This study aimed to evaluate the treatment outcomes and the efficiency of techniques of fronto-orbital advancement (FOA) and posterior cranial vault expansion (PCVE) using distraction osteogenesis in patients with multiple craniosynostosis. We assessed the treatment results and outcomes of 8 patients with multiple craniosynostosis at the Kagoshima University Hospital between 2005 and 2019. Each 4 patients underwent FOA and PCVE, respectively, using distraction osteogenesis. The cranial volume and developmental quotient (DQ) were measured at the preoperative period and 1 year after surgery. The mean patient age at surgery was 22 months. The mean preoperative cranial volume was 1027 and 1071 cm 3 in the FOA and PCVE groups, respectively. The mean preoperative DQ scores were 74 and 67, respectively. After 1-year of follow-up, the corresponding mean cranial volume became 1108 and 1243 cm 3 , respectively. The corresponding mean DQ scores also improved to 74 and 81, respectively. The postoperative follow-ups in all cases were uneventful, except for persistent epilepsy in 1 patient. Fronto-orbital advancement and PCVE using distraction osteogenesis might contribute to good outcomes in expanding cranial volume, cosmetic osteogenesis, and infantile development in patients with multiple craniosynostosis. Regarding the cranial volume expansion, especially, PCVE using distraction osteogenesis is more effective than FOA.
Deep Sylvian meningiomas are rare, accounting for 0.3–0.4% of all meningiomas, and mostly present in young adults and children. We report on a 32-year-old man who presented with headache but had no neurological deficits. Computed tomography of brain revealed a 24 × 19 × 21 mm 3 mass lesion in the right Sylvian fissure with calcification. Magnetic resonance imaging showed that the lesion was isointense on T 1 - and T 2 -weighted images (WI), with homogenous enhancement on post-gadolinium T 1 WI. The lesion was surgically removed via right fronto-temporal craniotomy. The tumor was located in deep Sylvian fissure and had no dural attachment. Histopathological examination of the lesion revealed both meningothelial and fibroblastic features, thereby suggesting the diagnosis of transitional meningioma (WHO grade I), with Ki-67 labeling index of 6.9%. Thus, meningioma should be considered as a differential diagnosis of enhancing mass lesions in the Sylvian fissure even in the absence of dural tail sign, especially in young adults and children.
Background: Cerebrospinal fluid (CSF) leakage is a common complication of ventriculoperitoneal shunt (VPS) and has the potential to induce shunt infection. Especially in infants and children, these are serious complications. DuraGen is a collagen matrix dural substitute used to reduce the risk of CSF leakage in various neurosurgeries. We report our VPS procedure with DuraGen for preventing postoperative CSF leakage in patients aged <1 year. Methods: We used DuraGen to prevent postoperative CSF leakage in six VPS surgeries. Antibiotic-impregnated shunt catheters and programmable valves with anti-siphon devices were also used in all cases. DuraGen was placed inside and atop the burr hole. All cases had an initial shunt pressure of 5 cmH2O. Fibrin glue was not used. Results: The patients underwent follow-up for a year after VPS surgery. There was no postoperative subcutaneous CSF collection or leakage after all six VPS surgeries. Furthermore, no postoperative shunt infections or DuraGen-induced adverse events were noted. Conclusion: We speculate that DuraGen has a preventive effect on postoperative CSF leakage in VPS cases aged <1 year.
Among middle cerebral artery aneurysms, those at the M1 portion of the middle cerebral artery have a lower incidence of occurrence. We retrospectively analyzed and reported the clinical features and management of 12 M1 aneurysms in 12 patients treated with direct clipping. Aneurysms arising at the M1 portion were mostly smaller in size and prevalent in older women, on the left side, with more intracerebral hematoma and less accompanied than those at the bifurcation. Ruptured aneurysms comprised 80% of the aneurysms and were larger than 5 mm in size, while 14.3% of those smaller than 5 mm in size were unruptured. Aneurysms were located in the upper (n=5), downward (n=5), anterior (n=1), and posterior (n=1) directions. Of the five aneurysms in the upper direction, three were in the early frontal branch, one was in the early temporal branch, and one was in the lenticulostriate artery. Two of the aneurysms in the upper direction had an intracerebral hematoma (ICH) in the frontal and temporal lobes, while one aneurysm in the downward direction had an ICH in the temporal lobe. The preoperative clinical grade of M1 aneurysms with ICH was worse than that of bifurcation aneurysms; however, the outcome was equal to that of bifurcation aneurysms.Aneurysms arising at the M1 portion should be treated with a preoperative meticulous investigation for their anatomical complexity, not only with direct clipping but also with endovascular techniques.
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