RESUMEN
BACKGROUND: Vestibular schwannomas (VS) are benign tumors arising from vestibular nerve's Schwann cells. Surgical resection via retrosigmoid (RS) or middle fossa (MF) is standard, but the optimal approach remains debated. This meta-analysis evaluated RS and MF approaches for VS management, emphasizing hearing preservation and Cranial nerve seven (CN VII) outcomes stratified by tumor size. METHODS: Systematic searches across PubMed, Cochrane, Web of Science, and Embase identified relevant studies. Hearing and CN VII outcomes were gauged using the American Academy of Otolaryngology-Head and Neck Surgery, Gardner Robertson, and House-Brackmann scores. RESULTS: Among 7228 patients, 56 % underwent RS and 44 % MF. For intracanalicular tumors, MF recorded 38 % hearing loss, compared to RS's 54 %. In small tumors (<1.5 cm), MF showed 41 % hearing loss, contrasting RS's lower 15 %. Medium-sized tumors (1.5 cm-2.9 cm) revealed 68 % hearing loss in MF and 55 % in RS. Large tumors (>3cm) were only reported in RS with a hearing loss rate of 62 %. CONCLUSION: Conclusively, while MF may be preferable for intracanalicular tumors, RS demonstrated superior hearing preservation for small to medium-sized tumors. This research underlines the significance of stratified outcomes by tumor size, guiding surgical decisions and enhancing patient outcomes.
Asunto(s)
Neuroma Acústico , Procedimientos Neuroquirúrgicos , Humanos , Fosa Craneal Media/cirugía , Nervio Facial/cirugía , Audición/fisiología , Pérdida Auditiva/etiología , Pérdida Auditiva/prevención & control , Pérdida Auditiva/cirugía , Neuroma Acústico/cirugía , Procedimientos Neuroquirúrgicos/métodosRESUMEN
Intracranial condylar dislocation to the middle fossa is rare, as it is not reported often. Known cases have an etiology, identified as erosion of the glenoid cavity from joint prostheses and/or traumatic events. As such, this case aims to offer a predisposing reason for the idiopathic condylar dislocation to the middle cranial fossa with nonfunctional limitations.
Asunto(s)
Luxaciones Articulares , Fracturas Mandibulares , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Fosa Craneal Media/diagnóstico por imagen , Fosa Craneal Media/cirugía , Fracturas Mandibulares/cirugía , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/cirugía , Articulación Temporomandibular/cirugíaRESUMEN
Trigeminal schwannomas are complex lesions that may be related to many critical neurovascular structures. We present the case of a 59-year-old male presenting a history of left-sided trigeminal neuralgia. Preoperative imaging demonstrated a mass highly suggestive of a trigeminal schwannoma, and microsurgical resection was indicated considering the progressive symptomatology and important mass effect (Video 1). A middle fossa route including an anterior petrosectomy was chosen. The patient was placed supine with the head rotated to the contralateral side, and an arcuate incision was performed. A V-shaped zygomatic osteotomy was done to mobilize the temporalis muscle more inferiorly and better expose the middle fossa floor. Following craniotomy, peeling of the dura propria from the lateral wall of cavernous sinus was carried out starting by coagulation of middle meningeal artery. Some tumor was already identified and removed, and then the anterior petrosectomy was performed until we exposed the posterior fossa dura. The middle fossa dural incision was connected with the other one at the posterior fossa dura, by coagulation of the superior petrosal sinus. The tentorium was completely cut toward the incisura. After lesion debulking, the tumor was progressively removed by peeling the arachnoid from the lesion to maintain arachnoid planes and preserve the nerves and their blood supply. Postoperative imaging demonstrated complete tumor resection. The patient's symptoms improved, and there were no neurologic deficits on follow-up. Extensive laboratory training is fundamental to be familiarized with the normal anatomic nuances and prepared to face the anatomy distorted by lesion. Informed consent was obtained from the patient for the procedure and publication of this operative video.
Asunto(s)
Neoplasias de los Nervios Craneales/cirugía , Microcirugia/métodos , Neurilemoma/cirugía , Procedimientos Neuroquirúrgicos/métodos , Hueso Petroso/cirugía , Enfermedades del Nervio Trigémino/cirugía , Fosa Craneal Media/cirugía , Neoplasias de los Nervios Craneales/complicaciones , Craneotomía , Humanos , Masculino , Persona de Mediana Edad , Neurilemoma/complicaciones , Enfermedades del Nervio Trigémino/complicaciones , Neuralgia del Trigémino/etiologíaRESUMEN
The displacement of the mandibular condyle into the cranial fossa is an uncommon event; when it occurs, there is a need for immediate and multidisciplinary surgical intervention. Due to its rare advent, there is still no consolidated service dynamics, as this condition has not yet been described in a sedimented way in the literature databases. In the present article, we performed a literature review of condylar dislocation for the intracranial fossa described in the past 10 years in the PubMed and Lilacs search databases.
Asunto(s)
Fosa Craneal Media/cirugía , Luxaciones Articulares/cirugía , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Articulación Temporomandibular/cirugía , Luxaciones Articulares/diagnóstico por imagen , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico por imagenRESUMEN
INTRODUCTION: Primitive neuroectodermal tumors of peripheral origin are very rare, and orbital neuroectodermal tumors are even more uncommon. Only 25 patients with primary orbital involvement in the pediatric age group have been reported. METHODS: In this article, the authors describe their experience in the multimodality treatment approach to treat neuroectodermal tumor of the orbit. The authors also present a male patient 3-year old presenting with a neuroectodermal tumor of the right orbit causing rapidly progressive proptosis. The patient underwent an upper and lateral orbital marginotomy. The entire bone defect was reconstructed with a bone graft, allowing for the reconstruction of the floor and the lateral wall of the middle cranial fossa, the floor of the anterior cranial fossa, the upper and lateral orbital frame, and the right zygomatic bone. Over a period of 16 months, the patient was subjected to chemotherapy. RESULTS: In the postoperative period, a favorable evolution of the disease was observed, with growth in the reconstructed structures, good projection of the orbit and the eyeball, and stable results without tumor recurrence. CONCLUSIONS: The authors present the clinical analysis, surgical management, as well as the chemotherapy treatment established, with follow-ups at 1 and 2 and a half years. This experience shows the effectiveness of multimodality therapy in the treatment of rare tumors of difficult handling.
Asunto(s)
Trasplante Óseo/métodos , Fosa Craneal Media/cirugía , Tumores Neuroectodérmicos/cirugía , Órbita/cirugía , Neoplasias Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Implantación de Prótesis/métodos , Antineoplásicos/uso terapéutico , Preescolar , Terapia Combinada , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Tumores Neuroectodérmicos/diagnóstico , Tumores Neuroectodérmicos/tratamiento farmacológico , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/tratamiento farmacológico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Cigoma/cirugíaRESUMEN
Introdução: A paralisia facial periférica caracteriza-se pela interrupção, definitiva ou temporária, do funcionamento da musculatura facial. Decorre de lesão ou mau funcionamento das fibras do nervo facial. É uma enfermidade que causa enorme impacto estético e funcional. O topodiagnóstico e o tratamento da paralisia facial periférica pode requer abordagem médica e fonoaudiológica; ser exclusivamente medicamentoso ou associado à terapia de reabilitação, ou ainda, medicamentoso e cirúrgico, seguido da reabilitação da mímica facial. A via FCM tem sido usada para a descompressão do NF quando a audição precisa ser preservada. Esse acesso pode ser realizado de forma isolada, ou combinado à via transmastóidea. Objetivo: Descrever uma técnica inovadora para a descompressão do nervo facial via fossa craniana média que permite a exposição direta dos segmentos labiríntico e timpânico do nervo facial, com a preservação da função da orelha interna. Métodos: Vinte cabeças extraídas de cadáveres adultos de ambos os gêneros, sem sinais de malformação, traumatismo, doença ou manipulação cirúrgica prévia foram usados neste estudo. Os pontos de referência utilizados foram a artéria meníngea média, o nevo petroso superficial maior, a eminência arqueada, o seio petroso superior, e o plano meatal seguido no ápice petroso a partir da sua porção mais anterior e medial. Foi feita a dissecação do plano meatal, com visualização do meato acústico interno, seguido no ápice petroso a partir da sua porção mais anterior e medial até a região do gânglio geniculado. Foi aberto o tégmen timpânico e identificada a porção timpânica do nervo facial. A dissecação seguiu no sentido retrógrado da porção timpânica do nervo facial em direção ao gânglio geniculado, até a sua porção labiríntica. A aracnoide do meato acústico interno era aberta, e depois de identificado o nervo facial, a bainha deste nervo era aberta em extensão exposta. Resultados: As distâncias médias, entre o canal semicircular...
Background: Peripheral facial palsy is characterized by the permanent or temporary interruption of the functioning of the facial muscles. The middle cranial fossa (MCF) approach has been used for the decompression of the facial nerve (FN) when hearing needs to be preserved. In this work, we describe an innovative technique for the decompression of the FN through the MCF approach that allows the direct exposure of the labyrinthine and entire tympanic segment of the FN, with the preservation of inner ear function. Methods: Twenty cadavers heads were used in this study. The reference landmarks used were the middle meningeal artery, the greater superficial petrosal nerve, the arcuate eminence, the inferior petrosal sinus and the meatal plane following the petrous apex from its most anterior and medial portion. Results: The tympanic segment of the FN presented, on average, a total length of 11 ± 0.67mm to the right, and 11.5 ± 0.60mm to the left. The longitudinal lengths of bone window in the tegmen tympani were 16.8±1.67mm to the right, and 16.8 ± 1.20mm to the left. The cross-sectional lengths of the bone window in the tegmen tympani were 5.5 ± 1.20mm and 5.0±1.75mm to the right and left sides, respectively. The average value of elliptical area formed by the longitudinal and transversal lengths of the bone window made in the tegmen tympani were 72.5 ± 22.5mm2 to the right, and 65.9 ± 30.3mm2 to the left. Conclusion: The proposed technique can be used for the surgical decompression of the tympanic, labyrinthine and meatal segments of the FN through the MCF, without imposing a risk to hearing, in addition to reducing the surgical time and the risk to patients.
Asunto(s)
Humanos , Masculino , Femenino , Cadáver , Nervio Facial , Fosa Craneal Media/anatomía & histología , Fosa Craneal Media/cirugía , Hueso Temporal/anatomía & histología , Hueso Temporal/cirugíaRESUMEN
Introdução: A técnica clássica para o implante coclear é realizada por meio de mastoidectomia seguida de timpanotomia posterior. O acesso pela fossa craniana média provou ser uma alternativa valiosa, embora seja usada para o implante coclear, ainda sem normatização. Objetivo: Descrever um novo acesso pela fossa craniana média que expõe o giro basal da cóclea para o implante coclear. Métodos: Estudo anatômico de ossos temporais. Foram dissecados 50 ossos temporais. A cocleostomia foi realizada mediante um acesso via fossa craniana média, na porção mais superficial do giro basal da cóclea, usando o plano meatal e seio petroso superior como as principais referências anatômicas. Foi determinada a distância entre os pontos de referência, o ângulo entre o plano meatal e a cocleostomia, e a distância entre esta estrutura e a janela redonda. Foi realizada tomografia computadorizada em 5 dos ossos temporais utilizados neste estudo. Resultados: Em todos os 50 ossos temporais, apenas a porção mais superficial do giro basal da cóclea foi aberta e tanto as escalas timpânica como a vestibular foram visualizadas. As distâncias médias ± DP, menores e maiores, entre a cocleostomia e o plano meatal foram estimadas em 2,48±0,88mm e 3,11±0,86mm, respectivamente. A distância média da cocleostomia até a janela redonda foi de 8,38±1,96mm, e daquela até o seio petroso superior 9,19±1,59mm. As distâncias médias, menores e maiores, entre a cocleostomia e o eixo longo do plano meatal a partir da sua porção mais proximal foram estimadas em 6,63±1,38mm e 8,2±1,43mm, respectivamente. O valor médio do ângulo entre a cocleostomia e o plano meatal foi igual a 22,54±7,400. As tomografias computadorizadas demonstraram a inserção do feixe de eletrodos por meio do giro basal da cóclea até o seu ápice em todas as peças submetidas a este exame. Conclusão: A técnica proposta para identificar o giro basal da cóclea é simples e confiável. Igualmente, permite a visualização da escala timpânica e a...
Introduction: The classic technique for cochlear implantation uses mastoidectomy followed by posterior tympanotomy. The middle cranial fossa approach has proved to be a valuable alternative for cochlear implantation, although the standardization of this technique is still needed. Objectives: To describe a novel approach through the middle cranial fossa for exposing the cochlear basal turn for cochlear implantation. Materials And Methods: Anatomical temporal bone study. Fifty temporal bones were dissected. A cochleostomy was performed via a middle fossa approach on the most superficial part of the cochlear basal turn, using the meatal plane and superior petrous sinus as the main landmarks. The distance between the landmarks, the angle between the cochleostomy and the meatal plane, and the distance between this structure and the round window were measured. A computed tomography was performed on 5 of the studied temporal bones. Results: In all 50 temporal bones, only the superficial portion of the cochlear basal turn was uncovered. The cochlear exposure allowed both the scala tympani and vestibule to be exposed. The mean ± SD minor and major distances between the cochleostomy and the meatal plane were estimated to be 2.48±0.88mm and 3.11±0.86mm, respectively. The mean distance from the cochleostomy to the round window was 8.38±1.96mm, and that to the superior petrosal sinus was 9.19±1.59mm. The mean minor and major distances between the cochleostomy and the long axis of the meatal plane from its most proximal portion were estimated to be 6.63±1.38mm and 8.29±1.43mm, respectively. The mean angle between the cochleostomy and the meatal plane was 22.54±7.400. The computed tomography of all 5 temporal bones demonstrated the insertion of the implant array from the cochlear basal turn towards its apex. Conclusion: The proposed technique for identifying the cochlear basal turn is simple and trustworthy. Additionally, it enables visualization of the scala tympani...
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Cadáver , Implantación Coclear , Fosa Craneal Media/anatomía & histología , Fosa Craneal Media/cirugía , Implantación Coclear/métodos , Neuroanatomía , Hueso Temporal/anatomía & histología , Hueso Temporal/cirugía , Pérdida Auditiva Sensorineural/cirugía , Pérdida Auditiva Sensorineural/rehabilitación , Tomografía Computarizada por Rayos XRESUMEN
UNLABELLED: The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation. OBJECTIVE: To describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa. METHOD: Fifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy. RESULTS: Only the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani. CONCLUSION: The proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.
Asunto(s)
Implantación Coclear/métodos , Fosa Craneal Media/cirugía , Hueso Temporal/cirugía , Cadáver , Fosa Craneal Media/diagnóstico por imagen , Humanos , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
A técnica clássica para o implante coclear é realizada através de mastoidectomia e timpanotomia posterior. A abordagem pela fossa craniana média provou ser uma alternativa valiosa, embora venha sendo usada para o implante coclear apenas esporadicamente e sem normatização. OBJETIVO: Descrever uma nova abordagem para expor o giro basal da cóclea para o implante coclear através da fossa craniana média. MÉTODO: Cinquenta ossos temporais foram dissecados. A cocleostomia foi realizada através de uma abordagem via fossa craniana média, na parte mais superficial do giro basal da cóclea, usando o plano meatal e seio petroso superior como pontos de reparo. A parede lateral do meato acústico interno foi dissecada após o broqueamento e esqueletização do ápice petroso. A parede dissecada do meato acústico interno foi acompanhada longitudinalmente até a cocleostomia. Design: Estudo anatômico de osso temporal. RESULTADOS: Em todos os ossos temporais, apenas a parte superficial do giro basal da cóclea foi aberta. A exposição do giro basal da cóclea permitiu que as escalas timpânica e vestibular fossem visualizadas. Assim, não houve dificuldade na inserção do feixe de eletrodos através da escala timpânica. CONCLUSÃO: A técnica proposta é simples e permite exposição suficiente do giro basal da cóclea.
The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation. OBJECTIVE: To describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa. METHOD: Fifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy. RESULTS: Only the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani. CONCLUSION: The proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.
Asunto(s)
Humanos , Implantación Coclear/métodos , Fosa Craneal Media/cirugía , Hueso Temporal/cirugía , Cadáver , Fosa Craneal Media , Tomografía Computarizada por Rayos X , Hueso TemporalRESUMEN
OBJECTIVE: The purpose of this study is to analyze symptomatic middle fossa arachnoid cysts and describe the advantages of the endoscopic technique to manage those cases that should be resolved surgically. METHODS: The physiopathology is described, and the clinical manifestations are analyzed. The diagnostic methodology and the surgical indications are presented. The endoscopic surgical technique is described thoroughly, and the advantages of the method are stated based on a series of 28 operated cases. The endoscope of choice has been a rigid endoscope with a 0° lens. RESULTS: All the cases in our series were solved by means of the endoscopic technique. One patient developed meningitis, recovering with antibiotic treatment, and 3 patients developed subdural hygromas: 2 were treated by means of subdural-peritoneal shunting, and the remaining subdural hematoma required surgical drainage. All of the complications reported occurred in patients affected by cysts classified as Galassi type III. There was no mortality. CONCLUSIONS: The effectiveness of neuroendoscopic management of middle fossa arachnoid cysts has not yet been superseded by any other surgical treatment. It has been shown to be a simple, reliable, and fast procedure, with a low rate of complications and shorter hospital stay. In general, patients can resume their usual daily activities quite soon.
Asunto(s)
Quistes Aracnoideos/cirugía , Fosa Craneal Media/cirugía , Endoscopía/métodos , Neuroendoscopía/métodos , Procedimientos Neuroquirúrgicos/métodos , Quistes Aracnoideos/diagnóstico , Quistes Aracnoideos/fisiopatología , Endoscopía/efectos adversos , Humanos , Imagen por Resonancia Magnética , Neuroendoscopía/efectos adversos , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases. STUDY DESIGN: Retrospective case review. SETTING: Tertiary-care referral center with a well-established cochlear implant program. PATIENTS: Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation. INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients. MAIN OUTCOME MEASURES: Complications, hearing thresholds, and speech perception outcomes were evaluated. RESULTS: Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP. CONCLUSION: Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.
Asunto(s)
Implantación Coclear/métodos , Fosa Craneal Media/cirugía , Pérdida Auditiva/terapia , Procedimientos Quirúrgicos Otológicos/métodos , Adulto , Umbral Auditivo/fisiología , Quimioradioterapia/efectos adversos , Colesteatoma del Oído Medio/complicaciones , Colesteatoma del Oído Medio/cirugía , Implantación Coclear/efectos adversos , Fosa Craneal Media/anatomía & histología , Enfermedades del Oído/terapia , Nervio Facial/fisiología , Femenino , Pérdida Auditiva Bilateral/cirugía , Humanos , Masculino , Apófisis Mastoides/cirugía , Persona de Mediana Edad , Monitoreo Fisiológico , Neoplasias Nasofaríngeas/complicaciones , Neoplasias Nasofaríngeas/terapia , Procedimientos Quirúrgicos Otológicos/efectos adversos , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Percepción del Habla , Telemetría , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We aim to describe the technical details of the transzygomatic approach to intracranial surgery. The incision begins at the level of the inferior border of the zygomatic arch, anterior to the tragus, and extends towards the contralateral pupillary line. A subgaleal and interfascial dissection is performed. Then, the zygomatic arch is vertically sectioned twice and mobilized downwards, together with the masseter muscle. Next, a fronto-temporo-sphenoidal craniotomy is performed and complete exposure of the anterior temporal dura achieved. Thus, the surgical possibilities are: (i) intradural access to the middle fossa; (ii) intradural pretemporal access to the basal cisterns; (iii) intradural transtemporal access to the insular region; and (iv) extradural access to the middle fossa. The transzygomatic approach offers excellent exposure to the floor of the middle fossa and the lateral wall of the cavernous sinus (both intradurally and extradurally). Also, combined with a pretemporal approach, it affords a good view of the interpeduncular cistern; and using a transtemporal approach, it provides good access to the insular region.
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Fosa Craneal Media/cirugía , Craneotomía/métodos , Base del Cráneo/cirugía , Cráneo/cirugía , Cigoma/cirugía , Fosa Craneal Media/anatomía & histología , Craneotomía/tendencias , Humanos , Cráneo/anatomía & histología , Base del Cráneo/anatomía & histología , Resultado del Tratamiento , Cigoma/anatomía & histologíaAsunto(s)
Quistes Aracnoideos/complicaciones , Hematoma Subdural/complicaciones , Adolescente , Quistes Aracnoideos/diagnóstico , Quistes Aracnoideos/cirugía , Preescolar , Fosa Craneal Media/cirugía , Hematoma Subdural/diagnóstico , Hematoma Subdural/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Efusión Subdural , Tomografía Computarizada por Rayos XAsunto(s)
Adolescente , Preescolar , Humanos , Masculino , Quistes Aracnoideos/complicaciones , Hematoma Subdural/complicaciones , Quistes Aracnoideos/diagnóstico , Quistes Aracnoideos/cirugía , Fosa Craneal Media/cirugía , Hematoma Subdural/diagnóstico , Hematoma Subdural/cirugía , Imagen por Resonancia Magnética , Efusión Subdural , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To present an alternative technique of endoscope-controlled microneurosurgery for the treatment of middle fossa epidermoid cysts. METHODS: The three operations described were performed through an approximately 2-cm diameter temporal craniotomy after a straight skin incision was made. Resection was then performed under the magnification of a 30-degree rigid endoscope, which mandated the use of exclusively conventional microsurgical instruments. RESULTS: Total resection was accomplished in all three patients with large middle fossa epidermoid cysts through a small temporal corticectomy, without damage to neurovascular structures. CONCLUSION: This procedure allowed the association of a smaller craniotomy, better cosmetic results, and minor retraction of the brain to wide resection of the tumor and satisfactory functional outcomes.
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Encefalopatías/patología , Encefalopatías/cirugía , Fosa Craneal Media/patología , Fosa Craneal Media/cirugía , Quiste Epidérmico/patología , Quiste Epidérmico/cirugía , Microcirugia/métodos , Neuroendoscopía/métodos , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Procedimientos Neuroquirúrgicos/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: A surgical variation of the technique of facial translocation procedure is proposed, which has been called midfacial translocation for approach to the entire medial and lateral region of the middle third of the face, including the rhinopharynx, sphenoid sinus, pterygomaxillary fossa, odontoid process, and clivus. PATIENTS AND METHODS: The medical records of five treated patients accordingly were reviewed for an analysis of the surgical technique, the disease, the topography of the lesion, and the complications. RESULTS: The approach permitted ventral decompression of the bulbomedullary junction with resection of the C1 arch and the odontoid process in four patients and resection of a chordoma of the clivus located along the midline and extending intradurally in the fifth patient. Only one patient presented with dehiscence of the posterior half of the soft palate, this being the only complication observed following surgery in these patients. Three months postoperatively, no patient presented any aesthetic alteration of the face. Functionally, there was only infraorbital hypoaesthesia on the side of flap rotation. CONCLUSION: The technique of midfacial translocation provides both good surgical approach and access to the rhinopharynx, pterygomaxillary fossa, high odontoid process and clivus, with few adverse sequelae for the patient.
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Fosa Craneal Posterior/cirugía , Cara/cirugía , Huesos Faciales/cirugía , Nasofaringe/cirugía , Apófisis Odontoides/cirugía , Cordoma/cirugía , Fosa Craneal Media/cirugía , Descompresión Quirúrgica , Duramadre/cirugía , Estudios de Seguimiento , Humanos , Hipoestesia/etiología , Persona de Mediana Edad , Órbita/inervación , Paladar Blando/patología , Platibasia/cirugía , Estudios Retrospectivos , Neoplasias de la Base del Cráneo/cirugía , Seno Esfenoidal/cirugía , Colgajos Quirúrgicos , Dehiscencia de la Herida Operatoria/etiologíaRESUMEN
BACKGROUND: Trigeminal neuralgia is a common cause of facial pain, characterized by shock-like pain affecting one or more branches of the trigeminal nerve. When conservative treatment fails and microdecompression is not indicated, percutaneous procedures are helpful. This percutaneous approach is done by a puncture up to the Gasserian ganglion, through the foramen ovale. Although simple and safe, this puncture demands some expertise from neurosurgeons. For that, a partnership between neurosurgeons and bio-engineers has developed a model for foramen ovale puncture, allowing practice for residents and young neurosurgeons. METHOD: A model for foramen ovale puncture has been created by interposition of synthetic materials over a skull, simulating the human face. FINDINGS: This model has shown great similarity with that found in conventional surgeries, even upon repeated testing by experienced functional neurosurgeons and young residents. CONCLUSION: This model for foramen ovale puncture training has demonstrated valuable help for initial practicing of this common neurosurgical procedure, particularly in centers where there are not many cadavers available for training.
Asunto(s)
Fosa Craneal Media/cirugía , Modelos Anatómicos , Procedimientos Neuroquirúrgicos/educación , Base del Cráneo/cirugía , Ganglio del Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Ablación por Catéter/métodos , Fosa Craneal Media/anatomía & histología , Desnervación/métodos , Cara/anatomía & histología , Humanos , Internado y Residencia/métodos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/fisiopatología , Complicaciones Intraoperatorias/prevención & control , Neurocirugia/educación , Procedimientos Neuroquirúrgicos/métodos , Elastómeros de Silicona , Base del Cráneo/anatomía & histología , Enseñanza/métodos , Ganglio del Trigémino/anatomía & histología , Ganglio del Trigémino/fisiopatología , Nervio Trigémino/anatomía & histología , Nervio Trigémino/fisiopatología , Nervio Trigémino/cirugía , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/fisiopatologíaRESUMEN
BACKGROUND: There are few reports on the outcome of surgical treatment of TGN without vascular compression. METHODS: Between 1984 and 2004, 668 patients underwent MVD for TGN. In 21 patients (3.1%), vascular compression was absent. The surgical strategy in these cases involved the following: (1) dissection and exposure of the entire trigeminal nerve root; (2) slight neurapraxia with bipolar tips at the trigeminal nerve root; and (3) isolation of trigeminal nerve with Teflon sponge fragments. RESULTS: The patients' (female/male, 20:1) ages ranged from 33 to 77 years. Their right side was the most frequently involved (61.9%). Their mean duration of pain before treatment was 7.6 years (range = 1-20 years). At surgical exploration, vascular compression or anatomical abnormalities were absent in 15 patients (71.4%), arachnoidal thickening was present in 5 (23.8%), and fiber dissociation of the trigeminal nerve was present in 1 (4.8%). Mean follow-up after surgery was 17.7 months (range = 4-65 months). Immediate relief from pain occurred in all 21 patients. On Kaplan-Meier analysis, recurrence was maintained at 14.8% for 12, 24, and 36 months, increasing to 43.2% at 48 months. Permanent hypoesthesia was present in 6 patients (28.6%), whereas loss of corneal reflex was observed transiently in 1 (4.8%). Motor function of the trigeminal nerve was intact in all patients. No other complication was found. CONCLUSION: The proposed surgical plan of standard MVD plus slight trigeminal nerve root neurapraxia is a safe and effective management option for TGN without vascular compression.
Asunto(s)
Descompresión Quirúrgica/métodos , Procedimientos Neuroquirúrgicos/métodos , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Aracnoides/patología , Aracnoides/fisiopatología , Arteria Basilar/patología , Arteria Basilar/fisiopatología , Fosa Craneal Media/anatomía & histología , Fosa Craneal Media/patología , Fosa Craneal Media/cirugía , Descompresión Quirúrgica/instrumentación , Descompresión Quirúrgica/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Estudios Prospectivos , Resultado del Tratamiento , Nervio Trigémino/patología , Nervio Trigémino/fisiopatología , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/fisiopatología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/patología , Insuficiencia Vertebrobasilar/fisiopatologíaRESUMEN
Há vários aspectos controversos no tratamento da paralisia facial traumática. Um destes é a natureza precisa da intervenção cirúrgica a ser usada, uma vez que a decisão de ser realizada tenha sido feita. FORMA DE ESTUDO: Clínico retrospectivo. OBJETIVOS E MÉTODOS: Entre o período de junho de 1984 e junho de 1993, 220 casos de paralisia facial traumática com boa função coclear foram tratados na Universidade de São Paulo pela seguinte técnica cirúrgica: descompressão dos segmentos mastóideo e timpânico através do acesso transmastoídeo e descompressão do gânglio geniculado e dos 50 por cento distais do segmento labiríntico, usando-se o acesso pela fossa média. Apresentamos uma revisão de literatura e a discussão e resultados de nosso trabalho.
Asunto(s)
Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fosa Craneal Media/cirugía , Traumatismos del Nervio Facial/cirugía , Parálisis Facial/cirugía , Ganglio Geniculado/cirugía , Complicaciones Posoperatorias , Estudios ProspectivosRESUMEN
There are several controversial aspects to the management of traumatic facial paralysis. One of these involves the precise nature of surgical intervention once the decision to operate has been made. Between June 1, 1984, and June 30, 1993, we surgically treated 220 cases of traumatic facial paralysis with good cochlear reserve by decompressing the tympanic and mastoid segments via a transmastoid approach followed by decompression of the geniculate ganglion and the distal half of the labyrinthine segment via a middle fossa approach. We discuss the results of surgery via the middle fossa approach, and we review the literature.