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Ifrach J, Neavling NB, Charcos IB, Zhang L, Mossop CM. Novel use of an image-guided supraorbital craniotomy via an eyebrow approach for the repair of a delayed traumatic orbital encephalocele: illustrative cases. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23297. [PMID: 37910005 PMCID: PMC10566521 DOI: 10.3171/case23297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Traumatic orbital encephaloceles are rare but severe complications of orbital fractures. These encephaloceles can present months to years after the initial injury. OBSERVATIONS The authors present two cases of traumatic orbital encephalocele in young males struck by motor vehicles. LESSONS The exact traumatic mechanism of these encephaloceles is unknown, and diagnosis can be confounded by concomitant injuries. The use of a minimally invasive supraorbital keyhole craniotomy has the potential to change how this disease process is managed and has not been previously documented in this setting.
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Kaplan N, Marques M, Scharf I, Yang K, Alkureishi L, Purnell C, Patel P, Zhao L. Virtual Reality and Augmented Reality in Plastic and Craniomaxillofacial Surgery: A Scoping Review. Bioengineering (Basel) 2023; 10:bioengineering10040480. [PMID: 37106667 PMCID: PMC10136227 DOI: 10.3390/bioengineering10040480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Virtual reality (VR) and augmented reality (AR) have evolved since their introduction to medicine in the 1990s. More powerful software, the miniaturization of hardware, and greater accessibility and affordability enabled novel applications of such virtual tools in surgical practice. This scoping review aims to conduct a comprehensive analysis of the literature by including all articles between 2018 and 2021 pertaining to VR and AR and their use by plastic and craniofacial surgeons in a clinician-as-user, patient-specific manner. From the initial 1637 articles, 10 were eligible for final review. These discussed a variety of clinical applications: perforator flaps reconstruction, mastectomy reconstruction, lymphovenous anastomosis, metopic craniosynostosis, dermal filler injection, auricular reconstruction, facial vascularized composite allotransplantation, and facial artery mapping. More than half (60%) involved VR/AR use intraoperatively with the remainder (40%) examining preoperative use. The hardware used predominantly comprised HoloLens (40%) and smartphones (40%). In total, 9/10 Studies utilized an AR platform. This review found consensus that VR/AR in plastic and craniomaxillofacial surgery has been used to enhance surgeons' knowledge of patient-specific anatomy and potentially facilitated decreased intraoperative time via preoperative planning. However, further outcome-focused research is required to better establish the usability of this technology in everyday practice.
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Affiliation(s)
- Nicolas Kaplan
- Division of Plastic, Reconstructive and Cosmetic Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Mitchell Marques
- Division of Plastic, Reconstructive and Cosmetic Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Isabel Scharf
- Division of Plastic, Reconstructive and Cosmetic Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Kevin Yang
- The Craniofacial Center, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Lee Alkureishi
- The Craniofacial Center, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
- Shriners Children's Chicago Hospital, Chicago, IL 60707, USA
| | - Chad Purnell
- The Craniofacial Center, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
- Shriners Children's Chicago Hospital, Chicago, IL 60707, USA
| | - Pravin Patel
- The Craniofacial Center, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
- Shriners Children's Chicago Hospital, Chicago, IL 60707, USA
| | - Linping Zhao
- The Craniofacial Center, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
- Shriners Children's Chicago Hospital, Chicago, IL 60707, USA
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Cammarata G, Altieri R, Certo F, Petrella L, Basile A, Pizzo A, Crimi S, Battaglia S, Bianchi A, Barbagallo G. Post-traumatic intra-orbital meningoencephalocele in adults: technical note on a rare entity and review of the literature. Neurosurg Rev 2022; 46:6. [PMID: 36471011 DOI: 10.1007/s10143-022-01906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Post-traumatic orbital meningoencephaloceles related to orbital roof fractures are a challenging clinical entity because of their rarity and difficult differential diagnosis. We report a case of post-traumatic intra-orbital meningoencephalocele in a 69-year-old man, secondary to a likely trapdoor mechanism, treated with a modified one-piece orbitozygomatic craniotomy. We also performed an extensive literature review of traumatic Intra-Orbital Encephalocele related to Orbital Roof Fracture focused on adult patients on electronic databases including Scopus, MEDLINE/PubMed, and Google Scholar. Patient well recovered after surgery with immediate exophthalmos resolution and discharged without visual or neurological deficits. The literature review included 22 papers with a total of 28 patients: 22 males (78.6%) and 6 females (21.4%), with a median age of 34.7 years. Twenty-six patients (92.9%) reported ocular injuries, with associated intracranial complications in 16 cases (61.5%). Twenty-seven patients (96.4%) were surgically treated, 18 of those underwent unilateral or bilateral frontal approach. Most orbital roof fractures can be managed nanoperatively if asymptomatic. Indeed, when the intra-orbital volume decreases, for example due to an encephalocele, the intra-orbital pressure could increase and determine an orbital compartment syndrome. In our case, we performed a one-piece modified orbitozygomatic approach, which has several advantages in comparison to the frequent unilateral or bilateral frontal craniotomy like the better exposure of the brain and orbit and a minimum brain retraction.
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Affiliation(s)
- Giacomo Cammarata
- Department of Neurological Surgery, Polyclinic "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio Ciampi 1, 95121, Catania, Italy.
| | - Roberto Altieri
- Department of Neurological Surgery, Polyclinic "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio Ciampi 1, 95121, Catania, Italy
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
- PhD Program at Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Francesco Certo
- Department of Neurological Surgery, Polyclinic "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio Ciampi 1, 95121, Catania, Italy
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Luca Petrella
- Department of Neurological Surgery, Polyclinic "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio Ciampi 1, 95121, Catania, Italy
| | - Angelo Basile
- Department of Neurological Surgery, Polyclinic "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio Ciampi 1, 95121, Catania, Italy
| | - Aurora Pizzo
- Department of Neurological Surgery, Polyclinic "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio Ciampi 1, 95121, Catania, Italy
| | - Salvatore Crimi
- Department of General Surgery, Section of Maxillo Facial Surgery of Polyclinic "G. Rodolico - San Marco" University Hospital, University of Catania, Catania, Italy
| | - Salvatore Battaglia
- Department of General Surgery, Section of Maxillo Facial Surgery of Polyclinic "G. Rodolico - San Marco" University Hospital, University of Catania, Catania, Italy
| | - Alberto Bianchi
- Department of General Surgery, Section of Maxillo Facial Surgery of Polyclinic "G. Rodolico - San Marco" University Hospital, University of Catania, Catania, Italy
| | - Giuseppe Barbagallo
- Department of Neurological Surgery, Polyclinic "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio Ciampi 1, 95121, Catania, Italy
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
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Nasi D, di Somma L, Gladi M, Moriconi E, Scerrati M, Iacoangeli M, Dobran M. New or Blossoming Hemorrhagic Contusions After Decompressive Craniectomy in Traumatic Brain Injury: Analysis of Risk Factors. Front Neurol 2019; 9:1186. [PMID: 30697186 PMCID: PMC6340989 DOI: 10.3389/fneur.2018.01186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/24/2018] [Indexed: 01/02/2023] Open
Abstract
Background: The development or expansion of a cerebral hemorrhagic contusion after decompressive craniectomy (DC) for traumatic brain injury (TBI) occurs commonly and it can result in an unfavorable outcome. However, risk factors predicting contusion expansion after DC are still uncertain. The aim of this study was to identify the factors associated with the growth or expansion of hemorrhagic contusion after DC in TBI. Then we evaluated the impact of contusion progression on outcome. Methods: We collected the data of patients treated with DC for TBI in our Center. Then we analyzed the risk factors associated with the growth or expansion of a hemorrhagic contusion after DC. Results: 182 patients (149 males and 41 females) were included in this study. Hemorrhagic contusions were detected on the initial CT scan or in the last CT scan before surgery in 103 out of 182 patients. New or blossoming hemorrhagic contusions were registered after DC in 47 patients out of 182 (25.82%). At multivariate analysis, only the presence of an acute subdural hematoma (p = 0.0076) and a total volume of contusions >20 cc before DC (p = < 0.0001) were significantly associated with blossoming contusions. The total volume of contusions before DC resulted to have higher accuracy and ability to predict postoperative blossoming of contusion with strong statistical significance rather than the presence of acute subdural hematoma (these risk factors presented respectively an area under the curve [AUC] of 0.896 vs. 0.595; P < 0.001). Patients with blossoming contusions presented an unfavorable outcome compared to patients without contusion progression (p < 0.0185). Conclusions: The presence of an acute subdural hematoma was associated with an increasing rate of new or expanded hemorrhagic contusions after DC. The total volume of hemorrhagic contusions > 20 cc before surgery was an independent and extremely accurate predictive radiological sign of contusion blossoming in decompressed patients for severe TBI. After DC, the patients who develop new or expanding contusions presented an increased risk for unfavorable outcome.
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Affiliation(s)
- Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Lucia di Somma
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Gladi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Elisa Moriconi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Scerrati
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Mauro Dobran
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
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Abstract
Orbital encephalocele is a rare catastrophic complication of orbital roof fractures. Early diagnosis of this posttraumatic orbital encephalocele is very crucial because this condition if untreated leads to rapid loss of vision. Whenever displaced orbital roof fracture is identified in a head injury patient, an orbital encephalocele should be suspected. Although magnetic resonance imaging is the investigation of choice, computed tomography of orbit with thin axial and coronal sequences often gives the diagnosis. Frontobasal approach is the most commonly used surgical approach. Supra-transorbital approach is a minimally invasive alternative. Good results with regard to the orbital symptoms can be expected.
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Affiliation(s)
- Saravanan Sadashivam
- Department of Neurosurgery, Kerala Institute of Medical Science, Trivandrum, Kerala, India
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