Inferior encephalocele: transpalatal repair using paired costal bone grafts with a 14-year follow-up

Hassani, Esmaiil; Karimi, Hamid; Hassani, Ali

doi:10.1016/j.jpedsurg.2011.06.026

Cited by 4 publications

(6 citation statements)

References 23 publications

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“…Hard palate already shortened. Nasal mucosal flaps have been incised to give access to the nasopharynx As demonstrated before by Grillo F. et al [3], it is possible to create specific-patient phantom with anatomical and accurate shapes that may be employed as an exciting alternative for surgical planning. This model's role in neurosurgery education programs is another critical aspect to be emphasized.…”

Section: Discussionmentioning

confidence: 99%

“…Nearly half of the participants answered that residents should achieve a satisfactory simulation proficiency score before receiving the real intraoperative training [8]. Synthetic phantom models have demonstrated increasing potential as useful simulators for neurosurgical training [3,14,16].…”

Section: Discussionmentioning

confidence: 99%

“…A basal encephalocele is defined as a neural element herniation, including the pituitary gland or optic chiasm, through an anatomical defect in the base of the skull [1][2][3][4]. They represent 1.5-5% of all cephaloceles, and the transsphenoidal encephalocele is the rarest form [2,5,6], with an incidence estimate of 1 in 700,000 live births [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, most reports focus on basal encephaloceles in newborns and infants who have a much smaller nasal cavity and more difficult access [7]. In cases of transsphenoidal encephaloceles with significant skull defects, most authors prefer transpalatal approaches to avoid the recurrence of the herniation through safe and wide access [3,4]. However, palatal osteotomies and removing the hard palate may be technically challenging as much as the reconstruction of the skull base and closure of the mucosal layer [4].…”

Section: Introductionmentioning

confidence: 99%

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A hybrid simulation model for pre-operative planning of transsphenoidal encephalocele

et al. 2020

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Congenital transsphenoidal encephalocele (CTE) surgical correction is a challenging procedure. Although rare, this anomaly, characterized with neural herniation elements, including the pituitary gland or optic pathway through the sphenoid bone with anatomical alteration, can be presented in many different ways and should be individually analyzed. Significant advances in medical technology and the 3D models may simulate the complex anatomical relations of the human body. Nowadays, medical education relies on the availability of standardized materials that can reliably emulate human anatomy. Therefore, realistic anatomical models have become an alternative for cadavers or animal specimens. In this technical note, the authors present a new technique to create personalized models that combine 3D printing, molding, and casting to create an anatomically and tactilely realistic model based on magnetic resonance and computerized tomography images. Produced from different silicon types, the model recreated the anatomic alterations precisely, allowing a multidisciplinary team to determine the adequate surgical approach for this patient. We describe a case of congenital transsphenoidal encephalocele of a 3-year-old boy, whose surgical correction was planned using a hybrid model. The technical description of the model is given in detail. This new hybrid model allowed a detailed discussion of the surgical approach aspects by having tissues of different consistencies and resistances and a very high prediction rate. This approach may allow a reduction in surgery time and possible complications after operative procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A hybrid simulation model for pre-operative planning of transsphenoidal encephalocele

et al. 2020

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“…[17][18][19] Clinical studies on the use of costal cartilage have grown exponentially. 17,20,21 Accordingly, research on costal cartilage dynamics increased as well. [21][22][23][24] With the related costs of care, feeding, and management for larger animals and a relatively large amount of tissue as specimen, in vivo studies on costal cartilage have largely used the medium-sized, New Zealand white rabbit for research.…”

Section: Discussionmentioning

confidence: 99%

The Rabbit Costal Cartilage Reconstructive Surgical Model

et al. 2014

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Rib grafts in facial plastic surgery are becoming more frequently used. Small animal models, although not ideal may be used to emulate costal cartilage-based procedures. A surgical characterization of this tissue will assist future research in the selection of appropriate costal segments, based on quantitative and qualitative properties. The objective of this study is to assess the surgical anatomy of the rabbit costal margin and evaluate costal cartilage for use in either in vivo or ex vivo studies and to examine reconstructive procedures. Detailed thoracic dissections of 21 New Zealand white rabbits were performed post-mortem. Costal cartilage of true, false, and floating ribs were harvested. The length, thickness, and width at proximal, medial, and distal locations of the cartilage, with perichondrium intact were measured. Further qualitative observation and digital images of curvature, flexibility, and segmental cross-sectional shape were recorded. The main outcome measure(s) is to characterize, describe, and assess the consistency of dimensions, location, and shape of costal cartilage. In this study, 12 to 13 ribs encase the thoracic cavity. Cartilage from true ribs has an average length, width, and depth of 23.75 ± 0.662, 3.02 ± 0.025, and 2.18 ± 0.018 mm, respectively. The cartilage from false ribs has an average length, width, and depth of 41.97 ± 1.48, 2.00 ± 0.07, 1.19 ± 0.03 mm, and that of floating ribs are 7.66 ± 0.29, 1.98 ± 0.04, and 0.96 ± 0.03 mm. Rib 8 is found to be the longest costal cartilage (49.10 ± 0.64 mm), with the widest and thickest at ribs 1 (3.91 ± 0.08 mm) and 6 (2.41 ± 0.11 mm), respectively. Cross-sectional segments reveal the distal cartilage to maintain an hourglass shape that broadens to become circular and eventually ovoid at the costochondral junction. The New Zealand white rabbit is a practical source of costal cartilage that is of sufficient size and reproducibility to use in surgical research where the long-term effects of operations, therapies, devices, and pharmacologic on cartilage can be studied in vivo.

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Repair of Giant Anterior Skull Base Encephalocele Containing Intralesional Eloquent Brain: Technical Note

Kobets¹,

Redett²,

Walsh³

et al. 2021

ONSURG

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BACKGROUND Encephaloceles are herniations of intracranial neural tissue and meninges through defects in the skull. Basal encephaloceles are rare anterior skull base defects incident in 1 in 35,000 live births. Sphenoethmoidal encephaloceles are even more uncommon, with an incidence of 1 in 700,000 live births. Anterior skull base encephaloceles may be life-threatening in infants, presenting as airway obstruction and respiratory compromise. They can also present with cerebrospinal fluid (CSF) rhinorrhea, purulent nasal drainage, or meningitis. OBJECTIVE To report a novel technique for repairing a giant sphenoethmoidal encephalocele containing eloquent neural tissue. METHODS A 16-mo-old girl presented with progressive airway obstruction from a giant sphenoethmoidal encephalocele that filled her oral cavity. She had multiple congenital anomalies including agenesis of the corpus callosum and cleft lip and palate. Computed tomography showed complete absence of the bony anterior cranial base, and magnetic resonance imaging demonstrated the presence of the pituitary gland and hypothalamus in the hernia sac. RESULTS We repaired the encephalocele using a combined microsurgical and endoscopic multidisciplinary approach working through transcranial, transnasal, and transpalatal corridors. The procedure was completed in a single stage, during which the midline cleft lip was also repaired. The child made an excellent neurological and aesthetic recovery with preservation of pituitary and hypothalamic function, without evidence of CSF fistula. CONCLUSION The authors describe a novel multidisciplinary technique for treating a giant sphenoethmoidal encephalocele containing eloquent brain. The cleft lip was also repaired at the same time. The ability to work through multiple corridors can enhance the safety and efficacy of an often-treacherous operative endeavor.

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Inferior encephalocele: transpalatal repair using paired costal bone grafts with a 14-year follow-up

Cited by 4 publications

References 23 publications

A hybrid simulation model for pre-operative planning of transsphenoidal encephalocele

A hybrid simulation model for pre-operative planning of transsphenoidal encephalocele

The Rabbit Costal Cartilage Reconstructive Surgical Model

Repair of Giant Anterior Skull Base Encephalocele Containing Intralesional Eloquent Brain: Technical Note

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