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Caetano Coimbra - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment of cerebrospinal fluid fistulae involving lateral extension of the sphenoid sinus
Neurosurgery, 1998Co-Authors: Fraser E Landreneau, Bruce E Mickey, Caetano CoimbraAbstract:OBJECTIVE AND IMPORTANCE: Four cases of spontaneous cerebrospinal fluid rhinorrhea caused by communication between the subarachnoid space of the middle cranial fossa and a lateral extension of the sphenoid sinus are presented. The cause and management of this unique type of cranial base defect are discussed. CLINICAL PRESENTATION: During the past 10 years, four patients referred to our institution with atraumatic cerebrospinal fluid fistulae were observed to have temporal encephaloceles (Encephalomeningoceles) traversing the floor of the middle cranial fossa. Three of the patients had previously undergone unsuccessful transnasal attempts to repair their fistulae by obliteration of the sphenoid sinus. The fourth patient presented before undergoing any treatment. No patient had associated hydrocephalus or tumor. Preoperative computed tomographic cisternograms revealed that all fistulae involved a lateral extension of the sphenoid sinus into the floor of the middle cranial fossa. INTERVENTION: After definitive localization, each patient was operated on transcranially through an anterior middle cranial fossa approach with extradural and/or intradural exploration. The associated temporal encephalocele was amputated or disconnected, and the dehiscent dura and middle cranial fossa floor defect were oversewn and packed with autogenous tissue, respectively. CONCLUSION: The surgical treatment of cerebrospinal fluid rhinorrhea secondary to middle fossa encephalocele associated with lateral extension of the sphenoidal sinus differs from the surgical strategy for more medial sphenoidal fistulae. Fistulae involving a lateral extension of the sphenoid sinus require a transcranial approach for direct visualization and obliteration of the defect, whereas fistulae involving the central portion of the sinus may be successfully obliterated transsphenoidally.
Fraser E Landreneau - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment of cerebrospinal fluid fistulae involving lateral extension of the sphenoid sinus
Neurosurgery, 1998Co-Authors: Fraser E Landreneau, Bruce E Mickey, Caetano CoimbraAbstract:OBJECTIVE AND IMPORTANCE: Four cases of spontaneous cerebrospinal fluid rhinorrhea caused by communication between the subarachnoid space of the middle cranial fossa and a lateral extension of the sphenoid sinus are presented. The cause and management of this unique type of cranial base defect are discussed. CLINICAL PRESENTATION: During the past 10 years, four patients referred to our institution with atraumatic cerebrospinal fluid fistulae were observed to have temporal encephaloceles (Encephalomeningoceles) traversing the floor of the middle cranial fossa. Three of the patients had previously undergone unsuccessful transnasal attempts to repair their fistulae by obliteration of the sphenoid sinus. The fourth patient presented before undergoing any treatment. No patient had associated hydrocephalus or tumor. Preoperative computed tomographic cisternograms revealed that all fistulae involved a lateral extension of the sphenoid sinus into the floor of the middle cranial fossa. INTERVENTION: After definitive localization, each patient was operated on transcranially through an anterior middle cranial fossa approach with extradural and/or intradural exploration. The associated temporal encephalocele was amputated or disconnected, and the dehiscent dura and middle cranial fossa floor defect were oversewn and packed with autogenous tissue, respectively. CONCLUSION: The surgical treatment of cerebrospinal fluid rhinorrhea secondary to middle fossa encephalocele associated with lateral extension of the sphenoidal sinus differs from the surgical strategy for more medial sphenoidal fistulae. Fistulae involving a lateral extension of the sphenoid sinus require a transcranial approach for direct visualization and obliteration of the defect, whereas fistulae involving the central portion of the sinus may be successfully obliterated transsphenoidally.
Tsung Lang Chiu - One of the best experts on this subject based on the ideXlab platform.
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One-Stage Operation for a Frontoethmoidal Encephalomeningocele Associated with Ventriculomegaly-A Case Report
Tzu Chi Medical Journal, 2006Co-Authors: Sheng-tzung Tsai, Chien Hsing Wang, Tsung Lang ChiuAbstract:Encephalomeningoceles, especially in the frontoethmoidal region, are a form of neural tube defect which affect patients in Southeast Asia more commonly than those in Western countries. We performed a 1-stage reconstruction and ventriculoperitoneal (V-P) shunt placement for a frontoethmoidal Encephalomeningocele in an 18-year-old male. We used the 3D reformation computed tomography (CT) and magnetic resonance imaging (MRI) to delineate the skull defect and the exit pathway of the herniated brain tissue and to determine the surgical strategy. The frontoethmoidal Encephalomeningocele was completely resected via a 1-stage operation. Neither hydrocephalus nor cerebrospinal fluid (CSF) rhinorrhea was noted after the operation. However, Klebsiella pneumoniae meningitis was diagnosed 2 weeks after the operation. The infection was cured by the use of meropenem. A good aesthetic result was achieved. A 1-stage operation is necessary for large frontoethmoidal Encephalomeningoceles and should be performed as early as possible in order to resect the mass, to reconstruct the defect, and to restore the aesthetic appearance with assistance of 3D reformation CT and MRI. A V-P shunt or extraventricular drainage (EVD) catheter placement needs to be considered during the operation for large Encephalomeningoceles coexisting with hydrocephalus.
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One-Stage Operation for a Frontoethmoidal Encephalomeningocele Associated with Ventriculomegaly-A Case Report
Tzu Chi Medical Journal, 2006Co-Authors: Sheng-tzung Tsai, Chien Hsing Wang, Tsung Lang ChiuAbstract:Encephalomeningoceles, especially in the frontoethmoidal region, are a form of neural tube defect which affect patients in Southeast Asia more commonly than those in Western countries. We performed a 1-stage reconstruction and ventriculoperitoneal (V-P) shunt placement for a frontoethmoidal Encephalomeningocele in an 18-year-old male. We used the 3D reformation computed tomography (CT) and magnetic resonance imaging (MRI) to delineate the skull defect and the exit pathway of the herniated brain tissue and to determine the surgical strategy. The frontoethmoidal Encephalomeningocele was completely resected via a 1-stage operation. Neither hydrocephalus nor cerebrospinal fluid (CSF) rhinorrhea was noted after the operation. However, Klebsiella pneumoniae meningitis was diagnosed 2 weeks after the operation. The infection was cured by the use of meropenem. A good aesthetic result was achieved. A 1-stage operation is necessary for large frontoethmoidal Encephalomeningoceles and should be performed as early as possible in order to resect the mass, to reconstruct the defect, and to restore the aesthetic appearance with assistance of 3D reformation CT and MRI. A V-P shunt or extraventricular drainage (EVD) catheter placement needs to be considered during the operation for large Encephalomeningoceles coexisting with hydrocephalus.
Charan Mahatumarat - One of the best experts on this subject based on the ideXlab platform.
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Risk factors associated with the occurrence of frontoethmoidal Encephalomeningocele.
European Journal of Paediatric Neurology, 2008Co-Authors: Kanya Suphapeetiporn, Charan Mahatumarat, Sumarlee Srivuthana, Nond Rojvachiranonda, Chopiew Taecholarn, Pichit Siriwan, Vorasuk ShotelersukAbstract:Abstract Objectives To determine factors associated with the occurrence of frontoethmoidal Encephalomeningocele (FEEM), a congenital defect with unique geographical distribution. Methods The subjects of this study were 160 unrelated cases of FEEM. Subjects were recruited between 1999 and 2006 from 15 medical centers throughout Thailand. Data obtained from FEEM cases were analyzed and compared with data from 349 cases of oral clefts studied in the same centers and during the same time and those from the general population (GP) taken in 2003. Results About 52% of FEEM cases had brain anomalies which were not different among types of FEEM. We found familial aggregation reflected by an increased risk to siblings. All of the FEEM cases were of Thai nationality and came from low socioeconomic status. Seven FEEM cases had amniotic rupture sequences. Compared with oral clefts, advanced maternal age (OR: 1.08, 95% CI: 1.02–1.15) was found to be associated with FEEM. In addition, the interpregnancy interval between the FEEM cases and their previous siblings was significantly longer than that of the oral cleft patients and unaffected sibs (OR: 1.17, 95% CI: 1.06–1.28). Conclusions Low socioeconomic status, advanced maternal age, and a long interpregnancy interval may lead to an unfavorable intrauterine environment which, with a certain genetic background such as Thai ethnicity, could contribute to the occurrence of FEEM.
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Correction of the frontoethmoidal Encephalomeningocele with minimal facial incision: modified Chula technique.
Journal of Craniofacial Surgery, 2006Co-Authors: Nond Rojvachiranonda, Charan Mahatumarat, Chopeow TaecholarnAbstract:BACKGROUND At present all surgical techniques to correct the frontoethmoidal Encephalomeningocele require extensive incisions over the mass and perinasal area, thus adding scars to the already-disfigured faces. This study demonstrates a possibility of doing definitive surgery with minimal facial incision. METHODS The technique follows the principles of the "Chula technique," which is the one-stage definitive technique without formal frontal craniotomy. However facial incision was kept to minimum, or even avoided, while amputation of the herniation, dural repair, skull defect closure, and repositioning of the medial canthal ligaments were performed mainly via the coronal incision. RESULTS There were 20 patients operated on using this modified Chula technique. No perinasal incision was needed at all in three patients (15%) with F1 masses (small- and medium-sized masses according to the "FEEM classification"). Three patients with F1 masses had only small stab incisions just medial to the medial canthus for medial canthopexy. The rest (70%) consisting of two F2 (large-sized) masses and twelve F1 masses had limited nasal incisions just to help removing the facial masses and correcting facial deformity. With an average of 287 days of follow-up period (14-997 days), there had been no cerebrospinal fluid leakage or disease recurrence. CONCLUSIONS Correction of the frontoethmoidal Encephalomeningocele can be done safely via the coronal incision alone while facial incision can be omitted or, if necessary, kept to minimum.
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Frontoethmoidal Encephalomeningocele: surgical correction by the Chula technique.
Plastic and Reconstructive Surgery, 2003Co-Authors: Charan Mahatumarat, Nond Rojvachiranonda, Chopoew TaecholarnAbstract:This study reevaluates a surgical technique known as the Chula technique, previously reported in 1991 for correction of frontoethmoidal Encephalomeningocele. From 1986 to 1999, 108 patients were operated on with this technique, which could remove the herniation mass, repair dural and bone defects, reconstruct the naso-orbital area, and restore aesthetic facial appearance in a single stage. Formal frontal craniotomy was not necessary. The result has been very satisfying in terms of safety, cure rate, and aesthetic outcome. Spontaneous improvement of lacrimal passage obstruction occurred in 85.2 percent of cases, and dacryocystorhinostomy was required in the rest. There was no mortality. Complications (e.g., wound infection, 6.5 percent; wire extrusion, 3.7 percent; meningitis, 2.8 percent; cerebrospinal fluid leakage, 2.8 percent; and postoperative increased intracranial pressure, 2.8 percent) were much less frequent than in other reports. With a mean follow-up period of 439 days (maximum, 12 years), there has been no recurrence.
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Spontaneous closure of bony defect in a frontoethmoidal Encephalomeningocele patient.
Journal of Craniofacial Surgery, 1999Co-Authors: Charan Mahatumarat, Chopeow Taecholarn, Nond RojvachiranondaAbstract:The frontoethmoidal Encephalomeningocele (FEEM) is a congenital herniation of meninges and brain tissue through the skull bony defect at the foramen cecum. The size of the defect may vary from a few millimeters to many. Those patients with a small defect may not always require a risky operation during childhood. We report on an infant whose bony defect has closed spontaneously with definite clinical evidence. It is proved that the skull defect and brain herniation are able to heal naturally, and this affirms an existence of the abortive subtype of FEE. Conservative treatment may be considered in those with a small bony defect, and surgery can be considered later when it is required.
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One-stage extracranial repair and reconstruction for frontoethmoidal Encephalomeningocele: a new simple technique.
Journal of Craniofacial Surgery, 1991Co-Authors: Charan Mahatumarat, Chopoew Taecholarn, Thavorn CharoonsmithAbstract:Forty-five patients born with frontoethmoidal Encephalomeningoceles were treated using the craniofacial technique of one-stage extracranial repair and reconstruction. The operation begins with a bicoronal scalp flap, involving frontonasosuperomedial orbital wall osteotomy, reduction of the interorbital distance by nasal bone segment removal, hernial sac amputation and dural repair, medial orbital wall mobilization, medial canthopexy, and rib augmentation rhinoplasty. The result was very satisfactory. This new method has undoubtedly contributed in a major way to the improved results in frontoethmoidal Encephalomeningocele treatment. We believe that the main advantages of this technique are that it offers a simple procedure for simultaneous correction of both soft tissue and bony deformities. The direct and external access to the neck of the hernial sac renders more secure dural repair with almost negligible cerebrospinal fluid leakage and eventually none of the postoperative brain sequelae. The postoperative course is less eventful and requires a shorter hospital stay than previous procedures.
Bruce E Mickey - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment of cerebrospinal fluid fistulae involving lateral extension of the sphenoid sinus
Neurosurgery, 1998Co-Authors: Fraser E Landreneau, Bruce E Mickey, Caetano CoimbraAbstract:OBJECTIVE AND IMPORTANCE: Four cases of spontaneous cerebrospinal fluid rhinorrhea caused by communication between the subarachnoid space of the middle cranial fossa and a lateral extension of the sphenoid sinus are presented. The cause and management of this unique type of cranial base defect are discussed. CLINICAL PRESENTATION: During the past 10 years, four patients referred to our institution with atraumatic cerebrospinal fluid fistulae were observed to have temporal encephaloceles (Encephalomeningoceles) traversing the floor of the middle cranial fossa. Three of the patients had previously undergone unsuccessful transnasal attempts to repair their fistulae by obliteration of the sphenoid sinus. The fourth patient presented before undergoing any treatment. No patient had associated hydrocephalus or tumor. Preoperative computed tomographic cisternograms revealed that all fistulae involved a lateral extension of the sphenoid sinus into the floor of the middle cranial fossa. INTERVENTION: After definitive localization, each patient was operated on transcranially through an anterior middle cranial fossa approach with extradural and/or intradural exploration. The associated temporal encephalocele was amputated or disconnected, and the dehiscent dura and middle cranial fossa floor defect were oversewn and packed with autogenous tissue, respectively. CONCLUSION: The surgical treatment of cerebrospinal fluid rhinorrhea secondary to middle fossa encephalocele associated with lateral extension of the sphenoidal sinus differs from the surgical strategy for more medial sphenoidal fistulae. Fistulae involving a lateral extension of the sphenoid sinus require a transcranial approach for direct visualization and obliteration of the defect, whereas fistulae involving the central portion of the sinus may be successfully obliterated transsphenoidally.