1/18. Transcranial approach for transsphenoidal encephalocele: report of two cases.BACKGROUND: Whereas the transcranial approach has been regarded as the therapy of choice for transethmoidal encephalocele, its feasibility for transsphenoidal encephalocele has remained controversial, particularly in neonates and infants. CASE REPORT: Two cases of transsphenoidal encephalocele operated transcranially are presented. In the first case, this 6-year-old boy underwent a transpalatal operation with repair of a cleft palate in another hospital before admission. reoperation via the transcranial route was carried out because of postoperative recurrent meningitis. With partial resection of the anterior wall, the encephalocele could be separated from the underlying tissue, and the interspace was filled with the pericranial flap. He made an uneventful recovery and has been well for the past 3 years. The second was a 3-month-old baby with a large encephalocele filling the nasopharyngeal space. As the cleft palate was absent, the transcranial approach was employed. In this case, the herniated tissue was excised at the lowest level possible. Postoperatively, panhypopituitarism became manifest. Re-evaluation of the preoperative magnetic resonance imaging (MRI) disclosed a small mass far below the dorsum sellae, which turned out to be an anomalous pituitary gland on histologic examination. CONCLUSIONS: The transcranial approach is considered a valid alternative for the therapy of transsphenoidal encephalocele, particularly when the transpalatal approach is unfeasible. While the anterior wall of the herniated sac may be safely resected, the posterior wall should under no circumstances be sacrificed. The preoperative MRI is essential, as it may provide valuable information as to the location of vital structures within the herniated tissue.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
2/18. Limb-body wall complex, report of 2 cases with their quintessence in prenatal diagnosis.Limb-body wall complex is a complicated fetal malformation with the essential features of: 1) exencephaly/encephalocele with facial clefts, 2) thoraco- and/or abdominoschisis, and 3) limb defect. The diagnosis was based on two of three of the above features. We report 2 cases of limb-body wall complex. The first case had thoraco-abdominal and limb anomalies while the other had abdominal wall, limb and neuro-facial anomalies. Both cases were diagnosed prenatally by ultrasonography. They were terminated by medical induction. Chromosome studies were evaluated for academic purposes. Autopsies were done to confirm diagnosis. Aspects of their varieties of clinical features, differences in differential diagnosis, and pitfalls in prenatal diagnosis were discussed.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
3/18. Atretic cephalocele--report of two cases with special reference to embryology.We report two cases of atretic cephalocele, a diverse form of cranium bifidum. The patients were 15-year-old and 3-month-old girls, who each had a hard, nonpulsatile, nonreducible lump covered by alopecic scalp in the parieto-occipital area. They were surgically treated. In case 2, microscopical examination of the operative specimen revealed a meninges under the mass, which was devoid of nervous tissue. Such lesions have rarely been reported, and their essential nature is still the subject of controversy. Pathological and embryological aspects of atretic cephalocele are discussed on the basis of the findings; the neural crest remnant was assumed to be the developmental origin of the lesion in each of these cases.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
4/18. life-threatening intracranial hypotension after diagnostic lumbar puncture.intracranial hypotension syndrome as a complication of diagnostic lumbar puncture is a rarely observed entity. intracranial hypotension syndrome is characterized by postural headache, neck pain/stiffness, blurred vision, nausea, vomiting, clouding of consciousness, dizziness and vertigo. The majority of cases resolve spontaneously with conservative treatment. Rarely, epidural blood patch is required. We report a 41-year-old man with multiple sclerosis, who developed intracranial hypotension syndrome after diagnostic lumbar puncture and who did not respond to conservative treatment. A subdural hematoma was subsequently found, when the patient showed considerable worsening of clinical conditions with life-threatening symptoms. Surgical evacuation of the subdural hematoma was not sufficient to improve significantly the patient's conditions, while complete symptoms remission was achieved 12 hours after epidural blood patch. We stress the need for epidural blood patch in any case of post-diagnostic lumbar puncture postural headache which does not resolve with conservative therapy.- - - - - - - - - - ranking = 370914.85716969keywords = intracranial hypotension, hypotension (Clic here for more details about this article) |
5/18. Neurosurgical reconstruction with acellular cadaveric dermal matrix.Acellular cadaveric dermal matrix (ACDM) is processed from human cadaver skin (AlloDerm; life Cell Corp., Branchburg, NJ). It does not require an immediate blood supply but can transmit essential interstitial fluids for nourishment of overlying tissues. A number of neurosurgical reconstructions have required the use of tissue that fills these specifications. The material has been used most recently for reconstruction of dura during craniotomies when primary closure is not possible or harvesting from an autologous site is not available. Because ACDM is harvested from nonneurologic cadaveric tissues and because the cellular and antigenic elements have been removed from the matrix, prion diseases are not a transmission risk. We present 6 examples of previously unreported uses of ACDM for successful repair of meningomyelocele, cauda equina, encephalocele, cerebrospinal fluid fistula, and neuroma. We propose the use of ACDM as a valuable tool in neurosurgical reconstruction.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
6/18. Acute cerebellitis complicated by hydrocephalus and impending cerebral herniation.We present a 7-year-old boy with acute cerebellitis who required an emergency ventriculoperitoneal shunt for hydrocephalus caused by cerebellar swelling. This represents a very unusual, potentially life-threatening complication of a usually self-limiting condition. early diagnosis of this complication is essential in view of the propensity to sudden and fatal deterioration. magnetic resonance imaging (MRI) is useful in differentiating this unusual course of acute cerebellar ataxia from that of a posterior fossa tumor. In developing countries, however, computed tomography (CT) is often the only existing diagnostic modality, and access to MRI, when available, is limited. Our case demonstrates that the shape of the fourth ventricle on CT can be helpful in differentiating between a tumor and edema of the cerebellum and thus can assist in management.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
7/18. Chiari-like tonsillar herniation associated with intracranial hypotension in marfan syndrome. Case report.The authors describe the case of a 12-year-old girl with marfan syndrome, sacral dural ectasia, and tonsillar herniation, who presented with headache. Initially, it was hypothesized that the headaches were secondary to the tonsillar herniation, and the patient consequently underwent surgical decompression of the foramen magnum. Postoperatively, the patient's condition did not improve, and additional magnetic resonance (MR) imaging demonstrated evidence of a cerebrospinal fluid (CSF) leak at the level of the dural ectasia. It was surmised that the girl's symptoms were due to spontaneous intracranial hypotension (SIH) and that the tonsillar herniation was caused by the leakage. The patient responded well to application of a blood patch at the level of the demonstrated leak, and her headache resolved. This appears to be the first reported case of a patient with marfan syndrome presenting with a symptomatic spontaneous CSF leak complicated by tonsillar herniation. In this rare association of SIH and connective tissue disorders, recognition of the clinical signs and typical MR imaging features of SIH may lead to more appropriate and less invasive treatment, potentially avoiding surgery.- - - - - - - - - - ranking = 370125.3246344keywords = intracranial hypotension, hypotension (Clic here for more details about this article) |
8/18. Early prenatal diagnosis of Meckel syndrome--a case report.Meckel syndrome is a rare autosomal recessive disorder. The triad of the syndrome consists of occipital encephalocele, polycystic kidneys and postaxial polydactyly. At least two of these features are essential for the diagnosis, but other malformations such as microcephaly, cleft palate and ambiguous genitalia may also be present. The condition is considered invariably fatal. This report demonstrates that the prenatal diagnosis can in principle be established by ultrasound examination alone, and as early as 13 weeks' gestation.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
9/18. Sequelae of temporal lobe herniation: MR imaging.Acute temporal lobe herniation is a serious complication that may occur with an expanding temporal or parietal lobe mass. temporal lobe herniation may produce further damage to intracranial structures due to compression or vascular compromise. Differentiation of clinical and imaging abnormalities due to the primary lesion from those related to temporal lobe herniation is essential for proper diagnosis and management. The CT and magnetic resonance findings in a 2 1/2-year-old child who survived severe temporal lobe herniation are reported.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
10/18. magnetic resonance imaging of congenital midline nasal masses.Congenital midline nasal masses are rare lesions with potential intracranial extensions. Thus, thoughtful preoperative evaluation is essential in planning the appropriate surgical approach, to prevent such complications as cerebral spinal fluid leaks and meningitis. Preoperative computerized tomographic (CT) scans are useful in visualizing bony defects, but are not well suited for soft tissue imaging. magnetic resonance imaging (MRI) is the latest advance in cross-sectional imaging technology. It offers superior soft tissue contrast, is noninvasive, and does not use ionizing radiation. It is particularly useful in imaging encephaloceles. Three cases of congenital midline masses are presented as illustrations. Two dermoid cysts demonstrate the usefulness of MRI in ruling out intracranial extension. A large encephalocele dramatically demonstrates the superiority of MRI in imaging the brain herniating into the nose. Since MRI is noninvasive and does not use ionizing radiation, it should be considered before CT scanning, to rule out intracranial extension.- - - - - - - - - - ranking = 1keywords = essential (Clic here for more details about this article) |
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