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Results for “Cranial Fossa, Anterior”

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At least 19 recordsLinked to original sources

PubMed2003

[Intranasal endoscopic surgery on the anterior cranial fossa via the anterior skull base].

OBJECTIVE: To explore the possibility of performing anterior cranial fossa surgery by an intranasal endoscope via the anterior skull base. METHOD AND RESULTS: A rare case of accidental insertion of chopstick into the anterior cranial fossa as deep as 6.5 cm was reviewed and analyzed. The residue of the plastic chopstick was successfully taken out from the anterior skull cavity by an intranasal endoscope that was insorted into the earity via the anterior cranial base followed by surgical management of the cerebrospinal fluid rhinorrhea with the skull defect repair. Complete postoperative recovery of the child was achieved. CONCLUSION: The foreign material near the anterior cranial base of the anterior skull cavity can be removed via intranasal endoscope through the anterior cranial base.

Cranial Fossa, Anterior↗

PubMedDate not supplied

[An approach to an esthesioneuroblastoma of the anterior cranial fossa via the anterior wall of the hypertrophied frontal sinus].

A 40-year-old patient with anterior cranial fossa esthesioblastoma was operated on. Surgical approach via anterior wall of enlarged frontal sinus was used. After removal of tumor from anterior cranial fossa, ethmoidal and frontal sinuses, skull base defect was closed with abdominal fat and periosteum. Different approaches to anterior cranial fossa are discussed.

Adult↗

PubMed1983

Anterior cranial fossa tumors.

The anterior cranial fossa may be invaded by malignant or nonmalignant tumors arising in the orbit, orbital contents, nose, nasopharynx, or frontal, ethmoid, or sphenoid sinuses. Skin and maxillary tumors can also spread to the skull base. One must be aware of this and assess the situation with the neurosurgeon, and use coronal and axial CAT scans. The approach is intracranial and extracranial, with total en bloc tumor resection under frozen section control. In nonmalignant tumors immediate reconstruction is performed; in malignant tumors, especially recurrent ones, the reconstruction is delayed twelve to eighteen months to lessen the chances of later recurrences. With this approach, recurrences have been few and survival rates excellent, even in advanced recurrent lesions.

Carcinoma, Squamous Cell↗

PubMed2004

Surgical management of an unruptured dural arteriovenous fistula of the anterior cranial fossa: natural history for 7 years.

BACKGROUND: Anterior cranial fossa dural arteriovenous fistulas (DAVFs), unlike those in other locations, form a distinct subgroup because of a high incidence of intracerebral hemorrhage and their unique anatomy. We surgically obliterated an unruptured anterior cranial fossa DAVF because the venous aneurysm in the DAVF increased in size during the follow-up period and we present the clinical symptoms, the natural history for a 7-year period before operation, the radiologic findings, and surgical management. This is the first case report in which the growth of a preexisting venous aneurysm in an anterior fossa DAVF was identified. The possible pathogeneses of the rupture of anterior cranial DAVFs are discussed. CASE DESCRIPTION: A 68-year-old man presented with diplopia, retro-orbital headache, and loss of consciousness. Cerebral angiography revealed an anterior cranial fossa DAVF. The primary source of arterial supply was from the ipsilateral anterior ethmoidal artery in combination with the contralateral anterior ethmoidal artery and other less prominent feeding vessels from the external carotid artery (ECA). Venous drainage was through the superior sagittal sinus via dilated pial veins. In addition, a subfrontal pial vein drained toward the region of the sphenoparietal and cavernous sinuses. The detection of the growth of a venous aneurysm 7 years after the initial evaluation prompted an aggressive therapeutic decision on considering a future catastrophic rupture risk. The vascular malformation was approached via a low-frontal craniotomy. A venous aneurysm with a dural feeder was encountered near the site of the anastomosis. The vascular connection between the dura of the cribriform plate and the pial vessels was completely occluded. Postoperative angiography confirmed the complete obliteration of the DAVF. CONCLUSION: In this case, we confirmed an increase in the size of a venous aneurysm of an anterior cranial fossa DAVF. Our findings support the belief that the catastrophic intracranial hemorrhage in an anterior cranial fossa DVAF may occur in the setting of increased hemodynamic pressure of its draining venous channel.

Central Nervous System Vascular Malformations↗

PubMed2000

Relation of the ethmoidal cells to the floor of the anterior cranial fossa.

The shape of the anterior part of the anterior cranial fossa undergoes important changes in the postnatal life depending on the degree of pneumatisation of the ethmoid labyrinth and/or the frontal sinus. There exist three possibilities in these relations: 1) From the newborn period up to 9 years of age, in the majority of the cases the cribrous plate is situated at the level of the roof of the ethmoid labyrinth with the width of the ethmoid incisure corresponding to the width of the cribrous plate. 2) In the period from 9-35 years of age, in the majority of cases, the ethmoidal cells are partly or completely incorporated into the floor of the anterior cranial fossa with the width of the ethmoid incisure corresponding to the number of cells forming the floor of the anterior cranial fossa. 3) In the period from 35-80 years of age, the cribrous lamina is in the majority of cases lowered due to the intensive development of the frontal sinus. The medial wall of the ethmoid labyrinth consists of a thin bony strip, the width of which depends upon the degree of lowering of the cribrous plate. Adequate CT imaging may clarify the situation.

Adolescent↗

PubMed2005

[Two surgically treated cases with dural arteriovenous malformation in the anterior cranial fossa].

Dural arteriovenous fistulae(dAVF) in the anterior cranial fossa comprise about 6% of all dAVFs, and is usually detected after intracranial hemorrhage. However, non-hemorrhagic symptoms are uncommon. We encountered two patients with hemorrhagic and non-hemorrhagic dAVF in the anterior cranial fossa. Both cases were successfully treated using craniotomy and histopathological examination was performed. A 71-year-old male experienced sudden onset of nausea and headache, followed by progression of left hemiparesis and disturbance of consciousness due to intracerebral and subdural hematoma in 2005. Intracerebral venous aneurysm adjacent to the intracerebral hematoma originated from the draining cortical red vein was identified and successfully treated by operation. Histopathological examination revealed disappearance of the internal elastic lamina and scant muscle tissue in the venous aneurysmal wall originating from draining cortical vein. A 69-year-old male suffered sudden onset of mild headache, followed by progression of bruits in 2005. MRI suggested dAVF in the left anterior cranial fossa. 123I-IMP SPECT revealed an area of low perfusion in the left frontotemporal region. Histopathological examination after surgical treatment revealed thickening of the intima and an indistinct lamina elastica interna, indicating progressive degenerative changes of the arterialized vein likely to result in hemorrhage. Surgical obliteration of fistulae is reasonable even in the dAVF of the anterior cranial fossa with ischemic onset.

Aged↗

PubMed1995

Fractures of the floor of the anterior cranial fossa.

We treated 28 patients with anterior cranial fossa floor fractures. Computed tomography (CT) scans adjusted to bone density disclosed three fracture types: (1) penetrating fractures through the orbita or ethmoid sinus; (2) simple or multiple linear fractures; and (3) extensive comminuted anterior cranial fossa floor fractures. Thirteen patients underwent emergent surgery for treatment of open depressed fractures (most common in type 3 fractures), for foreign bodies (in type 1 fractures), and for optic canal decompression. Large dural lacerations were always present in patients with type 3 fractures, and repairs were made with dural substitutes. Only one patient developed postoperative cerebrospinal fluid leakage. Nine (32%) of the patients in our series had visual involvement, but visual acuity recovered or improved in six patients. Our study shows that initial neuroradiologic evaluation with CT scans is important in patients with frontobasal fractures, and that secure dural repair during primary operation helps prevent cerebrospinal fluid leakage.

Adolescent↗

PubMed2003

Clinical anatomy of the human anterior cranial fossa during the prenatal period.

We examined the prenatal development of the human anterior cranial fossa and considered its clinical aspects. Our purpose was an evaluation of anterior cranial fossa geometry, its measurements and connections with the nasal cavity and middle cranial fossa. The study was performed on 29 foetuses from the first and second trimester of pregnancy. New methods of computer image analysis, Scion for Windows 98 and ELFv 4.2, were applied to examine this anatomical region. Different options used were binarisation, equalisation, filters, linear and non-linear transformations and mathematical operations of images. This enabled the dynamics of prenatal development to be accurately evaluated for parts of the base of the human skull. Measurements were taken of angles of the cranial base. The anterior cranial base angle (the apex in the middle of the sella turcica and the arms running through the zygomatic ossification points) decreased gradually between C-R 6 to 23.5 cm from 170 to 120 degrees and afterwards became constant. The contrary-medial cranial base angle (adjacent to the anterior cranial base angle and with a second arm running through the auricular cartilage) increased from 50 to 70 degrees. The anterior cranial fossa was first located on the same level as the middle and posterior fossae. The process of descent of the middle and posterior cranial fossa begins in the 4th gestational month. The geometry of the anterior cranial fossa changes rapidly, especially in the first trimester of pregnancy. The first trimester of pregnancy is crucial for the development of its defects. Preconception prophylaxis of inborn defects of the anterior cranial fossa is therefore extremely important.

Anthropometry↗

PubMed1999

Angiographically occult dural arteriovenous malformation in the anterior cranial fossa--case report.

A 62-year-old male presented with a dural arteriovenous malformation located in anterior cranial fossa manifesting as acute right frontal intracerebral and subdural hematomas. Cerebral angiography showed only mass sign, but surgical exploration disclosed the dural arteriovenous malformation in the anterior cranial fossa. Anterior cranial fossa dural arteriovenous malformation should be considered if computed tomography reveals intracranial bleeding involving the frontal base, even if cerebral angiography does not demonstrate vascular anomalies.

Cerebral Angiography↗

PubMed1989

Penetrating injuries involving the anterior cranial fossa.

Penetrating injuries of the anterior cranial fossa may result in permanent neurologic changes or even death if injuries are unrecognized and remain untreated. The diverse etiologies of such injuries are reviewed, as well as their diagnosis, treatment and prognosis.

Cerebrospinal Fluid Rhinorrhea↗

PubMed1990

[The clinical manifestations of epidural hematomas in the anterior cranial fossa].

Epidural hematomas of the anterior cranial fossa are a relatively rare localization of intracranial hemorrhage. Hematomas of this localization show a peculiar course and clinical manifestation. By the character of clinical manifestations, course of the injury, results of surgical treatment two groups of patients were distinguished: patients with isolated hematomas of the frontal region characterized by a paucity of clinical manifestations and patients with epidural hematomas of the frontal region associated with other intracranial lesions and are characterized by a grave course and high lethality.

Adolescent↗

PubMed2000

[Dural arteriovenous fistulae in the anterior cranial fossa--report of three cases].

Dural arteriovenous fistulae (DAVF's) in the anterior cranial fossa are uncommon. We encountered three patients with DAVF's in the anterior cranial fossa and reviewed the pertinent literature with regard to the etiology. All patients are middle-aged males. Two of three patients had massive intracranial hemorrhage, subarachnoidal hemorrhage in one and subdural hemorrhage in the other. One patient had a ruptured middle cerebral artery aneurysm and DAVF at the anterior cranial fossa was detected only incidentally. Angiographically, blood supplies were from the bilateral enlarged anterior ethmoidal arteries. These drained into the superior sagittal sinus via dilated frontal cortical veins. In all the patients, coagulation of the fistulous connections was carried out and the postoperative courses were uneventful. Angiographies revealed complete disappearance of the DAVF's. In conclusion, compared to cases of DAVF's in the other locations, DAVF's of the anterior cranial fossa are more likely to be brought on by sudden massive intracranial hemorrhage, and should be treated, even if asymptomatic, at the time of diagnosis. Surgical obliteration of the fistulous connection is sufficient treatment for DAVF in the anterior cranial fossa. Literature review strongly suggests that DAVF's involving the anterior cranial fossa are acquired lesions.

Aged↗

PubMed1996

Transient global amnesia and dural arteriovenous fistula of the anterior cranial fossa.

Dural arteriovenous fistula (AVF) of the anterior cranial fossa is associated usually with cerebral hemorrhage or subarachnoid hemorrhage, while an association with transient global amnesia has not been reported previously. A case presenting the latter unusual symptom is described and the surgical treatment of AVF is discussed. A 64-year-old woman was hospitalized complaining of transient memory impairment. Magnetic resonance (MR) imaging demonstrated a flow void in the left frontal lobe and temporal pole. Cerebral angiography revealed an AVF in the anterior cranial fossa, which was fed bilaterally by the ethmoidal arteries and by branches of the external carotid arteries. The AVF drained into the superior sagittal sinus and the superficial sylvian vein via large varices. Following transfemoral embolization, surgical treatment was carried out. Postoperative angiography revealed complete obliteration of the anomaly. There were no further episodes of amnesia. In our presented case, there is an association between the presenting symptoms and the AVF. The combination of ischemia and congestion in the frontal and temporal lobes may have caused transient memory impairment. From our surgical experience, the excision of the vascular connection between the dura and the frontal lobe following the coagulation of the dura mater of the anterior part of the base of the skull without extensive excision seems to be recommended.

Acute Disease↗

PubMedDate not supplied

[Dural fistulas of the anterior cranial fossa].

Dural arterio-venous shunts (DAVS) of the anterior cranial fossa are quite rare. There are only a few cases reported in the literature. The authors present 5 cases of dural arterio-venous shunts (DAVS) of the anterior cranial fossa, allowing more data for later reviews of this rare and aggressive localisation of DAVS. The clinical set, imaging findings (with emphasis in diagnostic angiography), treatment and outcome in these 5 patients are described. Haemorrhage was the presenting form in 4 patients; the other case presented was investigated for headache. There were bilateral symmetric feeders in two patients, unilateral feeders in another two and unilateral predominant feeders in one; contribution of the external carotid artery, when present, was always minimal. Venous drainage included one or combinations of these: superior sagittal sinus, sylvian veins and cavernous sinus. Three patients had venous aneurysms in anterior cranial fossa; of these, two presented with haemorrhage, but the third one of them has been asymptomatic for 7 years. Three patients were treated by surgical exclusion of the shunt and became clinical and angiographicaly normal. According to the literature, our cases confirm the highly aggressive behaviour of these DAVS. Surgical treatment is an efficacious method of therapy and should be done as soon as possible. Embolization can be attempted but is technically difficult and eventually too expensive.

Adult↗

PubMed2000

Thick-section reformatting of thinly collimated helical CT for reduction of skull base-related artifacts.

OBJECTIVE: Our purpose was to evaluate thick-section reformatted helical CT of the brain base as a technique for reducing skull base-related artifacts and to compare it with conventional CT. MATERIALS AND METHODS: Twenty-three patients with suspected intracranial abnormalities related to the brain base, as determined either by clinical examination or at the time of imaging, were evaluated with contrast-enhanced conventional CT of the brain (5-mm collimation, 140 kVp, 170 mA, 2-sec rotation time) and reformatted helical CT (1-mm collimation, 1.5 pitch, 120 kVp, 220 mA). Helical sections were reformatted to a thickness of 5 mm by a volume-averaging algorithm using a computer workstation. Three observers retrospectively and blindly reviewed the images and qualitatively scored artifacts at the foramen magnum, middle cranial fossa, anterior cranial fossa, interpetrous region, and internal occipital protuberance. Image graininess and observer confidence were also scored. Paired statistical analyses using score differences in each patient were possible. RESULTS: Reformatted helical CT reduced skull base-related artifacts across all five anatomic regions (p < 0.05). The foramen magnum showed the greatest reduction in artifacts and the anterior cranial fossa the least. Image graininess was increased on reformatted CT compared with conventional CT (p < 0.05), but observer confidence remained higher for reformatted CT (p < 0.05). Total additional scan time was 3.15 +/- 0.38 min with 5.3 +/- 1.2 min required for reformatting. CONCLUSION: Reformatted CT significantly decreases skull base-related artifacts in the brain, improving confidence in evaluation of the brain base and adding an average of only 8.45 +/- 1.6 min of scanning and processing time to each examination.

Adult↗

PubMed2005

Extensive anterior cranial fossa idiopathic hypertrophic pachymeningitis: a case report and review of the literature.

Idiopathic hypertrophic cranial pachymeningitis is a rare chronic inflammatory and fibrosing process of unknown etiology. This entity is characterized by fibrosis and thickening of the dura mater and resulting in neurological syndrome. The authors report a 72 year-old woman who presented with progressive bifrontal headache, bilateral visual loss and transient episode of confusion. Neurological examination revealed bilateral optic atrophy, apathy and no focal neurological deficit. Investigations showed anemia of chronic disease, elevated erythrocyte sedimentation rate and polyclonal hypergammaglobulinemia. No specific inflammatory diseases or malignancy such as systemic lupus erythematosus, syphilis, hematologic malignancy were found MRI of the brain revealed thickened and enhanced dura mater and leptomeninges at the inferior aspect of bilateral frontal lobes as well as vasogenic edema of the frontal lobes. Cerebrospinal fluid showed mild pleocytosis, high protein level and normal glucose level. Meningeal biopsy revealed nonspecific inflammatory process of the dura and leptomeninges. There was no granuloma formation or evidence of vasculitis. Special stain for tuberculous bacilli, fungus and malignancy were all negative. The diagnosis of "idiopathic hypertrophic pachymeningitis" was made. The patient was treated with oral prednisolone 45 mg/day. Her headache was improved, but the profound vision loss in both eyes remained unchanged after 2 years of follow-up. Prednisolone was tapered within 18 months. Idiopathic hypertrophic cranial pachymeningitis usually involves dura at tentorium cerebelli, cavernous sinus and base of the skull. The extensive involvement at the anterior cranial fossa is extremely rare.

Aged↗

PubMed2004

Detection of enlarged cortical vein by magnetic resonance imaging contributes to early diagnosis and better outcome for patients with anterior cranial fossa dural arteriovenous fistula.

Twelve patients (10 men, 2 women) with anterior cranial fossa dural arteriovenous fistula (AVF) were treated at our institute between January 1976 and March 2002. Intracranial hemorrhage was the presenting symptom in six patients. Magnetic resonance (MR) imaging findings identified abnormal cortical veins as flow voids in four of five patients. Angiography was the basis of the diagnosis in all patients. Surgery was the primary treatment in nine patients. The other three patients refused intervention and managed conservatively. Surgical morbidity was negligible and the treatment outcome was highly dependent on the clinical status at presentation. In contrast to the reported high incidence of intracranial hemorrhage in patients with dural AVF in the anterior cranial fossa, only half of our study population presented with hemorrhage. Enlarged cortical veins in the frontobasal area could be detected as flow voids on MR images. This finding contributed to the early diagnosis and treatment of patients treated at our institution for dural AVF in the anterior cranial fossa, and to the better outcomes we obtained in these patients.

Aged↗

PubMed2002

Cranial base kyphosis and the surface morphology of the anterior cranial fossa.

We investigated the relationship between the surface morphology of the anterior cranial fossa and cranial base kyphosis (sphenoid angle) in 52 cephalometric craniograms. Among them there were 25 female (mean age 54 +/- 15; range 31-82) and 27 male (mean age 43 +/- 18, range 19-85) skulls. The sphenoid angle and the altitudes of the highest elevation of the endofrontal eminence (cranial base over the orbital roof in the anterior cranial fossa) and the middle point of the sphenoid planum, measured according to the Frankfort horizontal, were analysed using classical cephalometric and morphometric analysis. Statistical analysis was performed by Pearson's product-moment correlation and simple linear regression. The sphenoid angle ranged from 97 degrees to 137 degrees (mean 118 +/- 9 degrees). The altitude ratio of the highest elevation of the endofrontal eminence and the middle point of the sphenoid planum ranged from 1.5 to 1.8 (mean 1.6 +/- 0.1). A significant correlation was found between this ratio and the sphenoid angle (r = -0.65; p < 0.001; coefficient of determination = 0.43). The elevation of the endofrontal eminence relative to the sphenoid planum was higher in skulls with increased cranial base kyphosis, whereas reduced sphenoid angle was associated with an increase in the elevations of the endofrontal eminence. Although the sphenoid angle has a significant effect on the morphology of the anterior cranial fossa, only 43% of the variance in altitude of the endofrontal eminence is likely to be explained by its relationship with the sphenoid angle.

Adult↗