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      Endoscopic Removal of a Bullet Penetrating the Middle Cranial Fossa

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          Abstract

          Reports of intracranial retained foreign bodies are relatively rare in the literature. Such objects can cause numerous complications requiring removal, such as infection, persistent cerebrospinal fluid (CSF) leak, or new-onset seizures. The transnasal endoscopic approach provides an excellent alternative to craniotomy for repairing middle cranial fossa (MCF) defects. We describe a case of a 57-year-old woman with a self-inflicted bullet piercing the MCF, creating a persistent CSF leak. The details regarding the removal of this penetrating foreign body from the MCF, including the unique management in the setting of a contralateral spontaneous CSF leak, are discussed.

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          A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap.

          Gustavo Hadad, Luis Bassagasteguy, Ricardo Carrau … (2006)
          In patients with large dural defects of the anterior and ventral skull base after endonasal skull base surgery, there is a significant risk of a postoperative cerebrospinal fluid leak after reconstruction. Reconstruction with vascularized tissue is desirable to facilitate rapid healing, especially in irradiated patients. We developed a neurovascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the nasoseptal artery, a branch of the posterior septal artery (Hadad-Bassagasteguy flap [HBF]). A retrospective review of patients undergoing endonasal skull base surgery at the University of Rosario, Argentina, and the University of Pittsburgh Medical Center was performed to identify patients who were reconstructed with a vascularized septal mucosal flap. Forty-three patients undergoing endonasal cranial base surgery were repaired with the septal mucosal flap. Two patients with postoperative cerebrospinal fluid leaks (5%) were successfully treated with focal fat grafts. We encountered no infectious or wound complications in this series of patients. One patient experienced a posterior nose bleed from the posterior nasal artery. This was controlled with electrocautery and the flap blood supply was preserved. The HBF is a versatile and reliable reconstructive technique for defects of the anterior, middle, clival, and parasellar skull base. Its use has resulted in a sharp decrease in the incidence of postoperative cerebrospinal fluid leaks after endonasal skull base surgery and is recommended for the reconstruction of large dural defects and when postoperative radiation therapy is anticipated.
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            Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study.

            R Medina, Paul James Donald, Theresa Kowalski … (2005)
            Advances in imaging, surgical technique, and perioperative care have made craniofacial resection (CFR) an effective and safe option for treating malignant tumors involving the skull base. The procedure does, however, have complications. Because of the relative rarity of these tumors, most existing data on postoperative complications come from individual reports of relatively small series of patients. This international collaborative report examines a large cohort of patients accumulated from multiple institutions with the aim of identifying patient-related and tumor-related predictors of postoperative morbidity and mortality and set a benchmark for future studies. One thousand one hundred ninety-three patients from 17 institutions were analyzed for postoperative mortality and complications. Postoperative complications were classified into systemic, wound, central nervous system (CNS), and orbit. Statistical analyses were carried out in relation to patient characteristics, extent of disease, prior radiation treatment, and type of reconstruction to determine factors that predicted mortality or complications. Postoperative mortality occurred in 56 patients (4.7%). The presence of medical comorbidity was the only independent predictor of mortality. Postoperative complications occurred in 433 patients (36.3%). Wound complications occurred in 237 (19.8%), CNS-related complications in 193 (16.2%), orbital complications in 20 (1.7%), and systemic complications in 57 (4.8%) patients. Medical comorbidity, prior radiation therapy, and the extent of intracranial tumour involvement were independent predictors of postoperative complications. CFR is a safe surgical treatment for malignant tumors of the skull base, with an overall mortality of 4.7% and complication rate of 36.3%. The impact of medical comorbidity and intracranial tumor extent should be carefully considered when planning therapy for patients whose tumors are amenable to CFR. (c) 2005 Wiley Periodicals, Inc.
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              Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years.

              Caroline Banks, James Palmer, Alexander G Chiu … (2009)
              Endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine approach. This study describes endoscopic closure of a large series over 21 years, focusing on management, surgical technique, and long-term outcomes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Skull Base Rep
                Journal ID (iso-abbrev): Skull Base Rep
                Title: Skull Base Reports
                Publisher: Thieme Medical Publishers (333 Seventh Avenue, New York, NY 10001, USA. )
                ISSN (Print): 2157-6971
                ISSN (Electronic): 2157-698X
                Publication date (Electronic): 30 March 2011
                Publication date (Print): May 2011
                Volume: 1
                Issue: 1
                Pages: 47-50
                Affiliations
                [1 ]Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Birmingham, Alabama
                [2 ]Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
                Author notes
                Address for correspondence Bradford A. Woodworth, M.D. BDB 563, 1530 3rd Ave. S Birmingham, AL 35294 bwoodwo@ 123456hotmail.com
                Article
                Publisher ID: 01047
                DOI: 10.1055/s-0031-1275633
                PMC ID: 3743583
                PubMed ID: 23984202
                SO-VID: 347b909f-e2e7-4a74-85a7-08f460646929
                Copyright © © Thieme Medical Publishers
                History
                Date received : 09 August 2010
                Date accepted : 24 January 2011
                Categories
                Subject: Article

                Keywords: middle cranial fossa,foreign body,skull base surgery,endoscopic approach
                Data availability:
                Keywords: middle cranial fossa, foreign body, skull base surgery, endoscopic approach

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