AIM: To investigate the specialty of transcranial surgery through pterional approach for removal of cranio-orbital tumors, introduce the ophthalmological experiences of entering the orbit to reduce the incidence rate ...AIM: To investigate the specialty of transcranial surgery through pterional approach for removal of cranio-orbital tumors, introduce the ophthalmological experiences of entering the orbit to reduce the incidence rate of associated complications of this operation. METHODS: We performed a retrospective analysis of a series of 37 cases involving patients who underwent transcranial surgery through pterional approach for treatment of cranio-orbital tumors in our department in the past 8 years. Pterion approach craniotomy was performed to all patients. After removing tumors in the skull by the neurosurgeon, ophthalmologist removed tumors in orbit. We took measures below to decrease complications, including grounding optic canal through an abrasive drilling when necessary, hanging various extraocular muscles to be exposed for protection, refrigerating by refrigeration heads to remove tumors, at last sewing up orbit septum after surgery. RESULTS: Tumors were removed completely in 32 cases, and incomplete in 5 cases due to extensive invasion into the cavernous sinus or sphenoid sinus. Of all the cases, benign tumors were demonstrated in 28 cases (75.6%, 28/37) and malignant in 9 (24.3%, 9/37). The most common lesion type was meningioma in 11 cases (29.7%, 11/37). Extraocular muscles (EOM) impairment, occurring in 21 cases (56.7%, 21/37), was the most frequent postoperative complication. The most serious consequence was vision loss occurred in 4 cases (10.8%, 4/37). Other complications, such as 11 cases of transient blepharoptosis 29.7% (11/37), 5 cases of mydriasis in 13.5% (5/7); 2 cases of cerebrospinal rhinorrhea in 5.4% (2/37). CONCLUSION: Cranio-orbital tumors can be removed completely using transcranial approach, and the pterional approach offers excellent exposure. Cooperation of interdisciplinary team of neurosurgeons and ophthalmologists conduces to full use of respective professional advantages. The experience of ophthalmic operation technology can decrease occurrence of ocular complications after surgery.展开更多
Background Data: Atlanto-occipital dislocation is a rare and fatal condition. Pain, limitation of movements, and weakness, were the main complaints of patients with upper cervical lesions. Internal fixation and fusion...Background Data: Atlanto-occipital dislocation is a rare and fatal condition. Pain, limitation of movements, and weakness, were the main complaints of patients with upper cervical lesions. Internal fixation and fusion was indicated in all patients of Atlanto occipital dislocation with deficits. CT scan is the imaging modality of choice for evaluation. Objective: To evaluate the efficacy and safety of rod and screw fixation in cranio-cervical instability. Study Design: Retrospective study reviewed all patient treated by rod and screw fixation, they were 12 patient operated for atlanto-occipital instability from April 2013 to April 2016 in Alazher University Hospital Damietta. Pre and postoperative data collection and analysis of the outcome were completed based on the Frankel classification and grading. Patients and Methods: We operated 12 patients, 10 with traumatic and 2 with pathologically diagnosed Atlanto occipital instability. From April 2013 to April 2016. All patients presented with neck pain, limitation of neck movement, and neurological deficits. The patients were investigated by standard plain X ray to the cervical spine, CT scan and MRI of the cervical spine pre-operatively, and they operated thorough posterior Cranio-cervical fixation. These patients followed post-operatively clinically for improving neural functions and radiologically for alignment, stability, fusion and efficacy of hard ware fixation. Results: The mean age of the studied cases was 42.1 years, trauma was the cause of instability in 10 patients, and 2 patients one with rheumatoid arthritis and one with neoplastic lesion. The mean follows up period is 14.7 months. We used screw rod system in posterior craniocervical fixation with iliac bone graft without operative or post-operative complications. All our patients were improved neurologically post-operatively and no hardware failure during the follow up period. Conclusion: Craniocervical instability was rare condition, with miss diagnosis and may be fatal condition. Posterior occipitocervical fixation when indicated can be done by various techniques. The screw rod system was the most upgraded used technique with immediate rigid fixation. Surgery in this area was possible with confident results.展开更多
Aim: Describe the epidemiological, clinical and therapeutic particularities of craniofacial trauma by encornment. Type of study: This was a retrospective and descriptive study. Material and methods: It took place in t...Aim: Describe the epidemiological, clinical and therapeutic particularities of craniofacial trauma by encornment. Type of study: This was a retrospective and descriptive study. Material and methods: It took place in the surgical emergency departments of Bouaké (Côte d’Ivoire) University Hospital from January 2013 to December 2017, for a period of 5 years. It focused on patients of 0 to 5 years old admitted for craniofacial trauma involving the horn of a bovine. Results: Of the 26 cases of traumatic encornment, 11 were craniofacial location (42%). There were 9 male and 2 female victims. The average age was 10.54 years with extremes of 6 months and 24 years. Patients came from rural areas of Côte d’Ivoire. Bovids were responsible for all causal encornements. The lesions involved the scalp (3 cases) and the face (8 cases). The lesions were cutaneous-musculo skeletal in 7 cases. The surgical treatment included debridement associated to a suture in all cases and associated with maxillo mandibular blockage in 3 cases and duro-cranioplasty in one case. Conclusion: In the local context, facial cranio traumatism by encornement is rare and seems to be essentially infantile, masculine and rural problem.展开更多
Purpose: It has been shown that cranial injuries associated with facial fractures may cause a great risk of mortality and neurological morbidity, which mainly occurs in young adults. Various studies have been carried ...Purpose: It has been shown that cranial injuries associated with facial fractures may cause a great risk of mortality and neurological morbidity, which mainly occurs in young adults. Various studies have been carried out in various countries to study the epidemiology of the cranio maxillofacial injuries but the studies from Egypt are few. The aim of this study was therefore to assess the prevelance, etiology, type of injury, and site of fractures among patient attending Assiut University Hospitals. Material and Methods: Retrospective hospital study was carried out at Trauma unit, Assiut University Hospitals (Single Tertiary Hospital) between January 2010 and December 2017. Radiographs and hospital data of 1745 patients with craniomaxillofacial trauma were gathered and analyzed. The identified fractures, such as, age, gender, etiology of injury, and anatomical sites of fractures were classified as: frontal/skull base, naso-orbital, maxilla, zygoma, and mandible. According to GCS, patients were classified into 3 grades: mild, moderate and severe. Gathered data was coded and entered into a computer and analyzed using SPSS version 22. Result: Overall prevalence of cranio maxillofacial injuries was 3%. Age ranged from 1 - 90 with mean ± SD 25.75 ± 15.5. The greatest number of the patients had 18 to 40 years old (48.4%) and most of them were male (M/F ratio was 7:1). The most prevalent causes of the trauma in this study were the road traffic accidents (67.7%) and accidental fall (15%), respectively. Firearm injuries accounted for fractures in 86 patients (4.9%). The most common bone fracture among the patients was the mandibular bone (47.7%). 837 patients (48%) required surgical intervention. Conclusions: This retrospective population study demonstrates an insight into the demographics and fracture patterns in craniomaxillofacial trauma patients. The most common etiology of craniomaxillofacial injury was road traffic accidents followed by falls and assaults, suggesting that interventions addressing the prevention of this mechanism, and treatment of the associated injury patterns, have not been sufficient and require to be revised. The majority of victims were young adult males between the ages of 18 to 40 years. The mandibular bone and maxilla were the most common sites of fracture.展开更多
文摘AIM: To investigate the specialty of transcranial surgery through pterional approach for removal of cranio-orbital tumors, introduce the ophthalmological experiences of entering the orbit to reduce the incidence rate of associated complications of this operation. METHODS: We performed a retrospective analysis of a series of 37 cases involving patients who underwent transcranial surgery through pterional approach for treatment of cranio-orbital tumors in our department in the past 8 years. Pterion approach craniotomy was performed to all patients. After removing tumors in the skull by the neurosurgeon, ophthalmologist removed tumors in orbit. We took measures below to decrease complications, including grounding optic canal through an abrasive drilling when necessary, hanging various extraocular muscles to be exposed for protection, refrigerating by refrigeration heads to remove tumors, at last sewing up orbit septum after surgery. RESULTS: Tumors were removed completely in 32 cases, and incomplete in 5 cases due to extensive invasion into the cavernous sinus or sphenoid sinus. Of all the cases, benign tumors were demonstrated in 28 cases (75.6%, 28/37) and malignant in 9 (24.3%, 9/37). The most common lesion type was meningioma in 11 cases (29.7%, 11/37). Extraocular muscles (EOM) impairment, occurring in 21 cases (56.7%, 21/37), was the most frequent postoperative complication. The most serious consequence was vision loss occurred in 4 cases (10.8%, 4/37). Other complications, such as 11 cases of transient blepharoptosis 29.7% (11/37), 5 cases of mydriasis in 13.5% (5/7); 2 cases of cerebrospinal rhinorrhea in 5.4% (2/37). CONCLUSION: Cranio-orbital tumors can be removed completely using transcranial approach, and the pterional approach offers excellent exposure. Cooperation of interdisciplinary team of neurosurgeons and ophthalmologists conduces to full use of respective professional advantages. The experience of ophthalmic operation technology can decrease occurrence of ocular complications after surgery.
文摘Background Data: Atlanto-occipital dislocation is a rare and fatal condition. Pain, limitation of movements, and weakness, were the main complaints of patients with upper cervical lesions. Internal fixation and fusion was indicated in all patients of Atlanto occipital dislocation with deficits. CT scan is the imaging modality of choice for evaluation. Objective: To evaluate the efficacy and safety of rod and screw fixation in cranio-cervical instability. Study Design: Retrospective study reviewed all patient treated by rod and screw fixation, they were 12 patient operated for atlanto-occipital instability from April 2013 to April 2016 in Alazher University Hospital Damietta. Pre and postoperative data collection and analysis of the outcome were completed based on the Frankel classification and grading. Patients and Methods: We operated 12 patients, 10 with traumatic and 2 with pathologically diagnosed Atlanto occipital instability. From April 2013 to April 2016. All patients presented with neck pain, limitation of neck movement, and neurological deficits. The patients were investigated by standard plain X ray to the cervical spine, CT scan and MRI of the cervical spine pre-operatively, and they operated thorough posterior Cranio-cervical fixation. These patients followed post-operatively clinically for improving neural functions and radiologically for alignment, stability, fusion and efficacy of hard ware fixation. Results: The mean age of the studied cases was 42.1 years, trauma was the cause of instability in 10 patients, and 2 patients one with rheumatoid arthritis and one with neoplastic lesion. The mean follows up period is 14.7 months. We used screw rod system in posterior craniocervical fixation with iliac bone graft without operative or post-operative complications. All our patients were improved neurologically post-operatively and no hardware failure during the follow up period. Conclusion: Craniocervical instability was rare condition, with miss diagnosis and may be fatal condition. Posterior occipitocervical fixation when indicated can be done by various techniques. The screw rod system was the most upgraded used technique with immediate rigid fixation. Surgery in this area was possible with confident results.
文摘Aim: Describe the epidemiological, clinical and therapeutic particularities of craniofacial trauma by encornment. Type of study: This was a retrospective and descriptive study. Material and methods: It took place in the surgical emergency departments of Bouaké (Côte d’Ivoire) University Hospital from January 2013 to December 2017, for a period of 5 years. It focused on patients of 0 to 5 years old admitted for craniofacial trauma involving the horn of a bovine. Results: Of the 26 cases of traumatic encornment, 11 were craniofacial location (42%). There were 9 male and 2 female victims. The average age was 10.54 years with extremes of 6 months and 24 years. Patients came from rural areas of Côte d’Ivoire. Bovids were responsible for all causal encornements. The lesions involved the scalp (3 cases) and the face (8 cases). The lesions were cutaneous-musculo skeletal in 7 cases. The surgical treatment included debridement associated to a suture in all cases and associated with maxillo mandibular blockage in 3 cases and duro-cranioplasty in one case. Conclusion: In the local context, facial cranio traumatism by encornement is rare and seems to be essentially infantile, masculine and rural problem.
文摘Purpose: It has been shown that cranial injuries associated with facial fractures may cause a great risk of mortality and neurological morbidity, which mainly occurs in young adults. Various studies have been carried out in various countries to study the epidemiology of the cranio maxillofacial injuries but the studies from Egypt are few. The aim of this study was therefore to assess the prevelance, etiology, type of injury, and site of fractures among patient attending Assiut University Hospitals. Material and Methods: Retrospective hospital study was carried out at Trauma unit, Assiut University Hospitals (Single Tertiary Hospital) between January 2010 and December 2017. Radiographs and hospital data of 1745 patients with craniomaxillofacial trauma were gathered and analyzed. The identified fractures, such as, age, gender, etiology of injury, and anatomical sites of fractures were classified as: frontal/skull base, naso-orbital, maxilla, zygoma, and mandible. According to GCS, patients were classified into 3 grades: mild, moderate and severe. Gathered data was coded and entered into a computer and analyzed using SPSS version 22. Result: Overall prevalence of cranio maxillofacial injuries was 3%. Age ranged from 1 - 90 with mean ± SD 25.75 ± 15.5. The greatest number of the patients had 18 to 40 years old (48.4%) and most of them were male (M/F ratio was 7:1). The most prevalent causes of the trauma in this study were the road traffic accidents (67.7%) and accidental fall (15%), respectively. Firearm injuries accounted for fractures in 86 patients (4.9%). The most common bone fracture among the patients was the mandibular bone (47.7%). 837 patients (48%) required surgical intervention. Conclusions: This retrospective population study demonstrates an insight into the demographics and fracture patterns in craniomaxillofacial trauma patients. The most common etiology of craniomaxillofacial injury was road traffic accidents followed by falls and assaults, suggesting that interventions addressing the prevention of this mechanism, and treatment of the associated injury patterns, have not been sufficient and require to be revised. The majority of victims were young adult males between the ages of 18 to 40 years. The mandibular bone and maxilla were the most common sites of fracture.
