Single flap fronto-temporo-orbito-zygomatic craniotomy for skull base lesions.
(33/308)
Surgery was performed, through single flap fronto-temporo-orbito-zygomatic approach in 22 patients with skull base lesions. In two of these patients, this approach was combined with a transpetrosal approach. The pathological spectrum consisted of trigeminal neurofibromas (5), spheno-orbital meningiomas (4), carotico-ophthalmic aneurysms (4), basilar top aneurysms (2), cavernous sinus haemangiomas (2), invasive pituitary tumours (2) and one patient each of metastatic adenocarcinoma of the cavernous sinus, transcranial fungal granuloma and tubercular granuloma of the cavernous sinus. Of the 14 tumours, 10 were excised totally/near totally while a subtotal excision was achieved in four. Removal of the anterior clinoid process facilitated the clipping of all the carotico-ophthalmic aneurysms. One basilar top aneurysm was wrapped and the other clipped. One patient of fungal granuloma died of fungal meningitis and one patient of basilar top aneurysm expired as a result of thalamic infarct. The advantages of this approach included excellent exposure of the skull base lesions, making the dissection distance shorter and wider, minimal brain retraction and easy replacement of the single bone flap. (+info)
Extended frontobasal approach to the skull base.
(34/308)
The extended frontobasal approach provides an adequate midline exposure from the anterior cranial fossa to the sphenoclival region. Between November 1991 and August 1999, 13 patients with extensive anterior and anterolateral skull base tumours extending to supra and parasellar regions, cavernous sinus and sphenoclival regions were operated upon using this approach alone (7 patients) or in combination with subtemporal -infratemporal (4 patients) or transfacial (2 patients) approaches. Gross total excision was performed in 8 patients while in 4 patients with malignant tumours and in a patient with extensive skull base fungal granuloma, only partial excision was possible. Basal repair was performed using pedicled pericranium, temporalis muscle or fascia lata. The complications included increase in the cranial nerve paresis, endophthalmitis, facial oedema, CSF leak, frontal haematoma and internal carotid artery injury. This study reviews the operative technique, the indications and the complications of extended frontobasal approach. (+info)
Massive aneurysmal bone cyst of the anterior cranial fossa floor--case report.
(35/308)
A 19-year-old male patient presented with a midline facial, nose, and forehead hard and bony swelling associated with hypertelorism. Neuroimaging revealed a massive tumor involving the anterior cranial fossa floor, which had occupied and enlarged all paranasal air sinuses, and displaced the orbits outwards and the frontal lobes of the brain superiorly. A basal transcranial route was used for radical resection of the massive and vascular tumor. Histological examination confirmed an aneurysmal bone cyst. Such tumors only rarely involve the cranial bones or paranasal air sinuses. (+info)
Morphological differences in the craniofacial structure between Japanese and Caucasian girls with Class II Division 1 malocclusions.
(36/308)
The craniofacial features of 49 Japanese and 75 British Caucasian girls with Class II division 1 malocclusions were evaluated from lateral cephalometric radiographs, and the morphological differences between both races were examined. The subjects' ages ranged from 11 years 1 month to 12 years 11 months. The mean values of 13 linear and 13 angular cephalometric parameters were compared. The Japanese Class II division 1 sample had a significantly shorter anterior cranial base length (S-N; P < 0.001) and a more obtuse articular angle (S-Ar-Go; P < 0.001). Analysis of the dentoalveolar components in Japanese subjects showed more proclined lower incisors (L1/Go-Me; P < 0.05) and a steeper occlusal plane (Occ.P/S-N; P < 0.01) relative to those of Caucasians. The short anterior cranial base length and excessive vertical development in the Japanese population might be common racial morphological features, but the main reason for the Class II division 1 skeletal disharmony in both races was different; it was caused by the anteriorly positioned maxilla in Caucasians and the backward rotated mandible in the Japanese. (+info)
Cephalometric measurements and facial deformities in subjects with beta-thalassaemia major.
(37/308)
This study was performed to identify cephalometric and facial features of patients with beta-thalassaemia major. A total of 54 thalassaemic subjects were examined for craniofacial deformities, including 37 patients (24 males and 13 females, aged 5-16 years) who had lateral cephalometric radiographs. The thalassaemic groups were compared with a normal control group matched for sex and dental age, using a t-test. All thalassaemic patients had a Class II skeletal base relationship. The average ANB angle was significantly larger than the controls in dental stages 2 and 3 (P < 0.05). Mandibular base length (Ar-Gn) was significantly less in thalassaemic patients than in controls, with the greatest differences (P < 0.001) found in the younger age group. The maxilla was of normal length (PNS-ANS, Ptm'-ANS') and appeared prominent (3.3 mm in males and 5.1 mm in females) due to a reduced cranial base length (Ar'-S') and a short mandible (Ar'-P'). Vertically, thalassaemic patients showed a significantly increased maxillary/mandibular planes angle in all groups, with differences ranging between 6.19 and 12.55 degrees (P < 0.001). Thalassaemic patients also showed a reduced posterior facial height (S-Go, Ar-Go) and increased anterior facial proportions. Of the 54 thalassaemic patients examined, 17 per cent had severe facial disfigurements (grade 3). (+info)
Preservation of the olfactory tract in bifrontal craniotomy.
(38/308)
The bifrontal craniotomy approach used to be associated with a high percentage of olfactory tract damage. We present our experience with this technique, that was used with excellent results in a series of 11 patients that underwent the surgical approach described in this paper. We support the idea that bilateral subfrontal craniotomy allows a wide operative exposure as well as the complete anatomic and functional preservation of the olfactory tracts bilaterally. (+info)
Ultrasound evaluation of the fetal skull base throughout pregnancy.
(39/308)
OBJECTIVE: To construct nomograms for cranial base parameters of normal fetuses. STUDY DESIGN: A cross-sectional study of 386 normal singleton fetuses at 14-40 weeks' gestation. Measurements of the length and width of the sphenoid bone anteriorly and the otic cartilage posteriorly and of the angles between the ridges were obtained. RESULTS: Nomograms of the length and width of sphenoid ridge and otic cartilage, and of the angles in the cranial fossae are presented. A linear growth function was observed between cranial base measurements (sphenoid ridge length, otic cartilage length, cranial base angles) and gestational age, femur length and biparietal diameter. CONCLUSION: Measurements of the length of cranial base ridges and the angles between them can be obtained easily in the second and third trimesters and might prove useful in the evaluation of pregnancies at high risk for associated fetal abnormalities. (+info)
Relationship between cranial base structure and maxillofacial components in children aged 3-5 years.
(40/308)
The aim of this study was to clarify the inter-relationships between cranial base angle, the morphological variations of maxillofacial components, and growth of the anterior cranial base length. One hundred and twenty-two Japanese children aged 3-5 years with normal occlusion in the primary dentition were included in this investigation. To analyse the relationship between cranial base structure and maxillofacial components, the subjects were divided into three groups according to facial type (prognathic, orthognathic, or retrognathic) assessed by the magnitude of their NSAr angle (as cranial base angle). These categorized cephalometric profiles suggested that the antero-posterior location of the maxillofacial components corresponded to the NSAr angle. Factor analysis of cephalometric variables showed that the variation of maxillofacial components from the S-N line was strongly related to the cranial base angle. This normal range of morphological variation was distinguished from that of growth by the factor loadings. From these results, theoretical models of cephalometric profiles with normal occlusion were computed by linear regression analysis. Using the models, a standard profile related to an arbitrary cranial base angle was obtained for children with normal occlusion, aged 3-5 years. (+info)