Dandy-Walker syndrome successfully treated with cystoperitoneal shunting--case report.
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A neonate presented with Dandy-Walker syndrome manifesting as a large posterior cranial fossa cyst, aplasia of the lower cerebellar vermis, and elevation of the confluence of the sinuses but without hydrocephalus. A cystoperitoneal shunt was placed at one month after birth. The cyst diminished in size, and marked development of the cerebellar hemispheres and descent of the confluence of sinuses were observed, but not vermis development. The primary pathology of Dandy-Walker syndrome is posterior cranial fossa cyst formation due to passage obstruction in the fourth ventricle exit area and aplasia of the lower cerebellar vermis. The first choice of treatment in patients with Dandy-Walker syndrome in whom the cerebral aqueduct is open is cystoperitoneal shunt surgery, regardless of the presence or absence of hydrocephalus. (+info)
Infratemporal fossa approaches to the lateral skull base.
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The infra-temporal fossa approach is one of the lateral approaches to the skull base. It is indicated for the treatment of tumors such as glomus tumor, petrous apex cholesteatoma, chondroma, lower cranial nerve neuroma and nasopharyngeal cancer. In the present paper, we described the surgical anatomy of the lateral skull base and the indications for the infra-temporal fossa approach with its variants. We showed the hints and pitfalls in the procedures. Five illustrative cases are also presented. (+info)
Aseptic meningitis after posterior fossa surgery treated by pseudomeningocele closure.
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Aseptic meningitis is a recognised complication after posterior fossa surgery. It is often self limiting but occasionally runs a protracted course requiring repeated CSF examination to exclude infection, and treatment with systemic steroids. A patient is described with aseptic meningitis after posterior fossa surgery who underwent posterior fossa re-exploration nearly 3 years after the initial operation. This disclosed a pseudomeningocele, which was closed. The patient remains symptom free almost 2 years after closure. In this case of chronic aseptic meningitis after posterior fossa surgery, closure of the pseudomeningocele found at exploratory surgery led to resolution of the symptoms. (+info)
Recurrence of clival chordoma along the surgical pathway.
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Chordomas are locally aggressive malignant tumors of notochordal origin whose metastatic potential is increasingly recognized. Surgical pathway recurrence has been noted only rarely in the literature. We present three patients with clival chordomas whose sole or initial recurrence was along the pathway of prior surgical access. A characteristic mass found along the pathway of prior surgical access for resection of a chordoma should suggest recurrent chordoma. (+info)
The use of craniotomy to approach supratentorial lesions is quite well established in the literature. The use of craniotomy for posterior fossa approaches, however, is not well described. The aim of this article is to describe the technical aspects of this approach and to delineate the important landmarks. In our cases, posterior fossa craniotomies have been utilized for treat different pathologies. Additionally, the technique has not added any additional risk, and the cosmetic results have been excellent. (+info)
A 21-year-old female presented with an unusual case of posterior fossa arteriovenous malformation (AVM) associated with ipsilateral persistent primitive trigeminal artery (PPTA), manifesting as intraparenchymal hemorrhage involving both the brain stem and the left cerebellar hemisphere. The presenting symptoms were compatible with Wallenberg's syndrome and Foville's syndrome on the left side. She was initially treated conservatively, and subsequently with transarterial embolization followed by stereotactic radiosurgery. This case combined the rare association of posterior fossa AVM and PPTA, with the clinical presentation of intraparenchymal hemorrhage causing both Wallenberg's syndrome and Foville's syndrome. (+info)
Cerebrospinal fluid seepage through polyglactin 910 dura substitute manifested as spinal extradural collection of fluid.
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Following excision of pilocytic astrocytoma, a 12-year-old girl underwent posterior cranial fossa synthetic duraplasty with polyglactin 910 mesh. On the 8th postoperative day, unusual extradural collection was diagnosed by spinal magnetic resonance imaging. On the 14th postoperative day, cerebrospinal fluid leakage in the upper part of the postoperative wound was noticed. Unusual extradural collection detected by spinal magnetic resonance imaging was assumed to be the consequence of cerebrospinal fluid seepage and a warning sign of cerebrospinal fluid leakage following synthetic posterior fossa duraplasty. This case shows that polyglactin 910 mesh may be ineffective when used for posterior cranial fossa duraplasty in children, although it is considered as valuable as autologous tissue. (+info)
Applicability and advantages of flow artifact-insensitive fluid-attenuated inversion-recovery MR sequences for imaging the posterior fossa.
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We describe a new sequence, flow artifact-insensitive fluid-attenuated inversion recovery (FAIS-FLAIR), that capitalizes on the advantages of fluid-attenuated inversion recovery (FLAIR) while minimizing FLAIR-related artifacts such as those often encountered in the posterior fossa. Twenty-eight patients with posterior fossa disease underwent FAIS-FLAIR, conventional FLAIR, and spin-echo MR studies, and the findings yielded by the three techniques were compared. In this patient population, postcontrast FAIS-FLAIR imaging was obtained in 20 patients and compared with postcontrast T1-weighted images. The images were assessed for lesion conspicuity by three radiologists. FAIS-FLAIR markedly reduces the inflow artifacts from noninverted CSF on FLAIR images. It does so with and without contrast agent administration, and produces higher lesion conspicuity compared with T1- and T2-weighted spin-echo sequences and conventional FLAIR images of the posterior fossa. (+info)