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Adult skull fractures
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The differential diagnosis of the isolated anterior cranial fossa fracture includes penetrating injuries through the orbital roof as well as direct trauma. Fragments of glass, after a road traffic accident, may penetrate the orbit and orbital roof. Radiological examination may identify glass, but one should be aware that not all glass fragments are identified by this means.
Neurological Disease of the Pharynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Nasopharyngeal carcinomas and particularly skull-base tumours compress and invade the lower cranial nerves producing a variety of symptoms. MRI and CT scanning of the anterior cranial fossa, brain and temporal bone should follow the appropriate clinical examination. Surgery or radiotherapy can then be considered. A variety of jugular foramen syndromes exist, described in Table 54.1. A small number of paraneoplastic syndromes have been associated with neurogenic dysphagia including squamous cell carcinoma of the skin, transitional cell carcinoma of the bladder, ovarian cancer, prostate cancer and chronic lymphocytic leukaemia.9–13
Craniofacial Surgery
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Benjamin Robertson, Sujata De, Astrid Webber, Ajay Sinha
The procedure is carried out with the patient supine. A coronal flap is raised. The forehead is then removed. This is designed by selecting bone that may subsequently facilitate a neo-forehead to be created. Techniques vary between institutions but usually this is carried out as a bilateral procedure (even for unicoronal synostosis). This then allows access to the anterior cranial fossa. The supraorbital bar is removed, protecting the frontal lobes of the brain and the eyes and optic nerves. This supraorbital bar is then corrected and remodelled to an ideal shape, allowing the neo-forehead to be attached to this. The construct is then usually replaced in an advanced position (subsequently creating an increased skull volume) and usually attached by resorbable plate fixation.
Simultaneous repair of bilateral temporal bone meningoencephaloceles by combined mastoid-middle cranial fossa approach
Published in Acta Oto-Laryngologica Case Reports, 2023
Kazuto Osaka, Takayuki Okano, Masahiro Tanji, Koichi Omori
The surgical approaches to MECs are chosen according to the size, location, and number of skull base defects and MECs. The transmastoid approach is generally used for a single, small dehiscence localized in the tegmen mastoideum or tegmen antri. If the bone defects or MECs are larger and/or multiple, as in the present case, the middle cranial fossa approach is preferable because it facilitates easier repair of bone or dural defects [14]. About half of patients with MECs have multiple lesions, limiting the indications for the transmastoid approach; this sometimes leads to a combination of both the transmastoid and middle fossa approaches [15]. Although there is no clear consensus regarding the indication for the combined approach, one of the advantages of the combined approach is that the lesion associated with otitis media in the middle ear can be simultaneously removed together with the MECs.
Important aspect of hypoglossal nerve injury following gunshot wound; Can the clivus has a role? A case report
Published in British Journal of Neurosurgery, 2023
Bulent Ozdemir, Ayhan Kanat, Cihangir Erturk, Osman Ersegun Batcik, Fatma Beyazal Celiker, Metin Celiker, Engin Dursun
We suggest that the effect of human skull anatomy with clivus is important. The thick clivus protects the structure of the brainstem and posterior cranial fossa. It measures about 4 to 5.5 cm long and about 3 cm wide at its midpoint.2 In this case, the bullet had entered from the nasal cavity (Figure 1(A), traversed to (Figure 1(B,C)) to the occipital condyle (Figure 1(D)). Hypoglossal nerve injury following gunshot injury is not a common event. In maxillofacial gunshot injury, the bullet may predilect the hypoglossal nerve, but we proposed that the Clivus is hard enough that bullets tend to bounce off it rather than penetrate it. Thats quite a bold claim, particularly if one of their cases was 74 years old and therefore presumably had some degree of osteoporosis. This case was injured with a low-velocity bullet. In the high-velocity bullet, this situation may not be credible. We suggest that the clivus protects the structures behind it from injury from incoming bullets, but at the expense of deflecting the bullets laterally. This bullet goes to injure the hypoglossal nerve, which is vulnerable to anything reflecting laterally off the clivus. This is the third reported isolated hypoglossal nerve injury case following gunshot wound in the world medical literature, previous cases were published by Ozdemir et al.1 and Hageman et al.3 What about other structures: such as the jugular, vagus, and accessory? The difference of three cases from other gunshot wound cases is that, all of these cases have had isolated hypoglossal nerve palsy without injured adjacent neurovascular structures.
Cavernous sinus haemangioma masquerading as a pituitary macroadenoma: how the unexpected lurks in neurosurgery
Published in British Journal of Neurosurgery, 2023
Simon Lammy, Jennifer Brown, Patricia Littlechild
Common locations include the middle cranial fossa, pituitary fossa, optic chiasm, cavernous sinus, Vth and VIIth cranial nerves, cerebello-pontine angle and ventricles.1–3 Therefore, symptoms include headache, and those attributable to cavernous sinus and chiasmal syndromes.2–5 Signs are insidious due to their quiescent nature5 and include ptosis1,2, diplopia1,2, decreased visual acuity, visual field defects, obesity, amenorrhoea and facial numbness and neuralgia due to Gasserian ganglion involvement.2,4 Further anatomical sub-locations include Parkinson’s triangle between IVth and V1 and Mullan’s triangle between V1 and V22. This contrasts CCMs that usually present in a haemorrhagic fashion (25%) displaying both focal neurological deficits and seizures. Less than 1% of CSH present as a haemorrhage despite being highly vascular.1–5