Perigeniculate arachnoid cysts and CSF fistulae of the fallopian canal: Histopathologic correlates of a rare clinical entity

xlomafota13 shared this article with you from Inoreader Perigeniculate arachnoid cysts and CSF fistulae of the fallopian canal: Histopathologic correlates of a rare clinical entity Via leak of cerebrospinal fluid World J Otorhinolaryngol Head Neck Surg. 2021 Jan 24;7(2):71-81. doi: 10.1016/j.wjorl.2020.12.005. eCollection 2021 Apr. ABSTRACT Cerebrospinal fluid (CSF) fistulae originating from the fallopian canal of the facial nerve is hypothesized to arise due to atypical patterns of subarachnoid space extension into the geniculate ganglion or more distal regions along the intratemporal course of the facial nerve, but its pathogenesis remains poorly understood. Although a rare etiology of CSF fistulae of the temporal bone, there are significant clinical ramifications due to the risk of recurrent meningitis, difficulty in identifying the anatomic location of the CSF leak, and technical challenges associated with surgical repair. We present three clinical cases of arachnoid cysts within the geniculate fossa with or without CSF fistulization and provide histopathologic correlates of this rare clinical phenomenon from a human temporal bone collection. The pediatric and adult patients presented suggest differential pathophysiologic mechanisms associated with CSF fistulae. Temporal bone histology reveals atypical patterns of subarachnoid space extension in the fallopian canal that may underlie arachnoid cyst formation and overt CSF leak from the geniculate region. PMID:33997715 | PMC:PMC8103539 | DOI:10.1016/j.wjorl.2020.12.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa

xlomafota13 shared this article with you from Inoreader Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa Via leak of cerebrospinal fluid World J Otorhinolaryngol Head Neck Surg. 2021 Mar 6;7(2):82-87. doi: 10.1016/j.wjorl.2021.01.003. eCollection 2021 Apr. ABSTRACT OBJECTIVE: To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube. METHODS: Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique. RESULTS: In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery. CONCLUSION: Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa. PMID:33997716 | PMC:PMC8103534 | DOI:10.1016/j.wjorl.2021.01.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

'She's sprung a leak': Significant cerebrospinal fluid leak in an infant post-lumbar puncture

xlomafota13 shared this article with you from Inoreader 'She's sprung a leak': Significant cerebrospinal fluid leak in an infant post-lumbar puncture Via leak of cerebrospinal fluid J Paediatr Child Health. 2021 May 17. doi: 10.1111/jpc.15547. Online ahead of print. NO ABSTRACT PMID:33998724 | DOI:10.1111/jpc.15547 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lessons Learned from A Case of Functional Total Laryngeal Obstruction Under Anaesthesia by Vocal Cord Polyp Managed by Vortex Approach

xlomafota13 shared this article with you from Inoreader Lessons Learned from A Case of Functional Total Laryngeal Obstruction Under Anaesthesia by Vocal Cord Polyp Managed by Vortex Approach Via Polyps Turk J Anaesthesiol Reanim. 2021 Apr;49(2):175-177. doi: 10.5152/TJAR.2021.64. Epub 2021 Apr 1. ABSTRACT Dynamic airway obstruction is a terrifying situation. Most of the time, the obstruction is intermittent. The situation becomes horrifying and panicky when this intermittent dynamic airway obstruction turns into a total laryngeal obstruction under anaesthesia. Herein, we present a case of a 56-year-old male with vocal cord polyp, who was posted for excision. The difficult airway was anticipated in view of a thick neck. He was also hypertensive and a suggestive case of obstructive sleep apnoea. The patient went to the cannot ventilate, cannot intubate, cannot oxygenate situation because of the polyp taking position between the vocal cords and completely obstructing the central airway gateway. The case was successfully managed by emergency cricothyroidotomy by following the Vortex approach but taught us a few lessons. The case shows us the re levance of clinical findings and the importance of vocal polyp as a cause of inducible laryngeal obstruction and highlights the consequences of intuition and minor lacuna in airway management. PMID:33997850 | PMC:PMC8098741 | DOI:10.5152/TJAR.2021.64 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Novel Use of Tracheostomy Shield for Emergency Tracheostomy in Covid 19 Era

xlomafota13 shared this article with you from Inoreader Novel Use of Tracheostomy Shield for Emergency Tracheostomy in Covid 19 Era Via Otolaryngology Indian Abstract To evaluate the problems in doing emergency tracheostomy and tracheostomy care of patients with unknown COVID-19 status. Study the usefulness of the specially designed Tracheostomy Shield. A prospective hospital-based study was conducted at a tertiary care center in India treating COVID and Non COVID patients. The study was done from April 2020 to December 2020. A total of 80 tracheostomy were done using Tracheostomy shield. Open tracheostomies were 38 while 42 patients were already intubated (closed circuit). The Tracheostomy shield was also used in 380 tracheostomy tubes changes. Two patients were found COVID positive on RT-PCR after tracheostomy. There was no scope for testing all tube changes with RT-PCR. The use of our indigenously designed Tracheostomy shield has been effective in reducing the aerosol spread and there was no COVID transmission reported. The use of patient Tracheostomy shield is of uttermost importance in reducing the respiratory droplets sp lashing on to the surgeon and assistant while doing awake tracheostomy. It is extremely useful while changing tubes as there are chances of false negatives antigen test which might be miss leading. The use of Tracheostomy shield is very important in the current context of new and fast evolving respiratory infections. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Central Auditory Nervous System Stimulation through the Cochlear Implant Use and Its Behavioral Impacts: A Longitudinal Study of Case Series

xlomafota13 shared this article with you from Inoreader Central Auditory Nervous System Stimulation through the Cochlear Implant Use and Its Behavioral Impacts: A Longitudinal Study of Case Series Via cortical auditory Case Rep Otolaryngol. 2021 Apr 27;2021:8888450. doi: 10.1155/2021/8888450. eCollection 2021. ABSTRACT The purpose of this study was to investigate, over a period of five years, the cortical maturation of the central auditory pathways and its impacts on the auditory and oral language development of children with effective use and without effective use of a Cochlear Implant (CI). A case series study was conducted with seven children who were CI users and seven children with normal hearing, with age- and gender-matched to CI users. The assessment was performed by long-latency auditory evoked potentials and auditory and oral language behavioral protocols. The results pronounced P1 latency decrease in all CI users in the first nine months. Over five years, five children with effective CI use presented decrease or stabilization of P1 latency and a gradual development of auditory and oral language skills, although, for most of the children, the elec trophysiological and behavior results remained poor than their hearing peers' results. Two children who stopped the effective use of CI after the first year of activation had worsened auditory and oral language behavioral skills and presented increased P1 latency. A negative correlation was observed between behavioral measures and the P1 latency, the P1 component being considered an important clinical resource capable of measuring the cortical maturation and the behavioral evolution. PMID:33996165 | PMC:PMC8096579 | DOI:10.1155/2021/8888450 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Skin Acceleration Levels Estimated by a Neck-surface Accelerometer during Phonation Are Affected by The Mechanical Properties of The Anterior Cervical Skin

xlomafota13 shared this article with you from Inoreader Skin Acceleration Levels Estimated by a Neck-surface Accelerometer during Phonation Are Affected by The Mechanical Properties of The Anterior Cervical Skin Via Journal of Voice The aim of the present study was to assess whether skin acceleration levels (SAL) estimated by a neck-surface accelerometer (ACC) are affected by the anterior neck skin condition. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma

xlomafota13 shared this article with you from Inoreader Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729995 Trigeminal schwannomas are rare nerve sheet tumors that represent the second most common intracranial site of occurrence after vestibular nerve origins. Microsurgical resection of giant dumbbell-shaped trigeminal schwannomas often requires complex skull base approaches. The extradural transcavernous approach is effective for the resection of these giant tumors involving the cavernous sinus.The patient is a 72-year-old man with headache, dizziness, imbalance, and cognitive decline. Neurological examination revealed left-sided sixth nerve palsy, a diminished corneal reflex, and wasting of temporalis muscle. Magnetic resonance imaging (MRI) showed a giant homogeneously e nhancing dumbbell-shaped extra-axial mass centered within the left cavernous sinus, Meckel's cave, and the petrous apex, with extension to the cerebellopontine angle. There was a significant mass effect on the brain stem causing hydrocephalus. Computed tomography (CT) scan showed erosion of the petrous apex resulting in partial anterior autopetrosectomy (Figs. 1 and 2).The decision was made to proceed with tumor resection using a transcavernous approach. Gross total resection was achieved. The surgery and postoperative course were uneventful, and the patient woke up the same as in the preoperative period. MRI confirmed gross total resection of the tumor. The histopathology was a trigeminal schwannoma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at http s://youtu.be/TMK5363836M [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic-Assisted Resection of Anterior Foramen Magnum Meningiomas through a Midline Suboccipital Subtonsillar Approach

xlomafota13 shared this article with you from Inoreader Endoscopic-Assisted Resection of Anterior Foramen Magnum Meningiomas through a Midline Suboccipital Subtonsillar Approach Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727126 Objective This study was aimed to demonstrate the resection of anterior foramen magnum meningiomas through an endoscopic-assisted posterior midline suboccipital subtonsillar approach. Design This study was designed with illustration of the surgical steps and safety of this approach. Setting Evidence of cerebrospinal fluid (CSF) cleft between the tumor and brainstem on MRI was studied (Fig. 1A and B). Preoperative tracheotomy was considered in cases of preoperative dysphagia to prevent any further neurological deterioration due to the bilateral access through the lower cranial nerves corridors. Semisitting position with extensive electrophysiological neuromonitoring and transesophageal echocardiogram was adopted. A standard midline incision with bilateral suboccipital craniotomy and C1-laminotomy was performed (Fig. 2A). After partial resection and elevation of the tonsils, tumor was debulked unilaterally around the lower cranial nerves and the vertebral artery, devascularized from the clival dura and then dissected from the brainstem (Fig. 2B, C). Endoscopic-assisted removal of its anterior portion followed. The same procedure was repeated from the opposite site for the contralateral portion, before approaching the purely anterior part with endoscope assistance (Fig. 2D). Participants Four consecutive patients were included in the study. Main Outcome Measures Grade of tumor resection and outcome (mRS) were primary measurement of this study. Results Clinical outcome and grade of resection are comparable to other series of patient treated with other foramen magnum approaches (Fig. 1C and D). Conclusion Anterior foramen magnum meningiomas can be safely removed through this relatively faster midline suboccipital approach with bilateral exposure of lower cranial nerves (CNs) and vertebral arteries and lower approach-related morbidity (no condyle drilling). The surgical corridor is created by the tumor during debulking reducing need for brain retraction and the removal of the anterior dural attachment coagulated under the microscope is verified and completed endoscopically with pituitary curettes (Simpson's grade II) (Fig. 1C and D).The link to the video can be found at: https://youtu.be/9eACAJVwQBs. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinoidal Meningioma with Cavernous Sinus Invasion

xlomafota13 shared this article with you from Inoreader Clinoidal Meningioma with Cavernous Sinus Invasion Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1727109 We present a-49-year old female presenting headache and progressive right eye visual loss in the last 6 months. Magnetic resonance imaging showed a large clinoidal meningioma on the right side, invading the superior, lateral and medial aspects of the cavernous sinus, the optic canal, and the clinoidal segment of the internal carotid artery (ICA).A cranio-orbital approach was performed. The anterior clinoid process was removed extradurally to achieve devascularization of the anterior clinoidal meningioma, followed by the peeling of the middle fossa to decompress V2 and open the superior orbital fissure. We open the dura in a standard fronto-temporal flap to access the lower portion of the skull base allowing retractorless dissection. We complete the removal of the anterior clinoid process and optic strut through an intradural approach. It allows safer dissection of the clinoidal segment of the ICA and avoids its injury by adherent and hard consistency tumor.Intraoperative neurophysiological monitoring, sharp dissection, and avoiding the use of bipolar coagulation when dissecting the cavernous sinus are essential to minimize the risk of cranial nerve injury. We also like to point that cranial nerve deficit caused by surgical manipulation without primary lesion of the nerve can be recovered postoperatively.The link to the video can be found at: https://youtu.be/ozUCsnUGxyM. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Risk Factors and Reconstruction Techniques for Persistent Cerebrospinal Fluid Leak in Patients Undergoing Endoscopic Endonasal Approach to the Posterior Fossa

xlomafota13 shared this article with you from Inoreader Risk Factors and Reconstruction Techniques for Persistent Cerebrospinal Fluid Leak in Patients Undergoing Endoscopic Endonasal Approach to the Posterior Fossa Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729904 Background High-flow skull base dural defects are associated with an increased risk of postoperative cerebrospinal fluid (CSF) leaks. Objective This study aimed to identify the risk factors for persistent postoperative CSF leak after endoscopic endonasal surgery (EES) and determine the ideal reconstruction strategy after initial failed repair. Methods Patients with CSF leak after intradural EES between October 2000 and February 2017 were identified. Cases with persistent CSF leak were compared with patients with similar pathologic diagnosis without a persistent leak to identify additional risk factors. Results Two hundred and twenty-three out of 3,232 patients developed postoperative CSF leak. Persistent leaks requiring more than one postoperative repair occurred in 7/223 patients (3.1%). All seven had undergone intradural approach to the posterior fossa for resection of recurrent/residual clival chordomas. This group was matched with 25 patients with recurrent/residual clival chordoma who underwent EES without postoperative CSF leak (control group). Age, gender, history of diabetes, smoking, or radiotherapy were not statistically different between the groups. Obesity (body mass index > 30) was significantly more common in the group with persistent leak (86%) compared with controls (36%) (p = 0.02). All patients with a persistent CSF leak developed meningitis (p = 0.001). Five patients with persistent leak required a pericranial flap to achieve definitive repair. Conclusion Multiple recurrent CSF leak after EES primarily occurs following resection of recurrent/residual posterior fossa chordoma. Obesity is a major risk factor and meningitis is universal with persistent leak. Flap necrosis may play a role in the development of persistent CSF leaks, and the use of secondary vascularized flaps, specifically extracranial–pericranial flaps, should be considered as an early rescue option in obese patients. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.