[Long-term results of the surgical treatment of anterior encephalocele].
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A 23-year-old male was seen with acute onset of decreased vision in the right eye. There was no associated facial abnormality, optic disc abnormality, or previous history of head trauma. A computerized tomography scan of the head revealed a soft tissue density in the right ethmoidal sinus. Surgical decompression of the ethmoid sinus for a possible pyocele or mucocele revealed the mass to be cerebral cortex. Successful neurosurgical repair of the defect in the cribiform plate and amputation of the abnormal brain tissue was accomplished with restoration of vision.
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A 32-year-old woman had a history of left temporal and occipital bone defects since her infancy and she developed left exophthalmos in the last three years following a ormin head injury. The left eye ball was displaced downward and rotated nasally, and she was unable to move the left eye voluntarily beyond the mid-line. The left eye ball could not be rotated beyond the mid-line even by muscle traction. Skull x-rays and carotid angiograms showed various abnormalities of skull dysplasia and positional abnormalities of intracranial arteries. Pneumoencephalography demonstrated dilatation of the arterior and temoral horns of the left lateral ventricle. Cranioplasty was performed and postoperative vasospasm occurred in the internal carotid and middle cerebral arteries, causing right hemiparesis and aphasia. Congenital vascular abnormality in neurofibromatosis was discussed in relation to the cerebral vasospasm.
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Nineteen cases of temporal bone brain herniation and cerebrospinal fluid (CSF) leaks in 17 adult patients since 1987 are reviewed. Of these 19 cases, 11 were spontaneous CSF leaks, 6 were related to chronic otitis media, and 2 were posttraumatic. Among the 10 women and 7 men, the average age was 51.2 years, with average follow-up time of 2 years, 7 months. Two cases were repaired by a middle fossa craniotomy approach, 1 case by a transmastoid approach, and 16 by a combined transmastoid and middle fossa approach. Ten cases utilized the preferred technique of fascia-bone-fascia to repair the defects. The diagnosis was made on clinical grounds in 18 of the 19 cases, with ancillary diagnostic test providing little useful information. There were no postoperative surgery-related complications, and definitive repair was accomplished in one stage in all cases.
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