Objective: To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient. Methods: Study Design:Surgical Instrumentation Setting:Tertiary Government Training Hospital Patient:One Results: Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted. Conclusion Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.
Human ; Male ; Adult (a Person 19-44 Years Of Age) ; Skull Fracture, Basilar ; Cranial Fossa, Posterior

PURPOSE: Fossa navicularis is a bone defect in the clivus. Familiarity with this anatomical variant is important because it is close to vital anatomical structures in the base of the skull. The aim of this study was to determine the prevalence and morphometric properties of fossa navicularis within the clivus in a Turkish subpopulation using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 168 CBCT scans (female: 96, male: 71) were evaluated. High-quality CBCT images of patients without a syndromic condition or a history of neurological disease or surgery were included in the study. The prevalence, depth, length, and width of the fossa navicularis were performed. RESULTS: The prevalence of fossa navicularis was 27.5% (n=46 patients). Sex was not associated with the depth, length, or width of the fossa navicularis (P>0.05). A significant positive correlation was found between age and length of the fossa navicularis (P>0.05). CONCLUSION: Fossa navicularis was found to be rare (27.5%). Anatomical variants of the skull base can also be clearly identified on CBCT images. The results of this study may be useful to radiologists, anatomists, and surgeons interested in the skull base.
Anatomists ; Cone-Beam Computed Tomography ; Cranial Fossa, Posterior ; Humans ; Male ; Prevalence ; Recognition (Psychology) ; Skull ; Skull Base ; Surgeons

Skull base chordomas are rare, malignant tumors arising from primitive notochord remnants of the axial skeleton and comprise approximately 25–35% of all chordoma cases. Nasal endoscopy in previous case reports has characterized nasopharyngeal chordomas as firm, semi-translucent masses protruding from the posterior nasopharyngeal wall with a pink, “meaty” appearance. However, the nasopharyngeal chordoma in the present case had a soft, cystic appearance, unlike the tumors previously described. Herein, an unusual case of an incidentally discovered nasopharyngeal chordoma is reported in a patient with papillary thyroid cancer; the discovered chordoma had a benign cystic appearance with no abnormal positron emission tomography-computed tomography (PET-CT) uptake.
Chordoma ; Cranial Fossa, Posterior ; Electrons ; Endoscopy ; Humans ; Notochord ; Skeleton ; Skull Base ; Thyroid Gland ; Thyroid Neoplasms

Variations of the dural folds and the dural venous sinuses are infrequently reported in the existing medical literature. Such variations in the posterior cranial fossa may pose difficulties in various analytical and surgical procedures of this region. We present a rare concurrent variation of the falx cerebelli and tentorium cerebelli that was detected during routine dissection of an adult male cadaver. While removing the brain, a partial duplication of tentorium cerebelli was observed below the left half of the tentorium cerebelli and above the left cerebellar hemisphere. This fold did not have any dural venous sinus in it. Further, a complete duplication of falx cerebelli with a single occipital venous sinus within its attached border was also observed. We present the review of literature and discuss the comparative anatomy of this case.
Adult ; Anatomy, Comparative ; Brain ; Cadaver ; Cranial Fossa, Posterior ; Dura Mater ; Humans ; Male ; Meninges ; Spinal Cord

A congenital cholesteatoma is a benign mass formed from the keratinizing stratified squamous epithelium. It usually occurs in young children's anterosuperior part of the middle ear. A congenital cholesteatoma which originates from mastoid temporal bone or expands to posterior cranial fossa is rare. Standard treatment of an intracranial cholesteatoma is surgical removal with craniotomy. A 69-year-old woman was diagnosed with a congenital cholesteatoma of mastoid temporal bone that expanded to the posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy. This is a first documented case of a congenital cholesteatoma of mastoid temporal bone that expanded to posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy.
Aged ; Cholesteatoma* ; Cranial Fossa, Posterior* ; Craniotomy ; Ear, Middle ; Epithelium ; Female ; Humans ; Mastoid* ; Occipital Bone ; Temporal Bone*

Gliosarcoma (GS), known as variant of glioblastoma multiforme, is aggressive and very rare primary central nervous system malignant neoplasm. They are usually located in the supratentorial area with possible direct dural invasion or only reactive dural thickening. However, in this case, GS was located in lateral side of left posterior cranial fossa. A 78-year-old man was admitted to our hospital with 3 month history of continuous dizziness and gait disturbance without past medical history. A gadolinium-enhanced MRI demonstrated 5.6×4.8×3.2 cm sized mass lesion in left posterior cranial fossa, heterogeneously enhanced. The patient underwent left retrosigmoid craniotomy with navigation system. The tumor was combined with 2 components, whitish firm mass and gray colored soft & suckable mass. On pathologic report, the final diagnosis was GS of WHO grade IV. In spite of successful gross total resection of tumor, we were no longer able to treat because of the patient's rejection of adjuvant treatment. The patient survived for nine months without receiving any special treatment from the hospital.
Aged ; Central Nervous System ; Cranial Fossa, Posterior ; Craniotomy ; Diagnosis ; Dizziness ; Gait ; Glioblastoma ; Gliosarcoma* ; Humans ; Magnetic Resonance Imaging

Posterior fossa epidural hematoma (EDH) is uncommon, but the related clinical deterioration can occur suddenly. Accompanying venous sinus injury and lacerations are associated with 40% to 80% mortality. The authors present one clinical case of a patient with posterior fossa EDH from transverse sinus bleeding. A 57-year-old male was injured after falling while working. He was taken to the hospital, where computed tomography scans of his brain revealed a right posterior temporal and cerebellar EDH with a right temporo-occipital fracture. He underwent a right parieto-occipital craniotomy, incorporating the fracture line. Longitudinal laceration of the right transverse sinus extending to the sigmoid sinus with profuse bleeding was identified. Four gauzes were inserted in the epidural space for tamponade of the injured sinus. Conventional angiography and coil embolization for the injured sinus were immediately performed. Subsequently, the patient was transferred to the operating room, wherein staff members removed the gauzes and remnant hematoma. Based on this experience, the authors recommend that for posterior fossa EDH from transverse sinus bleeding, bleeding control should be performed by gauze packing and endovascular treatment.
Accidental Falls ; Angiography ; Brain ; Colon, Sigmoid ; Cranial Fossa, Posterior ; Craniotomy ; Embolization, Therapeutic ; Epidural Space ; Hematoma ; Hematoma, Epidural, Cranial ; Hemorrhage* ; Humans ; Lacerations ; Male ; Middle Aged ; Mortality ; Operating Rooms

PURPOSE: The aim of this study is to propose a new, simplified formula using an upper incisor-sternal notch (UI-SN) to predict the airway length of optimal positioning of the endotracheal tube via a midsagittal magnetic resonance imaging (MRI) in pediatric patients. METHODS: Between August 2000 and September 2014, a total of 56 pediatric patients (under 8 years old) who underwent MRI for C-spine or whole spine were included for analysis. Variables, such as curved airway length from upper incisor to carina (UI-C), straight length from upper incisor to sternal notch (UI-SN), and from the clivus to sternal notch (C-SN), were measured. Linear regression was used to analyze the relationship among these variables. RESULTS: The average age was 3.5±2.6, and there were 30 (53.6%) males. The mean airway length for UI-C and UI-SN was 16.0±2.8 and 8.8±2.1 cm, respectively. There was a close linear correlation between UI-C and UI-SN (p<0.001). By linear regression, a formula was obtained as UI-C (cm)=1.26×UI-SN (cm)+5.0 (R²=0.873). CONCLUSION: The airway length from the upper incisor to the carina with the head placed in neutral position can be well predicted by a straight length from the upper incisor to the sternal notch. The proposed simplified formula (UI-C=1.26×UI-SN+5, cm) can provide good guidance in determining the optimal positioning of endotracheal tube in pediatric patients.
Cranial Fossa, Posterior ; Head ; Humans ; Incisor ; Intubation ; Linear Models ; Magnetic Resonance Imaging* ; Male ; Pediatrics ; Spine

Arachnoid cysts found under the age of 1 year are more likely to grow in size, relatively short term follow-up is required. Retrocerebellar location predicts a high risk of hydrocephalus, and the time window until irreversible neuronal damage is often narrow if the arachnoid cyst increases in size and becomes symptomatic. However, when and how to treat a neonatal or infantile patient with a retrocerebellar arachnoid cyst is still a controversial subject. We recently experienced 3 differently treated very young pediatric patients with retrocerebellar arachnoid cysts. One patient was treated two weeks after birth by a cystoperitoneal shunt. This patient showed normal development after the surgery. The other patient was treated by a ventriculoperitoneal shunt and subsequent cystoventriculostomy at the age of 4 months because of his mother's refusal on 14th day after birth. This one showed developmental delay despite of decreasing size of ventricles after the surgery. The last patient was treated with microscopic fenestration, which failed in its initial attempt. A revision operation by cyst excision succeeded and had no problem after the surgery. Therefore, we suggest that early surgical intervention for retrocerebellar arachnoid cyst can be considered. Although there are concerns of long term complications related to shunts, a cystoperitoneal shunt would be a feasible treatment if we consider the minor cerebrospinal fluid pathway which is the dominant cerebrospinal fluid dynamic at this age.
Arachnoid Cysts ; Arachnoid* ; Cerebrospinal Fluid ; Cranial Fossa, Posterior ; Follow-Up Studies ; Humans ; Hydrocephalus ; Neurons ; Parturition ; Pediatrics ; Ventriculoperitoneal Shunt

Cranial Fossa, Posterior ; Cranial Nerve Neoplasms ; diagnosis ; pathology ; Ganglioneuroma ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Skull Base Neoplasms ; diagnosis ; pathology ; Trigeminal Ganglion