DOCSLIB.ORG

Craniofacial Resection of Advanced Juvenile Nasopharyngeal Angiofibroma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Craniofacial Resection of Advanced Juvenile Nasopharyngeal Angiofibroma ORIGINAL ARTICLE Craniofacial Resection of Advanced Juvenile Nasopharyngeal Angiofibroma Christina Bales, BA; Mark Kotapka, MD; Laurie A. Loevner, MD; Mouwafak Al-Rawi, MD; Gregory Weinstein, MD; Robert Hurst, MD; Randal S. Weber, MD Objective: To describe the results of a craniofacial ap- Main Outcome Measures: Intraoperative and post- proach to resection of stage IIIB juvenile nasopharyn- operative morbidity. geal angiofibroma, performed by an integrated skull base surgical team. Results: The average operating time was 12 hours 47 minutes. Estimated blood loss ranged from 700 to 1750 Design: A retrospective case-series review was con- mL (mean, 1120 mL), with 2 patients requiring intra- ducted with postoperative follow-up ranging from 28 to operative transfusion. Patients were hospitalized for 63 months. a mean duration of 5.6 days. Long-term morbidity includes facial dysesthesia, nasal crusting, and malodor- Setting: Operations were performed at a tertiary medi- ous nasal discharge. No patients sustained stroke, ocu- cal center. lomotor dysfunction, vision loss, or auditory impair- ment. At most recent follow-up, which ranges from 28 Patients: A referred sample of 5 male patients, ranging to 63 months, tumor recurrence has been confirmed in in age from 10 to 23 years (mean, 15 years). 1 patient. Interventions: All patients underwent resection of na- Conclusions: A combined craniofacial approach is ap- sopharyngeal angiofibromas with intracranial exten- propriate for juvenile nasopharyngeal angiofibroma that sion. The procedure involved an infratemporal fossa ap- extends intracranially. Complete tumor removal with ac- proach via zygomatic osteotomy and subtemporal ceptable morbidity can be expected. craniectomy. Anterior exposure was gained through a standard facial translocation. Dissection of the cavern- ous carotid artery was required in 3 patients. Arch Otolaryngol Head Neck Surg. 2002;128:1071-1078 UVENILE NASOPHARYNGEAL angio- ated with tumor regression and symptom fibroma (JNA) is a benign, highly relief.7,8 Nevertheless, use of these non- vascular tumor that typically surgical modalities in the pediatric popu- originates at the superior mar- lation introduces additional sources of gin of the sphenopalatine fora- morbidity, including secondary malig- men. It predominantly occurs in nancy, cranial neuropathy, brainstem com- J 2,6 adolescent males and accounts promise, and growth arrest. The devel- for 0.05% of all head and neck neo- opment of contemporary craniofacial plasms.1 Despite histologically benign fea- surgical approaches to JNA has initiated tures, JNA can cause significant morbid- a trend away from radiation and chemo- ity and occasional mortality through therapy.4 This report reviews the results From the University of aggressive submucosal spread to adja- of our experience with the craniofacial ap- Pennsylvania Medical School, cent tissues.2-5 Approximately 20% of cases proach to extensive angiofibromas (stage Philadelphia (Ms Bales); pose a considerable obstacle to clinical IIIB tumors), performed by an integrated and the Departments of management due to skull base penetra- skull base surgical team. Neurosurgery (Dr Kotapka), tion and involvement of vital intracranial Radiology (Drs Loevner structures.3 PARTICIPANTS AND METHODS and Hurst), and Otorhinolaryngology–Head and Until recently, intracranially inva- Between 1996 and 1999, 5 patients were evalu- Neck Surgery (Drs Al-Rawi, sive angiofibromas were considered inop- ated and treated with a combined craniofacial Weinstein, and Weber), erable, leaving radiation and chemo- resection for JNA in the University of Penn- University of Pennsylvania therapy as the only viable treatment sylvania (Philadelphia) Departments of Oto- Medical Center, Philadelphia. strategies.4,6 Both alternatives are associ- rhinolaryngology–Head and Neck Surgery and (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 128, SEP 2002 WWW.ARCHOTO.COM 1071 ©2002 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 Figure 1. Hemicoronal and Weber-Fergusson incisions. Figure 2. Bone cuts associated with a standard facial translocation. Neurosurgery. The patients were white males, ranging in age Under an operating microscope, the dura was dissected from 10 to 23 years (mean, 15 years) at the time of surgery. All from the floor of the middle cranial fossa. The floor was then cases represented initial tumor presentations, with the excep- entered with a high-speed pneumatic drill to sequentially ex- tion of 1 patient referred with a recurrent tumor 23 months pose the following structures: (1) the superior orbital fissure; after his initial surgery. Each patient presented with evidence (2) the foramen rotundum with the second division of the of intracranial extension as determined by imaging studies. Ini- trigeminal nerve (V2); (3) the foramen ovale with the third di- tial patient evaluation involved a comprehensive head and neck vision of the trigeminal nerve (V3) and the accessory menin- history and physical examination, including fiberoptic exami- geal artery; (4) the foramen spinosum with the middle men- nation of the nasopharynx. Radiological staging was obtained ingeal artery and vein; (5) the greater superficial petrosal nerve; by computed tomography and magnetic resonance imaging. and (6) the carotid canal. The middle meningeal vessels and Studies were reviewed by a neuroradiologist specializing in head the trigeminal nerve divisions were selectively divided to pro- and neck imaging. Angiography was performed to identify pri- vide access to the tumor extensions in the middle cranial fossa mary feeding vessels to the tumor and to selectively embolize and the cavernous sinus. Additional removal of bone medial them prior to surgery. All embolizations took place within 24 to the foramen rotundum provided a lateral approach to the hours of tumor resection. tumor within the sphenoid sinus. Likewise, drilling medial to Surgery was initiated with an infratemporal fossa approach the foramen ovale permitted access to the tumor abutting the via zygomatic osteotomy and subtemporal craniectomy (Figure 1). petrous carotid artery. In cases of orbital tumor extensions, an After complete exposure and dissection of the tumor from the sphe- orbitozygomatic osteotomy was performed to facilitate tumor noid sinus, the superior orbital fissure, the middle cranial fossa, dissection from the orbital fissures. and the lateral cavernous sinus, anterior exposure was gained After the superior aspect of the angiofibroma had been com- through a standard facial translocation (Figure 2). The additional pletely mobilized, the transfacial approach was initiated through exposure permitted tumor mobilization from the nasopharynx, a Weber-Fergusson incision that extended through the underly- the paranasal sinuses, the pterygopalatine fossa, the infratempo- ing bone. The resulting cheek flap was turned to expose the piri- ral fossa, and the medial cavernous sinus. form aperture, the inferior orbital rim, and the inferior aspect of After induction of anesthesia, a subarachnoid lumbar drain- the anterior maxillary wall. The orbital contents were then reflected age catheter was inserted to facilitate intraoperative brain relax- posteriorly to expose the lacrimal sac. The lacrimal sac was divided, ation. The patient was placed supine with his head extended and the orbital contents were retracted, and the soft tissues lining the rotated 60° away from the intracranial tumor bulk. A hemicoro- inner aspect of the piriform aperture were elevated. Multiple bone nal skin incision was initiated in the preauricular region and ex- cuts were then made to allow the anterior maxilla and overlying tended behind the hairline. A scalp flap was subsequently el- cheek flap to be laterally reflected as a vascularized osteoplastic evated to expose the underlying zygomatic bone and arch. The flap (Figure 3). Specifically, cuts were made (1) from the supe- flap, which extended from the zygomaticomaxillary suture to the rior piriform aperture to the inferomedial orbit; (2) across the in- external auditory canal, incorporated the temporal fat pad to pre- ferior aspect of the maxillary buttress; (3) across the anterior wall serve the frontal branch of the facial nerve. A zygomatic oste- of the maxilla; and (4) through the lateral orbit. The bone of the otomy was performed, and the temporalis muscle was reflected posterior maxillary wall was removed, and the internal maxillary inferiorly through the resulting defect. Single burr holes were artery was clamped and divided. The pterygoid plates were then drilled at the pterion and above the zygomatic root. A bone flap removed with a high-speed pneumatic drill from either the trans- was turned with a craniotome and stored in a covered basin of facial or the cranial approach. Working concomitantly from above sterile isotonic sodium chloride solution. Perimeter holes were and below the skull base, the tumor was dissected and removed then placed to allow the dura to be secured with suture. en bloc. Although the presence of a tumor pseudocapsule largely (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 128, SEP 2002 WWW.ARCHOTO.COM 1072 ©2002 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 obviated the need for frozen sections, they were used in isolated a buttress against which the packing was placed. The skin in- cases in which a plane of dissection could not be clearly identi- cision was closed
Load more

Recommended publications
  • Craniotomy for Anterior Cranial Fossa Meningiomas: Historical Overview
    Neurosurg Focus 36 (4):E14, 2014 ©AANS, 2014 Craniotomy for anterior cranial fossa meningiomas: historical overview SAUL F. MORALES-VALERO, M.D., JAMIE J. VAN GOMPEL, M.D., IOANNIS LOUMIOTIS, M.D., AND GIUSEPPE LANZINO, M.D. Department of Neurologic Surgery, Mayo Clinic, Mayo Medical School, Rochester, Minnesota The surgical treatment of meningiomas located at the base of the anterior cranial fossa is often challenging, and the evolution of the surgical strategy to resect these tumors parallels the development of craniotomy, and neurosur- gery in general, over the past century. Early successful operations to treat these tumors were pioneered by prominent figures such as Sir William Macewen and Francesco Durante. Following these early reports, Harvey Cushing made significant contributions, allowing a better understanding and treatment of meningiomas in general, but particularly those involving the anterior cranial base. Initially, large-sized unilateral or bilateral craniotomies were necessary to approach these deep-seated lesions. Technical advances such as the introduction of electrosurgery, the operating microscope, and refined microsurgical instruments allowed neurosurgeons to perform less invasive surgical proce- dures with better results. Today, a wide variety of surgical strategies, including endoscopic surgery and radiosurgery, are used to treat these tumors. In this review, the authors trace the evolution of craniotomy for anterior cranial fossa meningiomas. (http://thejns.org/doi/abs/10.3171/2014.1.FOCUS13569) KEY WORDS • intracranial meningiomas • craniotomy • history • anterior cranial fossa ENINGIOMAS of the anterior cranial fossa represent has a few distinct clinical features. However, in practice, 12%–20% of all intracranial meningiomas.5,30 this group of tumors often represents a continuum.
    [Show full text]
  • Ardipithecus Ramidus and the Evolution of the Human Cranial Base
    Ardipithecus ramidus and the evolution of the human cranial base William H. Kimbela,1, Gen Suwab, Berhane Asfawc, Yoel Raka,d, and Tim D. Whitee,1 aInstitute of Human Origins and School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287; bThe University Museum, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; cRift Valley Research Service, Addis Ababa, Ethiopia; dDepartment of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel; and eDepartment of Integrative Biology, Human Evolution Research Center, University of California, Berkeley, CA 94720 Contributed by Tim D. White, December 5, 2013 (sent for review October 14, 2013) The early Pliocene African hominoid Ardipithecus ramidus was di- We report here results of a metrical and morphological study agnosed as a having a unique phylogenetic relationship with the of the Ar. ramidus basicranium as another test of its hypothesized Australopithecus + Homo clade based on nonhoning canine teeth, phylogenetic affinity with Australopithecus and Homo. We ana- a foreshortened cranial base, and postcranial characters related to lyzed the length and breadth of the external cranial base and the facultative bipedality. However, pedal and pelvic traits indicating structural relationship between the petrous and tympanic elements substantial arboreality have raised arguments that this taxon may of the temporal bone in Ar. ramidus, Australopithecus (including instead be an example of parallel evolution of human-like traits Paranthropus of some authors), and mixed-sex samples of extant among apes around the time of the chimpanzee–human split. Here African hominoid (Gorilla gorilla, Pan troglodytes, Pan paniscus) we investigated the basicranial morphology of Ar.
    [Show full text]
  • MBB: Head & Neck Anatomy
    MBB: Head & Neck Anatomy Skull Osteology • This is a comprehensive guide of all the skull features you must know by the practical exam. • Many of these structures will be presented multiple times during upcoming labs. • This PowerPoint Handout is the resource you will use during lab when you have access to skulls. Mind, Brain & Behavior 2021 Osteology of the Skull Slide Title Slide Number Slide Title Slide Number Ethmoid Slide 3 Paranasal Sinuses Slide 19 Vomer, Nasal Bone, and Inferior Turbinate (Concha) Slide4 Paranasal Sinus Imaging Slide 20 Lacrimal and Palatine Bones Slide 5 Paranasal Sinus Imaging (Sagittal Section) Slide 21 Zygomatic Bone Slide 6 Skull Sutures Slide 22 Frontal Bone Slide 7 Foramen RevieW Slide 23 Mandible Slide 8 Skull Subdivisions Slide 24 Maxilla Slide 9 Sphenoid Bone Slide 10 Skull Subdivisions: Viscerocranium Slide 25 Temporal Bone Slide 11 Skull Subdivisions: Neurocranium Slide 26 Temporal Bone (Continued) Slide 12 Cranial Base: Cranial Fossae Slide 27 Temporal Bone (Middle Ear Cavity and Facial Canal) Slide 13 Skull Development: Intramembranous vs Endochondral Slide 28 Occipital Bone Slide 14 Ossification Structures/Spaces Formed by More Than One Bone Slide 15 Intramembranous Ossification: Fontanelles Slide 29 Structures/Apertures Formed by More Than One Bone Slide 16 Intramembranous Ossification: Craniosynostosis Slide 30 Nasal Septum Slide 17 Endochondral Ossification Slide 31 Infratemporal Fossa & Pterygopalatine Fossa Slide 18 Achondroplasia and Skull Growth Slide 32 Ethmoid • Cribriform plate/foramina
    [Show full text]
  • Level I to III Craniofacial Approaches Based on Barrow Classification For
    Neurosurg Focus 30 (5):E5, 2011 Level I to III craniofacial approaches based on Barrow classification for treatment of skull base meningiomas: surgical technique, microsurgical anatomy, and case illustrations EMEL AVCı, M.D.,1 ERINÇ AKTÜRE, M.D.,1 HAKAN SEÇKIN, M.D., PH.D.,1 KUTLUAY ULUÇ, M.D.,1 ANDREW M. BAUER, M.D.,1 YUSUF IZCI, M.D.,1 JACQUes J. MORCOS, M.D.,2 AND MUSTAFA K. BAşKAYA, M.D.1 1Department of Neurological Surgery, University of Wisconsin–Madison, Wisconsin; and 2Department of Neurological Surgery, University of Miami, Florida Object. Although craniofacial approaches to the midline skull base have been defined and surgical results have been published, clear descriptions of these complex approaches in a step-wise manner are lacking. The objective of this study is to demonstrate the surgical technique of craniofacial approaches based on Barrow classification (Levels I–III) and to study the microsurgical anatomy pertinent to these complex craniofacial approaches. Methods. Ten adult cadaveric heads perfused with colored silicone and 24 dry human skulls were used to study the microsurgical anatomy and to demonstrate craniofacial approaches in a step-wise manner. In addition to cadaveric studies, case illustrations of anterior skull base meningiomas were presented to demonstrate the clinical application of the first 3 (Levels I–III) approaches. Results. Cadaveric head dissection was performed in 10 heads using craniofacial approaches. Ethmoid and sphe- noid sinuses, cribriform plate, orbit, planum sphenoidale, clivus, sellar, and parasellar regions were shown at Levels I, II, and III. In 24 human dry skulls (48 sides), a supraorbital notch (85.4%) was observed more frequently than the supraorbital foramen (14.6%).
    [Show full text]
  • Abnormal Facies, Myopia, Andshort Stature
    Arch Dis Child: first published as 10.1136/adc.47.255.787 on 1 October 1972. Downloaded from Archives of Disease in Childhood, 1972, 47, 787. Abnormal Facies, Myopia, and Short Stature C. G. KEITH, R. H. DOBBS, D. G. SHAW, and K. COTTRALL From the Queen Elizabeth Hospital for Children, London Keith, C. G., Dobbs, R. H., Shaw, D. G., and Cottrall, K. (1972). Archives of Disease in Childhood, 47, 787. Abnormal facies, myopia, and short stature. Three members of a family are described who have a curious facies due to a severely depressed nasal bridge, anteverted nostrils, wide-set eyes, high myopia, and short stature. The facial appearance is due to faulty development of the ethmoid bone, which also causes a short anterior cranial fossa. One member of the family was autistic and had a cleft palate. These cases closely resemble, but are thought to be distinct from, a family described by Marshall (1958) whose members had a similar facies which appeared to be due to a defective maxilla, deafness, myopia, and cataracts which were subject to many complications. One further case is described resembling Marshall's cases even more closely; she is deaf but does not have cataracts. In 1958 Marshall described 7 members of a widely open sagittal suture. The lower jaw was very family who had the following characteristics: the small, both eyes were protuberant, the nasal bridge nasal bridge was flattened, the eyes wide set, the nostrils anteverted, the mandible hypoplastic, and copyright. the teeth abnormal. Ocularly, there was myopia with a fluid vitreous, congenital and infantile cataracts, spontaneous and sudden maturation and absorption of congenital cataracts, and subluxation of cataracts.
    [Show full text]
  • Dimensions and Ossification of the Normal Anterior Cranial Fossa In
    Dimensions and Ossification of the Normal ORIGINAL RESEARCH Anterior Cranial Fossa in Children D.C. Hughes BACKGROUND AND PURPOSE: Interpretation of CT of the anterior skull base in children depends on M.J. Kaduthodil knowledge of the pattern and chronology of ossification. The purpose of this study was to ascertain the age at which the anterior cranial fossa is fully ossified as assessed on CT examinations. D.J.A. Connolly P.D. Griffiths MATERIALS AND METHODS: This was a retrospective review of 127 CT examinations of children ranging from 1 day to 16 years 7 months of age without known or suspected anterior cranial fossa abnormality. Measurements of the length and width of the anterior skull base and the presence and size of the most anterior unossified portion were determined by 2 investigators. RESULTS: At birth, the anterior skull base consists mainly of cartilage. There is a wide variation in ossification rates between individuals, but the anterior skull base was fully ossified at 3 years 10 months in all of our cases. CONCLUSIONS: In healthy individuals, the anterior skull base is fully ossified by 4 years of age. ABBREVIATIONS: cg ϭ crista galli; cp ϭ cribriform plate; f ϭ frontal bones; fc ϭ foramen cecum; hp ϭ hard palate: p ϭ perpendicular plate of the ethmoid bone; s ϭ sphenoid bone n important indication for imaging the anterior skull base computerized search. One hundred thirty-five patients were identi- Ais the evaluation of developmental midline masses fied initially, but after review of the clinical details from the imaging such as nasal dermal sinuses, anterior cephaloceles, and nasal requests and imaging reports, 8 patients with known metabolic or 1-3 gliomas.
    [Show full text]
  • Posterior Ethmoidal Foramen Anterior Cranial Fossa ل
    Norma verticalis * Norma frontalis Norma lateralis Norma occiptalis no Norma basalis externa Norma basalis interna Cranial fossa • The floor of the cranial cavity is divided into three distinct depressions. They are known as the anterior cranial fossa, middle cranial fossa and posterior cranial fossa. • Each fossa accommodates a different part of the brain. Anterior cranial fossa ل • CONTENTS 1.Features 2.Structures Going Through Different Foramina in the Anterior Cranial Fossa 1. Foramen Cecum 2. Cribriform Foramina 3. Anterior Ethmoidal Foramen 4. Posterior Ethmoidal Foramen Anterior cranial fossa ل • The anterior cranial fossa lodges the frontal lobes of the cerebral hemispheres. • Its floor consists of the portions of the subsequent 3 bones: ethmoid, frontal and sphenoid. • ACF • It’s demarcated from the middle cranial fossa by the: • Posterior free border of the lesser wing of sphenoid on every side • & Anterior border of the sulcus chiasmaticus (optic groove) in the median region • The junction between these 2 is marked by the anterior clinoid process. • The anterior cranial fossa presents these features: • In the median region, from before backwards these are: • Frontal crest, a vertical crest on the inner aspect of the frontal bone. • Foramen cecum (in between the frontal crest and crista galli). • Crista galli, bony crest, created by the perpendicular plate of the ethmoid. • Jugum sphenoidale (the superior surface of the anterior part of the body of the sphenoid). • on every side of crista galli is located the sieve-like cribriform plate of the ethmoid which separates the anterior cranial fossa from the nasal cavity. It • Possesses a number of small foramina, to supply passage for 15-20 filaments of the olfactory nerve, • possesses: • Nasal slits 1 on either side of crista galli to supply passage to the anterior ethmoidal nerve and • An anterior ethmoid canal along the lateral border anteriorly and a posterior ethmoidal canal along the lateral border posteriorly to supply passage to the anterior and posterior ethmoidal nerve and boats.
    [Show full text]
  • A Huge Osteoma in the Anterior Cranial Fossa by Vi
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.24.1.80 on 1 February 1961. Downloaded from J. Neurol. Neurosurg. Psychiat., 1961, 24, 80. A HUGE OSTEOMA IN THE ANTERIOR CRANIAL FOSSA BY VI. HUDOLIN, D. RIESSNER, S. KADRNKA, and M. KNEZEVIC From Neurolosko-Psihijatrijski Odjel, Zagreb Osteomata with intracranial complications are of the orbito-ethmoidal region; and 4, osteochon- rare, so that even today they attract interest droma arising from the base of the skull. (Campbell and Gottschalk, 1938; Hariga, 1960), Cushing (quoted by Zulch and Christensen, 1956) especially when they are not arising from the had in his series of 2,023 tumours only 14 osteomata. paranasal sinuses, where they usually originate. Zulch and Christensen (1956) in their own 4,000 Recently we had occasion to observe a patient cases of cerebral tumour mmntion 16 osteomata, with an osteoma of unusual size situated in the while Olivecrona (quoted by Zulch and Christensen, anterior cranial fossa. The clinical picture was that 1956) had no cases of osteoma in his series of of a case of frontal lobe syndrome with personality 5,250 cases. changes and symptomatic epilepsy. We are describ- The frontal lobe syndrome presents a psychiatric ing the case because of the unusual site of the clinical picture which although well recognizedProtected by copyright. osteoma and also as a contribution to the diagnosis cannot be accurately localized or aetiologically de- of the psychiatric syndrome in lesions of the frontal termined by clinical methods. When this syndrome lobe. has existed for some considerable time, and when Osteomata in the intracranial cavity must be there is also severe damage to the frontal lobe, the distinguished from secondary bone formations and question then arises whether restoration of mental from the so-called osteoplastic meningiomata faculties is in any degree possible, especially when (Cushing, 1937).
    [Show full text]
  • Imaging of Skull Base
    MINI-SYMPOSIA-HEAD AND NECK Imaging of skull base: Pictorial essay Abhijit A Raut, Prashant S Naphade1, Ashish Chawla2 Department of Radiology, Seven Hills Hospital, Mumbai, 1Department of Radiology, Employee’s State Insurance Corporation Hospital, Mumbai, Maharashtra, 2Department of Radiology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India Correspondence: Dr. Abhijit Raut, Department of Radiology, Seven Hills Hospital, Marol Maroshi Road, Andheri East, Mumbai ‑ 400 059, India. E‑mail: [email protected] Abstract The skull base anatomy is complex. Numerous vital neurovascular structures pass through multiple channels and foramina located in the base skull. With the advent of computerized tomography (CT) and magnetic resonance imaging (MRI), accurate preoperative lesion localization and evaluation of its relationship with adjacent neurovascular structures is possible. It is imperative that the radiologist and skull base surgeons are familiar with this complex anatomy for localizing the skull base lesion, reaching appropriate differential diagnosis, and deciding the optimal surgical approach. CT and MRI are complementary to each other and are often used together for the demonstration of the full disease extent. This article focuses on the radiological anatomy of the skull base and discusses few of the common pathologies affecting the skull base. Key words: Computed tomography; magnetic resonance imaging; skull base Introduction The skull base is composed of five bones: (1) ethmoid, (2) sphenoid, (3) occipital, (4) paired temporal, and (5) paired The skull base forms the floor of the cranial cavity that frontal bones. Three naturally contoured regions can be separates brain from facial structures and suprahyoid identified when skull base is viewed from above [Figure 1].
    [Show full text]
  • The Pediatric Anterior Skull Base: an Otolaryngologist's Perspective
    IJHNS The Pediatric Anterior Skull Base:10.5005/jp-journals-10001-1280 An Otolaryngologist’s Perspective REVIEW ARTICLE The Pediatric Anterior Skull Base: An Otolaryngologist’s Perspective 1Andrew J Chang, 2Ron B Mitchell, 3Gopi B Shah ABSTRACT encephaloceles predominate in children.2 In addition, juvenile nasopharyngeal angiofibromas (JNAs) originate Anterior skull base tumors have traditionally posed a therapeutic challenge. However, the advancement of skull base and from the sinonasal tract but can extend to involve the skull endoscopic surgery has allowed for more of these lesions to be base. Children pose a therapeutic challenge because of amenable to surgical resection. Though common in the adult their developing skull, face, and sinuses2,3,7 and the desire population, surgical approaches in the pediatric population is to avoid any intervention that may lead to developmental not widely described. This chapter discusses the presentation complications. This article will focus on the presentation and treatment for various pediatric anterior skull base lesions. Surgical approaches, complications, and the role of the and treatment of pediatric anterior skull base lesions. otolaryngologist is also discussed. Common surgical approaches, complications, outcomes, and, specifically, the role of the otolaryngologist in the Keywords: Anterior skull base tumors; Children; Pediatric skull base surgery. treatment team will be addressed. How to cite this article: Chang AJ, Mitchell RB, Shah GB. The Pediatric Anterior Skull Base: An Otolaryngologist’s
    [Show full text]
  • Skull – Communication
    Multimedial Unit of Dept. of Anatomy JU Anterior cranial fossa The floor: ● Cribriform plate of ethmoid ● Orbital parts of frontal ● Lesser wings of sphenoid ● Body of sphenoid – anterior to prechiasmatic sulcus Contents: ● Frontal lobes of brain ● Olfactory bulbs ● Olfactory tracts ● Anterior meningeal vessels (from anterior ethmoid) Communication: 1. Through cribriform plate of ethmoid with the nasal cavity Contents: ● Olfactory fila ● Anterior athmoidal vessels and nerves 2. Through foramen cecum with the nasal cavity ● Extension of dura mater ● Small vein connecting veins of nasal cavity and superior sagittal sinus Middle cranial fossa It consists of the central (body of sphenoid) and two lateral parts. Lateral parts consist of: ● Greater wing of sphenoid ● Squamous parts of temporal ● Anterior surfaces of pyramids of temporal The border between the anterior and middle cranial fossa ● Posterior margins of lesser wings of sphenoid ● Sphenoidal limbus The border between the middle and posterior cranial fossae: ● Superior margins of the petrous parts of temporal ● Dorsum sellae Contents: Central part ● Interbrain ● Intercavernous sinuses Lateral part ● Temporal lobes of brain ● Cavernous sinus ● Cranial nerves II – VI ● Internal carotid arteries ● Middle meningeal vessels ● Greater and lesser petrosal nerves Cavernous sinus Contents: ● Internal carotid artery ● Cavernous plexus ● Abducens nerve ● Lateral wall of cavernous sinus contains: ● Oculomotor nerve ● Trochlear nerve ● Ophthalmic nerve ● Maxillary nerve Communication of middle cranial fossa: 1. Through superior orbital fissure with the orbit Contents: ● Oculomotor nerve ● Trochlear nerve ● Ophthalmic nerve ● Abducens nerve ● Sympathetic postganglionic axons of the cavernous plexus ● Superior ophthalmic vein ● Superior branch of the inferior ophthalmic vein ● Ramus of middle meningeal artery 2. Optic canal – with orbit ● Optic nerve ● Ophthalmic artery 3.
    [Show full text]
  • Skull. Sphenoid and Ethmoid Bones
    Skull. Sphenoid and Ethmoid bones PhD., Dr. David Lendvai Department of Anatomy, Histology and Embriology Semmelweis University, Faculty of Medicine 2018. Skeletal system Structure of the skull Border between viscerocrainum and neurocranium Calvaria Main parts of the skull •Constitute by 22 bones: •neurocranium (8) – UNPAIRED: frontal, occipital, sphenoid, ethmoid bones PAIRED: temporal, parietal bones •viscerocranium (14) -UNPAIRED: mandibule, vomer. PAIRED: nasal, maxilla, zygomatic, lacrimal, palatine, inferior nasal concha Their role – formation of cavities, protect viscera, voice formation, initial portions of the gastrointerstinal and respiratory systems, insertion of muscles (mascication, head movements) Cavities: - Cranial cavity, - Nasal cavity, - Paranasal sinuses - Oral cavity, - Orbit, - (Tympanic cavity, Inner ear) Connections between cranial bones • Synchondrosis, synostosis (cartilagineal and bony connections) • Sutures – Coronal – Sagittal – Lambdoid Calvaria and the base of the skull Calvaria External aspect of the calvaria Base of the skull Internal aspect of the calvaria Fossae cranii Anterior cranial fossa MIddle cranial fossa Posterior cranial fossa • Posterior cranial fossa: • Anterior cranial fossa: • Occipital, temporal bones, frontal, ethmoid, lesser wings parietal bones of sphenoid • Middle cranial fossa: sphenoid, temporal bones, parietal bones Bones of the neurocranium Parietal bone Frontal bone Temporal bone Ethmoid Sphenoid Sphenoid bone Braus Part of the external skull base (- body (Corpus), pterygoid process,
    [Show full text]