Cerebrospinal Fluid Otorrhea ; surgery ; Craniotomy ; Encephalocele ; Humans ; Mastoid ; surgery

Adult ; Encephalocele ; surgery ; Endoscopy ; Female ; Humans ; Meningocele ; surgery ; Nasal Cavity ; surgery

We report an uncommon case of a 45-year-old woman who presented with spontaneous rhinorrhea. A computed tomography (CT) scan of the head revealed an abnormally large sphenoid sinus associated with a parasellar bony defect (Sternberg's canal) through which magnetic resonance imaging could detect an encephalocele of the right temporal lobe. An endoscope-assisted trans-sphenoidal approach was performed and, with the aid of image guided surgery, reduction of the encephalocele was obtained and followed by surgical repair of the dural and bony defects. The postoperative course was uneventful and the cerebrospinal fluid fistula was closed as confirmed by the postoperative CT scan and by the absence of rhinorrhea. After three years of monitoring the patient remained asymptomatic.
Encephalocele ; Female ; Fistula ; Head ; Humans ; Magnetic Resonance Imaging ; Sphenoid Sinus ; Surgery, Computer-Assisted ; Temporal Lobe

OBJECTIVETo investigate the management experience with transnasal endoscopic technique for meningoencephalocele.

METHODSNine patients with endonasal encephalomeningocele were managed by transnasal endoscopic surgery, and the skull base defect was repaired by fascia.

RESULTSEight cases were successfully managed at the time of the first operation, and no relapse case was found during 1 to 4 years follow-up. Only one case of a two years old child relapsed with cerebrospinal fluid rhinorrhea one month after operation. During the second operation, titanium mesh uncovering was found, and replacement of titanium mesh by fascia via skull base defect was done, without relapse one and half years after the second operation. Another case of a one year old child got a fever one day after operation, but no white blood cell was found in the cerebrospinal fluid, and the temperature recovered to normal after release cerebrospinal fluid management. There were no complications of cranial infection, hemorrhage, edema and water retention in brain to be found in all cases.

CONCLUSIONSIt is not only minimally invasive, safety and efficiency of transnasal endoscopic technique for meningoencephalocele, but also had a clear operating view for better recolonization of the position of leak and the structure of operating field, therefore, transnasal endoscopic technique is the first choice for the management of endonasal encephalomeningocele. The accurate localization of leak and selection of the appropriate repairing materials are the key point for the successful operation.

Adult ; Child, Preschool ; Encephalocele ; surgery ; Endoscopy ; Female ; Humans ; Infant ; Male ; Middle Aged ; Nasal Cavity ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods

OBJECTIVETo explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries.

METHODSA total of 2165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently.

RESULTSAfter treatment, 2024 (93.49%) cases survived and the other 141 (6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 (46.71%) and 53 (24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%-65.96% and 28.57% respectively, indicating a significant difference (P<0.05).

CONCLUSIONSTreatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.

Adult ; Craniocerebral Trauma ; surgery ; therapy ; Encephalocele ; etiology ; therapy ; Female ; Humans ; Male ; Multiple Trauma ; surgery ; therapy ; Retrospective Studies ; Shock, Hemorrhagic ; etiology ; therapy ; Thoracic Injuries ; surgery ; therapy

PURPOSE: Rapid decompressive craniectomy (DC) was the most effective method for the treatment of hypertensive intracerebral hemorrhage (HICH) with cerebral hernia, but the mortality and disability rate is still high. We suspected that hematoma puncture drainage (PD) + DC may improve the therapeutic effect and thus compared the combined surgery with DC alone. METHODS: From December 2013 to July 2019, patients with HICH from Linzhi, Tibet and Honghe, Yunnan Province were retrospectively analyzed. The selection criteria were as follows: (1) altitude ≥1500 m; (2) HICH patients with cerebral hernia; (3) Glascow coma scale score of 4-8 and time from onset to admission ≤3 h; (4) good liver and kidney function; and (5) complete case data. The included patients were divided into DC group and PD + DC group. The patients were followed up for 6 months. The outcome was assessed by Glasgow outcome scale (GOS) score, Kaplan-Meier survival curve and correlation between time from admission to operation and prognosis. A good outcome was defined as independent (GOS score, 4-5) and poor outcome defined as dependent (GOS score, 3-1). All data analyses were performed using SPSS 19, and comparison between two groups was conducted using separate t-tests or Chi-square tests. RESULTS: A total of 65 patients was included. The age ranged 34-90 years (mean, 63.00 ± 14.04 years). Among them, 31 patients had the operation of PD + DC, whereas 34 patients underwent DC. The two groups had no significant difference in the basic characteristics. After 6 months of follow-up, in the PD + DC group there were 8 death, 4 vegetative state, 4 severe disability (GOS score 1-3, poor outcome 51.6 %); 8 moderate disability, and 7 good recovery (GOS score 4-5, good outcome 48.4 %); while in the DC group the result was 15 death, 6 vegetative state, 5 severe disability (poor outcome 76.5 %), 4 moderate disability and 4 good recovery (good outcome 23.5 %). The GOS score and good outcome were significantly less in DC group than in PD + DC group (Z = -1.993, p = 0.046; χ CONCLUSION PD + DC treatment can improve the good outcomes better than DC treatment for HICH with cerebral hernia at a high altitude.
Adult ; Aged ; Aged, 80 and over ; Altitude ; China ; Decompressive Craniectomy ; Drainage ; Encephalocele/surgery* ; Hematoma ; Humans ; Intracranial Hemorrhage, Hypertensive/surgery* ; Middle Aged ; Prognosis ; Punctures ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo explore the treating method for severe craniocerebral trauma combined with transtentorial hernia in children.

METHODSWe treated 58 children with severe craniocerebral trauma combined with transtentorial hernia through evacuating the hematomas, incising the tentorium but preserving the floating bone flap between January 1996 and January 2002.

RESULTSGCS was 3-5 in 17 cases and 6-8 in 41 cases. After treatment, 46 patients (79.30%) recovered well, 6 (10.30%) suffered from mild disability, 1 (1.72%) suffered from severe disability, 1 (1.72%) was in vegetative state, and 4 (6.90%) died.

CONCLUSIONSEvacuating hematomas and incising tentorium can effectively treat the child patients with severe craniocerebral trauma combined with transtentorial hernia, which can decrease the disability and mortality rates greatly, preserve the skull, exempt reoperation for cranioplasty and relieve the psychologic and physiologic burden of the child patients.

Adolescent ; Child ; Child, Preschool ; Craniocerebral Trauma ; complications ; diagnostic imaging ; surgery ; Decompression, Surgical ; Encephalocele ; complications ; Female ; Glasgow Coma Scale ; Humans ; Infant ; Male ; Tomography, X-Ray Computed

Adolescent ; Adult ; Child ; Child, Preschool ; Choristoma ; metabolism ; pathology ; surgery ; Encephalocele ; metabolism ; pathology ; surgery ; Female ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Infant ; Male ; Meningocele ; metabolism ; pathology ; surgery ; Middle Aged ; Mucin-1 ; metabolism ; Neuroglia ; metabolism ; pathology ; Nose Diseases ; metabolism ; pathology ; surgery ; S100 Proteins ; metabolism ; Vimentin ; metabolism ; Young Adult