Compression Of Frontal Lobes Research Articles

Neuropsychological Profile of Internal Frontal Hyperostosis

AbstractBackgroundIn 1765 Giovanni Morgagni described internal frontal hyperostosis syndrome (IFH), obesity and hirsutism. Stevart (1928) and Morel (1930) added the presence of neurological and neuropsychiatric involvement, constituting the definition of Morgagni‐Stewart‐Morel Syndrome (MSM). There are cases of HFI with absence of the rest of symptoms.MethodClinical, neuropsychological and neuropsychiatric evaluation of 5 patients treated for cognitive and behavioral impairment in whom neuroimaging neuroimaging showed internal frontal hyperostosis, apparently of sufficient entity to be associated with frontal lobe compression. Independent evaluation of the rest of the clinical and and family history that could indicate the presence of the constellation of constitutive symptoms of MSM.ResultThe neuropsychological battery showed as fundamental findings: depressive mood, attentional deficit, deterioration of working and recent memory, loss of concentration. No productive psychotic symptoms. Difficulty in complex tasks or complex skills. Anhedonia. No obsessive or compulsive symptomatology, nor anxiety as a predominant symptom. Irritability and irascibility. Mnesic process of inactive profile, difficulty in the change of mnesic strategy or language, or inhibition of irrelevant stimuli, problems with calculation, reasoning, sequencing or mental organization. Reduced verbal and non‐verbal fluency and disordered self‐regulation. Attention was drawn to the discordance between the significant functional impairment of the patients and the relatively preserved performance on neurocognitive battery.ConclusionThe presence of psychiatric and neurocognitive symptomatology associated with HFI has a characteristic profile, a varied constellation of deficits attributable to frontal lobe dysfunction, but should be actively investigated, because of its difficult until it significantly affects the patient’s performance.

814 Bifrontal Craniectomy and Reconstruction with Synthes - a Surgical Approach for the Management of Symptomatic Hyperostosis Frontalis Interna

Abstract 57-year-old Caucasian female presented with depression, apathy, and personality changes with a markedly “flaccid face”. A computerized tomography (CT scan) revealed remarkable bilateral hyperostosis frontalis interna with significant frontal lobe compression. A definitive operative procedure with bilateral craniotomies was undertaken to relieve frontal compression and prevent further complications. During surgery, the bone flaps were found to be very hard to cut through with a craniotome or even a drill. The procedure was further complicated by dense adherence to the underlying dura. Craniotomy was eventually completed with multiple drilling efforts. Trimming down bone flaps proved to be difficult, thus they were not replaced back and were elected to be removed. Dura was covered with DuraGen and the galea was closed without the skull plates. Postsurgical imaging was done and synthetic bone plates made by “Synthes” were placed in a second-stage procedure. The patient recovered without significant focal deficits and remained stable at six months with an improved mental state. Pathology showed benign hyperostosis. This case highlights the difficulties of the surgical management of this rare case and discusses the improvised techniques adopted for the successful completion of the procedure with excellent outcomes.

Outcome of extradural devascularization in resection of giant olfactory groove meningioma in bilateral subfrontal approach

BackgroundOlfactory groove meningioma (OGM) is characterized by slow-growing tumors that are frequently bilateral as opposed to unilateral & asymmetrical and may cause progressive frontal lobe compression. We aimed to evaluate the value of extradural devascularization as a golden step in bilateral subfrontal approach in management of OGM.ResultsThe mean operative time was 158.32 ± 24.88. Blood loss ranged from 500 to 1000 cc with a mean value of 763.64 ± 155.98. The number of patients requiring blood transfusion was 5 (22.7%). Based on Simpson classification, 19 (86.4%) patients had whole tumor excision (grade I, II) & 3 (13.6%) patients had grade III and IV. The incidence of complications among the studied patients is: CSF leak did not occur to any case, pneumocephalus occurred in 1 (4.5%) patient, anosmia occurred in 1 (4.5%) patient, focal CNS deficit occurred in 1 (4.5%) patient, wound infection occurred in 1 (4.5%) patient and hematoma occurred in 1 (4.5%) patient. Only 1 (4.5%) case died due to pulmonary embolism, whereas behavioral manifestations occurred in 9.09% of patients.ConclusionsThe extradural devascularization is a golden step in this approach in management of OGM associated with lower incidence of blood loss intraoperatively (total blood loss was 500–1000 mL, recurrence rate, mortality and additional neurological deficits postoperatively.

The connection between frontal lobe brain tumors and lower urinary tract symptoms - Series of 347 patients.

The present study aimed to provide an early insight into the effect of intra-axial frontal lobe tumors on the micturition center and its potential role in producing compression in and around the prefrontal cortex. A total of 149 symptomatic patients were selected for urodynamic testing. The study sample included all patients with intra-axial frontal lobe tumors treated at two locations: the University Medical Center Tuebingen (Germany), and Azad University of Medical Sciences (Iran) between 2017 and 2020. Lower urinary tract symptoms (LUTS) were recorded in patients with frontal lobe compression due to local tumor growth. The symptomatic patients had brain magnetic resonance (MRI) images taken to examine for possible lesions. The treated patients (149 patients with a median age of 55 years) were evaluated using computer urodynamic investigation and voiding diaries. The results of urodynamic testing of 149 symptomatic patients showed detrusor over-activity in 82 (55%) patients, dyssynergia of detrusor-sphincter in 67 (45%) patients, uninhibited sphincter relaxation in 40 (27%) patients, and low-compliance bladder in 21 (14%) patients. There was no significant correlation found between tumor size and urinary symptoms (p = 0.103, Spearman q = 0.826). Frontal intra-axial tumors compressing and infiltrating the prefrontal cortex influence the micturition center and produce lower urinary tract symptoms. The tumors of the right frontal lobe were directly associated with incontinence, which was completely disappeared in 70% of the patients within 2 years.

Is there still a role for cranialization in modern sinus surgery?

To give an overview of recently published literature on the indications and use of cranialization of the frontal sinuses. Recent studies on cranialization have evaluated its role in frontal sinus fractures, inflammatory disease, and tumors involving both the frontal sinus and anterior cranial fossa. Currently, a more conservative approach is favored with traumatic injury to the frontal sinus outflow tract, with multiple studies demonstrating outflow recanalization with observation alone. Similarly, advancements in endoscopic sinus surgical approaches allow the many posterior table fractures to be managed without cranialization. Severe inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression have successfully been managed without cranialization in multiple studies suggesting an endoscopic surgical approach can be favored in these settings. Both benign and malignant tumors of the frontal sinus are managed without cranialization with select cases favoring an open approach with cranialization depending on tumor location. Malignant tumors of the frontal sinus are more likely to require cranialization as oncologic resection including margins can lead to large dural defects with significant tissue loss, which is unfavorable for more conservative reconstructive options. Cranialization remains a necessary and indicated procedure in the appropriate clinical circumstances. A more conservative approach to frontal sinus fractures is warranted, with recent literature supporting similar outcomes and less morbidity. Inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression can be managed without cranialization. Although most benign tumors can be resected via endoscopic approaches, cranialization remains a mainstay as part of the reconstructive plan after oncologic resection of malignant tumors involving the frontal sinus.

What urinary incontinence can hide? — Craniopharyngioma in an elderly female patient

Background: A benign tumor invading the surrounding structures just like a malignant one — the craniopharyngioma, situated near the sellar area, a rare clinical entity, usually accompanied by both neurological and endocrine dysfunctions, challenges the young clinician faced with vague, unspecific systemic symptoms. Clinical case: A 76 year old woman previously diagnosed with coronary heart disease, type 2 diabetes mellitus and hyperthyroidism presents at the emergency department with a 6 month history of physical asthenia, difficulty maintaining balance and recurrent urinary incontinence with polachiuria. She describes the symptoms as mild at debut but with a progressive evolution which urged her to seek medical advice. On physical examination the patient appears conscientious yet somnolent, with difficulties in maintaining walking balance. She is afebrile, with a regular heart rate of 75 bpm and a blood pressure of 120/60 mm Hg. The general physical examination reveals no abnormalities in the head, neck, chest, abdomen, or extremities. A thorough neurologic examination is performed, which reveals abolished tendon reflexes. Other neurologic examinations, including sensory and motor examinations and cerebellar tests are all within normal range. Her blood test results reveal an elevated ESR (30 mm/h), hyperglycemia (173 mg/dL), increased serum triglycerides (240 mg/dL), mildly increased blood urea nitrogen (51.70 mg/dL), low serum TSH (0.007 μUl/mL) with low fT3 and T4 values. Urine exam and cultures were negative for infection. Heart and carotid artery ultrasound exams found no significant abnormalities (LVEF 55%, impaired diastolic relaxation patterns and carotid atheromatosis, without significant stenosis). The obstetric examination excluded a perineal rupture as possible cause of the patient's urinary incontinence. Finally, the CT exam reveals a sellar and subsellar tumor with multiple calcifications, near the third ventricle. The mass causes hydrocephalus with periventricular edema. The native brain MRI exam describes the tumor with a craniocaudal diameter of 4 cm and axial 2.4/1.6 cm, with mixed solid and cystic structure and an aspect of a craniopharyngioma, with frontal lobe compression, coming in close contact to the optic chiasm. Thus, the common base between neurological symptoms and endocrine dysfunctions was revealed in the clinical entity described as a brain tumor associated with pituitary deficiency. Conclusion: We are presenting a rare and unspecific symptomatology for a craniopharyngioma, the patient showing none of the common signs of nausea, vomiting and headaches. The patient had previously been misdiagnosed and treated for hyperthyroidism while actually suffering from pituitary deficiency. After diagnosing the neoplasm, she was referred for further treatment by surgical resection and radiotherapy.

細菌性髄膜炎の経過中に“Mount Fuji sign”画像所見を呈した緊張性気脳症の1例

A 39-year-old man was suffered from bacterial meningitis spread from sphenoid sinusitis. During the first several days of the hospitalization, his clinical and laboratory findings were improved by the antibiotics. But he developed impaired consciousness and paraparesis on the sixth hospital day. A CT scan of the brain revealed pneumocephalus with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes, which was known as "Mount Fuji sign". Tension pneumocephalus was diagnosed on the basis of the clinical symptoms and the characteristic CT findings. As the bacterial meningitis itself was improving, the surgical treatment was not performed, but the antibiotics therapy continued. He gradually recovered and discharged without any other complications. The mechanism of tension pneumocephalus could not be disclosed. However, it was speculated that tension pneumocephalus was formed due to combined conditions of following factors; the fistula formation between sphenoid sinus and subdural space, the reduced CSF pressure on lumbar puncture, and a ball-valve mechanism though the fistula. We would emphasize that "Mount Fuji sign"on CT or MRI was the important finding to diagnose tension pneumocephalus.

Śluzowiak zatok sitowych penetrujący do oczodołu i przedniego dołu czaszki – opis przypadku

Paranasal sinus mucocele is the cystic formation lined by inflammatory changed mucoperiosteum. This is slow-growing pathology with a tendency to bone erosion. The symptoms are dependent on the direction of the penetration, and are as follows: increasing headaches, deformations of frontal or orbital region, ophthalmic manifestations such as lacrimation, decreased visual acuity, exophthalmos, ocular movement limitation, diplopia. The most common location of the mucocele is fronto-ethmoid region. The most useful diagnostic tests are a magnetic resonance imaging (MRI) and a computed tomography (CT) which show the progress of the disease and bone destructions. Surgery is the only method of treatment (external approach or FESS). This paper reports the case of a 74-year-old woman with ethmoid mucocele penetrating into the orbit, frontal sinus and anterior cranial fossa with compression of frontal lobe of the brain. The patient underwent CT and MRI and was treated with endoscopic intranasal marsupialization of the cyst. There are no clinical signs of disease recurrence 7 months after surgery. The endoscopic surgical management in treatment of sinus mucocele is a good alternative to the operation from external approach because of its low invasiveness, low complication risk, rapid healing and good therapeutic effects.

Giant frontal mucocele invading the anterior cranial fossa and orbit

Mucocele is a rare intracranial pathology. In majority mucoceles arise within the frontal and ethmoid sinuses. Intracranial and intraorbital extensions are uncommon. A 48 year old male with a history of head trauma with multiple craniofacial fructures for 30 years. After 30 years came to first generalized epileptic seizure, also the leftside exophthalmos was observed. The radiological investigations, computed tomography ( CT ) and magnetic resonanse ( MRI ), showed large extracerebral pathological mass invading the left frontal and ethmoid sinuses, left orbit and anterior cranial fossa with left frontal lobe compression. The left side fronto basal craniotomy was performed. The histopathological diagnosis was mucocele. Postoperative neurological examination revealed no deficit. The patient was seizures free and in good condition discharged from the department.Mucocele is a rare, benign pathology arising intracranial from the sinuses. The results are good, the frequency of complication is low.

Endoscopic Management of Sinus Disease with Frontal Lobe Displacement

Advanced inflammatory disease of the paranasal sinuses may result in erosion of the skull base with frontal lobe impingement. We present a series illustrating minimally invasive management of this process. We review 15 consecutive cases of advanced sinus inflammatory disease with frontal lobe displacement. Clinical presentation, diagnostic evaluation, and treatment modalities are described. Patients ranged in age from 19 to 83 years, and 13/15 were men. Presenting symptoms in all patients included progressive headache (15/15), frontal pressure (15/15), orbital involvement and visual symptoms (6/15), and new-onset seizure (1/15). Implicated diagnoses included mucocele (7/15), classic allergic fungal sinusitis (3/15), and both (5/15). Initially, 14 patients were treated endoscopically, with image-guided navigation in 12 patients. Four patients underwent trephination for combined above/below marsupialization, and three patients also underwent orbital decompression. Two patients failed initial endoscopic management. One of these was salvaged endoscopically and the other required cranialization. Another patient was managed via cranialization in the primary setting. In all cases, mucosa was observed directly against dura. No cerebrospinal fluid leaks were encountered. One patient expired 1 month postoperatively secondary to congestive heart failure. Mean follow-up in the remaining 14 patients was 13.6 months. Follow-up imaging revealed reexpansion of the frontal lobe into the decompressed space. Advanced sinus inflammatory disease associated with frontal lobe compression may have indolent presentation but significant morbidity. Minimally invasive techniques averted the need for craniotomy in 13/15 patients in this series.

Polyostotic fibrous dysplasia with craniofacial localization presenting with frontal lobe compression in a 14-year-old girl.

We describe a rare case of polyostotic fibrous dysplasia with craniofacial localization associated with involvement of the spine and extremities. A 14-year-old girl presented with progressive headache, left frontal swelling, exophthalmos of the left eye, deformity and palpable mass in the left frontal area. Cranial computerized tomography revealed extensive involvement of all cranial bones except right frontal and right parietal bones. Most of the facial bones were invaded. Especially, there was the involvement of ethmoidal air sinuses and frontal sinus also. Computerized tomography showed left frontal lobe compression. In addition, the spine and bones of the extremities were involved in the patient. Craniofacial approach was planned. Cranial surgery was performed by an extradural frontal approach. Firstly, the frontal cyst was excised. For left frontal lobe decompression, we removed successfully all the abnormal bones causing mass effect and frontal deformity. Secondly, facial surgery was performed with external approach. An attempt to remove all of the involved bone is necessary, as the lesion may recur and grow if a portion of dysplastic bone is left in place. However, the present case suggests that removal of all the involved bones in the polyostotic fibrous dysplasia may be possible in spite of extensive involvement. In this situation, it may be removal of only abnormal bones responsible for compression of affected neural elements is indicated.

Craniofacial Resection for Intracranial Inverting Papilloma and Frontal Sinus Mucocele

Inverting papilloma is a locally aggressive neoplasm; however, intracranial extension is very rare. The authors herein report a case of massive inverting papilloma with intracranial extension and an associated frontal sinus mucocele, causing marked frontal lobe compression. Treatment consisted of combined anterior craniofacial resection. Magnetic resonance imaging provided accurate preoperative differentiation between neoplasm and inflammation. Skull base reconstruction may prove more difficult when there is significant frontal dead space resulting from chronic brain displacement by an associated mucocele. The management of this unusual neoplasm and a review of the literature is presented.