No abstract available.
Adult* ; Brain Injuries* ; Cranial Nerve Injuries* ; Cranial Nerves* ; Humans

Oblique basal skull fractures resulting from lateral crushing injuries involving both clivus and occipital condyle are rare due to their deep locations. Furthermore, these fractures may present clinically with multiple cranial nerve injuries because neural exit routes are restricted in this intricate region. The authors present an interesting case of basal skull fractures involving the clivus and occipital condyle and presenting with sixth and contralateral twelfth cranial nerve deficits. Clinico-anatomic correlations and the courses of cranial nerve deficits are reiterated. To the authors' knowledge, no other report has been previously issued on concomitant sixth and contralateral twelfth cranial nerve palsies following closed head injury.
Cranial Fossa, Posterior ; Cranial Nerve Diseases ; Cranial Nerve Injuries ; Cranial Nerves ; Head Injuries, Closed ; Hypoglossal Nerve ; Paralysis ; Skull ; Skull Fractures

OBJECTIVE: Removal of the anterior clinoid process (ACP) is an essential process in the surgery of giant or complex aneurysms located near the proximal internal carotid artery or the distal basilar artery. An extradural clinoidectomy must be performed within the limits of the meningeal layers surrounding the ACP to prevent morbid complications. To identify the safest method of extradural exposure of the ACP, anatomical studies were done on cadaver heads. METHODS: Anatomical dissections for extradural exposure of the ACP were performed on both sides of seven cadavers. Before dividing the frontotemporal dural fold (FTDF), we measured its length from the superomedial apex attached to the periorbita to the posterolateral apex which connects to the anterosuperior end of the cavernous sinus. RESULTS: The average length of the FTDF on cadaver dissections was 7 mm on the right side and 7.14 mm on the left side. Cranial nerves were usually exposed when cutting FTDF more than 7 mm of the FTDF. CONCLUSION: The most delicate area in an extradural anterior clinoidectomy is the junction of the FTDF and the anterior triangular apex of the cavernous sinus. The FTDF must be cut from the anterior side of the triangle at the periorbital side rather than from the dural side. The length of the FTDF incision must not exceed 7 mm to avoid cranial nerve injury.
Aneurysm ; Basilar Artery ; Cadaver ; Carotid Artery, Internal ; Cavernous Sinus ; Caves ; Cranial Nerve Injuries ; Cranial Nerves

The clinical analysis of cranial nerve injuries was performed on 435 cases with cranoicrerbral trauma. This prospective study included the correlation between cranial nerve injuries and risk factors such as intracranial hematoma, initial Glasgow Coma Scale(GCS) score, pneumocephalus, and other combined injuries. The results were revealed as follows : 1) 133 cranial nerve injuries(on 97 patients) were noted among 435 craniocerebral trauma victims(97/435=22.2%). 2) The order of frequent cranial nerve injuries was facial nerve(7.3%), olfactory nerve(6.9%), oculomotor nerve(4.4%), abducens nerve(3.9%), optic nerve(3.2%), etc. 3) Bilateral involvment of cranial nerve injuries was noted in 16.5%(22/133). 4) The incidence of immediate onset of cranial nerve injuries was 66.9%(89/133). 5) The incidence of cranial nerve injuries was significantly high in patients with pneumocephalus and low initial GCS score. 6) The functional recovery of injured cranial nerve within 3 months was noted in 30.1%(40/133).
Coma ; Cranial Nerve Injuries* ; Cranial Nerves* ; Craniocerebral Trauma* ; Hematoma ; Humans ; Incidence ; Pneumocephalus ; Prospective Studies ; Risk Factors

BACKGROUND: The laryngeal mask airway (LMAⓇ) Protector™ (Teleflex Medical Co., Ireland) is the latest innovation in the second generation of LMA devices. One distinguishing feature of this device is its integrated, color-coded cuff pressure indicator (Cuff ™ technology) which enables continuous cuff pressure monitoring and allows adjustments when necessary; this ensures patient safety due to better monitoring.CASE: We report a case of postoperative unilateral hypoglossal nerve palsy after uncomplicated use of the LMA Protector. To the best of our knowledge, this could be the second reported case.CONCLUSIONS: This case demonstrates that anesthetists need to routinely measure cuff pressure and that the Cuff Pilot™ technology is not a panacea for potential cranial nerve injury after airway manipulation.
Cranial Nerve Injuries ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve ; Laryngeal Masks ; Patient Safety

PURPOSE: To analyze the relationship between prognosis and the severity of associated injuries in traumatic isolated 3rd, 4th and 6th cranial nerve palsies. METHODS: The records of 39 patients (39 eyes) who were diagnosed with isolated 3rd, 4th or 6th cranial nerve palsy following trauma were reviewed retrospectively to analyze the etiology of trauma, the degree of associated injuries, the degree of paralysis, and the prognosis. RESULTS: The 4th cranial nerve was affected most frequently (19 patients, 48.7%), followed by the 6th nerve (12 patients, 30.8%) and the 3rd nerve (8 patients, 20.5%). Traffic accidents were the most frequent etiology of traumatic cranial nerve palsies. Loss of consciousness, intracranial hemorrhage, craniofacial fracture, c-spine injury, and optic nerve injury were among the most common accompanying conditions. The 3rd cranial nerve was the most severely paralyzed and showed the highest number of associated injuries. The recovery rate of the all cranial nerve palsies was 46.2%. By nerve, the 3rd cranial nerve palsy showed the lowest recovery rate of 25%, followed by the 4th nerve at 47.4%, and the 6th nerve at 58.3%. CONCLUSIONS: The prognosis was worse in patients with intracranial hemorrhage, compared with those without intracranial hemorrhage. There was a higher average number of associated injuries and the degree of paralysis was more severe in 3rd nerve palsies.
Accidents, Traffic ; Cranial Nerve Diseases* ; Cranial Nerves* ; Humans ; Intracranial Hemorrhages ; Optic Nerve Injuries ; Paralysis ; Prognosis* ; Retrospective Studies ; Unconsciousness

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.
Cranial Nerve Injuries ; Deglutition Disorders ; Dilatation* ; Esophageal Sphincter, Upper* ; Humans ; Muscles ; Neurologic Manifestations ; Vagus Nerve Injuries* ; Vagus Nerve*

OBJECTIVE: Jugular foramen schwannomas are uncommon pathological conditions. This article is constituted for screening these tumors in a wide perspective. MATERIALS: One-hundred-and-ninty-nine patients published in 19 articles between 1984 to 2007 years was collected from Medline/Index Medicus. RESULTS: The series consist of 83 male and 98 female. The mean age of 199 operated patients was 40.4 years. The lesion located on the right side in 32 patients and on the left side in 60 patients. The most common presenting clinical symptoms were hearing loss, tinnitus, disphagia, ataxia, and hoarseness. Complete tumor removal was achieved in 159 patients. In fourteen patients tumor reappeared unexpectedly. The tumor was thought to originate from the glossopharyngeal nerve in forty seven cases; vagal nerve in twenty six cases; and cranial accessory nerve in eleven cases. The most common postoperative complications were lower cranial nerve palsy and facial nerve palsy. Cerebrospinal fluid leakage, meningitis, aspiration pneumonia and mastoiditis were seen as other complications. CONCLUSION: This review shows that jugular foramen schwannomas still have prominently high morbidity and those complications caused by postoperative lower cranial nerve injury are life threat.
Accessory Nerve ; Ataxia ; Cranial Nerve Diseases ; Cranial Nerve Injuries ; Cranial Nerves ; Facial Nerve ; Female ; Glossopharyngeal Nerve ; Hearing Loss ; Hoarseness ; Humans ; Male ; Mass Screening ; Mastoid ; Mastoiditis ; Meningitis ; Neurilemmoma ; Paralysis ; Pneumonia, Aspiration ; Postoperative Complications ; Tinnitus

The hypoglossal nerve palsy receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common. A literature review revealed that in most cases, isolated hypoglossal nerve palsy indicates the presence of an intracranial or extracranial space occupying lesion, head and neck injury, vascular abnormality, infection, autoimmune disease or neuropathy. Reports of idiopathic cases are rare and treated with steroid therapy. We report a 38-year-old woman with isolated hypoglossal nerve palsy improved spontaneously without steroid use. Considering our experience with isolated hypoglossal nerve palsy, we believe that no therapy is required in the patients with hypoglossal nerve palsy of probably idiopathic causes.
Adult ; Autoimmune Diseases ; Cranial Nerve Diseases ; Female ; Head ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve* ; Neck Injuries ; Paralysis

BACKGROUND AND OBJECTIVES: Traditionally, the surgical approach for the excision of second branchial cleft cysts involves performing a transverse cervical incision on the skin overlying the mass. Recently, there has been a significant interest on the cosmetic outcomes of this surgery, and it has been found that the retroauricular approach produces better results. The purpose of this study was to evaluate the feasibility of a retroauricular approach for the excision of second branchial cleft cysts without the assistance of endoscopic or robotic system. SUBJECTS AND METHOD: From August 2013 to May 2016, a total of 12 patients with second branchial cleft cysts underwent surgery for the excision of the cyst via retroauricular approach, which involved an incision along the retroauricular sulcus and hairline. The surgical outcomes, complications, and subjective satisfaction with incision scars were assessed. RESULTS: In all 12 cases, the second branchial cleft cysts were removed successfully under direct vision and without the requirement of endoscopic assistance. The mean operation time was 80.3 min (range, 65-105 min). No significant complications were reported, such as skin flap necrosis, hematoma, seroma, or serious cranial nerve injury. The mean visual analogue scale score for subjective satisfaction with the incision scar was 8.8 (range, 7-10). CONCLUSION: The excision of second branchial cleft cysts via retroauricular approach without the assistance of endoscopic or robotic system is technically feasible and it provides a favorable cosmetic outcome.
Branchial Region* ; Branchioma* ; Cicatrix ; Cranial Nerve Injuries ; Hematoma ; Humans ; Methods ; Necrosis ; Seroma ; Skin