Caudal Cranial Nerves Research Articles

Surgical management of anteriorly placed lesions at the craniocervical junction ? an alternative approach

Lesions ventral to the neuraxis at the craniocervical junction can pose a significant management problem because of their strategic location. Conventional posterolateral approaches sometimes may not permit adequate visualization of the entire base of the tumor without significant manipulation of the brain stem and spinal cord. The anterior transoral and extrapharyngeal approaches are alternate ways of exposing this region without neural retraction. However, these approaches do not provide adequate exposure of the lateral margins of the tumour, there is no control of the vertebral arteries and cranial nerves and the tumor--brain stem interface is not seen till the end of the operation. A lateral approach is described in this report which involves additional bone removal in the region of the mastoid process and the articular pillars in order to provide a true lateral perspective for the removal of these tumors. The advantages include excellent definition of the interface between the tumor and cord/brain stem without manipulation of the neuraxis, control of the ipsilateral vertrebral artery and caudal cranial nerves, ability to remove the intra- and extradural portions of the tumor in one operation and the ability to perform an immediate bony fusion if necessary. The application of this approach in the management of 9 patients with a variety of intra- and extradural lesions at the clivus and foramen magnum is discussed.

Transtemporal Approach to the Skull Base: An Anatomical Study

The surgical anatomy of a transtemporal approach to the structures of the clivus was defined with the aid of dissections in 10 cadaver heads. The steps in the dissection consisted of first exposing the cervical internal carotid artery (ICA), the internal jugular vein, and the caudal cranial nerves, each at the skull base; then performing small retromastoid and temporal craniotomies; and, finally, drilling away the petrous and tympanic bone to expose the intratemporal parts of the facial nerve, the petrous ICA, the sigmoid sinus, and the jugular bulb. To expose the structures of the lower clivus, the sigmoid sinus was ligated and divided, the facial nerve was displaced anterosuperiorly, and the inner ear structures were preserved. Dural opening exposed the anterolateral and anterior surfaces of the medulla, the pontomedullary junction, and the spinomedullary junction. The ipsilateral vertebral artery and often the contralateral vertebral artery and the vertebrobasilar junction, the caudal cranial nerves, and the origin of the 6th, 7th, and 8th cranial nerves were well exposed. To expose the structures of the middle clivus, we drilled away the labyrinth, the cochlea, and a portion of the clival bone. The facial nerve was displaced posteroinferiorly. Dural opening exposed the ipsilateral anterior surface of the pons, the midbasilar artery, and the ipsilateral 5th, 6th, 7th, and 8th cranial nerves. A portion of the contralateral anterior surface of the pons was also exposed at times. The superior limit of this exposure was just above the origin of the trigeminal nerve. The exposure of the upper clival structures was limited with this approach, and required medial temporal lobe retraction. Two case reports are included to illustrate the application of the transtemporal approach to the exposure and clipping of aneurysms of the vertebrobasilar system. The advantages and disadvantages of this approach are discussed.

Zur operativen Therapie der Schlucklähmung*

Disorder of deglutition is one of the severest signs in postoperative or posttraumatic paresis of the caudal cranial nerves. The main problem in these cases is aspiration. It is a serious disorder with potentially life-threatening pulmonary sequelae. In cases with unilateral paresis of the vagus and glossopharyngeal nerve we can consider the problem of surgical rehabilitation of swallowing as to be solved very well, as described in the present paper. However, in cases with bilateral vagus paresis we are faced with many more problems especially in the high-grade aspiration syndrome. The surgical procedures are described.

Polyradikulomeningoenzephalitis durch Epstein-Barr-Virusinfektion - Darstellung eines Falles mit tödlichem Ausgang

A 21 years old high school student, who, since early childhood, suffered from complete spinal paraplegia of unknown cause at D 10, suddenly, after a three week period with influenca -like prodromal symptoms, presented with acute polyradiculomeningoencephalitis . Positive reactions following Paul-Bunnell- Davidsohn -test and tests for specific antivirus IgG as well as specific IgM revealed acute Epstein-Barr-Virus infection, although no glandular signs could be found. The clinical findings consisted of peripheral sensory-motor tetraparesis, ataxia, nystagmus and disturbances of the caudal cranial nerves. Initially, the diagnosis of Fisher's syndrome was made. The orbicularis oculi reflex, however, indicated a circumscribed brainstem lesion in the medial reticular formation. This finding lead to the additional clinical diagnosis of encephalitis. Shortly after admission, a heart-arrest occurred, and, after successful reanimation, the patient presented with a "locked-in syndrome". On the 12th day after admission, he succumbed during a sudden drop of blood-pressure. Necropsy revealed septic shock as the cause of death, due to perforation of a duodenal ulcer. In the lower thoracic spinal cord a neurocytoma was found, which once lead to the paraplegia. Additionally, moderate inflammatory infiltrations were found in the basal leptomeninges, in the walls of several subcortical vessels and in the hypoglossal nerve. The infiltrations, at some sites, contained a large number of atypical lymphoid cells in the inflammatory meningeal exsudate . Microglial proliferation with satellitosis was found in the inferior olives, thus confirming the clinical diagnosis of polyradiculomeningoencephalitis . This case report should emphasize special features of EBV-infection with neurological complications: (1) in inflammatory diseases of the peripheral and central nervous system, infectious mononucleosis should always be drawn into the diagnostic considerations, even if heterophil antibodies and glandular symptoms are lacking. (2) In Guillain-Barré-syndrome, a transient external heart stimulator should be administered, in order to prevent heart arrest from acute autonomic neuropathy.

Lesions of the caudal cranial nerves a case of hypoglossal diplegia

A case of hypoglossal diplegia after closed head injury is reported, with discussion of etiology, symptomatology, prognosis and therapy of caudal cranial nerve lesions.