An Anatomical Model for Studying Cerebellar Tonsillar Herniation Related to Raised Intracranial Pressure

2021 ◽  
Author(s):  
Kennedy Carpenter ◽  
Joe Iwanaga ◽  
Aimee Aysenne ◽  
Aaron S. Dumont ◽  
C. J. Bui ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Raised Intracranial Pressure ◽  
Tonsillar Herniation ◽  
Anatomical Model ◽  
Cerebellar Tonsillar Herniation

scholarly journals Management of Cerebellar Tonsillar Herniation following Lumbar Puncture in Idiopathic Intracranial Hypertension

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Kenneth R. Hoffman ◽  
Sean W. Chan ◽  
Andrew R. Hughes ◽  
Stephen J. Halcrow
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Decompressive Craniectomy ◽  
Idiopathic Intracranial Hypertension ◽  
Neuronal Injury ◽  
Raised Intracranial Pressure ◽  
Tonsillar Herniation ◽  
Cerebellar Tonsillar Herniation

Lumbar puncture is performed routinely for diagnostic and therapeutic purposes in idiopathic intracranial hypertension, despite lumbar puncture being classically contraindicated in the setting of raised intracranial pressure. We report the case of a 30-year-old female with known idiopathic intracranial hypertension who had cerebellar tonsillar herniation following therapeutic lumbar puncture. Management followed guidelines regarding treatment of traumatic intracranial hypertension, including rescue decompressive craniectomy. We hypothesize that the changes in brain compliance that are thought to occur in the setting of idiopathic intracranial hypertension are protective against further neuronal injury due to axonal stretch following decompressive craniectomy.

Posterior calvarial distraction for complex craniosynostosis and cerebellar tonsillar herniation

2020 ◽  
Vol 26 (4) ◽  
pp. 421-430
Author(s):  
William B. Lo ◽  
Kyaw Z. Thant ◽  
Jameel Kaderbhai ◽  
Nicholas White ◽  
Hiroshi Nishikawa ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Volume Expansion ◽  
Csf Shunt ◽  
Width Ratio ◽  
Type I ◽  
Raised Intracranial Pressure ◽  
Tonsillar Herniation ◽  
Cerebellar Tonsillar Herniation ◽  
Lambdoid Synostosis ◽  
The Mean

OBJECTIVEChildren with syndromic, multisuture, and lambdoid craniosynostosis undergoing calvarial surgery often have Chiari malformation type I (CM-I) (or cerebellar tonsillar herniation). The optimal management of this patient group, including the surgical techniques and timing of surgery, remains uncertain. Posterior calvarial distraction (PCD) is an effective method to increase the supratentorial cranial volume and improve raised intracranial pressure in children with complex craniosynostosis. This study investigated the efficacy of PCD in posterior fossa (PF) volume expansion and treatment of CM-I and associated syringomyelia (syrinx) in this group of children.METHODSThis retrospective study included patients who were surgically treated between 2006 and 2015. Over 10 years, 16 patients with multisuture synostosis, lambdoid synostosis, or craniosynostosis associated with a confirmed genetic syndrome, and a concurrent CM-I, were included. The mean age at the time of surgery was 5.1 years (range 8 months–18 years). Fourteen patients had pansynostosis and 2 had lambdoid synostosis. Eight had a confirmed syndromic diagnosis (Crouzon in 8, Apert in 4, Pfeiffer in 1, and Saethre-Chotzen in 1). Ten patients had raised intracranial pressure; 4 had syringomyelia.RESULTSThe average clinical follow-up was 50 months (range 9–116 months). Clinically, 9 patients improved, 7 remained stable, and none deteriorated. The average distraction distance was 23 mm (range 16–28 mm). The PF anterior-posterior (AP) distance/width ratio increased from 0.73 to 0.80 mm (p = 0.0004). Although an osteotomy extending inferior to the torcula (compared with superior) was associated with a larger absolute PF AP distance increase (13 vs 6 mm, p = 0.028), such a difference was not demonstrable when the PF AP distance/width ratio was calculated. Overall, the mean tonsillar herniation improved from 9.3 to 6.0 mm (p = 0.011). Syrinx dimensions also improved in the AP (from 7.9 to 3.1 mm) and superior-inferior (from 203 to 136 mm) dimensions. No patients required further foramen magnum decompression for CM. Of the 16 patients, 2 had subsequent frontoorbital advancement and remodeling, of which 1 was for volume expansion and 1 was for cosmetic purposes. Two patients required CSF shunt insertion after PCD.CONCLUSIONSFollowing PCD, PF volume increased as well as supratentorial volume. This morphometric change was observed in osteotomies both inferior and superior to the torcula. The PF volume increase resulted in improvement of cerebellar tonsillar herniation and syrinx. PCD is an efficacious first-line, single-stage treatment for concurrent pansynostosis and lambdoid craniosynostosis, CM-I, and syrinx.

scholarly journals Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

2021 ◽  
Author(s):  
Lamkordor Tyngkan ◽  
Nazia Mahfouz ◽  
Sobia Bilal ◽  
Bazla Fatima ◽  
Nayil Malik
Keyword(s):  
Intracranial Pressure ◽  
Epidural Hematoma ◽  
Rare Complication ◽  
Rare Entity ◽  
Raised Intracranial Pressure ◽  
Extradural Hematoma ◽  
Transtentorial Herniation ◽  
Hematoma Evacuation ◽  
Brainstem Injury ◽  
Acute Epidural Hematoma

AbstractTraumatic brainstem injury can be classified as primary or secondary. Secondary brainstem hemorrhage that evolves from raised intracranial pressure (ICP) and transtentorial herniation is referred to as Duret hemorrhage. We report a 25-year-old male who underwent emergency craniotomy, with evacuation of acute epidural hematoma, and postoperatively developed fatal Duret hemorrhage. Duret hemorrhage after acute epidural hematoma (EDH) evacuation is a very rare complication and the outcome is grave in most of the cases.

Raised Intracranial Pressure

1991 ◽  
Vol 74 (4) ◽  
pp. 799-799
Author(s):  
Frederick E. Sieber
Keyword(s):  
Intracranial Pressure ◽  
Raised Intracranial Pressure

Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis

2002 ◽  
Vol 249 (9) ◽  
pp. 1292-1297 ◽  
Author(s):  
Frank Winkler ◽  
Stefan Kastenbauer ◽  
Tarek A. Yousry ◽  
Ulrich Maerz ◽  
Hans-W. Pfister
Keyword(s):  
Intracranial Pressure ◽  
Pneumococcal Meningitis ◽  
Ct Imaging ◽  
Raised Intracranial Pressure ◽  
Brain Ct
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