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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Remodelling the cranial vault in an attempt to increase the intracranial volume and thus control intracranial hypertension, whilst at the same time improving the patient's appearance, has been the mainstay of surgery for syndromic craniosynostosis. We report a case of craniosynostosis in whom cranial vault expansion was followed by the development of hind-brain herniation and hydrocephalus. This prompted a review of our other cases of craniosynostosis who had been evaluated by magnetic resonance imaging following surgery in order to assess the frequency of hind-brain herniation and hydrocephalus in these children. Magnetic resonance imaging had been performed in the postoperative evaluation of 34 cases of craniosynostosis who had undergone procedures intended to increase the intracranial volume. The position of the cerebellar tonsils and the presence or otherwise of hydrocephalus was recorded for all cases. The effectiveness of surgery in treating raised intracranial pressure (ICP) was evaluated by means of postoperative ICP monitoring and had been performed in 22 cases. Herniation of the hind-brain below the level of the foramen magnum was observed in 18 cases (53%). Hydrocephalus, requiring the insertion of a ventriculoperitoneal shunt, was present in 14 cases (41%) and had developed after the cranial vault procedure in 9. The mean sleeping ICP measured postoperatively was normal (<10 mm Hg) in 5, borderline (10-15) in 7, and raised (>15 mm Hg) in 10 cases. Cranial vault expansion in complex craniosynostosis may fail to address the underlying aetiology of intracranial hypertension. Furthermore, both hydrocephalus and hind-brain herniation may develop following such surgery. Neither the increase in intracranial volume afforded by cranial vault expansion nor the shunting of hydrocephalus precludes the persistence of abnormal ICP. These findings are discussed in the light of possible mechanisms, in addition to cephalocranial disproportion responsible for intracranial hypertension in complex craniosynostosis. The implications for the surgical management of complex craniosynostosis are reviewed.
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PMID:Consequences of cranial vault expansion surgery for craniosynostosis. 948 57

A morphological study, macro and microscopical, was made of brain lesions in 120 victims of fatal road traffic accidents. Parahipoccampal hernia, Duret haemorrhage and infarction in the medio-basal occipital lobe, clear evidence of raised intracranial pressure, occurred in 43 (35.8%) patients. The increased intracranial pressure from the head injury is caused by brain swelling and by intracranial haematomas. In this series 3 cases of extradural haematomas (7.0%), 9 of subdural haematomas (20.9%), 6 of intracerebral haematomas (14%), 6 of burst lobe (14%) and 9 of brain swelling (20.9%) were observed.
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PMID:[Intracranial hypertension in victims of fatal traffic accidents]. 1075 21

Longstanding hydrocephalus and raised intracranial pressure can lead to unusual anatomical variants in the floor of the third ventricle, which may be important when performing endoscopic third ventriculostomy. Two middle aged patients with symptomatic longstanding hydrocephalus had scans that showed ventricular hydrocephalus, an empty sella, and a dilated infundibular recess which herniated into the sella turcica. Endoscopic third ventriculostomy confirmed that instead of the tuber cinerum and infundibular recess, the anterior inferior floor of the third ventricle was hanging down ventral to the pons into the sellar floor. Third ventriculostomy to the prepontine cistern was made on the dorsal wall of the dilated infundibular recess to the area surrounded by the dorsum sellae, the basilar artery trunk, and the left superior cerebellar artery, with good symptomatic control. Association of the empty sella and persistence of the infundibular recess must be carefully evaluated by MRI before attempting endoscopic third ventriculostomy. Herniation of the anterior inferior floor of the third ventricle into the empty sella can lead to loss of anatomical landmarks that require special attention during third ventriculostomy.
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PMID:Anatomical variants in the floor of the third ventricle; implications for endoscopic third ventriculostomy. 1099 May 19

The aim of this study was to explore the spatiotemporal development of cerebral oedema in the early stage of severe burn (50% TBSA, third degree), using a four-dimensional (4D) mathematical model. Twenty-six male mongrel dogs were randomly divided into control and 6, 12, 18, and 24 post-burn hour (PBH) groups. The manifestation of magnetic resonance imaging (MRI) and histopathology, changes of brain water content, and intracranial pressure were observed in each group respectively. A 4D mathematical model was established on the basis of the results of MRI scanning. Two turning points (6 and 18 PBH) and three phases of pathological change were displayed by the 4D mathematical model of cerebral oedema in the early stage of severe burn. The first phase was in the subclinical period, and effective treatment should therefore be performed as quickly as possible in order to prevent deterioration of post-burn cerebral oedema. The second phase (6-18 PBH), with pathological characteristics of cytotoxic cerebral oedema, was in the apoptosis period. The third stage (18-24 PBH) was the danger period of cerebral oedema. Intracranial pressure increased rapidly owing to the limitation of the cranial cavity. As a result, cerebral hernia could easily occur. An S-shape curve in the pathological process of cerebral oedema occurred in the early post-burn stage following severe burn.
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PMID:Application of a Four-dimensional Mathematical Model in the Establishment of an Early Post-burn Cerebral Oedema Model in Severely Burned Dogs. 2199 Sep 86

Wenzel Leopold Gruber and Primo Dorello were great anatomists and researchers during the 19th and 20th centuries. Their contributions to neuroanatomy-namely the Gruber's (petrosphenoidal) ligament and Dorello's canal, respectively-have come to be important structures in various approaches through the middle fossa. These structures have also helped provide us with an understanding of the mechanism of sixth nerve paresis in various pathological conditions, such as raised intracranial pressure and Gradenigo syndrome. Their numerous publications have stood as a reference to anatomical researchers. Gruber's description of internal mesogastric hernia and the Meckel-Gruber anastomosis are also widely known in medical literature. The following article is an attempt to reflect upon the life and works of Gruber and Dorello and the importance of their research.
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PMID:Dorello's Canal and Gruber's Ligament: Historical Perspective. 2429 62