1/23. Growing skull fracture of the orbital roof. Case report.Growing skull fractures are rare complications of head trauma and very rarely arise in the skull base. The clinical and radiological finding and treatment of a growing fracture of the orbital roof in a 5-year-old boy are reported, and the relevant literature is reviewed. The clinical picture was eyelid swelling. Computed tomography (CT) scan was excellent for demonstrating the bony defect in the orbital roof. Frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing skull fracture of the orbital roof should be considered in the differential diagnosis in cases of persistent ocular symptoms. craniotomy with excision of gliotic brain and granulation tissue, dural repair and cranioplasty is the treatment of choice.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/23. Orbital blowout fracture with persistent mobility deficit due to fibrosis of the inferior rectus muscle and perimuscular tissue.A case of orbital blowout fracture accompanied by fibrosis of the inferior rectus muscle resulting in an irreversible orbital mobility deficit is reported. An 8-year-old girl with an orbital blowout fracture was treated with steroids for 10 days, as with other cases in our department. She exhibited a disturbance of vertical eye movement and a positive forced duction test result. Although surgery was performed on day 13, and on day 27 due to poor recovery after the first operation, almost no improvement of the ocular movement was noted. The results of a traction test, performed during the second operation, suggested that the inferior rectus muscle had adhered to the periosteum. magnetic resonance imaging performed 3 days after the second operation revealed fibrosis of the inferior rectus muscle and perimuscular tissue, resulting in an irreversible disturbance of the vertical ocular movement. The present findings suggest that the need for and timing of surgery in patients with blowout fractures should be determined on an individual basis.- - - - - - - - - - ranking = 0.875keywords = fracture (Clic here for more details about this article) |
3/23. Benign aqueductal cyst causing bilateral internuclear ophthalmoplegia after external ventricular drainage. Case report.The introduction of magnetic resonance (MR) imaging to the field of neuroimaging has allowed detection of various lesions that cause aqueductal stenosis. The authors report the case of a 3-year-old boy in whom a benign ventricular cyst developed in the aqueduct. The patient became drowsy after having complained of headache and vomiting; MR imaging revealed mild triventricular dilation and a normal-sized fourth ventricle. Repeated MR imaging performed 1 week later revealed an aqueductal cyst that had markedly enlarged during the intervening period. An external ventricular drainage system was installed, but recovery of consciousness in the child was unsatisfactory and a new bilateral internuclear ophthalmoplegia developed. Fenestration of the cyst wall and placement of a ventriculocisternostomy in the third ventricle were performed simultaneously by using a flexible neuroendoscope. By 2 weeks postsurgery, the patient's neurological symptoms had completely resolved. This case illustrates that simple rerouting of ventricular cerebrospinal fluid (CSF) can aggravate the symptoms of this rare lesion by causing severe compression of periaqueductal structures by a cyst that maintains a high intracystic pressure. Endoscopic surgery was an excellent choice of treatment to achieve both cyst fenestration and normalization of intracranial CSF pressure by creating a ventriculocisternostomy.- - - - - - - - - - ranking = 0.0028989571098701keywords = compression (Clic here for more details about this article) |
4/23. Internal orbital fractures in the pediatric age group: characterization and management.OBJECTIVE: To evaluate the specific characteristics and management of internal orbital fractures in the pediatric population. DESIGN: Retrospective observational case series. PARTICIPANTS: Thirty-four pediatric patients between the ages of 1 and 18 years with internal orbital ("blowout") fractures. methods: Records of pediatric patients presenting with internal orbital fractures over a 5-year period were reviewed, including detailed preoperative and postoperative evaluations, surgical management, and medical management. MAIN OUTCOME MEASURES: Ocular motility restriction, enophthalmos, nausea and vomiting, and postoperative complications. RESULTS: Floor fractures were by far the most common fracture type (71%). Eleven of 34 patients required surgical intervention for ocular motility restriction. Eight were trapdoor-type fractures with soft-tissue incarceration; five had nausea and vomiting. Early surgical intervention (<2 weeks) resulted in a more complete return of ocular motility compared with the late intervention group. CONCLUSIONS: Trapdoor-type fractures, usually involving the orbital floor, are common in the pediatric age group. These fractures may be small with minimal soft-tissue incarceration, making the findings on computed tomography scans quite subtle at times. Marked motility restriction and nausea/vomiting should alert the physician to the possibility of a trapdoor-type fracture and the need for prompt surgical intervention.- - - - - - - - - - ranking = 1.625keywords = fracture (Clic here for more details about this article) |
5/23. Remission of superior oblique myokymia after microvascular decompression.Superior oblique myokymia (SOM) is an ocular motility disorder characterized by oscillopsia, vertical or torsional diplopia, sometimes combined with pressure sensation. Although the pathophysiological basis is unclear, isolated case reports have documented its association with intracranial pathological processes. We present a case of SOM associated with a vascular compression of the fourth nerve at the root exit zone. Following microneurosurgical decompression, SOM completely resolved and paralysis of the fourth nerve occurred. This was less disturbing.- - - - - - - - - - ranking = 0.017393742659221keywords = compression (Clic here for more details about this article) |
6/23. Monocular elevator paresis in neurofibromatosis type 2.A retrospective review of 29 consecutive unselected patients referred for neuro-ophthalmic evaluation after the diagnosis of neurofibromatosis type 2 (NF2) showed that four of them had a monocular elevator paresis. In two of the four MRI demonstrated lesions, presumed to be schwannomas, of the third nerve. These findings indicate that monocular elevator paresis is a common neuro-ophthalmic finding in NF2, which the authors suspect is probably a sign of third nerve infiltration or compression by a schwannoma.- - - - - - - - - - ranking = 0.0028989571098701keywords = compression (Clic here for more details about this article) |
7/23. Brown's syndrome diagnosed following repair of an orbital roof fracture: a case report.The upgaze deficit of Brown's syndrome differs from the upgaze deficit of an orbital floor fracture with entrapment. In Brown's syndrome, the upgaze limitation is most evident in adduction of the eye. This difference may be difficult to establish at times, particularly beneath the periorbital edema of an acute traumatic injury. Nevertheless, it is important to recognize this differentiation, since the approach to management of these two clinical entities is distinctly dissimilar. Brown's syndrome is produced by restriction of the superior oblique muscle tendon, usually in the region of the trochlea. In the course of describing a case of Brown's syndrome, recognized following the repair of an orbital roof fracture, issues related to etiology, diagnosis, and management are discussed. In the case presented, surgical repair of the left eye was performed.- - - - - - - - - - ranking = 0.75keywords = fracture (Clic here for more details about this article) |
8/23. Endoscopic repair of posttraumatic enophthalmos using medial transconjunctival approach: a case report.A blowout fracture of the medial orbital wall should be suspected when periorbital trauma results in epistaxis, orbital hemorrhage, horizontal dysmotility or dystopia of the globe, and/or orbital emphysema. Large medial orbital wall blowout fractures are frequently complicated by posttraumatic enophthalmos. Clinicians should consider a medial transconjunctival approach for repair of these fractures when surgical repair is indicated by a comprehensive clinical and radiologic orbital evaluation. Excellent cosmetic and functional results can be achieved through the use of an extended transcaruncular incision, rigid endoscope, and high-density porous polyethylene implant placement. The technique can be used in the early, delayed, and late stages of medial orbital wall blowout fracture repair. The technique can be used alone in isolated medial orbital wall fractures or combined with other craniofacial approaches.- - - - - - - - - - ranking = 0.625keywords = fracture (Clic here for more details about this article) |
9/23. Pseudo-entrapment of extraocular muscles in patients with orbital fractures.diplopia is a prominent finding in patients who have suffered orbital fractures. If the patient's double vision or ocular motility restriction was caused by soft tissue entrapment into the fracture site, surgery is frequently performed in order to release this entrapment and restore normal eye movement. However, the presence of diplopia should not necessarily be an indication for surgery. Brief case reports are hereby presented to illustrate that the symptoms of diplopia and motility restriction are not always attributable to the presence of orbital fractures that require surgical repair. The purpose of this article is to describe other causes of abnormal ocular motility that are associated with orbital trauma but which are not caused by soft tissue entrapment.- - - - - - - - - - ranking = 0.875keywords = fracture (Clic here for more details about this article) |
10/23. Gaze-evoked amaurosis: a report of five cases.OBJECTIVE: To highlight the various causes of gaze-evoked amaurosis. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Five patients treated at our facility over the past 6 years. methods: Clinical presentation, radiologic studies, surgical management, and postsurgical results are presented. MAIN OUTCOME MEASURES: visual acuity, clinical findings of gaze-evoked amaurosis. RESULTS: Only two patients had classic intraorbital etiologies, one with an intraconal cavernous hemangioma and one with an intraconal foreign body. Three patients had extraorbital processes, two with orbital fractures and one with a sinus tumor. Only two of our patients initially were aware of the gaze-evoked amaurosis at presentation. Appropriate surgery was curative in all cases. CONCLUSIONS: Gaze-evoked amaurosis is a rare condition, classically implicating intraconal orbital pathology. In one of the largest case series published to date, we found extraorbital etiologies are also capable of producing gaze-evoked vision loss. Gaze-evoked amaurosis should be suspected and tested for in any orbital condition.- - - - - - - - - - ranking = 0.125keywords = fracture (Clic here for more details about this article) |
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