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Results for “Cranial Fossa, Middle”

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PubMedDate not supplied

[Arachnoid cysts of the middle cranial fossa presented as subdural hematomas].

The aim of the study was to present the authors' own experience and discuss the treatment method of arachnoid cysts of the middle cranial fossa disclosed as subdural hematoma. Three cases of male patients operated on because of chronic subdural hematoma are presented. Control CT studies after evacuation of hematomas revealed arachnoid cysts of the middle cranial fossa and all patients were qualified for delayed cystocisternostomy by open craniotomy. Indirect signs of presence of arachnoid cysts in the form of bony abnormalities and expanded the middle cranial fossa in the first CT were seen in all patients. Cysts were asymptomatic until the injury in all cases. The volumes of cysts in MRI scans were: 17.8 ml, 52.9 ml and 92.4 ml, respectively. All cysts were type II according to Galassi classification. After control MRI described above made to evaluate cyst appearance, delayed cystocisternostomy to basal cisterns was undertaken in two cases with full success. No complications were observed. The third patient refused surgery. During surgery the thick and non-transparent medial cyst wall and arachnoidea of tentorial notch cisterns were observed impeding the exact identification of neurovascular structures. In our opinion arachnoid cysts of the middle cranial fossa revealed as subdural hematoma should be operated on in two stages: in the first step subdural hematoma should be evacuated and in the second step cystocisternostomy should be performed. With regard to observed morphological changes of arachnoidea and cyst walls we think that open cystocisternostomy is treatment of choice in these cases.

Adult↗

PubMedDate not supplied

Middle cranial fossa acoustic neuroma excision: results and complications.

The middle cranial fossa surgical approach has been used for the removal of acoustic neuromas in 43 patients at the University of Iowa since 1974. Hearing was maintained in 50% of patients with tumors 1.5 cm or less outside the porus acusticus. Postoperative hearing, facial nerve function, and complications were similar to reports using the suboccipital or retrosigmoid approach to preserve hearing for this size tumor. The character of the tumor appears to dictate the postoperative outcome rather than the surgical approach.

Adult↗

PubMedDate not supplied

Facial nerve neurinoma presenting as middle cranial fossa mass: CT appearance.

Two cases of large seventh nerve neurinoma presenting as masses in the middle cranial fossa are presented. The radiographic findings are discussed with attention to CT appearance. In the appropriate clinical context, correlation with radiographic studies should strongly support diagnosis of middle fossa neurinoma originating from the seventh cranial nerve. Failure of preoperative diagnosis may result in unexpected operative loss of facial nerve function.

Adult↗

PubMed1988

[Circumscribed changes in the cranium due to extracerebral fluid collection in the middle cranial fossa].

On the basis of 26 cases with extracerebral fluid accumulation in the middle cranial fossa the bony changes occurring in this connection are described and discussed in respect of their aetiology. If there are bony accompanying reactions, two entities can be observed in principle. One group shows thinning and protrusion of the temporal squama, raising of the lesser wing of the sphenoid bone and protrusion of the greater wing of the sphenoid bone. The second group is associated with thickening of the temporal squama and of the lesser and greater wing of the sphenoid bone without showing any change in volume of the middle cranial fossa. If we postulate in the first group a space-occupying property of the extracerebral fluid accumulation, the prominent reactions in the second group are those usually associated with absence of pressure exercised on the cranial vault by a space-occupying growth.

Adolescent↗

PubMed2000

[Surgical treatment of middle cranial fossa arachnoid cyst in children with atypical symptoms--report of three cases].

We report three cases of symptomatic arachnoid cyst in the middle cranial fossa who presented with atypical symptoms including speech delay, vomiting and personality changes. They were improved by a cyst-peritoneal shunt operation. In many patients with a small or middle sized arachnoid cyst in the middle cranial fossa, their symptom tends to be so trivial that surgery is not the choice of treatment. The present cases suggest that peculiar symptoms caused by a limbic system lesion may be improved by treating the arachnoid cyst in the middle cranial fossa.

Arachnoid Cysts↗

PubMedDate not supplied

The arcuate eminence. Topographic orientation in middle cranial fossa surgery.

The superior semicircular canal (SSC) is an important landmark in the middle cranial fossa approach to the temporal bone. This landmark is frequently located by its topographic association to the arcuate eminence. An anatomic study is reported which examines the relationship of the arcuate eminence to the SSC. Techniques for orientation to the internal auditory canal by the middle cranial fossa approach are reviewed and a technique for localizing the SSC when no arcuate eminence is discernible is presented. 1) In 15% of temporal bone specimens, no arcuate eminence was discernible. 2) Of those specimens with an arcuate eminence, 50% demonstrated that the arcuate eminence was rotated posteriorly from the SSC. 3) Despite displacement of the arcuate eminence, the SSC tended to remain perpendicular to the petrous ridge and 60 degrees from the internal auditory canal. 4) Because of their variable relationship, the arcuate eminence should not be used as a substitute for the SSC in the topographic orientation to the internal auditory canal. 5) A technique for locating the SSC when the arcuate eminence is indiscernible is presented.

Adult↗

PubMed1982

CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects.

Thirty-one cases of arachnoid cysts of the middle cranial fossa were investigated by CT scan, 7 of them undergoing additional metrizamide CT cisternography. In this paper we analyze and correlate the different findings from these two examinations and propose a classification of arachnoid cysts of the middle cranial fossa into three basic types. Pathophysiological and surgical implications are discussed.

Adolescent↗

PubMed1989

Intrusion of the mandibular condyle into the middle cranial fossa: report of a case in an 11-year-old girl.

Intrusion of the head of the condyle into the middle cranial fossa is a rare but highly significant result of trauma to the mandible. Various treatment modalities for this type of injury have been reported in the literature. This case report concerns the intrusion of the left mandibular condyle into the middle cranial fossa in an 11-year-old girl. Five days after the original injury, severe limitation of opening was noted, as was a significant overjet and posterior open bite. A CT scan revealed intrusion of the left condyle into the middle cranial fossa. Treatment consisted of closed reduction with intermaxillary fixation. At the 10-month follow-up, full range of motion was possible with only minimal deviation.

Adolescent↗

PubMed2003

Endoscopic reconstruction of anterior and middle cranial fossa defects using acellular dermal allograft.

OBJECTIVE: To report our experience in reconstructing defects of the anterior and middle cranial fossa skull base using endoscopic placement of acellular dermal allograft (AlloDerm, LifeCell Corp., The Woodlands, TX). STUDY DESIGN: Retrospective chart review. METHODS: In all cases, the skull base repair was completed with a similar technique. After identification of the defect boundaries, endoscopic transnasal repair was performed through placement of a layered reconstruction of acellular dermal allograft, septal bone/cartilage, and acellular dermal allograft, which were all placed on the intracranial side of the defect. A mucosal free graft was draped over the reconstruction. Fibrin glue was used to hold the mucosal graft in place, and the reconstruction was supported by both absorbable and nonabsorbable nasal packing. RESULTS: Eight patients with nine skull base defects underwent the procedure for repair of cerebrospinal fluid rhinorrhea. All defects were successfully repaired. One patient underwent successful reconstruction of bilateral ethmoid roof defects that resulted from endoscopic resection of ethmoid adenocarcinoma. Twenty-four patients underwent primary resection of hypophyseal adenomas. Twenty-three patients had macroadenomas, and intraoperative cerebrospinal fluid leaks were noted in 11 patients. Sellar repairs after trans-sphenoidal hypophysectomy were successful in 22 of 24 patients. One patient with hypophysectomy required reoperation (1 of 24 [4%]) for secondary closure of a cerebrospinal fluid leak. Serious complications were avoided in all patients. Patients were followed for a period ranging from 5 to 57 months (mean period, 34 mo). CONCLUSIONS: Acellular dermal allograft can be successfully used for the reconstruction of anterior and middle cranial fossa skull base defects. This allograft, which is easy to manipulate endoscopically, provides an effective seal and barrier in skull base reconstruction and avoids the need for a donor site.

Adenocarcinoma↗

PubMed1995

Cholesterol granuloma in the middle cranial fossa: report of two cases.

We report two cases of cholesterol granuloma in the middle cranial fossa. On CT the lesions appeared as a nonspecific, nonenhancing soft-tissue mass with bone erosion. On MRI they were seen as areas of high signal intensity surrounded by a low-intensity peripheral zone on both T1- and T2-weighted images. Cholesterol granuloma is thought to occur when pneumatised cells in the temporal bone become obstructed. Although this lesion usually occurs in the petrous bone, it can extend to the middle cranial fossa. The diagnosis and surgical management are discussed.

Adult↗

PubMed2006

Intrusion of the mandibular condyle into the middle cranial fossa: case report and review of the literature.

OBJECTIVES: To describe a case of mandibular condyle intrusion into the middle cranial fossa in a young child and to systematically review the literature pertaining to this condition. STUDY DESIGN: The diagnostic procedures comprised clinical examination, health history, and both magnetic resonance imaging and computerized tomography. A systematic review of the literature from PubMed, Medline, and Web of Science databases from 1960 to 2005 was made and a total of 55 cases in 51 references were found, of which 36 were described in detail. CONCLUSIONS: Prompt diagnosis of mandibular condyle intrusion into the middle cranial fossa is essential to minimize complications. Advanced imaging modalities of computed tomography and magnetic resonance imaging are indicated.

Accidents, Traffic↗

PubMed1993

Arachnoid cysts of the middle cranial fossa: a consideration of their origins based on imaging.

Arachnoid cysts situated in the middle cranial fossa constitute the largest group of this type of lesion. Their origin has been the subject of debate since they were first described. There is still controversy as to whether they originate directly from the meninges adjacent to the temporal pole or whether partial agenesis of the temporal lobe favours secondary formation of the cyst. We assessed the morphology of the temporal lobe and the bulging of the squamous temporal bone. "Paradoxical changes" in adjacent-bone, described as very rare findings in arachnoid cysts of the middle cranial fossa, were common in our study and suggest, in association with direct signs of temporal atrophy, that this atrophy precedes, or is at least co-existent with, the formation of the cyst. The importance of being able to determine the origin of the cyst lies in its being a factor to assess as regards treatment.

Adolescent↗

PubMed1987

[A case of facial nerve schwannoma extending into the middle cranial fossa with characteristic CT findings].

Facial nerve schwannoma is rare. Since the first description by Schmid, about 150 cases have been reported mainly in the otological field. The authors recently had a case of facial nerve schwannoma with a marked capsular calcification, extending into the middle cranial fossa. A 63-year-old man was admitted to our hospital on June 20, 1986. About 44 years prior to the admission, he noted facial weakness of the right side which gradually progressed. Neurological examination on admission revealed complete right facial paralysis of the peripheral type with loss of taste, right hearing loss, diminution of lacrimal secretion and no reaction to caloric stimulation. Stenvers' view and tomogram of the right temporal bone showed destruction of petrous ridge. CT scan demonstrated bony destruction of the right petrous pyramid and high dense mass lesion, extending into the middle cranial fossa. Peritumoral and intratumoral calcifications, characteristics of facial nerve schwannoma were also noted. Right external carotid angiography demonstrated the tumor was fed by petrous branch of the right middle meningeal artery. On July 11, 1986 right temporal craniotomy and extradural approach to the floor of the petrous portion of the middle cranial fossa were performed. There was an extradural mass which extended to the middle cranial fossa through the destroyed pyramis. The tumor appeared to originate from the geniculate ganglion of the facial nerve and invaded the inner and middle ear which were almost completely removed. Operative specimen demonstrated that the tumor was a schwannoma. Postoperative hearing test and facial nerve function showed no changes as compared with preoperative findings. Similar case reports with CT findings were reviewed.

Brain↗

PubMed1990

A case of recurrent aural cholesteatoma extending into the middle cranial fossa.

A case of aural cholesteatoma extending into the middle cranial fossa is presented. The cholesteatoma appears to have recurred in an ear in which a radical mastoidectomy had been performed more than 40 years earlier. The patient complained only of a vague sensation of heat in the head and did not manifest distinct neurologic signs or symptoms. The cholesteatoma was removed through an extended endaural approach. Extension of aural cholesteatoma beyond the confines of the temporal bone appears to be quite unusual.

Adult↗

PubMed1997

Craniofacial access to the anterior and middle cranial fossae and skull base.

A profusion of surgical approaches to gain access to the anterior and middle cranial fossa and skull base have been described. An attempt has been made to simplify the position by suggesting a classification of surgical approaches and to describe a standard approach (of at most 4 defined osteotomies, or at least 2) to give a craniofacial approach to the anterior and middle cranial fossae, the infratemporal fossa, the orbit and the superior nasal cavity. The full extent of the osteotomies have been likened to an ancient Corinthian face mask, or to the stylized face-mask worn by the comic book hero, Batman.

Adult↗

PubMed1991

Results of acoustic neuroma surgery by the extended middle cranial fossa approach.

The results of surgery in 160 cases of AN are reported. Surgery was carried out by the extended middle cranial fossa (EMCF) approach in 138 cases and by the middle cranial fossa (MCF) approach in 22 cases. The tumor extended an average of 28.9 mm into the posterior cranial fossa; 42% of the tumors extended 31 mm or more. Mortality was 1.9%. Of the 3 cases of death, two had large tumors of 45 mm and 52 mm each, and one was a case of recurrence. Total tumor removal was achieved in an average of 78.8% of the cases. When the cases were classified by date of operation, the total tumor removal rate in the 60 most recent cases was 93.3%. The rate of facial nerve presentation was 82.4% on average and 93% in the recent cases. Hypoglossal-facial nerve anastomosis was performed in 33% of the cases in which facial nerve function failed to recover for an extended period of time. Among recent cases, however, anastomosis has been carried out in 22% of the cases. Hearing was preserved in 20 cases. Useful hearing was preserved in 8 (38%) of 22 cases. Recurrence was confirmed through surgery in 3 cases. Recurrence was suspected but was unconfirmed in 3 cases.

Adolescent↗

PubMed1987

MR imaging of the nasopharynx and floor of the middle cranial fossa. Part I. Normal anatomy.

The normal anatomy of the nasopharynx and floor of the middle cranial fossa was analyzed with magnetic resonance (MR) imaging. MR images from five healthy volunteers were correlated with whole-organ cryomicrotome sections from three cadavers. Anatomic connections exist between the paranasopharyngeal spaces and the surface structures of the skull base. These anatomic connections include the intimate relationship between the eustachian tube and the pharyngobasilar fascia, the attachment of the muscles of mastication and deglutition to the skull base, and vascular and nervous structures in the foramina. The inherent contrast between the soft tissues of the nasopharynx and related structures and the bone of the floor of the middle cranial fossa allowed excellent visualization of these anatomic connections.

Cadaver↗

PubMed2000

Huge facial schwannoma extending into the middle cranial fossa and cerebellopontine angle without facial nerve palsy--case report.

A 46-year-old male presented with a huge facial schwannoma extending into both the middle cranial fossa and the cerebellopontine angle but without manifesting facial nerve palsy. Neurological examination on admission revealed no deficits except for speech disturbance. Computed tomography showed a multicystic tumor extending into the middle cranial fossa and the cerebellopontine angle, with destruction of the petrous bone. The tumor was totally grossly removed. Histological examination identified schwannoma. Total facial nerve palsy appeared postoperatively, but hearing acuity was preserved at a useful level. Facial nerve palsy is one of the most typical symptoms in patients with facial schwannoma, but is not always manifested even if the tumor extends into both the middle cranial fossa and the cerebellopontine angle.

Adult↗