Left Middle Cranial Fossa Research Articles

Ocular Manifestations of Oblique Facial Clefts

In the Tessier classification, craniofacial clefts are numbered from 0 to 14 and extend along constant axes through the eyebrows, eyelids, maxilla, nostrils, and the lips. We studied a patient with bilateral cleft 10 associated with ocular abnormalities. Clinical report with orbital and cranial computed tomography. After pregnancy complicated by oligohydramnios, digoxin, and lisinopril exposure, a boy was born with facial and ocular dysmorphism. Examination at age 26 months showed bilateral epibulbar dermoids, covering half the corneal surface, and unilateral morning glory anomaly of the optic nerve. Ductions of the right eye were normal, but the left eye had severely impaired ductions in all directions, left hypotropia, and esotropia. Under anesthesia, the left eye could not be rotated freely in any direction. Bilateral Tessier cleft number 10 was implicated by the presence of colobomata of the middle third of the upper eyelids and eyebrows. As the cleft continued into the hairline, there was marked anterior scalp alopecia. Computed x-ray tomography showed a left middle cranial fossa arachnoid cyst and calcification of the reflected tendon of the superior oblique muscle, trochlea, and underlying sclera, with downward and lateral globe displacement. Tessier 10 clefts are very rare and usually associated with encephalocele. Bilateral 10 clefts have not been reported previously. In this case, there was coexisting unilateral morning glory anomaly and arachnoid cyst of the left middle cranial fossa but no encephalocele. Bilateral Tessier facial cleft 10 may be associated with alopecia, morning glory anomaly, epibulbar dermoids, arachnoid cyst, and restrictive strabismus.

Malignant Transformation of Calcifying Epithelial Odontogenic Tumor Is Associated With the Loss of p53 Transcriptional Activity: A Case Report With Review of the Literature

Malignant Transformation of Calcifying Epithelial Odontogenic Tumor Is Associated With the Loss of p53 Transcriptional Activity: A Case Report With Review of the Literature

Middle Cranial Fossa Arachnoid Cyst Presenting With Subdural Effusion and Endoscopic Detection of Tear of the Cyst -Case Report-

A 15-year-old boy presented with a case of middle cranial fossa arachnoid cyst associated with subdural effusion and manifesting as headache and vomiting after minor head injury. Computed tomography disclosed a cystic lesion in the left middle cranial fossa and ipsilateral subdural effusion. Fundoscopic examination revealed papilledema. A small tear of the cyst wall was confirmed endoscopically. Fenestration of the cyst was performed under the operating microscope. Postoperative course was uneventful. The tear in the outer wall of an arachnoid cyst may suggest the mechanism of occurrence of subdural effusion associated with middle cranial fossa arachnoid cyst.

A 6‐YEAR‐OLD GIRL WITH AN EXTRA‐AXIAL MASS IN THE MIDDLE CRANIAL FOSSA

A 6-year-old Japanese girl presented with psychomotor seizures. Magnetic resonance (MR) images disclosed a mass lesion in the left middle cranial fossa with an internal irregular-shaped area, which was hyperintense on T1-weighted images and hypointense on T2-weighted images. Gross total resection of the tumor was performed through left occipital craniotomy. The tumor was white-to-grayish hard tissue, focally showing blackish pigmentation. Histological, immunohistochemical and electron-microscopical analyses revealed that white-to-grayish hard tissue corresponded to an atypical meningioma, and the blackish pigmentation of the tumor was composed of non-neoplastic, reactive hyperplasia and colonization of meningeal melanocytes in the meningioma tissue. A meningioma with reactive hyperplasia and colonization of meningeal melanocytes is unusual, but it is clinically important to differentiate this entity from other melanocytic tumors.

Endoscopic Trans-sphenoidal Transclival Approach to Cholesterol Granuloma of the Petrous Apex

Cholesterol granulomas of the petrous apex present a challenge to the surgeon owing to their complicated anatomic position in close proximity to critical neural and vascular structures. Many approaches have been described, with recent descriptions using advances in endoscopes and image-guidance systems to refine the trans-sphenoidal approach first performed by Montgomery in 1977. The trans-sphenoidal approach has been described for lesions located in the medial portion of the petrous apex adjacent to the sphenoid sinus. We present a 16-year-old boy who presented with recurrence of a left-sided petrous apex cholesterol granuloma treated initially 2 years prior with a lateral skull base approach. Computed tomography and magnetic resonance imaging revealed a cholesterol granuloma involving the left middle cranial fossa and the left petrous apex, entirely posterior to the sphenoid and abutting the posterolateral surface of the clivus. We accomplished complete drainage with an endoscopic endonasal trans-sphenoidal transclival approach without the need for mobilization of the petrous carotid. The number of surgeries available to approach the petrous apex testifies to its enigmatic location. Endoscopic approaches continue to evolve, along with the skills and instruments powering them. The choice of appropriate surgery should depend on the surgeon's experience, anatomy of the lesion, and morbidity to the patient.

Middle cranial fossa arachnoid cysts complicated with subdural collections

Intracranial arachnoid cysts are congenital collections of fluid that develop within the arachnoid membrane be cause of splitting or duplication of this structure. It corresponds to 1% of all non-traumatic intracranial mass lesions 1 . Arachnoid cysts most frequently occur in the middle cranial fossa, followed by the posterior fossa, convexity, and suprasellar region. Middle cranial fossa cysts are more often associated with subdural hematoma, subdural hygroma, and intracystic hemorrhage. Usually, the patients present with signs and symptoms of intracranial hypertension, mainly headache and vomiting 2 . We report two cases of arachnoid cysts associated with concurrent subdural collections, describing their clinical presentation, radiographic findings and neurosur gical management. CaSeS Case 1 A 15-year-old male patient presented with a 3-day history of headache and vomiting. He reported an episode of mild head trauma without loss of consciousness four days before the admission. There was no history of drugs, alcohol abuse or previous neurological illness. The Glasgow coma score was 14 (confused conversation). Pupil reactions were normal and there was no other abnormality in the neurologic examination. Computed tomography (CT) revealed an arachnoid cyst in the left middle cranial fossa (Fig 1A) and a low-density crescentic collection across the entire left hemispheric convexity, corresponding to a chronic subdural hematoma, with signs of acute hemorrhage (Fig 1B). The patient underwent surgical treatment with evacuation of the subdural hematoma and endoscopic fenestration of the cyst to obtain communication with the chiasmatic cistern. The recovery was uneventful and an eight months follow-up CT showed a residual non-hypertensive cyst. There was no evidence of any subdural collection.

Congenital Glioependymal Cyst Presenting with Severe Proptosis

We discuss a unique case of a congenital glioependymal cyst arising from the left middle cranial fossa with extension into the left orbit causing severe proptosis, a presentation that has not been reported previously. A female neonate at 38 weeks’ gestational age was diagnosed with severe left

Two consecutive dural arteriovenous fistulae in a child: a case report of successful treatment with gamma knife radiosurgery

The occurrence of dural arteriovenous fistulae in children is quite rare. Endovascular embolization is typically the first line treatment. In general, Gamma Knife radiosurgery is used as adjuvant treatment and seldom performed as the first line treatment in children. We report a case of a 27-month-old girl who presented with an initial dural arteriovenous fistula (AVF) located at anterior base of the left middle cranial fossa. She subsequently developed another dural AVF over the left transverse-sigmoid sinus region 2 years later. Both fistulae were successfully obliterated with Gamma Knife radiosurgery.

Single-stage operation for a giant haemangiopericytoma following intracranial feeder embolization

Meningeal haemangiopericytomas (HPC) are malignant intracranial neoplasms that commonly recur and metastasize. Large size at diagnosis, abundant intracranial feeders and the risk of intraoperative bleeding can make them difficult to completely remove in one operation. We report here a rare case of a gaint HPC which was treated successfully using a one-stage operation following superselective intracranial feeder occlusion. A 30-year-old man presented with a left middle cranial fossa tumour extending to the left temporal lobe and cerebellar tentorium. Angiography revealed supply from a dilated left posterior temporal artery branching from the posterior cerebral artery. The tumour was totally removed in a single-stage excision after embolization of the intracranial major feeding artery. The present case suggests the usefulness of preoperative embolization for HPC, particularly of intracranial feeders, to achieve total resection safely in a single operation.

Primary Ewing's sarcoma of the paranasal sinus with intracranial and intraorbital extension

Extraskeletal Ewing's sarcoma is usually described as a tumor localizing the soft tissues lower extremities and the paravertebral region. Paranasal primary Ewing's sarcomas are extremely rare entity. We present a case of primary Ewing's sarcoma of the paranasal sinus extending left orbit and middle cranial fossa in a 14-year-old male. CT and MRI findings of the rare case are discussed.

Huge arachnoid cyst incorporating choroid plexus

We report a rare case of arachnoid cyst incorporating choroid plexus. This 7-month-old girl presented with macrocrania. Magnetic resonance (MR) imaging disclosed a cystic lesion arising from the left prepontine cistern extending to the left middle cranial fossa. First, we performed resection of the membrane microscopically and obtained an adequate reduction of the cystic size. However, 4 months after the first operation, the cyst was enlarged again, and bulging of the portion of the craniotomy was noted. Thus, we performed neuroendoscopic transcortical ventriculo-cyst-cysternostomy and confirmed the choroid plexus inside of the arachnoid cyst. Postoperative course was uneventful. This is the first reported case of choroid plexus within an arachnoid cyst, determined neuroendoscopically.

Neonatal cavernous carotid artery aneurysm

Neonatal intracranial aneurysms are rare. The authors report the case of a 4-week-old girl who presented with left-eye ptosis and proptosis. Computerized tomography scanning and magnetic resonance imaging demonstrated a mass involving the left cavernous sinus and middle cranial fossa. Cerebral angiography revealed a large complex left cavernous carotid artery (CA) aneurysm. The patient underwent endovascular treatment in which detachable coils and N-butyl cyanoacrylate glue were used to achieve complete obliteration of the aneurysm. To the authors' knowledge, this is the first reported neonatal intracranial aneurysm originating from the cavernous CA and treated endovascularly. The authors review the literature on neonatal intracranial aneurysms.

Intracranial Dural Arteriovenous Malformations: Results of Stereotactic Radiosurgery in 17 Patients

ABSTRACT: Aim: To assess the efficacy of stereotactic radiosurgery (STRS) for the treatment of dural arteriovenous fistulae (DAVF). Materials and methods: Between November 1987 and December 1998, 17 patients with a total of 18 DAVF were treated with STRS at the National Centre for Stereotactic Radiosurgery, Sheffield. Clinical and radiological data was collected retrospectively from the case notes and radiological records. Two neuroradiologists classified the pre-STRS appearance of the DAVF using the Borden criteria, and reviewed the follow-up imaging. Up to date follow-up was requested from the GPs and referring consultants. Results: In retrospect one DAVF had been misdiagnosed and was excluded from the study. The remaining 17 DAVF were located at the tentorium (6), cavernous sinus (3), right parasellar region (1), floor of left middle cranial fossa (1), midline posterior fossa (1), petrous apex (1) and transverse sinus (4). Ten were Borden type I, four were type II, three were type III. Follow-up angiography was available for 13 patients; 10 DAVF were completely obliterated, two showed considerable reduction in size, one showed deterioration. Clinical follow-up was available for 14 of the 16 patients. Conclusion: Stereotactic radiosurgery can successfully obliterate DAVF with few side effects. Copyright 2002 The Royal College of Radiologists. Published by Elsevier Science Ltd. All rights reserved.

Morphometric and neuropsychologic studies in children with arachnoid cysts

Temporal lobe arachnoid cysts are common findings during brain imaging. Debate exists regarding whether they result from temporal lobe agenesis or are a malformation of the arachnoid matter. We measured temporal lobe volumes in five children with left middle cranial fossa arachnoid cysts using morphometric analysis of magnetic resonance imaging scans. Three patients had neuropsychologic testing, and two patients had positron emission tomography scanning. All patients had significantly smaller left temporal lobes compared with the right side. On neuropsychologic testing two patients had cognitive deficits suggestive of left temporal lobe dysfunction. Temporal lobes adjacent to arachnoid cysts are smaller and less metabolically active when compared with the temporal regions on the opposite side. Patients with middle cranial fossa arachnoid cysts should undergo careful assessment of temporal lobe structure and function before any therapeutic intervention.

SKULL BASE MENINGIOMA IN CHILDHOOD

Meningiomas are rare in childhood and they constitute 1.5% of intracranial meningiomas. We report a case of a left middle cranial fossa meningioma in a 11‐year‐old boy who presented with left‐sided facial weakness and deafness. Neurological examination showed left lower motor neuron facial nerve palsy with sensori‐neural deafness of his left ear.Computed tomography demonstrated a contrast enhancing extra‐axial tumour in the left middle cranial fossa with calcification. Magnetic resonance imaging confirmed the presence of an extra‐axial tumour measuring 3 × 3.5 × 2.7 cm. The mass was isointense to gray matter on T1‐weighted images, with a markedly hypointense rim on T2‐weighted images. The lesion exhibited homogeneous enhancement with gadolinium. It eroded the petrous base, extending into the left internal auditory meatus and cerebello‐pontine cistern. The preoperative diagnosis was trigeminal schwannoma.Intraoperatively, a firm tumour was seen arising from the middle cranial fossa attached to the petrous temporal bone. Near‐total excision of tumour was achieved. The histological diagnosis was xanthomatous meningioma. The patient recovered uneventfully without additional neurological deficit. He underwent linac radiosurgery for the 1 cm tumour remnants in the internal acoustic meatus and the left cerebellopontine angle. Follow‐up MRI scans 14 months after radiosurgery showed shrinkage of the remaining tumour. At follow up 20 months after operation the child was well and had resumed his education.Conclusion: While surgery remains the main therapeutic modality, complete excision is not always possible in skull base meningiomas as it carries significant postoperative morbidity. Radiosurgery is a valuable complementary measure for local control in case of residual or recurrent tumour.

Role of MR imaging in the diagnosis of complicated arachnoid cyst

Arachnoid cysts are intra-arachnoidal cerebrospinal fluid collections that are usually asymptomatic, however, they may become acutely symptomatic due to enlargement of the cyst or the presence of hemorrhage. We report a case of a child presenting with a 3-week history of headaches, nausea, and vision problems. There was no history of trauma. MRI clearly demonstrated a left middle cranial fossa arachnoid cyst with associated subacute intracystic and subdural hematoma that was causing mass effect and required surgery. This lesion was isodense to the brain on CT. We focus on the importance of MR imaging in the differentiation of these subacute/early chronic hemorrhagic collections that may be overlooked with CT.

Atypical CT and MR Features of Chondroid Chordoma at the Base of the Skull: A Case Report

We report a case of chondroid chordoma without calcification in which T2-weighted MR images revealed homogeneous high signal intensity. The tumor was located in the left middle cranial fossa extending to the cerebellopontine angle and with displacement of the pituitary gland to the right side. Precontrast CT scans showed a homogeneous low-density mass, without calcification. T1-weighted MR images of the mass demonstrated relatively homogeneous low signal intensity, T2-weighted images showed homogeneous high signal intensity, and post -contrast T1-weighted images revealed somewhat heterogeneous enhancement.

Spontaneous disappearance of a middle cranial fossa arachnoid cyst after suppurative meningitis

Background Spontaneous disappearance of an arachnoid cyst is very rare, particularly after suppurative meningitis. Case Report A 2-month-old boy with a high fever was diagnosed with suppurative meningitis by cerebrospinal fluid examination. Computed tomography disclosed a large arachnoid cyst in the left middle cranial fossa. Two months later, the meningitis was cured. The arachnoid cyst disappeared with long-term antibiotic therapy alone. Conclusion Although an infected arachnoid cyst may disappear with antibiotic treatment alone, careful observation and individualized patient management are essential.

Giant intracranial aneurysms with skull base erosion and extracranial masses: CT and MR findings.

To present the CT and MR findings of three patients with giant intracranial aneurysms (GIAs), each of which eroded the skull base and had an extracranial mass component. A literature review of GIAs was also performed. In the past year the imaging studies of three patients with these unusual GIAs were collected at our institutions. All three patients had had CT, and one patient had had MR on a 1.5 T GE unit. One patient had a 5 cm GIA in the left petrocavernous region, filling the middle cranial fossa and extending into the left sphenoid sinus and the left posterior ethmoid complex. The aneurysm had heterogeneous high attenuation and extensive rim calcification. The second patient had a 5 cm GIA that filled most of the left middle cranial fossa, eroding the floor and lateral wall and extending into the infratemporal fossa and parapharyngeal space. The aneurysm was partially thrombosed and had minimal rim calcification. The third patient had a 4 cm left cavernous GIA that eroded the floor of the middle cranial fossa and extended into the subjacent parapharyngeal space. The lesion was partially thrombosed and had an enhancing lumen. The rim had low signal intensity on MR. None of these patients had a history of trauma. Giant intracranial aneurysms can cause significant skull base erosion and extend into the paranasal sinuses, parapharyngeal space, and infratemporal fossa. The CT and MR findings can lead to an accurate diagnosis.

A CASE OF SPONTANEOUS CSF OTORRHEA

Spontaneous CSF otorrhea is a rare condition, and about forty cases have been described in the literature to date. Here a case of spontaneous CSF otorrhea is reported.A 37-year-old man had suffered from recurrent bacterial meningitis and CSF otorrhea. Left mastoidectomy was carried out on May, 1989, by an otologist in the other hospital, but the origin of CSF leakage coudn't be identified. The patient was admitted to our hospital on January, 1990, to treat CSF otorrhea. Left temporal craniotomy was carried out. A dural defect was found in the left middle cranial fossa connecting to a bony defect at the left tegmen tympani. The defect was repaired by packing the tegmen tympani with fascia and fatty tissues. CSF otorrhea completely disappeared postoperatively.Spontaneous CSF otorrhea should be considered as a cause of recurrent bacterial meningitis. High resolution CT scan and MRI will be very useful in the diagnosis of this rare problem.