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Yoshinari Okumura, Toshisuke Sakaki and Hidehiro Hirabayashi

P rimary arachnoid cysts of the middle cranial fossa are encountered clinically with relative frequency. Numerous reports have focused on the pathophysiology of this condition. However, many questions relating to its etiology and natural history are still unresolved. Regarding therapeutic approaches for this lesion, some investigators consider that surgery is needed in all cases, including asymptomatic ones, to prevent bleeding from the cysts, 2 whereas others argue that surgical treatment is not necessary. 1, 6 Thus, there is no widely accepted therapeutic

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Taylor J. Abel, Abhineet Chowdhary, Mahesh Thapa, Joseph C. Rutledge, Joseph Gruss, Scott Manning and Anthony M. Avellino

definition “ectopias.” Heterotopia refers to the presence of tissue in an abnormal location within its organ of origin. Ectopia, on the other hand, is defined as the presence of tissue in an abnormal location outside its organ of origin. Therefore, lesions made up of glioneuronal tissue outside the CNS are appropriately defined as ectopias. Even more rare than a glioneuronal ectopia in general is the development of ectopic glioneuronal tissue in the middle cranial fossa region. 18 In 1977 Gallo and Smith 6 described the unique case of a neck mass with extensions to the

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Nasser M. F. El-Ghandour

A rachnoid cysts account for 1% of all intracranial lesions. 1 Those located in the middle cranial fossa are the most common, and account for 34% to 50% of all arachnoid cysts. 14 , 15 , 22 , 27 Middle cranial fossa arachnoid cysts are particularly challenging for neurosurgeons. The optimal surgical treatment and the indications for surgery are still a matter of debate. Traditional treatment is either by CPS placement or craniotomy and cyst marsupialization, with or without partial cyst excision. Neuroendoscopic management is emerging as a promising

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Matthew L. Carlson, William R. Copeland III, Colin L. Driscoll, Michael J. Link, David S. Haynes, Reid C. Thompson, Kyle D. Weaver and George B. Wanna

last 12 years utilizing a middle fossa craniotomy or combined mastoid–middle cranial fossa approach. Clinical presentation, radiological findings, operative strategy, and outcomes are reported, and variables associated with outcome are explored. Methods Data Collection After institutional review board approval, a retrospective chart review was conducted, and all patients who underwent surgical repair of a temporal bone encephalocele or CSFF over the last 12 years at 1 of 2 tertiary academic referral centers were identified. Data including clinical

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Mahmoud Taha, Thomas Carroll and Jeremy McMahon

A csf fistula is almost always associated with meningitis if it is not surgically treated. The cumulative risk of meningitis for conservatively treated fistulas reaches 85% over 10 years, and the risk of meningitis remains even after resolution of the CSF leakage. Surgical repair can reduce this risk to 7% at 10 years. 1 , 2 Surgical goals include the repair of osseous and dural defects and the creation of a barrier that will prevent recurrences of the brain herniation and CSF fistula. For middle cranial fossa fistulas, there are 2 main approaches for

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Y. S. Bhandari and R. A. C. Jones

O steomas presenting with intracranial complications are uncommon. 1 In this unit only nine such cases have been seen in the last 15 years; in eight the osteoma arose in relation to the frontoethmoidal sinuses, the most familiar site. The last case, however, was unusual since the osteoma arose from the inner table of the left temporal bone, projected into the middle cranial fossa, and was accompanied by a generalized epileptic seizure. Case Report A 49-year-old woman was admitted to another hospital on November 27, 1970, after a generalized epileptic

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G. Vasudeva Iyer, N. D. Vaishya, A. Bhaktaviziam, G. M. Taori and Jacob Abraham

removed a large lobulated mass 8.5 × 6.5 × 4 cm was seen partly covered by dura in the left middle cranial fossa and extending medially to the pituitary fossa with erosion of the clinoid processes. The dura with the tumor was easily separable from the bone, which appeared macroscopically normal. Posteriorly the tumor extended to the tentorial margin. The left sixth nerve, optic chiasm, and optic nerves were grossly distorted by the tumor. The meninges and dural sinuses were normal. The brain after fixation showed marked changes of softening especially in the left

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Anthony C. Wang, Steven B. Chinn, Khoi D. Than, H. Alexander Arts, Steven A. Telian, Hussam K. El-Kashlan and B. Gregory Thompson

middle cranial fossa approach . Otol Neurotol 27 : 234 – 241 , 2006 3 Betchen SA , Walsh J , Post KD : Long-term hearing preservation after surgery for vestibular schwannoma . J Neurosurg 102 : 6 – 9 , 2005 4 Chee GH , Nedzelski JM , Rowed D : Acoustic neuroma surgery: the results of long-term hearing preservation . Otol Neurotol 24 : 672 – 676 , 2003 5 Chopra R , Kondziolka D , Niranjan A , Lunsford LD , Flickinger JC : Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy

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Chiman Jeon, Chang-Ki Hong, Kyung In Woo, Sang Duk Hong, Do-Hyun Nam, Jung-Il Lee, Jung Won Choi, Ho Jun Seol and Doo-Sik Kong

S kull base lesions involving Meckel’s cave and the middle cranial fossa remain surgically challenging because of the anatomical complexity of this area; the proximity to critical neurovascular structures, including several cranial nerves and the internal carotid artery (ICA); and the risk of profuse bleeding from the venous plexus. 21 , 22 , 31 , 36 , 44 Classic transcranial approaches to such deep regions require extensive removal of bone and muscles and moderate brain retraction. 3 , 20 , 21 , 23 , 31 , 32 , 39 Although each approach has its own benefits

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Huy Q. Truong, Xicai Sun, Emrah Celtikci, Hamid Borghei-Razavi, Eric W. Wang, Carl H. Snyderman, Paul A. Gardner and Juan C. Fernandez-Miranda

M eckel ’s cave is a pouch of dural fold in the middle cranial fossa. Inside the diverticulum dwells the trigeminal nerve as it emerges from the posterior fossa, the Gasserian ganglion, and part of the 3 branches before they enter their respective foramina. 22 , 32 Given the simple contents of the structure, few types of pathology affect the area. The most frequent tumor type that originates from Meckel’s cave is trigeminal schwannoma; 3 , 17 other types include meningioma, 17 , 23 epidermoid cyst, 3 , 8 , 17 , 18 dermoid cyst, 17 melanoma, 7 and