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Ear, Nose, & Throat Journal May 2024The parapharyngeal space has been described as an inverted pyramid shape with the base of the skull and the great cornu of the hyoid bone at the top. Tumors of the...
The parapharyngeal space has been described as an inverted pyramid shape with the base of the skull and the great cornu of the hyoid bone at the top. Tumors of the parapharyngeal space account for 0.5% of head and neck tumors and a wide range of tumor types can occur in this area, 80% of which are benign, the most common being pleomorphic adenomas of the salivary glands and neurogenic tumors. We present a 39-year-old woman who was hospitalized due to left-sided neck pain with a feeling of blockage in the left ear and hearing loss for 10 months. Imaging showed that the mass was not connected to the cranium and the patient underwent surgical resection via a transoral approach, where the contents of the mass were found to be cerebrospinal fluid, and meningocele in the parapharyngeal space is a rare occurrence. The patient presented mainly with painful symptoms, which were eventually relieved by nerve block therapy.
PubMed: 38757650
DOI: 10.1177/01455613241249094 -
Neurology India 2021Ventriculoperitoneal shunt (VPS) is the most common procedure used in the management of hydrocephalus regardless of the etiology. The standard free-hand technique is...
BACKGROUND
Ventriculoperitoneal shunt (VPS) is the most common procedure used in the management of hydrocephalus regardless of the etiology. The standard free-hand technique is used for the placement of VPS in patients with enlarged ventricles. In patients with very small ventricles, CSF access through ventriculostomy becomes challenging and free-hand technique may be associated with high failure rates. In these situations, stereotactic-guided VPS becomes very useful.
OBJECTIVE
To validate and describe the technique of robotic-guided VPS in cases with very small ventricles.
METHODS
Three patients underwent VPS with robotic guidance between 2016 and 2019. One patient with a diagnosis of occipital meningocele, who later developed recalcitrant CSF leak from the operative site, and two other patients were diagnosed with idiopathic intracranial hypertension (IIH). Plain CT brain with 1-mm slice thickness acquired prior to the surgery was uploaded into the ROSA machine (Zimmer Biomet Warsaw, Indiana). The trajectory for the VPS is created on the robotic software presurgery. The patient is placed in the supine position with head turned to the side contralateral to VPS insertion and fixed with Mayfield clamp. Registration of the patient is done with the robot. The placement of the VPS is commenced with the robotic arm in the predetermined trajectory.
RESULTS
Ventricle was hit in a single attempt in all the cases. CSF leak stopped in the case with meningocele; headache, and visual acuity improved in both the cases of IIH.
CONCLUSION
Robotic-guidance provides a safe and accurate method of VPS placement even in the presence of slit-like ventricles.
Topics: Cerebral Ventricles; Humans; Hydrocephalus; Robotics; Treatment Outcome; Ventriculoperitoneal Shunt; Ventriculostomy
PubMed: 33904473
DOI: 10.4103/0028-3886.314585 -
ClinicoEconomics and Outcomes Research... 2024The prevention of myelomeningocele (MMC) and meningocele (MC) is a public health concern. A systematic review on economic factors associated with MMC and MC can help the... (Review)
Review
BACKGROUND
The prevention of myelomeningocele (MMC) and meningocele (MC) is a public health concern. A systematic review on economic factors associated with MMC and MC can help the policy makers to evaluate the cost-effectiveness of screening and treatment. To our knowledge, this is the first systematic review to provide up-to date pharmacoeconomic evidence of all economic studies present in literature on different aspects of MMC and MC.
METHODS
We searched in the National Health Service Economic Evaluation Database (NHSEED), PubMed, Cost-effectiveness Analysis Registry (CEA Registry), Centre for Reviews and Dissemination (CRD), Health Technology Assessment Database (HTAD), Cochrane Library, and Econlit. The PRISMA guidelines were followed in the search and evaluation of literature. Only articles in English not limited by the year of publication that fulfilled the eligibility criteria were included in this systematic review.
RESULTS
Nineteen papers were included in the study. The studies were very heterogeneous and reported a comparison of the costs between prenatal versus postnatal repair, the cost of fetoscopic approach versus open surgery, the cost of ventriculoperitoneal shunting (VPS) versus endoscopic third ventriculostomy (ETV), and ETV with choroid plexus cauterization (ETV/CPC), the cost of hospitalization, and the cost of diagnosis for MMC.
CONCLUSION
The results of this study can help in implementing new policies in different countries to assist MC and MMC patients with the cost of treatment and screening.
PubMed: 38352115
DOI: 10.2147/CEOR.S443120 -
Surgical Neurology International 2022Intrasacral occult sacral meningoceles (OSM) are uncommon congenital lesions that rarely become symptomatic, even over a patient's life time.
BACKGROUND
Intrasacral occult sacral meningoceles (OSM) are uncommon congenital lesions that rarely become symptomatic, even over a patient's life time.
METHODS
We operated on six patients with symptomatic OSM diagnosed on MR studies (all six) and/or CT examinations (four cases).
RESULTS
All six patients had uneventful postoperative recoveries. Nevertheless, despite the resolution of low back pain and radiculopathy, preoperative bladder dysfunction improved postoperatively in only one patient.
CONCLUSION
Few cases of patients undergoing surgery for symptomatic OSM are reported in the literature. Here, we recount our experience with six patients with symptomatic OSM who demonstrated significant postoperative neurological recoveries except for rare improvement in bladder function.
PubMed: 35399876
DOI: 10.25259/SNI_1258_2021 -
Current Opinion in Neurology Feb 2023Idiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure (ICP). Although the majority of patients with IIH present classically with... (Review)
Review
PURPOSE OF REVIEW
Idiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure (ICP). Although the majority of patients with IIH present classically with headache and papilledema, some patients may have unusual presentations or manifestations. Recent advancements in neuroimaging have facilitated the identification of other presentations associated with IIH. This review provides an overview of the expanding clinical spectrum of IIH.
RECENT FINDINGS
Presentations of IIH that are considered unusual include highly asymmetric or unilateral papilledema, IIH without papilledema, and IIH associated with cranial nerve involvement. These presentations likely reflect differences in the way cerebrospinal fluid (CSF) pressure is transmitted intracranially. Radiological signs of intracranial hypertension are increasingly recognized in patients with IIH and provide further insights into the effects of raised ICP on intracranial structures. Osseous changes in the skull base leading to formation of meningoceles and encephaloceles have been identified in patients with IIH, spontaneous skull base CSF leak, and drug-resistant temporal lobe epilepsy, suggesting a possible association.
SUMMARY
Clinicians should be familiar with the expanding clinical spectrum of IIH and the implications for the management of these presentations.
Topics: Humans; Pseudotumor Cerebri; Papilledema; Intracranial Hypertension; Cerebrospinal Fluid Leak; Neuroimaging
PubMed: 36444979
DOI: 10.1097/WCO.0000000000001131 -
American Journal of Translational... 2022The purpose of this study was to investigate the clinical value of microsurgery in the treatment of congenital neural tube defect (CNTD) in newborns.
OBJECTIVE
The purpose of this study was to investigate the clinical value of microsurgery in the treatment of congenital neural tube defect (CNTD) in newborns.
METHODS
Eighty-five CNTD newborns withlipomyelomeningocele admitted to our hospital from March 2016 to December 2018 were retrospectively selected as study subjects. They were divided into a study group (SG, 43 cases, that received meningocele repair combined with tethered cord release within 6 h to 30 d after birth) and the control group (CG, 42 cases, that received meningocele repair combined with tethered cord release past 30 d after birth) according to the treatment regimen. Newborns in both groups were evaluated for short-term and long-term outcome of the surgery and the degree of postoperative untethering, and both groups were followed up dynamically to record changes in gross motor function and quality of life and assess risk factors.
RESULTS
In terms of short-term outcomes, the total effective rate was 93.02% in SG and 85.71% in CG ( > 0.05); in terms of the long-term outcomes, the total effective rate was 88.37% in SG and 69.05% in CG ( < 0.05). The postoperative release of the newborns was evaluated according to the Kirollos grading system, which showed that SG had 40 (93.02%) cases of grade 1 untethering, 3 (6.98%) cases of grade 2 untethering, and 0 case of grade 3 untethering, and CG had 30 (71.43%) cases of grade 1 untethering, and 12 (28.57%) cases of grade 2 untethering. At 6 months postoperatively, there were no significant differences in gross motor function and quality of life scores between the two groups ( > 0.05), but at 1 year, 3 years and 4 years postoperatively, the gross motor function and quality of life scores of newborns in the SG were significantly higher than those in the CG ( < 0.05). Multivariate logistic regression analysis showed that age > 1 month was an independent risk factor for surgical outcome ( < 0.05).
CONCLUSION
Microsurgery has better short-term and long-term outcomes for newborns with CNTD, and the newborns showed an improvement in the long-term postoperative motor function and quality of life.
PubMed: 36105063
DOI: No ID Found -
The Pan African Medical Journal 2022
Topics: Humans; Meningocele; Meningomyelocele; Spinal Dysraphism
PubMed: 36405669
DOI: 10.11604/pamj.2022.42.288.36209 -
Journal of Radiology Case Reports Aug 2020The sphenoid sinus is an uncommon location for protrusion of a meningocele. When this does occur, it nearly always presents with leakage of cerebrospinal fluid through...
The sphenoid sinus is an uncommon location for protrusion of a meningocele. When this does occur, it nearly always presents with leakage of cerebrospinal fluid through the nasal cavity. We present a case of a 38-year-old female found to have a meningocele protruding into the left sphenoid sinus, who presented with intractable headache but no CSF rhinorrhea. The lesion was discovered on computed tomography angiography, which was performed in order to rule out intracranial pathology as the etiology of her headache. Prior imaging, including pre- and post-contrast MRI, demonstrated the fluid within the sphenoid sinus, but did not reveal the communication through a defect in the base of the skull. Thus, it was assumed to be strictly related to sinus disease in the past. Our case represents a phenomenon whereby meningoceles protruding through the basilar skull into the sphenoid sinus or any other location are potentially misdiagnosed due to poor visualization of the osseous defect and lack of awareness of this entity.
Topics: Adult; Computed Tomography Angiography; Female; Headache; Humans; Magnetic Resonance Imaging; Meningocele; Nausea; Photophobia; Sphenoid Sinus; Vision Disorders; Vomiting
PubMed: 33088417
DOI: 10.3941/jrcr.v14i8.3761 -
Cureus Oct 2023We present a case of a two-year-old male with a history of congenital scoliosis and anterolateral thoracic meningocele. He was able to walk and run, but his parents...
We present a case of a two-year-old male with a history of congenital scoliosis and anterolateral thoracic meningocele. He was able to walk and run, but his parents reported left leg weakness and a frequent cough. The patient had normal neurological examination findings. Magnetic resonance imaging (MRI) of the spine without contrast showed left convex upper thoracic congenital scoliosis and rightward anterolateral meningocele inferiorly to T3, with the spinal cord tethered at this location. Neurosurgical cord detethering and repair of the meningocele were performed simultaneously with scoliosis repair by orthopedics. During the dissection of the meningocele, the bulging neural tissue was found to be a split cord ending in a blind stump. The split cord was determined to be nonfunctional via Prass probe (Medtronic, Minneapolis, MN) stimulation and was subsequently dissected. Detethering of the spinal cord was followed by repair of the dural outpouching and dural closure. The patient was stable post-surgery, but long-term results remain to be seen.
PubMed: 37927626
DOI: 10.7759/cureus.46496 -
Korean Journal of Radiology Jan 2021Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed... (Review)
Review
Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group's three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.
Topics: Humans; Image Interpretation, Computer-Assisted; Lymphoma; Magnetic Resonance Imaging; Mediastinal Cyst; Mediastinal Neoplasms; Mediastinum; Societies, Medical; Thymoma; Thymus Hyperplasia
PubMed: 32783412
DOI: 10.3348/kjr.2019.0897