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PubMed1989

Cervical spinal deformity following craniotomy and upper cervical laminectomy for posterior fossa tumors in children.

Spinal deformity is not usually regarded as a potential complication of posterior fossa tumor resection. After cervical subluxation had been recognized in 2 children following removal of posterior fossa tumors, a review was carried out to determine the incidence of this complication. Of the 72 children who had undergone resection of a posterior fossa tumor, 4 patients, including the original 2, developed a cervical spinal deformity. Factors that predisposed to this complication included laminectomy of C2 or lower, local wound complications and possibly post-operative neck weakness. It is important to be aware that cervical subluxation can occur after resection of posterior fossa tumors, when laminectomy extending below C1 has been performed. Patients at risk should be followed closely.

Brain Neoplasms↗
PubMed1989

The state of the frontal sinus after craniotomy.

In 39 patients, 24 male, 15 female, the frontal sinus was opened during a frontal, a bifrontal or a pterional trephination for neurosurgical treatment of trauma, tumours or aneurysms. In 25 out of 39 patients the frontal sinus subsequently was obliterated, in 11 out of 39 patients the apical half or 2/3 of the sinus were ablated and the remaining caudal part covered with a galea periosteal flap leaving the fronto-nasal duct intact. In 3 out of 39 patients, the periphery of the sinus was ablated and the remaining part covered. All patients were followed over a mean period of 2 years and had a final evaluation using CTs, X-rays, ultrasonography and a complete ENT examination. In 4 out of 25 obliteration was successful and complete, in 16 out of 25 there was a partial or complete re-aeration of the residual sinus and in 5 out of 25 the sinus was infected. In one out of eleven patients where the frontal sinus was bisected with preservation of the lower half, the basal part of the sinus was infected, in 10 out of 11 the residual sinus was aerated and draining well. In one out of three patients where the periphery of the sinus was ablated, there was infection, two of three sinuses were aerated. Evaluating the experience in these 39 patients and our recent experience, obliteration of the sinus with muscle is very unreliable and the use of bone wax is obsolete. Covering a bisected or peripherally opened sinus with fascia or a galea periosteal flap will yield a well aerated and draining sinus, provided the naso-frontal duct is intact.

Adolescent↗
PubMed1989

Granuloma caused by oxidized cellulose following craniotomy.

Three cases are reported in which large granulomas developed 13 to 21 months respectively after removal of intracranial meningiomas (2 cases) and after operation for an anterior communicating artery aneurysm. In each of the cases oxidized cellulose had been used and left in place for haemostasis. All of the granulomas acted as space-occupying lesions. They could be removed operatively with good result. All of them consisted of mononuclear phagocytic and multi-nuclear giant cells and contained remnants of oxidized cellulose. No comparable cases have been reported in the literature. Diagnosis, treatment and possible aetiological factors are discussed.

Adult↗
PubMed1984

Venous air embolism in a child undergoing posterior fossa craniotomy: a case report.

The incidence of venous air embolism in children undergoing neurosurgical procedures in the sitting position may be as high as 33 per cent. It may be more serious in children because smaller total volumes of air can produce serious physiologic disturbances or fatalities, and the risk of systemic air embolism through a patent foramen ovale or patent ductus arteriosus may be greater than in adults. The case of a six-year-old child who sustained four separate episodes of air embolism while undergoing posterior fossa exploration is presented. Early episodes were well tolerated, but later episodes produced clinical instability. A total of 11 cc of air was recovered from an indwelling right atrial catheter, and the patient recovered uneventfully. This case report illustrates the physiologic changes produced by venous air embolism and reviews the importance of adequate monitoring techniques and early treatment.

Astrocytoma↗
PubMed1998

The vulnerability of the vein of labbé during combined craniotomies of the middle and posterior fossae.

During combined middle and posterior cranial fossae ("petrosal") approaches to the skull base, the anastamotic vein of Labbe, which bridges between the inferior surface of the temporal lobe and the transverse sinus is placed at risk. Occlusion of this vein, which may drain a large section of the temporal and parietal lobes, may lead to speech, memory, and/or other cognitive disorders. Labbe may be injured along its course on the inferior aspect of the temporal lobe where it may be laceraed during dural incision or thrombosed due to prolonged or overly vigorous retraction. The anastamotic segment of the vein, which bridges between the temporal lobe and transverse sinus, may be avulsed during elevation of the temporal lobe or injured during tentorial division. Labbé may course in close proximity to the upper surface of the tentorium or even travel within it for a short segment of its course en route to the transverse sinus. This article reviews the anatomy of the vein of Labbé, discusses its clinical significance, and highlights the technical points relevant to the preservation of this important structure.

Journal Article↗