Background: Penetrating skull base injuries are complex clinical scenarios requiring multidisciplinary management to address both immediate life-threatening conditions and long-term complications.Anterior skull base fractures account for 21% of skull fractures from which 4% were caused by head trauma [1]. Post-traumatic cerebrospinal fluid (CSF) leaks may arise, becoming a major source of morbidity; these can lead to the development of severe intracranial infections [2]. Endoscopic Endonasal Approach is a conservative technique that uses a multilayer coverage including a nasoseptal flap to create durable reconstruction [3]. We describe our experience using this technique to repair a wide anterior skull defect after extraction of a foreign body.
Case Description: A 46-year-old male experienced a traumatic CSF leak following a penetrating head injury from a fall at a construction site, where a steel bar penetrated from the left temporo-mandibular juntction through the sphenoid sinuses to the right eye socket. Initial brain involvement was minimal, and the injury was isolated to the head.
Conclusion: This case highlights the complexities of managing penetrating brain injuries. Prior to deciding the extraction of the foreign body and subsequent endoscopic repair of the skull base, the multidisciplinary team relied on imaging for a secure removal. Maintaining airway, stabilizing the patient, and executing skilled surgical intervention were key to successfully manage the case. Postoperative treatment was crucial, including monitoring for complications such as diabetes insipidus and ensuring the closure of the CSF leak through endoscopic techniques. The integration of fluorescein in CSF during surgery allowed us to localize leaks effectively. This case highlights the importance of a well-coordinated medical response to assess patient management in severe traumatic scenarios. Lessons learned from such cases contribute significantly to the evolving field of trauma surgery, emphasizing the need for a structured approach to both acute and postoperative care.
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http://dx.doi.org/10.1016/j.jocn.2024.110893 | DOI Listing |
J Med Case Rep
December 2024
Department of Neurosurgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Background: Giant prolactinoma (size > 4 cm) is a rare condition and accounts for less than 1% of pituitary adenomas. In even rarer cases, these lesions may involve craniocervical structures requiring surgical intervention. The present case is the largest reported giant prolactinoma (99 × 72 × 57 mm).
View Article and Find Full Text PDFBMC Pregnancy Childbirth
December 2024
Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Maternal and Child Health Care Hospital, Beijing, 100026, China.
Background: Blake's pouch cyst (BPC) is a midline cystic anomaly of the posterior fossa. BPC has been shown to have a risk of aneuploidy prenatally. Copy number variation (CNV) and/or genetic syndromes have been reported in a few prenatal/postnatal cases with BPC.
View Article and Find Full Text PDFJ Plast Reconstr Aesthet Surg
November 2024
Unit of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy.
Background: Orbital exenteration is a severe and disabling surgical procedure that involves the removal of all orbital contents. Effective reconstruction is crucial to managing the resulting defects. This study aims to propose a reconstructive algorithm utilizing free flaps derived from the lateral circumflex femoral artery (LCFA) system for orbital exenteration defects, based on our clinical experience.
View Article and Find Full Text PDFJ Neurosurg
December 2024
Departments of1Neurosurgery and.
Objective: Patients with sellar lesions compressing the optic nerve sometimes perceive visual improvement after lesion resection, despite the absence of visual impairment on preoperative ophthalmological examination. This study investigated the indicators of latent visual impairment in patients with sellar lesions.
Methods: Forty-five patients who underwent surgery for sellar lesions compressing the optic nerve with no preoperative visual abnormalities and no change in visual assessment between pre- and postoperative ophthalmological examinations were divided into two groups: 1) patients who perceived recovery of visual function after lesion resection (the improved group), and 2) patients who did not (the unaffected group).
Pak J Med Sci
December 2024
Ahtesham Khizar, MBBS, FCPS (Neurosurgery), Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
Chronic osteomyelitis of the skull base is a commonly reported pathology in existing scientific literature, but chronic osteomyelitis of the skull vault (COSV) is a rarely documented disease. We report the case of a 38 years old Afghan male with a presenting complaint of irregular swelling on the skull vault for six months. The patient had a history of head trauma one year back with a compound depressed fracture which had been surgically managed then.
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