dilatation of both lateraland third ventricles. b 3D-CISS MRI midsagittal sections of the brain showing aqueductalstenosis with obstructive hydrocephalus.c , d 3D-CISS MRI sagittal sectionsof the brain showingmultiple septaand locules within ventricle appearing as haustrations. The layering fluid within theventricles is probably due to high protein content secondary to infection.
Dhaval Shukla's lateral thought module in action! Pediatr Neurosurg 2010;46:247–248
There was no perception of light in right eye and she was able to count fingers at one feet in left eye . A small residual temporal field of vision exists in left.Papilledema in left fundus has resolved after first surgery. There is optic atrophy in both eyes, severe in right.
Discussion on this case till now [copied from Yahoo group site activity]
Chief,
Great excision of intracranial portion.
What is the histopathology report?
Its difficult to say how to remove the extracranial part. I feel there could be two ways to excise the extracranial part :
1. endonasal endoscopic excision (navigation assisted)
2. Le-Fort osteotomy and excision.
Let us know further.
Nitin
Hey CHief
Great removal of the intracranial component. Well the extracranial appears to involve the posterior ethmoids more on the left and extending into the sphnoid sinus and uper clivus. I would consider the following options:
1.Transethmoid approach with an ENT collegue, the posterior most may be difficult to reach..
2. ENdoscopic transnasal/transeth moid would also be a good option, best with navigation..
3.If you want an open approach then, extended subfrontal route, you will be able to remove the entire lesion. GOod ACF base repair is a must
4. Options for involved bone would be to wait for HPE and if grade 1 then wait and follow up oterwise to irradiate, stereotactic radiotherapy. ..
Regards,
MAqsood
