The supraorbital keyhole approach with eyebrow incisions for treating lesions in the anterior fossa and sellar region.
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BACKGROUND: Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to describe and evaluate the results of surgical treatment of lesions in the anterior fossa and sellar region via a supraorbital keyhole approach using eyebrow incisions. METHODS: Between April 1994 and July 2003, 54 patients with lesions in the anterior fossa and sellar region were operated on via the supraorbital keyhole approach. The surgical results were studied retrospectively and compared with that of patients with lesions at the same locations but treated via a conventional subfrontal approach. RESULTS: No significant difference in curative effect was found between the conventional subfrontal approach and the supraorbital keyhole approach. However, the supraorbital approach required a much smaller skin incision, causing less surgical trauma, while achieving excellent surgical exposure and good recovery. CONCLUSION: The supraorbital keyhole approach using an eyebrow incision is safe, effective, and both suitable and convenient for treating lesions in the anterior fossa and sellar region, with almost no adverse consequences on the facial features of patients. (+info)
Detection of enlarged cortical vein by magnetic resonance imaging contributes to early diagnosis and better outcome for patients with anterior cranial fossa dural arteriovenous fistula.
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Twelve patients (10 men, 2 women) with anterior cranial fossa dural arteriovenous fistula (AVF) were treated at our institute between January 1976 and March 2002. Intracranial hemorrhage was the presenting symptom in six patients. Magnetic resonance (MR) imaging findings identified abnormal cortical veins as flow voids in four of five patients. Angiography was the basis of the diagnosis in all patients. Surgery was the primary treatment in nine patients. The other three patients refused intervention and managed conservatively. Surgical morbidity was negligible and the treatment outcome was highly dependent on the clinical status at presentation. In contrast to the reported high incidence of intracranial hemorrhage in patients with dural AVF in the anterior cranial fossa, only half of our study population presented with hemorrhage. Enlarged cortical veins in the frontobasal area could be detected as flow voids on MR images. This finding contributed to the early diagnosis and treatment of patients treated at our institution for dural AVF in the anterior cranial fossa, and to the better outcomes we obtained in these patients. (+info)
Craniofacial resection for cranial base malignancies involving the infratemporal fossa.
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OBJECTIVE: Cranial base malignancies involving the infratemporal fossa have been considered unresectable. Advanced operative techniques have made tumor resection feasible in an en bloc fashion with negative histological margins, but there are limited data regarding outcome analysis in patients who have undergone resection of malignant tumors in this area. METHODS: At Memorial Sloan-Kettering Cancer Center, 25 patients underwent anterolateral cranial base resections for tumors that involved the infratemporal fossa during a 7-year period. The most common tumors were sarcoma (n = 9), squamous cell carcinoma (n = 6), and adenoid cystic carcinoma (n = 3). The median size of the tumors was 6 cm, and 12 tumors involved the anterior cranial base and/or orbit. Tumor resections were divided into three types. Twelve patients underwent Type 1 dissection for tumors involving only the infratemporal fossa and maxillary sinus; 2 patients underwent Type 2 dissections involving the infratemporal fossa and anterior cranial base; and 11 patients underwent Type 3 dissection, which included the infratemporal fossa, anterior cranial base, and orbit. All patients required free flap reconstruction, 22 of which were rectus abdominis free flaps. RESULTS: Complications occurred in seven patients, including a single mortality resulting from a myocardial infarction. The 2-, 3-, and 5-year survival rates were 69, 63, and 56%, respectively. The relapse-free survival rates were 47% at 2 and 3 years and 41% at 5 years. Recurrences were local in nine patients and distant in four patients. CONCLUSION: Despite the extensive nature of many infratemporal fossa tumors, they can be resected with acceptable morbidity. Survival rates approach those of anterior cranial base malignancies without infratemporal fossa involvement. (+info)
Anterior ethmoidal artery aneurysm and intracerebral hemorrhage.
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The association between the formation of intracranial aneurysms and situations of increased blood flow in certain areas of the brain is well accepted today. It has been seen in association with arteriovenous malformations of the brain, carotid occlusion, and Moyamoya disease. The occurrence of aneurysms in small arteries of the skull base, with the exception of the intracavernous carotid artery, however, is rare. We report a case of a 55-year-old woman who presented with an intracerebral hemorrhage caused by a ruptured anterior ethmoidal artery aneurysm. To the best of our knowledge, this is only the second case of documented intracranial bleeding from such a lesion. (+info)
Venous aneurysm development associated with a dural arteriovenous fistula of the anterior cranial fossa with devastating hemorrhage--case report.
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A 67-year-old man presented with devastating intracranial hemorrhage (ICH) from an anterior cranial fossa dural arteriovenous fistula (DAVF). Four years earlier, digital subtraction angiography had disclosed a DAVF at the right anterior cranial fossa fed mainly by the ethmoidal branches of the bilateral sphenopalatine arteries and slightly by the ethmoidal arteries of the bilateral ophthalmic arteries, and drained primarily by the sphenoparietal and cavernous sinuses via two dilated cortical veins and slightly by the superior sagittal sinus via a frontal ascending vein. Three-dimensional computed tomography angiography revealed the development of a venous aneurysm on the main draining vein over a 4-year period, but no other changes. Venous aneurysm development may be part of the natural history of DAVF with cortical venous drainage and may contribute to the occurrence of ICH. (+info)
Usefulness of T2*-weighted MR sequence for the diagnosis of subfrontal schwannoma.
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Subfrontal schwannomas are rare tumors that are usually diagnosed during surgery. They are often misdiagnosed as meningioma or esthesioneuroblastoma because of their similar clinical and radiological features. We report a case of schwannoma arising from the floor of the anterior cranial fossa that had radiological features similar to that of meningioma. However, T2*-weighted MR imaging revealed multiple foci of low signal intensities within the tumor related to microbleeds, which suggested a diagnosis of schwannoma that was confirmed by histopathology. This case report demonstrates the usefulness of T2*-weighted sequence in distinguishing meningioma from schwannoma, especially in cases where the tumor has an unusual location. (+info)
Osteoma of anterior cranial fossa complicated by intracranial mucocele with emphasis on its radiological diagnosis.
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We present a 43-year-old female patient who had recurrent headache for one year. An intracranial bony lesion surrounded by a cyst in the anterior cranial fossa was found on imaging. Postoperative histological examination confirmed the diagnosis of osteoma and mucocele. (+info)
Intracranial aspergilloma in immunocompetent patients successfully treated with radical surgical intervention and antifungal therapy: case series.
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INTRODUCTION: Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients with a high mortality. Surgical excision of the intracranial lesion combined with oral voriconazole has been proposed to improve the outcome in immunocompromised patients. Itraconazole has been considered not to be effective because of poor penetration into the brain tissue. We report the long-term outcome of 3 cases of intracranial aspergilloma in immunocompetent patients who were successfully treated with radical surgery combined with oral itraconazole. MATERIALS AND METHODS: This is a retrospective study in which chronic invasive intracranial aspergilloma was successfully treated in 3 apparently immunocompetent patients and followed-up for more than 5 years. RESULTS: Near complete or radical surgical removal of this localised chronic invasive intracranial aspergilloma whenever possible is the definitive treatment. When combined with the oral antifungal drug itraconazole, the management regimen is effective in achieving near complete long-term cure of more than 5 years. Oral itraconazole 200 mg twice daily should be given for a prolonged period of at least 6 months. CONCLUSION: In chronic invasive intracranial aspergilloma in an immunocompetent patient, it was suggested that radical excision of the intracranial aspergilloma combined with oral antifungal drug belonging to triazole group that can be either itraconazole or voriconazole given for a period of 6 months was likely to improve the long-term outcome. (+info)