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Yasuda T, Kurosaki Y, Ishibashi R, Takada K, Chin M. Endoscope-assisted microsurgical repair in trigeminal meningocele: case report. J Neurosurg Pediatr 2021; 27:600-605. [PMID: 33711806 DOI: 10.3171/2020.9.peds20259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/11/2020] [Indexed: 11/06/2022]
Abstract
Trigeminal meningocele is a rare disease that results in rhinorrhea. Treatments with endoscopic approaches and open craniotomies have high recurrence rates, and controversy regarding the most effective surgical strategy for trigeminal meningocele is ongoing. The authors report a case of a 13-year-old female patient with a diagnosis of trigeminal meningocele determined after she presented with a history of intermittent headaches, suspected rhinorrhea, and recurrent meningitis. In addition to the conventional method of covering the efflux point of CSF and filling the inside of the meningocele with fascial tissues, the authors selectively closed the influx point of CSF from the prepontine cistern to the meningocele using an anterior transpetrosal approach. On the basis of the preoperative images, the authors hypothesized that the influx point of CSF could not be observed under the microscopic direct view and instead used a flexible endoscope. A check valve-like structure with one-way communication of CSF from the prepontine cistern into the cystic cavity was identified and was closed. At the time of this report, 36 months postoperatively, the patient had no indications of recurrence. Although cases of trigeminal meningoceles are infrequently encountered and require a tailored approach, the results in this case thus far indicate that the use of an endoscope and open craniotomy is an effective strategy for surgical treatment.
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Chislett SP, Limjuco AP, Solyar AY, Lanza DC. Trans-pterygomaxillary fossa sphenoidotomy can result in insufficient exposure for lateral pterygoid recess encephalocele repair. Int Forum Allergy Rhinol 2020; 10:1110. [PMID: 32470224 DOI: 10.1002/alr.22570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | - Alexander P Limjuco
- Sinus & Nasal Institute of Florida, St. Petersburg, FL.,Bethlehem ENT Associates, Bethlehem, PA
| | - Alla Y Solyar
- Sinus & Nasal Institute of Florida, St. Petersburg, FL
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Ohno N, Miyati T, Chigusa T, Usui H, Ishida S, Hiramatsu Y, Kobayashi S, Gabata T, Alperin N. Technical Note: Development of a cranial phantom for assessing perfusion, diffusion, and biomechanics. Med Phys 2017; 44:1646-1654. [PMID: 28241107 DOI: 10.1002/mp.12182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 12/10/2016] [Accepted: 02/16/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A novel cranial phantom was developed to simulate the relationships among factors such as blood perfusion, water diffusion, and biomechanics in intracranial tissue. METHODS The cranial phantom consisted of a high-density polypropylene filter (mimicking brain parenchyma) with intra- and extrafilter spaces (mimicking cerebral artery and vein, respectively), and a capacitor space (mimicking the cerebrospinal fluid space). Pulsatile and steady flow with different flow rates were applied to the cranial phantom using a programmable pump. On 3.0-T MRI, the measurements of the internal pressure in the phantom, apparent diffusion coefficient (ADC) with monoexponential analysis in the filter, and total simulated cerebral blood flow (tSCBF) into the phantom were synchronized with the pulsatile flow. We obtained their maximum changes during the pulsation period (ΔP, ΔADC, and ΔtSCBF, respectively). Then, the compliance index (CI) was calculated by dividing the volume change (ΔV) by the ΔP in the phantom. Moreover, the same measurements were repeated after the compliance of the phantom was reduced by increasing the water volume in the capacitor space. Under steady flow conditions, we determined the regional SCBF (rSCBF) and perfusion-related and restricted diffusion coefficients (D* and D, respectively) with biexponential analysis in the filter. RESULTS The internal pressure, ADC, and tSCBF varied over the pulsation period depending on the input flow. Moreover, the ΔP, ΔADC, ΔtSCBF, and rSCBF increased with the input flow rate. Compared to the high compliance condition, in the low compliance condition, the ΔP and ΔADC were higher by factors of 2.5 and 1.3, respectively, and the CI was smaller by a factor of 2.7, whereas the ΔV was almost unchanged. The D* was strongly affected by the input flow. CONCLUSION Our original phantom models the relationships among the blood perfusion, water diffusion, and biomechanics of the intracranial tissue, potentially facilitating the validation of novel MRI techniques and optimization of imaging parameters.
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Affiliation(s)
- Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Tomohiro Chigusa
- Department of Radiology, Okazaki City Hospital, 3-1 Goshoai, Koryuji-cho, Okazaki, Aichi, 4448553, Japan
| | - Hikari Usui
- Department of Radiology, Yokohama City University Hospital, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Shota Ishida
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Yuki Hiramatsu
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Satoshi Kobayashi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan
| | - Noam Alperin
- Department of Radiology, University of Miami, 1150 NW 14th Street, Suite 713, FL, 33146, USA
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Alobaid A, Schaeffer T, Virojanapa J, Dehdashti AR. Rare cause of trigeminal neuralgia: Meckel's cave meningocele. Acta Neurochir (Wien) 2015; 157:1183-6. [PMID: 25951909 DOI: 10.1007/s00701-015-2434-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
The most common etiology of classic trigeminal neuralgia is vascular compression. However, other causes must be excluded. It is very unlikely that a meningocele presents with symptomatic trigeminal neuralgia. We present a rare case of a patient presenting with left trigeminal neuralgia. Thin-slice CT and MRI showed a transclival Meckel's cave meningocele. The patient underwent endoscopic repair of the meningocele, which resulted in complete resolution of her symptoms. Meckel's cave meningocele or encephalocele should be considered among the differential diagnoses of trigeminal neuralgia. Meningocele repair should be suggested as the first treatment option in this rare situation.
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