotactic device, the authors determined that the removal of the cochlea and skeletonization of the anterior internal auditory canal (Step 3) provided the most significant increase in both exposure and surgical freedom. Removal of the zygoma improved neither exposure nor surgical freedom.

Glomus jugulare tumor presenting with increased intracranial pressure

1979 ◽  
Vol 50 (6) ◽  
pp. 823-825 ◽  
Author(s):  
David W. Beck ◽  
Neal F. Kassell ◽  
Charles G. Drake
Keyword(s):  
Intracranial Pressure ◽  
Visual Loss ◽  
Intracranial Extension ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Glomus Jugulare Tumor ◽  
Glomus Jugulare ◽  
Venous Sinuses ◽  
Arterial Blood ◽  
Fine Print

✓ The authors report a case of glomus jugulare tumor presenting with papilledema and visual loss. The tumor was extremely vascular with significant shunting of arterial blood into venous sinuses. There was no intracranial extension of tumor, and papilledema resolved after removal of the lesion.

Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function

2002 ◽  
Vol 96 (3) ◽  
pp. 453-463 ◽  
Author(s):  
Ossama Al-Mefty ◽  
Samer Ayoubi ◽  
Esam Gaber
Keyword(s):  
Cranial Nerve ◽  
Nerve Function ◽  
Middle Fossa ◽  
Total Removal ◽  
Content Type ◽  
Middle Fossa Approach ◽  
Cranial Nerve Function ◽  
Nerve Paresis ◽  
Abducent Nerve ◽  
Fine Print

Object. As in patients with vestibular schwannomas, advances in surgical procedures have markedly improved outcomes in patients with trigeminal schwannomas. In this article the authors address the function of cranial nerves in a series of patients with trigeminal schwannomas that were treated with gross-total surgical removal. The authors emphasize a technique they use to remove a dumbbell-shaped tumor through the expanded Meckel cave, and discuss the advantage of the extradural zygomatic middle fossa approach for total removal of tumor and preservation or improvement of cranial nerve function. Methods. Within an 11-year period (1989–2000), 25 patients (14 female and 11 male patients with a mean age of 44.4 years) with benign trigeminal schwannomas were surgically treated by the senior author (O.A.) with the aim of total removal of the tumor. Three patients had undergone previous surgery elsewhere. Trigeminal nerve dysfunction was present in all but two patients. Abducent nerve paresis was present in 40%. The approach in each patient was selected according to the location and size of the lesion. Nineteen tumors were dumbbell shaped and extended into both middle and posterior fossae. All 25 tumors involved the cavernous sinus. The zygomatic middle fossa approach was particularly useful and was used in 14 patients. The mean follow-up period was 33.12 months. In patients who had not undergone previous surgery, the preoperative trigeminal sensory deficit improved in 44%, facial pain decreased in 73%, and trigeminal motor deficit improved in 80%. Among patients with preoperative abducent nerve paresis, recovery was attained in 63%. Three patients (12%) experienced a persistent new or worse cranial nerve function postoperatively. Fifth nerve sensory deficit persisted in one of these patients, sensory and motor dysfunction in another, and motor trigeminal weakness in the third patient. In all patients a good surgical outcome was achieved. One patient died 2 years after treatment from an unrelated cause. In three patients the tumors recurred after an average of 22.3 months. Conclusions. Preservation or improvement of cranial nerve function can be achieved through total removal of a trigeminal schwannoma, and skull base approaches are better suited to achieving this goal. The zygomatic middle fossa approach is particularly helpful and safe. It allows extradural tumor removal from the cavernous sinus, the infratemporal fossa, and the posterior fossa through the expanded Meckel cave.

Hearing preservation in acoustic neuroma surgery: importance of adhesion between the cochlear nerve and the tumor

2002 ◽  
Vol 97 (2) ◽  
pp. 337-340 ◽  
Author(s):  
Takuzou Moriyama ◽  
Takanori Fukushima ◽  
Katsuyuki Asaoka ◽  
Pierre-Hugues Roche ◽  
David M. Barrs ◽  
...  
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Significant Prognostic Factor ◽  
Speech Discrimination ◽  
Middle Fossa ◽  
Content Type ◽  
Middle Fossa Approach ◽  
Acoustic Neuromas ◽  
Fine Print

Object. To evaluate the possible prognostic factors for hearing preservation, the authors retrospectively reviewed the results of 30 consecutive acoustic neuroma operations in which hearing preservation was attempted, in a total series of 63 acoustic neuromas. Methods. Intracanalicular tumors or those that extended less than 3 mm outside the porus acusticus (10 cases) were resected via the middle fossa approach. The retrosigmoid approach was used for tumors exceeding the limits for the middle fossa approach (20 cases). Overall, hearing was preserved (pure tone average ≤ 50 dB and speech discrimination score ≥ 50%) in 21 patients (70%). There were 11 patients with severe adhesion between the cochlear nerve and tumor capsule, and 19 without. Hearing was preserved postoperatively in only two (18.2%) of 11 patients with severe adhesion, whereas all 19 without severe adhesion had hearing preservation. Conclusions. The presence or absence of severe adhesion in the interface between the cochlear nerve and the tumor might be the most significant prognostic factor for hearing preservation postsurgery.

Posterior fossa subdural hematoma of the newborn

1971 ◽  
Vol 34 (3) ◽  
pp. 423-426 ◽  
Author(s):  
L. Philip Carter ◽  
Hal W. Pittman
Keyword(s):  
Intracranial Pressure ◽  
Posterior Fossa ◽  
Newborn Infant ◽  
Subdural Hematoma ◽  
Communicating Hydrocephalus ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Surgical Evacuation ◽  
Increased Pressure ◽  
Fine Print

✓ A newborn infant with a posterior fossa subdural hematoma is described, and nine similar cases from the literature summarized. A postnatal asymptomatic period was followed by signs of increased intracranial pressure. The diagnosis was established on the basis of negative subdural taps, bloody or xanthochromic ventricular fluid under increased pressure, and demonstration of a posterior fossa mass on the ventriculogram. Surgical evacuation with careful observation for an associated intracerebellar hematoma is the treatment of choice. Five of the 10 cases developed postoperative communicating hydrocephalus.

Cerebral radiation necrosis simulating a brain tumor

1974 ◽  
Vol 40 (2) ◽  
pp. 267-271 ◽  
Author(s):  
E. Fletcher Eyster ◽  
Surl L. Nielsen ◽  
Glenn E. Sheline ◽  
Charles B. Wilson
Keyword(s):  
Brain Tumor ◽  
Intracranial Pressure ◽  
Frontal Lobe ◽  
Radiation Necrosis ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Cerebral Radiation Necrosis ◽  
Tentorial Herniation ◽  
The Brain ◽  
Fine Print

✓ Two years after undergoing irradiation for a malignant ethmoid tumor, a 50-year-old man developed signs of increased intracranial pressure, an expanding right frontal lobe mass, and tentorial herniation. Operation revealed a mass that grossly appeared to be a glioma, but microscopically proved to be radiation necrosis of the brain.

Vitreous hemorrhages and sudden increased intracranial pressure

1974 ◽  
Vol 41 (2) ◽  
pp. 167-176 ◽  
Author(s):  
R. Graham Vanderlinden ◽  
Lionel D. Chisholm
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Vitreous Body ◽  
Cerebral Aneurysms ◽  
Vitreous Hemorrhage ◽  
Slit Lamp ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Fine Print

✓ Six cases of bilateral hemorrhage into the vitreous body related to intracranial hypertension are presented. Four were associated with ruptured cerebral aneurysms, and the others followed head injury. The onset of vitreous hemorrhage was delayed in all cases, and in five patients subhyaloid hemorrhages were present from 2 to 27 days prior to their extension into the vitreous. Visual acuity was greatly reduced. The ophthalmoscopic and slit lamp appearance of the vitreous are described. The hemorrhages usually cleared spontaneously within 24 months, and vision returned to normal. Surgical treatment to remove residual vitreous blood in selected cases is outlined.

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