BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct ...BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.展开更多
Recurrent ameloblastoma is common following inadequate excision but rarely presents in the anterior skull base. We presented 3 patients with recurrent ameloblastoma in the anterior skull base including the frontotempo...Recurrent ameloblastoma is common following inadequate excision but rarely presents in the anterior skull base. We presented 3 patients with recurrent ameloblastoma in the anterior skull base including the frontotemporal fossa and the pterygomaxillary fossa that occurred following multiple enucleations, segmental mandibulectomy, or partial maxillectomy for ameloblastoma in the jaws. Attenborough approach was used in the exposure of the frontotemporal fossa. Attenborough plus Barbosa approach was used in the exposure of the pterygomaxillary fossa. The patients were treated by radical dissection. Microscopy confirmed that the histopathologic pattern of one case was fixed follicular and plexiform, two cases were follicular. All patients healed without serious complications. The local recurrences of the patients following the operations were found in 3 to 4 years. The present study showed that the tumors in the regions had a greater recurrence potential even when treated with radical dissection, and the original tumors were the high-risk follicular pattern.展开更多
BACKGROUND Hemangioblastoma(HB)is a rare tumor,comprising about 2%of all intracranial tumors.Although it is a benign tumor,due to the abundant blood supply and its close relationship with adjacent cerebral blood vesse...BACKGROUND Hemangioblastoma(HB)is a rare tumor,comprising about 2%of all intracranial tumors.Although it is a benign tumor,due to the abundant blood supply and its close relationship with adjacent cerebral blood vessels,surgical resection is difficult and may cause complications such as bleeding.If HB can be correctly diagnosed before surgery,complications can be avoided by methods such as vascular embolism before surgery.CASE SUMMARY A 51-year-old male patient was admitted to our hospital because of blurred vision in his left eye for 2 years.Ophthalmological examination revealed oculus dexter vision acuity of 1.0 and oculus sinister vision acuity of 0.6.His left vision had tubular visual field,while his right vision had a partial defect.Computed tomography and magnetic resonance imaging showed a mass lesion at the left anterior base of the skull,which could have been a meningioma.During the operation,the tumor was found to be located at the entrance of the left optic nerve tube,closely adhering to the left optic nerve and the blood supply was extremely abundant.The tumor was carefully separated and diagnosed as HB postoperatively after pathological examination.CONCLUSION A rare HB at the anterior skull base could be distinguished by its imaging features,which is essential to the surgical procedures.展开更多
Objectives: Sinonasal schwannomas account for less than 4% of head and neck schwannomas, with the primary treatment modality being surgical excision via external approaches. The aim of this report is to present a rare...Objectives: Sinonasal schwannomas account for less than 4% of head and neck schwannomas, with the primary treatment modality being surgical excision via external approaches. The aim of this report is to present a rare case of recurrent schwannoma of the ethmoid cavity involving the anterior skull base which was successfully managed with endoscopic resection. Study Design: Case report and review of the literature. Methods: The clinical presentation, radiographic features, histopathologic characteristics, surgical approach, and patient outcome were examined in the context of a literature review. Results: A 43-year-old woman presented with a 9-month history of left facial pain and pressure. She had a prior history of sinonasal schwannoma excision with cerebrospinal fluid (CSF) leak repair via bifrontal craniotomy in 2007. Magnetic resonance imaging (MRI) and nasal endoscopy revealed a left ethmoid mass measuring 2.2 cm × 2.7 cm × 2.4 cm abutting the anterior skull base. The tumor was completely removed using a transnasal endoscopic approach, and the anterior skull base reconstructed with tensor fascia lata graft. Histology of the specimen showed schwannoma, and there has been no evidence of tumor recurrence nor CSF leak after 24 months of follow-up. Conclusion: With continual advances in surgical technique and instrumentation, sinonasal schwannomas have become increasingly more amenable to endoscopic resection even in the case of recurrence and skull base involvement.展开更多
Objective: The authors report a rare case of uterine adenocarcinoma metastasis to both the skull base and cervical spine presenting with pathological fracture and myelopathy. Methods: We report the case of a 43-year-o...Objective: The authors report a rare case of uterine adenocarcinoma metastasis to both the skull base and cervical spine presenting with pathological fracture and myelopathy. Methods: We report the case of a 43-year-old Asian female with widely metastatic uterine adenocarcinoma who over the course of 3 years was diagnosed with a large clival mass and more recently a cervical spine pathological fracture presenting with myelopathy. Results: This patient underwent multiple procedures over a three-year period, including total hysterectomy with tumor debulking, endonasal biopsy of clival mass and most recently cervical corpectomy and fusion. She has received chemotherapy and radiation therapy for treatment of the unresectable clival mass and has done quite well despite having this pathology. Conclusion: This is the first documented case of clival involvement of endometrial adenocarcinoma. Additionally, this is a unique case of spinal metastatic endometrial adenocarcinoma presenting with pathological fracture and myelopathy.展开更多
Objective: To introduce the method of a modified transcranial approach for resection of paranasal sinuses tumors involving the anterior skull base and to address our experience with the approach. Patients and Methods:...Objective: To introduce the method of a modified transcranial approach for resection of paranasal sinuses tumors involving the anterior skull base and to address our experience with the approach. Patients and Methods: Ten cases were operated by the approach. Among them, 4 suffered from benign meningeomas, 6 with malignant tumors included one chondrosarcoma, two malignant meningeomas, two olfactory neuroblastomas, and one squamous sarcoma. Of the patients, 4 cases had primary tumor and 6 cases had recurrent tumors. Result: All of the ten cases underwent operation and no postopertion complication occurred. 7 cases have survived for one to four years without tumor recurrence. 3 cases with malignant tumor died of tumor relapse in one to two years. Conclusion: This method significantly has helped to reduce the persistence and recurrence of the disease.展开更多
The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of trauma...The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of traumatic brain injury.Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion.If not detected early and treated in time,the prognosis of patients is poor.This editorial makes a relevant analysis of this disease.展开更多
Purpose:A head injury(HI)may cause a skull fracture,which may or may not be associated with injury to the brain.In essence,a skull base fracture(SBF)is a linear fracture at the base of the skull.Loss of consciousness ...Purpose:A head injury(HI)may cause a skull fracture,which may or may not be associated with injury to the brain.In essence,a skull base fracture(SBF)is a linear fracture at the base of the skull.Loss of consciousness and Glasgow coma score(GCS)may vary depending on an associated intracranial pathology.The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault.Aim of this study is to define the correlation between SBF and intracranial hemorrhage(ICH)in patients with HI.Methods:Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr.Hasan Sadikin Hospital,Bandung,Indonesia from January 1,2012 to December 31,2017.The exclusion criteria in eluded age less than 15 years and no head computed tomography(CT)scan examination provided.Results:A total of 9006 patients were in eluded into this study in which they were divided into 3 groups:group 1,HI with no ICH;group 2,HI with single ICH and group 3,HI with multiple ICH.In all the SBF cases,SBF at anterior fossa accounted for 69.40%of them,which were mostly accompanied with mild HI(64.70%).Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan,thus these factors were able to predict whether there were traumatic brain lesions or not.Most of the patients with epidural hemorrhage(EDH)has single traumatic lesion on CT scan,whereas most of the patients with cerebral contusion(CC)has multiple traumatic lesions on CT scan.On patients with both traumatic brain injury and SBF,most of the patients with anterior fossa SBF has EDH;whereas most of the patients with middle fossa SBF were accompanied with CC.Surgery was not required for most of the patients with SBF.Conclusion:SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.展开更多
Objective:There has been a significant shift from open craniofacial resection of the anterior skull base to endoscopic approaches that accomplish the same outcomes in tumor ablation.However,when open resection is requ...Objective:There has been a significant shift from open craniofacial resection of the anterior skull base to endoscopic approaches that accomplish the same outcomes in tumor ablation.However,when open resection is required,free flap reconstruction is often necessary to provide sufficient well-vascularized tissue for optimal wound healing as well as providing adequate tissue bulk for cosmesis.This articleaims to providea focused review of free flaps most commonly used in anterior skull base reconstruction.Methods:This is a state-of-the-art review based on expert opinion and previously published reviews and journal articles,queried using PubMed and Google Scholar.Results&conclusion:Anterior skull base reconstruction via free tissue transfer is imperative in limiting complications and promoting healing,particularly with large defects,post-radiation,and in at-risk patients.The type of free flap utilized for a particular anterior skull base reconstruction should be tailored to the patient and nature of the disease.This review offers insight into the numerous reconstructive options for the free flap surgeon.展开更多
To describe and assess the repair technique and perioperative management for cerebrospinal fluid(CSF)leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach.;This was a r...To describe and assess the repair technique and perioperative management for cerebrospinal fluid(CSF)leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach.;This was a retrospective review conducted at the Department of Neurosurgery of the Shanghai Tenth People's Hospital from January 2015 to April 2020.Patients with traumatic CSF rhinorrhea resulting from extensive anterior skull base fracture treated surgically via extended extradural anterior skull base approach were included in this study.The data of medical and radiological records,surgical approaches,repair techniques,peritoperative management,surgical outcome and postoperative follow-up were analyzed.Surgical repair techniques were tailored to the condition of associated injuries of the scalp,bony and dura injuries and associated intracranial lesions.Patients were followed up for the outcome of CSF leak and surgical complications.Data were presented as frequency and percent.;Thirty-five patients were included in this series.The patients'mean age was 33 years(range 11-71 years).Eight patients were treated surgically within 2 weeks;while the other 27 patients,with prolonged or recurrent CSF rhinorrhea,received the repair surgery at 17 days to 10 years after the initial trauma.The mean overall length of follow-up was 23 months(range 3-65 months).All the patients suffered from frontobasal multiple fractures.The basic repair tenet was to achieve watertight seal of the dura.The frontal pericranial flap alone was used in 20 patients,combined with temporalis muscle and/or its facia in 10 patients.Free fascia lata graft was used instead in the rest 5 patients.No CSF leak was found in all the patients at discharge.There was no surgical mortality in this series.Bilateral anosmia was the most common complication.At follow-up,no recurrent CSF leak or meningitis occurred.No patients developed mucoceles,epidural abscess or osteomyelitis.One patient ultimately required ventriculoperitoneal shunt because of progressive hydrocephalus.;Traumatic CSF rhinorrhea associated with extensive anterior skull base fractures often requires aggressive treatment via extended intracranial extradural approach.Vascularized tissue flaps are ideal grafts for cranial base reconstruction,either alone or in combination with temporalis muscle and its fascia---fascia lata sometimes can be opted as free autologous graft.The approach is usually reserved for patients with traumatic CSF rhinorrhea in complex frontobasal injuries.展开更多
Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always...Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for head trauma(n=13).The ASB mean frontal lobe position is-0.2 mm superior to the nasion-sellar line(range:-9.2 to 10.4 mm),while the control’’s mean frontal lobe position is 1.1 mm inferior to the nasion-sellar line.This difference is not statistically significant(P=0.13)and does not reach our a priori definition of clinical significance.The frontal lobe position of ASB subjects who had radiation is closer to the nasion-sellar line as compared with those who did not undergo radiation.Conclusions:Single-layer acellular dermal graft repair maintains frontal lobe support and position in large ASB defects.展开更多
Nine patients with neuroblastoma were surgically treated and postoperatively followed up. Of the 9 cases, 8 survived well while the other one died of extensive metastasis within cranium 2 years after the operation. ...Nine patients with neuroblastoma were surgically treated and postoperatively followed up. Of the 9 cases, 8 survived well while the other one died of extensive metastasis within cranium 2 years after the operation. One patient had stayed alive for over 12 years.展开更多
To clarify whether it is necessary to reconstruct bone defects at the anterior s kull base Methods A long term follow up study of 50 patients with anterior skull base defects i n which the dura was reconstructed ...To clarify whether it is necessary to reconstruct bone defects at the anterior s kull base Methods A long term follow up study of 50 patients with anterior skull base defects i n which the dura was reconstructed without bone grafts was conducted CT and MR I examinations were taken periodically after surgery Results The ordinates of the bone defects averaged 3 5?cm (range, 2-6?cm), and the ab scissas averaged 2 8?cm (range, 2-5?cm) The abscissas of the bone defects m easured 2-3?cm in 38 patients, 3-4?cm in 10 patients, and 4-5?cm in 2 patient s The follow up ranged from 3 months to 5 years (average, 2 years) Conclusions At normal intracranial pressure, if the dura mater is repaired properly at the s kull base defects and reinforced with a pedicled pericranial flap, encephalomen ingocele and cerebrospinal fluid (CSF) leakage can be prevented It may not be necessary to make free bone grafts when the size of the cranial base bone defect is smaller than 4?cm展开更多
文摘BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.
文摘Recurrent ameloblastoma is common following inadequate excision but rarely presents in the anterior skull base. We presented 3 patients with recurrent ameloblastoma in the anterior skull base including the frontotemporal fossa and the pterygomaxillary fossa that occurred following multiple enucleations, segmental mandibulectomy, or partial maxillectomy for ameloblastoma in the jaws. Attenborough approach was used in the exposure of the frontotemporal fossa. Attenborough plus Barbosa approach was used in the exposure of the pterygomaxillary fossa. The patients were treated by radical dissection. Microscopy confirmed that the histopathologic pattern of one case was fixed follicular and plexiform, two cases were follicular. All patients healed without serious complications. The local recurrences of the patients following the operations were found in 3 to 4 years. The present study showed that the tumors in the regions had a greater recurrence potential even when treated with radical dissection, and the original tumors were the high-risk follicular pattern.
基金Supported by Shanghai Sailing Program,No.22YF1405000Greater Bay Area Institute of Precision Medicine(Guangzhou),No.KCH2310094。
文摘BACKGROUND Hemangioblastoma(HB)is a rare tumor,comprising about 2%of all intracranial tumors.Although it is a benign tumor,due to the abundant blood supply and its close relationship with adjacent cerebral blood vessels,surgical resection is difficult and may cause complications such as bleeding.If HB can be correctly diagnosed before surgery,complications can be avoided by methods such as vascular embolism before surgery.CASE SUMMARY A 51-year-old male patient was admitted to our hospital because of blurred vision in his left eye for 2 years.Ophthalmological examination revealed oculus dexter vision acuity of 1.0 and oculus sinister vision acuity of 0.6.His left vision had tubular visual field,while his right vision had a partial defect.Computed tomography and magnetic resonance imaging showed a mass lesion at the left anterior base of the skull,which could have been a meningioma.During the operation,the tumor was found to be located at the entrance of the left optic nerve tube,closely adhering to the left optic nerve and the blood supply was extremely abundant.The tumor was carefully separated and diagnosed as HB postoperatively after pathological examination.CONCLUSION A rare HB at the anterior skull base could be distinguished by its imaging features,which is essential to the surgical procedures.
文摘Objectives: Sinonasal schwannomas account for less than 4% of head and neck schwannomas, with the primary treatment modality being surgical excision via external approaches. The aim of this report is to present a rare case of recurrent schwannoma of the ethmoid cavity involving the anterior skull base which was successfully managed with endoscopic resection. Study Design: Case report and review of the literature. Methods: The clinical presentation, radiographic features, histopathologic characteristics, surgical approach, and patient outcome were examined in the context of a literature review. Results: A 43-year-old woman presented with a 9-month history of left facial pain and pressure. She had a prior history of sinonasal schwannoma excision with cerebrospinal fluid (CSF) leak repair via bifrontal craniotomy in 2007. Magnetic resonance imaging (MRI) and nasal endoscopy revealed a left ethmoid mass measuring 2.2 cm × 2.7 cm × 2.4 cm abutting the anterior skull base. The tumor was completely removed using a transnasal endoscopic approach, and the anterior skull base reconstructed with tensor fascia lata graft. Histology of the specimen showed schwannoma, and there has been no evidence of tumor recurrence nor CSF leak after 24 months of follow-up. Conclusion: With continual advances in surgical technique and instrumentation, sinonasal schwannomas have become increasingly more amenable to endoscopic resection even in the case of recurrence and skull base involvement.
文摘Objective: The authors report a rare case of uterine adenocarcinoma metastasis to both the skull base and cervical spine presenting with pathological fracture and myelopathy. Methods: We report the case of a 43-year-old Asian female with widely metastatic uterine adenocarcinoma who over the course of 3 years was diagnosed with a large clival mass and more recently a cervical spine pathological fracture presenting with myelopathy. Results: This patient underwent multiple procedures over a three-year period, including total hysterectomy with tumor debulking, endonasal biopsy of clival mass and most recently cervical corpectomy and fusion. She has received chemotherapy and radiation therapy for treatment of the unresectable clival mass and has done quite well despite having this pathology. Conclusion: This is the first documented case of clival involvement of endometrial adenocarcinoma. Additionally, this is a unique case of spinal metastatic endometrial adenocarcinoma presenting with pathological fracture and myelopathy.
文摘Objective: To introduce the method of a modified transcranial approach for resection of paranasal sinuses tumors involving the anterior skull base and to address our experience with the approach. Patients and Methods: Ten cases were operated by the approach. Among them, 4 suffered from benign meningeomas, 6 with malignant tumors included one chondrosarcoma, two malignant meningeomas, two olfactory neuroblastomas, and one squamous sarcoma. Of the patients, 4 cases had primary tumor and 6 cases had recurrent tumors. Result: All of the ten cases underwent operation and no postopertion complication occurred. 7 cases have survived for one to four years without tumor recurrence. 3 cases with malignant tumor died of tumor relapse in one to two years. Conclusion: This method significantly has helped to reduce the persistence and recurrence of the disease.
基金Supported by the Science and Technology Program of Nantong Health Committee,No.MA2019003 and No.MA2021017Science and Technology Program of Nantong City,No.Key003 and No.JCZ2022040Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD019,and No.KD2022KYJJZD022.
文摘The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of traumatic brain injury.Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion.If not detected early and treated in time,the prognosis of patients is poor.This editorial makes a relevant analysis of this disease.
文摘Purpose:A head injury(HI)may cause a skull fracture,which may or may not be associated with injury to the brain.In essence,a skull base fracture(SBF)is a linear fracture at the base of the skull.Loss of consciousness and Glasgow coma score(GCS)may vary depending on an associated intracranial pathology.The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault.Aim of this study is to define the correlation between SBF and intracranial hemorrhage(ICH)in patients with HI.Methods:Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr.Hasan Sadikin Hospital,Bandung,Indonesia from January 1,2012 to December 31,2017.The exclusion criteria in eluded age less than 15 years and no head computed tomography(CT)scan examination provided.Results:A total of 9006 patients were in eluded into this study in which they were divided into 3 groups:group 1,HI with no ICH;group 2,HI with single ICH and group 3,HI with multiple ICH.In all the SBF cases,SBF at anterior fossa accounted for 69.40%of them,which were mostly accompanied with mild HI(64.70%).Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan,thus these factors were able to predict whether there were traumatic brain lesions or not.Most of the patients with epidural hemorrhage(EDH)has single traumatic lesion on CT scan,whereas most of the patients with cerebral contusion(CC)has multiple traumatic lesions on CT scan.On patients with both traumatic brain injury and SBF,most of the patients with anterior fossa SBF has EDH;whereas most of the patients with middle fossa SBF were accompanied with CC.Surgery was not required for most of the patients with SBF.Conclusion:SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.
文摘Objective:There has been a significant shift from open craniofacial resection of the anterior skull base to endoscopic approaches that accomplish the same outcomes in tumor ablation.However,when open resection is required,free flap reconstruction is often necessary to provide sufficient well-vascularized tissue for optimal wound healing as well as providing adequate tissue bulk for cosmesis.This articleaims to providea focused review of free flaps most commonly used in anterior skull base reconstruction.Methods:This is a state-of-the-art review based on expert opinion and previously published reviews and journal articles,queried using PubMed and Google Scholar.Results&conclusion:Anterior skull base reconstruction via free tissue transfer is imperative in limiting complications and promoting healing,particularly with large defects,post-radiation,and in at-risk patients.The type of free flap utilized for a particular anterior skull base reconstruction should be tailored to the patient and nature of the disease.This review offers insight into the numerous reconstructive options for the free flap surgeon.
文摘To describe and assess the repair technique and perioperative management for cerebrospinal fluid(CSF)leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach.;This was a retrospective review conducted at the Department of Neurosurgery of the Shanghai Tenth People's Hospital from January 2015 to April 2020.Patients with traumatic CSF rhinorrhea resulting from extensive anterior skull base fracture treated surgically via extended extradural anterior skull base approach were included in this study.The data of medical and radiological records,surgical approaches,repair techniques,peritoperative management,surgical outcome and postoperative follow-up were analyzed.Surgical repair techniques were tailored to the condition of associated injuries of the scalp,bony and dura injuries and associated intracranial lesions.Patients were followed up for the outcome of CSF leak and surgical complications.Data were presented as frequency and percent.;Thirty-five patients were included in this series.The patients'mean age was 33 years(range 11-71 years).Eight patients were treated surgically within 2 weeks;while the other 27 patients,with prolonged or recurrent CSF rhinorrhea,received the repair surgery at 17 days to 10 years after the initial trauma.The mean overall length of follow-up was 23 months(range 3-65 months).All the patients suffered from frontobasal multiple fractures.The basic repair tenet was to achieve watertight seal of the dura.The frontal pericranial flap alone was used in 20 patients,combined with temporalis muscle and/or its facia in 10 patients.Free fascia lata graft was used instead in the rest 5 patients.No CSF leak was found in all the patients at discharge.There was no surgical mortality in this series.Bilateral anosmia was the most common complication.At follow-up,no recurrent CSF leak or meningitis occurred.No patients developed mucoceles,epidural abscess or osteomyelitis.One patient ultimately required ventriculoperitoneal shunt because of progressive hydrocephalus.;Traumatic CSF rhinorrhea associated with extensive anterior skull base fractures often requires aggressive treatment via extended intracranial extradural approach.Vascularized tissue flaps are ideal grafts for cranial base reconstruction,either alone or in combination with temporalis muscle and its fascia---fascia lata sometimes can be opted as free autologous graft.The approach is usually reserved for patients with traumatic CSF rhinorrhea in complex frontobasal injuries.
文摘Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for head trauma(n=13).The ASB mean frontal lobe position is-0.2 mm superior to the nasion-sellar line(range:-9.2 to 10.4 mm),while the control’’s mean frontal lobe position is 1.1 mm inferior to the nasion-sellar line.This difference is not statistically significant(P=0.13)and does not reach our a priori definition of clinical significance.The frontal lobe position of ASB subjects who had radiation is closer to the nasion-sellar line as compared with those who did not undergo radiation.Conclusions:Single-layer acellular dermal graft repair maintains frontal lobe support and position in large ASB defects.
文摘Nine patients with neuroblastoma were surgically treated and postoperatively followed up. Of the 9 cases, 8 survived well while the other one died of extensive metastasis within cranium 2 years after the operation. One patient had stayed alive for over 12 years.
基金agrantfromtheNationalNaturalScienceFoundationofChina (No 3 9670 199)
文摘To clarify whether it is necessary to reconstruct bone defects at the anterior s kull base Methods A long term follow up study of 50 patients with anterior skull base defects i n which the dura was reconstructed without bone grafts was conducted CT and MR I examinations were taken periodically after surgery Results The ordinates of the bone defects averaged 3 5?cm (range, 2-6?cm), and the ab scissas averaged 2 8?cm (range, 2-5?cm) The abscissas of the bone defects m easured 2-3?cm in 38 patients, 3-4?cm in 10 patients, and 4-5?cm in 2 patient s The follow up ranged from 3 months to 5 years (average, 2 years) Conclusions At normal intracranial pressure, if the dura mater is repaired properly at the s kull base defects and reinforced with a pedicled pericranial flap, encephalomen ingocele and cerebrospinal fluid (CSF) leakage can be prevented It may not be necessary to make free bone grafts when the size of the cranial base bone defect is smaller than 4?cm
