PubMed · 13503421
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J B CURTIS. 1958-01-18. Subdural hygroma.. https://pubmed.ncbi.nlm.nih.gov/13503421/
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BACKGROUND: Anterior clinoidectomy is useful in the surgical treatment of paraclinoid and parasellar lesions. Previously reported procedures require expertise in drilling, the alternative method reported here reduces the drilling procedure. METHODS AND RESULTS: En-bloc clinoidectomy is performed intradurally via the standard pterional approach. A 1 to 2 mm-wide narrow drill line is placed with a 1 mm-wide diamond burr through the lesser sphenoid wing. It encircles the medial border of the optic canal and the lateral border of the lesser sphenoid wing over the superior orbital fissure, and is located about 1 cm anterior to the posterior margin of the optic canal. After drilling, one bony piece that includes the anterior clinoid process (ACP) and the optic canal roof remains connected to the basisphenoid bone by the optic strut alone. The optic strut is then fractured easily by applying leverage near its junction with the basisphenoid bone and the piece is removed en bloc with the major part of the optic strut, requiring little or no additional drilling of the residual bony fragments. Of 37 patients who underwent our en-bloc clinoidectomy, only one suffered complications consisting of cerebrospinal fluid (CSF) leakage through the sphenoid sinus. Our procedure requires an average of 20 min. CONCLUSIONS: Intradural en-bloc removal of the ACP with fracture of the optic strut requires minimal drilling, resulting in decreased risk of injury to the optic nerve and a shortened time for clinoidectomy.
We report a 54-year-old female with rheumatoid factor-positive hypertrophic cranial pachymeningitis. At age of 51 years she developed headache, hearing loss, right vagal nerve palsy, and right accessory nerve palsy. MRI revealed thickening and gadolinium-enhancement of the cranial dura mater. The initial symptoms significantly improved with corticosteroid therapy. Two years later, she presented with severe headache and neck pain. Although gadolinium-enhanced MR images failed to show any change compared with those before recurrence, 201Tl single-photon emission CT (SPECT) showed a remarkable accumulation of thallium-201 in the dura mater. Furthermore, the abnormal uptake of thallium-201 returned to normal after treatment with corticosteroid. 201T1-SPECT was a useful tool for the evaluation of disease activity in the patient with hypertrophic pachymeningitis.
This study was designed to determine whether solvent-preserved dura mater and fascia lata grafts would be as effective as palatal mucosal grafts for vestibuloplasty. All graft systems succeeded in covering the alveolar ridge with firmly attached tissue, which is needed to ensure prosthetic stability. There was no remarkable reduction in area until the stents were removed. However, after 6 months of vestibuloplasty, there was a significant reduction in gained vestibular area in the fascia lata group, whereas no significant difference between dura mater and palatal grafts was observed. These findings suggest that dura mater could serve as a biologic oral dressing for mucosal defects as effectively as palatal grafts in vestibuloplasty.