Surgical tactics in fractures of frontal bone involving frontal sinus

Review of literature dealing with fractures of frontal bone involving frontal sinus is presented. 3 cases of successful surgical treatment of different frontal sinus injuries are reported in the paper. The author demonstrates importance of selection of correct surgical tactics for primary reconstruction of frontal bone using craniofacial osteosynthesis. The key moment of surgical procedure is making a decision about preservation or elimination (obliteration or cranialization) of the frontal sinus which should be based on meticulous analysis of symptoms and CT data preoperatively and intraoperatively. Special attention should be paid to application of pericranial flap for closure of fractured posterior wall of the frontal sinus. Original technique of using a split pericranial pedicled flap for isolation of dura from sinus and stimulation of reparative osteogenesis is described.     

Growth disturbance of frontal lobe in BCECTS presenting with frontal dysfunction

A considerable proportion of children with benign childhood epilepsy with centrotemporal spikes (BCECTS) have increasingly been found to show neuropsychiatric deficits such as cognitive impairment and impulsivity, possibly associated with frontal lobe dysfunctions. We performed 3-dimensional magnetic resonance imaging (MRI)-based brain volumetry to characterize serial changes in frontal and prefrontal lobe volumes and compare volumetric changes with clinical symptoms. Serial changes in regional cerebral volumes were measured in a 5-year-old boy with BCECTS. Seizures were not easily controlled, and he demonstrated oromotor deficits, cognitive impairments and behavioral problems. Cognitive and behavioral deficits persisted even after remission of seizure disorder and oromotor deficits. Two BCECTS patients (5–6 years old) without neuropsychological disorders served as typical BCECTS, and nine normal subjects (4–10 years old) served as controls. Volumes of the frontal and prefrontal lobes were determined using a workstation, and prefrontal to frontal lobe volume ratio was calculated. Frontal and prefrontal lobe volumes showed no growth even after remission of seizure disorders. Prefrontal to frontal lobe volume ratio reduced slightly even after remission of both seizure disorders and EEG abnormalities. The result suggests that BCECTS presenting with atypical course may be associated with frontal lobe dysfunction resulting in cognitive and behavioral deficits.     

Planning impairments in frontal lobe dementia and frontal lobe lesion patients

Patients with frontal lobe brain damage are reportedly impaired on tasks that require plan development and execution. In this study, we examined the performance of 15 patients diagnosed with frontal lobe dementia and 14 patients with focal frontal lobe lesions on the Tower of London planning task. Patients with frontal lobe dementia committed a significantly higher number of rule violations, made more moves, and demonstrated longer solution time latencies compared to their matched controls. Patients with frontal lobe lesions demonstrated significantly delayed solution times and also made more moves compared to their matched controls. Frontal lobe lesion patient performance suggests an impairment in execution-related processes, while frontal lobe dementia patients appear to be impaired in both plan development and execution. Despite these findings, the identification of a specific cognitive impairment that induces these planning problems remains elusive.     

A case of bilateral frontal tumors without “frontal syndrome”

We report the longitudinal case study of a right-handed patient harboring two frontal tumors that benefited from bilateral simultaneous surgery. The tumors were WHO Grade II gliomas located in the left inferior frontal area (including the cingulate gyrus) and the right anterior superior frontal gyrus. The double tumor resection was guided by direct electrical stimulation of brain areas while the patient was awake. Neuropsychological assessments were administered before and after the surgery to analyse how the brain functions in the presence of two frontal gliomas that affect both hemispheres and reacts to a bilateral resection, which can brutally compromise the neuronal connectivity, progressively established during the infiltrating process. We showed that both the tumor infiltration and their bilateral resection did not lead to a “frontal syndrome” or a “dysexecutive syndrome” predicted by the localization models. However, a subtle fragility was observed in fine-grain language, memory and emotional skills. This case study reveals the significance of brain plasticity in the reorganization of cognitive networks, even in cases of bilateral tumors. It also confirms the clinical relevance of hodotopical brain models, which considers the brain to be organized in parallel-distributed networks around cortical centers and epicenters.     

Somatosensory disinhibition and frontal alien hand signs following medial frontal damage.

We report augmentation of somatosensory evoked potentials (SEP) in a patient with frontal alien hand signs after left medial frontal lobe damage. The SEP components occurring later than 30 msec post stimuli were enhanced over the parietal and frontal scalp sites of the lesioned hemisphere. This finding suggests that deficits in inhibitory control of somatosensory processing in parietal and frontal lobes contributes in some way to frontal alien hand signs.     

Bilateral frontal epidural abscess

DESCRIPTION: A 19-year-old male with periorbital painful swelling, headache and vomiting was admitted to our clinic. Because of the diagnosis of sinusitis he had received medical treatment in another center two months before, consisting of antibiotics and analgesics. However as a result of valid persistence of the patients' complaints, brain CT and MR imaging were required; showing bilateral epidural abscess. The patient was operated upon through a coronal incision and bifrontal craniotomy, draining both abscesses and removing their membranes. CONCLUSION: Epidural abscess constitute 5-25% of all the localized intracranial infections. Microorganism colonization may be produced by contiguous infection, hematogenous spread, open cranial trauma or as a consequence of neurosurgical intervention. Sinusitis is one of the most relevant causes of epidural abscesses, mostly in the frontal region. Bilateral occurrence is rare. In this paper a case of bilateral epidural abscess is pre-sent. Diagnosis criteria and treatment approaches are reviewed.     

Topography of projections to the frontal lobe from the macaque frontal eye fields

Efferents from the frontal eye fields (FEF) to the ipsilateral frontal lobe were studied by autoradiography of tritiated tracers (leucine, proline, and fucose) in seven macaque monkeys that were used previously to describe subcortical connections. In four of the cases, tracer injection sites were confirmed by low thresholds for the electrical elicitation of saccadic eye movements. Cases were grouped as lFEF or sFEF cases according to large or small saccades that were characteristic of the injection site. Projections from the FEF terminated in five frontal regions: (1) area FD on the dorsomedial convexity; (2) area FC (containing SEF) medial to the upper limb of the arcuate sulcus; (3) areas FD and FDΔ along the walls of the principal sulcus; (4) area FCBm on the deep, posterior wall of the arcuate sulcus inferior to the sulcal spur; and (5) the inferolateral cortex (area FDi) on the convexity and lateral two thirds of the anterior wall of the arcuate sulcus. Projections in sFEF cases tended to be confined to medial parts of dorsomedial FD and FC and the lateral wall of the principal sulcus and inferolateral convexity. Neither lFEF nor sFEF appeared to project to the SMA or pericingulate cortex. Label in these areas was found only in the cases in which tracer spread into non-FEF areas. FEF projections terminated in column-like patches of about 500–600 μm in diameter. Labeled axons and terminals were seen in all cortical layers regardless of location in the frontal lobe.     

Fibrous dysplasia of the frontal sinus: an uncommon cause of frontal lobe abscess

Fibrous dysplasia of the cranial air sinuses is rarely reported in the literature. This is the first report of frontal lobe abscess (FLA) associated with fibrous dysplasia of the frontal sinus (FDFS). A 29-year-old female presented with seizures and acute confusion. Cranial computed tomography (CT) revealed fibrous dysplasia of the left frontal sinus and associated FLA. She was referred to the neurosurgical service and the abscess and dysplastic tissue were removed. Histological examination confirmed fibrous dysplasia. We review the radiological appearance of FDFS with FLA. Clinicians should be aware of the association between these two conditions.     

Motor abilities after frontal leukotomy

The effect of bilateral frontal leukotomy on motor function was evaluated by neurologic examination, tests of praxis, and appropriate neuropsychologic tests administered to five groups of subjects. Postleukotomy schizophrenic patients were subdivided into three degrees of recovery. Two nonleukotomized groups served as controls for effects of schizophrenia, age, and education. The results indicate that the size of the bifrontal damage was not significant in the response to the motor tests, whereas the severity of schizophrenia clearly affected results. As tested, bilateral orbitofrontal white matter lesions did not disturb motor competency.     

Topiramate in frontal lobe epilepsy

BACKGROUND: Frontal lobe epilepsy (FLE) is a type of epilepsy that is difficult to treat and there are few studies about the use of topiramate (TPM). AIM OF THE STUDY: To evaluate the efficacy and tolerability of TPM monotherapy in FLE. METHODS: The study group consisted of 55 (33 male; 22 female) patients. TPM was administered as a first drug (n = 16) or converted after previous treatment (n = 39). All patients were followed every 3 months for at least 1 year. The patients were subdivided into two groups: 'newly diagnosed' patients and 'difficult-to-treat' patients. RESULTS: Overall, all patients completed the 1-year study. At the end of follow-up, 10 patients showed disappearance of seizures and 33 patients showed improvement in seizure frequency. In particular, among the newly diagnosed patients 6/16 patients showed complete cessation of seizures and 5/16 patients showed very good response; in the other group, 4/39 patients showed complete cessation and 4/39 patients showed a very good response. No patients of both groups had worsening of seizures. No treatment-limiting adverse events associated with TPM were reported. CONCLUSIONS: TPM is effective in newly diagnosed patients with FLE; TPM can be considered for the treatment of FLE.     

Kleptomania in frontal lobe lesion

A case of a kleptomaniac with frontal lobe dysfunction is presented. Kleptomania is related to the obsessive-compulsive spectrum disorders and the affective spectrum disorders. In obsessive-compulsive spectrum disorders neuroimaging and neuropsychological tasks have revealed abnormal functioning in the frontal brain which also could be related to kleptomania. Consolidated findings from animal and human studies have implied central serotonergic transmission in the genesis of obsessive-compulsive spectrum disorders and affective spectrum disorders. Altogether, these results suggest that kleptomania, like other disorders of the above mentioned spectrums, could have an abnormality in serotonergic transmission in common.     

Personality in frontal lobe disorders

Personality changes in frontal lobe disorders are easy to recognize, but their evolution can be hard to predict. Both focal lesions and diffuse neurodegenerative processes may produce personality change based on interruption of prefrontal cortex or subcortical structures that comprise the frontal-subcortical circuits. Observed changes in personality have been classified by behavioral neurologists into three frontal-subcortical circuit syndromes, yet a given patient may defy this classification system by manifesting only selective features of one or more syndromes simultaneously, based on the neuroanatomic distribution of pathology. The orbitofrontal syndrome is the most well known and consists of major antisocial behaviors such as disinhibition, emotional lability, and impulsivity. In some cases, changes are severe enough to lead to new onset of criminality. Apathy and amotivational state lie at the other end of the personality change spectrum. Many psychologic instruments can measure the degree of change in personality, but none of them can be used to extrapolate a patient’s ability to function at home or at large in society. The psychopathy checklist by Hare may predict risk of violence but has been validated only for use in criminal populations.