Base Of Anterior Cranial Fossa Research Articles

The use of platelet gel for repair of a cerebrospinal fluid fistula of the skull base (a case report and literature review)

Nasal liquorrhea is a serious problem in surgery of skull base tumors, which is associated with a high risk of purulent-septic complications. This paper presents a case of successful repair of a cerebrospinal fluid fistula with an autologous platelet gel in the postoperative period after removal of meningioma of the anterior cranial fossa base, which was accompanied by a purulent-inflammatory complication in the surgical wound area.

Transpalpebral craniotomy in skull base surgery

We present the preliminary results of using transpalpebral craniotomy in surgery of supratentorial aneurysms and anterior cranial fossa tumors. In the period between 2015 and 2107, we used this approach in surgical treatment of 30 aneurysms (10 aneurysms in the 'cold' period of hemorrhage and 20 unruptured aneurysms) and 10 anterior cranial fossa base tumors. The approach included a superior eyelid incision and a fronto-orbital craniotomy. We retrospectively evaluated outcomes, postoperative complications, and cosmetic results after these operations. The mean follow-up period was 6 months. There were no deaths, disabilities, or serious permanent approach-associated complications. All patients had expected periorbital edema that was not considered as a complication. Transpalpebral craniotomy is a safe and effective approach to anterior cranial fossa neoplasms and anterior circle of Willis aneurysms. This approach avoids injury to the frontal and temporal muscles as well as to the facial and trigeminal nerve branches. Patients assessed the postoperative cosmetic result as excellent.

Clinical, radiological, surgical, and pathological determinants of olfactory groove schwannoma

Olfactory groove schwannomas (OGS) are rare anterior cranial fossa base tumors with only 41 cases reported in literature. Olfactory ensheathing cell schwannoma (OECS) has similar clinico-radiological features as OGS, but a different cell of origin. In recent years, there is growing interest in OECS as more cases are being reported. The objective was to study the clinico-radiological features of OGS and define the histological differentiation from OECS. We retrospectively analyzed clinical, radiological, surgical and histopathological picture of all cases of OGS managed in our institute. Immuno histochemical studies were performed in these tumors for differentiating from OECS. A comprehensive review of articles published until date describing the operative treatment was done. All three cases had presented with seizures, two had anosmia and papilledema. Gross-total resection was achieved in all our patients. One patient expired in the postoperative period due to septicemia. Positive expression to newer immuno histochemical biomarker CD57 (Leu7), with negative staining to smooth muscle α-actin (SMA) was helpful in confirming the diagnosis of OGS and differentiating it from OECS in all our cases. OECS, though rare has to be differentiated from OGS using immuno histochemistry. Gross-total resection of OGS with preservation of olfactory function is often possible and curative. Although these tumors are commonly treated with microsurgical skull base approaches, an endoscopic endonasal approach can be considered in some cases, with repair using mucoperiosteal pedicled flap to prevent cerebrospinal fluid leak.

The trans-eyebrow supraorbital approach for removal of anterior cranial fossa and suprasellar meningiomas

The study included 7 patients who underwent surgery for meningioma using the trans-eyebrow supraorbital approach at the Burdenko Neurosurgical Institute in the period between 2013 and 2017. The age of patients ranged from 51 to 75 years (median, 60 years); there were 5 females and 2 males. The maximum diameter of resected tumors ranged from 20 to 60 mm (median 40 mm). Total resection of the tumor was achieved in all 7 cases, which was confirmed by postoperative MRI control. All 7 patients had a good cosmetic result. In 1 case, there was postoperative cerebrospinal fluid rhinorrhea due to incomplete closure of the frontal sinus, which required the patient to be re-operated. None of 7 cases was associated with injury to the main vessels or cavernous sinus. Supraorbital trans-eyebrow craniotomy provides a minimally invasive approach for removing most anterior cranial fossa base and suprasellar tumors. The advantages of keyhole surgery, in comparison with traditional craniotomies, are minimal complications associated with the approach.

Different methods for the reconstruction of the skull base of open craniocerebral injury combined with comminuted factures of the base of anterior cranial fossa

Objective To investigate the efficacy of different methods for reconstruction of the skull base of open craniocerebral injury combined with the base of anterior cranial fossa fracture. Methods The data of 46 patients with skull base reconstruction admitted from October 2009 to October 2014 were studied retrospectively. They were divided into either an observation group(n=21)or a control group(n=25)according to the ways of skull base reconstruction. The observation group was repaired withsandwichtherapy; while the control group only used artificial dura or direct suture of tendon membrane for reconstruction. The complications such as postoperative cerebrospinal fluid leakage, intracranial infection, meningoencephalocele, and reject reaction of both groups were observed. Results The patients were followed up for 3 to 36 months(mean 15.8). Of the 21 patients in the observation group, only 1 occurred cerebrospinal fluid leakage. They were cured after treatment. No complications, such as intracranial infection and meningoencephalocele were observed. The incidence of complications was 4.8%(1/21). Of the 25 patient in the control group, 8 occurred cerebrospinal fluid leakage, including 5 cases complicated with intracranial infection. They were cured after treatment. Two patients had meningoencephalocele. The incidence of complications was 40.0%(10/25). There was significant difference in the incidence of complications between the 2 groups(P<0.05). Conclusion In the emergency operation for open craniocerebral injury combined with the factures of base of anterior cranial fossa, performingsandwichtherapy for skull base reconstruction may effectively control the complications, such as intracranial infection and cerebrospinal fluid leakage, and improve the prognosis of patients. Key words: Skull base; Bone remodeling; Skull fractures; Cranial fossa, anterior; Central nervous system bacterial infections; Cerebrospinal fluid leakage

Observation of successful treatment of penetrating traumatic brain injury followed by nasal liquorrhea for 61 years

An observation of penetrating traumatic brain injury, made by awl in childhood, followed by remittent nasal liquorrhea and purulent meningoencephalitis for 61 years, is given.For diagnosis clarifying biochemical study of nasal secretion, rhinologic study, MRI and CT-cisternography of the brain were performed. Liquor fistula was closed in two stages, ethmoid bone meningocele, causing obturation of left half of the nose, was removed.On the first stage, using transnasal approach, ethmoid bone meningocele was removed, on the next stage liquor fistula was discharged, using transcranial intradural approach. Anterior cranial fossa base defect was closed with temporal muscle fragment and fixed with fibrin-thrombin glue.

Extensive Sphenoethmoid Mucocele-An Endoscopic Management

Sphenoethmoidal mucoceles are rare tumors. They gradually expand in size and rarely produce bony destruction of sinus walls, leading to orbital, ocular, and intracranial involvement. We present a rare case of sphenoethmoidal mucocele with bone destruction and intracranial extension, who presented with nasal blockade and loss of visual acuity. Computed tomographic scan revealed a soft tissue mass, eroding the base of anterior cranial fossa, extending intracranially into the parasellar temporal fossa. The patient was treated successfully by endoscopic excision. Although a transfacial approach is generally preferred in cases of extensive mucoceles with intracranial extensions, a thorough anatomy of the nasal skull base and proficient use of the endoscope can be a good alternative to such lesions.

Rzadki przypadek płynotoku nosowego

Cerebrospinal fluid rhinorrhea is a result of a damage to bones and dura mater of the anterior cranial fossa base. In more than 90% it is of trauamatic etiology. The aim of the study was to present a case of a 23 year old female patient with post-traumatic rhinorrhea. Cerebrospinal fluid rhinorrhea occured as a result of unintentional damage of cribriform plate of the ethmoid bone on the right side when the patient was opening a box of cosmetic with the use of a screwdriver. Two days after the accident she was admitted to our Department with apparent cerebrospinal fluid rhinorrhea and forehead headache. Radiological and laboratory testing were performed, than she was consulted by a neurologist and a neurosurgeon. It was decided to introduce conservative management in the ENT department. During 24 days of hospitalization with medical management including avoidance of activities that increased the intracranial pressure, head elevation and antibiotics the cerebrospinal fluid rhinorrhea decreased and ceased. This was confirmed by physical examination, nasal endoscopy, radiological studies and neurosurgical consultation. After more than 3 months of follow-up, there was no evidence of rhinorrhea.

Nasal NK/T-cell Lymphoma: Computed Tomography and Magnetic Resonance Imaging Findings

Primary nasal natural killer (NK)/T-cell lymphoma is the most common cellular subtype seen in nasal lymphomas. It is rare in the Western population but occurs more frequently in Asia, South America, and Mexico. The purpose of this study was to describe the computed tomography (CT) and magnetic resonance (MR) imaging findings of primary nasal NK/T-cell lymphoma. During the period between January 1990 and June 2006, the CT (n=24) and MR (n=6) images of 24 patients with biopsy-proved nasal NK/T-cell lymphoma were reviewed retrospectively. Both CT and MR images were evaluated for site and extent of disease and for pattern of involvement of adjacent areas. The most common symptoms at presentation were nasal obstruction, nasal discharge, and epistaxis. There was involvement of the unilateral nasal cavity in 16, bilateral nasal cavity including nasal septum in 5 and nasal choana in 3. Sites of extension outside the nasal cavity included tumor extension into paranasal sinuses (n=15), nasopharynx (n=5), nasal labial fold (n=3), oropharynx (n=2), infratemporal fossa (n=2), other subcutaneous soft tissue of the face (n=2) and anterior cranial fossa base (n=1). Bony destruction was demonstrated in 18 cases, involving the sinus bony wall (n=15), nasal turbinate (n=10), lamina papyracea (n=6), orbital floor (n=3), and hard palate (n=2). Regional lymphadenopathy was also detected in 3 patients with nasal NK/T-cell lymphoma. The CT and MR appearances of nasal NK/T-cell lymphoma are nonspecific, and the diagnosis requires histologic confirmation. However, the differential diagnosis of nasal NK/T-cell lymphoma should be included if the images present soft tissue of the nasal cavity with bony erosion or destruction; involvement of the orbital cavity, nasopharynx and infratemporal fossa; and subcutaneous or nasolabial fold soft tissue infiltration, especially in Asian populations.