Anatomy for neurotrauma
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
The anterior cranial fossa supports the frontal lobes of the cerebral hemispheres. Its floor is formed by the orbital plate of the frontal bone; the cribriform plate (for passage of the olfactory nerve) and crista galli (for attachment of falx cerebri) of the ethmoid bone; and the lesser wings, planum sphenoidale, and prechiasmatic sulcus of the sphenoid bone. The olfactory tracts lie above the planum sphenoidale, while the optic chiasma usually lies above the prechiasmatic sulcus. Skull base fractures (Figure 2.1) in the region of the anterior cranial fossa may cause CSF rhinorrhoea, pneumocephalus, olfactory nerve damage leading to anosmia (due to damage to the cribriform plate), bilateral periorbital ecchymosis (Raccoon’s eyes), and damage to optic nerve and orbital contents. Frontal lobe injury leading to personality and behavioral changes may also occur in such fractures.
Growth of the Cranial Base HHiH
D. Dixon Andrew, A.N. Hoyte David, Ronning Olli in Fundamentals of Craniofacial Growth, 2017
The cranial base is derived from the primitive chondrocranium (De Beer, 1937), and comprises the midline bones and the cranial fossae — anterior, middle and posterior — which in large part also originate in the chondrocranium, with additions, in certain bones, ossifying in membrane. The midline bones are the basioccipital, sphenoid — comprising at various stages in different animals and man a basisphenoid (or postsphenoid) and a presphenoid — and the ethmoid at the junction of base and face. The anterior cranial fossa is roofed-in in front by the frontal bone, whose orbital plates form most of the floor of the fossa, meeting the cribriform plate of the ethmoid in the midline, and the lesser wings of the sphenoid behind. The sphenoid bone could be said to be the linch-pin of the middle fossa, with its greater wing extending laterally to floor the fossa, anteriorly to wall in the orbit posterolaterally, and further laterally to share with the squamosal the wall of the temporal fossa. Separating the middle from the posterior fossa is the obliquely lying petrous part of the temporal bone (see Chapter 12). The parts of the occipital bone derived from the chondrocranium complete the floor and walls of the posterior fossa, surrounding the foramen magnum — the basioccipital, here forming with the posterior aspect of the sphenoid bone the clivus, the exoccipitals, and the supraoccipital. The membranous interparietal bone which joins with supraoccipital to form the occipital squama belongs more properly to the skull vault, and will not be considered here.
Medical Negligence in Otorhinolaryngology
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
For example, in one case, a trainee undertook a difficult nasal polypectomy endoscopically. The procedure was recorded and a breach of the anterior cranial fossa, and how it was acquired, could clearly be seen on the video. In this particular instance there was a dehiscence of the cribriform plate, with absence of bone in the anterior cranial fossa. The repair was also filmed. An explanation was given to the patient, who was quite satisfied. However, his children, who lived some distance away, attended the hospital some days later. One daughter, a nurse in a maxillofacial surgical department, clearly felt that causing a cerebrospinal fluid (CSF) leak had to be negligent. Fortunately the video material was available, which was immediately shown to the family and carefully explained. This diffused the aggression and was successful in preventing litigation.
Assessment of olfactory function after traumatic brain injury: comparison of single odour tool with detailed assessment tool
Published in Brain Injury, 2018
OD is common within clinical practice. It may be due to several different clinical conditions including Parkinson’s disease, hypertension, diabetes mellitus and idiopathic changes with age (3). However, up to 60% of OD cases are due to traumatic brain injury (TBI) and upper respiratory tract infection (URTI) including nasal and paranasal sinus disease (4). The relationship between OD and TBI is well understood, as the olfactory system is at risk of damage following TBI. The peripheral olfactory pathways may be damaged owing to blunt force trauma to the nose and olfactory epithelium or owing to shearing forces acting on the nerves in the cribriform plate. Alternatively, compression of the secondary olfactory centres within the basal frontal and temporal lobes can occur against the skull base of the anterior cranial fossa because of contrecoup damage following blunt force trauma to the occipital aspect of the skull (5). The incidence of OD following TBI increases with TBI severity (6–9).
Lateral supraorbital approach for resection of large and giant olfactory groove meningiomas: a single center experience
Published in British Journal of Neurosurgery, 2023
Hussam Abou-Al-Shaar, Kevin P. Patel, Arka N. Mallela, Raymond F. Sekula
Olfactory groove meningiomas (OGMs), arise in the anterior cranial fossa (ACF), extending from the cribriform plate to planum sphenoidale, and account for approximately 10% of intracranial meningiomas.1,2 These tumors may present insidiously depending on their size and impingement on adjacent neurovascular structures. Patient may present with anosmia, visual deficits, mental disturbances, headache, and occasionally seizures.1,3,4 Transcranial approaches for OGMs include bicoronal approaches or unilateral frontal, pterional, and lateral supraorbital (LSO) approaches.1,3,5 With advancements in surgical techniques and endoscopic instrumentations, the endoscopic endonasal approach (EEA), has been increasingly reported in the management of these lesions.6 Both endonasal and transcranial approaches, however, offer distinct advantages and inherent limitations. However, the superiority of one approach over the other remains controversial.2,5,7–10
Esthesioneuroblastoma presenting with orbital signs and ectopic adrenocorticotropic hormone syndrome
Published in Baylor University Medical Center Proceedings, 2022
Wesley M. Gillette, Donald Carroll Hubbard, Jana Nicole Waters, Adam Stephen Johnson
A 23-year-old woman with known nasal polyps and a recent seizure presented to the emergency department with a 1-month history of binocular diplopia. She also noted unilateral rhinorrhea and weight gain worsening for several months. On examination, there was proptosis of the left eye, incomitant left esotropia, and left-sided adduction and abduction deficits. Nasal exam disclosed a large, gray and flesh-colored mass occluding the left nasal cavity. Hirsutism, central obesity with purple striae, moon facies, and a dorsocervical fat pad were also noted. A computed tomography (CT) scan of the head revealed a 6.4 cm sinonasal mass eroding into the inferonasal left orbit (Figure 1a). The mass abutted the optic nerve without displacing it, and there was displacement of the medial rectus muscle. Magnetic resonance imaging (MRI) of the face demonstrated extensive involvement of the maxillary sinus, nasal cavity, nasopharynx, and nasal vestibule with extension to the left anterior cranial fossa floor (Figure 1b). A biopsy of the mass in the left nasal cavity was performed. During this time the patient required treatment for refractory hypokalemia. An adrenocorticotropic hormone level was obtained and returned >1000 pg/mL (reference range 6–76 pg/mL).
Related Knowledge Centers
- Cribriform Plate
- Ethmoid Bone
- Middle Cranial Fossa
- Sphenoid Bone
- Frontal Lobe
- Frontal Bone
- Orbital Part of Frontal Bone
- Lesser Wing of Sphenoid Bone
- Chiasmatic Groove
- Frontoethmoidal Suture