PubMed Central (PMC3 - NLM DTD)
(2,081,148 recursos)
Archive of life sciences journal literature at the U.S. National Institutes of Health (NIH), developed and managed by NIH's National Center for Biotechnology Information (NCBI) in the National Library of Medicine (NLM).
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The Effects of Clonidine Premedication and Scalp Infiltration of Lidocaine on Hemodynamic Responses to Laryngoscopy and Skull Pin Head-Holder Insertion During Skull Base Procedures - Jellish, W. Scott; Theard, M. Angele; Cheng, Mary Ann; Leonetti, John P.; Crowder, C. Michael; Tempelhoff, Rene
This study was designed to determine if oral clonidine or lidocaine, injected into the scalp before head-holder (H-H) insertion, would attenuate the hemodynamic effects associated with intubation and H-H placement. Thirty-four patients undergoing skull base procedures were randomized to four groups. Group 1 received clonidine 5 mcg/kg po before surgery with 10 to 15 ml of 1% lidocaine infiltrated at pin insertion sites; Group 2 received clonidine with saline infiltration; Group 3 received a placebo preoperatively and had lidocaine infiltrated at pin sites; and Group 4 received a placebo with saline infiltrated. All patients had a standard anesthetic titrated to...
63.
A Cranio-Orbital-Zygomatic Approach to Dumbbell-Shaped Trigeminal Neurinomas Using the Petrous Window - Chung, Young Seob; Gwak, Ho-Shin; Jung, Hee-Won; Paek, Sun-Ha; Kim, Dong Gyu; Choi, Kil-Soo
We applied a cranio-orbital-zygomatic approach that extends the temporal craniotomy more posteriorly and minimizes the frontal orbitotomy of an ordinary orbitozygomatic approach in order to provide wide access to the already eroded petrous apices along the long axis of trigeminal neurinomas. We treated seven dumbbell-shaped trigeminal neurinomas between 1991 and 1998 (mean follow-up, 38 months; range, 9 to 109 months). The configuration of the tumor mass was assessed on magnetic resonance imaging by measuring its long diameter in the middle and posterior fossae and the width of petrous erosion. Tumors were then classified into five types based on their distribution...
65.
Posterior Fossa Ependymoma - Grady, M. Sean; Judy, Kevin D.; Bigelow, Douglas C.; Sinson, Grant P.; Rostomily, Robert; Winn, H. Richard
66.
Carotid-Cavernous Fistulas: Pathogenesis and Routes of Approach to Endovascular Treatment - Shownkeen, Harish; Bova, Davide; Origitano, Thomas C.; Petruzzelli, Guy J.; Leonetti, John P.
The etiology, classification, clinical presentation, complications, and intravascular routes to image and treat carotid-cavernous fistulas percutaneously are described. Endoarterial and transvenous approaches (through the jugular, inferior petrosal, or cavernous veins) are discussed in relation to the etiology, size, and characteristics of the fistulas, as well as in relation to the planned therapeutic approach and its possible complications. Possible outcomes, with particular attention to the internal carotid circulation, side effects, and complications also are discussed in relation to etiology and type of fistula. Four exemplary cases are presented.
68.
Fully Endoscopic Vascular Decompression of the Facial Nerve for Hemifacial Spasm - Eby, Joseph B.; Cha, Sung Tae; Shahinian, Hrayr K.
Hemifacial spasm is an uncommon disorder manifesting as a unilateral, involuntary, sporadic contraction of the musculature innervated by the seventh cranial nerve. Although debated, the etiology of hemifacial spasm is generally accepted as compression of the facial nerve by vessels of the posterior circulation. Early surgical techniques were ineffective and fraught with morbidity. Over the past 25 years microvascular decompression surgery has allowed the safe and effective treatment of hemifacial spasm. Recent reports combining microsurgical and endoscopic techniques have documented the advantages of the endoscope in exposing the anatomy of this region. Enhanced visualization allows a less traumatic dissection and...
69.
Staged Resection of Large Hypervascular Vestibular Schwannomas in Young Adults - Abe, Takumi; Izumiyama, Hitoshi; Imaizumi, Youichi; Kobayashi, Shinsuke; Shimazu, Motohiko; Sasaki, Ken; Matsumoto, Kiyoshi; Kushima, Miki
Two young adults underwent resection of large hypervascular vestibular schwannomas (acoustic neuromas) via two-stage surgery. The first patient, a 27-year-old woman with hydrocephalus, had a large hypervascular vestibular tumor in the left cerebellopontine angle (CPA) supplied by the left anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA). The second patient, a 34-year-old woman, had a large AICA-supplied hypervascular vestibular tumor in the left CPA that displaced the brain stem significantly. At the initial stage, only the lateral aspect of the tumor was debulked due to excessive bleeding from the tumor bed. Angiography 1 or 2 months after...
70.
Meningiomas Intrinsic to the Geniculate Ganglion - Falcioni, Maurizio; Piccirillo, Enrico; Taibah, Abdelkader; Sanna, Mario
Geniculate ganglion meningiomas are extremely rare lesionsonly 14 cases have been reported in the literature. Two new cases of these tumors are described. On computed tomography and magnetic resonance imaging, both lesions appeared centered on the area of the geniculate ganglion, extending to the tympanic cleft and eroding the middle cranial fossa floor. The first case was treated through a middle cranial fossa approach. Because the tumor was so large in the second case, a subtotal petrosectomy was used. The authors review the literature to clarify the clinical and radiological characteristics of these tumors and their surgical treatment.
71.
Anteromedial Approach to the Orbit - Deda, Haluk; Ugur, Hasan Çaglar; Yorulmaz, Irfan; Kucuk, Babur
This study evaluated the surgical results of the anteromedial approach for treatment of orbital lesions in 16 patients. Pre- and postoperatively, all patients underwent a complete physical examination focusing on the head and neck area including a thorough ophthalmologic evaluation, computerized tomography, and magnetic resonance imaging. The surgical approach was limited to a medial orbitotomy in five patients; the remaining 11 patients underwent a medial orbitotomy combined with an external sphenoethmoidectomy. The tumor was removed completely without damaging the intraorbital neurovascular structures in all but one patient whose recurrent clival chordoma extended beyond the limits of an extracranial approach. Fibro-osseous...
73.
Extreme Lateral Approach to Ventral and Ventrolaterally Situated Lesions of the Lower Brainstem and Upper Cervical Cord - Kumar, C.V. Ravi; Satyanarayana, Satish; Rao, B. Ravi Mohan; Palur, Ravikanth S.
Lesions situated ventrally and ventrolaterally to the lower brainstem and upper cervical spinal cord test the skills of neurosurgeons. We present our experience with eight such patients who underwent the extreme lateral craniocervical approach. The pathologies encountered include three distal vertebral aneurysms, one prepontine epidermoid, one anterior foramen magnum meningioma, and three high cervical dumbbell neurofibromas. All lesions were treated effectively. Postoperatively, the patients improved significantly. Complications included transient lower cranial nerve paresis in three patients, meningitis in one patient, and a pseudomeningocele in two patients. All complications improved with therapy. We conclude that the extreme lateral approach offers excellent...
74.
Zygomatic Anterior Subtemporal Approach for Lesions in the Interpeduncular Cistern - Deda, Haluk; Ugur, Hasan Çaglar
The interpeduncular cistern is a difficult region to approach through conventional methods due to its deep location and important adjacent neurovascular structures. Therefore, it is usually difficult to expose the region sufficiently. Technical problems associated with various surgical approaches have led to emergence of combined approaches and their modifications (i.e., the removal of the zygomatic arch). In addition, a frontotemporal craniotomy is reported to provide a wide exposure of the anterior temporal base, thus allowing oblique access to the interpeduncular cistern with minimal brain retraction. This study describes clinicians' experience and the surgical results of 24 patients who underwent a...
75.
Cochlear Schwannomas - Barbieri, Marco; Bruzzo, Michel; Mora, Renato; Meller, Renaud; Chays, André; Magnan, Jacques
In a series of 179 cerebellopontine angle (CPA) tumors, the authors present nine cases (5%) that were cochlear nerve neuromas. There were six men and three women (mean age, 51 years). Preoperative magnetic resonance imaging confirmed the diagnosis in one case with a labyrinthine extension and raised suspicions in the other four cases, which were confirmed during surgery. The remaining neuromas were discovered intraoperatively. The mean time between first observation and surgery was 9 months. Preoperatively, all patients underwent a complete otoneurological assessment. The middle fossa approach was used for the patient with the labyrinthine extension, and the retrosigmoid approach...
76.
Use of the LandmarX Surgical Navigation System in Lateral Skull Base and Temporal Bone Surgery - Staecker, Hinrich; O'Malley, Bert W.; Eisenberg, Howard; Yoder, B. Emmerich
Despite the widespread availability of surgical navigation devices, their use in lateral skull base and temporal bone surgery has been limited. Problems with current systems include difficulty of use and inadequate accuracy. We present a series of cases using the LandmarX surgical navigation system as an adjunct for lateral skull base and temporal bone procedures. This infrared emitting diodes (IRED)-driven system has a post that carries the IREDs and bypasses the need to place the patient in a Mayfield head holder. This configuration allows greater mobility of the surgical field. Registration of the patient can include a combination of fiducial...
77.
Navigation with the StealthStation in Skull Base Surgery: An Otolaryngological Perspective - Heermann, Ralf; Schwab, Burkard; Issing, Peter R.; Haupt, Cornel; Lenarz, Thomas
The introduction of computer-assisted navigation systems has played a significant role in assuring the integration and consistent intraoperative use of radiological information. We used a frameless stereotactic navigation system to treat 62 patients with a variety of skull base pathologies. The optoelectric appliance uses digital imaging information to locate surgical instruments in the operative area. The aim of this study was to evaluate the clinical accuracy, practicality, and impact of this navigation system on otolaryngological procedures. In conjunction with rigid head fixation and bone-anchored registration markers, the precision of registration was 0.8 mm and the accuracy of clinical measurements was...
78.
Extra-Axial Cavernous Hemangioma: Two Case Reports - Kanaan, Imad; Jallu, Ashraf; Alwatban, Jehad; Patay, Zoltan; Hessler, Richard
Two patients with extra-axial cavernous hemangioma who presented with headache and oculovisual disturbances were investigated with computed tomography and magnetic resonance imaging. The lesions masqueraded as basal meningioma, but this diagnosis was not supported by magnetic resonance spectroscopy in one patient. Cerebral angiography with embolization was indicated in one patient, but embolization was not justified in the other. Both patients underwent a pterional craniotomy. The lesions were extradural and highly vascular, necessitating excessive transfusion in one patient in whom gross total resection was achieved, and precluding satisfactory removal in the other. There was no mortality. Transient ophthalmoplegia, the only complication...
79.
Reconstruction of Complicated Skull Base Defects Utilizing Free Tissue Transfer - Djalilian, Hamid R.; Gapany, Markus; Levine, Samuel C.
We managed five patients with large skull base defects complicated by complex infections with microvascular free tissue transfer. The first patient developed an infection, cerebrospinal fluid (CSF) leak, and meningitis after undergoing a translabyrinthine resection of an acoustic neuroma. The second patient had a history of a gunshot wound to the temporal bone, with a large defect and an infected cholesteatoma that caused several episodes of meningitis. The third through the fifth patients had persistent CSF leakage and infection refractory to conventional therapy. In all cases prior attempts of closure with fat grafts or regional flaps had failed. Rectus abdominis...
80.
Dural and Arachnoid Membraneous Protection of the Abducens Nerve at the Petroclival Region - Ozveren, M. Faik; Uchida, Koichi; Tekdemir, Ibrahim; Cobanoglu, Bengu; Akdemir, Ismail; Kawase, Takeshi; Deda, Haluk
The goal of this study was to determine the membranous protection of the abducens nerve in the petroclival region. The petroclival portion of the abducens nerve was studied in ten dissections from five cadaveric head specimens. One of the heads was used for histological sections. Four heads were injected with colored latex for microsurgical dissections. The histological sections were prepared from petroclival dura mater, embedded in paraffin blocks, stained, sectioned in the axial, coronal, and sagittal planes, and evaluated by light microscopy. The abducens nerve was covered by a dural sleeve and arachnoidal membrane during its course within the petroclival...
61.
