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Cranial Nerve 10

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9681. Internal cranial expansion procedure for the treatment of symptomatic intracranial hypertension. (Abstract)

Internal cranial expansion procedure for the treatment of symptomatic intracranial hypertension. The authors describe the internal cranial expansion (ICE) procedure, a surgical technique that was used to treat two chronically shunt-treated children who presented with medically and surgically refractory intracranial hypertension despite the presence of functioning cerebrospinal fluid shunt systems. The ICE procedure was used as a means to increase intracranial volume without sacrificing (...) calvarial rigidity. Intracranial volume was increased by 5% in one case and 10% in the other. Both patients have returned to their neurological and functional baselines, and they are free of symptoms related to intracranial hypertension.

2007 Journal of Neurosurgery

9682. A stereotactic device for rabbits based on mandibular and cranial landmarks: technical note. Full Text available with Trip Pro

A stereotactic device for rabbits based on mandibular and cranial landmarks: technical note. The authors have developed a stereotactic device for use in rabbits that uses the plane at the base of the mandible combined with cranial sutures as an anatomical reference. The device was developed for a study designed to evaluate catheters for infection prophylaxis, and this required the implantation of silicone catheters along a reproducible trajectory through the lateral ventricle. Cadaver and atlas (...) ' brains demonstrated 78.6% accuracy of the trajectory within a tolerance of deviation of 5 degrees , and 94.6% accuracy within a tolerance of 10 degrees . The accuracy of the trajectory of the last 18 consecutively operated animals was constantly within a tolerance of 5 degrees . The device can be autoclaved and, since it is relatively simple and inexpensive to build, the authors manufactured 3 identical frames and used them alternately to operate under sterile conditions. The fast and pain-free head

2008 Journal of Neurosurgery

9683. The spectrum of cranial neuropathy in patients with Bell's palsy. (Abstract)

The spectrum of cranial neuropathy in patients with Bell's palsy. There is controversy regarding whether, and how frequently, other cranial nerve deficits accompany Bell's palsy. We sought to determine prospectively the presence of signs indicating an associated cranial neuropathy in patients with Bell's palsy.All subjects presenting to an emergency department with Bell's palsy over a 2-year period were evaluated. The study included 51 consecutive patients. One patient with Bell's palsy (...) was not examined by a neurologist at the time of presentation and was excluded. The main outcome measure was presence of other cranial nerve deficits.We identified 4 patients with additional cranial neuropathies (contralateral trigeminal [n=1], glossopharyngeal [n=2], and hypoglossal [n=1]). We also identified 13 patients with ipsilateral facial sensory loss, suggesting an ipsilateral trigeminal neuropathy; 3 patients with a contralateral facial palsy; and 3 patients with hearing impairment.This prospective

2004 Archives of Internal Medicine

9684. Pediatric orbital multifocal cavernous hemangiomas associated with bilateral arachnoid cysts of the middle cranial fossa. Case report and review of the literature. (Abstract)

sporadic and single. So far, the authors have not encountered any study reporting the coexistence of bilateral arachnoid cysts of the middle cranial fossa and orbital multifocal cavernous hemangiomas. In this report, they describe a 10-year-old boy with such a hemangioma that included the eyelid, conjunctiva, and retrobulbar space. His was the first case of a surgically treated pediatric orbital multifocal cavernous hemangioma associated with bilateral arachnoid cysts of the middle cranial fossa (...) Pediatric orbital multifocal cavernous hemangiomas associated with bilateral arachnoid cysts of the middle cranial fossa. Case report and review of the literature. Cavernous hemangiomas of the orbit are benign vascular growths that commonly occur in adults and account for 6% of all intraorbital tumors. Multifocal intraorbital cavernous hemangiomas are quite rare. The reported incidence of arachnoid cysts accounts for only 1% of lesions that occupy intracranial space, and they are nearly always

2005 Journal of Neurosurgery

9685. A superciliary approach for anterior cranial fossa lesions in children. Technical note. (Abstract)

x 3-cm bone opening just above the eyebrow through a superciliary incision, has been previously described in adults for many lesions situated in the anterior cranial fossa, including tumors and aneurysms. The authors review their experience in using this approach in 27 children for a variety of intracranial lesions. This approach was used for 28 procedures in children ranging in age from 1 to 16 years (mean age 10 years). The lesions included arachnoid cysts, cerebrospinal fluid fistulas (...) A superciliary approach for anterior cranial fossa lesions in children. Technical note. Many subfrontal and orbitofrontal craniotomy techniques have been proposed and developed for anterior cranial fossa lesions. The purpose of this study was to evaluate the surgical experience with the frontolateral keyhole craniotomy through a superciliary skin incision in children. The keyhole craniotomy is a modification of the traditional pterional approach. This modified approach, a craniotomy with a 2.5

2005 Journal of Neurosurgery

9686. Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities. (Abstract)

of treatment. Symptoms improved in 48.4% of patients undergoing microsurgery and 16.7% of those who underwent GKS. Transient and permanent cranial nerve morbidity was 7.9 compared with 2.9%, and 5.3 compared with 8.5% for GKS and microsurgery, respectively. In a patient satisfaction survey 93.1% of microsurgery patients and 91.2% of GKS patients were highly satisfied.Both GKS and microsurgery serve important roles in the overall management of patients with meningiomas. Both are safe and effective (...) Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities. The authors sought to assess the respective roles of microsurgery and gamma knife surgery (GKS) in the treatment of patients with meningiomas.The authors culled from a 4-year prospective database data on 74 cases of meningiomas. Thirty-eight were treated with GKS and 35 with microsurgery. Simpson Grade 1 or 2

2005 Journal of Neurosurgery

9687. Subacute spinal subdural hematoma after spontaneous resolution of cranial subdural hematoma: causal relationship or coincidence? Case report. (Abstract)

Subacute spinal subdural hematoma after spontaneous resolution of cranial subdural hematoma: causal relationship or coincidence? Case report. The etiopathogenesis of traumatic spinal subdural hematoma (SSH) is uncertain. Unlike the supratentorial subdural space, no bridging veins traverse the spinal subdural space. The authors describe a case of subacute SSH that occurred after spontaneous resolution of traumatic intracranial SDH and suggest a causal relationship between the two. A 23-year-old (...) woman suffered an acute intracranial SDH after a snowboarding accident. There was no clinical or radiological evidence of spine injury. Conservative management of the supratentorial SDH resulted in spontaneous radiologically documented resolution with redistribution of blood in the subdural space. Four days after the injury, the patient started noticing new onset of mild low-back pain. The pain progressively worsened. Magnetic resonance imaging of the lumbosacral spine 10 days after the original

2004 Journal of Neurosurgery

9688. Successful treatment without cranial radiotherapy of children receiving intensified chemotherapy for acute lymphoblastic leukaemia: results of the risk-stratified randomized central nervous system treatment trial MRC UKALL XI (ISRC TN 16757172). (Abstract)

Successful treatment without cranial radiotherapy of children receiving intensified chemotherapy for acute lymphoblastic leukaemia: results of the risk-stratified randomized central nervous system treatment trial MRC UKALL XI (ISRC TN 16757172). Concern about late adverse effects of cranial radiotherapy (XRT) has led to alternative approaches to eliminate leukaemia from the central nervous system (CNS) in childhood acute lymphoblastic leukaemia (ALL). The Medical Research Council UKALL XI trial (...) recruited 2090 children with ALL between 1990 and 1997. Median follow-up is 7 years 9 months; event-free survival (EFS) and overall survival were 63.1% and 84.6%, respectively, at 5 years and 59.8% and 79.4% at 10 years. The isolated CNS relapse rate was 7.0% at 10 years. Patients were randomized for CNS-directed therapy within white blood cell (WBC) groups. For WBC <50 x 10(9)/l, high-dose intravenous methotrexate (HDMTX) (6-8 g/m2) with intrathecal methotrexate (ITMTX) was compared with ITMTX alone

2004 British journal of haematology Controlled trial quality: uncertain

9689. Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer. (Abstract)

Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer. Prophylactic cranial irradiation has been used in patients with small cell lung cancer to reduce the incidence of brain metastasis after primary therapy. The purpose of this study was to evaluate the effects of prophylactic cranial irradiation (PCI) on overall survival and cause-specific survival.A total of 7995 patients with limited stage small cell lung cancer diagnosed between 1988 and 1997 were (...) prognostic factors.The median follow-up time was 13 months (range, 1 month to 180 months). Overall survival at 2 years, 5 years, and 10 years was 23%, 11%, and 6%, respectively, in patients who did not receive PCI. In patients who received PCI, the 2-year, 5-year, and 10-year overall survival rates were 42%, 19%, and 9%, respectively (P =or <.001). The cause-specific survival rate at 2 years, 5 years, and 10 years was 28%, 15%, 11%, respectively, in patients who did not receive PCI and 45%, 24%, 17

2008 Cancer

9690. Splitting of the Extraocular Horizontal Rectus Muscle in Congenital Cranial Dysinnervation Disorders. (Abstract)

Splitting of the Extraocular Horizontal Rectus Muscle in Congenital Cranial Dysinnervation Disorders. To analyze the horizontal rectus extraocular muscles (EOMs) by orbital magnetic resonance imaging (MRI) in patients with congenital cranial dysinnervation disorders that arises from abnormal development of cranial nerve nuclei or their axonal connections.Case series, retrospective analysis.The morphology of the horizontal rectus EOMs was analyzed in orbital MRI on 4 patients with congenital (...) , and 1 of the 4 patients (25%) with oculomotor palsy, but in none of the 6 normal subjects and 12 patients with acquired cranial nerve palsy.Since splitting of the horizontal rectus EOMs was noted in patients with congenital dysinnervation disorders, including Duane syndrome, Sevel's theory that the horizontal rectus EOMs develop from the superior and inferior mesodermal complexes is considered to be reasonable.

2008 American Journal of Ophthalmology

9691. Using the processus cochleariformis as a multipurpose landmark in middle cranial fossa surgery. (Abstract)

cochleariformis to inner-ear structures, and to define 14 other measurements that relate inner-ear structures to adjacent structures within the intact bone.Using 10 cadaver specimens, 20 reproducible measurements were defined. The first six of these defined the relation of the processus cochleariformis to inner-ear structures in the middle cranial fossa approach. The other measurements defined the exact location of the inner-ear structures and adjacent structures within the intact bone.The vertical crest lies (...) cochleariformis to the coronal plane. The other measurements obtained give important clues about the position of the cochlea, vestibulum, greater superficial petrosal nerve and labyrinthine segment of the facial nerve.If the classical landmarks are indiscernible during middle cranial fossa surgery, then the processus cochleariformis, with its intimate and constant relationships to inner-ear structures, is a safe and constant landmark.

2008 Journal of Laryngology & Otology

9692. A case of cranial fasciitis masquerading as acute mastoiditis. (Abstract)

A case of cranial fasciitis masquerading as acute mastoiditis. We report a case of infection against a background of pre-existing cranial fasciitis.Case report and review of world literature on cranial fasciitis.Cranial fasciitis of childhood is a benign condition and a rare variant of nodular fasciitis. We present the case of a 10-week-old infant with symptoms and signs consistent with a subperiosteal abscess complicating acute mastoiditis. Subsequent findings showed this to be an infection (...) against a background of pre-existing cranial fasciitis.To our knowledge, this is the first such reported case in the literature. Knowledge of the distinctive histopathological features, coupled with an awareness of the condition, are crucial to establishing a definitive diagnosis of cranial fasciitis and, in turn, to instituting appropriate management. The aetiopathogenesis of the condition remains unclear.

2008 Journal of Laryngology & Otology

9693. Otogenic Cranial Base Osteomyelitis: A Proposed Prognosis-Based System for Disease Classification. (Abstract)

Charlson comorbidity score was 5, and 63% of patients were diabetic. The most common presenting symptoms were pain and otorrhea, and 8 patients had cranial nerve neuropathy. Pseudomonas aeruginosa was the most common bacterial pathogen (n = 28; 74%), and 9 patients had fungal or mixed infections. On average, antibiotics were administered for 161 days, and 6 patients had concomitant surgery. The average follow-up was 33 months, and 3-year disease-specific survival was 76%. Univariate predictors (...) of survival were the SPECT grade, fungal/mixed infections, Charlson score, immune compromise, and cranial nerve neuropathy. The only independent predictor of survival on multivariate Cox regression was the SPECT stage at presentation.Cranial base osteomyelitis is associated with significant morbidity and mortality and requires prolonged treatment. Long-term outcome can be predicted from the initial SPECT scan.

2008 Otology and Neurotology

9694. Cranial Neuropathy as a Presenting Sign of Recurrent Aggressive Skin Cancer. (Abstract)

with multiple cranial neuropathies. All exhibited neuropathy of the trigeminal nerve (cranial nerve V). The tumors involved were squamous cell carcinoma (4) and melanoma (2). All patients were multiply symptomatic, presenting with a mean of three neurologic symptoms, including facial numbness (5), facial paralysis or weakness (3), facial pain (3), diplopia (3), paresthesia (3), hearing loss (1), or formication (2). Symptoms were present for an average of 7 months prior to diagnosis of perineural recurrence (...) . Cranial nerve involvement was confirmed in all patients by magnetic resonance imaging, and five patients manifested histologic evidence of perineural tumor infiltration. Treatment consisted of various combinations of surgery, radiation, and chemotherapy for five patients, and one patient declined any intervention. Death rate subsequent to disease was 50%, and follow-up has continued within our institution on all patients for an average of 25.5 months (range, 3-72 months).Cranial neuropathy is a rare

2008 Dermatologic Surgery

9695. Sensitivity of Noncontrast Cranial Computed Tomography for the Emergency Department Diagnosis of Subarachnoid Hemorrhage. (Abstract)

, 2001, to December 31, 2004, with spontaneous subarachnoid hemorrhage. We determined whether patients were diagnosed by cranial CT or lumbar puncture, the presence of headache and level of consciousness at ED presentation, and whether or not they had an aneurysm or arteriovenous malformation.We identified 149 patients who were diagnosed with spontaneous subarachnoid hemorrhage during the study period. Noncontrast cranial CT scan diagnosed 139 patients, and 10 were diagnosed with lumbar puncture (...) Sensitivity of Noncontrast Cranial Computed Tomography for the Emergency Department Diagnosis of Subarachnoid Hemorrhage. Emergency physicians use noncontrast cranial computed tomographic (CT) imaging of headache patients to identify subarachnoid hemorrhage caused by aneurysms or arteriovenous malformations. Given sufficiently high sensitivity, CT imaging could be used as a definitive diagnostic study in these patients. The purpose of this study is to determine the sensitivity of noncontrast

2008 Annals of Emergency Medicine

9696. Neurocognitive function in patients with small cell lung cancer : effect of prophylactic cranial irradiation. (Abstract)

Neurocognitive function in patients with small cell lung cancer : effect of prophylactic cranial irradiation. The use of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC) has been tempered by fears of detrimental effects on cognitive function. Neuropsychologic testing was prospectively conducted before and after PCI to evaluate its effects on cognitive function in patients with SCLC.Ninety-six patients who completely or partially responded to initial therapy (...) underwent formal neurocognitive testing before PCI. Three patients who had central nervous system metastasis were excluded. Of the remaining patients, 69 received PCI (mean dose, 25 grays [Gy] in 10 fractions). Repeat testing was performed on 37 patients (median follow-up, 23 months; range, 6-120 months).Baseline impairment was defined as > or =1.5 standard deviations below the normative mean. Before undergoing PCI, 47% of patients had evidence of impaired cognitive function. After PCI, univariate

2007 Cancer

9697. Current definitions of hypotension do not predict abnormal cranial ultrasound findings in preterm infants. (Abstract)

catheters in the first 3 days of life. Sequential 5-minute epochs of continuous mean arterial pressure recordings were assigned a mean value and a coefficient of variation. We applied to our data 3 definitions of hypotension in current clinical use and derived a hypotensive index for each definition. We examined the association between these definitions of hypotension and abnormal cranial ultrasound findings between days 5 and 10. In addition, we evaluated the effect of illness severity (Score (...) Current definitions of hypotension do not predict abnormal cranial ultrasound findings in preterm infants. Hypotension is a commonly treated complication of prematurity, although definitions and management guidelines vary widely. Our goal was to examine the relationship between current definitions of hypotension and early abnormal cranial ultrasound findings.We prospectively measured mean arterial pressure in 84 infants who were < or = 30 weeks' gestational age and had umbilical arterial

2007 Pediatrics

9698. A True Minimally Invasive Approach for Cochlear Implantation: High Accuracy in Cranial Base Navigation Through Flat-Panel-Based Volume Computed Tomography. (Abstract)

A True Minimally Invasive Approach for Cochlear Implantation: High Accuracy in Cranial Base Navigation Through Flat-Panel-Based Volume Computed Tomography. High-precision intraoperative navigation using high-resolution flat-panel volume computed tomography makes feasible the possibility of minimally invasive cochlear implant surgery, including cochleostomy. Conventional cochlear implant surgery is typically performed via mastoidectomy with facial recess to identify and avoid damage to vital (...) functional important structures (e.g., facial nerve, chorda tympani, incus).Postoperatively, computed tomographic imaging and conventional surgical exploration of the drilled route to the cochlea were performed.All 4 specimens showed a cochleostomy located at the scala tympani anterior inferior to the round window. The chorda tympani was damaged in 1 specimen--this was preoperatively planned as a narrow facial recess was encountered.Using flat-panel volume computed tomography for image-guided surgical

2007 Otology and Neurotology

9699. RAB23 mutations in Carpenter syndrome imply an unexpected role for hedgehog signaling in cranial-suture development and obesity. Full Text available with Trip Pro

RAB23 mutations in Carpenter syndrome imply an unexpected role for hedgehog signaling in cranial-suture development and obesity. Carpenter syndrome is a pleiotropic disorder with autosomal recessive inheritance, the cardinal features of which include craniosynostosis, polysyndactyly, obesity, and cardiac defects. Using homozygosity mapping, we found linkage to chromosome 6p12.1-q12 and, in 15 independent families, identified five different mutations (four truncating and one missense) in RAB23 (...) , which encodes a member of the RAB guanosine triphosphatase (GTPase) family of vesicle transport proteins and acts as a negative regulator of hedgehog (HH) signaling. In 10 patients, the disease was caused by homozygosity for the same nonsense mutation, L145X, that resides on a common haplotype, indicative of a founder effect in patients of northern European descent. Surprisingly, nonsense mutations of Rab23 in open brain mice cause recessive embryonic lethality with neural-tube defects, suggesting

2007 American Journal of Human Genetics

9700. New method of identifying the internal auditory canal as seen from the middle cranial fossa approach. (Abstract)

New method of identifying the internal auditory canal as seen from the middle cranial fossa approach. The middle cranial fossa approach allows one to remove acoustic tumors and preserve the facial nerve and hearing. However, there are no consistent landmarks on the surface of the temporal bone to identify the internal auditory canal. This study was designed to identify the internal auditory canal by use of external and internal references as seen during the middle cranial fossa approach.We (...) dissected 32 temporal bones using the middle cranial fossa approach and measured the distances from the posterior origin of the zygomatic arch to an imaginary coronal line between the foramen spinosum and the foramen ovale. We measured the angle between the lines drawn from the posterior origin of the zygomatic root to the foramen spinosum and from the foramen spinosum to the porus of the internal auditory canal.The distances were 14.7 mm and 22.9 mm, respectively, and the angle was roughly 90

2006 Rhinology and Laryngology

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