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Evolution of transmaxillary approach to tumors in pterygopalatine fossa and infratemporal fossa:anatomic simulation and clinical practice

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Chinese Medical Journal 2019年第7期132卷 798-804页

作者： Zhan Xue Jian Liu Zhi-Yong Bi Zhi-Qiang Yi Sheng-De Bao Pi-Nan Liu Zhi-Jun Yang Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China Department of Neurosurgery Peking University First HospitalBeijing 100034China

Background:The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa(PPF)and infratemporal fossa(ITF).Herein,this study aimed to describe a modified approach for resection of the tumors in these areas,both in cadaveric specimen and clinical patients.Methods:The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study.For the cadaveric specimens,ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach.The exposure areas were compared between two groups and main anatomic structure were measured.Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy.Perioperative management,intraoperative findings and postoperative complications were recorded and analyzed.Results:The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did.The diameter of maxillary artery in the PPF was 3.77±0.78 mm(range:2.06-4.82mm),the diameter of middle meningeal artery in the ITF was 2.79±0.61 mm(range:1.54-3.78 mm).Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal.The main complications were facial numbness and pericoronitis of the wisdom tooth.No permanent complication was found.Conclusions:With the widespread use of neuroendoscopy,the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF,which has significant advantages on less trauma and complications to the patients.

关键词： Neuroendoscopy Pterygopalatine fossa Infratemporal fossa Maxillary sinus Surgical approach

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Endoscopic endonasal transclival removal of tumors of the clivus and anterior region of the posterior cranial fossa (results of surgical treatment of 140 patients)

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Chinese Neurosurgical Journal 2018年第4期4卷 219-232页

作者： Alexey N. Shkarubo Konstantin V. Koval Ilia V. Chernov Dmitry N. Andreev Alexey B. Kurnosov Andrey A. Panteleyev Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (N.N. Burdenko NMRCN) 4-ya Tverskaya-YAmskaya street 16 Moscow Russian Federation

Background: Until recently, tumors of the clivus and the anterior region of the posterior cranial fossa were considered extremely difficult to access and often inoperable using standard transcranial approaches. With the introduction into the neurosurgical practice of minimally invasive methods utilizing endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of the posterior cranial fossa. Methods: From 2008 to the present time, the inpatient institution has operated on 140 patients with various tumors of the base of the skull, localized to the clivus and anterior region of the posterior cranial fossa (65 men and 75 women). The age of patients ranged from 3 to 74 years. Tumor distribution according to the histopathological features was as follows: chordomas, 103 (73.57%);meningiomas, 12 (8.57%);pituitary adenomas, 9 (6.43%);fibrous dysplasia, 4 (2.86%);cholesteatoma, 3 (2.14%);craniopharyngiomas, 2 (1.43%);plasmacytomas, 2 (1.43%);and other tumors (giant cell tumor, neurohypophyseal glioma, osteoma, carcinoid, chondroma), 5 (3.57%). The tumors had the following size distribution: giant (more than 60 mm), 35 (25%);large (35–59 mm), 83 (59.3%);medium (21–35 mm), 21 (15%);and small (less than 20 mm), 1 (0.7%). In 11 cases, intraoperative monitoring of the cranial nerves was performed (21 cranial nerves were identified). Results: Upper, middle, and lower transclival approaches provide access to the anterior surface of the upper, middle, and lower neurovascular complexes of the posterior cranial fossa. The chordoma cases were distributed as follows according to extent of removal: total removal, 68 (66.02%);subtotal removal, 25 (24.27%);and partial removal, 10 (9.71%). The adenomas of the pituitary gland were removed totally in 6 cases, subtotally in 1 case and partially in 2 cases. The meningiomas were removed totally in 1 case, subtotally in 5 cases, and partially in 5 cases, with less than 50% of the tumor removed in 1 case. Other tumors (

关键词： Clivus Clival chordoma Endoscopic endonasal transclival approach Monitoring of cranial nerves Posterior cranial fossa Skull base anatomy Skull base surgery

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Duration of Preoperative External Ventricular Drain in Pediatric Posterior fossa Tumors—Does It Matter?

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Open Journal of Pediatrics 2017年第2期7卷 86-97页

作者： Ehtesham Ghani Ayman AlBanyan Abdulrahman Sabbagh Maqsood Ahmad Department of Pediatric Neurosurgery National Neuroscience Institute King Fahad Medical City Riyadh KSA

Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: The study was conducted in the Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia from January 2010 to December 2013. The data were collected retrospectively. The patients who had emergency insertion of external ventricular drain (EVD) due to hydrocephalus before the definitive posterior fossa tumor surgery were included in the study. Results: The preoperative emergency insertion of EVD was done in 38 patients with pediatric posterior fossa tumors. The patients were divided into two groups. Group A consists of those patients who had duration of preoperative EVD equal or less than 7 days. Group B includes those patients who had duration of preoperative EVD more than 7 days. Group A has 16 patients while Group B has 22 patients. The predominant clinical feature was symptoms and signs of raised intracranial pressure (ICP) only. Infection related to EVD was seen in seven patients. Ventriculoperitoneal (VP) shunt was required in 31.25% of Group A patients and 18.18% of Group B patients (p value = 0.35). Overall shunt rate was 23.68%. Conclusion: There are well known number of factors that can determine the need of permanent CSF diversion in patients with posterior fossa tumors. However, there is no effect of preoperative duration of EVD in determining the requirement of postoperative VP shunt.

关键词： Posterior fossa Tumors External Ventricular Drain Hydrocephalus Ventriculoperitoneal Shunt CSF Diversion

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Undiagnosed Anterior Cranial fossa Dural Arteriovenous Fistula with Intracranial Hematoma: Case Report and Review of the Literature about Its Natural History

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Open Journal of Modern Neurosurgery 2015年第2期5卷 64-69页

作者： Takashi Yamaguchi Satsuki Miyata Toshihiro Mashiko Eiju Watanabe Department of Neurosurgery Jichi Medical University Shimotsuke Japan

Dural arteriovenous fistulas (dAVFs) of an anterior cranial fossa are rare. Because of the high risk of intracranial hemorrhage and relatively easy access for direct surgery, aggressive treatment has been recommended. The natural history of anterior cranial fossa dAVFs (ACF dAVFs) is unclear in spite of many reports for the natural history of general dAVFs. To treat ACF dAVFs, direct surgery has traditionally been performed and endovascular surgery has recently been introduced. A 74-year-old man was transferred with severe consciousness disturbance and presented with devastating intracerebral hemorrhage on the CT scan. Digital subtraction angiography revealed the ACF dAVFs with a large venous pouch. The patient received direct surgery, nevertheless he became vegetative state. Later on, a smaller venous pouch was recognized on the CT scan when he had suffered from the thalamic hemorrhage sixteen months before. There are twelve cases including our case which was treated for a certain period and documented in detail. Eleven of twelve cases were asymptomatic. Three of the six cases with a venous pouch had some events possibly related to the disease, though none of the six cases without a venous pouch had any events during observation. In conclusion, an ACF dAVF with a venous pouch should be treated by direct surgery or endovascular surgery even if it is incidentally found. By contrast, careful observation might be a possible therapeutic option for an ACF dAVF without a venous pouch if there is mild reflux flow.

关键词： Dural Arteriovenous Fistula Anterior Cranial fossa Natural History Venous Pouch Intracranial Hemorrhage

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Extrapineal mature teratoma of the posterior fossa in a child

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Open Journal of Pediatrics 2012年第3期2卷 257-259页

作者： Mónica Rivero-Garvía Javier Márquez-Rivas Eloy Rivas Ana Belén Rueda-Torres Mónica Rivero Garvía Division of Pediatric Neurosurgery Hospital Virgen del Rocío Manuel Siruot s/n Seville Spain

Introduction: teratomas are non-malignantgerm cell tumors commonly composed of cell types derived from all of the three germ layers. Intracerebral teratomas typically are midline or paraxial lesions located in the pituitary stalk or the pineal region. We report our experience with mature teratomas of the posterior fossa. Case report: we present the case of an 11-year-old caucasian female with progressive headache that caused interrupted sleep. Cerebral magnetic resonance imaging showed a midline lesion in the posterior fossa with mass effect and without contrast enhancement. Anatomic pathology revealed a mature teratoma. Conclusion: differential diagnosis of midline lesions in pediatric patients must include teratomas in spite of being posterior fossa lesions.

关键词： Mature Teratoma Posterior fossa Child Gross Total Reseccion Extrapineal

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Large Foreign Body in the Nasal Cavity, Maxillary Sinus and Infratemporal fossa—Atypical Presentation

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International Journal of Otolaryngology and Head & Neck Surgery 2014年第6期3卷 371-375页

作者： Subrat Kumar Behera Niranjan Mishra Sharath Govindappa Department of ENT S.C.B. Medical College Cuttack India Department of OMFS S.C.B. Medical College Cuttack India

A 59-year-old male presented with complaints of trismus and discharge of altered blood from nose for 1 year. Patient had a history of facial trauma one year back. Nasal endoscopy and CT scan revealed a foreign body lodged in posterior half of both nasal cavity, left maxillary sinus and left infratemporal fossa penetrating the walls of maxillary sinus and nasal septum. Foreign body was removed by infratemporal fossa approach. This case has a rare location of a forgotten foreign body with atypical presentation.

关键词： Foreign Body Nose and Paranasal Sinuses Infratemporal fossa Trismus

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Temporal fossa Abscess Caused by Apical Periodontitis: A Case Report

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Open Journal of Clinical Diagnostics 2018年第4期8卷 47-51页

作者： Sayaka Yoshiba Takaaki Kamatani Tatsuo Shirota Department of Dental and Oral Surgery Showa University Northern Yokohama Hospital Tokyo Japan Department of Oral and Maxillofacial Surgery Showa University School of Dentistry Tokyo Japan

According to the progress of the antibiotic medicine, the severe infection case is decreasing recently. We recently experienced a case of temporal fossa abscess caused by periapical periodontitis the upper left side of the second molar. A 79-year-old woman visited to Showa University Dental Hospital complaining of the painful swelling at the left side of the temporal and trismus. The routine blood test exhibited a severe inflammation. We performed drainage treatment at temporal skin and normal oral bacterial flora was detected by the bacteriological examination. Under treatment included the administration of antibiotics, the inflammation healed without serious complication and she recovered completely.

关键词： Temporal fossa Abscess Odontogenic Infection Apical Periodontitis

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Adult Posterior Cranial fossa Arachnoid Cyst: A Case Report

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Open Journal of Modern Neurosurgery 2019年第4期9卷 436-440页

作者： Ibrahima Berete Alpha Boubacar Bah Hammas Nawal Mohammed Benzagmout Khalid Chakour Faiz Chaoui Department of Neurosurgery CHU de Donka Conakry Guinea Department of Pathology Hassan II Teaching Hospial Fez Morocco Department of Neurosurgery Hassan II Teaching Hospital Fez Morocco

Adult posterior fossa arachnoid cysts are rare lesions that are considered to be mostly congenital in origin. We present 49-year-old man admitted with a chief complaint of tremor and balance problems for the past 2 months. He had ataxia on examination. Magnetic resonance imaging revealed a well circumscribed midline cystic lesion of the posterior fossa sharing the same signal characteristics as cerebrospinal fluid and non-communicating to the fourth ventricle. He underwent surgical treatment for his symptomatic posterior fossa arachnoid cyst with a good outcome at 2 years follow up.

关键词： Posterior fossa Arachnoid Cyst Subocciptal Craniotomy Cerebellar Ataxia

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Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal fossa: A Volunteer Study

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Open Journal of Anesthesiology 2013年第5期3卷 288-292页

作者： Eric P. Chiang Paul Dangerfield Daniel Asay Anita Cucchiaro Jeffrey S. Berger The George Washington University School of Medicine & Health Sciences Washington DC USA.

The Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx? with 38-mm broadband linear array, 13-6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to m

关键词： Ultrasonography Nerve Block Methods Peripheral Nerve Block Popliteal fossa Sciatic Nerve Analgesia Methods

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Decompressive Craniectomy in Posterior fossa Ischemic Stroke

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International Journal of Clinical Medicine 2012年第4期3卷 302-303页

作者： Luciano Santana-Cabrera Guillermo Pérez-Acosta Cristina Rodríguez-Escot Rosa Lorenzo-Torrent Manuel Sánchez-Palacios Intensive Care Unit Insular Universitary Hospital of Gran Canaria Las Palmas of Gran Canaria Spain. South maritime avenue n/n. Las Palmas of Gran Canaria. Canary Islands. Spain. Postal Code: 35016 Intensive Care Unit Insular Universitary Hospital of Gran Canaria Las Palmas of Gran Canaria Spain. South maritime avenue n/n. Las Palmas of Gran Canaria. Canary Islands. Spain. Postal Code: 35016. Intensive Care Unit Insular Universitary Hospital of Gran Canaria Las Palmas of Gran Canaria Spain. South maritime avenue n/n.Las Palmas of Gran Canaria. Canary Islands. Spain. Postal Code: 35016

Ischemic damage produced in the posterior cerebral territory causes significant morbidity and urgently must be considered if the patient need a surgical attitude. Surgical decompression by suboccipital craniectomy seams to be effective to treat secondary edema due to cerebellar damage or in posterior fossa, when medical treatment is not able to control side effects. We report a clinical case of a patient with a subacute ischemic infarction in the vertebro-basilar territory, with perilesional edema, and a posterior fossa decompressive craniectomy (DC) was carried out.

关键词： Decompressive Craniectomy Posterior fossa Suboccipital Craniectomy Vertebrobasilar Insufficiency

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