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Alzaben KA, Mousa A, Al-Abdi L, Alkuraya FS, Alsulaiman SM. Surgical Outcomes of Retinal Detachment in Knobloch Syndrome. Ophthalmol Retina 2024:S2468-6530(24)00168-4. [PMID: 38556002 DOI: 10.1016/j.oret.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To describe the rate, characteristics, and outcomes of rhegmatogenous retinal detachment (RD) in patients with Knobloch syndrome. DESIGN A single-center retrospective cohort study. PARTICIPANTS 50 patients with Knobloch syndrome diagnosed clinically with or without molecular confirmation of recessive pathogenic COL18A1 variants. METHODS A retrospective chart review of all patients diagnosed with Knobloch syndrome from November 1st, 1983, to March 31st, 2023. Demographic data, ophthalmic evaluation at baseline and follow-up, interventions, and final anatomic and visual outcomes were collected. MAIN OUTCOME MEASURES Rate, time of onset, characteristics, and treatment outcomes of RD. RESULTS Fifty patients with Knobloch syndrome were included. Males constituted 56% of cases. The diagnosis was confirmed with molecular genetic testing in 37 (74%) patients. 22 patients (44%) had documented occipital bony defects or scalp lesions. Forty-eight of 100 eyes (48%) developed RD at a mean age of 6.5 (SD = 6.1) years. The mean follow-up was 7.7 (SD = 5.6) years [range 6 months - 24.3 years]. Macular hole-related RD comprised 33% of RD cases. The overall single surgery success rate was 36% and the final anatomical success rate was 70%. Macular hole-related RD carried a slightly worse prognosis with a 58% final anatomical success rate. Vitrectomy with adjunct scleral buckle and silicone oil tamponade provided the highest single surgery success (62.2%). In eyes with measurable best corrected visual acuity (BCVA), the mean preoperative BCVA was 1.2 logMAR (Snellen equivalent 20/320). After successful repair, mean VA was 1.3 logMAR (Snellen equivalent 20/500). CONCLUSIONS Retinal Detachment in Knobloch syndrome is frequent and occurs in young children. Macular hole retinal detachment comprises one-third of RD cases and requires careful macular evaluation. Vitrectomy, combined with scleral buckling and silicone oil tamponade appear to provide the best anatomical outcomes.
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Affiliation(s)
| | - Ahmed Mousa
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Lama Al-Abdi
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Anatomy and Cell Biology, College of Medicine, Al-faisal University, Riyadh, Saudi Arabia
| | - Fowzan S Alkuraya
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Anatomy and Cell Biology, College of Medicine, Al-faisal University, Riyadh, Saudi Arabia
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Kadri H, Dughly M, Shehadeh Agha M, Abouharb R, Mackieh R, Bakleh S, Kadri T. Surviving against the odds: exploring the clinical and radiological features of iniencephaly compatible with life. Illustrative case. J Neurosurg Case Lessons 2024; 7:CASE2414. [PMID: 38467043 PMCID: PMC10936937 DOI: 10.3171/case2414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/09/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Iniencephaly is a rare neural tube defect (NTD) characterized by deformities in the occiput and inion, along with rachischisis in the cervical and thoracic spine, resulting in the head appearing in retroflexion. OBSERVATIONS This report details the case of a female newborn who underwent surgery for an encephalocele. She survived up to 6 months, exhibiting good overall health, although she displayed physical abnormalities, including facial deformity, a short neck, and minor spasms in all limbs. Both cardiovascular and abdominal assessments remained stable, and imaging revealed defects in the occipital bone, a large cephalocele, and spinal dysraphism. LESSONS Although iniencephaly is generally incompatible with life, a few cases have been reported otherwise. Our patient, one of these notable exceptions, remains alive at 6 months old, possibly due to the lack of major vascular deformities. However, she does exhibit significant psychomotor retardation.
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Affiliation(s)
| | - Mazen Dughly
- Department of Neuroradiology DNH, Damascus, Syria; and
| | - Mohamad Shehadeh Agha
- Pediatrics, Children’s University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Raed Abouharb
- Pediatrics, Children’s University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Sameer Bakleh
- Pediatrics, Children’s University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Thea Kadri
- Department of Biology, The George Washington University, Washington, DC
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Alsallom F, Alzahrany M, Gonzalez-Martinez J, Jehi L. Epilepsy Surgery Outcome of Traumatic Intradiploic Meningo encephalocele: A Case Report and Literature Review. Clin EEG Neurosci 2024; 55:241-247. [PMID: 36520585 DOI: 10.1177/15500594221144420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We highlight an under-recognized epileptic pathology in a 56-year-old left-handed female with progressive right facial numbness and weekly focal seizures characterized by episodic aphasia. She was found to have a left frontoparietal intradiploic meningoencephalocele (IDME). Her only epilepsy risk factor was minor head trauma 10 years prior to presentation. She underwent craniotomy for encephalocele resection and mesh cranioplasty without residual neurological deficits and excellent seizure outcome: at 3-year follow-up, she was still seizure-free since surgery, except for an isolated breakthrough seizure at 7 postoperative months when she discontinued her preoperative regimen of Lacosamide monotherapy. Traumatic IDME is a rare condition and rarely presents with seizures. Symptoms may arise up to decades following minor head trauma and are progressive in nature. The likely definitive treatment is cranioplasty and dural repair with or without resecting the protruding parenchyma.
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Affiliation(s)
- Faisal Alsallom
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majed Alzahrany
- Epilepsy Center, Neurological Institute Cleveland Clinic, Cleveland, OH, USA
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jorge Gonzalez-Martinez
- Neurosurgery and Epilepsy Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lara Jehi
- Epilepsy Center, Neurological Institute Cleveland Clinic, Cleveland, OH, USA
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Antal DC, Altenmüller DM, Dümpelmann M, Scheiwe C, Reinacher PC, Crihan ET, Ignat BE, Cuciureanu ID, Demerath T, Urbach H, Schulze-Bonhage A, Heers M. Semiautomated electric source imaging determines epileptogenicity of encephaloceles in temporal lobe epilepsy. Epilepsia 2024; 65:651-663. [PMID: 38258618 DOI: 10.1111/epi.17879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE We aimed to assess the ability of semiautomated electric source imaging (ESI) from long-term video-electroencephalographic (EEG) monitoring (LTM) to determine the epileptogenicity of temporopolar encephaloceles (TEs) in patients with temporal lobe epilepsy. METHODS We conducted a retrospective study involving 32 temporal lobe epilepsy patients with TEs as potentially epileptogenic lesions in structural magnetic resonance imaging scans. Findings were validated through invasive intracerebral stereo-EEG in six of 32 patients and postsurgical outcome after tailored resection of the TE in 17 of 32 patients. LTM (mean duration = 6 days) was performed using the 10/20 system with additional T1/T2 for all patients and sphenoidal electrodes in 23 of 32 patients. Semiautomated detection and clustering of interictal epileptiform discharges (IEDs) were carried out to create IED types. ESI was performed on the averages of the two most frequent IED types per patient, utilizing individual head models, and two independent inverse methods (sLORETA [standardized low-resolution brain electromagnetic tomography], MUSIC [multiple signal classification]). ESI maxima concordance and propagation in spatial relation to TEs were quantified for sources with good signal quality (signal-to-noise ratio > 2, explained signal > 60%). RESULTS ESI maxima correctly colocalized with a TE in 20 of 32 patients (62.5%) either at the onset or half-rising flank of at least one IED type per patient. ESI maxima showed propagation from the temporal pole to other temporal or extratemporal regions in 14 of 32 patients (44%), confirming propagation originating in the area of the TE. The findings from both inverse methods validated each other in 14 of 20 patients (70%), and sphenoidal electrodes exhibited the highest signal amplitudes in 17 of 23 patients (74%). The concordance of ESI with the TE predicted a seizure-free postsurgical outcome (Engel I vs. >I) with a diagnostic odds ratio of 2.1. SIGNIFICANCE Semiautomated ESI from LTM often successfully identifies the epileptogenicity of TEs and the IED onset zone within the area of the TEs. Additionally, it shows potential predictive power for postsurgical outcomes in these patients.
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Affiliation(s)
- Dorin-Cristian Antal
- Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
- Neurology Clinic, Rehabilitation Clinical Hospital, Iași, Romania
- I Neurology Clinic, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, Iasi, Romania
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | | | - Matthias Dümpelmann
- Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for Laser Technology, Aachen, Germany
| | | | - Bogdan-Emilian Ignat
- Neurology Clinic, Rehabilitation Clinical Hospital, Iași, Romania
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Iulian-Dan Cuciureanu
- I Neurology Clinic, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, Iasi, Romania
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Theo Demerath
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Marcel Heers
- Faculty of Medicine, Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
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Tosi U, Jackson C, D'Souza G, Rabinowitz M, Farrell C, Parsel SM, Anand VK, Kacker A, Tabaee A, Zenonos GA, Snyderman CH, Wang EW, Evans J, Rosen M, Nyquist G, Gardner PA, Schwartz TH. Endoscopic endonasal repair of encephaloceles of the lateral sphenoid sinus: multiinstitution confirmation of a new classification. J Neurosurg 2024; 140:705-711. [PMID: 37877971 DOI: 10.3171/2023.7.jns23544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/14/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Encephaloceles of the lateral sphenoid sinus are rare. Originally believed to be due to defects in a patent lateral craniopharyngeal canal (Sternberg canal), they are now thought to originate more commonly from idiopathic intracranial hypertension, not unlike encephaloceles elsewhere in the skull base. A new classification of these encephaloceles was recently introduced, which divided them in relation to the foramen rotundum. Whether this classification can be applied to a larger cohort from multiple institutions and whether it might be useful in predicting outcome is unknown. Thus, the authors' goal was to divide a multiinstitutional cohort of patients with lateral sphenoid encephaloceles into four subtypes to determine their incidence and any correlation with surgical outcome. METHODS A multicenter retrospective review of prospectively acquired databases was carried out across three institutions. Cases were categorized into one of four subtypes (type I, Sternberg canal; type II, medial to rotundum; type III, lateral to rotundum; and type IV, both medial and lateral with rotundum enlargement). Demographic and outcome metrics were collected. Kaplan-Meyer curves were used to determine the rate of recurrence after surgical repair. RESULTS A total of 49 patients (71% female) were included. The average BMI was 32.8. All encephaloceles fell within the classification scheme. Type III was the most common (71.4%), followed by type IV (16.3%), type II (10.2%), and type I (2%). Cases were repaired endonasally, via a transpterygoidal approach. Lumbar drains were placed in 78% of cases. A variety of materials was used for closure, with a nasoseptal flap used in 65%. After a mean follow-up of 47 months, there were 4 (8%) CSF leak recurrences, all in patients with type III or type IV leaks and all within 1 year of the first repair. Two leaks were fixed with ventriculoperitoneal shunt and reoperation, 1 with ventriculoperitoneal shunt only, and 1 with a lumbar drain only. Of 45 patients in whom detailed information was available, there were 12 (26.7%) with postoperative dry eye or facial numbness, with facial numbness occurring in type III or type IV defects only. CONCLUSIONS Endoscopic endonasal repair of lateral sphenoid wing encephaloceles is highly successful, but repair may lead to dry eye or facial numbness. True Sternberg (type I) leaks were uncommon. Failures and facial numbness occurred only in patients with type III and type IV leaks.
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Affiliation(s)
| | - Christina Jackson
- 2Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and
| | - Glen D'Souza
- Departments of3Otolaryngology-Head and Neck Surgery and
| | | | | | - Sean M Parsel
- Departments of3Otolaryngology-Head and Neck Surgery and
| | - Vijay K Anand
- 4Otolaryngology Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Ashutosh Kacker
- 4Otolaryngology Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Abtin Tabaee
- 4Otolaryngology Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Georgios A Zenonos
- 2Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and
| | - Carl H Snyderman
- 2Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and
| | - Eric W Wang
- 2Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and
| | - James Evans
- 5Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Marc Rosen
- Departments of3Otolaryngology-Head and Neck Surgery and
- 5Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gurston Nyquist
- Departments of3Otolaryngology-Head and Neck Surgery and
- 5Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Paul A Gardner
- 2Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and
| | - Theodore H Schwartz
- Departments of1Neurological Surgery, and
- 4Otolaryngology Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
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Li Z, Zhao P, Yang X, Fu C, Zhang Z, Huo R, Xu G. Successful repair of an encephalocele wound in a child following a car accident: A case report. Exp Ther Med 2024; 27:50. [PMID: 38234611 PMCID: PMC10790164 DOI: 10.3892/etm.2023.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/03/2023] [Indexed: 01/19/2024] Open
Abstract
Repair of large cranial complex traumas in children is difficult. Notably, children have poorer underlying conditions than adults and are frailer under trauma. In addition, children have more limited treatment options, leading to the need to consider long-term functional and aesthetic outcomes. The present report describes the case of a 2-year-old child weighing 9 kg who experienced a skull fracture with encephalocele after a car accident and had a poor underlying condition. An artificial dura mater combined with bone cement was used to repair the skull, and then a free latissimus dorsi muscle flap (LDMF) combined with a split-thickness skin graft (STSG) was used to cover the wound, allowing the child to overcome the life-threatening situation as soon as possible with a satisfactory outcome. LDMF combined with STSG is an ideal option in repairing head wounds in children. Preoperative imaging and postoperative care also serve an important role in the success of the operation. When the situation is critical, multidisciplinary team treatment can guarantee the safety of the child.
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Affiliation(s)
- Zhiyu Li
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Pu Zhao
- Department of Plastic Surgery, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng, Shandong 252000, P.R. China
| | - Xinjun Yang
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Cong Fu
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Zhen Zhang
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Ran Huo
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, P.R. China
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Guangqi Xu
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, P.R. China
- Institute of Pharmaceutical Research, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250011, P.R. China
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Kalybaeva NA, Dimertsev AV, Mazalova MV, Kuzovkina AK, Altunina GE, Odeniyazova MA, Balatskaya AS, Utyashev NP, Bychenko VG, Bronov OY, Pedyash NV, Zemlyansky MY, Kopachev DN, Zuev AA, Golovteev AL. [Surgical treatment of focal drug-resistant epilepsy associated with temporal lobe encephalocele]. Zh Vopr Neirokhir Im N N Burdenko 2024; 88:39-47. [PMID: 38334729 DOI: 10.17116/neiro20248801139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND In recent years, temporal lobe encephalocele has become more common in patients with focal drug-resistant epilepsy. Despite available experience, there are still no clear recommendations for choosing the extent of surgery in these patients. OBJECTIVE To evaluate the effectiveness of diagnosis and surgical treatment of focal drug-resistant epilepsy associated with temporal lobe encephalocele. MATERIAL AND METHODS The study included 21 patients with focal temporal lobe epilepsy and temporal lobe encephalocele. All patients underwent continuous video-EEG monitoring and MRI of the brain. There were 12 (57.4%) selective encephalocele resections and 9 (42.6%) anterior temporal lobectomies. The median follow-up period was 31 months. RESULTS The overall effectiveness of surgical treatment with postoperative Engel class I was 76% (16 cases). Selective encephalocele resection was followed by postoperative Engel class I in 10 patients (83%). There were 6 (67%) patients with similar outcomes after temporal lobectomy. Mean volume of resected tissue adjacent to encephalocele was 8.3 cm3. CONCLUSION Surgery is a highly effective treatment for patients with epileptic seizures following temporal lobe encephalocele. In our sample, favorable postoperative outcomes were achieved in 76% of patients (Engel class I). There were no significant differences in effectiveness between selective resection and temporal lobectomy. Further research is necessary for a clear protocol of surgical treatment of focal drug-resistant epilepsy associated with encephalocele.
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Affiliation(s)
| | - A V Dimertsev
- Pirogov National Medical Surgical Center, Moscow, Russia
| | | | | | | | | | - A S Balatskaya
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - N P Utyashev
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - V G Bychenko
- Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - O Yu Bronov
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - N V Pedyash
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - M Yu Zemlyansky
- Epilepsy Center, Moscow, Russia
- Pirogov National Medical Surgical Center, Moscow, Russia
| | - D N Kopachev
- Epilepsy Center, Moscow, Russia
- Neurology Research Center, Moscow, Russia
| | - A A Zuev
- Pirogov National Medical Surgical Center, Moscow, Russia
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Ashari S, Saekhu M, Gunawan K, Aldilla A, Zaragita N, Nugroho SW. Bone fusion in transcele reconstruction of frontoethmoidal meningo encephalocele. Br J Neurosurg 2023; 37:1619-1623. [PMID: 35254175 DOI: 10.1080/02688697.2022.2047156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/23/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE In surgical correction of frontoethmoidal encephalocele with transcranial approach, advanced facilities are required. While with extracranial approach, though deemed as a safe option in area with limited facilities, procedure was associated with cerebrospinal fluid (CSF) leakage. In this case series, we evaluate the results of transcele reconstruction of frontoethmoidal encephalocele, our approach to reduce the incidence of CSF leaks by focusing on the closure of layers by its embryological derivatives, by its bone fusion. METHODS A case series of 14 patients with various types of frontoethmoidal encephalocele who underwent surgery for defect closure using transcele approach between June 2015 and December 2018 was carried out. Surgery was done by a single surgeon in the Department of Neurosurgery of Cipto Mangunkusumo Hospital in Jakarta, Indonesia. We collected the data of intraoperative blood loss and any signs of infection and CSF leak during the patients' one-year follow up. Bone fusion in the defect was evaluated from 3D rendering of head CT scan that was performed before and in 1 year after surgery. RESULTS The median percentage of intraoperative blood loss was 5.9% (0.5-18.7%). All 3D rendering of head CT post-surgery during 1 year follow up showed bone fusion and no patient experienced CSF leaks or CNS infections. CONCLUSIONS This study showed that using transcele approach in frontoethmoidal reconstruction could give good bone fusion with minimal blood loss and no CSF leaks. We assumed that closure of the layers by its embryological derivative played an important part in bone fusion and in reducing the incidence of CSF leaks, although this finding has to be validated with large-scale studies.
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Affiliation(s)
- Samsul Ashari
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Mohammad Saekhu
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kevin Gunawan
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Amanda Aldilla
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Nadya Zaragita
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Setyo Widi Nugroho
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Whalen H, Yazbek S. Atretic cephalocele and differential considerations: A small case series. Neuroradiol J 2023:19714009231212367. [PMID: 37918912 DOI: 10.1177/19714009231212367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Any posterior midline cystic or soft tissue scalp mass in an infant needs evaluation with MRI brain and MRV brain to look for intracranial extension of the lesion. One of the differential considerations is an atretic cephalocele, which can be a difficult diagnosis, especially when the cystic lesions are small. The presence of a small calvarial defect adjacent to the cystic mass and a persistent primitive falcine vein, which points towards the cystic mass, are imaging clues to this diagnosis. Correct diagnosis is needed prior to surgical resection to avoid potentially serious postoperative complications.
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Affiliation(s)
- Hallie Whalen
- Department of Diagnostic Radiology and Nuclear Medicine, Neuroradiology Section, University of Maryland Medical Center, USA
| | - Sandrine Yazbek
- Department of Diagnostic Radiology and Nuclear Medicine, Neuroradiology Section, University of Maryland Medical Center, USA
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Evans SP, Ailes EC, Kramer MR, Shumate CJ, Reefhuis J, Insaf TZ, Yazdy MM, Carmichael SL, Romitti PA, Feldkamp ML, Neo DT, Nembhard WN, Shaw GM, Palmi E, Gilboa SM. Neighborhood Deprivation and Neural Tube Defects. Epidemiology 2023; 34:774-785. [PMID: 37757869 PMCID: PMC10928547 DOI: 10.1097/ede.0000000000001655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Individual measures of socioeconomic status (SES) have been associated with an increased risk of neural tube defects (NTDs); however, the association between neighborhood SES and NTD risk is unknown. Using data from the National Birth Defects Prevention Study (NBDPS) from 1997 to 2011, we investigated the association between measures of census tract SES and NTD risk. METHODS The study population included 10,028 controls and 1829 NTD cases. We linked maternal addresses to census tract SES measures and used these measures to calculate the neighborhood deprivation index. We used generalized estimating equations to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) estimating the impact of quartiles of census tract deprivation on NTDs adjusting for maternal race-ethnicity, maternal education, and maternal age at delivery. RESULTS Quartiles of higher neighborhood deprivation were associated with NTDs when compared with the least deprived quartile (Q2: aOR = 1.2; 95% CI = 1.0, 1.4; Q3: aOR = 1.3, 95% CI = 1.1, 1.5; Q4 (highest): aOR = 1.2; 95% CI = 1.0, 1.4). Results for spina bifida were similar; however, estimates for anencephaly and encephalocele were attenuated. Associations differed by maternal race-ethnicity. CONCLUSIONS Our findings suggest that residing in a census tract with more socioeconomic deprivation is associated with an increased risk for NTDs, specifically spina bifida.
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Affiliation(s)
- Shannon Pruitt Evans
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Eagle Global Scientific LLC, San Antonio, TX
| | - Elizabeth C. Ailes
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Charles J. Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tabassum Z. Insaf
- New York State Department of Health, Albany, NY
- School of Public Health, University at Albany, Rensselaer, NY
| | - Mahsa M. Yazdy
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Suzan L. Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Dayna T. Neo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wendy N. Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Gary M. Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Elizabeth Palmi
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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11
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Rand D, Dlouhy BJ, Kanotra SP. Extended External Rhinoplasty Approach For Nasal Dermoids With Intracranial Extension. Laryngoscope 2023; 133:2798-2802. [PMID: 36688249 DOI: 10.1002/lary.30551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 01/24/2023]
Abstract
We present an extended external rhinoplasty approach with bilateral marginal and alar base incisions for removal of a nasal dermoid cyst with intracranial extension in a 3-year-old patient. This approach provides adequate exposure, enables nasal bone osteotomies, and allows access to the skull base while achieving a cosmetically acceptable scar. Laryngoscope, 133:2798-2802, 2023.
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Affiliation(s)
- Dayton Rand
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brian J Dlouhy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Sohit Paul Kanotra
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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12
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Chaisrisawadisuk S, Khampalikit I, Moore MH, Anderson PJ, Chaisrisawadisuk S. Proboscis Lateralis With Basal Encephalocele: A Report of Clinical Management and Reconstructive Approach. Cleft Palate Craniofac J 2023; 60:1331-1336. [PMID: 35473415 DOI: 10.1177/10556656221096323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Proboscis lateralis is a rare craniofacial anomaly in which a rudimentary nasal appendage arises at the medial canthal area. The severity depends on organ involvement, including eyes, nose, cleft lip/palate, and/or concomitant intracranial anomalies. Here, we present a child with proboscis lateralis and associated trans-ethmoidal encephalocele. We suggest doing the preoperative CT and/or MRI to rule out associated intracranial anomalies and reliably preoperative planning tools. Moreover, we proposed an alternative nasal reconstructive technique using a composite graft from the proboscis mass at the same time as encephalocele repair with promising results.
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Affiliation(s)
- Sarut Chaisrisawadisuk
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Inthira Khampalikit
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mark H Moore
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, Australia
| | - Peter J Anderson
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, Australia
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13
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Zhao X, Prather KY, Tavakol SA, Gernsback JE. Bilateral cerebellopontine angle lipomas in an infant with encephalocele: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23315. [PMID: 37773761 PMCID: PMC10555580 DOI: 10.3171/case23315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/15/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Bilateral cerebellopontine angle (CPA) lipomas are extremely rare. Herein the authors present a case of bilateral CPA lipomas in an infant along with a literature review of bilateral CPA lipomas. OBSERVATIONS A newborn girl was incidentally found to have bilateral CPA lipomas during the workup for an occipital encephalocele. The encephalocele was repaired primarily on day 2 after birth. The patient demonstrated no symptoms associated with the bilateral CPA lipomas. Eight cases of bilateral CPA lipomas were identified in the literature review and are summarized. Conservative management is the consensus strategy, given minimum growth of the tumor and the high risk of surgical intervention. LESSONS This is the first reported case of bilateral CPA lipomas in an infant as well as the first with a coexisting intracranial malformation. Intracranial lipomas share an extremely low growth rate and typically do not cause severe symptoms. The management of asymptomatic or mildly symptomatic bilateral CPA lipomas is usually conservative.
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14
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Hussen E, Gebremedhin FW. Giant Occipital Encephalocele: A Case Report and Literature Review. Int Med Case Rep J 2023; 16:529-535. [PMID: 37720365 PMCID: PMC10505012 DOI: 10.2147/imcrj.s433167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Background Protrusion of cerebrospinal fluid and meninges is called meningocele. Meningoencephalocele is a protrusion of neural tissue and meninges. The incidence of an Encephalocele is 1 in every 5000 live births. Anterior encephalocele is more common in men, while occipital encephalocele is seen in 70% of women. In a large encephalocele, the head size is small. Encephaloceles can occasionally be very large and are called giant encephaloceles. Occipital encephaloceles accounted for 80% to 90% of encephalocele cases in the western hemisphere. Encephaloceles vary in size and content. Various factors affecting the prognosis of patients with occipital encephalocele. Among them: extent, amount of brain tissue in the sac with or without Dural venous sinuses in the sac, with the brain or occipital lobe with hydrocephalus or presence of ventricles. Rarely, the sagittal and transverse sinuses are adjacent to the sac. Case Presentation This is a case of an 8-month old male infant born to a mother who had no regular antenatal care. After the baby presented with progressively increasing posterior head mass which is cystic, transilluminating, tender and size is 40cmX35cm imaging demonstrated small brain tissue mainly part of right occipital lobe with most of the sac being occupied by cerebrospinal fluid. Repair done and dysplastic brain tissue resected then healthy-looking brain tissue and Dural sinuses reduced to the skull, then patient stayed in the hospital and closely followed for hydrocephalus for seven days and discharged with no hydrocephalus and no neurologic deficit.
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Affiliation(s)
- Endris Hussen
- Department of Neurosurgery, St. Paul’s Millennium Medical College, Addis Ababa, Ethiopia
| | - Feleke Woldemichael Gebremedhin
- Addis Ababa University College of Medicine and Health Sciences Hospital-Currently Practicing at St. Peter’s Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
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15
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Al-Balushi N, Bouthour W, Banc A, Mosleh R, Saindane AM, Newman NJ, Biousse V. Seizures as the Initial Manifestation of Idiopathic Intracranial Hypertension Spectrum Disorder. Neuroophthalmology 2023; 47:248-254. [PMID: 38130812 PMCID: PMC10732617 DOI: 10.1080/01658107.2023.2251579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/14/2023] [Indexed: 12/23/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a syndrome of isolated elevated intracranial pressure of unknown aetiology. The IIH spectrum has evolved over the past decade making the diagnosis and management more challenging. The neurological examination in IIH is typically normal except for papilloedema and possible cranial nerve 6 palsy. Recent publications have highlighted skull base thinning and remodelling in patients with chronic IIH. Resulting skull base defects can cause meningo-encephalocoeles, which are potential epileptogenic foci. We describe the clinical and radiological characteristics of five IIH patients with seizures and meningo-encephalocoeles as the presenting manifestations of IIH spectrum disorder.
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Affiliation(s)
- Nisreen Al-Balushi
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Ophthalmology, Al-Nahdha Hospital, Muscat, Sultanate of Oman
| | - Walid Bouthour
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ana Banc
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Ophthalmology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rasha Mosleh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Amit M. Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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16
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Oswal R, Hathi D, Shah HR, Joshi G, Gemnani R. Traumatic Encephalocele in a 16-Year-Old Male: A Rare Phenomenon. Cureus 2023; 15:e44507. [PMID: 37790011 PMCID: PMC10544548 DOI: 10.7759/cureus.44507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
The term "encephalocele" refers to the herniation of brain tissue caused by a cranial bone defect. It could be congenital, traumatic, neoplastic, or arise spontaneously. The possibility of traumatic fronto-ethmoidal encephalocele should be considered in patients who have experienced trauma. We report a case of a 16-year-old male with a recent history of a bike accident presented with sudden unilateral rhinorrhea. Non-contrast computed tomography (NCCT) brain was done, which showed findings of left fronto-ethmoidal encephalocele. The patient was managed with single-staged surgery without any complications.
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Affiliation(s)
- Rajul Oswal
- Department of Radiology, Civil Hospital, Silvassa, IND
| | - Deep Hathi
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, IND
| | - Hemant R Shah
- Department of Radiology, Civil Hospital, Silvassa, IND
| | - Geetanjali Joshi
- Department of Radiology, Employees' State Insurance Corporation (ESIC) Hospital, Delhi, IND
| | - Rinkle Gemnani
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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17
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Hamad A, Alageel DF, Khan AR, Joueidi F, Alyazidi AS, Ismail AB, Spangenberg P, Kanaan I. Frontonasal Encephalocele Complicated With Pseudotumor Cerebri: A Case Report and Literature Review. Cureus 2023; 15:e45509. [PMID: 37868498 PMCID: PMC10585118 DOI: 10.7759/cureus.45509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Primary pseudotumor cerebri syndrome (PPTS) is a rare disorder of elevated intracranial pressure (ICP) in the absence of an identifiable underlying etiology. Afflicted patients are usually obese women in their reproductive age presenting with symptoms of elevated ICP. Seldom, patients can present with an encephalocele. We reported a case of a 31-year-old female who initially presented to our center with complaints of headaches, foreign body sensation in the nasal cavity, and decreased ability to smell. Brain computed tomography (CT) scan showed a large intranasal encephalocele and defect along the frontal skull base, through which brain tissue was herniating. The patient was successfully treated surgically by implantation of a lumboperitoneal shunt to manage the high ICP caused by her PPTS. In combination, reconstruction of the frontal skull base defect for the encephalocele was performed. Currently, the patient is doing well despite some on-and-off headaches.
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Affiliation(s)
- Alaa Hamad
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | | | | | | | | | - Peter Spangenberg
- Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Imaduddin Kanaan
- Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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18
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Kotowski M. The Differential Diagnosis of Congenital Developmental Midline Nasal Masses: Histopathological, Clinical, and Radiological Aspects. Diagnostics (Basel) 2023; 13:2796. [PMID: 37685334 PMCID: PMC10486988 DOI: 10.3390/diagnostics13172796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Developmental midline nasal masses including nasal dermoids (NDs), encephaloceles (EPHCs), and nasal glial heterotopias (NGHs) are a consequence of disrupted embryonal developmental processes in the frontonasal region. Surgery is the only method of treatment in order to prevent local and intracranial inflammatory complications as well as distant deformities of the facial skeleton. Due to their rarity, similar location, and clinical and radiological symptoms, meticulous preoperative differential diagnostics is mandatory. The aim of this thorough literature review was to present and discuss all clinical, histopathological, and radiological aspects of NDs, NGHs, and EPHCs that are crucial for their differential diagnosis.
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Affiliation(s)
- Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 60-572 Poznań, Poland
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19
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Tena-Cucala R, Sala-Padró J, Jaraba S, Hernández G, Fernández-Coello A, Rosselló A, Camins À, Naval-Baudin P, Fernández-Viñas M, Rodríguez-Bel L, Reynes G, Falip M. Eating-induced seizures: A semiological sign of the right temporal pole. Epileptic Disord 2023; 25:480-491. [PMID: 37309048 DOI: 10.1002/epd2.20035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/07/2022] [Accepted: 01/22/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Eating-induced seizures (EIS) are a rare form of reflex seizures. The objective of this study was to report a series of cases of EIS involving patients admitted to our epilepsy unit, and to analyze the clinical characteristics, etiology, and treatment response of this type of infrequent seizure. METHODS We performed a single-center retrospective analysis of all consecutive patients diagnosed with epilepsy with eating-induced seizures between 2008 and 2020. RESULTS We included eight patients (six women) with mean age 54.75 years (range: 40-79), and mean age at epilepsy onset 30.75 years (range: 9-58 years). EIS were triggered during a meal in 5/8 (at dinner 1/8, at breakfast in 1/8, and without time preference in 3/8), by a certain flavor in 1/8, by eating different textures or drinking soft drinks in 1/8, and by slicing food in 1/8. All patients suffered nonreflex seizures and 3/8 other types of reflex seizures. In 6/8 of patients, EIS originated in the right hemisphere. In 5/8, the EIS progressed to impaired awareness with oromandibular automatisms. In 6/8, the epilepsy was drug-resistant. Temporopolar encephalocele was the most frequent etiology, in 4/8. Three of the eight underwent surgical treatment, with Engel IA 1 year in 3/3. Three of the eight were treated with vagal stimulation therapy, with McHugh A 1 year in 2/3. SIGNIFICANCE In our series, eating-induced seizures were observed in patients with focal epilepsy. It was frequently drug-resistant and started predominantly in the right hemisphere, due to temporal pole involvement in half of the patients.
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Affiliation(s)
- Raquel Tena-Cucala
- Epilepsy Unit, Neurology Service, Neurological Diseases and Neurogenetics Group, Neuroscience Area, Bellvitge Institute for Biomedical Research (IDIBELL), Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Jacint Sala-Padró
- Epilepsy Unit, Neurology Service, Brain and Cognition Group, Neuroscience Area, Bellvitge Institute for Biomedical Research (IDIBELL), Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sònia Jaraba
- Epilepsy Unit, Neurology Service, Neurological Diseases and Neurogenetics Group, Neuroscience Area, Bellvitge Institute for Biomedical Research (IDIBELL), Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Hernández
- Epilepsy Unit, Neurology Service, Neurological Diseases and Neurogenetics Group, Neuroscience Area, Bellvitge Institute for Biomedical Research (IDIBELL), Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Alejandro Fernández-Coello
- Epilepsy Unit, Neurosurgery Service, Neuroscience Area, Bellvitge Institute for Biomedical Research (IDIBELL), Universitat de Barcelona, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Aleix Rosselló
- Epilepsy Unit, Neurosurgery Service, Neuroscience Area, Bellvitge Institute for Biomedical Research (IDIBELL), Universitat de Barcelona, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Àngels Camins
- IDI, Image Diagnostic Institute, Neuroradiology Division, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Pablo Naval-Baudin
- IDI, Image Diagnostic Institute, Neuroradiology Division, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Montserrat Fernández-Viñas
- IDI, Image Diagnostic Institute, Neuroradiology Division, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Laura Rodríguez-Bel
- PET Unit, Department of Nuclear Medicine-IDI, IDIBELL, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Gabriel Reynes
- PET Unit, Department of Nuclear Medicine-IDI, IDIBELL, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Mercè Falip
- Epilepsy Unit, Neurology Service, Neurological Diseases and Neurogenetics Group, Neuroscience Area, Bellvitge Institute for Biomedical Research (IDIBELL), Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
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20
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Pastora Bucardo DM, González F, Montes Pastora M, Pimienta Ramirez PA, Bonilla IL, Vielot NA, Finnell RH. Neural tube defects: Prevalence, mortality, and maternal characteristics in two departmental hospitals in the northwestern region of Nicaragua, 2006-2018. Birth Defects Res 2023; 115:945-953. [PMID: 37025002 DOI: 10.1002/bdr2.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Congenital anomalies are the fifth most common cause of neonatal mortality in Nicaragua, and neural tube defects (NTDs) are the most common of all cases of lethality associated with a birth defect. Prevalence and mortality estimates are needed to propose effective intervention strategies that prevent NTDs over time. METHODS A cross-sectional study was carried out in northwestern Nicaragua from January 2006 to December 2018. All cases of NTDs (anencephaly, spina bifida, and encephalocele) were registered in hospital surveillance systems, and the medical histories of the mothers and newborns were reviewed. Prevalence was calculated by considering the number of live births and stillbirths older than 20 weeks of gestation with NTDs, divided by the total number of live births and stillbirths in each study year. Neonatal mortality rate (NMR) for NTD, and case fatality for spina bifida was calculated. RESULTS Two hundred fifty cases of NTDs were identified from 178,498 deliveries (177,316 live births and 1,182 stillbirths). The prevalence of NTDs during this time period was 14.01 (95% CI: 12.27-15.74) per 10,000 births. The prevalence of spina bifida (n = 140), anencephaly (n = 97), and encephalocele (n = 13) was 7.84, (95% CI: 6.54-9.14), 5.43 (95% CI: 4.30-6.45), and 0.73 (95% CI: 0.33-1.12) per 10,000 births, respectively. Mothers with fetus or newborns affected with NTDs did not use folic acid prior to conception, and 11% experienced periods of hyperthermia during the first trimester of pregnancy. NMR for NTDs was 0.55 per 1.000 livebirths. Case fatality for all NTDs and for spina bifida were 55% and 18%, respectively. CONCLUSION The prevalence and mortality of NTDs in the northwestern region of Nicaragua present peaks and troughs during the study period. Spina bifida was the most frequent type of NTD. We believe that these findings could be of use by health policy makers to strengthen the primary prevention of NTDs in the region through the monitoring of the food fortification policy and folic acid supplementation to women of childbearing age. Additional etiologic studies of NTDs should be considered to identify additional prevention measures.
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Affiliation(s)
| | - Fredman González
- Department of Microbiology, Faculty of Medical Sciences, National Autonomous University of Nicaragua-León, León, Nicaragua
| | - María Montes Pastora
- Department of Public Health, National Autonomous University of Nicaragua, León, Nicaragua
| | - Paula Andrea Pimienta Ramirez
- Center for Precision Environmental Health, Departments of Molecular and Human Genetics, Molecular and Cellular Biology and Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Indiana López Bonilla
- Department of Public Health, National Autonomous University of Nicaragua, León, Nicaragua
| | - Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Richard H Finnell
- Center for Precision Environmental Health, Departments of Molecular and Human Genetics, Molecular and Cellular Biology and Medicine, Baylor College of Medicine, Houston, Texas, USA
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21
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Loya J, Brown NJ, Gonda D, Levy M. Challenging, giant occipital encephalocele in a pediatric saipanese male. Clin Case Rep 2023; 11:e7380. [PMID: 37215965 PMCID: PMC10196437 DOI: 10.1002/ccr3.7380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/01/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Key Clinical Message Giant occipital encephalocele is a rare form of congenital anomaly that involves protrusion of brain tissue (greater in size than the patient's cranial cavity) from a defect in the skull. This case reports illustrates repair of a giant encephalocele and emphasizes important methods to reduce risk for blood loss and other complications. Abstract A rare form of congenital anomaly, giant occipital encephalocele involves protrusion of brain tissue from a defect in the skull (in this case from the occiput). While encephalocele itself is a fairly rare entity, those qualifying as "giant"-defined by size of the deformity exceeding that of the skull itself - require very technically challenging surgery.
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Affiliation(s)
- Joshua Loya
- Department of NeurosurgeryUniversity of California San Diego, Rady's Children's HospitalSan DiegoCaliforniaUSA
| | - Nolan J. Brown
- Department of NeurosurgeryUniversity of California San Diego, Rady's Children's HospitalSan DiegoCaliforniaUSA
| | - David Gonda
- Department of NeurosurgeryUniversity of California San Diego, Rady's Children's HospitalSan DiegoCaliforniaUSA
| | - Michael Levy
- Department of NeurosurgeryUniversity of California San Diego, Rady's Children's HospitalSan DiegoCaliforniaUSA
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22
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Kankam SB, Tavallaii A, Mohammadi E, Nejat A, Habibi Z, Nejat F. The neurodevelopmental outcomes of children with encephalocele: a series of 102 patients. J Neurosurg Pediatr 2023; 31:151-158. [PMID: 36433870 DOI: 10.3171/2022.10.peds22304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The overall prognosis of encephalocele (EC) is not well described. However, the presence of some risk factors may result in neurodevelopmental delay (NDD) and negatively affect the prognosis of affected patients. The goal of this study was to evaluate neurodevelopmental outcome, as well as the impact of a number of factors on the outcome in patients with ECs. METHODS This was an observational, retrospective study including 102 children with EC who were followed at the pediatric neurosurgery department of a tertiary medical center between the years 2010 and 2021. The authors evaluated NDD status according to the Centers for Disease Control and Prevention classification via clinical evaluation and parent interviews in the outpatient setting. RESULTS There were 52 boys and 50 girls. The median age at the time of surgery was 4 months (range 1 day-7.5 years). Seventy-one patients (69.6%) had posterior ECs, whereas 31 (30.4%) had anterior ECs. Forty-three (42.2%) of the ECs contained neural tissue. Of the 102 patients, 33 (32.4%) had ventriculomegaly. In terms of NDD, 14 (14.9%) had mild/moderate delay, whereas 17 patients (18.1%) had severe NDD. On univariate analysis, posterior location, size of sac, presence of neural tissue, ventriculomegaly, symptomatic hydrocephalus, and postoperative infection were correlated with NDD. On a multivariate logistic regression model, only neural tissue presence had a statistically significant association with NDD (OR 7.04, 95% CI 1.33-37.2, p = 0.022). Although not statistically significant, children with ventriculomegaly were 2.6 times as likely to have NDD (95% CI 0.59-11.19, p = 0.362). CONCLUSIONS This is a single-center study with a large sample size in which the neurodevelopmental status of patients with EC was assessed, and the authors tried to find the risk factors of NDD in these patients. The results showed that the presence of neural tissue within the EC sac was the only risk factor that had independent statistically significant association with NDD.
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Affiliation(s)
- Samuel Berchi Kankam
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran; and
| | - Amin Tavallaii
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran; and
| | - Esmaeil Mohammadi
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran; and
| | - Amirhosein Nejat
- 2Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zohreh Habibi
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran; and
| | - Farideh Nejat
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran; and
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Lang-Orsini M, Champion SN, Duhaime AC, Rapalino O, Hedley-Whyte ET, Louis DN, Nazarian RM. Atretic cephalocele and encephalocele: A single-institution clinicopathological study. J Cutan Pathol 2023. [PMID: 36700349 DOI: 10.1111/cup.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Encephaloceles are neural tube defects characterized by herniation of meninges, neural tissue and cerebrospinal fluid, while atretic cephaloceles denote a rudimentary connection to the intracranial space with absence of herniated neural tissue and represent an infrequent dermatopathologic diagnosis. Limited reports of these entities confound the challenge in their histopathologic distinction. Accurate classification is important given associated anomalies and neurologic manifestations that impact prognosis. METHODS We describe the clinicopathological and immunohistochemical [glial fibrillary acidic protein (GFAP), S100, epithelial membrane antigen (EMA), and somatostatin receptor subtype 2A (SSTR2A)] features in a retrospective series encountered at a single institution between 1994 and 2020. RESULTS We identified 13 cases classified as atretic cephalocele (n = 11) and encephalocele (n = 2). Hamartomatous changes and multinucleated cells were unique to atretic cephaloceles while myxoid areas were unique to encephaloceles. At least focal staining for SSTRA was seen in all atretic cephaloceles with the majority (87.5%) staining for EMA; negative staining for GFAP and S100 confirmed absence of neural tissue. Encephaloceles were GFAP and S100 positive, and negative for SSTR2 and EMA. Atretic cephaloceles had a favorable prognosis compared to encephaloceles, with severe morbidity present in both encephalocele cases. CONCLUSION Our study raises awareness of atretic cephalocele and encephalocele among dermatopathologists and reveals a mutually exclusive immunophenotype that facilitates their distinction for prognostication and management.
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Affiliation(s)
- Melanie Lang-Orsini
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha N Champion
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann-Christine Duhaime
- Pediatric Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - E Tessa Hedley-Whyte
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David N Louis
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosalynn M Nazarian
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kankam SB, Nejat A, Tavallaii A, Tayebi Meybodi K, Habibi Z, Nejat F. Hydrocephalus in patients with encephalocele: introduction of a scoring system for estimating the likelihood of hydrocephalus based on an 11-year experience from a tertiary center. J Neurosurg Pediatr 2023; 31:298-305. [PMID: 36640101 DOI: 10.3171/2022.12.peds22475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The goal of this study was to investigate and identify the predictors associated with the incidence of hydrocephalus requiring shunt insertion in patients with encephalocele (EC), and to develop a scoring system to estimate the probability of hydrocephalus occurrence over time in these patients. METHODS A retrospective analysis was undertaken on data from patients treated for EC at a tertiary medical center between 2010 and 2021. Data including patient age at presentation, sex, sac location, sac size, contents, presence of ventriculomegaly/hydrocephalus, CSF leakage, and other associated intracranial/extracranial anomalies were among the variables evaluated for their predictive value. In addition, logistic regression analyses were performed to identify the independent predictors. A predictive scoring system was developed based on regression coefficients. RESULTS A total of 102 cases of EC were identified. The patient group consisted of 52 boys and 50 girls. Seventy-one patients (69.6%) had posterior ECs. Forty-three (42.2%) of the ECs contained neural tissue. Thirty-three patients presented with ventriculomegaly (32.4%), 30 of whom (90.9%) underwent ventriculoperitoneal shunt placement for hydrocephalus. Multivariate analysis revealed that the presence of other associated anomalies (OR 2.8, 95% CI 1.1-7.4, p = 0.027), larger EC sac size (OR 1.3, 95% CI 1.01-1.6, p = 0.042), and infections (OR 6.8, 95% CI 1.3-34.8, p = 0.034) were associated with ventriculomegaly. The logistic regression model consisted of 5 variables including the patients' history of meningitis, their sex, sac location, sac size, and presence of other other associated anomalies; analysis resulted in the maximum accuracy of 86% for the prediction of hydrocephalus occurrence. CONCLUSIONS According to the findings, the presence of other associated anomalies, a larger sac, and infections are significant independent predictors of hydrocephalus. By considering these 3 predictors as well as sac location and the patient's sex, it will be possible to predict hydrocephalus occurrence in patients with EC with significant accuracy.
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Affiliation(s)
- Samuel B Kankam
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhosein Nejat
- 2Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; and
| | - Amin Tavallaii
- 3Department of Pediatric Neurosurgery, Akbar Children's Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Keyvan Tayebi Meybodi
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Habibi
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Nejat
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Yamazaki K, Kanaya K, Uda T, Fukuyama T, Nishioka M, Hoshino Y, Kaneko T, Hardian RF, Yamazaki D, Kuwabara H, Funato K, Horiuchi T. Frontal Encephalocele Plus Epilepsy: A Case Report and Review of the Literature. Brain Sci 2023; 13. [PMID: 36672096 DOI: 10.3390/brainsci13010115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/26/2022] [Accepted: 01/07/2023] [Indexed: 01/10/2023] Open
Abstract
An encephalocele is a pathological brain herniation caused by osseous dural defects. Encephaloceles are known to be regions of epileptogenic foci. We describe the case of a 44-year-old woman with refractory epilepsy associated with a frontal skull base encephalocele. Epilepsy surgery for encephalocele resection was performed; however, the epilepsy was refractory. A second epilepsy surgery for frontal lobectomy using intraoperative electroencephalography was required to achieve adequate seizure control. Previous reports have shown that only encephalocele resection can result in good seizure control, and refractory epilepsy due to frontal lobe encephalocele has rarely been reported. To the best of our knowledge, this is the first report of frontal encephalocele plus epilepsy in which good seizure control using only encephalocele resection was difficult to achieve. Herein, we describe the possible mechanisms of encephalocele plus epilepsy and the surgical strategy for refractory epilepsy with encephalocele, including a literature review.
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Atli B, Rath S, Burtscher J, Hainfellner JA, Hametner S. Frontal intradiploic encephalocele in a 44-year-old male patient: illustrative case. J Neurosurg Case Lessons 2022; 4:CASE2270. [PMID: 36088567 PMCID: PMC9706332 DOI: 10.3171/case2270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Encephaloceles are protrusions of the cerebral tissue through a skull defect. They occur mostly in children and very rarely in adults. OBSERVATIONS The authors present a case of a 44-year-old man presenting with a first-time generalized seizure. Computed tomography of the head showed bone destruction associated with a right frontal lesion. Magnetic resonance imaging scans demonstrated a largely isointense lesion in the intradiploic space that contained small, hyperintense nodular components and showed a low to moderate contrast agent enhancement. LESSONS The patient underwent resection, during which the histological examination found the lesion to be an intradiploic encephalocele. The patient had an uneventful postoperative course with a cessation of seizures. The imaging and neuropathological findings as well as a literature review, together with a discussion on the etiology of intradiploic encephaloceles, are contained in this report.
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Affiliation(s)
- Baran Atli
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria; and
| | - Sebastian Rath
- Department of Neurosurgery, Wiener Neustadt State Hospital, Wiener Neustadt, Austria
| | - Johannes Burtscher
- Department of Neurosurgery, Wiener Neustadt State Hospital, Wiener Neustadt, Austria
| | - Johannes A. Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria; and
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria; and
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27
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Xu M, Wang J, Chen XD, Xue T, Chen FQ. Comparison of two surgical approaches in the management of cerebrospinal fluid rhinorrhea in the lateral recess of sphenoid sinus: A retrospective study. Ear Nose Throat J 2022:1455613221112760. [PMID: 35796349 DOI: 10.1177/01455613221112760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage from the lateral recess of the sphenoid sinus (LRSS) is usually repaired using endoscopic endonasal approaches, which can be challenging. Various surgical techniques have been developed for the disease. OBJECTIVE To report our experience with repairing CSF leak from the LRSS via transethmoid sphenoidotomy approach (TESA) and transprelacrimal recess pterygoid root approach (TPLRA), to assess the efficiency of TPLRA by comparing it with TESA. METHODS This retrospective study included patients with LRSS CSF rhinorrhea who underwent TESA (n = 10) or TPLRA (n = 5) from January 2011 to December 2020. Demographic characteristics and operation-related parameters were recorded. RESULTS The mean operation time was 169.5 and 225.0 mins in the TESA and TPLRA groups, respectively, with a mean blood loss of 65 mL and 68 mL, respectively. Histopathological examinations confirmed encephalocele in 11 (73.33%) and 4 (26.67%) cases with meningocele, respectively. CSF rhinorrhea was successfully repaired in the first attempt in both groups during the mean follow-up time of 54 months. Postoperative permanent numbness of the cheek was observed in two patients in the TESA group. No cases of lacrimal overflow or subjective dry eye were observed. CONCLUSIONS The TPLRA, which could be an alternative procedure to treat CSF rhinorrhea in the LRSS, provides a straight-line trajectory and effective maneuverability. We also found that CSF rhinorrhea in the LRSS was accompanied by encephalocele or meningocele, with encephalocele presenting more commonly.
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Affiliation(s)
- Min Xu
- Department of Otolaryngology and Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jian Wang
- Department of Otolaryngology and Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiao-Dong Chen
- Department of Otolaryngology and Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Tao Xue
- Department of Otolaryngology and Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fu-Quan Chen
- Department of Otolaryngology and Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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28
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Tabatabaei RS, Fatahi-Meibodi N, Meibodi B, Javaheri A, Abbasi H, Hadadan A, Bahrami R, Mirjalili SR, Karimi-Zarchi M, Neamatzadeh H. Association of Fetal MTHFR C677T Polymorphism with Susceptibility to Neural Tube Defects: A Systematic Review and Update Meta-Analysis. Fetal Pediatr Pathol 2022; 41:225-241. [PMID: 32536242 DOI: 10.1080/15513815.2020.1775734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background MTHFR gene may be a key epigenetic regulation-related factor crucial during embryogenesis. We performed a meta-analysis to determine the association of fetal MTHFR C677T polymorphism with neural tube defects (NTDs).Methods A comprehensive literature search of the PubMed, Embase, and CNKI database was performed up to April 10, 2020.Results A total of 19 case-control studies with 2,228 NTDs cases and 4,220 controls were identified. Pooled data revealed that the fetal MTHFR C677T polymorphism was significantly highly correlated with development of NTDs in the overall population. Stratified analysis showed a significant association among Caucasians and Asians, but not in mixed populations. There was a significant association between the MTHFR C677T polymorphism and spina bifida risk. No publication bias was found under any genetic model.Conclusions Our pooled data support the fetal MTHFR C677T polymorphism association with risk of NTDs, especially among Caucasians and Asians.
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Affiliation(s)
- Razieh Sadat Tabatabaei
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Neda Fatahi-Meibodi
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Bahare Meibodi
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Atiyeh Javaheri
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Hajar Abbasi
- Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
| | - Amaneh Hadadan
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Reza Bahrami
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Reza Mirjalili
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojgan Karimi-Zarchi
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran.,Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Neamatzadeh
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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29
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Michael AP, Elbuluk O, Tsiouris AJ, Tabaee A, Kacker A, Anand VK, Schwartz TH. The critical importance of a vascularized flap in preventing recurrence after endoscopic repair of spontaneous cerebrospinal fluid leaks and meningo encephaloceles. J Neurosurg 2021; 137:1-8. [PMID: 34767535 DOI: 10.3171/2021.7.jns211427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spontaneous CSF leaks into the anterior skull base nasal sinuses are often associated with meningoencephaloceles and occur in patients with idiopathic intracranial hypertension (IIH). Endonasal endoscopic repair has become the primary method of choice for repair. The authors sought to evaluate the success rate of endoscopic closure and to identify predictive factors for CSF leak recurrence. METHODS A consecutive series of endonasally repaired anterior skull base meningoencephaloceles was drawn from a prospectively acquired database. Lumbar punctures were not performed as part of a treatment algorithm. All patients had at least 5 months of follow-up. Chart review and phone calls were used to determine the timing and predictors of recurrence. Demographic information and details of operative technique were correlated with recurrence. Two independent radiologists reviewed all preoperative imaging to identify radiographic markers of IIH, as well as the location and size of the meningoencephalocele. RESULTS From a total of 54 patients there were 5 with recurrences (9.3%), but of the 39 patients in whom a vascularized nasoseptal (n = 31) or turbinate (n = 8) flap was used there were no recurrences (p = 0.0009). The mean time to recurrence was 24.8 months (range 9-38 months). There was a trend to higher BMI in patients whose leak recurred (mean [± SD] 36.6 ± 8.6) compared with those whose leak did not recur (31.8 ± 7.4; p = 0.182). Although the lateral recess of the sphenoid sinus was the most common site of meningoencephalocele, the fovea ethmoidalis was the most common site in recurrent cases (80%; p = 0.013). However, a vascularized flap was used in significantly more patients with sphenoid (78.3%) defects than in patients with fovea ethmoidalis (28.6%) defects (Fisher's exact test, p = 0.005). Radiographic signs of IIH were equally present in all patients whose leak recurred (75%) compared with patients whose leak did not recur (63.3%); however, an enlarged Meckel cave was present in 100% (2/2) of patients whose leaks recurred compared with 13.3% (4/30) of patients whose leaks did not recur (p = 0.03). The average meningoencephalocele diameter tended to be larger (1.73 ± 1.3 cm) in patients with recurrence compared to those without recurrence (1.2 ± 0.66 cm; p = 0.22). A ventriculoperitoneal shunt was already in place in 3 patients, placed perioperatively in 5, and placed at recurrence in 2, none of whose leaks recurred. CONCLUSIONS Recurrence after endonasal repair of spontaneous CSF leaks from meningoencephaloceles can be dramatically reduced with the use of a vascularized flap. Although failures of endonasal repair tend to occur in patients who have higher BMI, larger brain herniations, and no CSF diversion, the lack of vascularized flap was the single most important risk factor predictive of failure.
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Affiliation(s)
| | | | | | | | | | | | - Theodore H Schwartz
- Departments of1Neurological Surgery
- 3Otolaryngology, and
- 4Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Mayer M, Treutlein E, Zenk J, Naumann M, Thoelken R, Jering M. Paraparesis after low dose administration of fluorescein for endoscopic resection of an encephalocele: a case report. Br J Neurosurg 2021:1-4. [PMID: 34755590 DOI: 10.1080/02688697.2021.2001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/24/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
The main causes for cerebrospinal fluid (CSF) leaks are known to be traumatic, iatrogenic, neoplastic, a meningoencephalocele, congenital bone defects, and spontaneous. Off-label intrathecal administration of fluorescein is widely used to localize a CSF leak. Complications are rare and low dose administration is described to be safe. In this case report, we present a case of a patient, who showed a CSF leak due to an encephalocele. Low dose fluorescein was applied intrathecally via lumbar catheter, the CSF leaks could be identified, and multilayered closure was performed. Postoperatively, the patient presented with motor and sensory deficits in the lower limbs which regressed only partially within 2 months. A possible explanation may be an increased local concentration of fluorescein, possibly on the basis of a preexisting lumbar spinal canal stenosis. To our knowledge, this is the first case in which a dose as low as 20 mg of fluorescein (2% saline mixture) led to persisting paraplegia. Therefore, the potential benefits and risks of the intrathecal fluorescein use in the detection of a CSF leak have to be discussed comprehensively prior to surgery.
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Affiliation(s)
- Marcel Mayer
- Department of Otolaryngology, University Hospital Augsburg, Augsburg, Germany
| | - Eric Treutlein
- Department of Otolaryngology, University Hospital Augsburg, Augsburg, Germany
| | - Johannes Zenk
- Department of Otolaryngology, University Hospital Augsburg, Augsburg, Germany
| | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Rubens Thoelken
- Department of Otolaryngology, University Hospital Augsburg, Augsburg, Germany
| | - Monika Jering
- Department of Otolaryngology, University Hospital Augsburg, Augsburg, Germany
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31
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Sandhu MRS, Mandel M, McGrath H, Lamsam L, Farooque P, Bronen RA, Spencer DD, Damisah EC. Management of patients with medically intractable epilepsy and anterior temporal lobe encephaloceles. J Neurosurg 2021; 136:709-716. [PMID: 34507290 DOI: 10.3171/2021.3.jns21133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Temporal lobe encephaloceles (TLENs) are a significant cause of medically refractory epilepsy, but there is little consensus regarding their workup and treatment. This study characterizes these lesions and their role in seizures and aims to standardize preoperative evaluation and surgical management. METHODS Patients with TLEN who had undergone resective epilepsy surgery from December 2015 to August 2020 at a single institution were included in the study. Medical records were reviewed for each patient to collect relevant seizure workup information including demographics, radiological findings, surgical data, and neuropsychological evaluation. RESULTS For patients who presented to the authors' program with suspected medically intractable temporal lobe epilepsy (219 patients), TLEN was considered to be the epileptogenic focus in 5.5%. Ten patients with TLEN had undergone resection and were included in this study. Concordance between ictal scalp electroencephalography (EEG) lateralization and TLEN was found in 9/10 patients (90%), and 4/10 patients (40%) had signs suggestive of idiopathic intracranial hypertension (IIH). Surgical outcome was reported in patients with at least 12 months of follow-up (9/10). Patients with scalp EEG findings concordant with the TLEN side had a good outcome (Engel class I: 7 patients, class II: 1 patient). One patient with discordant EEG findings had a bad outcome (Engel class III). No significant neuropsychological deficits were observed after the surgery. CONCLUSIONS TLENs are epileptogenic lesions that should be screened for in patients with medically refractory epilepsy who have signs of IIH and no other lesions on MRI. Restricted resection is safe and effective in patients with scalp EEG findings concordant with TLEN.
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Affiliation(s)
| | | | | | | | | | - Richard A Bronen
- 3Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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Aranda-Sánchez CI, Bobadilla-Morales L, Corona-Rivera A, Cuero-Quezada I, Santana-Hernández J, Baldomero-López A, Romero-Bolaño YM, Peña-Padilla C, Corona-Rivera JR. MTHFR C677T and A1298C variants in Mexican Mestizo infants with neural tube defects from Western Mexico. Congenit Anom (Kyoto) 2021; 61:188-192. [PMID: 34015145 DOI: 10.1111/cga.12429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
Our study investigated the role of MTHFR C677T and A1298C variants in infants with neural tube defects (NTDs) from western Mexico. Using TaqMan allelic discrimination assay, we genotyped 101 live-born patients with NTDs (cases) and 247 controls. Our findings do not support that homozygosity or heterozygosity for the variants C677T and A1298C in the MTHFR gene are associated with NTDs in infants. However, since we have the highest worldwide frequency of homozygotes for the MTHFR C677T variant, we cannot rule out that our propensity for NTDs may be related to how such gene variant interacts with other factors, mainly with our secular patterns of inappropriate folate intake.
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Affiliation(s)
- Cristian Irela Aranda-Sánchez
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, "Dr. Juan I. Menchaca", Civil Hospital of Guadalajara, Guadalajara, Mexico
| | - Lucina Bobadilla-Morales
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, "Dr. Juan I. Menchaca", Civil Hospital of Guadalajara, Guadalajara, Mexico.,"Dr. Enrique Corona-Rivera" Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Mexico
| | - Alfredo Corona-Rivera
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, "Dr. Juan I. Menchaca", Civil Hospital of Guadalajara, Guadalajara, Mexico.,"Dr. Enrique Corona-Rivera" Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Mexico
| | - Idalid Cuero-Quezada
- "Dr. Enrique Corona-Rivera" Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Mexico
| | - Jennifer Santana-Hernández
- "Dr. Enrique Corona-Rivera" Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Mexico
| | - Alejandra Baldomero-López
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, "Dr. Juan I. Menchaca", Civil Hospital of Guadalajara, Guadalajara, Mexico
| | - Yaneris M Romero-Bolaño
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, "Dr. Juan I. Menchaca", Civil Hospital of Guadalajara, Guadalajara, Mexico
| | - Christian Peña-Padilla
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, "Dr. Juan I. Menchaca", Civil Hospital of Guadalajara, Guadalajara, Mexico
| | - Jorge Román Corona-Rivera
- Center for Registry and Research in Congenital Anomalies (CRIAC), Service of Genetics and Cytogenetics Unit, Pediatrics Division, "Dr. Juan I. Menchaca", Civil Hospital of Guadalajara, Guadalajara, Mexico.,"Dr. Enrique Corona-Rivera" Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Mexico
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Lam J, Lee DJ, Oladunjoye A. Large Primary Transethmoidal Encephalocele Presenting in an Adult. Cureus 2021; 13:e16122. [PMID: 34367756 PMCID: PMC8330510 DOI: 10.7759/cureus.16122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/05/2022] Open
Abstract
Transethmoidal encephaloceles are rare and most commonly present at birth with congenital abnormalities, cerebrospinal fluid rhinorrhea, or visual symptoms. Here, we report the case of a 43-year-old presenting with longstanding headache, blurry vision, anosmia, and rhinorrhea. Magnetic resonance imaging confirmed a transethmoidal encephalocele. The patient underwent craniotomy for resection of the encephalocele and repair of the cribriform defect. The postoperative course was uneventful, and the patient was discharged home with the resolution of rhinorrhea and headache. This report highlights a rare case of primary transethmoidal encephalocele undiagnosed until adulthood despite longstanding symptoms and successful treatment with resolution of symptoms.
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Affiliation(s)
- Jordan Lam
- Neurological Surgery, University of Michigan, Ann Arbor, USA
| | - Darrin J Lee
- Neurological Surgery, University of Southern California, Los Angeles, USA
| | - Azeem Oladunjoye
- Department of Surgery, San Joaquin General Hospital, French Camp, USA
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34
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De Jesus O, Pagán-Rodríguez A, Santiago Quiñones G, Pérez-Berenguer JL. Trigeminal Numbness After Intracranial Repair of a Spontaneous Meningo encephalocele of the Lateral Wall of the Sphenoid Sinus. Cureus 2021; 13:e16026. [PMID: 34336514 PMCID: PMC8320768 DOI: 10.7759/cureus.16026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/21/2022] Open
Abstract
A 58-year-old female with an eight-year history of rhinorrhea and a two-day history of subjective fever, chills, and vomiting presented to the emergency department for neurosurgical evaluation. Brain MRI demonstrated herniation of the meninges and portions of the inferomedial right temporal lobe through a defect of the lateral wall of the right sphenoid sinus, extending to the sphenoethmoidal recess and posterior right ethmoid air cells. A right pterional craniotomy was performed where the herniated part of the right temporal lobe, and its associated meninges, were excised. After surgery, she had hypoesthesia at the right maxillary division of the trigeminal nerve. This finding was caused by the proximity of the trigeminal nerve to the dural dissection that we performed at the bone defect. This rare complication has never been described after intracranial surgery. Only eight literature reports have described hypoesthesia or paresthesia of the trigeminal nerve after endoscopic resection of a sphenoid sinus meningoencephalocele. The patient has not had any recurrence of rhinorrhea after a six-month follow-up period.
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Affiliation(s)
- Orlando De Jesus
- Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | | | - George Santiago Quiñones
- Pathology and Laboratory Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Juan L Pérez-Berenguer
- Pathology and Laboratory Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
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35
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Veerabathini BC, Manthani K, Hussain A. Congenital Central Nervous System Malformations: A Rare Case of an Encephalocele and Literature Review of Its Associations, Imaging Modalities, Radiological Findings, and Treatments. Cureus 2021; 13:e15959. [PMID: 34336454 PMCID: PMC8315298 DOI: 10.7759/cureus.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/23/2022] Open
Abstract
Congenital central nervous system (CNS) malformations are relatively rare conditions present in fetuses that may result in intrauterine fetal deaths (IUFDs). We report a case of a 42-year-old female who presented at 29 weeks gestation with lack of a fetal heart beat likely due to a congenital malformation resulting in IUFD. This case report and literature review provides a better understanding of the encephalocele as a harbinger for IUFD.
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Affiliation(s)
- Bala C Veerabathini
- Transitional Year Resident, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
| | - Kaushik Manthani
- Family Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
| | - Ayesha Hussain
- Maternal Fetal Medicine, Stony Brook University Medical Center, Stony Brook, USA
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36
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Singh BK, Maria A, Bandyopadhyay T, Choudhary SK. Clinico-epidemiological profile and outcomes of babies with neural tube defects in a tertiary care center in Northern India. J Matern Fetal Neonatal Med 2021; 35:7052-7057. [PMID: 34121591 DOI: 10.1080/14767058.2021.1937102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neural tube defects constitute a major source of disability among children. Proper management requires accurate diagnosis, an assessment of the severity of the lesion, a decision whether intervention is warranted, the nature of the intervention, and educating the family of the need for lifelong medical care. But to do so, reliable data regarding presentation and outcome is very crucial. AIM OF THE STUDY To discuss the clinical epidemiological profile and outcome of babies admitted with neural tube defects (NTDs). MATERIAL AND METHODS Retrospective observational study was done by extracting data from case notes and follow-up files in Department of Neonatology, PGIMER and Dr. RML Hospital, New Delhi over a period from March 2015 to July 2020. RESULTS A total of 25 babies were included in the study. Majority of babies were born to mother at a median age group of 24 (19-36) yrs and nearly one-third of them were illiterate. The history of maternal periconceptional folic acid intake was seen in only five babies (21%). Two third of babies were male (64%) and the median age at admission was at 9 (1-27) days of life. Majority of the cases were open types of NTDs with most common type being meningomyelocele (88%) followed by occipital encephalocele (12%) and there was one case of closed type of neural tube defect having lipomeningomyelocele (4%). The most common associated anomaly was hydrocephalus (76%) followed by Arnold chiari malformation (56%). Motor weakness in form of paraparesis or paraplegia was present in 21 (84%) babies and sensory deficit was present in 44% babies. Bowel and bladder dysfuntion was present in 48% of cases. Ventriculitis was the most common associated morbidity (38%). Meningomyelocele (MMC) repair was the most commonly performed primary surgery (33%) followed by Ventriculo-peritoneal (VP) shunt repair (24%). Twelve babies (48%) were discharged while 2 (8%) expired and 11 (44%) babies left against medical advice. CONCLUSION Neural tube defect is a congenital disorder with significant morbidity. The clinical severity of the NTDs and the uncertainty in their cause makes this a priority for further research. National policies for prevention, in utero diagnosis, and early surgical intervention are required for a better prognosis.
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Affiliation(s)
- Bhawana Komal Singh
- Department of Neonatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India, Atal Bihari Vajpayi Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arti Maria
- Department of Neonatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India, Atal Bihari Vajpayi Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India, Atal Bihari Vajpayi Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Sushil Kumar Choudhary
- Department of Neonatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India, Atal Bihari Vajpayi Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia Hospital, New Delhi, India
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37
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Sreenath SB, Tang DM, Ting JY, Illing EA, Recinos PF, Soni P, Kshettry VR, Cohen-Gadol A, Woodard TD, Sindwani R. Modified Transpterygoid Approach to Sphenoid Meningo encephaloceles: A Shorter Run for a Longer Slide. Laryngoscope 2021; 131:2224-2230. [PMID: 34096616 DOI: 10.1002/lary.29672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/01/2021] [Accepted: 05/25/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Cerebrospinal fluid (CSF) leaks and meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be challenging. The traditional transpterygoid approach through the pterygopalatine fossa (PPF) is time consuming and places important structures at risk, which can lead to significant morbidity. We report a multi-institutional experience using a simplified, endoscopic modified transpterygoid approach (MTPA), which spares the PPF contents in the management of lateral sphenoid sinus meningoencephaloceles and CSF leaks. STUDY DESIGN Multi-Institutional, Retrospective Case Series. METHODS Patients with lateral sphenoid recess CSF leaks and meningoencephaloceles between 2014 and 2020 who underwent the MTPA at two academic medical centers were identified. Repair techniques and outcomes were evaluated. RESULTS Thirty-three patients underwent the MTPA for management. Skull base reconstruction was performed using a free mucosal graft (24/33, 72.7%), nasoseptal flap (4/33, 12.1%), bone grafts (3/33, 9.1%), and abdominal fat grafts (2/33, 6.1%). Lumbar drains and perioperative intracranial pressure measurements were routinely employed. Postoperative complications were uncommon and included three patients (9.7%) with temporary V2 anesthesia, one patient (3.2%) with prolonged V2 anesthesia, and one patient (3.2%) with subjective dry eye, all of which resolved at 9 months postoperatively. There were no recurrent CSF leaks resulting in a 100% success rate. Average follow-up was 13 months. CONCLUSION The MTPA reduces morbidity and greatly simplifies access to the lateral sphenoid sinus for the management of CSF leaks and meningoencephaloceles, without compromising exposure. This technique avoids the need for extensive PPF dissection and should be considered for the management of benign lesions involving the lateral sphenoid sinus. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
| | - Dennis M Tang
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, U.S.A.,Department of Neurosurgery, Indiana University, Indianapolis, Indiana, U.S.A
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, U.S.A.,Department of Neurosurgery, Indiana University, Indianapolis, Indiana, U.S.A
| | - Pablo F Recinos
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Pranay Soni
- Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Varun R Kshettry
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Aaron Cohen-Gadol
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, U.S.A.,Department of Neurosurgery, Indiana University, Indianapolis, Indiana, U.S.A
| | - Troy D Woodard
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, U.S.A
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38
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Gartrell BD, Argilla LS, Chatterton J, Dennison-Gibby S, Digby A, Fulton J, Hunter S, Johnson KL, Jolly M, Lenting B. Surgical repair of a meningoencephalocoele in a kākāpō ( Strigops habroptilus). N Z Vet J 2021; 69:247-254. [PMID: 33906586 DOI: 10.1080/00480169.2021.1909509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CASE HISTORY A kākāpō (Strigops habroptilus) chick hatched on an off-shore island of New Zealand with a small white mass protruding through the cranial skin of the head. The chick's growth followed a normal pattern for kākāpō but at 3 weeks of age the cranium mass was non-reducible and fixed in place and the chick was removed from the island for diagnostic imaging and hand-rearing. CLINICAL FINDINGS AND TREATMENT A computed tomography (CT) examination revealed a full-thickness circular defect in the central cranium with suspected herniation of brain and dura. Surgery was performed at 37 days of age, and the herniated dura was dissected from the open fontanelle. Attempts to reduce the herniated tissue were unsuccessful, so the herniated dura and cortex were clamped and resected. The dura was closed and the periosteum of the skull was scarified and monofilament polypropylene mesh was secured tautly over the fontanelle. The mesh graft was infused with autologous bone marrow harvested from the ulna in an attempt to stimulate osteogenesis in the mesh repair. The skin flap was then closed. Post-operative recovery and healing were without complication. A CT examination 4 weeks after surgery showed no recurrence of the hernia, and a composite of mesh and scar over the open fontanelle which had reduced in diameter. The chick was released back onto an off-shore island with a radio transmitter and it continues to be monitored regularly. PATHOLOGICAL FINDINGS The tissue resected at surgery consisted of a cylindrical core of cerebral parenchyma overlain by a mildly hyperplastic epidermis, and large amounts of oedematous fibrovascular tissue arising from the leptomeninges. DIAGNOSIS Rostral parietal meningoencephalocoele. CLINICAL RELEVANCE This is the first report of successful surgical resolution of a meningoencephalocoele in any bird. Techniques from human neurosurgery were adapted for the unique anatomical features of the avian skull. The risks of the procedure included increased intra-cranial pressure resulting in anaesthetic complications or death, cerebrospinal fluid leakage, meningitis or recurrence of the meningoencephalocoele. In the longer term, there was a risk of developmental deficits in cognition or behaviour. None of these complications eventuated in the short to medium term, probably due to the small size of the meningoencephalocoele.
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Affiliation(s)
- B D Gartrell
- Wildbase, Tāwharau Ora, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - L S Argilla
- The Wildlife Hospital Dunedin, Otago Polytechnic, Dunedin, New Zealand
| | - J Chatterton
- New Zealand Centre for Conservation Medicine, Auckland Zoo, Auckland, New Zealand
| | | | - A Digby
- Kakapo Recovery Team, Department of Conservation, Invercargill, New Zealand
| | - J Fulton
- Pacific Radiology, Marinoto Clinic, Dunedin, New Zealand
| | - S Hunter
- Wildbase, Tāwharau Ora, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - K L Johnson
- Wildbase, Tāwharau Ora, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - M Jolly
- Wildbase, Tāwharau Ora, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - B Lenting
- The Nest Te Kōhanga, Wellington Zoo, Wellington, New Zealand
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39
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Ozaki D, Akashi T, Morita T, Nishimura S, Kanamori M, Tominaga T. A Rare Case of Intracerebral Pneumocephalus Caused by Preexisting Multiple Bone Defects and Encephalocele after Resection of Meningioma. NMC Case Rep J 2021; 8:39-44. [PMID: 34012747 PMCID: PMC8116923 DOI: 10.2176/nmccrj.cr.2020-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/01/2020] [Indexed: 11/20/2022] Open
Abstract
Pneumocephalus is generally secondary to direct damage to the skull base. Spontaneous intracerebral pneumatocele without head injury was extremely rare, but previously reported as a serious complication of shunt procedures. We describe a 40-year-old man with intracerebral pneumocephalus who previously underwent craniotomy for large frontal convexity meningioma and lumbo-peritoneal shunting. He presented with gait disturbance 14 months after tumor resection. Computed tomography and magnetic resonance imaging showed intracerebral pneumocephalus in the right temporal lobe, which continued into the mastoid air cells through a bone defect of the right petrous bone. We performed urgent right temporal craniotomy to reduce the mass effect and to repair the fistula. Intraoperatively, bone defects were identified at the roof petrous bone, into which the encephalocele had penetrated. The herniated cerebral parenchyma was removed, and the pneumocephalus opened. The dura was closed with sutures and covered with fascia. To elucidate the underlying mechanism for the development of intracranial pneumocephalus, the previous images obtained before or immediately after resection of meningioma were reviewed. We founded that multiple preexisting bone defects and encephaloceles, one of which was considered to be the cause of the intracerebral pneumocephalus. This case demonstrates that intracerebral pneumocephalus can be caused by preexisting bone defect and encephalocele, and this finding may be useful for prediction of pneumocephalus after shunt procedures.
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Affiliation(s)
- Dan Ozaki
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshiaki Akashi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takahiro Morita
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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40
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Kumar A, Shah J, Melmed K, Pacione D, Lieberman S, Lewis A. Meningitis in the Setting of Frontoethmoidal and Temporal Meningo encephaloceles. Neurohospitalist 2021; 11:183-184. [PMID: 33791067 DOI: 10.1177/1941874420958839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This is a patient with multiple meningoencephaloceles which resulted in bacterial meningitis and subsequent status epilepticus. We identify impressive imaging findings demonstrating herniation of the meninges from nasal and bitemporal skull base defects possibly as a result of intracranial hypertension.
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Affiliation(s)
- Arooshi Kumar
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Jugal Shah
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Kara Melmed
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA.,Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | - Seth Lieberman
- Department of Otolaryngology, NYU Langone Medical Center, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA.,Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
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41
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Waser B, Wood HM, Mews P, Lalloo S. Transverse sinus stenting for treatment of papilloedema secondary to a large brain herniation into a dural venous sinus with associated tectal plate lesion: Case report and literature review. Interv Neuroradiol 2021; 27:756-762. [PMID: 33779375 DOI: 10.1177/15910199211003451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Brain herniation into a dural venous sinus is a rare entity of unknown clinical significance without a clear relationship to raised intracranial pressure. There are yet to be detailed reports of interventional neuroradiology procedures involving sinus stenting across brain herniations. The authors of this paper present the first case of a stent placed across a large brain herniation into the transverse sinus in a patient with a tectal plate lesion and features of chronically raised intracranial pressure. This case demonstrates objective resolution of papilloedema and venous sinus pressure gradient at six months without complication.
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Affiliation(s)
- Barton Waser
- Department of Neurosurgery, The Canberra Hospital, Australian Capital Territory, Australia
| | - Hannah M Wood
- Department of Neurosurgery, The Canberra Hospital, Australian Capital Territory, Australia
| | - Peter Mews
- Department of Neurosurgery, The Canberra Hospital, Australian Capital Territory, Australia.,Australian National University Medical School, Australian National University, Australian Capital Territory, Australia
| | - Shivendra Lalloo
- Medical Imaging, The Canberra Hospital, Australian Capital Territory, Australia
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42
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Abstract
Chiari malformations (CMs) are a group of disorders involving deformities of the posterior fossa and hindbrain. There are seven types of CMs: 0, I, 1.5, II, III, IV, and V. CMIII is a very infrequent disorder characterized by low occipital or superior cervical encephalocele and inferior displacement of the brainstem. Here we present a unique case of CMIII associated with cleft palate, abnormal midbrain, and abnormal corpus callosum. CMIII is a very rare condition, which needs to be reported. This study primarily aims to compare our case to other cases of CMIII. We did not find another case with cleft palate and CMIII. There are only a few cases reported of CMIII. That is why it is vital to report each of these cases. Among reported CMIII cases, our case is unique regarding the co-occurrence of cleft palate. There seems to be an embryological link between these two conditions. However, cleft palate is a relatively common congenital defect, which means that the co-occurrence could be just a coincidence as well. Further research is warranted to broaden the information of this extremely rare syndrome.
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Affiliation(s)
- Juan Fernando Ortiz
- Neurology, Universidad San Francisco de Quito, Quito, ECU.,Neurology, Larkin Community Hospital, Miami, USA
| | | | - Ammar Alli
- Medicine, Tishreen University Faculty of Medicine, Latakia, SYR.,Internal Medicine, Universitat de Barcelona, Barcelona, ESP
| | - Taras Halan
- General Medicine, Ternopil National Medical University, Ternopil, UKR
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43
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Sreenath SB, Tang DM, Almeida JPD, Soni P, Woodard TD, Recinos PF, Kshettry VR, Sindwani R. Simplifying Access to the Lateral Sphenoid Recess: A Modification of the Transpterygoid Approach. Am J Rhinol Allergy 2021; 35:798-801. [PMID: 33761785 DOI: 10.1177/19458924211003813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be difficult to access. Historically, the endoscopic transpterygoid approach was advocated, which carries additional morbidity given the dissection of the pterygopalatine fossa (PPF) contents to provide a direct line approach to the defect. Given our increased facility with angled endoscopes and instrumentation, we now approach this region in a less invasive manner. METHODS We describe the endoscopic modified transpterygoid approach (MTPA), a quicker approach to the lateral sphenoid recess which preserves the PPF contents through a single nostril corridor. RESULTS In the MTPA, the face of the sphenoid and anterior junction of the pterygoid plates are removed, allowing for mobilization of the PPF contents with the periosteum intact. Angled instrumentation is then used to resect the meningoencephalocele and repair the skull base defect in the lateral recess. If increased exposure is needed, this can be gained by sacrificing the sphenopalatine artery and even the vidian nerve, although this is rarely required. CONCLUSIONS The MTPA obviates the need for PPF dissection and simplifies access to the lateral sphenoid recess while minimizing postoperative morbidity. This approach should be considered for accessing meningoencephaloceles and other benign lesions in this challenging location.
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Affiliation(s)
| | - Dennis M Tang
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California
| | - João Paulo De Almeida
- Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Pranay Soni
- Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Troy D Woodard
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Pablo F Recinos
- Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Varun R Kshettry
- Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
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44
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Khatana R, Khatana A. A rare case of Beckwith-Wiedemann syndrome with encephalocele. Pan Afr Med J 2021; 37:317. [PMID: 33654536 PMCID: PMC7896524 DOI: 10.11604/pamj.2020.37.317.26158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rakesh Khatana
- Mahatma Gandhi Ayurved College hospital and research Centre, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Anamika Khatana
- Department of Rog-Nidan, Shri Dhanwantri Ayurvedic Medical College and Research Centre, Chhata, Mathura (UP)
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45
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Paquin R, Ryan L, Vale FL, Rutkowski M, Byrd JK. CSF Leak After COVID-19 Nasopharyngeal Swab: A Case Report. Laryngoscope 2021; 131:1927-1929. [PMID: 33577104 PMCID: PMC8014120 DOI: 10.1002/lary.29462] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
The nasopharyngeal swab has been used with increased frequency since the beginning of the COVID‐19 pandemic. Little has been written in the literature regarding the complications arising from this procedure, as it is generally accepted as safe. In this report, we describe a case in which a young woman sustained a traumatic skull base injury during a nasopharyngeal swab for COVID‐19. We then discuss the subsequent treatment and outcome. This case demonstrates the potential for significant complications arising from this widespread procedure and the necessity for awareness of these potential complications. Laryngoscope, 131:1927–1929, 2021
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Affiliation(s)
- Rebecca Paquin
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
| | - Lindsey Ryan
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
| | - Fernando L Vale
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
| | - Martin Rutkowski
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
| | - James Kenneth Byrd
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
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46
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Zarzycki A, Thomas ZM, Mazrier H. Comparison of inherited neural tube defects in companion animals and livestock. Birth Defects Res 2020; 113:319-348. [PMID: 33615733 DOI: 10.1002/bdr2.1848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022]
Abstract
Neural tube defects (NTDs) are congenital malformations resulting from the improper or incomplete closure of the neural tube during embryonic development. A number of similar malformations of the protective coverings surrounding the central nervous system are also often included under this umbrella term, which may not strictly fit this definition. A range of NTD phenotypes exist and have been reported in humans and a wide range of domestic and livestock species. In the veterinary literature, these include cases of anencephaly, encephalocele, dermoid sinus, spina bifida, and craniorachischisis. While environmental factors have a role, genetic predisposition may account for a significant part of the risk of NTDs in these animal cases. Studies of laboratory model species (fish, birds, amphibians, and rodents) have been instrumental in improving our understanding of the neurulation process. In mice, over 200 genes that may be involved in this process have been identified and variant phenotypes investigated. Like laboratory mouse models, domestic animals and livestock species display a wide range of NTD phenotypes. They remain, however, a largely underutilized population and could complement already established laboratory models. Here we review reports of NTDs in companion animals and livestock, and compare these to other animal species and human cases. We aim to highlight the potential of nonlaboratory animal models for mutation discovery as well as general insights into the mechanisms of neurulation and the development of NTDs.
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Affiliation(s)
- Alexandra Zarzycki
- Faculty of Science, School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Zoe M Thomas
- Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Hamutal Mazrier
- Faculty of Science, School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Science, Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
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47
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Sepúlveda-González G, Arroyo-Lemarroy T, Basurto D, Davila I, Lizárraga-Cepeda E, Guerra-de la Garza Evia AR, Alcázar-Juárez A. Intracranial Translucency, Its Use as a Potential First Trimester Ultrasound Marker for Screening of Neural Tube Defects. Diagnostics (Basel) 2020; 10:E986. [PMID: 33266467 PMCID: PMC7700296 DOI: 10.3390/diagnostics10110986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of the study was to describe a case-series of neural tube defects (NTD) with an abnormal intracranial translucency (IT) detected during the first-trimester ultrasound scan, performed on a low-risk obstetric population in Mexico. Certified Fetal Medicine specialists performed all US scans; the IT was assessed using the mid-sagittal view of the fetal head, which is already systematically used for nuchal translucency and nasal bone evaluation. During the study, we were able to find that eight fetuses had an absence of the intracranial translucency, out of which two were reassessed at 14 weeks' gestation and IT was normal, six of them were later diagnosed to have an NTD that consisted in spina bifida aperta (n = 5) and encephalocele (n = 1). Conclusion: As previous studies have shown, IT evaluation during the first-trimester US routine scan may be a useful screening marker for early detection of NTDs.
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Affiliation(s)
- Gerardo Sepúlveda-González
- Medicina y Cirugía Fetal Monterrey, 66267 San Pedro Garza García, Nuevo León, Mexico; (I.D.); (E.L.-C.)
- Hospital Regional Materno Infantil de Alta Especialidad, 66110 Guadalupe, Nuevo León, Mexico;
| | - Tayde Arroyo-Lemarroy
- Hospital Regional Materno Infantil de Alta Especialidad, 66110 Guadalupe, Nuevo León, Mexico;
| | - David Basurto
- My fetUZ Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium;
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, 11320 Ciudad de México, Mexico
| | - Ivan Davila
- Medicina y Cirugía Fetal Monterrey, 66267 San Pedro Garza García, Nuevo León, Mexico; (I.D.); (E.L.-C.)
- Departamento de Ginecología y Obstetricia, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autonóma de Nuevo León, 64460 Monterrey, Nuevo León, Mexico
| | - Esteban Lizárraga-Cepeda
- Medicina y Cirugía Fetal Monterrey, 66267 San Pedro Garza García, Nuevo León, Mexico; (I.D.); (E.L.-C.)
- Hospital Regional Materno Infantil de Alta Especialidad, 66110 Guadalupe, Nuevo León, Mexico;
| | | | - Andrea Alcázar-Juárez
- División de Ciencias de la Salud, Universidad de Monterrey, 66238 San Pedro Garza García, Nuevo León, Mexico;
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48
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Marinho M, Lourenço C, Nogueira R, Valente F. Prenatal diagnosis of frontal encephalocele. J Clin Ultrasound 2020; 48:557-559. [PMID: 33031571 DOI: 10.1002/jcu.22848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
Encephalocele is a rare congenital form of neural tube defect characterized by a protrusion of the meninges and cerebral tissue through a skull defect. These defects are classified according to their location: frontal, parietal and occipital, the last one being the most common form of presentation. The prognosis is related to the anatomical site, the volume of the neural contents and the presence of coexisting abnormalities. Most pregnancies are terminated, since the prognosis is poor. We report a case of an isolated fetal frontal encephalocele diagnosed at 21 weeks of gestation.
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Affiliation(s)
- Márcia Marinho
- Obstetrics and Gynecology Department, Centro Hospitalar Vila Nova de Gaia, Porto, Portugal
| | - Cátia Lourenço
- Obstetrics and Gynecology Department, Centro Hospitalar Vila Nova de Gaia, Porto, Portugal
| | - Rosete Nogueira
- Pathology Laboratory Department, CGC Genetics/Centro de Genética Clínica, Porto, Portugal
- Medical School, University of Minho, & ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Francisco Valente
- Obstetrics and Gynecology Department, Centro Hospitalar Vila Nova de Gaia, Porto, Portugal
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49
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Hasnaoui M, Guizani R. [Sphenoid sinus meningo encephalocele in an adult patient]. Pan Afr Med J 2020; 37:119. [PMID: 33425152 PMCID: PMC7755373 DOI: 10.11604/pamj.2020.37.119.25543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/11/2022] Open
Abstract
The incidence of sphenoid sinus meningoencephalocele is very low. It is estimated one person out of 700 000 live births. This clinical entity is rarer in adults. We here report the case of a 51-year old woman presenting with feeling of intranasal heaviness that had progressed since the young age without rhinorrhea or nasal obstruction. She had no dysosmia or headache. She did not have a history of recurrent meningitis, skull base surgery or head trauma. Both nasal fossae were free. Computed tomography (CT) scan of the facial skeleton showed subtotal filling of the right sphenoid sinus, with spontaneously hyperdense content at places, without significant contrast enhancement associated with lysis of the lateral wall of the right sphenoid sinus. Brain and facial skeleton magnetic resonance imaging (MRI) showed dehiscence of the lateral wall of the right sphenoid sinus with herniation of the cerebrospinal fluid presenting hyposinal on T1, hypersignal on T2, cerebral parenchyma in T1 and T2 isosignal. We opted for therapeutic abstention because the patient was asymptomatic.
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Affiliation(s)
- Mehdi Hasnaoui
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Rihab Guizani
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
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50
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Deora H, Srinivas D, Shukla D, Devi BI, Mishra A, Beniwal M, Kannepalli NR, Somanna S. Multiple-site neural tube defects: embryogenesis with complete review of existing literature. Neurosurg Focus 2020; 47:E18. [PMID: 31574472 DOI: 10.3171/2019.8.focus19437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple-site neural tube defects (MNTDs) are very uncommon, with the predominant number of cases being reported in developing countries. The classic theory of neural tube closure fails to explain the occurrence of these defects. Multisite closure theory, first proposed in 1995, explains most of the occurrences with a few modifications specific to a few defects. In this paper, the authors endeavor to explain all the defects, along with their genetic and embryological bases, and to review the available literature and discuss their own experience in the management of these complex cases. METHODS The authors retrospectively reviewed the data of all the patients treated surgically for MNTDs over that past 14 years. All possible demographic data, clinical details, and radiological imaging data were reviewed. In addition, surgical parameters, complications, and status at follow-up of more than 12 months were evaluated. All previously reported cases of MNTD were analyzed, and comparisons with the present series were made. RESULTS A total of 3 major series (including the present one) on MNTDs have been from India. A total of 57 such cases (including those of the present series) have been reported in the available literature. While previous series reported a higher incidence of spinal defects, the present series had a higher rate of cephalic defects (55%). Among the reported cases, insertion of a ventriculoperitoneal shunt was necessary in 12 (26%), and only 4 patients were operated on in 2 stages. Neurological status at presentation dictated outcome. CONCLUSIONS MNTDs are extremely rare, and their embryogenesis is different from that of single neural tube defects. Simultaneous repair of 2 or even 3 defects is possible in a single-stage surgery. The requirement of a shunt is uncommon, and complications following surgery are rare. Folic acid supplementation may reduce the incidence of defects.
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