Sample records for labyrinthectomy petrous apicectomy

  1. Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study.

    Chanda, Amitabha; Nanda, Anil


    The petroclival region generally is thought to be an inaccessible area in the intracranial compartment. A number of ways of reaching this area during surgery have been described, including the presigmoid petrosal approach. The partial labyrinthectomy petrous apicectomy approach is a relatively new approach to this region and is a variant of the presigmoid petrosal approach. This study aims to demonstrate the technique and the microsurgical anatomy of the partial labyrinthectomy petrous apicectomy approach and to provide a quantitative study of its exposure to compare it with other common approaches to this region, particularly the presigmoid petrosal approach. Bilateral stepwise dissections were performed on 15 formalin-fixed and dye-injected cadaveric heads (30 sides) under x3 to x40 magnification. A temporal craniotomy was performed after a complete mastoidectomy. A partial labyrinthectomy and petrous apicectomy were performed next. The amount of dura exposed was measured before and after the partial labyrinthectomy and the petrous apicectomy. By measuring the angles of exposure, the approach was examined to analyze how much increased access was gained. This approach provided wide exposure to the petroclival region, the cerebellopontine angle, Meckel's cave, the cavernous sinus, and the prepontine region. On average, there was an increase of 10.8 mm in horizontal exposure as compared with the retrolabyrinthine approach. The average angle of vision achieved with the clival pit as the target was 58.9 degrees. In most of the specimens, an area from the IIIrd to the IXth cranial nerves was easily visible without any significant brain retraction. A high jugular bulb did not reduce the exposure. The partial labyrinthectomy petrous apicectomy approach converts two narrow tunnels into a wide corridor. It increases the angle of exposure markedly, providing easy and excellent exposure of the otherwise difficult-to-access petroclival region, and it may also preserve hearing.

  2. The partial labyrinthectomy petrous apicectomy approach to petroclival meningiomas. A quantitative anatomic comparison with other approaches to the same region.

    Mandelli, C; Porras, L; López-Sánchez, C; Sicuri, G M; Lomonaco, I; García-Martínez, V


    The partial labyrinthectomy petrous apicectomy (PLPA) approach is a transpetrous route that provides the advantages of the labyrinthine removal but with hearing preservation. Using seven temporal bone tissue blocks and three formaldehyde-fixed cadaveric heads we have made a morphometric and comparative study on this approach that summarizes the invasiveness, the optimal surgical exposure, the anatomic complexity of the skull base approaches and, on the other hand, the spirit of preservation that is the constant aim of modern neurosurgery. The morphometric analysis is designed to make the bony phase of the PLPA approach safer and to define the relationship between petrous landmarks. The comparative study is made between the PLPA and other neurosurgical routes enhancing the potentiality of the PLPA approach that permits a wider angle of incidence towards the brainstem than with the retrosigmoid routes.

  3. Early Conquest of the Rock: Julius Lempert's Life and the Complete Apicectomy Technique for the Treatment of Suppurative Petrous Apicitis.

    Krisht, Khaled M; Shelton, Clough; Couldwell, William T


    Julius Lempert (1891-1968) was one of the most revolutionary and innovative neuro-otologists of the 20th century. He had a remarkable role in advancing the field of otolaryngology to its modern shape and form, especially through his groundbreaking introduction of the fenestration procedure for the treatment of otosclerosis. Although he is highly celebrated by many neuro-otologists for his contributions to our surgical and anatomical understanding of the petrous bone, he is not well known to the neurosurgical community. In this article, we give a detailed account of Dr. Lempert's life and discuss his invaluable contribution to skull base petrous bone anatomy and surgery through his pioneering work on the complete apicectomy for the treatment of suppurative petrous apicitis.

  4. Endoscopic-Assisted Posterior Intradural Petrous Apicectomy in Petroclival Meningiomas: A Clinical Series and Assessment of Perioperative Morbidity.

    Tatagiba, Marcos; Rigante, Luigi; Mesquita Filho, Paulo; Ebner, Florian H; Roser, Florian


    To describe the clinical feasibility and outcome of the endoscopic-assisted posterior intradural petrous apicectomy approach (PIPA) for petroclival meningiomas extending into the supratentorial space. From 2005-2013, 29 patients with a petroclival meningioma underwent tumor removal through a PIPA approach. The approach consists of a retrosigmoid approach, intradural anterior resection of the petrous apex and microsurgical removal of the tumor, followed by endoscopic-assisted visualization and removal of tumor parts in the middle fossa or anterior to the brainstem. Patients consisted of 7 men and 22 women; the mean age of patients was 52.7 years. In 24 patients, surgery was performed with the patient in a semisitting position; in 5 patients, surgery was performed with the patient in a supine position. A total resection was achieved in 19 patients (66%). A Karnofsky performance scale score >60% was recorded in 27 patients (93%), with surgical complications that involved a cerebrospinal fluid leak in 3 patients, bleeding in the surgical cavity in 2 patients, and pneumocephalus in 1 patient. The most frequent postoperative neurologic deficit was facial palsy (34%), which disappeared or improved consistently in all but 1 patient, who required a cranial nerve VII-cranial nerve XII anastomosis. For petroclival meningiomas extending into the middle fossa, the endoscopic-assisted PIPA approach is safe and straightforward. The principal advantages of the PIPA approach are familiarity with the retrosigmoid route; the absence of temporal lobe retraction; and early control of the cranial nerves, vessels, and brainstem. However, careful patient selection regarding tumor extension is fundamental to obtaining optimal outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Petrosectomy and Topographical Anatomy in Traditional Kawase and Posterior Intradural Petrous Apicectomy (PIPA) Approach: An Anatomical Study.

    Rigante, Luigi; Herlan, Stephan; Tatagiba, Marcos Soares; Stanojevic, Milan; Hirt, Bernhard; Ebner, Florian Heinrich


    To compare the anatomical exposure and petrosectomy extent in the Kawase and posterior intradural petrous apicectomy (PIPA) approaches. Kawase and PIPA approaches were performed on 4 fixed cadaveric heads (3 alcohol-fixed, 1 formaldehyde-fixed silicone-injected; 4 Kawase and 4 PIPA approaches). The microsurgical anatomy was examined by means of Zeiss Opmi CS/NC-4 microscopes. HD Karl Storz Endoscopes (AIDA system) were used to display intradural exposure. Petrosectomy volumes was assessed by comparing pre- and postoperative thin-slice computed tomography scans (Analyze 12.0; AnalyzeDirect Mayo Clinic). The Kawase approach exposed the rhomboid fossa with Meckel's cave extradurally, the upper half of the clivus, superior cerebellopontine angle, ventrolateral brainstem, the intrameatal region, basilar apex, and the preganglionic root of cranial nerve (CN) V, CN III-IV-VI intradurally. The PIPA approach exposed the cerebello-pontine angle with CN VI-XII, Meckel's cave, CN III-V, and the middle and lower clivus intradurally from a posterior view. The area of surgical exposure is wide in both approaches; however, the volume of petrosectomy, the working angle, and surgical corridor differ significantly. The Kawase approach allows wide exposure of the middle cranial fossa (MCF) and posterior cranial fossa, requiring extradural temporal lobe retraction and an extradural petrosectomy with preservation of the internal acoustic meatus and cochlea. No temporal lobe retraction and direct control of neurovascular structures make the PIPA approach a valid alternative for lesions extending mostly in the Posterior cranial fossa with minor extension in the MCF. The longer surgical corridor, cerebellar retraction, and limited exposure of the anterior brainstem make this approach less indicated for lesions with major extension in the MCF and the anterior cavernous sinus. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Early Conquest of the Rock: Julius Lempert's Life and the Complete Apicectomy Technique for the Treatment of Suppurative Petrous Apicitis

    Khaled M. Krisht; Shelton, Clough; Couldwell, William T.


    Julius Lempert (1891–1968) was one of the most revolutionary and innovative neuro-otologists of the 20th century. He had a remarkable role in advancing the field of otolaryngology to its modern shape and form, especially through his groundbreaking introduction of the fenestration procedure for the treatment of otosclerosis. Although he is highly celebrated by many neuro-otologists for his contributions to our surgical and anatomical understanding of the petrous bone, he is not well known to t...

  7. Paraganglioma presenting as cholesterol granuloma of the petrous apex.

    Heman-Ackah, Selena E; Huang, Tina C


    We report the unique finding of a petrous apex cholesterol granuloma associated with a paraganglioma, also known as a glomus jugulare tumor, in a 52-year-old woman who presented to our department with pulsatile tinnitus, hearing loss, aural fullness, and disequilibrium. She had been treated for a petrous apex cholesterol granuloma 20 years earlier, at which time she had undergone drainage of the granuloma via subtotal petrous apicectomy. When she came to our facility approximately 20 years later, she had signs and symptoms consistent with a jugular paraganglioma, which was likely to have been present at the time of her initial presentation for the cholesterol granuloma. In fact, microscopic bleeding from the paraganglioma might have led to the formation of the cholesterol granuloma. The metachronous presentation of these two entities, which to our knowledge has not been reported previously in the literature, indicates the potential association of paragangliomas with the formation of cholesterol granulomas of the petrous apex.

  8. Petrous Bone Cholesteatoma

    Sanna, Mario; Zini, Carlo; Gamoletti, Roberto; Frau, Niccolò; Taibah, Abdel Kader; Russo, Alessandra; Pasanisi, Enrico


    Petrous bone cholesteatoma is a rare pathologic entity and may be a difficult surgical challenge because of potential involvement of the facial nerve, carotid artery, dura mater, otic capsule, and risk of cerebrospinal fluid leak. The objective of this article is to present a personal classification of petrous bone cholesteatomas, a survey of recent surgical attitudes, and our present surgical strategy based on our experience with 54 operations between 1978 and 1990. Radical petromastoid exenteration with marsupialization and the middle cranial fossa approach were used only for small pure infra- or supralabyrinthine cholesteatomas, respectively. The enlarged transcochlear approach with closure of the external auditory canal was used for infralabyrinthine, infralabyrinthine-apical, and massive petrous bone cholesteatomas. Five cases with petrous bone cholesteatomas in different locations are described in detail to present the signs and symptoms together with the management. ImagesFigure 10Figure 11Figure 12Figure 13Figure 14Figure 15Figure 16Figure 17Figure 18 PMID:17170912

  9. Neurovestibular Compensation following Ototoxic Lesion and Labyrinthectomy

    Yazdanshenas, Hamed


    Full Text Available Introduction Unilateral labyrinthectomy and intra-tympanic gentamycin have been employed in the treatment of Ménière's disease, but the efficacy of these techniques has not been well established. Objective The objective of this study is to measure the time course of recovery from a unilateral labyrinthectomy either after ipsilateral topical treatment with gentamicin to the inner ear or without the previous insult. Methods Twenty-nine adult Mongolian gerbils were randomized into two experimental groups. Group 1 (n = 17 received a right ear gentamicin drug-induced lesion by unilateral labyrinthectomy (UL. Group 2 (n = 12 only received a right unilateral labyrinthectomy lesion. We measured the horizontal vestibulo-ocular responses in gerbils before and after the lesion. The gerbils received an angular acceleration stimulus and their eye movements were recorded. Results The gentamicin lesion resulted in a quicker recovery. Experimental groups underwent a similar time course of recovery. Statistical analysis showed no significant difference between the two groups. Both groups displayed adaptation to the lesion by day 21, but long-term compensation did not completely revert to the original pre-lesion state. Conclusions In a lesion requiring both static and dynamic compensation as in UL, the need for a static compensation may alter pre-existing compensation from a previous dynamic insult and require a new compensation. A previous lesion and adaptation is not preserved for a second lesion and the subject has to re-compensate. Therefore, surgical treatment in Meniere's disease such as UL can be considered without prior gentamicin treatment. Static and dynamic compensations do not appear to be as independent as previous studies have suggested.

  10. A rare case of petrous apex osteoma.

    Cece, Hasan; Yildiz, Sema; Iynen, Ismail; Karakas, Omer; Karakas, Ekrem; Dogan, Ferit


    Osteomas are the most common tumours of the cranial vault and facial skeleton. Temporal bone osteoma is a rare entity. An osteoma arising from the petrous apex is extremely rare. We present a case of osteoma arising from the petrous apex followed by a discussion of the etiology, presentation, and radiologic findings.

  11. Petrous apex lesions in the pediatric population

    Radhakrishnan, Rupa [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Son, Hwa Jung [University of Cincinnati College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH (United States); Koch, Bernadette L. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)


    A variety of abnormal imaging findings of the petrous apex are encountered in children. Many petrous apex lesions are identified incidentally while images of the brain or head and neck are being obtained for indications unrelated to the temporal bone. Differential considerations of petrous apex lesions in children include ''leave me alone'' lesions, infectious or inflammatory lesions, fibro-osseous lesions, neoplasms and neoplasm-like lesions, as well as a few rare miscellaneous conditions. Some lesions are similar to those encountered in adults, and some are unique to children. Langerhans cell histiocytosis (LCH) and primary and metastatic pediatric malignancies such as neuroblastoma, rhabomyosarcoma and Ewing sarcoma are more likely to be encountered in children. Lesions such as petrous apex cholesterol granuloma, cholesteatoma and chondrosarcoma are more common in adults and are rarely a diagnostic consideration in children. We present a comprehensive pictorial review of CT and MRI appearances of pediatric petrous apex lesions. (orig.)

  12. Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

    Alarcón, Alfredo Vega; Hidalgo, Lourdes Olivia Vales; Arévalo, Rodrigo Jácome; Diaz, Marite Palma


    Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity. Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review. Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is the most certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high. PMID:28382129

  13. Petrous apex mucocele: high resolution CT

    Memis, A. [Dept. of Radiology, Hospital of Ege Univ., Bornova, Izmir (Turkey); Memis, A. [Dept. of Radiology, Hospital of Ege Univ., Bornova, Izmir (Turkey); Alper, H. [Dept. of Radiology, Hospital of Ege Univ., Bornova, Izmir (Turkey); Calli, C. [Dept. of Radiology, Hospital of Ege Univ., Bornova, Izmir (Turkey); Ozer, H. [Dept. of Radiology, Hospital of Ege Univ., Bornova, Izmir (Turkey); Ozdamar, N. [Dept. of Neurosurgery, Hospital of Ege Univ., Bornova, Izmir (Turkey)


    Mucocele of the petrous apex is very rare, only three cases having been reported. Since this area is inaccessible to direct examination, imaging, preferably high resolution computed tomography (HR CT) is essential. We report a case showing an eroding, non enhancing mass with sharp, lobulated contours, within the petrous apex. The presence of a large air cell on the opposite side suggested a mucocele. (orig.)

  14. Temperature variation during apicectomy with Er:YAG laser.

    Bodrumlu, Emre; Keskiner, Ilker; Sumer, Mahmut; Sumer, A Pinar; Telcıoglu, N Tuba


    The purpose of this in vitro study was to evaluate the generated temperature of the Er:YAG laser, with three different pulse durations for apicectomy, compared with tungsten bur and surgical saw. Apicectomy is an endodontic surgery performed to remove the root apex and curette adjacent periapical tissue because of lesions of the apical area that are not healing properly. Sixty single-rooted extracted human teeth were resected by three cutting methods: tungsten bur, surgical saw, and Er:YAG laser irradiation with three different pulse durations; pulse duration 50 μs, pulse duration 100 μs, and pulse duration 300 μs. Teflon-insulated, type K thermocouples were used to measure temperature changes during the apicectomy process. Data were analyzed using the general linear models procedure of the SPSS statistical software program. Although there was no statistically significant difference for the mean values of temperature changes at 1 mm away to the cutting site of teeth, there was statistically significant difference among groups for the mean values of temperature changes at 3 mm away to the cutting site of teeth. Additionally, there was statistically significant difference among groups for the total time required for apicectomy. The laser irradiation with pulse duration 50 μs appears to have the lowest temperature rise and the shortest time required for apicectomy of the three pulse durations. However, Er:YAG laser for apicectomy in all pulse durations could be used safely for resection in endodontics in the presence of sufficient water.

  15. Petrous apex lesions outcome in 21 cases

    Hekmatara M


    Full Text Available Petrous apex lesions of temporal bone progress slowly. Most of the time not only destruct this area but also involve neighbouring element. The symptoms of the neighbouring neuro-vasculare involvement we can recognize these lesions. The most common symptoms of involvement of the petrous apex are: headache, conductive hearing loss or sensorineural type, paresthesia and anesthesia of the trigeminal nerve, paresia and paralysis of the facial nerve, abducent nerve. In retrospective study which has been in the ENT and HNS wards of Amiralam hospital, 148 patients have been operated due to temporal bone tumor; from these numbers, 21 (13.6% patients had petrous apex lesions of temporal bone. Eleven (52.9% patients of these 21 persons were men and the remaining 10 (47-6% were women. The average age of the patients was 37 years. The common pathology of these patients were glomus jugulare tumors, hemangioma, schwannoma, meningioma, congenital cholesteatoma, giant cell granuloma. The kind of operations that have been done on these patients were: infratemporal, translabyrinthine and middle fossa approaches. The conclusion of this study shows that petrous apex area is an occult site. The symptoms of this lesion are not characteristic, meticulous attention to the history and physical examination are very helpful to recognition of these lesions and it's extention.

  16. Intraosseous Schwannoma of the Petrous Apex.

    Tamura, Ryota; Takahashi, Satoshi; Kohno, Maya; Kameyama, Kaori; Fujiwara, Hirokazu; Yoshida, Kazunari


    Background and Importance Intraosseous schwannoma is a relatively rare clinical entity that typically arises in vertebral and mandibular bone. Intraosseous schwannoma located entirely within the petrous bone is exceedingly rare, and only two cases have been reported to date. Clinical Presentation A 47-year-old Asian man was referred to our hospital with a chief complaint of double vision. Neurologic examination revealed left abducens nerve palsy. Radiologic imaging showed a 35-mm osteolytic expansive lesion located in the left petrous apex. We made a preoperative diagnosis of chondrosarcoma and performed surgical resection. Surgery was performed via a left subtemporal epidural approach with anterior petrosectomy. The histopathologic diagnosis of the tumor was schwannoma. Schwannoma arising from cranial nerves was excluded from intraoperative findings in conjunction with the results for cranial nerves, and intraosseous schwannoma was diagnosed. Postoperative course was uneventful, and abducens nerve palsy resolved immediately after surgery. Conclusion The differential diagnosis of intraosseous schwannoma should be considered for an osteolytic mass lesion within the petrous apex. Subcapsular tumor removal was considered ideal in terms of preservation of the cranial nerves and vessels around the tumor.

  17. Cholesterol granuloma of the petrous apex: CT diagnosis

    Lo, W.W.M.; Solti-Bohman, L.G.; Brackmann, D.E.; Gruskin, P.


    Cholesterol granuloma of the petrous apex is a readily recognizable and treatable entity that is more common than previously realized. Cholesterol granuloma grows slowly in the petrous apex as a mass lesion until it produces hearing loss, tinnitus, vertigo, and facial twitching. Twelve cases of cholesterol granuloma of the petrous apex are illustrated; ten of these analyzed in detail, especially with respect to CT findings. A sharply and smoothly marginated expansile lesion in the petrous apex, isodense with plain and nonenhancing on CT, is in all probability a cholesterol granuloma. Preoperative recognition by CT is important for planning proper treatment.

  18. Aspergillosis of the Petrous Apex and Meckel's Cave

    Ederies, Ash; Chen, Joseph; Aviv, Richard I.; Pirouzmand, Farhad; Bilbao, Juan M.; Thompson, Andrew L.; Symons, Sean P.


    Cranial cerebral aspergillosis is a rare entity in immunocompetent patients. Invasive disease involving the petrous apex and Meckel's cave has rarely been described. We present a case of localized invasive petrous apical and Meckel's cave disease in an immunocompetent patient who presented with hemicranial neuralgic pain.

  19. Petrous apex arachnoid cyst extending into Meckel's cave.

    Batra, Arun; Tripathi, Rajendra Prasad; Singh, Anil Kumar; Tatke, Medha


    A rare case of arachnoid cyst involving the petrous apex with an unusual clinical presentation has been described with special emphasis in the imaging features and importance of accurate presurgical diagnosis. Differentiation from the other benign lesions involving the petrous apex and the role of newer MR techniques in the diagnosis of these lesions has been highlighted.

  20. Petrous apex cephalocele er en sjælden lidelse

    Ingolfsdottir, Harpa Maria; Martens, Pernille Christina; Kaltoft, Nicolai;


    Petrous apex cephalocele (PAC) is a rare lesion, which represents a herniation from the posteriolateral portion of Meckel's cave into the petrous apex. The pathologic explanation is still unknown. We report a patient with clinical symptoms of facial pain, hearing loss and cerebrospinal fluid...

  1. Aspergillosis of the Petrous Apex and Meckel's Cave.

    Ederies, Ash; Chen, Joseph; Aviv, Richard I; Pirouzmand, Farhad; Bilbao, Juan M; Thompson, Andrew L; Symons, Sean P


    Cranial cerebral aspergillosis is a rare entity in immunocompetent patients. Invasive disease involving the petrous apex and Meckel's cave has rarely been described. We present a case of localized invasive petrous apical and Meckel's cave disease in an immunocompetent patient who presented with hemicranial neuralgic pain.

  2. Neurothekeoma of petrous apex: A rare entity

    Zarina Abdul Assis


    Full Text Available Intraosseous nerve sheath tumors are very rare tumors accounting for lesser than 0.2% of primary bone tumors. We present an 18-year-old female who presented with left facial paresis for the last 1 year. Magnetic resonance imaging (MRI demonstrated expansile, multiseptated, enhancing bony lesion in the left petrous apex. There was also abnormal enhancement of the 7-8 th nerve complex within the internal auditory canal. Tumor was excised by subtemporal extradural approach. The lesion was diagnosed as intraosseous neurothekeoma on histopathology. This is an extremely rare tumor and its MRI appearance in this location is being described for the first time in literature.

  3. The changing role of the apicectomy operation in dentistry.

    Chandler, N P; Koshy, S


    Enormous progress has been made in the last quarter of a century in understanding the nature of root canal infection and periapical disease. New techniques and materials may be expected to increase the already high success of conventional root canal treatment. Surgical intervention is required for cases where retreatment has failed or is not an option, and the tooth is to be retained rather than extracted. This article reviews the operation of apicectomy and how this minor oral surgical procedure has evolved. Recent modifications to techniques and materials are likely to improve its success, allowing conservation of previously unsaveable teeth.

  4. Comparing Ancient DNA Preservation in Petrous Bone and Tooth Cementum

    Margaryan, Ashot; Stenderup, Jesper; Lynnerup, Niels; Willerslev, Eske; Allentoft, Morten E.


    Large-scale genomic analyses of ancient human populations have become feasible partly due to refined sampling methods. The inner part of petrous bones and the cementum layer in teeth roots are currently recognized as the best substrates for such research. We present a comparative analysis of DNA preservation in these two substrates obtained from the same human skulls, across a range of different ages and preservation environments. Both substrates display significantly higher endogenous DNA content (average of 16.4% and 40.0% for teeth and petrous bones, respectively) than parietal skull bone (average of 2.2%). Despite sample-to-sample variation, petrous bone overall performs better than tooth cementum (p = 0.001). This difference, however, is driven largely by a cluster of viking skeletons from one particular locality, showing relatively poor molecular tooth preservation (preservation (good/bad) applied to each sample prior to DNA-extraction predicted the above/below 10% endogenous DNA threshold in 80% of the cases. Interestingly, we observe signficantly higher levels of cytosine to thymine deamination damage and lower proportions of mitochondrial/nuclear DNA in petrous bone compared to tooth cementum. Lastly, we show that petrous bones from ancient cremated individuals contain no measurable levels of authentic human DNA. Based on these findings we discuss the pros and cons of sampling the different elements. PMID:28129388

  5. Sixth Nerve Palsy from Cholesterol Granuloma of the Petrous Apex

    Roemer, Ségolène; Maeder, Philippe; Daniel, Roy Thomas; Kawasaki, Aki


    Herein, we report a patient who had an isolated sixth nerve palsy due to a petrous apex cholesterol granuloma. The sixth nerve palsy appeared acutely and then spontaneously resolved over several months, initially suggesting a microvascular origin of the palsy. Subsequent recurrences of the palsy indicated a different pathophysiologic etiology and MRI revealed the lesion at the petrous apex. Surgical resection improved the compressive effect of the lesion at Dorello’s canal and clinical improvement was observed. A relapsing–remitting sixth nerve palsy is an unusual presentation of this rare lesion. PMID:28261154

  6. [Multifrequency vestibular study after vestibular neurotomy and chemical labyrinthectomy].

    Morel, N; Dumas, G; Righini, C; Karkas, A; Hitter, A; Schmerber, S


    Vestibular neurotomy (VN) and chemical labyrinthectomy (CL) are the two most common techniques of vestibular deafferention to treat patients with intractable vertigo. A long-term evaluation of vestibular function has been performed with a variety of vestibular tests to find out whether there persisted any residual vestibular function after each technique. We called in all patients who have been treated for the last 10 years and have no known vestibular disease in the non treated ear. Low frequencies were analyzed with caloric tests, medium frequencies with the head-shaking test and head-impulse test, and high frequencies with the skull vibration test. The otolithic function was explored with the subjective vertical visual analysis and otolithic myogenic evoked potentials. Nine patients treated with VN and 12 with CL presented to our department. We were thus able to compare VN and CL patients with a group of 10 normal patients and another group of nine patients that had had a translabyrinthine approach for an acoustic neuroma. We found out that vestibular responses did persist in seven out of nine (78 %) patients after VN and 11 out of 12 (92 %) patients after CL. On the other hand, no vestibular response was detected following resection of vestibular schwannoma through a translabyrinthine approach. We came to the conclusion that the two latter techniques, unlike vestibulocochlear nerve section via the translabyrinthine approach, are only incomplete methods of vestibular deafferention.

  7. Lateral angle: a method for sexing using the petrous bone

    Norén, Anna; Lynnerup, Niels; Czarnetzki, Alfred


    We report on the results of applying the so-called lateral angle method for sex determination on skeletal remains. The lateral angle denotes the angle of the internal auditory canal in relation to the medial surface of the petrous part of the temporal bone. The method involves making a small cast...

  8. Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals

    Gale, T M; Wesson, C M


    ..., has seemed also to hold out the prospect of an advance. Whilst the data reported in this paper concerning the comparative success rates of apicectomy with amalgam REF associated with the different molars, the probable sites of failure and the risks of damage to the inferior dental nerve (IDN) in mandibular molar apicectomy continue to have relevance, our o...

  9. Comparing ancient DNA preservation in petrous bone and tooth cementum

    Hansen, Henrik B.; Damgaard, Peter de Barros; Margaryan, Ashot


    preservation in these two substrates obtained from the same human skulls, across a range of different ages and preservation environments. Both substrates display significantly higher endogenous DNA content (average of 16.4% and 40.0% for teeth and petrous bones, respectively) than parietal skull bone (average...... of 2.2%). Despite sample-to-sample variation, petrous bone overall performs better than tooth cementum (p = 0.001). This difference, however, is driven largely by a cluster of viking skeletons from one particular locality, showing relatively poor molecular tooth preservation (...). In the remaining skeletons there is no systematic difference between the two substrates. A crude preservation (good/bad) applied to each sample prior to DNA-extraction predicted the above/below 10% endogenous DNA threshold in 80% of the cases. Interestingly, we observe signficantly higher levels of cytosine...

  10. Wholly Endoscopic Permeatal Removal of a Petrous Apex Cholesteatoma

    Todd Kanzara


    Full Text Available We report a case of a petrous apex cholesteatoma which was managed with a wholly endoscopic permeatal approach. A 63-year-old Caucasian male presented with a 10-year history of right-sided facial palsy and profound deafness. On examination in our clinic, the patient had a grade VI House-Brackmann paresis, otoscopic evidence of attic cholesteatoma behind an intact drum, and extensive scarring of the face from previous facial reanimation surgery. Imaging review was suggestive of petrous apex cholesteatoma. An initial decision to manage the patient conservatively was later reviewed on account of the patient suffering recurrent epileptic seizures. A wholly endoscopic permeatal approach was used with successful outcomes. In addition to the case report we also provide a brief description of the technique and a review of the relevant literature.

  11. Petrous Apex Cephalocele: Report of Two Cases and Review of the Literature

    Jeong, Bo Seong; Lee, Ghi Jai; Shim, Jae Chan; Leee, Jae Myeong; Nam, Mee Young; Kim, Ho Kyun [Dept. of Diagnostic Radiology, Seoul Paik Hospital, Injei University College of Medicine, Seoul (Korea, Republic of)


    A petrous apex cephalocele is a rare lesion of the petrous apex. It can be discovered incidentally or can cause a suite of clinical problems, such as trigeminal neuralgia or cerebrospinal fluid leakage. Although this lesion can be misinterpreted as a pathologic lesion, the characteristic radiologic features can provide the diagnostic clue for distinguishing these two lesions and avoid unnecessary treatment. Here we present CT and MRI finding of petrous apex cephalocele in two patients with review of the literature.

  12. Periodontal status following trapezoidal and semilunar flaps in apicectomy.

    Chindia, M L; Valderhaug, J


    Apicectomy is offered where routine endodontics cannot resolve periapical inflammation. This study compared the influence on periodontal attachment level of two surgical procedures, the trapezoidal (TF) and the semilunar (SF) flaps. Twenty patients aged 16-44 years (mean 23.2 years), were randomly assigned to either flap procedure. Prior to surgery the patients received periodontal prophylaxis and oral hygiene instruction. Records were made of gingival indices, pocket depth and the distance from the cemento-enamel junction to the bottom of the gingival pocket. The measurements involved buccal surfaces of 13 to 23. The TF flap extended from 14 to 24 between the interdental papillae, whereas the SF flap was carried in a semi circle from 14 to 24 about 2mm from the attached gingiva. The surgical wounds were closed with black silk sutures. Antibiotics and analgesics were prescribed. Sutures were removed after one week. On recall after 6, 12 and 24 weeks the same measurements as before surgery were made. No statistically significant change was observed in pocket depth or attachment level between TF and SF flaps (p > 0.05). However, the TF flap produced less noticeable scarification than the SF flap.

  13. [Management of apicectomy and root canal obturation completed one time under direct vision].

    Wei, Yi-bo; Zhu, Qiang; Cao, Zhi-zhong


    To evaluate the clinical effect of apicectomy and root canal obturation completed one time under direct vision on chronic periapical periodontitis of anterior teeth. 34 cases(40 teeth) with RCT failing or larger periodontal lesion, which couldn't be cured depending on RCT only, were chosen for this clinical study. They were randomly divided into two groups with 20 teeth in each group. Root canal obturation was done after apicectomy under direct vision(group A),or apicectomy was done after RCT(group B).The time of filling process, the ratio of postobturation pain, the obturation quality and short-term efficiency of the treatment were assessed. The data were separately subjected to t test, Chi-square test, Mann-Whitney U test with SPSS12.0 software package. The time of filling process in group A was significantly less than group B (Papicectomy and root canal obturation completed one time under direct vision is rapid, simple and effective in treating chronic periapical periodontitis of anterior teeth.The short-term clinical therapeutic efficiency is similar to that of apicectomy done after RCT.

  14. Effect of propolis on vestibular compensation following unilateral labyrinthectomy in rats



    Unilateral labyrinthectomy (UL) results in the vestibular syndrome including nausea, vomiting, vertigo, spontaneous nystagrnus (SN) and postural disturbance which abate over time in a process of behavioral recovery known as vestibular compensation. In order to investigate the effect of propolis on bestibular compensation, SN and expression of c-Fos protein in the medial vestibular nucleus (MVN) were measured in unilateral labyrinthectomized Sprague-Dawley rats with pretreatment of propolis.

  15. [Experimental study of post-labyrinthectomy compensation by means of the torsion pendulum].

    Benítez-Díaz, L; Martinez-Mena, A; Davalos-Valenzuela, E; Ugalde-Martinez, S


    Recovery patterns after unilateral labyrinthectomy were studied using a torsion pendulum to produce angular accelerations in unanaesthetized, immovilized cats. The oculomotor activity before and during angular accelerations was recorded and cuantified in 10 post-labyrinthectomized cats during 26 days of recovery both with and without environmental fixation (eyes open or covered). The integrated nistagmus obtained with rotation in each direction was used as a measure of oculomotor activity, as well as an indicator of directional preponderance. It was found this indicator to be far more sensitive than the raw electronystagmic tracings to detect asymmetries in the oculomotor response. The integrated movement of the eyes without ambiental fixation (eyes covered) was consistently 40% of the pendulum's displacement; while having both eyes open, the ocular displacement was equal (100%) to that of the environment. These relations changed in a predictable and characteristic way after labyrinthectomy. Approximately between 5 and 12 days post-labyrinthectomy, the responses to stimulus in both directions become of very small magnitude, indicating a depression of the reflexes originating in the remaining normal labyrinth.

  16. Three-year outcomes of apicectomy (apicoectomy): Mining an insurance database.

    Raedel, Michael; Hartmann, Andrea; Bohm, Steffen; Walter, Michael H


    The outcome of apicectomy in clinical reality is supposed to be different compared to outcomes reported from clinical trials. The objective of this study was to measure the outcome of apicectomies under practice conditions by mining an insurance data base. This retrospective study was based on claims data of a major German national health insurance company (BARMER GEK). Through the company's data warehouse fee codes and treatment dates were accessible and allowed the tracing of clinical courses. Kaplan-Meier survival analyses for the target event 'extraction' were conducted for all teeth that underwent apicectomies within a 3 year period. Testing for differences among survival rates across groups was performed with the Log-Rank-test. A total of 93,797 teeth in 77,636 patients could be traced after apicectomy. The cumulative 3-year survival rate was 81.6%. Anterior teeth showed a significantly higher survival rate of 84.0% compared to premolars (80.4%) and molars (80.2%). The survival rate in men (83.5%) was significantly higher than in women (80.6%). Analysis of survival by age revealed continuously declining survival rates with age (93.3% for subjects under 18 years of age to 75.6% for subjects over 84 years of age). The 3-year outcomes of apicectomy were still acceptable for an intervention that is mostly conducted as a retreatment after failure of a preceding measure. However at a population level, the question remains to be answered whether other treatment options would potentially be more effective. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Comparison of subtemporal versus presigmoidal approaches for exposing petrous apex utilizing virtual reality technique

    Ke TANG


    Full Text Available Objective To perform quantitative comparison of microanatomical features between subtemporal and presigmoidal minimally invasive approaches for exposing petrous apex on the basis of virtual reality image model.  Methods CT and MRI were performed on 15 adult cadaver heads (30 sides to establish virtual reality three-dimensional anatomical model of petrous apex. The superior edge of the root of temporal bone zygomatic process and the mastoidale on the calvaria were selected as landmark points of craniotomy through subtempral and presigmoidal approaches. Petrous apex was selected as exposure landmark point on the skull base. The lines between craniotomy and exposure landmark points were used as axis to outline a cylinder simulating surgical routes of subtemporal and presigmoidal approaches. Anatomical exposures in two surgical routes were observed and measured. Statistical comparison was launched by paired t test.  Results Surgical route of subtemporal approach passed through middle skull base and temporal lobe, and then reached petrous apex. Petrous bone drilling was performed to expose internal acoustic meatus, facial nerve and labyrinth. Then, trigeminal nerve, superior petrous sinus and cavernous sinus were exposed. Surgical route of presigmoidal approach was performed by drilling petrous bone through mastoid and passing vertical segment of facial nerve. Then, glomus jugulare, the lower cranial nerves, ossicular chain, labyrinth and internal carotid artery (ICA were exposed in turn. Reaching internal acoustic meatus, the route exposed anterior inferior cerebellar artery (AICA and facial-acoustic nerve complex. Reaching petrous apex, the route involved superior cerebellar artery, superior petrous sinus, inferior petrous sinus, cavernous sinus, trigeminal nerve and partial temporal lobe. The volumes of route, osseous structures, facial-acoustic complex, labyrinth and vein involved in presigmoidal approach were more than those in subtemporal

  18. Long-term results of amalgam versus glass ionomer cement as apical sealant after apicectomy.

    Jesslén, P; Zetterqvist, L; Heimdahl, A


    A total of 67 teeth in 64 patients were treated with apicectomy and retrograde fillings. They were randomized to receive fillings of amalgam or glass ionomer cement in a comparative clinical study. Healing was evaluated clinically and radiographically after 1 and 5 years. Evaluation showed no difference in healing capacity between the two materials. Overall success rates in both groups were registered as 90% at 1 year and 85% at 5 years. Contamination with blood or saliva during insertion of the filling material did not affect healing adversely. The study shows that the 5-year follow-up result can be predicted in more than 95% of the cases at the 1-year follow-up. It can be concluded that glass ionomer cement is a valid alternative to amalgam as an apical sealant after apicectomy with equally good long-term clinical results.

  19. A 5-year audit of outcome of apicectomies carried out in a district general hospital.

    Lyons, A. J.; Hughes, C. E.; Dixon, E. J.


    Success rates of up to 90% have been claimed for apicectomy. However, the conditions that this procedure is carried out under at district general hospitals may be at variance with such studies. A 5-year audit of outcome was therefore carried out within a district general hospital. It was found that 89% of apicected teeth still remained at 5 years. Outcome was not influenced by any of the factors examined, and could not be predicted radiographically. Most failures occurred after the average postoperative review period of 10.5 months. Patient satisfaction with the procedure was high at over 90%. Based on these results it was concluded that apicectomy was an effective procedure when carried out by staff of all grades within the district general hospital, and that repeated follow-up appointments with radiographs over the first postoperative year were not useful. PMID:7574319

  20. A 5-year audit of outcome of apicectomies carried out in a district general hospital.

    Lyons, A. J.; Hughes, C E; Dixon, E. J.


    Success rates of up to 90% have been claimed for apicectomy. However, the conditions that this procedure is carried out under at district general hospitals may be at variance with such studies. A 5-year audit of outcome was therefore carried out within a district general hospital. It was found that 89% of apicected teeth still remained at 5 years. Outcome was not influenced by any of the factors examined, and could not be predicted radiographically. Most failures occurred after the average po...

  1. In vitro study of the variable square pulse Er:YAG laser cutting efficacy for apicectomy.

    Grgurević, Josko; Grgurević, Lovro; Miletić, Ivana; Karlović, Zoran; Krmek, Silvana Jukić; Anić, Ivica


    Variable square pulse (VSP) Er:YAG laser should be quicker than older Er:YAG lasers. The objectives were: (1) comparison of VSP laser and mechanical handpiece efficacy for apicectomy and (2) determination of optimal pulse width/energy/frequency combination. Sixty extracted, single-rooted mature human teeth with round apical parts were instrumented, root filled, cleaned, and divided into four groups. Apical 2 mm of each root were apicectomized with mechanical handpiece and Er:YAG laser with three different settings (LaserA = 200 mJ/300 microseconds/ 8 Hz; LaserB = 200 mJ/100 microseconds/8 Hz; LaserC = 380 mJ/100 microseconds/20 Hz). Timing results were statistically compared. LaserC was the most efficient setting. Differences between groups were significant except between LaserC-Mechanical and LaserA-LaserC (P apicectomy is slower by a factor of 7-31 than mechanical handpiece, but treatment outcome is acceptable. Optimal settings for apicectomy with VSP laser are 380 mJ/100 microseconds/20 Hz. Copyright 2005 Wiley-Liss, Inc.

  2. Patient perceived burden of implant placement compared to surgical tooth removal and apicectomy.

    Reissmann, Daniel R; Poulopoulos, Georgios; Durham, Justin


    To assess how patients actually perceive implant placement, to evaluate whether patients' perceived burdens are related to specific stages during implant placement, and to compare patients' perceptions during implant placement with other surgical procedures. A sample of 287 patients was consecutively recruited. Only patients with implantations (n=45), surgical tooth removal (n=147), or apicectomies (n=95) were included. Patients' perceptions during oral surgery and implantation were assessed using the Burdens in Oral Surgery Questionnaire (BiOS-Q). Effects of treatment on BiOS-Q total and domain scores were assessed using multivariate linear regression analyses, and effect sizes (Cohen's d) were computed. Overall, patients' perceived burdens during oral surgery were low indicated by a mean BiOS-Q total score of 28.5 points, with lowest scores for Side effects (19.4) and highest scores for Anesthesia (34.1). Among treatment groups, implantation was perceived least unpleasant. This was related to lower burdens during Bone and soft tissue manipulation during implantation than during surgical tooth removal (difference: 14.8 points; d=0.8) or apicectomy (difference: 13.1 points; d=0.7). Implantation has a low overall perceived burden and is significantly less burdensome during bone and soft tissue manipulation than surgical tooth removal or apicectomy. Patients can be informed that implant placement is less unpleasing than other commonly performed oral surgery procedures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Guided bone regeneration (GBR) using membranes and calcium sulphate after apicectomy: a comparative histomorphometrical study.

    Yoshikawa, G; Murashima, Y; Wadachi, R; Sawada, N; Suda, H


    The purpose of the present study was to evaluate the effects of resorbable and non-resorbable membranes, and calcium sulphate on bone regeneration in osseous defects in conjunction with apicectomy. The mandibular third and fourth premolars of 12 beagle dogs were root treated, and apicectomies were performed. The osseous defects were divided randomly into five groups. In groups A, B and C the osseous defects were covered with e-PTFE membranes, PLGA membranes, and collagen membranes, respectively. In group D, defects were filled with calcium sulphate. Nothing was used in group E, which served as controls. The dogs were sacrificed 4, 8, and 16 weeks after the surgery. Undemineralized sections were obtained and evaluated histomorphometrically. Newly formed cortical bone had closed the defect in the cortical plate in all groups at 16 weeks. The degree of concavity of the new cortical bone at 16 weeks in groups A and D was significantly less than in group B (P apicectomy, and that calcium sulphate could be substituted for e-PTFE membrane.

  4. CT of meningiomas on the posterior surface of the petrous bone

    Valavanis, A.; Schubiger, O.; Hayek, J.; Pouliadis, G.


    A detailed analysis of the CT findings in 16 surgically verified cases of meningioma of the posterior surface of the petrous bone is presented. The results indicate that a correct preoperative diagnosis is possible in almost every case. Frequently occuring specific CT criteria for meningioma of the posterior surface of the petrous bone include: hyperdense, homogeneously enhancing, extra-axial, CPA mass; inverse relationship between precontrast attenuation value and degree of contrast enhancement of the tumor; oval shape; obtuse angle between lateral tumor border and posterior surface of petrous bone, and evidence of transcisternal supratentorial tumor extension. Infrequently occuring specific CT criteria include: tumor calcification; hyperostosis or exostosis of the posterior surface of the petrous bone; a comma-shaped tumor configuration in cases with transcisternal tumor extension and evidence of transtentorial tumor extension. Oxygen CT cisternography is the most sensitive and reliable technique for detecting small tumors. The CT differential diagnosis of meningioma of the posterior surface of the petrous bone is discussed.

  5. Homer syndrome after thoracoscopic apicectomy for spontaneous pneumothorax as a complication of chest tube placement.

    Piccoli, Micaela; Golinelli, Marco; Colli, Giovanni; Mullineris, Barbara; Melotti, Gianluigi


    We describe a case of Horner syndrome occurring secondary only to the high insertion of a chest tube after video-thoracoscopic apicectomy for spontaneous pneumothorax. Because all other causes could be ruled out, the Authors assume that the lesion to the sympathetic nerve fibres was caused by pressure exerted by the tip of the chest tube. Horner syndrome due to this cause can easily be avoided. The tip of the chest tube should be kept at the level of, or below, the third posterior rib, unless the clinical situation dictates otherwise. This cause of Horner syndrome must be taken into account because, if recognized and treated promptly, it can be fully resolved.

  6. Typical tumors of the petrous bone; Typische Tumoren des Felsenbeins

    Ahlhelm, F.; Mueller, U. [Kantonsspital Baden AG, Abteilung fuer Neuroradiologie, Institut fuer Radiologie, Baden (Switzerland); Ulmer, S. [Medizinisch-Radiologisches Institut, Zuerich (Switzerland)


    In the region of the petrous bone, inner acoustic canal and cerebellopontine angle, a variety of different tissues can be found, such as bony, epithelial, neural and vascular structures. Tumorous or tumor-like lesions, vascular or bony malformations or other pathologies can therefore be found in all of these areas. We discuss various frequently occurring tumorous or tumor-like pathologies including congential lesions, such as mucoceles, inflammatory disorders including osteomyelitis, pseudotumors and Wegener's granulomatosis. Benign non-neoplastic lesions, such as cholesteatoma, cholesterol granuloma, epidermoid and benign neoplastic tumors, such as the most commonly found vestibular schwannoma, meningeoma, paraganglioma, vascular pathologies and finally malignant lesions, such as metastasis, chordoma or chondrosarcoma and endolymphatic sac tumor (ELST) are also discussed. The emphasis of this article is on the appearance of these entities in computed tomography (CT) and more so magnetic resonance imaging (MRI), it provides key facts and typical images and discusses possibilities how to distinguish these pathologies. (orig.) [German] In der Region des Felsenbein, inneren Gehoerkanals und Kleinhirnbrueckenwinkels findet sich eine Vielzahl an unterschiedlichen Gewebearten inklusive knoechernes, epitheliales, nervales und vaskulaeres Gewebe. Tumoren oder tumoraehnliche Laesionen, ossaere oder vaskulaere Pathologien koennen entsprechend dort gefunden werden. Wir diskutieren verschiedene Tumoren oder tumoraehnliche Pathologien inklusive angeborene Laesionen wie Muko- und Meningozelen, entzuendliche Veraenderungen wie die Osteomyelitis, Pseudotumoren, die Wegener-Granulomatose, nichtneoplastische Tumoren wie das Epidermoid, Cholesteatom oder Cholesterolgranulom und gutartige neoplastische Tumoren wie das am haeufigsten zu findende Vestibularisschwannom, das Paragangliom und das Meningeom, Gefaessprozesse/-pathologien und schliesslich maligne Laesionen wie Metastasen

  7. Simulation of petrous bone drilling in subtemporal approach utilizing virtual reality system

    TANG Ke


    Full Text Available Objective To evaluate the utilizing value of virtual reality technique for microanatomy of petrous bone by comparing the anatomic characteristics and data measurement between virtual reality and cadaveric head specimens in subtemporal approach. Methods CT scan data of 15 adult cadaveric heads were inputted into the Dextroscope virtual reality system to build three-dimensional model of petrous bone. Petrous bone drilling was performed on cadaveric heads and virtual reality models respectively to expose anatomic structures step by step, and the distance and angle was measured based on selected mark points. Bland-Altman method was used for the uniformity of checking. Results Visibility effect of simulation of petrous bone drilling in virtual reality system was good. The anatomical structure of facial nerve in petrous bone, greater superficial petrosal nerve, cochlea, semicircular canal, internal carotid artery and glomus jugulare, were displayed clearly. Comparative analysis between cadaveric head and virtual reality by Bland-Altman method showed that bias for distance between geniculate ganglion and start point of common osseus crus of semicircular canal bony, geniculate ganglion and vertex of cochlea, and vertex of cochlea and start point of horizontal segment of internal carotid artery in petrous bone, were 0.020, 0.020, and -0.010 respectively, and 95% confidence intervals were -0.240-0.270, -0.190-0.220, and -0.170-0.150, respectively. Good consistency was demonstrated in scatter diagram. For the limitation of visual angle in cadaveric head, the angle between internal acoustic meatus and groove of great superficial petrosal nerve and the distance between start point of common osseus crus of semicircular canal and superior margin of glomus jugulare could not be measured, while data measurement of petrous bone model in virtual reality system was convenient and quick, without limitation of visual angle. The distance between start point of common

  8. Calcium sulphate as a bone substitute for various osseous defects in conjunction with apicectomy.

    Murashima, Y; Yoshikawa, G; Wadachi, R; Sawada, N; Suda, H


    The purpose of this study was to investigate the effect of calcium sulphate on various osseous defects when used in conjunction with apicectomy. Mandibular third and fourth premolars of 11 beagle dogs were used. After root-canal treatment and apicectomy, three types of osseous defects were prepared on both sides of the mandible as follows: type 1, osseous defect communicating with the gingival sulcus: type 2, large osseous defect including two roots; type 3, 'through and through' osseous defect. The experimental side was allocated randomly, and the osseous defects were filled with medical grade calcium sulphate. The defects on the opposite side were left unfilled as controls. The dogs were sacrificed at 8 and 16 weeks postoperatively. Undemineralized sections were obtained and examined histomorphometrically. In type 1 defects, bone was not observed on the buccal side of the root on either experimental or control side at 8 and 16 weeks. In both type 2 and 3 defects, bone volume/tissue volume (BV/TV) values on the experimental side were significantly higher than those on the control side (P < 0.01), and mineral apposition rate (MAR) values on the experimental side were significantly higher than those on the control side (P < 0.01). The use of calcium sulphate was effective in bone regeneration on both large osseous defects and 'through and through' osseous defects. It was less effective in osseous defects communicating with the gingival sulcus.

  9. Orthograde retreatment and apexification after unsuccessful endodontic treatment, retreatment and apicectomy.

    Sedgley, C M; Wagner, R


    To describe a case where a second orthograde retreatment was successful in the management of an infected mandibular right first molar that previously had received both orthograde and retrograde treatments. Periapical surgery is unlikely to be successful unless the root canal system has been adequately debrided and sealed. A case is described where orthograde endodontic treatment, retreatment and apicectomy were unsuccessful in the management of and infected mandibular right first molar. The periapical radiolucency eventually disappeared following a second orthograde retreatment. Teh second retreatment included 12 months of intracanal calcium hydroxide placement to promote apexification, thus allowing subsequent controlled obturation with gutta percha and AH26. At a 5-year review following completion of treatment, the tooth remained asymptomatic and was in normal function. Orthograde retreatment is a treatment option to manage refractory lesions in teeth that have previously received endodontic treatment, retreatment and apicectomy. Orthograde retreatment using long-term intracanal calcium hydroxide can help promote root-end closure of a resected apex.

  10. Petrous apex chordoma - a case report; Cordoma de apice petroso - relato de um caso

    Silveira, Claudio Regis S. [Clinica Boghos Boyadjian, Fortaleza, CE (Brazil); Barreto, Cristina Marques; Rossi, Luis Antonio [Hospital do Servidor Publico Estadual de Sao Paulo, SP (Brazil). Servico de Radiologia; Michiloski, Custodio; Rotta, Jose Marcus [Hospital do Servidor Publico Estadual de Sao Paulo, SP (Brazil). Servico de Neurocirurgia; Almeida, Serguey Malaquias de


    Chordomas are rare neoplasms arising from notochordal remnants that persist along the axial skeleton. Intracranial chordomas occur more frequently in the midline. We describe a typical case of an off-midline chordoma arising from the petrous apex, and discuss the embryogenic factors which determine that location, as well as the symptoms, imaging findings, surgical treatment and evolution. (author)

  11. Congenital cholesteatoma of petrous apex: Rare case report: Diagnostic and management challenge

    Arun Dehadaray


    Full Text Available A rare case of congenital cholesteatoma of petrous apex with facial nerve palsy and its successful management is reported. 49 year old female presented with progressive vertigo since 2 years. Patient developed tinnitus and hearing loss in the right ear since 7 months and right sided complete facial asymmetry since 6 months. She had normal right tympanic membrane and complete right lower motor neuron facial nerve palsy. She also had profound sensorineural hearing loss with positive Cerebellar signs. Magnetic resonance imaging and High resolution computed tomography with contrast temporal bone showed extensive bony destruction and petrous apex lesion. Facial nerve and vestibular cochlear nerve was compressed by abnormal soft-tissue present in the internal auditory meatus. Transmastoid translabyrinthine exploration was carried out for petrous apex lesion. Intra-operative extensive bony erosion was noted in the temporal bone. Erosion was extending upto Internal Acoustic Meatus compressing VII and VIII nerve bundle. Post-operatively patient was relieved of vertigo and tinnitus. Though hearing didn′t improve, but there was an improvement in facial palsy. Congenital petrous apex cholesteatoma is very rare case. With no specific radiological signs congenital cholesteatoma is difficult to diagnose pre-operatively. It was a challenge to treat surgically such a rare case with extensive neurosurgical presentation without any neurological deficit. Patient showed improvement official nerve after the 1΍ year of surgery.

  12. The use of the erbium yttrium aluminium garnet (2,940 nm) in a laser-assisted apicectomy procedure.

    Reyhanian, A; Parker, S; Moshonov, J


    If conventional endodontic treatment is not possible or not successful, apical endodontic surgery may be indicated. New techniques, materials and technologies have been used to increase the already high success rate of root canal treatment. The purpose of this article is to describe the use of the Erbium:YAG (2,940 nm) laser in treatment of apicectomy as a central tool, with the advantages of enhanced patient comfort, better bactericidal and decontamination effects.

  13. Plasticity of histamine H3 receptor expression and binding in the vestibular nuclei after labyrinthectomy in rat

    Karlstedt Kaj


    Full Text Available Abstract Background In rat, deafferentation of one labyrinth (unilateral labyrinthectomy results in a characteristic syndrome of ocular and motor postural disorders (e.g., barrel rotation, circling behavior, and spontaneous nystagmus. Behavioral recovery (e.g., diminished symptoms, encompassing 1 week after unilateral labyrinthectomy, has been termed vestibular compensation. Evidence suggesting that the histamine H3 receptor plays a key role in vestibular compensation comes from studies indicating that betahistine, a histamine-like drug that acts as both a partial histamine H1 receptor agonist and an H3 receptor antagonist, can accelerate the process of vestibular compensation. Results Expression levels for histamine H3 receptor (total as well as three isoforms which display variable lengths of the third intracellular loop of the receptor were analyzed using in situ hybridization on brain sections containing the rat medial vestibular nucleus after unilateral labyrinthectomy. We compared these expression levels to H3 receptor binding densities. Total H3 receptor mRNA levels (detected by oligo probe H3X as well as mRNA levels of the three receptor isoforms studied (detected by oligo probes H3A, H3B, and H3C showed a pattern of increase, which was bilaterally significant at 24 h post-lesion for both H3X and H3C, followed by significant bilateral decreases in medial vestibular nuclei occurring 48 h (H3X and H3B and 1 week post-lesion (H3A, H3B, and H3C. Expression levels of H3B was an exception to the forementioned pattern with significant decreases already detected at 24 h post-lesion. Coinciding with the decreasing trends in H3 receptor mRNA levels was an observed increase in H3 receptor binding densities occurring in the ipsilateral medial vestibular nuclei 48 h post-lesion. Conclusion Progressive recovery of the resting discharge of the deafferentated medial vestibular nuclei neurons results in functional restoration of the static postural and

  14. Primary aneurysmal bone cyst of the petrous temporal bone: A case report and review of literature

    Sharma, Mayur; Velho, Vernon; Kharosekar, Hrushikesh


    Aneurysmal bone cyst (ABC) arising in the petrous portion of the temporal bone is a rare entity with only five such reported cases in the literature. We report the case of a 28-year-old man who presented with a tender swelling in the right preauricular region with right ear discharge and conductive hearing loss of 4 years' duration. Computed tomography and Magnetic Resonance imaging showed a destructive lesion in the right petrous bone with cavitation consistent with the diagnosis of ABC. Gross total resection of the lesion was achieved and diagnosis was confirmed histologically. The patient had no recurrence at 12 months of follow-up. This report presents the unusual location of an uncommon bony tumor with a review of its clinical, radiological, and histopathological features as well as the treatment modalities available.

  15. Hearing preservation in acoustic neuroma resection: Analysis of petrous bone measurement and intraoperative application

    Levent Tanrikulu


    Conclusion: Petrous bone measurement by high-resolution MRI data enables safe surgical exposure of the internal acoustic canal with avoidance of injury to the labyrinth and a better postoperative prognosis, especially for intrameatal ANs and for the resection of intrameatal portions of larger neuromas. The prognostic factors enable the patients and the surgeon a better estimation of postoperative results regarding deafness and postoperative hypacusis and support a consolidated treatment planning.

  16. Quantification of the presigmoid transpetrosal keyhole approach to petroclival region

    WU Chen-yi; LAN Qing


    Background Despite the presigmoid transpetrosal approach has been used by different researchers in various ways, the surgical injury rate remains high. Applying a minimally invasive keyhole idea, we devised a presigmoid transpetrosal keyhole approach(PTKA), classified and quantitatively assessed their approach to the petroclival area on a cadaver model by using a neuronavigation system. Methods The presigmoid transpetrosal keyhole approach was divided into four increasingly morbidity-producing steps: retrolabyrinthine, partial labyrinthectomy with petrous apicectomy, translabyrinthine and transcochlear keyhole approaches. Six latex-injected cadaveric heads(twelve sides)underwent dissection in which a neuronavigation system was used. An area of exposure 10 cm superficial to a central target(working area)was calculated. The area of clival exposure with each subsequent dissection was also calculated. Results The retrolabyrinthine keyhole approach(RLK)spares hearing and facial function in theory but provides for only a small window of upper clival exposure. The view afforded by partial labyrinthectomy with petrous apicectomy keyhole approach (PLPAK)provides for up to four times this exposure. The translabyrinthine keyhole approach(TLK)and transcochlear keyhole approach(TCK), although producing more morbidity, add little in terms of a larger petroclival window. However, with each step, the surgical freedom for manipulation of instruments increases. Conclusions The presigmoid transpetrosal keyhole approach to the petroclival area is feasible and useful. The RLK has relatively limited utility. For lesions without bone invasion, the PLPAK provides a much more versatile exposure with an excellent chance of hearing and facial nerve preservation. The TLK provides for greater versatility in treating lesions but clival exposure is not greatly enhanced. The TCK adds little in terms of intradural exposure but should be reserved for cases in which access to the petrous carotid

  17. Effectiveness of submucosal dexamethasone to control postoperative pain & swelling in apicectomy of maxillary anterior teeth.

    Shah, Shahzad Ali; Khan, Irfanullah; Shah, Humera Shahzad


    The purpose of this study was to evaluate the effect of submucosal dexamethasone injection to control postoperative pain and swelling in apicectomy of maxillary anterior teeth. A randomized, controlled trial comprising 60 adult patients (68.3% male, 31.7% female) with no local or systemic problems was conducted. Patients were randomly divided into two groups: Group A was given 4mg dexamethasone injection perioperatively. Group B (control group) was treated conventionally without any steroid injection. Postoperative pain and swelling was evaluated using a visual analog scale (VAS). Objective measurements of facial pain and swelling were performed daily up to six days postoperatively. Dexamethasone group showed significant reduction in pain and swelling postoperatively compared with the control. Submucosal dexamethasone 4mg injection is an effective therapeutic strategy for swift and comfortable improvement after surgical procedure and has a significant effect on reducing postoperative pain and swelling. The treatment offers a simple, safe, painless, noninvasive and cost effective therapeutic option for moderate and severe cases.

  18. Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals.

    Wesson, C M; Gale, T M


    To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. Multicentre, prospective study. The departments of oral and maxillo-facial surgery in two district general hospitals. One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000. Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could

  19. Inflammatory diseases of the petrous portion of the temporal bone; Entzuendliche Erkrankungen des Felsenbeins

    Koerner, H. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)


    Inflammatory lesions of the petrous portion of the temporal bone are very common and can be followed by cerebral complications. Thin layer computed tomography (CT) is useful for detecting bony changes of the temporal bone and contrast-enhanced magnetic resonance imaging (CE MRI) is a sensitive method for detecting cerebral complications. (orig.) [German] Entzuendliche Erkrankungen des Felsenbeins sind sehr haeufig und koennen mit zerebralen Komplikationen einhergehen. Mit der Duennschicht-CT lassen sich sehr gut ossaere Veraenderungen im Felsenbein nachweisen. Die kontrastmittelgestuetzte MRT ist sensitiv fuer zerebrale Komplikationen. (orig.)

  20. The Petrous Bone—A New Sampling Site for Identifying Early Dietary Patterns in Stable Isotopic Studies

    Jørkov, Marie Louise Schjellerup; Heinemeier, Jan; Lynnerup, Niels


    Intraskeletal variation in the composition of carbon (delta(13)C) and nitrogen (delta(15)N) stable isotopes measured in collagen is tested from various human bones and dentine. Samples were taken from the femur, rib, and petrous part of the temporal bone from well-preserved skeletons of both adults...... (n = 34) and subadults (n = 24). Additional samples of dentine from the root of 1st molars were taken from 16 individuals. The skeletal material is from a medieval cemetery (AD 1200-1573) in Holbaek, Denmark. Our results indicate that the petrous bone has an isotopic signal that differs significantly...

  1. [Vestibular neurotomy versus chemical labyrinthectomy for disabling Menière disease].

    Morel, N; Dumas, G; Nguyen, D-Q; Mohr, E; Hitter, A; Schmerber, S


    To evaluate the efficiency on the vertigos and the impact on the audition of the vestibular neurotomy (VN) and the chemical labyrinthectomy (CL) in patients with severe Menière's disease, in order to determine the precise place for each technique in treatment algorithm. Retrospective study of 71 VN (performed between 1986 and 2003) and 35 CL (performed between 1997 and 2003). These two treatments both aim at obtaining a vestibular deafferentation in order to free definitely the patient of vertigo manifestations. Vestibular results have been assessed by caloric tests performed before and 6 months after treatment. Subjective success was evaluated by searching for recurrent attacks of vertigo and by the AAO-HNS (American Academy of Otolaryngology-Head and Neck Society) scale of subjective evaluation of vertigos (follow-up of 6.4 years after VN and 2.4 years after CL). Pure tone audiometry before treatment and then 6 months later was performed. Complications of two types of treatment were recorded and evaluated. In 90% of the cases after VN and 86% of the cases after CL, caloric tests indicated a strong vestibular hyporeflexy (hypovalence > 90%). Attacks of vertigo reoccurred in 5.6% of the cases when the hyporeflexy was strong and 85.7% of the cases when it was weak. The quality of the vestibular results on vertigo depends on the degree of hypovalence after treatment. An improvement of the AAO-HNS scale have been obtained in 93% of the cases in the NV group and in 81% of the cases in the LC group. Attacks of vertigo were recurrent in 7% of the patients operated on by VN and 11.4% of the patients treated by CL. Mean pure tone auditory thresholds changed from 50.24 dB HL to 55.64 dB HL (p=0.003) in the VN group and from 69.11 dB HL to 74.51 dB HL (p=0.41) in the CL group. Comparison of the variations of the mean pure tone auditory thresholds before treatment and 6 months after the end of the treatment doesn't show any significant difference between the 2 groups (p > 0

  2. Medullary Venous Hypertension Secondary to a Petrous Apex Dural Arteriovenous Fistula: A Case Report

    Meghan Murphy


    Full Text Available Background: Dural arteriovenous fistulae (dAVF are common intracranial vascular lesions typically becoming symptomatic with cortical venous hypertension and possible hemorrhage. Here, we present a case illustration of a petrous apex dAVF with marked medullary venous hypertension and a unique clinical presentation. Methods: Case report. Results: A 72-year-old female, whose clinical progression was significant for altered mental status and progressive weakness, presented with diplopia, right leg paresis, and ataxia. Magnetic resonance imaging revealed edema involving the medulla. On digital subtraction cerebral angiogram, the patient was found to have a petrous apex dAVF, Cognard type IV. Following treatment with Onyx embolization, her symptoms rapidly improved, with complete resolution of diplopia and drastic improvement of her ataxia. Conclusion: The importance of this case is in the presentation and deterioration of the clinical exam, resembling an acute ischemic event. Further, this case illustrates that dAVF may cause venous hypertension with rapid onset of focal neurologic symptoms not exclusive to cortical locations.

  3. Rare case study of a primary carcinoma of the petrous bone and a brief literature review.

    Atallah, Ihab; Karkas, Alexandre; Righini, Christian Adrien; Lantuejoul, Sylvie; Schmerber, Sébastien


    Temporal bone carcinoma is an aggressive tumor with multiple unconfirmed risk factors. Herein, we present a rare case of a primary petrous bone carcinoma in a female patient (65 years old) with an irrelevant medical history. She presented a postauricular swelling that revealed a multilocular osteolytic cystic lesion of the mastoid portion of the temporal bone on the CT scan. The patient underwent resection of the lesion and pathological analysis revealed moderately to well-differentiated squamous cell carcinoma. Postoperative radiotherapy was carried out. Until the present time, the patient shows complete remission on regular clinical and radiological follow-up. Although no widely accepted strategy for managing temporal bone tumors exists, a review of the literature showed that surgery with or without radiotherapy is the treatment of choice. Preoperative assessment and accurate staging are vital in ensuring that the treatment is adequate for each disease stage. © 2014 Wiley Periodicals, Inc.

  4. An aberrant vascular channel in the petrous bone: persistent lateral capital vein?

    Hermans, Robert [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Rensburg, Leon J. van [University of the Western Cape, Department of Radiology and Diagnostics, Tygerberg (South Africa)


    An aberrant channel was identified on CT in the petrous bone in four patients presenting with unrelated otological symptoms. These channels occurred unilaterally in each case. In two patients, the channel was seen to run between the sigmoid sinus sulcus and the superior petrosal sinus sulcus; in one of these patients, a vascular structure was identified within this channel on MRI, connecting the sigmoid sinus and the superior petrosal sinus. In the two other patients, an aberrant channel was seen between the superior petrosal sinus sulcus and the posterior genu of the facial nerve canal. There were no symptoms that could be attributed to the presence of these channels. We postulate that these aberrant vascular channels correspond to a persistent embryological vein, the lateral capital vein. (orig.)

  5. Association between proximal internal carotid artery steno-occlusive disease and diffuse wall thickening in its petrous segment: a magnetic resonance vessel wall imaging study

    Chen, Xiaoyi; Li, Dongye [Capital Medical University and Beijing Institute for Brain Disorders, Center for Brain Disorders Research, Beijing (China); Tsinghua University School of Medicine, Center for Biomedical Imaging Research, Department of Biomedical Engineering, Beijing (China); Zhao, Huilin [Shanghai Jiao Tong University, Department of Radiology, Renji Hospital, School of Medicine, Shanghai (China); Chen, Zhensen; Qiao, Huiyu; He, Le; Li, Rui [Tsinghua University School of Medicine, Center for Biomedical Imaging Research, Department of Biomedical Engineering, Beijing (China); Cui, Yuanyuan [PLA General Hospital, Department of Radiology, Beijing (China); Zhou, Zechen [Philips Research China, Healthcare Department, Beijing (China); Yuan, Chun [Tsinghua University School of Medicine, Center for Biomedical Imaging Research, Department of Biomedical Engineering, Beijing (China); University of Washington, Department of Radiology, Seattle, WA (United States); Zhao, Xihai [Tsinghua University School of Medicine, Center for Biomedical Imaging Research, Department of Biomedical Engineering, Beijing (China); Beijing Institute for Brain Disorders, Center for Stroke, Beijing (China)


    Significant stenosis or occlusion in carotid arteries may lead to diffuse wall thickening (DWT) in the arterial wall of downstream. This study aimed to investigate the correlation between proximal internal carotid artery (ICA) steno-occlusive disease and DWT in ipsilateral petrous ICA. Symptomatic patients with atherosclerotic stenosis (>0%) in proximal ICA were recruited and underwent carotid MR vessel wall imaging. The 3D motion sensitized-driven equilibrium prepared rapid gradient-echo (3D-MERGE) was acquired for characterizing the wall thickness and longitudinal extent of the lesions in petrous ICA and the distance from proximal lesion to the petrous ICA. The stenosis degree in proximal ICA was measured on the time-of-flight (TOF) images. In total, 166 carotid arteries from 125 patients (mean age 61.0 ± 10.5 years, 99 males) were eligible for final analysis and 64 showed DWT in petrous ICAs. The prevalence of severe DWT in petrous ICA was 1.4%, 5.3%, 5.9%, and 80.4% in ipsilateral proximal ICAs with stenosis category of 1%-49%, 50%-69%, 70%-99%, and total occlusion, respectively. Proximal ICA stenosis was significantly correlated with the wall thickness in petrous ICA (r = 0.767, P < 0.001). Logistic regression analysis showed that proximal ICA stenosis was independently associated with DWT in ipsilateral petrous ICA (odds ratio (OR) = 2.459, 95% confidence interval (CI) 1.896-3.189, P < 0.001). Proximal ICA steno-occlusive disease is independently associated with DWT in ipsilateral petrous ICA. (orig.)

  6. A simple standard technique for labyrinthectomy in the rat: A methodical communication with a detailed description of the surgical process.

    Nádasy, G L; Raffai, G; Fehér, E; Schaming, G; Monos, E


    Aims Labyrinthectomized rats are suitable models to test consequences of vestibular lesion and are widely used to study neural plasticity. We describe a combined microsurgical-chemical technique that can be routinely performed with minimum damage. Methods Caudal leaflet of the parotis is elevated. The tendinous fascia covering the bulla is opened frontally from the sternomastoid muscle's tendon while sparing facial nerve branches. A 4 mm diameter hole is drilled into the bulla's hind lower lateral wall to open the common (in rodents) mastoid-tympanic cavity. The cochlear crista (promontory) at the lower posterior part of its medial wall is identified as a bony prominence. A 1 mm diameter hole is drilled into its lower part. The perilymphatic/endolymphatic fluids with tissue debris of the Corti organ are suctioned. Ethanol is injected into the hole. Finally, 10 µL of sodium arsenite solution (50 µM/mL) is pumped into the labyrinth and left in place for 15 min. Simple closure in two layers (fascia and skin) is sufficient. Results and conclusion All rats had neurological symptoms specific for labyrinthectomy (muscle tone, body position, rotatory movements, nystagmus, central deafness). Otherwise, their behavior was unaffected, drinking and eating normally. After a few days, they learned to balance relying on visual and somatic stimuli (neuroplasticity).

  7. Incidence of auditory ossicle luxation and petrous bone fractures detected in post-mortem multislice computed tomography (MSCT).

    Hollinger, A; Christe, A; Thali, M J; Kneubuehl, B P; Oesterhelweg, L; Ross, S; Spendlove, D; Bolliger, S A


    As the auditory ossicles are difficult to display without harming them in conventional autopsies, lesions of these minute bones and the ossicular chain are regularly missed. In this study, the method of choice in clinical medicine for the examination of such lesions, namely multislice computed tomography, was applied to 100 corpses. The hereby obtained results regarding ossicle luxation and petrous bone fracture indicated that the lesions were not dependant on the amount, but rather on the type of energy inflicted to the head.

  8. A minimally-invasive method for sampling human petrous bones from the cranial base for ancient DNA analysis.

    Sirak, Kendra A; Fernandes, Daniel M; Cheronet, Olivia; Novak, Mario; Gamarra, Beatriz; Balassa, Tímea; Bernert, Zsolt; Cséki, Andrea; Dani, János; Gallina, József Zsolt; Kocsis-Buruzs, Gábor; Kővári, Ivett; László, Orsolya; Pap, Ildikó; Patay, Róbert; Petkes, Zsolt; Szenthe, Gergely; Szeniczey, Tamás; Hajdu, Tamás; Pinhasi, Ron


    Ancient DNA (aDNA) research involves invasive and destructive sampling procedures that are often incompatible with anthropological, anatomical, and bioarcheological analyses requiring intact skeletal remains. The osseous labyrinth inside the petrous bone has been shown to yield higher amounts of endogenous DNA than any other skeletal element; however, accessing this labyrinth in cases of a complete or reconstructed skull involves causing major structural damage to the cranial vault or base. Here, we describe a novel cranial base drilling method (CBDM) for accessing the osseous labyrinth from the cranial base that prevents damaging the surrounding cranial features, making it highly complementary to morphological analyses. We assessed this method by comparing the aDNA results from one petrous bone processed using our novel method to its pair, which was processed using established protocols for sampling disarticulated petrous bones. We show a decrease in endogenous DNA and molecular copy numbers when the drilling method is used; however, we also show that this method produces more endogenous DNA and higher copy numbers than any postcranial bone. Our results demonstrate that this minimally-invasive method reduces the loss of genetic data associated with the use of other skeletal elements and enables the combined craniometric and genetic study of individuals with archeological, cultural, and evolutionary value.

  9. Comparative study of dentine permeability after apicectomy and surface treatment with 9.6 microm TEA CO2 and Er:YAG laser irradiation.

    Gouw-Soares, S; Stabholz, A; Lage-Marques, J L; Zezell, D M; Groth, E B; Eduardo, C P


    Failure of apicectomies is generally attributed to dentine surface permeability as well as to the lack of an adequate marginal sealing of the retrofilling material, which allows the percolation of microorganisms and their products from the root canal system to the periodontal region, thus compromising periapical healing. The purpose of this study was to evaluate dentine and the marginal permeability after apicectomy and surface treatment with 9.6 micro m TEA CO(2) or Er:YAG 2.94 micro m laser irradiation. Sixty-five single rooted human endodontically treated teeth were divided into five experimental groups: group I (control), apicectomy with high speed bur; group II, similar procedure to that of group I, followed by dentinal surface treatment with 9.6 micro m CO(2) laser; group III, similar procedure to group I followed by dentinal surface treatment with Er:YAG laser 2.94 micro m; group IV, apicectomy and surface treatment with CO(2) 9.6 micro m laser; and group V, apicectomy and surface treatment with Er:YAG laser 2.94 micro m. The analysis of methylene blue dye infiltration through the dentinal surface and the retrofilling material demonstrated that the samples from the groups that were irradiated with the lasers showed significantly lower infiltration indexes than the ones from the control group. These results were compatible with the structural morphological changes evidenced through SEM analysis. Samples from groups II and IV (9.6 micro m CO(2)) showed clean smooth surfaces, fusion, and recrystallized dentine distributed homogeneously throughout the irradiated area sealing the dentinal tubules. Samples from groups III and V (Er:YAG 2.94 micro m) also presented clean surfaces, without smear layer, but roughly compatible to the ablationed dentine and without evidence of dentinal tubules. Through the conditions of this study, the Er:YAG 2.94 micro m and the 9.6 micro m CO(2) laser used for root canal resection and dentine surface treatment showed a reduction of

  10. Cordoma de ápice petroso: relato de um caso Petrous apex chordoma: a case report

    Cláudio Régis S. Silveira


    Full Text Available Cordomas são neoplasias raras que se originam dos remanescentes da notocorda primitiva. Estes remanescentes persistem ao longo de todo o esqueleto axial. Os cordomas intracranianos, mais freqüentemente, se localizam no clivus, próximo à sincondrose esfenooccipital, tipicamente na linha média. Nós descrevemos um caso atípico de cordoma fora da linha média, mais especificamente no ápice petroso, e discutimos as causas embriológicas que determinam esta localização, bem como sintomas, achados de imagem, tratamento cirúrgico e evolução.Chordomas are rare neoplasms arising from notochordal remnants that persist along the axial skeleton. Intracranial chordomas occur more frequently in the midline. We describe an atypical case of an off-midline chordoma arising from the petrous apex, and discuss the embryogenic factors which determine that location, as well as the symptoms, imaging findings, surgical treatment and evolution.

  11. Vestibular neurectomy vs. chemical labyrinthectomy in the treatment of disabling Menière's disease: a long-term comparative study.

    Schmerber, Sébastien; Dumas, Georges; Morel, Nils; Chahine, Karim; Karkas, Alexandre


    To compare the efficiency of vestibular neurectomy (VN) and chemical labyrinthectomy (CL) in the treatment of Menière's disease's disabling vertigo, and to assess their subsequent effects on hearing. This is a retrospective study of 58 VN procedures and 35 CL procedures. Treatment results were assessed by caloric testing and pure-tone audiometry performed before and after treatment. Subjective success was defined by the number of recurrent attacks of vertigo and by the AAO-HNS vertigo scale. Caloric testing revealed strong vestibular hyporeflexia in 91.0% of VN cases and 86.0% of CL cases. Vertigo recurred in 7.0% of cases in the VN group and in 11.4% of cases in the CL group. Mean pure-tone auditory thresholds increased from 45.00dB HL to 50.84dB HL (p=0.19) in the VN group and from 69.11dB HL to 74.51dB HL (p=0.41) in the CL group. Vestibular neurectomy and chemical labyrinthectomy offer similar control of vertigo in patients with Menière's disease. CL is a simple, minimally invasive procedure that emerges as an effective method for treating Menière's disabling vertigo without causing significant hearing deterioration.

  12. Volumetry and analysis of anatomical variants of the anterior portion of the petrous apex outlined by the kawase triangle using computed tomography.

    Adams Pérez, Juliano; Rassier Isolan, Gustavo; Pires de Aguiar, Paulo Henrique; Antunes, Apio Martins


    Background Anterior petrosectomy has become an increasingly used approach for petroclival lesions. This study measures the volume and the anatomical variants of the anterior portion of the petrous apex outlined by the Kawase triangle using computed tomography (CT). Methods This was a transversal retrospective study. We assessed the anterior petrous apex portion outlined by the Kawase triangle in consecutive patients > 18 years of age from CT scans of temporal bone stored in an archive system. The volumetry was performed on a workstation. Results A total of 154 petrosal apex were analyzed in 77 patients (36 men). The average volume of the region outlined by the Kawase triangle was 1.89 ± 0.52 cm(3). The volume average in men was 2.01 ± 0.58 cm(3), and the average in women was 1.79 ± 0.41 cm(3). Intra- and interobserver agreement were both excellent, and there was little variance. Nineteen petrous apex demonstrated anatomical variations. In 18 cases it was pneumatized, and in one case a vascular or nerve-like structure was identified, a report we did not find in the literature. Conclusion The volumetry of the petrous apex anterior portion outlined by the Kawase triangle can be made by CT with excellent intra- and interobserver agreement and reproducibility. There are anatomical variants in this region that are relevant to surgery.

  13. “Spontaneous” CSF Fistula due to Transtegmental Brain Herniation in Combination with Signs of Increased Intracranial Pressure and Petrous Bone Hyperpneumatization: An Illustrative Case Report

    Rivera, Diones; Fermin-Delgado, Rafael; Stoeter, Peter


    Background and Importance Transtegmental brain herniation into the petrous bone is a rare cause of rhinoliquorrhea. Our case presents a combination of several typical clinical and imaging findings illustrating the ongoing etiologic discussion of such cerebrospinal fluid (CSF) fistulas. Clinical Presentation A 53-year-old man presented with nasal discharge after a strong effort to suppress coughing. Imaging revealed a transtegmental herniation of parts of the inferior temporal gyrus into the petrous bone and in addition a combination of signs of chronically increased intracranial pressure and a hyperpneumatization of the petrous bone. The fistula was closed by a middle cranial fossa approach. Conclusion The case illustrates the two main predisposing factors for development of petrous bone CSF fistulas: increased intracranial pressure and thinning of the tegmental roof due to extensive development of air cells. Because the CSF leakage repair does not change the underlying cause, patients have to be informed about the possibility of developing increased intracranial pressure and recurrences of brain herniations at other sites. PMID:25485224

  14. Chordoma of the petrous apex - a case report and review of the literature; Cordoma de apice petroso - relato de um caso e revisao da literatura

    Loureiro, Ricardo; Leal Junior, Osvaldo S. [Pernambuco Univ., Recife, PE (Brazil). Faculdade de Medicina; Loureiro, Lautonio Junior [Universidade de Pernambuco, Recife, PE (Brazil). Faculdade de Ciencias Medicas; Buril, Marlus V.M. [Hospital das Clinicas, Recife, PE (Brazil). Centro de Terapia Intensiva


    Chordomas are rare tumours arising from remnants of the embryologic notochord, typically at a midline position. Although 35-40% of these lesions are intracranial, these tumors answer for less than 1% of all intracranial tumors. The intracranial chordomas originate most frequently from the clival region at the midline. Nevertheless eventually may arise off the midline primarily in petrous apex or, very rarely, in paranasal sinuses. The authors report a case of histopathologically proved intracranial chordoma that arose atypical site in the petrous apex. The computed tomographic and magnetic resonance imaging finding were similar to those observed in midline chordomas. The computed tomographic examination revealed a well-defined soft tissue mass associated with bone destruction and foci of calcification. The magnetic resonance imaging study demonstrated a growing extra-axial formation that appeared with hypo-intensity of signal on T1-weighted images, hyperintensity on T2-weighted images and heterogeneous enhancement after paramagnetic agent injection. (author) 8 refs., 8 figs.

  15. Changes in Histamine Receptors (H1, H2, and H3 Expression in Rat Medial Vestibular Nucleus and Flocculus after Unilateral Labyrinthectomy: Histamine Receptors in Vestibular Compensation.

    Liuqing Zhou

    Full Text Available Vestibular compensation is the process of behavioral recovery following peripheral vestibular lesion. In clinics, the histaminergic medicine is the most widely prescribed for the treatment of vertigo and motion sickness, however, the molecular mechanisms by which histamine modulates vestibular function remain unclear. During recovery from the lesion, the modulation of histamine receptors in the medial vestibular nucleus (MVN and the flocculus may play an important role. Here with the means of quantitative real-time PCR, western blotting and immunohistochemistry, we studied the expression of histamine receptors (H1, H2, and H3 in the bilateral MVN and the flocculus of rats on the 1st, 3rd, and 7th day following unilateral labyrinthectomy (UL. Our results have shown that on the ipsi-lesional flocculus the H1, H2 and H3 receptors mRNA and the protein increased significantly on the 1st and 3rd day, with compare of sham controls and as well the contralateral side of UL. However, on the 7th day after UL, this expression returned to basal levels. Furthermore, elevated mRNA and protein levels of H1, H2 and H3 receptors were observed in the ipsi-lesional MVN on the 1st day after UL compared with sham controls and as well the contralateral side of UL. However, this asymmetric expression was absent by the 3rd post-UL. Our findings suggest that the upregulation of histamine receptors in the MVN and the flocculus may contribute to rebalancing the spontaneous discharge in bilateral MVN neurons during vestibular compensation.

  16. Extradural subtemporal transzygomatic approach to the clival and paraclival region with endoscopic assist.

    Gagliardi, Filippo; Boari, Nicola; Roberti, Fabio; Gragnaniello, Cristian; Biglioli, Federico; Caputy, Anthony J; Mortini, Pietro


    The authors describe the extradural subtemporal transzygomatic (ESTZ) approach and its variants to expose the clival and paraclival areas. A microanatomical study was conducted to quantify the clival and paraclival exposure and the maneuverability areas obtained by microscope and endoscope using the ESTZ approach. Section versus preservation of the third trigeminal branch (V3) and petrous apicectomy to obtain a wider clival exposure and a better internal carotid artery control are discussed. Eight cadaveric specimens were dissected to obtain morphometric measurements after performing the ESTZ approach and its variants. Anatomic areas exposed by the approaches were calculated using the ImageJ 1.37a software. The ESTZ approach performed with sectioning of V3 and petrous apicectomy allowed for a mean incremental exposed area of 1.8 cm2 (range, 1.24-2.43 cm2). The mean amount of additional anatomic areas visualized after the ESTZ approach with petrous apicectomy if compared with the ESTZ approach without petrous apicectomy was 24% (range, 14.4%-37.5%). The mean percentage increase of maneuverability area after petrous apicectomy was 69.9% (range, 43.8%-96.6%). The ESTZ approach is suitable when dealing with extradural tumors of the middle-upper clivus extending into the ipsilateral paraclival area. V3 section and petrous apicectomy increase the operability, the surgical exposure, and the maneuverability area and improve vascular control on the internal carotid artery. Application of endoscopy does not impact on the maneuverability area but enhances the visualization of blind corners; endoscopic surgical view without drilling the petrous apex is comparable to that obtained by the microscope after petrous apicectomy.

  17. 豚鼠一侧前庭损毁后前庭内侧核GFAP表达%Expression of GFAP in medial vestibular neucleus following unilateral labyrinthectomy in guinea pigs

    吴子明; 王锦玲; 王尔贵; 姜鸿彦; 邓瑶珠; 刘顺利


    AIM To observe the expression of GFAP in the medial vestibularnucleus (MVN) following unilateral labyrinthectomy (UL). METHODS After secting left labyrinthectomy, the immunohistological staining of GFAP was performed. RESULTS GFAP staining enhancement was induced in bilateral MVN following unilateral labyrinthectomy. However, that of the lesioned side was stronger than that of the unlesioned side. The reaction became evident 10 h post-UL and was intense 20~40 h after the lesoin. Then it declined until 20 d, but was still intenser than that of the control group. CONCLUSION UL can induce reactive stronger GFAP immunostaining in the MVN. The fall in the resting discharge of the primary vestibular afferents and/or in the deafferented central vestibular neurons may cause the astrocytic reaction. But the significance of the reactive satrocytes in the vestibular compensation is still unknown.%目的 观察左侧迷路切除后前庭内侧核(MVN)胶质纤维酸性蛋白(GFAP)的表达变化.方法 左侧迷路切除后,不同存活时间行前庭内侧核GFAP二步法免疫组化染色.结果 一侧迷路切除(UL)后可诱导双侧MVN区星形胶质细胞GFAP免疫反应增强,且术侧大于未损侧,GFAP反应在术后10h已较正常对照增强,20h强于10h,此后40h至20dGFAP反应处于下降趋势.结论 UL后可诱导MVN区胶质细胞GFAP免疫反应增强.初级前庭传入或中枢前庭神经元的静息放电降低可能与胶质细胞反应有关,但其在前庭代偿中的作用尚有待研究.

  18. Periapical Bone Healing after Apicectomy with and without Retrograde Root Filling with Mineral Trioxide Aggregate: A 6-year Follow-up of a Randomized Controlled Trial.

    Kruse, Casper; Spin-Neto, Rubens; Christiansen, René; Wenzel, Ann; Kirkevang, Lise-Lotte


    In cases of post-treatment periapical disease, retreatment may be necessary. To choose the most appropriate retreatment method, knowledge of the long-term prognosis is important. Surgical endodontic retreatment (SER) is a relevant treatment method. This study assessed changes in outcome from 1 to 6 years after surgery. SER was performed on teeth randomly allocated to have a MTA root-end filling (MTA group) or smoothing of the orthograde gutta-percha filling after apicectomy (GP group). Patients participating in the 1-year follow-up were reinvited for a 6-year clinical and radiographic examination. Three observers assessed treatment outcome both clinically and radiographically from the 1-year and 6-year follow-up examination. At the 6-year follow-up, 39 of 52 teeth were available and examined (75% participation rate). In the MTA group, 16 of 19 teeth (86%) and in the GP group 11 of 20 teeth (55%) were assessed as successful (P = .04). In the MTA group and the GP group, 80% and 90%, respectively, of teeth assessed as successful at the 1-year follow-up remained successful. All unsuccessful teeth in the MTA group (3 teeth) were lost because of vertical root fracture. The proportion of healed cases was larger in the MTA group than in the GP group at both the 1-year and 6-year follow-up. Findings indicate that a 1-year follow-up may not be sufficient in assessing the long-term outcome of surgical endodontic retreatment. With a longer follow-up, other factors not directly related to the endodontic treatment may be relevant for a successful outcome. This needs further investigation in larger patient samples. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. Morphological assessment of dentine and cementum following apicectomy with Zekrya burs and Er:YAG laser associated with direct and indirect Nd:YAG laser irradiation.

    de Moura, Abilio Albuquerque Maranhão; Moura-Netto, Cacio; Barletta, Fernando Branco; Vieira-Júnior, Nilson Dias; Eduardo, Carlos de Paula


    This study aimed to assess the apical surface morphology of maxillary central incisors resected 3.0 mm from the tooth apex using Zekrya burs or Er:YAG laser, with or without subsequent direct Nd:YAG laser irradiation (apical and buccal surfaces) and indirect irradiation (palatal surface). Forty maxillary central incisors were instrumented and obturated. The roots were divided into 4 groups according to the root resection method (Zekrya bur or Er:YAG laser - 1.8 W, 450 mJ, 4 Hz, 113 J/cm(2)) and further surface treatment (none or Nd:YAG laser - 2.0 W, 100 mJ, 20 Hz, 124 J/cm(2)). The teeth were prepared for SEM analysis. Scores ranging from 1 to 4 were attributed to cut quality and morphological changes. The data were analyzed by the Kruskal-Wallis test and by Dunn's test. SEM images showed irregular surfaces on the apical portions resected with Zekrya burs, with smear layer and grooves in the resected dentine and slight gutta-percha displacement and plasticization. On the other hand, apicectomies carried out with Er:YAG laser showed morphological changes compatible with ablated dentine, with rough surfaces and craters. In spite of the presence of plasticized gutta-percha, with the presence of bubbles, an irregular adaptation of the filling material to the root walls was also observed. Direct Nd:YAG laser irradiation of the apical and buccal surfaces of the resected roots resulted in areas of resolidification and fusion in the dentine and cementum, with a vitrified aspect; indirect Nd:YAG laser irradiation of the palatal surfaces yielded a lower number of changes in the cementum, with irregular resolidification areas. There were no differences in terms of cut quality between the use of burs and Er:YAG laser or between the 2 surfaces (apical and buccal) treated with Nd:YAG laser with direct irradiation. However, morphological changes were significantly less frequent on surfaces submitted to indirect irradiation (palatal) when compared with those directly irradiated

  20. 三半规管阻塞与迷路切除术后前庭功能动态变化%Vestibular compensation after triple semicircular canal occlusion and labyrinthectomy

    殷善开; 张英; 黄艳艳; 张茂椿; 李漫娜


    目的:比较豚鼠三半规管阻塞与迷路切除术后前庭功能代偿的异同。材料与方法:将15只健康豚鼠分为2组,其中8只豚鼠行右侧三半规管阻塞术(triple semicircular canal occlusion,TCO),7只豚鼠行右侧迷路切除术(labyrinthectomy,LE),于术后一个月内观察豚鼠行为学及眼震电图(ENG)的动态变化。结果:发现术后第1天两组均出现自发性眼震,正弦摆动刺激术侧时未引出诱发性眼震,头向右侧偏斜并沿地面垂直轴向术侧旋转;LE组却出现翻滚现象。术后第3、5、10、15、30天正弦摆动眼震试验,两组豚鼠术侧眼震均随时间的推移逐渐恢复,TCO组于15天左右向眼震基本恢复对称,而LE组至术后30天仅摆动幅度120°、150°、180°左右向眼震基本对称,摆动幅度为60°、90°双向眼震反应差异仍有显著性意义(P<0.05);另外,LE组有3只豚鼠仍存在头偏。结论:TCO组要比LE组动物恢复快,建立代偿和失平衡时间短。%Objective:To evaluate the difference of vestibular compensation between triple semicircular canal occlusion(TCO) and labyrinthectomy(LE)in guinea pigs.Material and Methods:TCO was performed on 8 guinea pigs,while LE was did on 7 guinea pigs.Behavior and ENG were recorded in detail preoperatively and repeatedly up to one month postoperatively according to the experiment design.Results:There was spontaneous nystagmus towards the nonoperated side on the first postoperative day and nystagmus absence during sinusoidal angular acceleration stimuli on the operated side was observed in all the animals.All the animals displayed head tilt towards the operated side (right)and an unsteady gait towards the right along the vertical axis after surgery,while the animals performed LE rolled towards the operated side.On the 3rd postoperative day,faint nystagmus appeared on the operated side,but the left and right nystagmus was significantly asymmetrical.The left and

  1. Surgical management of large posterior petrous meningiomas through extended retrosigmoid approach%经扩大乙状窦后入路手术切除大型岩骨后脑膜瘤

    何升学; 张岩松; 刘宏毅; 常义; 刘翔; 胡新华; 杨坤; 罗正祥


    目的 探讨经扩大乙状窦后入路切除大型岩骨后脑膜瘤的手术方法和治疗效果.方法 应用扩大乙状窦后入路切除16例大型岩骨后脑膜瘤,肿瘤最大径均超过4 cm,有4例肿瘤侵入岩骨,术中完全暴露横窦和乙状窦,与硬脑膜一并分别向上方和前方牵开,充分暴露小脑幕下方和岩骨背面.结果 本组肿瘤全切除15例,次全切除1例,无手术死亡,15例患者术前症状消失或改善,术后永久性面瘫1例,脑脊液漏1例.随访3个月-5年,随访期间复查MRI未见肿瘤复发.结论 经扩大乙状窦后入路切除大型岩骨后脑膜瘤具有能够早期处理肿瘤基底、有效控制术中出血、明显扩大手术暴露和提高肿瘤全切率等优点.%Objective To evaluate extended retrosigmoid approach for surgery on large posterior petrous meningiomas. Methods During 5 - year period between 2004 and 2009, sixteen patients with large posterior petrous meningiomas were treateded through extended retrosigmoid approach. The maximum diameters of tumors were all more than 4 cm. The petrous bone erosion by lesions was found in 4 cases. The sigmoid sinus and the transverse sinus were thoroughly exposed after bone removal including mastoid and occipital bones. The sigmoid sinus was pulled anteriorly and the transverse sinus upward in order to widen the opening into the infratentorial space and the posterior surface of the petrous bone. Results Gross total resection of the tumors were achieved in 15 cases, subtotal resection in 1 case. There was no perioperative death. The symptoms disappeared or improved after surgery in 15 patients. There was a patient with irreversible hemifacial palsy. Cerebrospinal fluid rhinorrhea was found in one case. There was no tumor recurrence in all cases confirmed by MRI scanning during the follow - up period ( 3 to 60 months).Conclusion The extended retrosigmoid approach provides early devascularization of the tumor from its dural attachment to

  2. Expression of groupⅠmGluRs in rat flocculus after unilateral labyrinthectomy%前庭代偿过程中代谢性谷氨酸受体Ⅰ组在大鼠小脑绒球中的表达

    张亚民; 孔维佳


    Objective: Studies revealed that cerebellar flocculus-parafiocculus complex plays an importmant in vestibular compensation. To observe the expression change of Group Ⅰ mGluRs in flocculus following left unilateral labyrinthectomy(UL). Method: After secting left la.byrinthectomy, the change of Group Ⅰ mGluRs was detected by RT-PCR. Result :Group Ⅰ mGluR5 was induced increase in both side flocculus after unilateral labyrinthectomy. By contrast, mGluR1 was induced decrease. However, that of the lesioned side was stronger than that of the unle-sionedside. Conclusion: UL can induce change of Group Ⅰ mGluRs in the flocculus. The fall in the resting discharge of the primary vestibular afferents and/or in the deafferented central vestibular neurons may cause the change of mGluRs. But the significance of the change of mGluRs in the vestibular c6mpensation is still un-known.%目的:阐明大鼠小脑绒球中代谢性谷氨酸受体Ⅰ组在前庭代偿过程中的作用.方法:用RT-PCR方法对单侧迷路切除术后前庭代偿过程中代谢性谷氨酸受体Ⅰ组在小脑绒球中的表达进行研究.结果:代谢性谷氨酸受体Ⅰ组在双侧绒球中均有表达,双侧的手术组和对照组比较均差异有统计学意义,而双侧之间无差异.结论:大鼠小脑绒球存在代谢性谷氨酸受体Ⅰ组,在前庭代偿过程中有变化,表明其参与前庭代偿的过程.

  3. Neuropatía sensitiva trigeminal secundaria a granuloma de colesterol de la punta del peñasco del temporal Trigeminal neuralgia secondary to cholesterol granuloma of the petrous bone apex

    M.A. Pons García


    Full Text Available La neuropatía aislada de la rama sensitiva del trigémino es una entidad poco habitual. Los pacientes suelen referir hipoestesia y /o disestesia generalmente a nivel de la segunda y tercera rama del trigémino, mientras que la neuralgia es muy infrecuente.¹ Su asociación con enfermedades sistémicas del tejido conectivo es bien conocida.² Se ha descrito asociada a distintas lesiones del SNC sobre todo tumores de fosa posterior o base de cráneo, así como neoplasias mandibulares.3,4 Presentamos una paciente con hipoestesia en el territorio V2-V3 asociada a dolor hemifacial paroxístico secundario a una lesión del peñasco del temporal.Trigeminal Neuralgia is an uncommon entity. The patients report hypoesthesia and/or dysesthesia of the second and third ramus of trigeminal nerve, while neuralgia is very rare.¹ Its association with systemic diseases of connective tissue is well know.² It has been described as being associated with different lesions of the central nervous system, especially with the posterior cavity or cranial base tumors, as well as jaw neoplasias.3,4 We presented a patient with hypoesthesia V2-V3 and hemi facial paroxysmal pain secondary to lesion of petrous apex of temporal bone.

  4. 内镜经鼻岩尖胆固醇肉芽肿手术治疗初步体会%Preliminary experience on endoscopic endonasal management of petrous apex cholesterol granuloma

    王瑾; 陈雷; 杨静


    目的 探讨内镜经鼻入路治疗岩尖胆固醇肉芽肿的可行性.方法 回顾性分析解放军总医院2011-2014年间3例内镜经鼻入路手术治疗岩尖胆固醇肉芽肿患者的临床资料,分析总结其症状、体征、影像学特征、手术方法及预后.结果 3例患者均以耳鸣、听力下降为主要临床表现,平均听阈40 ~ 50 dBHL.行全麻内镜经鼻入路岩尖胆固醇肉芽肿切除手术后,3例患者耳鸣症状消失,平均听阈恢复至10~ 30 dBHL.术后随访6~45个月,1例引流口与蝶窦相通者形成永久性引流口,2例咽隐窝处造口者术后3~6个月引流口闭塞,但症状无复发.结论 内镜经鼻入路手术是治疗岩尖胆固醇肉芽肿的可行方法,近期疗效好,永久性造瘘口的维持需继续随访观察及大样本观察研究.%Objective To explore the feasibility and related aspects on endoscopic endonasal management of petrous apex cholesterol granuloma.Methods Retrospective data analysis was performed on 3 cases in which the endoscopic endonasal approach was used to manage this lesion between 2011 and 2014.Case information including radiological data,surgical technique,symptoms,and complications was reviewed.Results The main clinical manifestations in these 3 patients were tinnitus,hearing loss at the hearing threshold of 40-50 dBHL.After operation,all 3 patients showed disappearance of their tinnitus and improvement of the hearing threshold of 10-30 dBHL (follow-up 6-45 months).Permanent drainage route was performed in 1 case which communicated with sphenoid sinus.While the other 2 cases which drained to pharyngeal recess resulted in drainage route blocking within the 3-6 months after surgery,but without obvious symptoms.Condusions This procedure for the drainage of petrous apex cholesterol granuloma showed to be effective,safe and minimally invasive.Although there is no recurrence in short-term,however,long-term surveillance and large case series are necessary

  5. The application of individual three-dimensional digital manikin on transnasal endoscopic approach of petrous bone%个体化三维数字模型在内镜经鼻颞骨岩部解剖中的应用

    何海勇; 李文胜; 王辉; 蔡梅钦; 罗伦; 张保豫; 郭英


    目的 研究个体化三维数字模型(three-dimension digital manikin,3D-DM)在内镜经鼻颞骨岩部解剖中的应用,探讨其临床应用价值.方法 10例(20侧)成人头部标本灌注后经CT扫描,将图像导入3Dview软件,重建出个体化3D-DM,运用“逆向骨窗形成”技术设计并模拟颞骨岩部骨窗形成.然后在3D-DM辅助下对颞骨岩部进行内镜解剖,对头部标本解剖与个体化3D-DM视野及相关测量进行比较.结果 通过逆向骨窗形成技术可术前模拟颞骨岩部磨除,头部标本解剖与个体化3D-DM下视野高度一致,相关测量间比较无统计学差异.结论 个体化3D-DM为内镜下经鼻入路暴露颞骨岩部提供详尽解剖数据,可以术前模拟颞骨岩部磨除,提高术中颞骨岩部磨除的准确性和安全性,对该手术入路的临床应用具重要指导意义.%Objective To investigate clinical value of individual three-dimensional digital manikin (3D-DM) on the transnasal endoscopic approach to petrous bone. Methods Ten adult cadaveric heads (20 sides) fixed with formalin were dyed through the artery with silicone rubber (RTV3110) and 12.5% Iopromide. Then specimens were scanned by 320-detector-row spiral CT with coronal, axial and sagittal positions. The images were stored in DICOM format, imported into 3D view software and reconstructed individual 3D-DM, on which the technology of "reverse bone window formed" were used to design and simulate the bone window formation of petrous bone. The anatomic marks of skull base related to the transnasal endoscopic approach to petrous bone in individual 3D-DM were observed and the distances between the related anatomic marks were measured. The endoscopic images were recorded, and the relationships of the surgical marks were observed and measured. Finally,The consistency between anatomy and 3D-DM data were explored. Results Individual 3D-DM of the samples was well reconstructed. The vision of individual 3D-DM was similar to

  6. Influence of betahistine on the expression of histamine H3 receptor in the medial vestibular nucleus following unilateral labyrinthectomy in guinea pigs%倍他司汀对豚鼠单侧迷路破坏后前庭内侧核组胺H3受体表达的影响

    舒竞铖; 尹时华; 刘渊; 饶秀丽; 韦顺莲


    目的 观察倍他司汀(betahistine)对单侧迷路毁损后的豚鼠前庭内侧核(medial vestibular nucleus)组胺H3受体表达的影响.方法 选择听性脑干反应(ABR)阈值小于40 dBSPL的健康黑色赤目纯种豚鼠56只,采用随机数字表法分为3组:假手术组(8只),单侧迷路破坏组(24只),单侧迷路破坏+倍他司汀组(24只).单侧迷路破坏组和单侧迷路破坏+倍他司汀组均损毁左侧迷路,假手术组手术打开听泡但保持迷路完好.单侧迷路破坏+倍他司汀组损毁迷路后给予倍他司汀2.17 mg/kg腹腔注射,每天1次,连续给药至处死当天;另外两组腹腔注射等量生理盐水.破坏单侧迷路的两组在不同观察时间点(术后1、3、7d)各取8只豚鼠通过免疫组织化学染色观察双侧前庭内侧核组胺H3受体的表达变化.采用SPSS 16.0软件对实验数据进行统计分析.结果 单侧迷路破坏组术后1d及3d,受损侧前庭内侧核组胺H3受体表达增加,与假手术组相比,差异具有统计学意义(P<0.05),术后7d则恢复至正常水平,与假手术组相比差异无统计学意义(P>0.05);未损侧前庭内侧核组胺H3受体表达强度各观察时间点与假手术组相比,差异无统计学意义(P值均>0.05).单侧迷路破坏+倍他司汀组受损侧前庭内侧核组胺H3受体术后1d及3d较同期单侧迷路破坏组表达减弱(4.25 ±0.71、3.50 ±0.92 vs 5.75 ±0.71、5.50 ±0.93,P值均<0.05);术后3d、7d与假手术组相比差异无统计学意义(P值均>0.05).结论 豚鼠单侧迷路破坏后同侧前庭内侧核中组胺H3受体表达上调,倍他司汀可促进H3受体表达恢复至正常水平.%Objective To observe the influence of betahistine on the expression of histamine H3 receptor in the medial vestibular nucleus (MVN) following unilateral labyrinthectomy (UL).Methods Fifty-six healthy guinea pigs were randomly divided into three groups:the sham-operated group (group Ⅰ),the UL group [group

  7. Spontaneous osteo-dural fistulae of petrous bone posterior wall.

    Junet, P; Bertolo, A; Schmerber, S


    To raise awareness of the possibility of spontaneous temporal bone cerebrospinal fistula in case of clear retrotympanic effusion. A 63-year-old man with no particular history presented with unilateral spontaneous right retrotympanic clear effusion. CT found defects in the posterior part of the right temporal bone, in contact with arachnoid granulations, with no other visible abnormalities. Unilateral clear retrotympanic effusion in an adult subject should, apart from serous otitis media, suggest possible cerebrospinal fistula. In the absence of otologic or traumatic history, arachnoid granulation is one possible etiology, inducing spontaneous cerebrospinal fluid leakage when facing the temporal bone. Diagnosis is suggested by bone defects in the tegmen tympani or posterior wall of the temporal bone on CT, with the adjacent mastoid cavities filled with fluid. Pneumococcal vaccination and early surgical repair of the fistula should be performed to avoid neuromeningeal infection. Copyright © 2013. Published by Elsevier Masson SAS.

  8. Efficacy of healing process of bone defects after apicectomy: results after 6 and 12 months.

    Dominiak, M; Lysiak-Drwal, K; Gedrange, T; Zietek, M; Gerber, H


    The aim of this study was to assess the efficacy of selected surgical treatment techniques of bone defects after apectomy. A total of 106 postresection bone defects, located in maxilla and mandible were included in the study: the defects were treated with resorbable collagen membrane (BG I- 26 defects), xenogenic bovine material (BOC II- 30 defects) and xenogenic bovine material with platelet rich plasma (BOC/PRP III- 20 defects). In the control group the defects were left to heal spontaneously. Clinical and radiological assessment was performed at 6 and 12 months after the procedures. The analysis among groups revealed higher efficiency of the method of treatment that uses guide bone regeneration in comparison to the group in both post-operative control periods. After 6 months, the differences were statistically significant for each group using the regeneration methods, but after 12 months only for the BOC/PRP group. Treatment using selected guided bone regeneration techniques proved superior to the control group in both observation periods, but after 6 as well 12 months the best results in the BOC/PRP group were observed.

  9. Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy.

    Küçükyavuz, Zuhal; Cambazoğlu, Mine


    We studied the effects of low-dose midazolam with propofol for patient control sedation (PCS) in 30 healthy (ASA grade I) patients who were randomly allocated into two equal groups (n = 15 in each). They were given a propofol infusion of 2mg/kg/h after a bolus dose of 0.7 mg/kg. The second group was given the 2mg/kg/h propofol infusion after a dose of midazolam 0.03 mg/kg and a bolus dose of propofol 0.7 mg/kg. The standard dose for PCS was propofol 0.2mg/kg in both groups. Clinical data were taken and haemodynamic variables, and oxygen saturation were recorded before and on the 5th, 10th, 20th, and 30th minutes during the operations. The level of sedation, amnesia and conditions of each patient were evaluated during the study. Patients' satisfaction was recorded using a modified visual analogue scale (VAS). All results were evaluated statistically. We conclude that low-dose midazolam with propofol during PCS neither reduced oxygen saturation nor prolonged the time of discharge. Low-dose midazolam with propofol also improved the acceptability and comfort for patients and made the operation easier, which makes it preferable to propofol alone.

  10. Studies suggest alternatives to amalgam as a retrograde filling material for apicectomy.

    Naito, Toru


    Sources were Medline and the Cochrane Library. Studies included were in vivo with human subjects, had experimental and control groups, and gave quantitative results in English, German or French. Success and failure rates were derived from randomised controlled trials (RCT), clinical controlled trials (CCT), cohort studies (CS) and case-controlled studies (CCS). Qualitative synthesis of results was performed. Two RCT, six CCT and 14 CCS were identified. The two RCT suggest that glass ionomer may be more effective than amalgam, conversely one CCT showed amalgam to be more effective. CCTs also suggest that EBA (reinforced zinc oxide eugenol) cement, composite with GLUMA (Bayer AG., Leverkusen, Germany) and gold leaf retrograde filling may be more effective than amalgam. A further CCT suggested that gutta-percha used as a retrograde filing is less effective than when used following an orthograde approach. Based on the outcome of two RCT, glass ionomer appears as effective as amalgam. EBA cement, composite with GLUMA and gold leaf and orthograde gutta-percha may also be as effective as amalgam. Evidence is limited, however, and further research is needed.

  11. Pneumomediastinum, bilateral pneumothorax, pleural effusion, and surgical emphysema after routine apicectomy caused by vomiting.

    Gulati, Archita; Baldwin, Andrew; Intosh, Ian Mc; Krishnan, A


    Mediastinal and subcutaneous emphysema may occur after dental and oral surgery as a result of iatrogenic introduction of air or injury to the tracheobronchial tree. We report a patient who developed emphysema and pneumothorax after dentoalveolar surgery, which made diagnosis and management difficult. We suggest that persistent postoperative vomiting caused inhalation of mediastinal and intrathoracic air.

  12. Malformations and abnormalities of the petrous portion of the temporal bone; Fehlbildungen und Missbildungen des Felsenbeins

    Reith, W.; Yilmaz, U. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany); Heumueller, I. [Westpfalzklinikum Kaiserslautern, Institut fuer Radiologie, Kaiserslautern (Germany)


    High-resolution computed tomography (HRCT) is the procedure of choice in the diagnostics of abnormalities of the middle and inner ear. It allows a detailed presentation of anatomical features and achieves the prerequisites for selection of the various therapeutic options. The highly diverse abnormalities can be described using detailed imaging analyses. Malformations with an abnormally developed modiolus are assumed to be early embryological defects, such as the classical Mondini dysplasia. The essential therapeutic option for middle ear deformities is still a cochlear implant. The domain of magnetic resonance imaging (MRI) is not only in the analysis of the cochlear nerve and for exclusion of fibrosis or ossification of the labyrinth but is also able to visualize details of isolated malformations, such as an extended vestibular aqueduct or subtle alterations to the vestibule or can visualize them better in comparison to CT. Radiological diagnostics are used not only for classification but also to recognize typical clinical problem situations and play a key role in the diagnostics of hearing disorders and selection of the optimal therapeutic procedure. (orig.) [German] Die hochaufloesende CT ist das Verfahren der Wahl in der Diagnostik von Fehlbildungen des Mittel- und Innenohrs. Sie erlaubt die detaillierte Darstellung anatomischer Details und schafft die Voraussetzung fuer die unterschiedlichen Therapieoptionen. Durch detaillierte bildgebenden Analysen koennen die unterschiedlichsten Fehlbildungen beschrieben werden. Fehlbildungen mit einem nicht normal ausgebildeten Modiolus werden als fruehere embryologische Schaedigungen als die klassische Mondini-Dysplasie angesehen. Die wesentliche therapeutische Option bei Mittelohrfehlbildung bleibt das Kochleaimplantat. Die Domaene der MRT liegt nicht nur in der Analyse des N. cochlearis und im Ausschluss von Fibrosierungen oder Ossifikationen des Labyrinths, sondern darueber hinaus ist sie in der Lage, Details einzelner Fehlbildungen, wie des erweiterten Aquaeductus vestibulae oder diskreter Fehlbildungen des Vestibulums zu erkennen oder im Vergleich zur CT besser darzustellen. Die radiologische Diagnostik vermag nicht nur zu klassifizieren, sondern auch typische klinische Problemsituationen zu erkennen und stellt eine Schluesselrolle in der Diagnostik von Hoerstoerungen und der Wahl der optimalen therapeutischen Verfahren dar. (orig.)

  13. Transvenous embolization of cavernous sinus dural arteriovenous fistula via angiographic occlusive inferior petrous sinus

    Chao-Bao Luo


    Conclusion: Angiographic occlusive IPS of CSDAVF may be related to true occlusion of IPS or patent IPS with compartment of the IPS-CS. There is no statistically significant difference in procedural times for these two different fistula anatomies. Transvenous embolization via angiographic occlusive IPS is a safe and effective method to manage CSDAVFs.

  14. [Malformations and abnormalities of the petrous portion of the temporal bone].

    Reith, W; Yilmaz, U; Heumüller, I


    High-resolution computed tomography (HRCT) is the procedure of choice in the diagnostics of abnormalities of the middle and inner ear. It allows a detailed presentation of anatomical features and achieves the prerequisites for selection of the various therapeutic options. The highly diverse abnormalities can be described using detailed imaging analyses. Malformations with an abnormally developed modiolus are assumed to be early embryological defects, such as the classical Mondini dysplasia. The essential therapeutic option for middle ear deformities is still a cochlear implant. The domain of magnetic resonance imaging (MRI) is not only in the analysis of the cochlear nerve and for exclusion of fibrosis or ossification of the labyrinth but is also able to visualize details of isolated malformations, such as an extended vestibular aqueduct or subtle alterations to the vestibule or can visualize them better in comparison to CT. Radiological diagnostics are used not only for classification but also to recognize typical clinical problem situations and play a key role in the diagnostics of hearing disorders and selection of the optimal therapeutic procedure.

  15. Clinical study of refractory apical periodontitis treated by apicectomy. Part 1. Root canal morphology of resected apex.

    Wada, M; Takase, T; Nakanuma, K; Arisue, K; Nagahama, F; Yamazaki, M


    The morphology of the root apex was analysed by observation of the anatomy of specimens obtained by apicoectomy in cases of refractory apical periodontitis that did not respond to nonsurgical root canal treatment. Apical ramifications were present in 19 (70%) of the roots, while one were found in the remaining eight (3%) roots. This frequency is far higher than that reported by other investigators, suggesting that there is a close relationship between the anatomical complexity of the root canal and the occurrence of refractory apical periodontitis.

  16. Apical sealing quality of in vitro apicectomy procedures after using both Er:YAG and Nd:YAG.

    Leonardi, Denise Piotto; Sivieri-Araujo, Gustavo; Zielak, Joao Cesar; Baratto-Filho, Flares; Moriyama, Lilian Tan; Berbert, Fabio Luiz Camargo Villela


    The aim of this study was to evaluate the apical sealing of dentinal tubules after root-end surface cutting by using Er:YAG and Nd:YAG lasers. After root-canal instrumentation and filling, apices of 50 extracted maxillary canine human teeth were resected by Er:YAG with 400 mJ, 10 Hz, for 30 sec. The samples were randomly assigned to five groups (n = 10): (GI) treated without root-end cavity, but with Nd:YAG (1.0 W, 10 Hz, 20 sec) for dentinal tubules sealing; (GII) treated with root-end cavity without the use of Nd:YAG; (GIII) treated with root-end cavity and Nd:YAG application; (GIV) treated with root-end cavity made by Er:YAG with no focus and without Nd:YAG application; and (GV) treated without root-end cavity and without Nd:YAG application. The root-end cavities were performed by using Er:YAG at 300 mJ, 10 Hz, for 20 sec. Subsequently, all teeth were waterproofed and immersed in 2% methylene blue for 48 h in a vacuum environment. The samples were longitudinally sectioned, and microleakage was measured. ANOVA and the Fisher LSD test showed that GIV was less susceptible to microleakage than were the other groups (p < 0.05). Interestingly, the use of the Er:YAG with no focus showed superior dentinal tubule sealing in comparison with the other groups, even with or without root-end cavity and Nd:YAG application.

  17. Apicectomy with the Er:YAG laser or bur, followed by retrograde root filling with zinc oxide/eugenol or sealer 26.

    Francischone, Carlos Eduardo; Padovan, Lia Almeida Prado De Araújo; Padovan, Luis Eduardo Marques; Duarte, Marco Antônio Húngaro; Fraga, Sylvio De Campos; Curvêllo, Victor Prado


    This study evaluated the influence of root resection, by means of the use of erbium:YAG laser in sealing two different materials, OZE and Sealer 26, in retrograde obturations. Few studies with sufficient data have been conducted in this area. Forty uniradicular teeth were used. They were biomechanically prepared using the step-back technique and obturated using the lateral condensation technique. The teeth were divided into two groups of 20 teeth, one group using the erbium:YAG laser (350 mJ and 6 Hz) for the resection process and the other using the Zekrya Drill, in high rotation. Then, the retrograde cavities were prepared using a micro counter-angle with a number 2 spherical bur. After preparing the cavities, the teeth were impermeabilized and divided into two subgroups. One subgroup used the retrograde obturation technique with Sealer 26 cement, and the other subgroup used OZE. After completing the retrograde obturation, the teeth were immersed in 2% methylene blue for a 7-day period. Teeth were then removed from the dye, washed, scraped, and sectioned in the vestibule-lingual direction. The results were analyzed with the aid of a magnifying lens, and scores were attributed based on the magnitude of infiltration. The data were then submitted to statistical analysis. No statistical difference was noticed regarding the root resection methods; however, in comparing materials, Sealer 26 was statistically superior to OZE. In the subgroup comparison, a significant difference was noticed in the Laser and Sealer 26 and the Laser and OZE and bur and OZE.

  18. Computer tomography in children and adolescents with suspected malformation of the petrous portion of the temporal bone; Computertomographie bei Kindern und Jugendlichen mit Verdacht auf eine Felsenbeinmissbildung

    Koesling, S.; Schneider-Moebius, C. [Klinik und Poliklinik fuer Diagnostische Radiologie, Univ. Leipzig (Germany); Koenig, E.; Meister, E.F. [Klinik und Poliklinik fuer Hals-Nasen-Ohrenkrankheiten, Univ. Leipzig (Germany)


    Purpose: To demonstrate HRCT findings and their therapeutic relevance in suspected congenital hearing disorders. Material and Methods: It was checked in 96 young patients if HRCT findings of the temporal bone could explain functional findings. Furthermore, the therapeutic consequences were noted. Results: Normal CT and normal functional findings were obtained in 49 temporal bones (TB). In conductive hearing loss (41 TB), dysplasias of the conducting apparatus (37 TB) and inflammatory changes (3 TB) were found. Combined hearing loss (18 TB) was clarified completely or partially in half the cases. There were 22 dysplasias of the inner ear, 3 dysplasias of the middle ear, 1 adandoned examination (2 TB), and 55 normal CT findings in senorineural hearing disorders (82 TB). 1 retardate had a malformation of the inner ear and, contralaterally, inflammatory middle ear. In cases of vestibular disorders (24 TB), 14 malformations of the inner ear were detected. (orig./AJ) [Deutsch] Ziel der Untersuchung war die Darstellung von HR-CT-Befunden und ihrer therapeutischen Relevanz bei Verdacht auf angeborene Hoerstoerungen. An 96 jungen Patienten wurde ueberprueft, inwieweit die Felsenbein-HRT-CT-Befunde mit Ergebnissen funktioneller Tests uebereinstimmten und welche therapeutischen Konsequenzen sich ergaben. Normale Funktions- und CT-Befunde zeigten 49 Felsenbeine (FB). Bei Schalleitungsschwerhoerigkeit (41 FB) wurden Missbildungen des Schalleitungsapparates (37 FB) bzw. entzuendliche Veraenderungen (3 FB) gefunden. Kombinierte Schwerhoerigkeiten (18 FB) konnten zur Haelfte teilweise oder vollstaendig abgeklaert werden. Bei sensorineuralen Hoerstoerungen (82 FB) fanden sich 22 Innenohrmissbildungen, 3 Mittelohrmissbildungen, 55 Normalbefunde, ein Untersuchungsabbruch (2 FB). 1 Debiler wies eine Innenohrmissbildung, kontralateral entzuendliche Mittelohrveraenderungen auf. (orig./AJ)

  19. Clinical Study of High Level Apicectomy in Preserving the Offending Teeth of Jaw Cysts%高位截根保存颌骨囊肿受累牙的临床研究

    卢丽虹; 胡顺广; 魏远坚


    目的 研究颌骨囊肿受累牙行高位截根术后的临床效果.方法 67例颌骨囊肿208颗受累牙于术前完成根管治疗,颌骨囊肿切除术中对受累牙行高位截根,保存受累牙齿,所有受累牙的截根位置均在根中1/2以上,平均截根长度6.0 mm.术后1、 3、 6、 12个月复查,随访1年,检查病灶牙的松动、咬合情况并摄X线全景片.结果 67例患者中,除3例10颗受累牙失访外,余64例患者198颗受累牙术后均随访1年,无1例囊肿复发.术后3个月时,有2例各1颗受累牙Ⅲ度松动予以拔除,余196颗牙齿成功保留.结论 颌骨囊肿受累牙行高位截根术后可予保留,且不增加囊肿复发率.

  20. Learning by doing virtually.

    von Sternberg, N; Bartsch, M S; Petersik, A; Wiltfang, J; Sibbersen, W; Grindel, T; Tiede, U; Warnke, P H; Heiland, M; Russo, P A J; Terheyden, H; Pohlenz, P; Springer, I N


    Selective reduction of bone without collateral damage (nerves, teeth) is essential in apicectomy. To test whether skills acquired on a virtual apicectomy simulator (VOXEL-MAN system with integrated force-feedback) are transferable from virtual to physical reality, two groups of trainees were compared. Group 1 received computer-based virtual surgical training before performing an apicectomy in a pig cadaver model. The probability of preserving vital neighboring structures was improved significantly, i.e. six-fold, after virtual surgical training (Papicectomy simulator appears to be effective, and the skills acquired are transferable to physical reality.

  1. Apicectomía o implante: Reporte de un caso clínico

    Fernández Bodereau, Enrique; Tortolini, Patricia


    We report a clinical case of a patient who underwent apicectomy on an upper premolar, presumably by endodontic done improperly, and have cast a bolt where the extraction run the risk of tooth fracture...

  2. Evaluation quality of life after apicoectomy using two defferent flap design

    Dimova, Cena; Popovska, Lidija; Popovska, Mirjana; Evrosimovska, Biljana


    INTRODUCTION. Apicectomy has become an integral part of a comprehensive dental treatment. The primary objective of apicectomy is to eradicate the etiological agents of periapical pathoses and to restore the periodontium to a state of biologic and functional health. The aim of this study was to evaluate patient experience of quality of life following apicoectomy using two different flap design gingival (envelope) and semilunar. MATERIAL AND METHOD. The study consisted of 60 patients ref...

  3. Evaluation quality of life after apicoectomy using two different flap design

    Dimova, Cena; Popovska, Mirjana; Popovska, Lidija; Evrosimovska, Biljana


    INTRODUCTION. Apicectomy has become an integral part of a comprehensive dental treatment. The primary objective of apicectomy is to eradicate the etiological agents of periapical pathoses and to restore the periodontium to a state of biologic and functional health. MATERIAL AND METHOD. The study consisted of 60 patients referred for oral surgical treatment - apicoectomy with periapical osteotomy. All patients were given a questionnaire with 15 questions to evaluate their quality of lif...

  4. Internal carotid false aneurysm after thermocoagulation of the gasserian ganglion.

    Schmerber, Sébastien; Vasdev, Ashok; Chahine, Karim; Tournaire, Romain; Bing, Fabrice


    To identify petrous internal carotid bleeding aneurysm as a complication of gasserian ganglion thermocoagulation. A single case presenting with epistaxis and otorrhagia 1 month after gasserian ganglion thermocoagulation in the treatment of refractory trigeminal neuralgia. Gasserian ganglion thermocoagulation, computed tomographic scan, and angiocomputed tomographic scan revealing petrous internal carotid ruptured aneurysm and internal carotid embolization. Radiologic diagnosis of the vascular injury after gasserian ganglion thermocoagulation. Radiologic identification of ruptured internal carotid artery as the cause of simultaneous epistaxis and otorrhagia. Gasserian ganglion thermocoagulation may cause aneurysm and rupture of the petrous portion of the internal carotid artery.

  5. An unusual dilacerated root of a second maxillary molar

    Ngeow, W. C.


    An unusual case of a second maxillary molar with a dilacerated root visible clinically is described. Apicectomy followed by retrograde amalgam filling was performed whereby gingival coverage and gingival seal was achieved. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

  6. Changes of Root Length and Root-to-Crown Ratio after Apical Surgery

    von Arx, Thomas; Jensen, Simon S; Bornstein, Michael M


    the length of apicectomy and calculated the loss of root length and changes of RCR after apical surgery. METHODS: In a prospective clinical study, cone-beam computed tomography scans were taken preoperatively and postoperatively. From these images, the crown and root lengths of 61 roots (54 teeth in 47...

  7. Diagnostic validity of periapical radiography and CBCT for assessing periapical lesions that persist after endodontic surgery

    Kruse, Casper; Spin-Neto, Rubens; Reibel, Jesper


    OBJECTIVES: Traditionally, healing after surgical endodontic retreatment (SER); i.e. apicectomy with or without a retrograde filling, is assessed in periapical radiographs (PR). Recently, the use of Cone Beam CT (CBCT) has increased within endodontics. Generally, CBCT detects more periapical...

  8. Management of acute mastoiditis in children. A retrospective study and literature review

    Wafa Abid


    Conclusion: Initial management of acute mastoiditis starts with intravenous antibiotics and computerized tomographic scan of the petrous temporal bones. Surgical approach is required in case of complications or failure of medical treatment. Watchful clinical monitoring is essential in all cases.

  9. Trigeminal Neuralgia Due to a Small Meckel's Cave Epidermoid Tumor: Surgery Using an Extradural Corridor.

    Furtado, Sunil V; Hegde, Alangar S


    Tumors at the petrous apex are associated with a variety of symptoms, which most often involve the trigeminal nerve. The authors present a rare case of a small epidermoid tumor in Meckel's cave that caused medically refractory trigeminal neuralgia. The surgical challenge associated with approaches to such lesions is discussed. The skull base tumor was excised completely through a small temporal craniotomy. The practicality of neuronavigation in reaching the petrous apex using a small extradural window is presented.

  10. Trigeminal Neuralgia Due to a Small Meckel's Cave Epidermoid Tumor: Surgery Using an Extradural Corridor

    Sunil V Furtado; Hegde, Alangar S


    Tumors at the petrous apex are associated with a variety of symptoms, which most often involve the trigeminal nerve. The authors present a rare case of a small epidermoid tumor in Meckel's cave that caused medically refractory trigeminal neuralgia. The surgical challenge associated with approaches to such lesions is discussed. The skull base tumor was excised completely through a small temporal craniotomy. The practicality of neuronavigation in reaching the petrous apex using a small extradur...

  11. High resolution computed tomography for peripheral facial nerve paralysis

    Koester, O.; Straehler-Pohl, H.J.


    High resolution computer tomographic examinations of the petrous bones were performed on 19 patients with confirmed peripheral facial nerve paralysis. High resolution CT provides accurate information regarding the extent, and usually regarding the type, of pathological process; this can be accurately localised with a view to possible surgical treatments. The examination also differentiates this from idiopathic paresis, which showed no radiological changes. Destruction of the petrous bone, without facial nerve symptoms, makes early suitable treatment mandatory.

  12. Refractory Positional Vertigo With Apogeotropic Horizontal Nystagmus After Labyrinthitis: Surgical Treatment and Identification of Dysmorphic Ampullae.

    Ahmed, Sameer; Heidenreich, Katherine D; McHugh, Jonathan B; Altschuler, Richard A; Carender, Wendy J; Telian, Steven A


    To describe the rationale, intraoperative details, and histopathologic findings discovered when treating an unusual case of apogeotropic horizontal canal positional vertigo with a transmastoid labyrinthectomy. A single case report. Therapeutic. Resolution of apogeotropic nystagmus and improvement of positional vertigo. The apogeotropic variant of horizontal canal positional vertigo can be a difficult entity to treat. This report describes a patient who developed profound sensorineural hearing loss and vertigo after an acute left labyrinthitis. Ten months later, she developed vertigo with apogeotropic positional nystagmus involving the left horizontal semicircular canal. Particle repositioning maneuvers and vestibular physical therapy were unsuccessful. In addition, she developed intermittent positional vertigo affecting the ipsilateral vertical semicircular canals. Given the persistence of her vertigo, multiple canal involvement, and patient preference for definitive treatment, a transmastoid labyrinthectomy was performed. Intraoperatively, the ampulla of the horizontal canal as well as that of the other canals was grossly abnormal as later confirmed on histology. After surgery, her apogeotropic nystagmus and vertigo resolved, and her balance ability gradually improved to a highly functional level. This case illustrates a unique form of positional vertigo that developed and persisted after acute labyrinthitis. Conservative measures were unsuccessful and a transmastoid labyrinthectomy documented dense inflammatory tissue involving all three ampullae. We postulate that the post-labyrinthitic inflammatory changes resulted in mass loading of the membranous ampullae, causing abnormal nystagmus patterns and positional vertigo, which resolved after the labyrinthectomy.

  13. Evaluation of dental anxiety in patients undergoing dentoalveolar surgery with laser treatment.

    Ugurlu, Faysal; Cavus, Onur; Kaya, Alper; Sener, Cem B


    The purpose of this study was to evaluate dental anxiety in patients undergoing apicectomy procedures performed with conventional instruments or an erbium-doped yttrium aluminum garnet (Er:YAG) laser. Twenty-eight patients undergoing apicectomy were divided into two groups; roots were removed with an Er:YAG laser in group A (n=14) and with conventional instruments in group B (n=14). All patients completed preoperative State-Trait Anxiety Inventories (STAI) and postoperative questionnaires. Although state anxiety, trait anxiety, and postoperative questionnaire scores were lower in patients undergoing Er:YAG laser treatment than in those treated with conventional instruments, the differences were not statistically significant. Surgical instruments affect the anxiety levels of dental patients. Even with the STAI scores being lower for patients treated with Er:YAG, use of the Er:YAG laser alone cannot contribute to the resolution of dental anxiety. A patient's individual condition is the major factor influencing that patient's anxiety level.

  14. [New surgical approach in apicoectomy of maxillary molars' palatal root].

    Hrusztics, Aminett; Bogdán, Sándor; Fellegi, Veronika; Szabó, György


    The term of apicectomy has been well-known for more than 200 years, nevertheless it is not performed frequently on molars. As a result of this a lot of molars became extracted. The aim of the authors was to present the new surgical technique which is described in detail. The radicular cyst localised on the palatal root of the first maxillary molar was operated on. Uneventful healing was obtained. This surgical technique is recommended in some special cases.

  15. Paraendodontic surgery: case report

    Letícia Marchetti LODI; Sheila POLETO; Renata Grazziotin SOARES; Luis Eduardo Duarte IRALA; Salles, Alexandre Azevedo; Limongi,Orlando


    Introduction: Paraendodontic surgery is a procedure that aims problemsresolution that couldn’t be solved by the conventional endodontictreatment, or when the accomplishment conventional treatment is notpossible. Case report and conclusion: The aim of this study was to report a clinical case where was made apicectomy on the teeth 11, 21 and 22.The tooth 22 was sealing of root-end cavity MTA retrofilling.

  16. Carbonization of a radicular cyst using fiber-optic diode laser: a case report

    Kafas, Panagiotis; Kalfas, Sotirios


    A female patient, 51 years old, complaint of painful swelling on the anatomical area of the upper left lateral incisor. The diagnosis of radicular cyst was confirmed histo-pathologically. Nowadays, radicular cysts may be treated using conventional root canal methods or surgical apicectomy. The possible soft-laser reaction to radicular cysts after contact application has not been investigated. We present an in vitro case of a diagnosed radicular cyst which carbonized after contact application ...

  17. Clinical use of mineral trioxide aggregate (MTA) in periapical lesions and the treatment of root perforations

    Pineda Mejía, Martha Elena; Departamento Académico Estomatología Rehabilitadora, Facultad Odontología, UNMSM.; Silva Infantes, Manuel; Departamento Académico Medico Quirúrgico, Facultad Odontología, UNMSM.; Salcedo Moncada, Doris; Departamento Académico Estomatología Rehabilitadora, Facultad Odontología, UNMSM.; Castro Rodríguez, Antonia; Departamento Académico de Estomatologia Biosocial, Facultad Odontología, UNMSM.; Terán Casafranca, Liliana; Departamento Académico Estomatología Rehabilitadora, Facultad Odontología, UNMSM.; Ortiz Cárdenas, Eduardo; Departamento Académico Estomatología Rehabilitadora, Facultad Odontología, UNMSM.; Ochoa Tataje, Julio; Departamento Académico Estomatología Rehabilitadora, Facultad Odontología, UNMSM.; Gaitán Velásquez, Jorge; Departamento Académico Estomatología Rehabilitadora, Facultad Odontología, UNMSM.; Watanabe Velásquez, Romel; Departamento Académico Estomatología Rehabilitadora, Facultad Odontología, UNMSM.


    The use of MTA cement (mineral trioxide aggregate) to solve endodontics treatment complications, like pulpar floor camera perforations during root canal treatment, as well as a retrograde obturation material of apicectomy treatment, was the purpose of this investigation. White MTA Angelus, (Industria de productos odontologicos Ltda. Londrina-PR-Brazil) was used wich has 10 – 15 minutes as initial and final hardening time. The radiopacity showed by the material was somewhat superior to that of...

  18. Apicectomía o implante: Reporte de un caso clínico.

    Enrique Fernández-Bodereau; Patricia Tortolini


    We report a clinical case of a patient who underwent apicectomy on an upper premolar, presumably by endodontic done improperly, and have cast a bolt where the extraction run the risk of tooth fracture. Failed such treatment, an implant is performed, placed immediately after extraction, in which bone filling with xenograft and guided bone regeneration with resorbable collagen membrane was done. From this we deduce that the phase diagnosed is of paramount importance. Two months after functional...

  19. Evaluation of life quality after apicoectomy

    Dimova, Cena; Kovacevska, Ivona; Papakoca, Kiro


    AIM. The aim of this study was to evaluate patient experience of quality of life following apicoectomy using two different techniques: preoperative and intra operative ortograde canal opturation. MATERIAL AND METHOD. The study consisted of 40 patients referred for oral surgical treatment (apicectomy with periapical osteotomy). All patients were given a questionnaire with 15 questions to evaluate their quality of life for 7 days after the oral surgery interventions. RESULTS. The average ti...

  20. Apicetomy or dental implant: Report of a clinical case.

    Enrique Fernández-Bodereau; Patricia Tortolini


    We report a clinical case of a patient who underwent apicectomy on an upper premolar, presumably by endodontic done improperly, and have cast a bolt where the extraction run the risk of tooth fracture. Failed such treatment, an implant is performed, placed immediately after extraction, in which bone filling with xenograft and guided bone regeneration with resorbable collagen membrane was done. From this we deduce that the phase diagnosed is of paramount importance. Two months after functional...

  1. An innovative approach in the management of palatogingival groove using Biodentine™ and platelet-rich fibrin membrane

    Dexton Antony Johns; Vasundhara Yayathi Shivashankar; Shobha, K; Manu Johns


    Palatogingival groove is an anatomical malformation that often causes severe periodontal defects. Treatments of such an anomaly present a clinical challenge to the operator. Careful endodontic and periodontal procedures may restore the form and function. In the present case; root canal therapy, apicectomy, and sealing of the groove with Biodentine TM were done. Bone graft was placed followed by platelet-rich fibrin (PRF) membrane. This treatment modality resulted in gain in attachment, reduct...

  2. Histopathological and ultrastructural analysis of vestibular endorgans in Meniere's disease reveals basement membrane pathology

    McCall Andrew A


    Full Text Available Abstract Background We report the systematic analysis of the ultrastructural and cytological histopathology of vestibular endorgans acquired from labyrinthectomy in Meniere's disease. Methods 17 subjects with intractable Meniere's disease and ipsilateral non-serviceable hearing presenting to the Neurotology Clinic from 1997 to 2006 who chose ablative labyrinthectomy (average age = 62 years; range 29–83 years participated. The average duration of symptoms prior to surgery was 7 years (range 1–20 years. Results Nearly all vestibular endorgans demonstrated varying degrees of degeneration. A monolayer of epithelial cells occurred significantly more frequently in the horizontal cristae (12/13 = 92% (p Conclusion Systematic histopathological analysis of the vestibular endorgans from Meniere's disease demonstrated neuroepithelial degeneration which was highly correlated with an associated BM thickening. Other findings included hair cell and supporting cell microvessicles, increased intercellular clear spaces in the stroma, and endothelial cell vacuolization and stromal perivascular BM thickening.

  3. Giant cell tumor of the temporal bone – a case report

    Rao Saraswathi G


    Full Text Available Abstract Background Giant cell tumor is a benign but locally aggressive bone neoplasm which uncommonly involves the skull. The petrous portion of the temporal bone forms a rare location for this tumor. Case presentation The authors report a case of a large giant cell tumor involving the petrous and squamous portions of the temporal bone in a 26 year old male patient. He presented with right side severe hearing loss and facial paresis. Radical excision of the tumor was achieved but facial palsy could not be avoided. Conclusion Radical excision of skull base giant cell tumor may be hazardous but if achieved is the optimal treatment and may be curative.

  4. Congenital nasal piriform aperture stenosis with vestibular abnormality

    Rajaram, Smitha; Raghavan, Ashok [Sheffield Children' s Hospital, Department of Paediatric Radiology, Sheffield (United Kingdom); Bateman, Neil [Sheffield Children' s Hospital, ENT Department, Sheffield (United Kingdom)


    We present a neonate with congenital nasal piriform aperture stenosis associated with an abnormal vestibular aperture. Radiological evaluation with CT is essential to confirm the diagnosis and delineate the anatomy for surgical planning. Extension of the scan field of view to include the petrous temporal bone is essential to identify associated abnormalities of the vestibule. (orig.)

  5. Tuberculoma of the Cavernous Sinus and Meckel's Cave in a Child.

    Kumar, V R Roopesh; Madhugiri, Venkatesh S; Verma, Surendra Kumar; Barathi, S Deepak; Yadav, Awdhesh Kumar; Bidkar, Prasanna


    Tuberculous infection of the cavernous sinus and Meckel's cave is extremely rare. In this report, we describe a patient with tuberculoma of the cavernous sinus and Meckel's cave, extending to the petrous apex. The patient underwent microsurgical excision of the lesion and antitubercular chemotherapy resulting in a good outcome. We describe the diagnostic difficulties and review the relevant literature.

  6. An innovative approach in the management of palatogingival groove using Biodentine™ and platelet-rich fibrin membrane

    Johns, Dexton Antony; Shivashankar, Vasundhara Yayathi; Shobha, K; Johns, Manu


    Palatogingival groove is an anatomical malformation that often causes severe periodontal defects. Treatments of such an anomaly present a clinical challenge to the operator. Careful endodontic and periodontal procedures may restore the form and function. In the present case; root canal therapy, apicectomy, and sealing of the groove with Biodentine™ were done. Bone graft was placed followed by platelet-rich fibrin (PRF) membrane. This treatment modality resulted in gain in attachment, reduction in pocket depth, and deposition of bone in the osseous defect. A 24 month follow-up is included. PMID:24554867

  7. Cone Beam CT use in the pre-prosthetic evaluation of endodontically treated of the rear maxilla



    SUMMARY With our study we wanted to compare the diagnostic accuracy of conventional radiography (orthopanoramic and intraoral radiography) and Cone Beam CT (CBCT) for the diagnosis of periapical lesions on the posterior elements of the upper maxilla endodontically treated. The images were analyzed by a radiologist and an endodontist whose interpretation of radiological examinations is unique. Were examined 34 molars (23 first molars and 13 second molars) with a total of 102 roots. The CBCT detected a significantly higher number of lesions (43%, p apicectomy) of a lesion diagnosed with 2D techniques. PMID:23285405

  8. Carbonization of a radicular cyst using fiber-optic diode laser: a case report

    Kafas, Panagiotis; Kalfas, Sotirios


    A female patient, 51 years old, complaint of painful swelling on the anatomical area of the upper left lateral incisor. The diagnosis of radicular cyst was confirmed histo-pathologically. Nowadays, radicular cysts may be treated using conventional root canal methods or surgical apicectomy. The possible soft-laser reaction to radicular cysts after contact application has not been investigated. We present an in vitro case of a diagnosed radicular cyst which carbonized after contact application of diode laser. The need for future clinical trials will be essential to prove the sensitivity of this procedure in humans. PMID:18713459

  9. Enterococcus faecalis leakage in MTA silver amalgam and glass ionomer as root-end filling materials

    Pineda Mejía, Martha Elena; Departamento Académico Estomatología Rehabilitadora. Facultad Odontología UNMSM. Lima Perú.; Salcedo Moncada, Doris; Departamento Académico Estomatología Rehabilitadora. Facultad Odontología UNMSM. Lima Perú.; Castro Rodríguez, Antonia; Departamento Académico Estomatología Biosocial. Facultad Odontología UNMSM. Lima Perú.; Palacios Alva, Elmo; Departamento Académico Médico Quirúrgico. Facultad Odontología UNMSM. Lima Perú.; Moromi Nakata, Hilda; Departamento Académico de Ciencias Básicas. Facultad Odontología UNMSM. Lima Perú.; Martínez Cadillo, Elba; Departamento Académico de Ciencias Básicas. Facultad Odontología UNMSM. Lima Perú.; Ortiz Cárdenas, Ántero; Departamento Académico Estomatología Rehabilitadora. Facultad Odontología UNMSM. Lima Perú.; Watanabe Velásquez, Rómel; Departamento Académico Estomatología Rehabilitadora. Facultad Odontología UNMSM. Lima Perú.; Zambrano de la Peña, Livia; Departamento Académico Médico Quirúrgico. Facultad Odontología UNMSM. Lima Perú.; Ochoa Tataje, Julio; Departamento Académico Estomatología Rehabilitadora. Facultad Odontología UNMSM. Lima Perú.; Lara Téllez, Lourdes; Departamento Académico Estomatología Rehabilitadora. Facultad Odontología UNMSM. Lima Perú.; Ayala de la Vega, Gerardo; Departamento Académico Estomatología Rehabilitadora. Facultad Odontología UNMSM. Lima Perú.; Ventocilla Huasupoma, María; Departamento Académico Estomatología Rehabilitadora. Facultad Odontología UNMSM. Lima Perú.


    One of the aims of a root-end filling material placed in an apicectomy treatment is to provide apical seal that can inhibits the coronary migration of antigens to perirradicular tissues. Many materials are used for this end; however, to date there has not been any material that satisfies all the requirements of an ideal material. With the purpose of making a comparative analysis of the apical sealing abilities of three root-end filling materials: silver amalgam, glass ionomer and MTA (mineral...

  10. An innovative approach in the management of palatogingival groove using Biodentine™ and platelet-rich fibrin membrane.

    Johns, Dexton Antony; Shivashankar, Vasundhara Yayathi; Shobha, K; Johns, Manu


    Palatogingival groove is an anatomical malformation that often causes severe periodontal defects. Treatments of such an anomaly present a clinical challenge to the operator. Careful endodontic and periodontal procedures may restore the form and function. In the present case; root canal therapy, apicectomy, and sealing of the groove with Biodentine™ were done. Bone graft was placed followed by platelet-rich fibrin (PRF) membrane. This treatment modality resulted in gain in attachment, reduction in pocket depth, and deposition of bone in the osseous defect. A 24 month follow-up is included.

  11. Effect of physical exercise prelabyrinthectomy on locomotor balance compensation in the squirrel monkey

    Igarashi, M.; Ohashi, K.; Yoshihara, T.; MacDonald, S.


    This study examines the effectiveness of physical exercise, during a prepathology state, on locomotor balance compensation after subsequent unilateral labyrinthectomy in squirrel monkeys. An experimental group underwent 3 hr. of daily running exercise on a treadmill for 3 mo. prior to the surgery, whereas a control group was not exercised. Postoperatively, the locomotor balance function of both groups was tested for 3 mo. There was no significant difference in gait deviation counts in the acute phase of compensation. However, in the chronic compensation maintenance phase, the number of gait deviation counts was fewer in the exercise group, which showed significantly better performance stability.

  12. The History and Evolution of Surgery on the Vestibular Labyrinth.

    Naples, James G; Eisen, Marc D


    The history of surgery on the vestibular labyrinth is rich but sparsely documented in the literature. The story begins over a century ago with the labyrinthectomy in an era that consisted exclusively of ablative surgery for infection or vertigo. Improved understanding of vestibular physiology and pathology produced an era of selective ablation and hearing preservation that includes semicircular canal occlusion for benign paroxysmal positional vertigo. An era of restoration began with a discovery of superior semicircular canal dehiscence and its repair. The final era of vestibular replacement is upon us as the possibility of successful prosthetic vestibular implantation becomes reality. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  13. Risk factors for tooth loss in an adult population: a radiographic study.

    Bahrami, Golnosh; Vaeth, Michael; Kirkevang, Lise-Lotte; Wenzel, Ann; Isidor, Flemming


    The aim of the present study was to estimate the incidence and identify risk factors for tooth loss during a 5-year period in a randomly selected Danish population. In 1997 and 2003, 473 randomly selected adults received a full-mouth radiographic examination. The total number of teeth was 12,444. For each tooth, the following information was recorded from the radiographs: marginal bone level, filling, crown, root canal post, root filling, apicectomy, periapical status and caries lesion. Unconditional and conditional logistic regression analyses were used to identify risk factors for tooth loss. During the study period, 107 teeth in 60 individuals were lost. On the individual level, reduced marginal bone level and apical periodontitis (AP) were highly associated with tooth loss. On the tooth level, a reduced marginal bone level, AP and apicectomy were strongly associated with tooth loss. Canines were not lost often, whereas tooth loss was more frequently observed in molars and premolars than in incisors. A reduced marginal bone level and AP were associated with tooth loss over time. Furthermore, there was a higher risk of tooth loss in the posterior regions than in the anterior region.

  14. Sexual dimorphism of the lateral angle of the internal auditory canal and its potential for sex estimation of burned human skeletal remains.

    Gonçalves, David; Thompson, Tim J U; Cunha, Eugénia


    The potential of the petrous bone for sex estimation has been recurrently investigated in the past because it is very resilient and therefore tends to preserve rather well. The sexual dimorphism of the lateral angle of the internal auditory canal was investigated in two samples of cremated Portuguese individuals in order to assess its usefulness for sex estimation in burned remains. These comprised the cremated petrous bones from fleshed cadavers (N = 54) and from dry and disarticulated bones (N = 36). Although differences between males and females were more patent in the sample of skeletons, none presented a very significant sexual dimorphism, thus precluding any attempt of sex estimation. This may have been the result of a difficult application of the method and of a differential impact of heat-induced warping which is known to be less frequent in cremains from dry skeletons. Results suggest that the lateral angle method cannot be applied to burned human skeletal remains.

  15. [A caloric vestibular test with increased positive evidence (author's transl)].

    Kurzeja, A; Strauss, P; Kapell, H


    A decrease of the variance of a caloric test would increase the importance of the statement of this test. An important source of variance are the differences concerning the timecourse of the induced heat wave, determined by the different anatomic conditions in the petrous bone, particularly the pneumatisation. A constant temperature gradient is obtained by the irigation in a pessimum position with the head flexed 30 degrees to the front. This temperature gradient evokes immediately a constant maximum vestibular stimulus after having reflected the head 90 degrees to the back. Comparing this new method with the traditional irrigation, one can state an important reduction of variance. The dependence of the nystagumus response on caloric irrigation of the petrous bone demands a X-ray-examination according to the technique of Schüller before starting with the caloric examination. In case of differences between the right and left sides the described test would be necessary in our opinion.

  16. Interpositional carotid artery bypass strategies in the surgical management of aneurysms and tumors of the skull base.

    Liu, James K; Couldwell, William T


    Cerebral revascularization is an important component in the surgical management of complex skull base tumors and aneurysms. Patients who harbor complex aneurysms that cannot be clipped directly and in whom parent vessel occlusion cannot be tolerated may require cerebrovascular bypass surgery. In cases in which skull base tumors encase the carotid artery (CA) and a resection is desired, a cerebrovascular bypass may be necessary in planned CA occlusion or sacrifice. In this review the authors discuss options for performing high-flow anterograde interposition CA bypass for lesions of the skull base. The authors review three important bypass techniques involving saphenous vein grafts: the cervical-to-petrous internal carotid artery (ICA), petrous-to-supraclinoid ICA, and cervical-to-supraclinoid ICA bypass. These revascularization techniques are important tools in the surgical treatment of complex aneurysms and tumors of the skull base and cavernous sinus.

  17. Endolymphatic sac tumor : a rare cerebellopontine angle tumor.

    Joseph B


    Full Text Available Endolymphatic sac tumors (ELST are rare papillary tumors of the temporal bone. Previously named as aggressive papillary middle ear tumors, they have recently been shown to arise from the endolymphatic sac. They are a rare in cerebello-pontine angle (CPA. We present a case of an ELST who presented as a CPA tumor with hydrocephalus. He underwent a ventriculo-peritoneal shunt initially. On exploration of the CP angle, the tumor was found to be extremely vascular. He was re-explored following embolization, and a subtotal excision of the tumor was done. Extensive petrous bone infiltration and vascularity of the tumor makes total excision almost impossible with high risk of cranial nerve deficits, excessive blood loss and CSF leak. This tumor should be considered in the differential diagnosis of vascular CPA tumors which erode the petrous temporal bone. The relevant literature is reviewed.

  18. [Synopsis of a standardized, schematic analysis of the ossicles and tympanic walls, visualized with high-resolution computed tomography (using help lines and pictograms)].

    Grobovschek, M


    As in other radiological examinations there is an essay to show the ossicles and their surrounding tympanic walls of the petrous bone in the high resolution computed tomography. This should be standardized to simplify the interpretation and to allow the comparison. For the axial imaging of the ossicles corresponding to their particular topographic situation the head is tilted to the non-examined side and a little bit dorsally flected to turn especially the stapes in the scanning plane and to image the malleus and incus axially. The standard slices of the tympanon were schematized with the help of pictogramms. This allows a faster orientation and an easier recognition of a changed topographical situation meaning a pathological condition. The coronary view is as the important second part of the HR CT of the petrous bone integrated.

  19. Head-neck-radiology; Kopf-Hals-Radiologie

    Cohnen, Mathias (ed.) [Staedtische Kliniken Neuss Lukaskrankenhaus GmbH (Germany). Institut fuer klinische Radiologie


    The book on head-neck-radiology covers the following issues: (1) Methodic fundamentals: conventional radiography, angiography, sonography, computerized tomography, digital volume tomography, NMR imaging, nuclear medicine. (2) Base of the skull. (3) Petrous bone. (4) Pharynx. (5) Paranasal sinuses. (6) Eye socket. (7) Temporomandibular joint. (8) Salivary gland. (9) Oral cavity. (19) Parynx. (11) Neck soft tissue and lymph nodes. (12) Thyroid and parathyroid. (13) Teeth and jaw. (14) Interventions.

  20. Selective Transvenous Coil Embolization of Dural Arteriovenous Fistula: A Report of Three Cases


    We herein report three cases of dural arteriovenous fistula (DAVF) in which the venous outlet immediately adjacent to the fistula was selectively embolized. Case 1: A 69-year-old man presented with a subarachnoid hemorrhage (SAH). Angiography demonstrated a DAVF in the left superior petrous sinus. Case 2: A 59-year-old woman presented with dizziness. Angiography demonstrated a DAVF adjacent to great vein of Galen. The DAVF drained through the great vein of Galen with retrograde leptomeningeal...

  1. The internal acoustic canal - another review area in paediatric sensorineural hearing loss

    Chetcuti, Karen [The Royal Children' s Hospital, Department of Medical Imaging, Parkville, VIC (Australia); Kumbla, Surekha [The Royal Children' s Hospital, Department of Medical Imaging, Parkville, VIC (Australia); Monash Health, Clayton, VIC (Australia)


    Morphological abnormalities of the internal acoustic canal (IAC), albeit rare, are sometimes associated with hearing loss in children. We present an illustration of the spectrum of IAC abnormalities together with a brief review of the embryology and anatomy of the IAC and the techniques used when imaging the petrous temporal bone. This review focuses on morphological abnormalities of the IAC together with their clinical implications and impact on clinical management. (orig.)

  2. Peripheral facial palsy, the only presentation of a primitive neuroectodermal tumor of the skull base

    Kim, Hyung Jin; Kang, Ben; Joo, Eun Young; Kim, Eun Young; Kwon, Young Se


    Introduction Peripheral facial palsy is rarely caused by primary neoplasms, which are mostly constituted of tumors of the central nervous system, head and neck, and leukemia. Presentation of case A 2-month-old male infant presented with asymmetric facial expression for 3 weeks. Physical examination revealed suspicious findings of right peripheral facial palsy. Computed tomography of the temporal bone revealed a suspicious bone tumor centered in the right petrous bone involving surrounding bon...

  3. Tuberculous otitis media: findings on high-resolution CT

    Lungenschmid, D. [Dept. of Radiodiagnostics, University Hospital Innsbruck (Austria)]|[Dept. of Magnetic Resonance and Spectroscopy, University Hospital of Innsbruck (Austria); Buchberger, W. [Dept. of Radiodiagnostics, University Hospital Innsbruck (Austria)]|[Dept. of Magnetic Resonance and Spectroscopy, University Hospital of Innsbruck (Austria); Schoen, G. [Dept. of Radiodiagnostics, University Hospital Innsbruck (Austria); Schoepf, R. [Radiologic Inst., Landeck (Austria); Mihatsch, T. [Dept. of Oto-Rhino-Laryngology, University Hospital of Innsbruck (Austria); Birbamer, G. [Dept. of Magnetic Resonance and Spectroscopy, University Hospital of Innsbruck (Austria); Wicke, K. [Inst. of Computed Tomography, University Hospital of Innsbruck (Austria)


    We describe two cases of tuberculous otitis media studied with high-resolution computed tomography (CT). Findings included extensive soft tissue densities with fluid levels in the tympanic cavity, the antrum, the mastoid and petrous air cells. Multifocal bony erosions and reactive bone sclerosis were seen as well. CT proved valuable for planning therapy by accurately displaying the involvement of the various structures of the middle and inner ear. However, the specific nature of the disease could only be presumed. (orig.)

  4. Ear embryonic rabdomiosarcoma. A case report; Rabdomiosarcoma embrionario de oido. A proposito de un caso

    Cueto, L.; Canabal, A.; Blanco, A.; Sabate, J. [Hospital Virgen Macarena. Sevilla (Spain)


    A case of embryonic rabdomiosarcoma in the ear of a 5-year-old girl who initially shows clinical symptoms of otitis media. The CT reveals a dense lesion of soft tissue which shows up slightly in the right external auditory channel. Also of interest were osteolytic areas in the petrous, clivus and zygomatic arch. A hypointensive lesion with marked enhancement after Gd-DPTA injection is observed. Discussed are the imaging methods used in the diagnosis of this tumor. (Author) 10 refs.

  5. Epidermoid tumor within Meckel's cave--case report.

    Nadkarni, T; Dindorkar, K; Muzumdar, D; Goel, A


    A rare case of an epidermoid tumor lying within Meckel's cave is reported. A 27-year-old housewife presented with complaints of right facial hypesthesia for two and a half years. On examination she had partial loss of touch sensation in the right trigeminal nerve distribution. Magnetic resonance imaging revealed a tumor located at the right petrous apex and cavernous sinus. The epidermoid tumor was excised through a lateral basal subtemporal approach. The symptoms resolved following surgery.

  6. Metastase til os temporale som årsag til akut vestibulært syndrom og hørenedsættelse

    Grubbe Gregersen, Kristine; Hansen, Søren


    Metastasis to the petrous apex of the temporal bone may cause acute peripheral vestibular syndrome and impaired hearing or be asymptomatic. Contrast computed tomography should be performed to exclude pathology in the temporal bone in patients with vestibulocochlear deficit, a history of cancer...... and no findings on cerebral magnetic resonance imaging. We describe a case of a 61-year-old man with metastatic prostatic carcinoma to the temporal bone....


    Chavarría Campos, Javier; Quesada Aguilar, Carlos I.


    The case of a young male patient, previouslyhealthy, attended at the Hospital San Juan deDios in San Jose, Costa Rica is presented. Hecomplained of fever, headache, diplopia, earacheand otorrhea. Meticilin Resistant Staphylococcusaureus (MRSA) was isolated in the ear secretionas well as in two blood cultures. CT scan showedinflammatory changes at the petrous portion ofthe temporal bone. Se presenta el caso de un paciente masculino joven, sin antecedentes médicos conocidos,  quien consultó ...

  8. [Vertigo induced by noise or pressure to the left ear].

    Seidel, D U; Dülks, A; Remmert, S


    A 49-year-old male patient presented with recently acquired vertigo induced by noise or pressure to the left ear. With appropriate stimulation, oscillopsia with a rotatory component could be reproduced in videooculography. Cervical vestibular evoked myogenic potentials (VEMP) showed increased amplitudes and a lowered threshold on the left side. CT of the petrous bone showed a bony dehiscence of the left superior semicircular canal. Conservative therapy was initiated as a first step.

  9. Stenting for Atherosclerotic Stenosis of the Intracranial or Skull Base Cerebral Arteries: Effectiveness and Problems

    Harakuni, T.; Hyodo, A.; Shingaki, T.; Kugai, M.; Kinjyo, T.; Tsuchida, H.; Sugimoto, K.; Yoshii, Y.; Matsumaru, Y.


    Since May 1992, we have performed percutaneous transluminal angioplasty (PTA) or stenting 70 times for 65 lesions in 62 patients with atherosclerotic stenosis of the intracranial or skull base cerebral arteries. Stenting was carried out nine times for nine lesions in nine cases. Stenting was performed on patients with an average age of 62. The patients were eight men and one woman. The stenotic lesions involved the internal carotid artery (petrous portion) in four cases, the internal carotid ...

  10. Computerized tomography. Yesterday and today

    Ethier, R.; Melanson, D. (Montreal Neurological Inst., Quebec (Canada))


    This presentation describes the evolution of computerized tomography over the past decade and its contribution to the radiologic investigation of neurologic disorders. This new technique has not only stimulated development in the diagnosis of cerebral diseases, but the whole body as well. Detailed investigation of the spine, spinal cord, sella turcica, the orbits, as well as the petrous pyramids has been made possible through the development of high resolution scanning.

  11. Cervical internal carotid artery pseudoaneurysm complicating malignant otitis externa: first case report.

    Baker, Andrew; Rizk, Habib; Carroll, William; Lambert, Paul


    Pseudoaneurysm of the internal carotid artery (ICA) is a rare complication of head and neck infections. To date, three cases of petrous ICA pseudoaneurysm have been described as a complication of otogenic infection, including only one secondary to malignant otitis externa. We present here the first case of cervical ICA pseudoaneurysm as a complication of malignant otitis externa, and stress the importance of timely diagnosis to avoid fatal outcomes.

  12. Cremated human remains: is measurement of the lateral angle of the meatus acusticus internus a reliable method of sex determination?

    Masotti, Sabrina; Succi-Leonelli, Elisa; Gualdi-Russo, Emanuela


    The purpose of this study was to evaluate the lateral angle (LA) method-based on the measurement of the angle at which the internal acoustic canal opens up to the surface of the petrous bone-for sex determination in cremated skeletal remains of Italians. The sample consisted of 160 adult individuals of known age and sex who had recently died and were cremated in the crematorium of Ferrara (northern Italy). Several studies have demonstrated that the petrous portion of the temporal bone may be a valuable tool for sex diagnosis in unburned skeletal remains. Since petrous bones are usually preserved after cremation, this method could be of particular interest in the case of burned skeletal remains. The repeatability of intra- and inter-observer measurements was good. The results indicated that male and female lateral angles were significantly different but that the values did not differ among age-groups. There was no bilateral difference in LA. However, neither the 45° angle, proposed in earlier studies as the sectioning point for this variable from male and female data distributions, nor another angular value allowed satisfactory discrimination between the sexes in our sample. The influence of the "age" factor (about 82 % of females were of ≥ 75 years of age) on the results is critically discussed. The results of this study suggest that the LA method is not sufficiently reliable to assess the sex of elderly Italian individuals from their burned remains and thus should only be used in conjunction with other sexing techniques.

  13. Epidural anterior petrosectomy with subdural visualization of sphenobasal vein via the anterior transpetrosal approach--technical case report.

    Ichimura, Shinya; Yoshida, Kazunari; Kagami, Hiroshi; Inaba, Makoto; Orii, Maaya; Kitamura, Yohei; Saga, Isako; Toda, Masahiro


    The drainage of the superficial middle cerebral vein (SMCV) is classified into four subtypes. The sphenobasal vein (SBV) drains from the SMCV to the pterygoid venous plexus at the temporal skull base. Epidural procedures in the standard anterior transpetrosal approach (ATPA) may damage the route of the SBV. We report a case in which modified surgical procedures via the ATPA were used to preserve the SBV. A 45-year-old man complained of right facial pain. Magnetic resonance images revealed a right cerebellopontine tumor suggestive of an epidermoid cyst. Right carotid angiography revealed that the SMCV drained into the pterygoid venous plexus via the SBV. The convexity dura mater of the temporal lobe was cut and the anterior part of the temporal lobe was retracted subdurally. The SBV was visualized from the subdural side. The basal dura mater of the temporal lobe posterior to the SBV was cut and the posterior part of the temporal lobe was retracted epidurally. After dissecting the dura mater medial to the greater petrosal nerve and to the edge of the petrous apex, the petrous apex was exposed and drilled out without injuring the SBV. The superior petrous sinus and the tentorium were cut. The tumor compressed the root exit zone of the trigeminal nerve. The tumor was grossly totally removed. The modified ATPA (epidural anterior petrosectomy with subdural visualization of the SBV) is effective in preserving the SBV.

  14. Subtemporal-anterior transtentoral approach to middle cranial fossa microsurgical anatomy.

    Xu, Zhiming; Wang, Weimin; Zhang, Jingjing; Liu, Wei; Feng, Yugong; Li, Gang


    This study aimed to describe the topography of inferior and external dura mater of the middle cranial fossa through subtemporal-anterior transpetrosal approach and discuss the feasibility of improving the approach. Eight formalin-fixed adult cadaveric heads were studied, with the bones milled away in the lateral triangle region of the petrous bone, Kawase rhombus region, and inner triangle region of the petrous apex. The distances between the targets in these regions, as well as the angles after the dissection of zygomatic arch, were measured, and then the exposed petroclival and retrochiasmatic areas were observed under the microscope. There were significant variations in the distances between targets in the 3 milled regions among the specimens. After the dissection of zygomatic arch, the surgical view got an average increase of 12 degrees. The subtemporal anterior transpetrosal approach, as an improved subtemporal approach, can expose the lesions optimally, causing no injury to the hearing and reducing injuries to temporal lobe. On the other hand, the lateral bone of the petrous parts of the temporal bone is removed so as to improve the view to the retrochiasmatic area and expand the operative field.

  15. Surgery for vertigo: 10-year audit from a contemporary vertigo clinic.

    Patnaik, U; Srivastava, A; Sikka, K; Thakar, A


    To present the profile of patients undergoing surgical treatment for vertigo at a contemporary institutional vertigo clinic. A retrospective analysis of clinical charts. The charts of 1060 patients, referred to an institutional vertigo clinic from January 2003 to December 2012, were studied. The clinical profile and long-term outcomes of patients who underwent surgery were analysed. Of 1060 patients, 12 (1.13 per cent) were managed surgically. Of these, disease-modifying surgical procedures included perilymphatic fistula repair (n = 7) and microvascular decompression of the vestibular nerve (n = 1). Labyrinth destructive procedures included transmastoid labyrinthectomy (n = 2) and labyrinthectomy with vestibular nerve section (n = 1). One patient with vestibular schwannoma underwent both a disease-modifying and destructive procedure (translabyrinthine excision). All patients achieved excellent vertigo control, classified as per the American Academy of Otolaryngology - Head and Neck Surgery 1995 criteria. With the advent of intratympanic treatments, surgical treatments for vertigo have become further limited. However, surgery with directed intent, in select patients, can give excellent results.


    YI Haijin; GUO Hong; WANG Chunhong; XIA Yin


    Objective To report outcomes of nonsurgical and surgical management of Menière's disease at Beijing Tiantan Hospital . Methods Patients with Menière's disease were categorized into groups based on hearing and quality of life. Individualized management was provided, including life style modification, drug therapies, endolymphatic sac decompression and labyrin-thectomy. Treatment outcomes were evaluated during up to 24 months follow up . Results Eighty seven patients under-went life style modification and drug therapies. The vertigo control rate of Grade A and B was 76.9% and 83.8% respec-tively. Six patients received surgical management, including endolymphatic sac decompression (n = 5) and labyrinthecto-my (n = 1) . For these patients, the vertigo control rate of Grade A and B was 80% and 100%, respectively. Conclu-Isions Management of Menière's disease depends on several factors, i.e. severities of vertigo and hearing loss, quality of life, surgical contraindications and patient subjective desire. The treatment is drug therapies for the majority of patients, as well as life style modification. Surgical indications are rare and the least invasive procedures should be considered first. The results of surgery are generally satisfying.

  17. Anatomical study of the cavernous sinus emphasizing operative approaches and related vascular and neural reconstruction.

    Sekhar, L N; Burgess, J; Akin, O


    The efficacy of three operative approaches to the cavernous sinus (CS) and the possibilities of vascular and cranial nerve reconstruction in and around the CS were studied in 50 cadaver specimens (25 heads). The lateral operative approach was through the lateral wall, between Cranial Nerves V1 and IV, or between Cranial Nerves V1 and V2. The superior approach was through the superior wall of the CS after removing the anterior clinoid process and unroofing the optic canal. The inferior approach followed the petrous internal carotid artery (ICA) into the CS after an extradural subtemporal exposure or after a combined subtemporal and infratemporal fossa exposure. The different exposures of the spaces of the CS and of the intracavernous structures provided by the superior and the lateral approaches were complementary. The exposure provided by the inferior approach was minimal; however, the junction of the petrous and cavernous ICA was best exposed by this route. The combined subtemporal and infratemporal fossa approach exposed the petrous ICA (for proximal control or for reconstruction) with the greatest ease and with the least temporal lobe retraction. The combination of the superior and lateral approaches and the complete mobilization of the intracavernous ICA facilitated its repair after experimental lacerations. Lacerations of either the inferior and the inferomedial aspects of any portion of the cavernous ICA or of the anterior surface of the posterior vertical segment of the artery were the most difficult to repair. End-to-end anastomosis was more difficult with the posterior third of the artery than with the anterior two-thirds. A vein graft with an average length of 3.5 cm could be sutured from the petrous to the supraclinoid ICA to bypass the cavernous ICA, with an average occlusion time of 45 minutes. End-to-end technique was judged better for the proximal anastomosis, but end (graft)-to-side anastomosis was easier to perform at the distal end because of the

  18. 虚拟现实技术构建岩骨三维解剖模型%Application of virtual reality technique in construction of 3-dimensional petrons bone model

    汤可; 莫大鹏; 鲍圣德; 伊志强


    目的 利用虚拟现实技术构建岩骨三维解剖模型,探讨其应用价值.方法 对15例尸头进行CT平扫.获得DICOM数据利用虚拟现实技术进行图像三维重建,提取并重建岩骨表面、听骨链等骨性结构三维图像,利用反转图像强度技术获得岩骨骨管和压迹内结构三维图像.在虚拟影像中测量膝状神经节、耳蜗、颈内动脉、颈静脉球、内听道外口之间距离.结果 虚拟现实三维影像能直观清楚地显示岩骨内神经、血管和骨性结构的空间关系,三维影像数据测量方便快捷,不受死角限制.结论 虚拟现实系统所构建岩骨三维解剖模型,可视化效果良好并可测量解剖数据.%Objective To evaluate the application of virtual reality system in construction of 3-dimensional petrous bone model.Methods The DICOM data of the CT performed for 15 adult cadaver heads were transferred to and reconstructed in the Destroscope virtual reality system.Images were extracted to show surface of petrous bone and ossicular chain.The images of structures in osseous tube and impression of petrous bone were extracted by the skill of invert intensity.The lengths of correlated anatomical structures such as geniculate ganglion,cochlear,internal carotid artery,glomus jugulare,external aperture of inner acoustic meatus were measured in the virtual reality environment.Results Three-dimensional images could illustrate the spatial relationship of anatomic structures related to the petrous bone distinctly.The data of measure were obtained conveniently,which had no dead angles of observation.Conclusion The 3-dimentional petrous bone model constructed by virtual reality technique can be used in anatomic research with good visualization.

  19. [Skull vibratory test in partial vestibular lesions--influence of the stimulus frequency on the nystagmus direction].

    Dumas, G; Perrin, P; Morel, N; N'Guyen, D Q; Schmerber, S


    Results of the skull vibratory test (SVT) in partial unilateral vestibular peripheral lesions (PUVL) are different from the results in total vestibular lesions (TUVL). To reveal a correlation between the results of the analysis of the skull vibratory nystagmus (SVN) horizontal component and the side of the lesion; to correlate these results with the stimulus frequency. To find out a predictive correlation between the SVN horizontal and vertical components and the topography of a vestibular lesion. To appreciate the degree of vestibular deafferentation (extended to high frequencies) provoked by gentamicin labyrinthectomy and its efficiency in Meniere's disease. 53 patients with a SVN and a PUVL were included and compared with 10 TUVL and 10 normal subjects. Protocol included a HST (2 Hz), a SVT at 30, 60 and 100 Hz and a caloric test. Recordings were performed with a 2D and 3D VNG device. In PUVL, SVN at 30, 60 and 100 Hz was obtained in 80, 90 and 90% of cases respectively. SVN is correlated with the side of the lesion at 30, 60 and 100 Hz respectively in 65%, 63%, 80% of cases. SVN is not correlated with the side of the lesion in 20% of Meniere's disease, in 8% of vestibular neuritis and in 6% of vestibular schwannoma. In PUVL HSN is correlated with the side of the lesion in 69% of cases. The direction of the HSN and of the SVN was different in 23% when the nystagmus attended at the same time for both tests. In PUVL the direction of the SVN is different at 100 Hz and 30 Hz in 16% of cases when they are concomittant on the same patient. After Gentamicine labyrinthectomy, the coherence of the results in caloric test, HSN and SVN (areflexy and lesional nystagmus beating toward the safe side) was correlated with the efficiency of the therapy. A SVN vertical component was met in 10% of PUVL (essentially in anterior canal dehiscence and few cases of partial labyrinthitis). The horizontal SVN SPV is significantly slower in PUVL than in TUVL patients (p=0.0004). The SVT

  20. Apicetomy or dental implant: Report of a clinical case.

    Enrique Fernández-Bodereau


    Full Text Available We report a clinical case of a patient who underwent apicectomy on an upper premolar, presumably by endodontic done improperly, and have cast a bolt where the extraction run the risk of tooth fracture. Failed such treatment, an implant is performed, placed immediately after extraction, in which bone filling with xenograft and guided bone regeneration with resorbable collagen membrane was done. From this we deduce that the phase diagnosed is of paramount importance. Two months after functional load of the implant is made with a cemented ceramic crown. One of the factors that influenced the positive outcome of this case, where immediately implants are placed to the tooth extraction is ultra microtextured surface of the used implant, besides being the bone table of these dental elements of thicker vestibular.

  1. Poland's syndrome and recurrent pneumothorax: is there a connection?

    Stamoulis Konstantinos


    Full Text Available Abstract Aim. To investigate the possible connection of Poland's syndrome with the presence of lung bullae and, thus, with an increased risk for recurrent pneumothorax. Patients-methods. Two male patients, aged 19 and 21 years respectively were submitted to our department after their second incident of pneumothorax. Both had Poland's syndrome (unilaterally hypoplastic chest wall with pectoralis major muscle atrophy and both had multiple bullae to the ipsilateral lung based on CT findings. The patients were treated operatively (bullectomy, lung apicectomy, partial parietal pleurectomy and chemical pleurodesis due to the recurrent state of their pneumothorax. Results. The patients had good results with total expansion of the affected lung. Conclusions. Poland's syndrome can be combined with ipsilateral presence of lung bullae, a common cause of pneumothorax. Whether this finding is part or a variation of the syndrome needs to be confirmed by a larger number of similar cases.

  2. Patient discomfort following periapical surgery.

    Christiansen, René; Kirkevang, Lise-Lotte; Hørsted-Bindslev, Preben; Wenzel, Ann


    The aim of the study was to assess patient discomfort following periapical surgery. Forty-two patients with apical periodontitis were allocated to apicectomy with either smoothening of the gutta-percha root filling or a retrograde root filling with mineral trioxide aggregate (MTA). Pooling all patients, VAS score for pain peaked 3 hours postoperatively (mean VAS = 29). The VAS score for swelling peaked 1 day postoperatively (mean VAS = 41). Patients' overall perception of postoperative discomfort was induced by (questions asked at the day for suture removal): Oral awareness (36 yes, 6 no); swelling (30 yes, 12 no); compromised chewing ability (18 yes, 24 no); pain (15 yes, 27 no). There was no correlation between the operating time and VAS scores for pain and swelling (r .11). Patients experienced little pain and moderate swelling after periapical surgery. Oral awareness was the most reported reason for postoperative discomfort. The operating time was not a decisive factor in relation to postoperative discomfort.

  3. Endodontic re-treatment associated with the elimination of amalgam root-end filling through sinus tracts: a report of two cases.

    Soares, Janir Alves; Nunes, Eduardo; Silveira, Frank Ferreira; Santos, Suelleng Maria Cunha; Oliveira, Maiolino Thomaz Fonseca


    Two patients presented with complaints of recurrent drainage of purulent exudate from sinus tracts, inflammation and pain after endodontic re-treatment of the maxillary left (Case 1) and right (Case 2) lateral incisors. The periapical lesions persisted after apical curettage, apicectomy and root-end filling with silver amalgam. Radiographic examination exposed the poor quality of the endodontic treatments and the silver amalgam root-end fillings, which were associated with periapical radiolucent areas in both teeth. The sinus tract persisted after root canal cleaning and shaping, followed by a calcium hydroxide root canal dressing. The root-end fillings were periapically dislodged with endodontic K-files, and showed progressive displacement by sinus tracts up to elimination in the oral cavity. Follow ups of 42 and 65 months post procedure revealed clinical disappearance of the symptoms, sinus tracts and exudates, and radiographs revealed that the repair process of the periapical radiolucent areas was quite advanced.

  4. Laser applications in endodontics: an update review.

    Mohammadi, Zahed


    The search for new devices and technologies for endodontic procedures always has been challenging. Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of potential applications for lasers in endodontics have been proposed. With the development of thinner, more flexible and durable laser fibres, laser applications in endodontics have increased. Since laser devices are still relatively costly, access to them is limited. The purpose of this paper is to summarise laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilisation of root canals, root canal shaping and obturation and apicectomy. The effects of lasers on root canal walls and periodontal tissues are also reviewed.

  5. Poland's syndrome and recurrent pneumothorax: is there a connection?


    Aim. To investigate the possible connection of Poland's syndrome with the presence of lung bullae and, thus, with an increased risk for recurrent pneumothorax. Patients-methods. Two male patients, aged 19 and 21 years respectively were submitted to our department after their second incident of pneumothorax. Both had Poland's syndrome (unilaterally hypoplastic chest wall with pectoralis major muscle atrophy) and both had multiple bullae to the ipsilateral lung based on CT findings. The patients were treated operatively (bullectomy, lung apicectomy, partial parietal pleurectomy and chemical pleurodesis) due to the recurrent state of their pneumothorax. Results. The patients had good results with total expansion of the affected lung. Conclusions. Poland's syndrome can be combined with ipsilateral presence of lung bullae, a common cause of pneumothorax. Whether this finding is part or a variation of the syndrome needs to be confirmed by a larger number of similar cases. PMID:21418595

  6. Alternative oblique head CT scanning technique reduces bone artifact and improves interpretability of brainstem anatomy

    Sam Douglas Kampondeni


    Full Text Available Brainstem pathology due to infections, infarcts and tumors are common in developing countries, but neuroimaging technology in these resource-poor settings is often limited to single slice, and occasionally spiral, CT. Unlike multislice CT and MRI, single slice and spiral CT are compromised by bone artifacts in the posterior fossa due to the dense petrous bones, often making imaging of the brainstem non-diagnostic. With appropriate head positioning, the petrous ridges can be avoided with 40˚ sagittal oblique scans parallel to either petrous ridge. We describe an alternative sagittal oblique scanning technique that significantly reduces brainstem CT artifacts thereby improving clarity of anatomy. With Inst­itutional Ethical approval, 13 adult patients were enrolled (5 males; 39%. All patients had routine axial brain CT and sagittal oblique scans with no lesions found. Images were read by 2 readers who gave a score for amount of artefact and clarity of structures in the posterior fossa. The mean artifact score was higher for routine axial images compared to sagittal oblique (2.92 vs. 1.23; P<0.0001. The mean anatomical certainty scores for the brainstem were significantly better in the sagittal oblique views compared to routine axial (1.23 vs. 2.77; P<0.0001. No difference was found between the two techniques with respect to the fourth ventricle or the cerebellum (axial vs. sag oblique: 1.15 vs. 1.27; P=0.37. When using single slice CT, the sagittal oblique scanning technique is valuable in improving clarity of anatomy in the brainstem if axial images are non-diagnostic due to bone artifacts.

  7. [Surgery for vertigo].

    Lacombe, H


    Spontaneous recovery or central compensation makes surgical procedures rare in patients with vertigo. Surgery for vertigo proposed after pharmacological or physical therapy fails to eliminate Ménière's disease and some very rare cases of paroxystic positional vertigo. The main target in treating Ménière's disease is to promote vestibular compensation, which is possible only with a nonprogressive and stable deficit leading to readjustment of vestibular reflexes. Surgical procedures can be classified as nondestructive (endolymphatic sac decompression, vestibular nerve decompression, patching of perilymphatic fistulas), selectively destructive (middle fossa or retrosigmoid vestibular neurotomy, lateral semi-circular plugging) and destructive (labyrinthectomy). Surgical indications essentially concern incapacitating vertigo and depend mainly on hearing status. In Ménière's disease, vestibular neurotomy can be regarded as the gold standard considering its good results on vertiginous episodes; however, scoring with functional and quality-of-life scales bring out residual deficiency in some cases.

  8. Changing trends in the surgical treatment of Ménière's disease: results of a 10-year survey.

    Silverstein, Herbert; Lewis, William B; Jackson, Lance E; Rosenberg, Seth I; Thompson, Jack H; Hoffmann, Karen K


    In order to discern trends in surgical procedures used to treat Ménière's disease in the United States during the 1990s, we mailed a questionnaire to 700 members of the American Otological Society and the American Neurotology Society. These physicians were asked about the frequency, results, and complications of surgical procedures for Ménière's disease that they had performed between Jan. 1, 1990, and Dec. 31, 1999. Questionnaires were returned by 137 surgeons (19.6%). Their responses indicated that the number of vestibular neurectomies, labyrinthectomies, and endolymphatic sac surgeries all decreased during 1999. Meanwhile, the use of office-administered intratympanic gentamicin therapy increased rapidly throughout the entire 10-year period, and by 1999 it had become the most frequently used invasive treatment for Ménière's disease. Surgeons now seem to reserve inpatient procedures for cases where intratympanic gentamicin fails to control vertigo.

  9. Short latency vestibular evoked potentials in the chicken embryo

    Jones, S. M.; Jones, T. A.


    Electrophysiological responses to pulsed linear acceleration stimuli were recorded in chicken embryos incubated for 19 or 20 days (E19/E20). Responses occurred within the first 16 ms following the stimulus onset. The evoked potentials disappeared following bilateral labyrinthectomy, but persisted following cochlear destruction alone, thus demonstrating that the responses were vestibular. Approximately 8 to 10 response peaks could be identified. The first 4 positive and corresponding negative components (early peaks with latencies embryos was -15.9dBre 1.0 g/ms, which was significantly higher (P embryos and 2-week-old animals, but amplitude/intensity functions for embryos were significantly shallower than those for 2-week-old birds (P embryo and, as such, the method shows promise as an investigative tool. The results of the present study form the definitive basis for using vestibular evoked potentials in the detailed study of avian vestibular ontogeny and factors that may influence it.

  10. Gradenigo's syndrome--surgical management in a child.

    Humayun, Hassan Nabeel; Akhtar, Shabbir; Ahmed, Shakeel


    Otits media is a common problem. Some of its complications that were seen frequently in the preantibiotic era are rare today. We report a case of an 8 year boy who presented with earache, retro-orbital pain and diplopia secondary to a sixth nerve palsy--Gradenigo's syndrome. In this syndrome infection from the middle ear spreads medially to the petrous apex of the temporal bone. Work-up includes CT scan of the temporal bones. Timely management with intravenous antibiotics (+ surgery) is needed to prevent intra-cranial complications.

  11. MR and CT imaging in the Dyke-Davidoff-Masson syndrome: report of three cases and contribution to pathogenesis and differential diagnosis



    Full Text Available Cerebral hemiatrophy or Dyke-Davidoff-Masson syndrome is a condition characterized by seizures, facial asymmetry, contralateral hemiplegia or hemiparesis, and mental retardation. These findings are due to cerebral injury that may occur early in life or in utero. The radiological features are unilateral loss of cerebral volume and associated compensatory bone alterations in the calvarium, like thickening, hyperpneumatization of the paranasal sinuses and mastoid cells and elevation of the petrous ridge. The authors describe three cases. Classical findings of the syndrome are present in variable degrees according to the extent of the brain injury. Pathogenesis is commented.

  12. Trigeminal neuralgia secondary to basilar impression: A case report

    de Almeida Holanda, Maurus Marques; Pereira Neto, Normando Guedes; de Moura Peixoto, Gustavo; Pinheiro Santos, Rayan Haquim


    We report a rare case of trigeminal neuralgia. A 23-year-old woman with a history of 1 year of typical trigeminal neuralgia manifested the characteristics of basilar impression. Magnetic resonance imaging (MRI) demonstrated basilar impression, deformity of the posterior fossa with asymmetry of petrous bone, and compression of medulla oblongata in the topography of the odontoid apophysis. The operation was performed through a suboccipital craniectomy. The neuralgia disappeared after surgery and remains completely resolved until today. This is the second reported case of trigeminal neuralgia in a patient with basilar impression in Brazil. PMID:25972713

  13. Pneumatization of the temporal portion of the zygomatic arch: The contribution of computed tomography to the reconstruction in volumetric two-dimensional and three-dimensional, with the aid of image rendering protocols

    C M Romano-Sousa


    Full Text Available Pneumatization refers to the asymptomatic development of cavities containing air within them. There is great variability in the extent of temporal bone pneumatization. Nevertheless, in a few cases it extends to the zygomatic process. Images are presented in which the panoramic radiograph and hypocycloidal tomography reveal this variation from the norm, to which professionals must be alert, since the images may simulate the presence of pathology. In this case report we describe the presence of pneumatization of the petrous and zygomatic portions of the temporal bone, demonstrating the contribution of CT to reconstruction in volumetric 2D and 3D, with the aid of image rendering protocols.

  14. Digital subtraction angiography in head and neck radiology

    Carmody, R.F.; Seeger, J.F.; Smith, R.L.; Horsley, W.W.; Miller, R.W.


    Intravenous digital subtraction angiography (IVDSA) was used to evaluate 44 patients with suspected otolaryngologic abnormalities. Sixteen had IVDSA for pulsatile tinnitus or suspected glomus tumor of the petrous bone. Nine patients were evaluated because of pulsatile neck masses, and 12 others had suspected tumors of the neck, face, and paranasal sinuses. Seven had IVDSA following head and neck trauma. The technique of examination is described. The current indications of IVDSA in head and neck radiology are discussed. It is concluded that IVDSA is a suitable substitute for conventional angiography for many otolaryngologic conditions and, because of its safety, can be used more liberally.

  15. Cholesterol granuloma of temporal bone: CT and MR findings. Granulomas colesterinicos del hueso temporal: hallazgos por TC y RM

    Ruiz Jauriguizuria, J.C.; Ferrero Collado, A.; Ereo Ealo, M.J.; Grande Icaran, D.


    Three cases of cholesterol granuloma of the left temporal bone are presented, two located in the petrous apex and the other at the otomastoid level. One of the patients had a history of mastoid surgery and the other surgery of the bone ridge. The three cases were confirmed histologically following surgical resection. The etiopathogenesis of the lesion is discussed, as are the clinical, histological and radiological features, with a broad description of the computed tomography and magnetic resonance findings. The differential diagnosis is also dealt with. (Author)

  16. Skull Base Clear Cell Carcinoma, Metastasis of Renal Primary Tumor: A Case Report and Literature Review

    Ilson Sepúlveda


    Full Text Available We report on a patient who presented with cranial nerve VI bilateral paresis, absence of pharyngeal reflex, dysarthria, right tongue deviation, and right facial paralysis. Imaging studies showed an expansive process in the cranial base with clivus and petrous apex osteolysis. A biopsy confirmed the presence of clear cell adenocarcinoma and suspicion of renal tumor metastases. Abdominal imaging studies revealed a mass in the right kidney. Consequently, radiotherapy was performed, and the patient was enrolled in a palliative care and pain control program.

  17. Facial nerve neuromas: MR imaging. Report of four cases

    Martin, N. (G.H. Pitie-Salpetriere, 75 - Paris (France). Dept. of Neuroradiology); Sterkers, O. (Hospital Beaujon, Clichy (France). Dept. of Otorhinolaryngology); Mompoint, D.; Nahum, H. (Hopital Beaujon, Clichy (France). Dept. of Radiology)


    Four cases of facial nerve neuroma were evaluated by computed tomographic (CT) scan and magnetic resonance imaging (MRI). The extension of the tumor in the petrous bone or the parotid gland was well defined by MRI in all cases. CT scan was useful to demonstrate bone erosions and the relation of the tumor to inner ear structures. In cases of progressive facial palsy, CT and MRI should be combined to detect a facial neuroma and to plan the surgical approach for tumor removal and nerve grafting. (orig.).

  18. Congenital absence of the internal carotid artery and the basilar artery with persistent trigeminal artery associated with coarctation of the aorta

    Jaeger, H.J.; Mehring, U.M.; Gissler, H.M.; Mathias, K.D. [Dept. of Diagnostic Radiology, Staedtische Kliniken Dortmund (Germany); Dept. of Radiology and MicroTherapy, Univ. of Witten/Herdecke (Germany)


    We report a case of congenital absence of the cervical and petrous part of the left internal carotid artery, the middle and proximal part of the basilar artery, and the V4 segment of the left vertebral artery associated with a left persistent trigeminal artery and a coarctation of the aorta. The left cerebral vessels are supplied via the anterior communicating artery and the left persistent trigeminal artery. The coexisting coarctation of the aorta led to a subclavian steal phenomenon. The alteration of the cerebral hemodynamics has to be taken in consideration when performing cerebral angiography and surgical correction in such a case. (orig.)

  19. Skull Base Aneurysmal Bone Cyst Presented with Foramen Jugular Syndrome and Multi-Osseous Involvement

    Leila Aghaghazvini


    Full Text Available Aneurysmal bone cyst (ABC is an expansile bone lesion that usually involves the long bones. Skull base involvement is rare. Hereby, we describe a 17-year-old man with hoarseness, facial asymmetry, left sided sensorineural hearing loss and left jugular foramen syndrome. CT scan and MRI showed a skull base mass that was confirmed as ABC in histopathology. The case was unusual and interesting due to the clinical presentation of jugular foramen syndrome and radiological findings such as severe enhancement and multiosseous involvement.Keywords: Bone Cysts,Aneurysmal,Petrous Bone,Skull Base,Cranial Fossa,Posterior

  20. High resolution computed tomography for malformations of the cochlear and vestibular organs

    Koester, O.; Straehler-Pohl, H.J.; Kim, K.H.


    Twenty-one patients with congenital deformities of the petrous bones were examined by high resolution computed tomography. This allows an accurate description of the extent of the malformation in all parts of the cochlear and vestibular organs; only localised changes in the auditory ossicles, such as fixation of the stapes and changes in the soft tissue portions of the labyrinth, cannot be shown. Improved demonstration of soft tissues while using less radiation makes high resolution CT preferable to conventional polytomography. It is also easier to perform and provides axial projections which are essential for the elucidation of malformations of the middle and inner ear.

  1. Morphometric analysis of posterior fossa in Indian CP angle acoustic schwannoma patients.

    Patibandla, Mohana Rao; Panigrahi, Manas K; Gurram, Paniraj L; Thotakura, Amit Kumar; Kulkarni, Dilip


    To study the morphometry of posterior fossa in Indian CP angle schwannoma patients in order to know its influence on the extent of excision of the CP angle acoustic schwannomas. One hundred cases of cerebellopontine angle schwannomas treated surgically by the senior author and 20 controls between January 2006 and June 2011 were consecutively investigated with computed tomography (CT) using the high-resolution CT bone windows before surgery. Evaluation of anatomic parameters of the petrous bone and posterior fossa cavity were done in all patients and controls. Data were entered in Excel software and were analyzed using NCSS software. All possible regression analysis was done to select the important variables to be included in the model to predict the excision of tumor with these variables. A prediction model was developed defining the binary outcome as total excision or subtotal excision as dependent variable and the morphometric data and grading of tumor as independent variables. Interpetrous distance (IP) is the distance between the two petrous apices. Sigmoid distance (IS) distance is the distance between the two sigmoid points. Sigmoid point is the point at which the scalloped impression of the sigmoid sinus straightens to join the occipital bone posteriorly. SAG is the distance between the mid IP point and the mid-point on the inner wall of the occipital bone. The PM angle was 47.8±4.14 degrees (38-58), the PA angle was 42.68±4.47 degrees (34-53), the IP distance was 2.07±0.13 cm (1.5-2.8), the sagittal diameter of posterior fossa was 6.22±0.73 cm (5.1-9.8) and the intersigmoid distance was 9.45±0.73 cm (7.4-11). There was no significant gender difference in the posterior fossa morphometry between patients and controls. Inter-sigmoid distance and the petrous-apex angle were more in the Indians when compared to the European population mentioned in the Mathies and Samii study. The posterior fossa morphological parameters of the Indian and European population

  2. Surgical treatment of traumatic injuries of the cranial base.

    Lin, Derrick T; Lin, Alice C


    Skull-base fractures involve one or more of the cribriform plate of the ethmoid bone, orbital plate of the frontal bone, sphenoid bone, occipital bone, and petrous or temporal bone. Although the fractures themselves only require reduction and reconstruction when the skull base is severely comminuted and altered, even small fractures and the traumatic shear forces can create tears in the meninges and thus predispose to cerebrospinal fluid leaks. This article explores the preoperative, intraoperative, and postoperative management of skull-base fractures, which most commonly involves resolution of the cerebrospinal fluid leak and the prevention of future leaks or meningoencephaloceles. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Spontaneous external auditory canal cholesteatoma in a young male: Imaging findings and differential diagnoses

    Yashant Aswani


    Full Text Available A cholesteatoma is a non-neoplastic lesion of the petrous temporal bone commonly described as “skin in the wrong place.” It typically arises within the middle ear cavity, may drain externally via tympanic membrane (mural type, or may originate in the external auditory canal (EAC. The latter type is rarely encountered and typically affects the elderly. EAC cholesteatoma poses diagnostic challenges because it has numerous differential diagnoses. The present case describes a 19-year-old male who presented with gradually progressive diminution of hearing in a previously naïve right ear since 8 months. A soft tissue attenuation lesion confined to the right EAC with erosion of the canal on computed tomography prompted magnetic resonance imaging (MRI. The lesion showed restricted diffusion on MRI. Thus, a diagnosis of spontaneous EAC cholesteatoma was established. The case elucidates the rarity of spontaneous EAC cholesteatoma in a young male. In addition, it describes the role of imaging to detect, delineate the extent, and characterize lesions of petrous temporal bone. The case also discusses common differential diagnoses of EAC cholesteatoma, as well as the importance of diffusion weighted imaging in EAC cholesteatoma similar to its middle ear counterpart.

  4. Searching for the mother missed since the Second World War.

    Zupanič Pajnič, Irena; Petaros, Anja; Balažic, Jože; Geršak, Ksenija


    The aim of the study was to perform the genetic identification of a human cranium from a Second World War gravesite in Slovenia and find out if it belonged to the mother of a woman used as a family reference. Both genetic and anthropological examinations were carried out. The genetic examination was performed on 2 molars and petrous bone. Prior to DNA isolation 0.5 g of tooth and bone powder was decalcified. The DNA was purified in a Biorobot EZ1 (Qiagen) device. The nuclear DNA of the samples was quantified and short tandem repeat (STR) typing performed using two different autosomal and Y-STR kits. Up to 22.4 ng DNA/g of powder was obtained from samples analyzed. We managed to obtain nuclear DNA for successful STR typing from the left second molar and from the petrous bone. Full autosomal genetic profile including amelogenin locus revealed the male origin of the cranium that was further confirmed by the analyses of Y-STRs. The same conclusions were adopted after the anthropological analysis which identified the cranium as that of a very young Caucasoid male. The male origin of the cranium rejected the possibility of motherhood for the compared daughter. For traceability in the event of contamination, we created an elimination database including genetic profiles of the nuclear and Y-STRs of all persons that had been in contact with the analyzed cranium and no match was found.

  5. Infantile osteopetrosis, craniosynostosis, and Chiari malformation type I with novel OSTEM1 mutation

    A H Mahmoud Adel


    Full Text Available We report a case of a 9-month-old Arab infant, with novel OSTEM mutation and unpublished triad of osteopetrosis (OP, craniosynostosis (CS, and Chiari malformation type I (CM1. The index presented with progressive irritability, abnormal movements, following an accidental fall. The history revealed early onset of irritability, progressive visual loss, and global developmental delay, more prominent at the gross motor level and a suspected congenital cytomegalovirus infection. The pregnancy was uneventful with subsequent unremarkable delivery. The parents are Arabs′first cousins with no apparent symptoms or signs of bone disease. Three dimensional brain computed tomography (CT showed ventriculomegaly, thick calvaria, and CS of the coronal and sagittal sutures. Patient had signs of left lower motor neuron facial palsy, and CT of petrous bones confirms the presence of osteopetrotic petrous with slim mastoid portions of the facial nerve canals both sides. Brain magnetic resonance imaging showed CM1. Skeletal survey showed sclerotic skeleton. He needed ventriculoperitoneal shunt and died at 18 months of age. Molecular testing for OSTEM1 gene revealed novel homozygous mutation that segregated from his parents. This novel OSTEM1 gene novel mutation and the combination of OP, infantile CS, and CM1 is to our knowledge never been reported.

  6. Intradural anterior transpetrosal approach.

    Ichimura, Shinya; Hori, Satoshi; Hecht, Nils; Czabanka, Marcus; Vajkoczy, Peter


    The standard anterior transpetrosal approach (ATPA) for petroclival lesions is fundamentally an epidural approach and has been practiced for many decades quite successfully. However, this approach has some disadvantages, such as epidural venous bleeding around foramen ovale. We describe here our experience with a modified technique for anterior petrosectomy via an intradural approach that overcomes these disadvantages. Five patients with petroclival lesions underwent surgery via the intradural ATPA. The intraoperative hallmarks are detailed, and surgical results are reported. Total removal of the lesions was achieved in two patients with petroclival meningioma and two patients with pontine cavernoma, whereas subtotal removal was achieved in one patient with petroclival meningioma without significant morbidity. No patient experienced cerebrospinal fluid leakage. The intradural approach is allowed to tailor the extent of anterior petrosectomy to the individually required exposure, and the surgical procedure appeared to be more straightforward than via the epidural route. Caveats encountered with the approach were the temporal basal veins that could be spared as well as identification of the petrous apex due to the lack of familial epidural landmarks. The risk of injury to the temporal bridging veins is higher in this approach than in the epidural approach. Intradural approach is recommended in patients with a large epidural venous route, such as sphenobasal and sphenopetrosal vein. Navigation via bone-window computed tomography is useful to identify the petrous apex.

  7. Pseudo-cerebrospinal fluid rhinorrhea following traumatic cerebrospinal fluid rhinorrhea surgery: a case report


    @@Pseudo-cerebrospinal fluid rhinorrhea is very rarely reported. In 1994, our hospital admitted such a case, and we report it here. CASE REPORT On May 28, 1994, a 37-year-old man was readmitted to our hospital one-year following treatment for head injury and cerebrospinal fluid rhinorrhea. He had been suffering from a recurrence of rhinorrhea for three months at the time of his readmission. One year prior, the patient had been suffering from a recurrence of the rhinorrhea for three meters. He complained of headaches, dizziness and a right rhinorrhea. The fluid was positive for glucose. Skull-base film showed a traverse fracture of the right petrous bone. For three months, conservative treatment of the rhinorrhea continued, then he was first admitted to our hospital. After admission, a right temperal craniotomy was performed. During surgery, a traverse fracture of the petrous bone was found. In addition, the dura matter over the fracture line was torn, and the fibrotic brain tissue with arachnoid protruded into the fracture fissure. The dura adhering to the edge of the fracture fissure was explored and the bared internal carotid artery discovered. The fracture fissure was occluded with free-muscle and fascia lata grafts. Postoperative intravenous antibiotic therapy and cerebrospinal fluid drainage were carried on for 72 hours. Ten days after the operation the patient was discharged without any symptoms.

  8. As solid as a rock-comparison of CE- and MPS-based analyses of the petrosal bone as a source of DNA for forensic identification of challenging cranial bones.

    Kulstein, Galina; Hadrys, Thorsten; Wiegand, Peter


    Short tandem repeat (STR) typing from skeletal remains can be a difficult task. Dependent on the environmental conditions of the provenance of the bones, DNA can be degraded and STR typing inhibited. Generally, dense and compact bones are known to preserve DNA better. Several studies already proved that femora and teeth have high DNA typing success rates. Unfortunately, these elements are not present in all cases involving skeletal remains. Processing partial or singular skeletal elements, it is favorable to select bone areas where DNA preservation is comparably higher. Especially, cranial bones are often accidentally discovered during criminal investigations. The cranial bone is composed of multiple parts. In this examination, we evaluated the potential of the petrous bone for human identification of skeletal remains in forensic case work. Material from different sections of eight unknown cranial bones and-where available-additionally other skeletal elements, collected at the DNA department of the Institute of Legal Medicine in Ulm, Germany, from 2010 to 2017, were processed with an optimized DNA extraction and STR typing strategy. The results highlight that STR typing from the petrous bones leads to reportable profiles in all individuals, even in cases where the analysis of the parietal bone failed. Moreover, the comparison of capillary electrophorese (CE) typing to massively parallel sequencing (MPS) analysis shows that MPS has the potential to analyze degraded human remains and is even capable to provide additional information about phenotype and ancestry of unknown individuals.

  9. Efficiency of the radiological diagnosis of acoustic neuromas

    Nidecker, A.; Wehrle, T.; Elke, M.


    In a retrospective study we tried to define the diagnostic value of different X-ray studies in 43 histologically proved acoustic neuromas. We divided the examinations into such which definitely confirmed a clinical suspicion i.e. formed the last preoperative studies, and into others, which only increased the clinical suspicion. We were especially interested, whether or not Stenvers and transorbital projections of the petrous bones and internal acoustic canals and petrous bone tomographies were essentially confirming clinical diagnosis. - Whereas 13 out of 37 Stenvers, 2 out of 5 transorbital projections and 14 out of 18 frontal tomographies increased the suspicion of an existing Neuroma, a true diagnostic confirmation was never possible with these 3 techniques. Vice versa out of 45 computertomographies 33 were confirming the clinical diagnosis and 1 increased the clinical suspicion, with 5 false negatives and 6 nonconclusive studies. CT and Air-CT-Cisternography represent today the definitive diagnostic studies. For economical reasons they should be employed early in the diagnostic course, in those cases with high clinical suspicion or when clinical symptoms suggesting AN persist.

  10. Imaging of the inner ear; Bildgebung des Innenohrs

    Casselman, J.W. [Dept. of Radiology, A.Z.St.-Jan Brugge (Belgium); Bensimon, J.L. [Imagerie O.R.L. et Generale, Paris (France)


    New computed tomography (CT) and magnetic resonance (MR) techniques allow more detailed anatomic studies of the inner ear. CT is still the best technique to study patients with fractures, congenital malformations and otodystrophies involving the inner ear. During recent years MR imaging has emerged as an excellent method to detect pathology in the internal auditory canal, membranous labyrinth and bony labyrinth and to characterize petrous apex lesions. MR has even proved its value in patients with fractures and congenital malformations making the diagnosis of, for instance, labyrinthine concussion and absence of the vestibulocochlear nerve possible. The diagnosis of acute/chronic labyrinthitis and intralabyrinthine tumors has also became possible. However, MR and CT are often complementary, as is the case in patients with mixed hearing loss, congenital malformations and petrous apex lesions. (orig.) [Deutsch] Neuere CT- und MR-Untersuchungsmethoden erlauben eine detaillierte anatomische Darstellung des Innenohres. Die CT ist unveraendert die beste Bildgebungstechnik zur Darstellung von Frakturen, angeborenen Missbildungen und Otodystrophien im Innenohr. In den letzten Jahren hat sich die MRT im Nachweis pathologischer Veraenderungen von innerem Gehoergang, membranoesem und knoechernem Labyrinth und zur Charakterisierung von Schlaefenbeinspitzenlaesionen als diagnostisch aeusserst wertvoll erwiesen. Bei Patienten mit Frakturen oder kongenitalen Missbildungen erlaubt die MRT den Nachweis von labyrinthaeren Kontusionen bzw. Aplasie des vestibulocochlearen Nervs. Die Diagnose einer Labyrinthitis sowie von intralabyrinthaeren Tumoren wurde erstmals bildgebend mittels MRT moeglich. Es muss aber betont werden, dass MRT und CT meist komplementaere Methoden sind. Dies trifft insbesondere bei Patienten mit gemischtem Hoerverlust, kongenitalen Missbildungen und Schlaefenbeinapexlaesionen zu. (orig.)

  11. Mastoidectomy: anatomical parameters x surgical difficulty

    Pereira Júnior, Anastácio Rodrigues


    Full Text Available Introduction: The lowered temporal meninges and/ or anterior sigmoid sinus are contiditions that can determine surgical difficulties in performing mastoidectomy. Objective: To correlate in the tomography the extent of the prolapse of the sigmoid sinus and of temporal meninges with the surgical difficulty in the mastoidectomy. Method: The tomographic measurements of prolapse sigmoid and of temporal meninges were correlated with the presence or non-presence of the surgical difficulty observed during the mastoidectomy procedure in patients with ostomatoiditis chronic (n=30. Form of study: Contemporary cohort transverse. Results: In 10 patients were observed surgical difficulty distributed as: due to prolapse of the sigmoid sinus (n = 2 or temporal meninges prolapse (n = 7 or both (n = 1. In patients in which the surgical difficulty was due to sigmoid sinus prolapse, the tomography distance of the anterior border of the sigmoid sinus to posterior wall of external auditory canal was lower than 9 mm. In patients in which surgical difficulty was due to temporal meninges prolapse, the tomographic distance to the upper plane of the petrous bone was 7 mm. Conclusion: The computerized tomography distance between the temporal meninges and the upper plane of the petrous bone 7 mm and the distance of the anterior border of the sigmoid sinus to posterior wall of external auditory canal was lower than 9 mm are predictive to the surgical difficulties to perform mastoidectomy.

  12. A case of generalized lymphatic anomaly causing skull-base leakage and bacterial meningitis.

    Suga, Kenichi; Goji, Aya; Inoue, Miki; Kawahito, Masami; Taki, Masako; Mori, Kazuhiro


    Generalized lymphatic anomaly is a multifocal lymphatic malformation that affects the skin, thoracic viscera, and bones. A 3year-old Japanese boy presented with right facial palsy due to cystic tumors in the ipsilateral petrous bone. Pericardial effusion had been found incidentally and generalized lymphatic anomaly had been diagnosed by pericardial biopsy. Petrous bone tumor had been followed up without surgery. At the age of seven he presented with fever and disturbance of consciousness, and bacterial meningitis due to Streptococcus pneumoniae was diagnosed. Computed tomography and magnetic resonance imaging revealed middle skull-base leakage due to lymphatic malformation. He achieved complete recovery under intensive care with antibiotics and mechanical ventilation. One year later, he presented with multiple cystic formations in bilateral femora. At the 3-year follow-up, the patient was healthy with no recurrence of meningitis and osteolytic lesions in the femora were non-progressive. Computed tomography and magnetic resonance imaging are useful for demonstration of skull-base leakage by generalized lymphatic anomaly. We should consider generalized lymphatic anomaly among the differential diagnoses for skull-base leakage. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  13. Development of a snake-like dexterous manipulator for skull base surgery.

    Coemert, Suat; Anzhu Gao; Carey, John P; Traeger, Mattias F; Taylor, Russell H; Lueth, Tim C; Armand, Mehran


    Petrous apex lesions constitute considerable surgical challenges due to their location in the skull base and close relationship with critical structures such as inner ear, carotid arteries, facial nerves and jugular bulb. These lesions often cannot be treated completely with rigid tools due to the limited accessibility. We are aiming to develop a snake-like manipulator to assist surgeons with the infralabyrinthine treatment of petrous apex lesions with increased dexterity. This snake-like dexterous manipulator (SDM) with 3.3 mm outer diameter and 40 mm working length was designed including a tool channel with a diameter of 1.8 mm and an endoscope channel with a diameter of 0.7 mm. The SDM can be actuated in one plane and two directions enabling the C- and S-shaped bends and rotated around its longitudinal axis. The constant curvature modeling was implemented to predict the deflection in one direction. Experiments were carried out with optical microscope to find out different bending modes. Experimental bending modes were in a good agreement with the theoretical ones in terms of the bending behavior. However tip position prediction showed discrepancies up to 1 mm in X and 2 mm in Z axes.

  14. Arcuate eminence: Is it due to semicircular canal?

    Manvikar Purushottam Rao


    Full Text Available Background: Arcuate eminence (AE is an arc-like elevation seen on the anterior surface of petrous part of temporal bone in the middle cranial fossa (MCF. It has been believed and conventionally taught that AE is a protrusion caused because of the superior semicircular canal (SSC present in the petrous bone. AE is an useful anatomical landmark in the MCF during surgical approaches to acoustic neuroma through suprapetrosal approach. However, the relevance of relation to AE and SSC has been questioned in recent times. Presence of AE of various shapes and dimensions supports this view. Aim: To study and to establish the relation between shape of AE and inferior surface of cerebral hemispheres. Classify various types and subtypes in case of variation in shape based on its appearance. AE could be a negative impression of either gyrus or a sulcus. Material and Methods: The study was conducted in two parts. In the first part, the shape of AE and the impression on cerebral surface were correlated while removing brain from cranial cavity in 8 cadavers (16 wet temporal bones. In second part of the study, 100 dry temporal bones were examined. Relevant photographs were taken. A total of 116 temporal bones were studied. AE was classified as linear, globular, generalized swelling, and flat based on the appearance. Results and Conclusion: 10 AE of 16 wet temporal bones were linear type and did correspond with a sulcus, whilein 1 cadaver no relation was seen. In dry bones, maximum linear variety was seen. There was no relation to shape of AE and cerebral surface in two cadavers. Diversity in shapes, (linear type 47% and correlation with sulci on cerebral surface contests the earlier understanding that AE is due to SSC. Thickness of bone over SSC was not measured in this study. Having seen so many shapes of AE in this study, authors are of the opinion that there is a need to revisit this bony landmark in MCF and rethink if it can be used as a guide in middle

  15. Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants.

    Broekema, Ferdinand I; van Minnen, Baucke; Jansma, Johan; Bos, Rudolf R M


    To avoid increasing the risk of thromboembolic events, it is recommended that treatment with anticoagulants should be continued during dentoalveolar operations. We have evaluated the incidence of bleeding after dentoalveolar operations in a prospective study of 206 patients, 103 who were, and 103 who were not, taking anticoagulants. Seventy-one were taking thrombocyte aggregation inhibitors and 32 vitamin K antagonists. Patients were treated according to guidelines developed at the Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. The operations studied included surgical extraction (when the surgeon had to incise the gingiva before extraction), non-surgical extraction, apicectomy, and placement of implants. Patients were given standard postoperative care and those taking vitamin K antagonists used tranexamic acid mouthwash postoperatively. No patient developed a severe bleed that required intervention. Seven patients (7%) taking anticoagulants developed mild postoperative bleeds. Patients taking vitamin K antagonists reported 3 episodes (9%) compared with 4 (6%) in the group taking thrombocyte aggregation inhibitors. Among patients not taking anticoagulants, two (2%) developed mild bleeding. The differences between the groups were not significant. All bleeding was controlled by the patients themselves with compression with gauze. We conclude that dentoalveolar surgery is safe in patients being treated with anticoagulants provided that the conditions described in the ACTA guidelines are met. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Histopathological profile of surgically removed persistent periapical radiolucent lesions of endodontic origin.

    Love, R M; Firth, N


    To determine the types of periapical lesions associated with root filled teeth with persistent periapical pathosis that required surgical treatment based on specific inclusion and exclusion criteria. Periapical lesions from a consecutive clinical sample of 100 patients were examined histopathologically to determine a definitive diagnosis. Females were more represented (n = 56), the average age was 46.5 years and there were no age differences between gender or lesion type. A diagnosis of periapical granuloma was the most common finding with a similar number present in females (n = 40) and males (n = 37). A cyst was present in 18% of the cases with a majority of females (n = 12) represented in the sample. Evidence of foreign material, with an appearance consistent with endodontic sealer materials, was seen in 25 periapical granulomas, two cysts and one scar. Two periapical scars were seen, one had a history of apicectomy and amalgam root-end filling while the other was associated with extruded root filling material. By using defined clinical inclusion and exclusion criteria a predictable clinical diagnosis of a persistent periapical lesion due to endodontic origin can be reliably made. Periapical granulomas and cysts were the most common periapical lesions of endodontic origin associated with persistent periapical pathosis with the overall incidence of periapical cysts similar to previous studies. The presence of endodontic material in a high proportion of periapical lesions suggests a cause-effect association with the inference that clinicians should employ canal preparation techniques that limit apical extrusion of material.

  17. Evaluation of ultrasonic and ErCr:YSGG laser retrograde cavity preparation.

    Batista de Faria-Junior, Norberto; Tanomaru-Filho, Mário; Guerreiro-Tanomaru, Juliane Maria; de Toledo Leonardo, Renato; Camargo Villela Berbert, Fábio Luiz


    Root end cavity preparation techniques aim to create a clean and properly shaped cavity in a short time. Although the use of ultrasonics has been widely recommended, a laser can also be used. This study evaluated the time required and quality of retrograde cavity preparations using ultrasonics or ErCr:YSGG laser. Thirty single-rooted teeth were instrumented, root filled, submitted to apicectomies, and grouped. Root end cavities were prepared by using the following: group 1 (G1): CVD (6.1107-6) ultrasonic retrotips (CVD-Vale, São José dos Campos, Brazil); group 2 (G2): EMS (DT-060/Berutti) ultrasonic retrotips (EMS, LeSentier, Switzerland); and group 3 (G3): ErCr:YSGG (G6/Waterlase; Biolase Technology, San Clemente, CA) laser tips. The time taken to complete the preparation was recorded. Epoxy resin replicas of the root apices were examined under a scanning electron microscope. The parameters for evaluation were the presence of fractures, and the quality of the preparations. The Waterlase showed the highest mean time for preparation of the root end cavities (p 0.05). Fractures in the cavosurface angle occurred only in G2. G1 and G2 showed better scores for quality of preparation than G3 (p < 0.05). These results suggest that root end cavities should be prepared by ultrasonic tips.

  18. SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

    Damle, Nishikant Avinash; Kumar, Rakesh; Kumar, Praveen; Jaganthan, Sriram; Patnecha, Manish; Bal, Chandrasekhar; Bandopadhyaya, Gurupad; Malhotra, Arun [All India Institute of Medical Sciences, New Delhi (India)


    Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A {sup 99mT}c MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

  19. The suprameatal dural flap for superior petrosal vein protection during the retrosigmoid intradural suprameatal approach.

    Mortini, Pietro; Gagliardi, Filippo; Boari, Nicola; Spina, Alfio; Bailo, Michele; Franzin, Alberto


    The drilling of the suprameatal bone during the retrosigmoid intradural suprameatal approach (RISA) puts the superior petrosal vein complex at risk of heating and mechanical injury, which may lead to cerebellar swelling and infarction. We present a new technique to protect the superior petrosal venous complex during suprameatal bone drilling. A microanatomical laboratory investigation on cadaver was conducted. The surgical technique is described and intraoperative schematic pictures are provided. The surgical steps of this technique and the related intraoperative images are reported. One case illustration regarding the removal of a large petrous apex meningioma with Meckel cave extension is described to demonstrate the application of the technique in a clinical setting. Reflecting a dural flap onto the posterior trigeminal nerve root and the superior petrosal vein complex can be a simple way to protect the nerve and the vein during the suprameatal bone drilling during the RISA. Georg Thieme Verlag KG Stuttgart · New York.

  20. [The vestibular system: from structure to function].

    Collard, M


    The two vestibular receptors, right and left, hidden in the petrous part of the temporal bone with the cochlear receptors, receive information from angular and linear movements of the head and transform them into a nerve message sent to the nuclei of the brainstem, which are connected directly on the one hand to the oculomotor nuclei, at the origin of the oculovestibular reflex (induction of nystagmus), and on the other hand, to the spinal motor neurons, at the origin of the vestibulospinal reflex. These reflexes are associated with responses to visual and somaesthetic information for maintenance or return to the standing position, which characterises the function of equilibrium. Vertigo and disorders of balance reflect a conflict of information between these two labyrinths, or between the vestibular apparatus and the messages issued by other captors, and sometimes also dysfunction of central nervous system treatment of information or a lesion of the effector motor systems.

  1. Lateral skull base chondroblastoma resected with facial nerve posterior transposition.

    Adnot, J; Langlois, O; Tollard, E; Crahes, M; Auquit-Auckbur, I; Marie, J-P


    Chondroblastoma is a rare tumor that can involve the temporal bone. Because it is a benign tumor, functional surgery must be proposed. We report a case of a patient with a massive chondroblastoma operated on with preservation of the facial nerve, and description of the surgical technique. A 37-year-old man presented with a 9-month history of a growing left pre-auricular mass and hearing loss. Neuroimaging showed an osteolytic mass invading the temporal bone and temporomandibular joint. Excision was performed via a transpetrosal and transcochlear approach with posterior transposition of the facial nerve. EMG monitoring was effective in preventing facial palsy. Four years later, no sign of recurrence was observed. Chondroblastoma is a locally aggressive tumor, especially when located in the petrous bone and temporomandibular joint. The suggested treatment is a complete excision. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Tinnitus and its radiological diagnosis and therpy

    Nadjmi, M.; Hofmann, E.; Ratzka, M.; Schuknecht, B.


    Tinnitus is a familiar symptom in diseases of the central nervous system. Its aetiology being of a varied nature, the type of tinnitus is a pointer to the pathoanatomic findings that are responsible for the disease. The causes of tinnitus are often found in the borderline areas between various neighbouring disciplines, such as otology, neurology and neurosurgery, whereas the final identification of the real causes is mainly within the scope of radiological diagnosis, in which computed tomography and superselective angiography play an essential role. In addition to arteriovenous fistulas near the petrous bone and glomus tumours, which are well known, there are a few other aetiologies of pulse-synchronous tinnitus that are being discussed in this paper. In recent years there has been substantial therapeutical progress owing to the introduction of new techniques and the development of improved materials for embolisation in international neuroradiology. Their application is discussed in connection with various patient groups.

  3. Postcoital Internal Carotid Artery Dissection Presenting as Isolated Painful Horner Syndrome: A Case Report

    Eren Gozke


    Full Text Available Postcoital artery dissection is a rare condition. Here we report a 40-year-old male patient with painful Horner syndrome related to postcoital internal carotid artery (ICA dissection. In neurologic examination of the patient, semiptosis, enophthalmus, and myosis were observed on the left side. There were no carotid bruits. On T1-weighted and fat-suppressed cranial MRI, hyperintensity consistent with intramural hematoma was observed within cervical and temporal petrous segments of left ICA. On cervical and cranial MRA, marked decrease in the calibration of C1 and C2 segments of the left ICA was remarkable. The patient was diagnosed as left ICA dissection and anticoagulant therapy was initiated. A prominent improvement was noted in clinical findings during two months of followup period.

  4. Genome-wide patterns of selection in 230 ancient Eurasians

    Mathieson, Iain; Lazaridis, Iosif; Rohland, Nadin; Mallick, Swapan; Patterson, Nick; Roodenberg, Songül Alpaslan; Harney, Eadaoin; Stewardson, Kristin; Fernandes, Daniel; Novak, Mario; Sirak, Kendra; Gamba, Cristina; Jones, Eppie R.; Llamas, Bastien; Dryomov, Stanislav; Pickrel, Joseph; Arsuaga, Juan Luís; de Castro, José María Bermúdez; Carbonell, Eudald; Gerritsen, Fokke; Khokhlov, Aleksandr; Kuznetsov, Pavel; Lozano, Marina; Meller, Harald; Mochalov, Oleg; Moiseyev, Vayacheslav; Rojo Guerra, Manuel A.; Roodenberg, Jacob; Vergès, Josep Maria; Krause, Johannes; Cooper, Alan; Alt, Kurt W.; Brown, Dorcas; Anthony, David; Lalueza-Fox, Carles; Haak, Wolfgang; Pinhasi, Ron; Reich, David


    Ancient DNA makes it possible to directly witness natural selection by analyzing samples from populations before, during and after adaptation events. Here we report the first scan for selection using ancient DNA, capitalizing on the largest genome-wide dataset yet assembled: 230 West Eurasians dating to between 6500 and 1000 BCE, including 163 with newly reported data. The new samples include the first genome-wide data from the Anatolian Neolithic culture whose genetic material we extracted from the DNA-rich petrous bone and who we show were members of the population that was the source of Europe’s first farmers. We also report a complete transect of the steppe region in Samara between 5500 and 1200 BCE that allows us to recognize admixture from at least two external sources into steppe populations during this period. We detect selection at loci associated with diet, pigmentation and immunity, and two independent episodes of selection on height. PMID:26595274

  5. Unusual fatal petrositis presenting as myofascial pain and dysfunction of the temporal muscle.

    Loretan, Stefan; Duvoisin, Bernard; Scolozzi, Paolo


    Petrositis is a rare and severe complication of acute otitis media and mastoiditis. Although the extension of the inflammatory process from the petrous apex to the adjacent Meckel cave can lead to trigeminal pain, an irritation of the trigeminal nerve roots resulting in acute or chronic hyperactivity of masticatory muscles has never been reported. We report here the unusual case of an 86-year-old man who presented with a handicapping myofascial pain and dysfunction syndrome of the right temporal muscle as a heralding manifestation of an unusual form of petrositis. The patient progressively developed a retropharyngeal abscess, a right sphenoid sinusitis, and fatal meningitis. This case demonstrated that (1) myofascial pain and dysfunction syndrome that does not respond to conventional treatments may suggest an unusual etiology and warrant further medical investigations and a detailed medical history and that (2) petrositis can manifest itself with atypical clinical symptoms and radiologic signs.

  6. Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review

    Sultan Şevik Eliçora


    Full Text Available Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

  7. Acute Otitis Media-Induced Gradenigo Syndrome, a Dramatic Response to Intravenous Antibiotic

    Tayebeh Kazemi


    Full Text Available Introduction: Petrositis is a rare but severe complication of acute otitis media and mastoiditis. Despite efficient antibiotic therapy, there are still reports of both intratemporal and intracranial complications of otitis media with the potential risk of high morbidity and mortality. Petrositis has traditionally been treated with surgery, but recent advances in imaging, with improved antibiotic treatment, allow more conservative management.   Case Report: In this case report we describe the clinical course and treatment of a 33-year-old man with petrous apicitis who presented with severe otalgia, retro-orbital pain, and sixth cranial nerve palsy Gradenigo syndrome. Our patient showed a dramatic response to intravenous antibiotics only, without need for any surgical intervention, even myringotomy.   Conclusion: It seems that early detection and management of this syndrome before development of other intratemporal or intracranial complications may prevent the need for surgical intervention.

  8. Langerhans Cell Histiocytosis in Bilateral Mastoid Cavity

    Kazım Bozdemir


    Full Text Available A 39-year-old male was admitted to our clinic with symptoms of headache, dizziness, nausea, otalgia, otorrhea, tinnitus, and hearing loss in both ears for 3 weeks. Physical examination revealed edema in the tympanic membrane and external ear canal, and pain by palpation in the mastoid area bilaterally. There was no nystagmus, and the rest of the physical examination was otherwise normal. Temporal bone high resolution computed tomography (CT showed a lesion causing erosion in the mastoid cortex, tegmen tympani, ossicles, and in the bone covering the sigmoid sinus bilaterally. There was also erosion in the superior semicircular canal and petrous bone on the left side. Cortical mastoidectomy was performed under general anesthesia. Histopathologic examination of the tissue revealed Langerhans cell histiocytosis (LCH. In this paper a case with LCH, presenting with bilateral mastoid involvement which has been rarely reported in the literature, is discussed with the existing literature.

  9. Extradural Dermoid Cyst of Mastoid Bone: A Case Report

    Hamad S. Al-Muhaimeed


    Full Text Available Dermoid cysts of the head and neck are rare congenital benign tumors. According to the literature they represent about seven percent of all dermoids and less than one percent of all intracranial neoplasms. Extradural dermoid cysts are very rare. We report a case of intracranial extradural dermoid cyst of mastoid bone. We believe that this is the second documented extradural dermoid cyst, the first case reported in the literature (Ammirati et al., 2007 was in close relation to the petrous apex but ours is in close relation to mastoid antrum. Hearing loss was the only clinical presentation in this case, while neurological symptoms were the main presenting symptoms in the first reported case. We present our management of this rare case with respect to the clinical, radiological, histopathological, and surgical aspects and conclude that dermoid tumors, though rare, need to be included in differential diagnosis of middle ear lesions.

  10. Cholesterol granuloma presenting as a mass obstructing the external ear canal

    Psifidis Dimosthenis


    Full Text Available Abstract Background Cholesterol granuloma (CG may involve the middle ear, the mastoid bone and the petrous apex. However, CG presenting as a mass obstructing the external ear canal (EEC is relatively rare and it can be a diagnostic challenge. Case Presentation We report a case of a CG occupying the mastoid antrum and presenting as a mass into the EEC. Temporal bone computerized tomography showed a soft tissue mass which eroded the posterior-superior bony wall of the EEC. On magnetic resonance imaging, the mass revealed a high signal on both T1 and T2-weighted images. The CG was removed by a mastoidectomy procedure and the histopathologic report confirmed the diagnosis of CG. A type III tympanoplasty was performed. Conclusions The postoperative course was uneventful.

  11. Cochlear implant electrode array misplaced in Hyrtl's fissure.

    Mouzali, Amina; Ouennoughi, Kheiredidine; Haraoubia, Mohamed-Salah; Zemirli, Omar; Triglia, Jean Michel


    Hyrtl's fissure is a cleft that is present in the developing fetal petrous temporal bone and extends from the area inferior to the round window to the meninges of the posterior fossa. Persistent Hyrtl's fissure, due to incomplete ossification, is considered a rare temporal bone malformation, and is a known cause of perilabyrinthine cerebrospinal fluid fistula. Very few cases are reported as being at risk of complication of cochlear implant surgery. Here we report the case of an 8-year-old boy with misplacement of an electrode array in Hyrtl's fissure. The diagnosis was made postoperatively, since cochlear implant failure was suspected from non-auditory responses. Computed tomography (CT) revealed the extracochlear location of the electrode array. We emphasize the role of presurgical imaging CT and magnetic resonance imaging in detecting temporal bone abnormalities, and we discuss the value of intraoperative auditory nerve response telemetry and postoperative radiological evaluation in diagnosing cochlear implant misplacement.

  12. Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves

    Soo Ryang Kim; Fumio Kanda; Hiroshi Kobessho; Koji Sugimoto; Toshiyuki Matsuoka; Masatoshi Kudo; Yoshitake Hayashi


    We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma (HCC) metastasizing to the skull base involving multiple cranial nerves in a 50-yearold woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy, indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography (CT) revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging (MRI)disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced MRI with gadolinium-chelated contrast medium, the mass showed inhomogeneous intermediate enhancement.The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.

  13. Delayed otogenic pneumocephalus complicating ventriculoperitoneal shunt

    Francesco Pieri


    Full Text Available Tension pneumocephalus complicating ventriculoperitoneal shunt is extremely rare. We report an elderly male who developed delayed tension pneumocephalus 12 months after ventriculoperitoneal shunt for hydrocephalus complicating aneurysmal subarachnoid hemorrhage. Fine-cut reformatted computer tomography scan revealed a large pneumatocele on the petrous apex associated with tegmen tympani defect. The shunt valve pressure was temporarily raised from 120 mm H 2 O to 200 mm H 2 O, and the patient underwent successful subtemporal extradural repair of the bony defect in the temporal bone. Although extremely rare, otogenic tension pneumocephalus is a potentially life-threatening condition, and urgent surgical repair of the bony defect in the temporal bone reduces the risk of both the morbidity and mortality.

  14. MRI of paraganglioma of the filum terminale

    Boncoeur-Martel, M.P.; Lesort, A.; Moreau, J.J.; Labrousse, F.; Roche, I.; Bouillet, P.; Pascaud, J.L.; Dupuy, J.P. [Cabinet of Rheumatology, Limoges (France)


    Paragangliomas are benign tumors arising from paraganglionic cells of the sympathetic nervous system. They are of neuroectodermal derivation, with the majority occurring in the adrenal medulla. Extraadrenal locations are usually nonfunctioning and mostly observed (90%) in the head and neck region (carotid body or glomus jugulare tumors). Rare reported locations include the mediastinum, retroperitoneum, lungs, duodenum, and bladder. Within the CNS, paragangliomas have been observed in the pineal region, petrous ridge, sella turcica, and spinal canal. Paraganglioma of the cauda equina was first reported, but not recognized as such, in 1970. We know of 10 reports that describe MRI appearance. We present a new case and review the imaging findings of a paraganglioma of the filum terminale. 14 refs., 3 figs.

  15. A case of a cholesterol granuloma occluding the external auditory canal in a 12-year-old girl.

    Kong, Ji Sun; Kim, Mee-Seon; Lee, Kyu-Yup


    Cholesterol granulomas are benign granulomatous lesions caused by tissue reaction to a foreign body such as cholesterol crystals. These crystals have been are associated with pathological conditions of pneumatized spaces, including those causing inadequate aeration, obstruction of drainage, and hemorrhage in pneumatized spaces, and where materials trapping materials, such as hemosiderin or cholesterol become trapped, and then forming a cholesterol granuloma. Cholesterol granulomas are frequently found in the temporal bones, with the middle ear, mastoid caverna, and petrous apex being the most commonly affected sites. As there have been few reported cases of cholesterol granulomas presenting as a mass in the external acoustic canal (EAC), a cholesterol granuloma occluding the entire EAC in a pediatric patient is considered quite rare. We encountered a large cholesterol granuloma occupying the entire EAC, resulting in total EAC occlusion in a 12-year-old girl. The granuloma was diagnosed via medical imaging and surgically excised.

  16. Endoscope-assisted retrosigmoid intradural suprameatal approach for surgical treatment of trigeminal schwannomas.

    Samii, Madjid; Alimohamadi, Maysam; Gerganov, Venelin


    Trigeminal schwannomas are the most common intracranial nonvestibular schwannomas, and the dumbbell-shaped subtype is the most challenging. To evaluate the efficiency and safety of the endoscope-assisted retrosigmoid intradural suprameatal approach (EA-RISA) for dumbbell trigeminal schwannomas and to compare EA-RISA with classic RISA. A retrospective study of all patients with trigeminal schwannomas was performed with a focus on dumbbell tumors. Tumors were classified according to a modified Samii classification. Extent of tumor removal, outcome, and morbidity rates in the 2 subgroups were compared. Twenty patients were enrolled: 8 had dumbbell-shaped tumors (type C1), 8 had middle fossa tumors (A1-3), 3 had extracranial extension (D2), and 1 had posterior fossa tumor. Gross total resection was achieved in 15 and near-total resection in 5 patients. In 4 patients with dumbbell tumors, the classic RISA (Samii approach) was used; EA-RISA was used in the other 4 patients. The extent of petrous apex drilling was determined individually on the basis of the anatomic variability of suprameatal tubercle and degree of tumor-induced petrous apex erosion; in 2 patients, only minimal drilling was needed. The endoscope was applied after microsurgical tumor removal and in 3 of 4 patients revealed a significant unrecognized tumor remnant in the anterolateral and superolateral aspects of the Meckel cave. Thus, the EA-RISA technique allowed gross total resection of the tumor. The EA-RISA enlarges the exposure obtained with the classic RISA. Its judicious use can help achieve safe and radical removal of dumbbell-shaped trigeminal schwannomas (C1 type).

  17. 急性中耳炎并发岩尖炎1例临床分析及文献复习%Petrositis due to acute otitis media: a case report and literature review

    陈敏; 刘冰; 张杰; 刘世琳


    目的:探讨急性中耳炎并发岩尖炎的临床特点与治疗.方法:结合文献复习报告1例岩尖炎.症状期间颞骨CT表现为岩尖气房模糊,小梁结构不清.症状消失短期内MRI仍表现为岩尖部不规则、不连续长T1及长T2信号.结果:岩尖炎患者经抗炎、激素及营养神经药物治疗痊愈.4个月后复查颢骨CT岩尖气房充气好.随访1年无复发.结论:岩尖炎的诊断有赖于特征性的临床表现、颞骨CT及MRI所提供的影像学证据.保守治疗可作为岩尖炎治疗的一种选择.%Objective:To study the clinical features and conservative treatment of petrositis. Method:One case of pertositis was reported and literatures were reviewed. Opacificated air cells in CT, and anomalous, discontinuous hypersignal in MRI T1 and T2 provided evidence of infection of the apex of the petrous temporal bone. Result: The patient recovered totally after conservative treatment with intravenous antibiotic, glucocorticoid and neurotro-phy therapy, and no recurrence occurred in 1 year follow-up. CT rescan showed the clear air cells of the petrous a-pex 4 months later. Conclusion; Petrositis can be diagnosed with specific clinical features, the image of CT and MRI. Conservative treatment could be a good choice.

  18. Composition and distribution of elements and ultrastructural topography of a human cardiac calculus.

    Cheng, Ching-Li; Chang, Hsiao-Huang; Huang, Pei-Jung; Chu, Yu-Ting; Lin, Shan-Yang


    Trace elements (TEs) may contribute to the formation of calculi or stones or be involved in the aetiopathogenesis of stone diseases. The compositions and spatial distribution of elements from the inner nucleus to outer crust of the cardiac calculus were investigated by energy-dispersive X-ray fluorescence (EDXRF) spectrometer. The surface topograph, distribution map of elements, elemental and chemical compositions were also determined by environmental scanning electron microscope (ESEM)-energy-dispersive X-ray (EDX) analysis. Twenty-five elements were identifiable from 18 positions on the cardiac calculus by EDXRF spectrometer, in which the highest concentrations of toxic TEs (Ni, Pt, Hg, Sn, Pb, W, Au, Al, Si) and higher levels of essential TEs (Ca, Sr, Cr, P) were detected. A moderate positive Pearson's correlation between TEs concentrations of Mg, Ca or P and location differences from centre to periphery in the cardiac calculus was observed. A positive correlation was also found for Ca/Zn and Ca/Cu, indicating the gradual increase of calcium concentration from inner nucleus to outer crust of cardiac calculus. The drop-like nodules/crystals on the surface of petrous part of cardiac calculus were observed from ESEM analysis. ESEM-EDX analysis determined the calculus to be predominantly composed of calcium hydroxyapatite and cholesterol, as indicated by the petrous surface and drop-like nodules/crystals, respectively. This composition was confirmed using a portable Raman analyser. The spatial distribution analysis indicated a gradual increase in Mg, P and Ca concentrations from the inner nucleus to the outer crust of the cardiac calculus. The major chemical compositions of calcium hydroxyapatite and cholesterol were detected on this cardiac calculus.

  19. MRI-based diagnostic imaging of the intratemporal facial nerve; Die kernspintomographische Darstellung des intratemporalen N. facialis

    Kress, B.; Baehren, W. [Bundeswehrkrankenhaus Ulm (Germany). Abt. fuer Radiologie


    Detailed imaging of the five sections of the full intratemporal course of the facial nerve can be achieved by MRI and using thin tomographic section techniques and surface coils. Contrast media are required for tomographic imaging of pathological processes. Established methods are available for diagnostic evaluation of cerebellopontine angle tumors and chronic Bell's palsy, as well as hemifacial spasms. A method still under discussion is MRI for diagnostic evaluation of Bell's palsy in the presence of fractures of the petrous bone, when blood volumes in the petrous bone make evaluation even more difficult. MRI-based diagnostic evaluation of the idiopatic facial paralysis currently is subject to change. Its usual application cannot be recommended for routine evaluation at present. However, a quantitative analysis of contrast medium uptake of the nerve may be an approach to improve the prognostic value of MRI in acute phases of Bell's palsy. (orig./CB) [German] Die detaillierte kernspintomographische Darstellung des aus 5 Abschnitten bestehenden intratemporalen Verlaufes des N. facialis gelingt mit der MRI unter Einsatz von Duennschichttechniken und Oberflaechenspulen. Zur Darstellung von pathologischen Vorgaengen ist die Gabe von Kontrastmittel notwendig. Die Untersuchung in der Diagnostik von Kleinhirnbrueckenwinkeltumoren und der chronischen Facialisparese ist etabliert, ebenso wie die Diagnostik des Hemispasmus facialis. In der Diskussion ist die MRI zur Dokumentation der Facialisparese bei Felsenbeinfrakturen, wobei die Einblutungen im Felsenbein die Beurteilung erschweren. Die kernspintomographische Diagnostik der idiopathischen Facialisparese befindet sich im Wandel. In der herkoemmlichen Form wird sie nicht zur Routinediagnostik empfohlen. Die quantitative Analyse der Kontrastmittelaufnahme im Nerv koennte jedoch die prognostische Bedeutung der MRI in der Akutphase der Bell's palsy erhoehen. (orig.)

  20. Preoperative cellulose porous beads for therapeutic embolization of meningioma: provocation test and technical considerations

    Kai, Yutaka; Morioka, Motohiro; Yano, Shigetoshi; Nakamura, Hideo; Makino, Keishi; Mizuno, Takamasa; Takeshima, Hideo; Kuratsu, Jun-ichi [Kumamoto University, Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto (Japan); Hamada, Jun-ichiro [Kanazawa University, Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa (Japan)


    Cellulose porous beads (CPBs) are exceptionally uniform in size and nonabsorbable and they provide highly effective tumor devascularization. The risk of cranial nerve palsy must not be overlooked when embolization with CPBs is considered in meningioma patients. We attempted to identify patients at risk of cranial nerve palsy after meningioma embolization. Prior to preoperative superselective embolization with 200 {mu}m diameter CPBs, 141 patients with meningioma underwent provocation test with lidocaine and amytal. They were divided into two groups on the basis of whether they were or were not considered eligible for embolization. We evaluated the differences between the two groups with respect to tumor anatomy, angiographic findings, and clinical presentation and recorded complications associated with the embolization of the meningioma. Of the 141 patients, 128 underwent CPB embolization (group 2); 13 were not embolized because their provocation test results were positive (group 1, n = 11) or because they showed vasospasm (n = 2). Group 1 patients had meningioma in the cavernous sinus or petroclival region. Characteristically, the feeders were of middle meningeal artery origin and exhibited a posteromedial course toward the petrous apex or cavernous sinus. In group 2 patients the middle meningeal artery was the feeder, but it lacked branches coursing posteromedially. Three of these patients experienced complications which included intratumoral hemorrhage (n = 2) and post-embolization hearing disturbance (n = 1). Patients with meningioma whose tumor-feeding arteries run posteromedially toward the petrous apex or cavernous sinus are at increased risk of post-embolization cranial nerve palsy. Appropriate protocols, including lidocaine and amytal provocation tests, may reduce the risk of complications after CPB embolization of the external carotid territory in this group of patients. (orig.)


    葛顺楠; 董玉琳; 张富兴; 李金莲


    为了探讨旋转刺激与运动病发生的关系,本研究利用一种复杂的围绕两轴旋转的加速度刺激器刺激大鼠后,观察大鼠全脑内Fos蛋白的表达情况.动物被随机地分成四组,即正常对照组、两轴旋转刺激组、双侧迷路毁损组以及双侧迷路毁损后接受旋转刺激组.采用免疫组织化学染色方法观察全脑不同核团内Fos蛋白的表达情况.结果显示:(1)正常对照组和双侧迷路毁损组大鼠的脑内均未检测到Fos样免疫阳性产物;(2)两轴旋转刺激组的大鼠在给予复杂的围绕两轴旋转的加速度刺激后,在大鼠脑和脑干的多个核团内均可检测到Fos样免疫阳性神经元,其阳性产物主要表达于细胞核.其中在脑干内的前庭复合体的不同亚核(包括前庭内侧核、前庭上核和前庭下核),孤束核、蓝斑核、臂旁内侧核、臂旁外侧核,间脑的室旁核以及边缘系统的杏仁核等内均可观察到密集分布的Fos样免疫阳性神经元;(3)双侧迷路毁损组大鼠在接受复杂的围绕两轴旋转刺激后,在上述相应核团内均难以检测到Fos蛋白的表达.以上研究结果提示两轴旋转刺激可以有效地激活前庭神经元,而大鼠在接受前庭刺激后,脑和脑干的许多核团内大量的神经元可能通过与前庭核复合体发生直接或间接的纤维联系也被激活,这些被激活的神经元可能与运动病发生的复杂机制有关.%To investigate the relationship of the rotation stimulation with motion sickness, the expression of Fos protein in the whole brain of the rat stimulated by complex double rotation on two axes was observed in the present study. The rats were randomly divided into four groups: normal contral group; double-axes rotation stimulation group; the bilateral labyrinthectomy group; group of two-axes rotation stimulation after the bilateral labyrinthectomy. Immunohistochemical staining method was used to detect the expression of Fos

  2. MR findings in intralabyrinthine schwannomas

    Montague, Mary-Louise; Kishore, Ameet; Hadley, Donald M.; O' Reilly, Brian


    AIM: Intralabyrinthine schwannomas (ILS) are rare benign tumours. They are not always recognized on routine magnetic resonance imaging (MRI). We aimed to study the clinical presentation and MRI findings in our patients with ILS. MATERIALS AND METHODS: Retrospective analysis of patients with vestibular schwannomas treated at this center. RESULTS: Of 144 vestibular schwannomas studied at this centre, three patients had an ILS. The most common presenting symptoms were unilateral hearing loss, tinnitus and vertigo. Two patients demonstrated a progressive sensorineural hearing loss (SNHL). The third patient had a severe SNHL at presentation. MRI enhanced with contrast medium was positive in the two patients with progressive SNHL and negative in the patient with the severe SNHL. CONCLUSION: This series demonstrates the ability of MRI to identify schwannomas filling the labyrinth, and also its inability to identify extremely small ILS. It underlines the importance of sending the cristae of patients undergoing labyrinthectomy for presumed Meniere's disease for histological examination. Montague, M.-L. et al. (2002)

  3. Non-Pharmacological Countermeasure to Decrease Landing Sickness and Improve Functional Performance

    Rosenberg, M. J. F.; Kreutzberg, G. A.; Galvan-Garza, R. C.; Mulavara, A. P.; Reschke, M. F.


    Upon return from long-duration spaceflight, 100% of crewmembers experience motion sickness (MS) symptoms. The interactions between crewmembers' adaptation to a gravitational transition, the performance decrements resulting from MS and/or use of promethazine (PMZ), and the constraints imposed by mission task demands could significantly challenge and limit an astronaut's ability to perform functional tasks during gravitational transitions. Stochastic resonance (SR) is "noise benefit": adding noise to a system might increase the information (examples to the left and above). Stochastic vestibular stimulation (SVS), or low levels of noise applied to the vestibular system, improves balance and locomotor performance (Goel et al. 2015, Mulavara et al. 2011, 2015). In hemi-lesioned rat models, Samoudi et al. 2012 found that SVS increased GABA release on the lesioned, but not the intact side. Activation of the GABA pathway is important in modulating MS and promoting adaptability (Cohen 2008) and was seen to reverse MS symptoms in rats after unilateral labyrinthectomy (Magnusson et al. 2000). Thus, SVS could be used to promote GABA pathways to reduce MS and promote adaptability, eliminate the need for PMZ or other performance-inhibiting drugs.

  4. 梅尼埃病的个体化治疗及疗效评估%Individual management of Meniere's disease and evaluation of functional outcome

    陈颖; 杨军; 吴皓; 黄琦; 汪照炎; 张治华


    目的:探讨梅尼埃病的个性化临床治疗方法,评估梅尼埃病的非手术及手术疗效.方法:将所有梅尼埃病患者根据听力及生活质量情况进行分期;根据分期情况予以非手术治疗(改变生活方式、口服药物以及鼓室内注射地塞米松)、内淋巴囊减压或引流术、前庭神经切断术或迷路切除术.分析手术治疗梅尼埃病患者病史特点和手术情况;对于手术满1年以上的梅尼埃病患者进行术前术后的眩晕、听力及生活质量等疗效评价.结果:接受鼓室内注射地塞米松的梅尼埃病患者为20例,眩晕改善者占70%(14/20),耳鸣及耳闷改善率分别为41%(7/17)及36%(4/11).手术治疗梅尼埃病共55例患者57次手术,其中内淋巴囊手术28次,前庭神经切断术26次,迷路切除术3次.术后1年的眩晕控制率为:内淋巴囊手术75%,前庭神经切断术100%.3例迷路切除术后随访2例,眩晕均消失;1例术后随访不满1年,正在观察中.结论:非手术治疗以及内淋巴囊减压或引流术叮以减轻患者眩晕、改善患者的生活质量;前庭神经切断术和迷路切除术是有效控制梅尼埃病患者眩晕的手术方法;梅尼埃病的治疗需要依靠患者的眩晕分级、听力分期、生活质量以及是否存在手术禁忌证、主观愿望等诸多因素综合评估,从而制定适合个人的个体化治疗.%Objective:To investigate individual management for Meniere's disease and analyze outcomes of non-surgical and surgical management of Meniere's disease. Method:Patients with Meniere's disease were staged accord-ing to hearing and quality of life. The individual management according to the staging was established, including outpatient treatment (lifestyle change , medical management and intratympanic steroids), endolymphatic sac de-compression or drainage, vestibular neurectomy and labyrinthectomy. The characteristics of patients who under-went surgical management were analyzed. The

  5. Influence of the parameters of the Er:YAG laser on the apical sealing of apicectomized teeth.

    Marques, Aparecida Maria Cordeiro; Gerbi, Marleny Elizabeth M M; dos Santos, Jean Nunes; Noia, Manuela Pimentel; Oliveira, Priscila Chagas; Brugnera Junior, Aldo; Zanin, Fátima Antonia Aparecida; Pinheiro, Antonio Luiz Barbosa


    Failures in the sealing of the tooth apex have been considered to be responsible for most of the failures of apical surgeries. The Er:YAG laser has been proposed as an alternative for the use of rotator instruments in surgical endodontics due to its precision, lack of vibration, less post-operative discomfort, bacterial reduction, and less stress for patients and professionals. Following approval by the ethics committee, 12 extracted human canines without previous endodontic treatment with anatomically normal roots and free from apical lesions were washed in running tap water and disinfected. The teeth were sectioned axially at the crown-root junction and submitted to routine endodontic treatment. The apical limit was set at 1 mm before the apical foramen. The root canals were routinely filled with Gutta-Percha points and Sealer 26 and were randomly distributed into two groups (n = 6). In group I, apicectomy was performed with the Er:YAG laser (KAVO KEY Laser II®, Germany, λ = 2.940 nm, pulsed mode, 2051 tip, with air spray cooling, 250 mJ/15 Hz). Apical cut was performed of perpendicular mode 3 mm from the apical foramen. In group II, the same procedures and the same sequence as above was used, varying only the parameters of the Er:YAG laser (400 mJ/6 Hz). Sealing of the cervical end the apex was carried out with acrylic resin; the roots were covered by a layer of epoxy glue and two layers of nail polish. The specimens were divided into groups and fixed, by the cervical third, on wax. Impermeabilization of the residual root apical third was performed following the same procedures used in the cervical third but the residual apex was left free from the impermeabilization. After that, the roots were immersed in a 2% methylene blue solution and placed in a bacteriological oven for 48 h and then washed in running tap water for 2 h. The samples were sagittally split into two parts. The segments were visually observed and the one showing the greatest

  6. Diagnostic validity of periapical radiography and CBCT for assessing periapical lesions that persist after endodontic surgery.

    Kruse, Casper; Spin-Neto, Rubens; Reibel, Jesper; Wenzel, Ann; Kirkevang, Lise-Lotte


    Traditionally, healing after surgical endodontic retreatment (SER); i.e. apicectomy with or without a retrograde filling, is assessed in periapical radiographs (PR). Recently, the use of Cone Beam CT (CBCT) has increased within endodontics. Generally, CBCT detects more periapical lesions than PR, but basic research on the true nature of these lesions is missing. The objective was to assess the diagnostic validity of PR and CBCT for determining inflammation in SER-cases that were re-operated (SER-R) due to unsuccessful healing, using histology of the periapical lesion as reference for inflammation. Records from 149 patients, receiving SER 2004-10, were screened. In total 108 patients (119 teeth) were recalled for clinical follow-up examination, PR and CBCT, of which 74 patients (83 teeth) participated. Three observers assessed PR and CBCT as "successful healing" or "unsuccessful healing" using Rud and Molven´s criteria. SER-R was offered to all non-healed teeth with expected favorable prognosis for subsequent functional retention. During SER-R, biopsy was performed and histopathology verified whether or not inflammation was present. All re-operated cases were assessed non-healed in CBCT while 11 of these were assessed successfully healed in PR. Nineteen biopsies were examined. Histopathologic diagnosis revealed 42% (teeth=8) without periapical inflammation, 16% (teeth=3) with mild inflammation, and 42% (teeth=8) with moderate to intense inflammation. A correct diagnosis was obtained in 58% with CBCT (true positives) and 63% with PR (true positives+true negatives). Of the re-operated teeth, 42% had no periapical inflammatory lesion, and hence no benefit from SER-R. Not all lesions observed in CBCT represented periapical inflammatory lesions.

  7. Do Parameters Of Irradiation Influences The Apical Sealing Of Er:YAG Laser Apicetomies?

    Marques, Aparecida Maria Cordeiro; dos Santos, Jean Nunes; Pinheiro, Antonio Luiz Barbosa


    Failures on the sealing of the tooth apex are responsible for many failures of apical surgeries. The Er:YAG laser has been proposed as an alternative for the use of rotator instruments on surgical endodontics. 12 human extracted canines had root endodontic treatment being the apical limit was set at 1mm before the apical foramen and were distributed into 2 groups. On group I, apicectomy was performed with the Er:YAG laser (250 mJ/15 Hz). Apical cut was performed of perpendicular mode with 3mm from the apical foramen. On Group II, the same procedures and the same sequence as above was used, varying only the parameters of the Er:YAG laser (400 mJ/6 Hz). The specimens were divided into groups and fixed, by the cervical third, on wax. Impermeabilization of the residual root apical third was performed following the same procedures used in the cervical third but the residual apex was left free from the impermeabilization. After that, the roots were immersed in a 2% methylene blue solution and placed in a bacteriological oven for 48 h. The segments were visually observed and the one showing greatest level of dye leakage was selected and kept in individual container and coded accordingly. Apical staining was measured using a stereoscopic magnifying glass; a compass; and caliper. The results showed that Group I showed significantly different higher mean level of dye leakage (5.67±4.9, papicectomies carried out with 400 mJ/6 Hz showed the smallest infiltration value.

  8. Persistent extraradicular infection in root-filled asymptomatic human tooth: scanning electron microscopic analysis and microbial investigation after apical microsurgery.

    Signoretti, Fernanda G C; Endo, Marcos S; Gomes, Brenda P F A; Montagner, Francisco; Tosello, Fernanda B; Jacinto, Rogério C


    Procedural accidents have a negative effect on healing and might contribute to the persistence of infections in inaccessible apical areas, requiring surgical intervention. This report describes a case of persistent apical periodontitis of a lower left first molar associated with the sinus tract and a periapical lesion that required nonsurgical endodontic retreatment and apical surgery for resolution. The tooth had received endodontic treatment 3 years ago and had to be retreated using the crown-down technique with chemical auxiliary substance (2% chlorhexidine gel), foramen patency, and enlargement and was filled in a single appointment. The occlusal access cavity was immediately restored with composite resin. After 1 month, it could be observed that the sinus tract persisted and, radiographically, the lesion remained unaltered. Therefore, endodontic microsurgery was indicated. Apical microsurgery was performed under magnification with the use of a dental operating microscope including apicectomy, root end with ultrasound, and sealing with mineral trioxide aggregate. A microbiological sample was collected from the apical lesion. The resected distal root apex was observed by scanning electron microscopy. The following species were detected: Actinomyces naeslundii and Actinomyces meyeri, Propionibacterium propionicum, Clostridium botullinum, Parvimonas micra, and Bacteroides ureolyticus; scanning electron microscopic analysis revealed bacterial biofilm surrounding the apical foramen and external radicular surface. Gutta-percha overfilling at the apex because of a zip caused during initial endodontic treatment could be observed. A 6-month follow-up showed apparent radiographic periapical healing, which progressed after 24 months. Gram-positive anaerobic bacteria and extraradicular biofilm seem to participate in the maintenance of persistent periapical pathology, and endodontic retreatment followed by periapical microsurgery proved to be a successful alternative in the

  9. Detection of human cytomegalovirus and Epstein-Barr Virus in symptomatic and asymptomatic apical periodontitis lesions by real-time PCR

    Ozbek, Selcuk M.; Yavuz, Muhammed S.


    Objectives: Recent studies have investigated the occurrence of human cytomegalovirus and Epstein-Barr Virus in samples from apical periodontitis lesions and a role in the pathogenesis of this disease has been suggested. Because genotype distribution and seroprevalence of EBV and HCMV differ among populations, it is important to determine the presence of these viruses in endodontic periapical lesions of different populations. The aims of this study were to determine the presence of HCMV and EBV DNAs in samples from Turkish patients with symptomatic and asymptomatic apical periodontitis lesions using real-time polymerase chain reaction method and to evaluate their presence in both symptomatic and asymptomatic apical periodontitis lesions. Study Design: Periapical samples were collected from 12 asymptomatic and 16 symptomatic periapical lesions in conjunction with apicectomy. HCMV and EBV DNAs were identified in the samples by real-time PCR. The chi-squared test with Yates’s correction or the Fisher’s exact test was used to analyse the significance of differences. Results: HCMV DNA was detected in 10 of the 16 (62.5%) symptomatic and in five of the 12 (41.7 %) asymptomatic periapical study lesions. The EBV DNA was identified in seven of the 16 (43.7 %) symptomatic and three of the 12 (25 %) asymptomatic periapical lesions. The difference in occurrence of HCMV and EBV DNA between symptomatic and asymptomatic periapical lesions was not statistically significant. (All comparisons have p > 0.05). Conclusions: Our findings suggest that HCMV and EBV is a frequent inhabitant of both symptomatic and asymptomatic apical periodontitis lesions of endodontic origin in Turkish population. Key words:Human cytomegalovirus, Epstein-Barr Virus, apical periodontitis, Polymerase chain reaction method. PMID:23722135

  10. A novel conservative approach combining “SealBio” and “Surgical Fenestration” for healing of large periapical cystic lesions of endodontic origin: A pilot study

    Naseem Shah


    Full Text Available Objectives: To evaluate the treatment outcome of large periapical cystic lesions treated by combining two novel, conservative approaches, “SealBio” and “Surgical Fenestration”. Materials and Methods: Five cases (4M:1F, age range 14-38 years, mean age 24.5 years of large periapical cystic lesions, diagnosed on clinical and radiographic examination, were included in the study. After informed consent, endodontic treatment was initiated; chemo-mechanical preparation and intra-canal dressing of calcium hydroxide was given. At the next sitting after one week, further disinfection root canals was done by “apical clearing”, “apical foramen widening” and irrigation. A cotton pellet was kept in the access cavity. After local anaesthesia, full thickness muco-periosteal flap was reflected and the thinned out bone was removed with bone rongers, a small piece of cystic lining was excised and the cystic cavity was copiously flushed with Betadine solution. The remaining cystic lining was gently curetted and the flap was sutured back. “SealBio” was performed after gentle irrigation with saline and intentional over instrumentation. A calcium sulphate based cement was pushed in the cervical third of the canal and the access opening was sealed with glass ionomer cement. Patient was prescribed antibiotics and anti-inflammatory drugs for 5 days and sutures were removed after 7 days. Patients were followed up clinically and radiographically at regular intervals. Conclusions: In this pilot study, treatment outcome after combined technique of “SealBio” and “Surgical fenestration” was found to be highly effective in healing of large periapical cystic lesions. It was simple to perform and very conservative treatment; it required minimal bone removal, obviated the need for complete cyst enucleation, apicectomy and retrograde filling.

  11. Neuronal detection thresholds during vestibular compensation: contributions of response variability and sensory substitution.

    Jamali, Mohsen; Mitchell, Diana E; Dale, Alexis; Carriot, Jerome; Sadeghi, Soroush G; Cullen, Kathleen E


    The vestibular system is responsible for processing self-motion, allowing normal subjects to discriminate the direction of rotational movements as slow as 1-2 deg s(-1). After unilateral vestibular injury patients' direction-discrimination thresholds worsen to ∼20 deg s(-1), and despite some improvement thresholds remain substantially elevated following compensation. To date, however, the underlying neural mechanisms of this recovery have not been addressed. Here, we recorded from first-order central neurons in the macaque monkey that provide vestibular information to higher brain areas for self-motion perception. Immediately following unilateral labyrinthectomy, neuronal detection thresholds increased by more than two-fold (from 14 to 30 deg s(-1)). While thresholds showed slight improvement by week 3 (25 deg s(-1)), they never recovered to control values - a trend mirroring the time course of perceptual thresholds in patients. We further discovered that changes in neuronal response variability paralleled changes in sensitivity for vestibular stimulation during compensation, thereby causing detection thresholds to remain elevated over time. However, we found that in a subset of neurons, the emergence of neck proprioceptive responses combined with residual vestibular modulation during head-on-body motion led to better neuronal detection thresholds. Taken together, our results emphasize that increases in response variability to vestibular inputs ultimately constrain neural thresholds and provide evidence that sensory substitution with extravestibular (i.e. proprioceptive) inputs at the first central stage of vestibular processing is a neural substrate for improvements in self-motion perception following vestibular loss. Thus, our results provide a neural correlate for the patient benefits provided by rehabilitative strategies that take advantage of the convergence of these multisensory cues.

  12. The frog vestibular system as a model for lesion-induced plasticity: basic neural principles and implications for posture control

    Francois M Lambert


    Full Text Available Studies of behavioral consequences after unilateral labyrinthectomy have a long tradition in the quest of determining rules and limitations of the CNS to exert plastic changes that assist the recuperation from the loss of sensory inputs. Frogs were among the first animal models to illustrate general principles of regenerative capacity and reorganizational neural flexibility after a vestibular lesion. The continuous successful use of the latter animals is in part based on the easy access and identifiability of nerve branches to inner ear organs for surgical intervention, the possibility to employ whole brain preparations for in vitro studies and the limited degree of freedom of postural reflexes for quantification of behavioral impairments and subsequent improvements. Major discoveries that increased the knowledge of post-lesional reactive mechanisms in the central nervous system include alterations in vestibular commissural signal processing and activation of cooperative changes in excitatory and inhibitory inputs to disfacilitated neurons. Moreover, the observed increase of synaptic efficacy in propriospinal circuits illustrates the importance of limb proprioceptive inputs for postural recovery. Accumulated evidence suggests that the lesion-induced neural plasticity is not a goal-directed process that aims towards a meaningful restoration of vestibular reflexes but rather attempts a survival of those neurons that have lost their excitatory inputs. Accordingly, the reaction mechanism causes an improvement of some components but also a deterioration of other aspects as seen by spatio-temporally inappropriate vestibulo-motor responses, similar to the consequences of plasticity processes in various sensory systems and species. The generality of the findings indicate that frogs continue to form a highly amenable vertebrate model system for exploring molecular and physiological events during cellular and network reorganization after a loss of

  13. Neurocinematography in Pre-World War II Netherlands: The Magnus-Rademaker Collection.

    Koehler, Peter J; Lameris, Bregt; Hielscher, Eva


    Historical films made by neuroscientists have shown up in several countries during past years. Although originally supposed to have been lost, we recently found a collection of films produced between 1909 and 1940 by Rudolf Magnus (1873-1927), professor of pharmacology (Utrecht) and his student Gysbertus Rademaker (1887-1957), professor of physiology (1928, succeeding Willem Einthoven) and neurology (1945, both in Leiden). Both collections deal with the physiology of body posture by the equilibrium of reflex musculature contractions for which experimental studies were done with animals (labyrinthectomies, cerebellectomies, and brainstem sections) and observations on patients. The films demonstrate the results of these studies. Moreover, there are films with babies showing tonic neck reflexes and moving images capturing adults with cerebellar symptoms following cerebellectomies for tumors and several other conditions. Magnus' studies resulted in his well-known Körperstellung (1924, "Body Posture") and Rademaker's research in his Das Stehen (1931, "Standing"). The films probably had an educative and scientific purpose. Magnus demonstrated his films at congresses, including the Eighth International Congress of Physiologists (Vienna, 1910) and Rademaker screened his moving images at meetings of the Amsterdam Neurologists Society (at several occasions as reflected in the Winkler-Monakow correspondence and the Nederlands Tijdschrift voor Geneeskunde). Next to these purposes, the films were used to analyze movement and a series of images from the films were published in articles and books. The films are important historical sources that provide a portrait of the pre-World War II era in neuroscience, partly answering questions on how physicians dealt with patients and researchers with their laboratory animals. Moreover, the films confirm that cinematography was an important scientific tool in neuroscience research.

  14. Reconsidering the role of neuronal intrinsic properties and neuromodulation in vestibular homeostasis

    Mathieu eBeraneck


    Full Text Available The sensorimotor transformations performed by central vestibular neurons (2°VN constantly adapt as the animal faces conflicting sensory information or sustains injuries. In order to ensure the homeostasis of vestibular-related functions, neural changes could in part rely on the regulation of 2°VN intrinsic properties. Here, we review evidence which demonstrates modulation and plasticity of 2°VN intrinsic properties. We first present partition of rodents 2°VN into distinct subtypes, namely type A and type B. Then, we focus on the respective properties of each type and their putative roles in vestibular functions. The intrinsic properties of 2°VN can be swiftly modulated by a wealth of neuromodulators, to adapt rapidly, for example, to temporary changes of the ecophysiological surroundings. To illustrate how intrinsic excitability can rapidly be modified in physiological conditions and therefore be targeted in the clinic, we present the modulation of vestibular reflexes in relation to the neuromodulatory fluctuation of the sleep/wake cycle. On the other hand, intrinsic properties can also be slowly yet deeply modified in response to major perturbations as is the case following a unilateral labyrinthectomy (UL. We revisit the experimental evidence which demonstrate that drastic alterations of the 2°VN intrinsic properties occur following UL, however with a slow dynamic, more on par with the compensation of dynamic deficits than static ones. Data are interpreted in the framework of a distributed process which progress from the global, large scale coping mechanisms (e.g. changes in behavioural strategies to the local, small scale ones (e.g. changes in intrinsic properties. Within this framework, the compensation of dynamic deficits improves with time as deeper modifications are engraved within the finer parts of the vestibular-related networks. Finally, we propose perspectives and working hypotheses to pave the way for future research aiming at

  15. Menière's disease in the elderly.

    Ballester, Michel; Liard, Pierre; Vibert, Dominique; Häusler, Rudolf


    To assess the prevalence, presentation, treatment, and evolution of Menière's disease in elderly patients (> or = 65 yr old). Retrospective clinical study and case report. A neuro-otology referral center at the university hospital in Bern, Switzerland, and a neurotologic practice in Geneva, Switzerland. Patients were selected from the hospital clinic and otolaryngologic practice registers. Among 8423 neurotologic checkups performed between 1988 and 1998, 432 (5.1%) patients had definite Menière's disease and 66 (15.3%) of these patients were > or = 65 years old. The files of these 66 patients were analyzed. Menière's disease in the elderly had 2 modes of presentation: reactivation of longstanding Menière's disease (40.9%) and de novo Menière's disease (59.1%), where the first dizzy spells, tinnitus, and hearing loss appeared after 65 years of age. Drop attacks occurred in 11.1 and 25.6% of the cases, respectively, and could be responsible for misdiagnosis of strokes of the brainstem. The patients were treated by mild antivertiginous drugs (betahistine, cinnarizine). Twenty-seven patients (41%) underwent surgery: transtympanic ventilation tubes (19 patients), sacculotomy (4 patients), vestibular neurectomy (3 patients), surgical labyrinthectomy (1 patient). The vertigo spells disappeared in 73.3 to 100% of the cases according to the type of surgery performed. Our study shows that Menière's disease in the elderly is not at all uncommon. It can appear as a de novo disease or as a reactivated longstanding disease. Drop attacks are more frequent than reported in general patient populations with Menière's disease and can mimic a stroke of the brainstem. Medical and surgical treatments have to be cautious because many of these elderly patients are fragile.

  16. Treatment of Menière's Disease.

    Sharon, Jeffrey D; Trevino, Carolina; Schubert, Michael C; Carey, John P


    Diagnosis of Menière's disease is made with a characteristic patient history, including discrete episodes of vertigo lasting 20 min or longer, accompanied by sensorineural hearing loss, which is typically low frequency at first, aural fullness, and tinnitus. Workup includes audiometry, a contrast enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms, like otosyphilis, autoimmune inner ear disease, perilymphatic fistula, superior semicircular canal syndrome, Lyme disease, multiple sclerosis, vestibular paroxysmia, and temporal bone tumors. A history of migraine should be sought as well because of a high rate of co-occurrence (Rauch, Otolaryngol Clin North Am 43:1011-1017, 2010). Treatment begins with conservative measures, including low salt diet, avoidance of stress and caffeine, and sleep hygiene. Medical therapy with a diuretic is the usual next step. If that fails to control symptoms, then the options of intratympanic (IT) steroids and betahistine are discussed. Next tier treatments include the Meniett device and endolymphatic sac surgery, but the efficacy of both is controversial. If the above measures fail to provide symptomatic control of vertigo, then ablative therapies like intratympanic gentamicin are considered. Rarely, vestibular nerve section or labyrinthectomy is considered for a patient with severe symptoms who does not show a reduction in vestibular function with gentamicin. Benzodiazepines and anti-emetics are used for symptomatic control during vertigo episodes. Rehabilitative options for unilateral vestibular weakness include physical therapy and for unilateral hearing loss include conventional hearing aids, contralateral routing of sound (CROS) and osseointegrated hearing aids.

  17. Evaluation of the chemical model of vestibular lesions induced by arsanilate in rats

    Vignaux, G. [INSERM, ERI27, Caen, F-14000 (France); Univ Caen, Caen, F-14000 (France); Chabbert, C.; Gaboyard-Niay, S.; Travo, C. [INSERM U1051, Institut des Neurosciences de Montpellier, Montpellier, F-34090,France (France); Machado, M.L. [INSERM, ERI27, Caen, F-14000 (France); Univ Caen, Caen, F-14000 (France); Denise, P. [INSERM, ERI27, Caen, F-14000 (France); Univ Caen, Caen, F-14000 (France); CHRU Caen, Explorations Fonctionnelles, Caen, F-14000 (France); Comoz, F. [CHRU Caen, Laboratoire d' anatomopathologie, Caen, F-14000 (France); Hitier, M. [CHRU Caen, Service d' Otorhinolaryngologie, Caen, F-14000,France (France); Landemore, G. [CHRU Caen, Laboratoire d' anatomopathologie, Caen, F-14000 (France); Philoxène, B. [INSERM, ERI27, Caen, F-14000 (France); Univ Caen, Caen, F-14000 (France); CHRU Caen, Explorations Fonctionnelles, Caen, F-14000 (France); Besnard, S., E-mail: [INSERM, ERI27, Caen, F-14000 (France); Univ Caen, Caen, F-14000 (France); CHRU Caen, Explorations Fonctionnelles, Caen, F-14000 (France)


    Several animal models of vestibular deficits that mimic the human pathology phenotype have previously been developed to correlate the degree of vestibular injury to cognate vestibular deficits in a time-dependent manner. Sodium arsanilate is one of the most commonly used substances for chemical vestibular lesioning, but it is not well described in the literature. In the present study, we used histological and functional approaches to conduct a detailed exploration of the model of vestibular lesions induced by transtympanic injection of sodium arsanilate in rats. The arsanilate-induced damage was restricted to the vestibular sensory organs without affecting the external ear, the oropharynx, or Scarpa's ganglion. This finding strongly supports the absence of diffusion of arsanilate into the external ear or Eustachian tubes, or through the eighth cranial nerve sheath leading to the brainstem. One of the striking observations of the present study is the complete restructuring of the sensory epithelia into a non sensory epithelial monolayer observed at 3 months after arsanilate application. This atrophy resembles the monolayer epithelia observed postmortem in the vestibular epithelia of patients with a history of lesioned vestibular deficits such as labyrinthectomy, antibiotic treatment, vestibular neuritis, or Ménière's disease. In cases of Ménière's disease, aminoglycosides, and platinum-based chemotherapy, vestibular hair cells are destroyed, regardless of the physiopathological process, as reproduced with the arsanilate model of vestibular lesion. These observations, together with those presented in this study of arsanilate vestibular toxicity, suggest that this atrophy process relies on a common mechanism of degeneration of the sensory epithelia.

  18. Short-term galvanic vestibular stimulation promotes functional recovery and neurogenesis in unilaterally labyrinthectomized rats.

    Shaabani, Moslem; Lotfi, Yones; Karimian, Seyed Morteza; Rahgozar, Mehdi; Hooshmandi, Mehdi


    Current experimental research on the therapeutic effects of galvanic vestibular stimulation (GVS) has mainly focused on neurodegenerative disorders. However, it primarily stimulates the vestibular nuclei and could be potentially effective in modulating imbalance between them in the case of unilateral labyrinthectomy (UL). Fifty male Wistar rats (180-220g) were used in 5 groups of 10: intact, sham, right-UL (RUL; without intervention), and two other right-UL groups with GVS intervention [one group treated with low rate GVS (GVS.LF; 6-7Hz), and the other treated with high rate GVS (GVS.HF; 17-18Hz)]. The UL models were prepared by intratympanic injection of sodium arsanilate. GVS protocols were implemented 30min/day and continued for 14 days via ring-shaped copper electrodes inserted subcutaneously over each mastoid. Functional recovery was assessed by several postural tests including support surface area, landing and air-righting reflexes, and rotarod procedure. Immunohistochemical investigations were performed on ipsi- and contra-lesional medial vestibular nuclei (MVN) using bromodeoxyuridine (BrdU) and Ki67, as markers of cell proliferation. Behavioral evaluations showed significant functional recovery of GVS-treated groups compared to RUL group. The percent of marked cells with BrdU and Ki67 were significantly higher in the ipsilesional MVN of both GVS-treated groups compared with other groups. Our findings confirmed the effectiveness of GVS-intervention in accelerating static and dynamic vestibular compensation. This could be explained by the cell proliferation in ipsilesional MVN cells and rapid rebalancing of the VNs and the modulation of their motor outputs. Therefore, GVS could be promising for rehabilitating patients with unilateral vestibular weakness.

  19. The Magnus-Rademaker Scientific Film Collection: Ethical Issues on Animal Experimentation (1908-1940).

    Koehler, Peter J; Lameris, Bregt


    The Magnus-Rademaker scientific film collection (1908-1940) deals with the physiology of body posture by the equilibrium of reflex musculature contractions for which experimental studies were carried out with animals (e.g., labyrinthectomies, cerebellectomies, and brain stem sections) as well as observations done on patients. The films were made for demonstrations at congresses as well as educational objectives and film stills were published in their books. The purpose of the present study is to position these films and their makers within the contemporary discourse on ethical issues and animal rights in the Netherlands and the earlier international debates. Following an introduction on animal rights and antivivisection movements, we describe what Magnus and Rademaker thought about these issues. Their publications did not provide much information in this respect, probably reflecting their adherence to implicit ethical codes that did not need explicit mentioning in publications. Newspaper articles, however, revealed interesting information. Unnecessary suffering of an animal never found mercy in Magnus' opinion. The use of cinematography was expanded to the reduction of animal experimentation in student education, at least in the case of Rademaker, who in the 1930s was involved in a governmental committee for the regulation of vivisection and cooperated with the antivivisection movement. This resulted not only in a propaganda film for the movement but also in films that demonstrate physiological experiments for students with the purpose to avert repetition and to improve the teaching of experiments. We were able to identify the pertinent films in the Magnus-Rademaker film collection. The production of vivisection films with this purpose appears to have been common, as is shown in news messages in European medical journals of the period.

  20. Trigemino-cardiac reflex during skull-base neurosurgeries: a case report

    Mohammad Reza Khajavi


    Full Text Available Background: The Trigemino-cardiac reflex (TCR has been studied as a phenomenon including; bradycardia, arterial hypotension, apnea and gastric hypermotility during manipulation of the peripheral or central parts of the trigeminal nerve.Case presentation: We report a case of a 26-year-old man undergoing surgery for a skull base extra axial tumor in right petrous bone suspected to metastasis of a previous renal cell carcinoma which had been treated four years ago. The patient presented with continuous and unilateral headache and difficulty in swallowing, sensory neural hearing loss, nasal speech and tongue deviation to left side. He underwent general anesthesia with standard monitoring and total intravenous anesthetic technique. The first episode of sudden onset bradycardia and hypotension related to surgical manipulation was detected intraoperatively in which the heart rate spontaneously returned to normal level once the surgical manipulation stopped. However, it repeated several times by beginning of tumor resection and manipulation in the region of trigeminal nerve. The intensity of bradycardia in subsequent episodes of TCR was relatively crescendo and had no fatigability. Finally, it was treated by administration of a single dose of atropine (0.5mg/IV and did not happen again.Conclusion: The risk of TCR should be considered in any neurosurgical intervention involving trigeminal nerve and its branches, especially at the skull base surgeries. The vigilance of the medical team and continuous intraoperative hemodynamic monitoring alerts the surgeons to interrupt surgical maneuvers upon the TCR occurrence, immediately.

  1. Java brucea and Chinese herbal medicine for the treatment of cholesterol granuloma in the suprasellar and sellar regions

    Sun, Zhe; Cao, Yang; Zhai, Lin-zhu


    Abstract Rationale: A cholesterol granuloma (CG) is usually found in the middle ear, papilla, orbits, petrous apex, and choroid plexus, but is highly uncommon in the skull. In spite of benign clinicopathological lesions, bone erosion can be seen occasionally in the patient with CG. The optimal treatment strategy is radical surgery, but complete excision is usually impossible due to anatomical restrictions and a risk of injury to the key structures located nearby. Here, we report a patient with CGs in the suprasellar and sellar regions who was successfully treated with Java brucea and Chinese herbal medicine. Patient concerns: A 31-year-old man presenting with progressive decreased vision in both eyes was analyzed. Diagnoses: A skull magnetic resonance imaging (MRI) scan showed a low-density tumor in the uprasellar and sellar regions and histopathological examination revealed a CG. Interventions: The patient was referred the surgery and radiotherapy. In the meantime, brucea soft capsules and herbal medicine combined were administered to him. Outcomes: The related clinical symptoms and signs resolved significantly after several months, as his therapy progressed. The patient showed no sign of recurrence during the treatment period. Furthermore, he was still alive and disease-free at 37 months of follow-up visit. Lessons: Overall, brucea soft capsules and a Chinese herbal formula treatment combined could be beneficial in improving the patient's quality of life with CG in the skull. PMID:28151875

  2. What is expected of the facial nerve in michel aplasia? Anatomic variation.

    Zarandy, Masoud Motasaddi; Kouhi, Ali; Kashany, Shervin Sharif; Rabiei, Sohrab; Hajimohamadi, Fatemeh; Rabbani-Anari, Mahtab


    We sought better understanding about the facial nerve anatomy in the rare inner ear Michel anomaly to help better define this aplasia and prevent potential complications in surgery on these patients. The data from computed tomography scans and magnetic resonance images of six Michel aplastic ears (three patients) were evaluated for a facial nerve course. Facial nerve course and anatomic landmarks were noted. Based on data obtained from this group of very rare patients, three different facial nerve anatomies were encountered. The first patient had normal-looking mastoid cells, normal middle ear ossicles, and a completely formed facial nerve canal through the middle ear. The second patient had pneumatized mastoid air cells despite an anomalous ossicular chain. This patient also had a facial nerve canal but not through the middle ear. In the third patient, although mastoid cells were present, neither ossicles nor a definite facial nerve canal could be detected. With guidance provided by the anatomy of the other parts of the ear, such as air cells and the ossicular chain, the danger zones posing a high probability of facial nerve injury can be predicted. Although all Michel aplasias may have aplastic petrous bone in common, there are some degrees of variation.

  3. 乙状窦后人路显露靶点对手术创伤影响的虚拟现实解剖测量%Impact of target exposure via retrosigmoidal approach in surgical injury measured by virtual reality skill

    钱增辉; 汤可; 江涛


    目的 在构建虚拟现实解剖模型基础上探讨乙状窦后入路显露靶点对手术创伤的影响. 方法 根据15例尸头的CT和MRI数据构建岩骨三维解剖模型,在颅盖和颅底中选择骨性标志点设计乙状窦后入路对不同靶点进行显露的手术路径:路径a显露颈静脉结节前缘,路径b显露内听道外口上缘,路径c显露岩尖.观察不同手术路径中解剖结构的空间形态和顺序,测量并比较解剖组织体积. 结果 所有路径均由横窦下方穿过,经过小脑半球外侧,路径a显露后组颅神经和小脑前下动脉,到达颈静脉结节时显露岩下窦;路径b显露小脑前下动脉、迷路和面听神经复合体;路径c经过岩上窦内侧,显露面听神经复合体,到达岩尖时显露三叉神经、小脑上动脉和海绵窦.不同手术路径、颅神经、骨性结构、小脑、动脉体积不同,差异有统计学意义(P<0.05).路径c、路径a、路径b的手术路径和颅神经体积依次降低;路径c、路径b、路径a中包含的骨性结构体积依次降低;路径b、路径a、路径c中包含小脑体积依次降低;路径a、路径c、路径b中包含动脉体积依次降低,差异均有统计学意义.路径a中静脉体积[(68.91±1.91) mm3]低于路径c中静脉体积[(248.92±11.26)mm3],差异有统计学意义(t=-90.274,P=0.000),路径b中不包含静脉结构. 结论 颅底显露靶点对乙状窦后人路经过解剖组织结构的范围影响显著,通过测量组织体积能够客观评价创伤和显露的关系.%Objective To discuss the impact of target exposure via retrosigmoidal approach in surgical injury based on virtual reality anatomic models.Methods CT and MR imaging data of 15 adult cadaver heads were utilized to establish three-dimensional anatomy models of petrous bone.Surgical routes exposing different targets though retrosigmoidal approach were simulated by selecting osseous landmark points on the calvaria and skull base.Special form

  4. Exoftalmo unilateral por metástase orbitária de carcinoma de próstata Unilateral exophthalmos secondary to orbital metastatic carcinoma of the prostate: a case report

    José Carlos Corrêa Barbosa


    Full Text Available É relatado um caso de exoftalmo ou proptose unilateral direita, causado por metástase orbitária de carcinoma da próstata em paciente negro, na 6.ª década de vida, com evolução de 9 meses. O exame neuro-ocular revelou acentuada diminuição da agudeza visual, perturbação para visão de cores, perda da convergência, diminuição dos reflexos à luz e acomodação e restrição dos movimentos oculares. O paciente apresentava discreta disbasia esquerda por metástase no fêmur. Exames laboratoriais, radiológicos e a biópsia confirmaram a etiologia carcinomatosa da manifestação ocular.A case of right unilateral exophthalmos secondary to metastatic carcinoma of the prostate, in a 68 years old negro patient in which the ocular manifestation lasted 9 months is reported The extrinsic movements of the eye were limited. Pupils reacted slightly to light and accommodation. There was no ocular convergence. The vision of the right eye was blurred and there was mild color vision. The prostate was found to be petrous by touch specially in the right portion. The laboratory findings pointed to a prostatic carcinoma. Bone X-rays were strongly suggestive of metastatic tumour. The histological examination of the orbital tumour showed prostatic tumour cells.

  5. Elongated Styloid Process - A Radiographic Study

    Vajendra Joshi


    Full Text Available Eagle′s syndrome, also known as elongated styloid process syndrome, is a condition that may be the source of craniofacial and cervical pain. The styloid process is a slender bony projection arising from the lower surface of the petrous portion of the temporal bone. It has been estimated that between 2% to 28% of the general adult population has radiographic evidence of elongated styloid process. In adults, the mean radiographic length of the styloid process is 20 to 30 mm and its tip is located between the external and internal carotid arteries, just lateral to the tonsillar fossa. This study was done to evaluate the elongation of the styloid process and/or ligament ossification by using panoramic radiographs. Both ossification of stylohyoid and stylomandibular ligaments and truly elongated styloid process were defined as elongated styloid process. Elongated styloid processes should be kept in mind when the clinician is faced with oropharyngeal/ maxillary pain originating from impacted or unerupted third molars or dental caries.

  6. Contralateral Cochlear Labyrinthine Concussion without Temporal Bone Fracture: Unusual Posttraumatic Consequence

    Méndez, D.; Silva, J. M. Duque; del Álamo, P. Ortega


    Introduction. Labyrinthine concussion is a term used to describe a rare cause of sensorineural hearing loss with or without vestibular symptoms occurring after head trauma. Isolated damage to the inner ear without involving the vestibular organ would be designated as a cochlear labyrinthine concussion. Hearing loss is not a rare finding in head trauma that involves petrous bone fractures. Nevertheless it generally occurs ipsilateral to the side of the head injury and extraordinarily in the contralateral side and moreover without the presence of a fracture. Case Report. The present case describes a 37-year-old patient with sensorineural hearing loss and tinnitus in his right ear after a blunt head trauma of the left-sided temporal bone (contralateral). Otoscopy and radiological images showed no fractures or any abnormalities. A severe sensorineural hearing loss was found in his right ear with a normal hearing of the left side. Conclusion. The temporal bone trauma requires a complete diagnostic battery which includes a neurotologic examination and a high resolution computed tomography scan in the first place. Hearing loss after a head injury extraordinarily occurs in the contralateral side of the trauma as what happened in our case. In addition, the absence of fractures makes this phenomenon even more unusual.

  7. Keyhole approach surgery for petroclival meningioma

    ZHU Wei; MAO Ying; ZHOU Liang-fu; ZHANG Rong; CHEN Liang


    Background In China, the feasibility of keyhole approach in surgical treatment of petroclival meningioma has not been well evaluated. This report summarized our experience in 25 patients with petroclival meningioma who had been treated with keyhole approach surgery.Methods From July 2000 to July 2005, 25 patients with petroclival meningioma were subjected to resection via subtemporal, retrosigmoid or combined keyhole approaches. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated.Results The maximum diameter of tumors ranged from 2 to 7 cm (mean, 4.5 cm). Gross total resection (GTR)was achieved in 14 patients, giving a GTR rate of 56%. Subtotal resection (STR) was carried out in 8 patients and partial resection in 3. Thirteen patients kept normal neurological status, whereas others suffered from cranial nerve deficits (Ⅶ, Ⅶ, Ⅲ and lower CN). One patient died in the postoperative period.Conclusions Keyhole approach surgery, especially the combined keyhole approach is suitable for the treatment of petroclival meningioma. It provides easy and quick access to the supra- and infratentorial juxta-clival region without drilling of the petrous bone. Complications related to the approach can be minimized.

  8. Retrospective correction of B0-field-induced geometric distortions in multislice echo planar images: a 3D solution

    McColl, Roderick W.; Coburn, Edward A.


    A method has been developed to utilize a 3D B0 fieldmap, with a multi-volume-of-interest segmentation map, to quantify and correct geometric distortions in echo-planar images. The purpose is to provide accurate co-registration of anatomical MRI to functional MRI time course sequences. A data structure capable of extracting and reporting the necessary information forms a central part of the solution. Images were obtained from a 1.5 Tesla scanner with an experimental y-gradient insert coil. Two 3D-gradient echo sequences supply the data needed to calculate the B0 map across the volume. Segmentation of the volume into brain/background produces the data needed for the phase unwrapping and volume(s) of interest generation, from which the global B0 variation map is obtained. Subsequent EPI acquisition yields the fMRI time- course information. Tests were carried out on a phantom and a human volunteer engaged in a motor task (finger-tapping). Strong distortions were measured, and subsequently corrected, particularly near the petrous bone/mastoid air cells and in the frontal and maxillary sinuses. Additionally, a strong eddy current resulting from the unshielded y-gradient was detected. The method facilitates geometric distortion correction through an imaging volume, containing multiple regions of interest within a slice, starting from a single starting point.

  9. Relationship between the condyle and adjacent structures in double temporomandibular joint view using panorama

    Lee, Chang Yul; Kim, Jae Duk [Chosun Univ. Dental School, Gwangju (Korea, Republic of)


    To investigate the ability of double TMJ view by multifunctional panorama to view the bony components and the space of the temporomandibular joint. Ten dry skulls fitted with resin shims over the caricular surface of the condyle were used to reproduce the temporomandibular joint space. Fine metal wires were attached to the three portions of contours of the condylar head and the articular eminence. With 10 dry skulls and 20 cases having TMJ dysfunction, double TMJ views by multifunctional panorama (Planmeca 2002 Proline CC) and transcranial views were taken, analyzed from the anatomical view point, and compared statistically in view of the widths of the posterior joint space and the condylar head. In double TMJ view, the supero-anterior part of the condyle represented the lateral 1/3, the most superior part represented center portion, and the posterior part medial 1/3 of the condyle. In maximum mouth opening, no other structures were statistically with the condyle in double TMJ view. In double TMJ view, petrous bone was moderately superimposed with the superior part of the condyle. The tendency of reduction in the posterior joint space appeared in the side of TMJ dysfunction compared with the normal side. The posterior joint spaces in double TMJ view were statistically wider (p<0.05) than those in transcranial view. The correlation coefficient was 0.5179 between the widths of the posterior joint spaces in two radiographic views. Double TMJ view can be substituted for transcracial view in evaluating the TMJ dysfunction.

  10. Time-saving and fail-safe dissection method for vestibulocochlear organs in gross anatomy classes.

    Suzuki, Ryoji; Konno, Naoaki; Ishizawa, Akimitsu; Kanatsu, Yoshinori; Funakoshi, Kodai; Akashi, Hideo; Zhou, Ming; Abe, Hiroshi


    Because the vestibulocochlear organs are tiny and complex, and are covered by the petrous part of the temporal bone, they are very difficult for medical students to dissect and visualize during gross anatomy classes. Here, we report a time-saving and fail-safe procedure we have devised, using a hand-held hobby router. Nine en bloc temporal bone samples from donated human cadavers were used as trial materials for devising an appropriate procedure for dissecting the vestibulocochlear organs. A hand-held hobby router was used to cut through the temporal bone. After trials, the most time-saving and fail-safe method was selected. The performance of the selected method was assessed by a survey of 242 sides of 121 cadavers during gross anatomy classes for vestibulocochlear dissection. The assessment was based on the observation ratio. The best procedure appeared to be removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof. The whole procedure was completed within two dissection classes, each lasting 4.5 hr. The ratio of surveillance for the chorda tympani and three semicircular canals by students was significantly improved during 2013 through 2016. In our dissection class, "removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof" was the best procedure for students in the limited time available. Clin. Anat. 30:703-710, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  11. Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa

    Takafumi Nishizaki


    Full Text Available Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve.

  12. Acúfeno unilateral: Presentación de un caso UNILATERAL ACOUSMA. A CASE REPORT

    Eulalia Alfonso Muñoz


    Full Text Available El estudio detallado de los pacientes con acúfeno unilateral es de gran importancia, sobre todo cuando se trata de pacientes en la cuarta década de su vida, sin patología auditiva demostrable e hipoacusia neurosensorial asimétrica. Es indispensable en estos casos descartar el origen coclear o no del daño auditivo, y la tomografía axial computadorizada comparativa de peñascos o en su defecto, los rayos X mastoides en diferentes vistas, nos definirán si existen tumoraciones o anomalías vasculares.The thorough study of the patients with unilateral acousma is very important, mainly when patients are in the fourth decade of life, without demonstrable auditive pathology and asymmetric neurosensorial hypoacusia. It is indispensable in these cases to discard the cochlear origin or not of the auditive damage. The computerized axial tomography of the petrous portions of the temporal bone, or the mastoideal X- rays in different views, will define if there are vascular tumours or abnormalities.

  13. Upregulation of Phosphorylated HSP27, PRDX2, GRP75, GRP78 and GRP94 in Acquired Middle Ear Cholesteatoma Growth

    Kuen Yao Ho


    Full Text Available Cholesteatoma is a destructive and expanding growth of keratinizing squamous epithelium in the middle ear or petrous apex. The molecular and cellular processes of the pathogenesis of acquired middle ear cholesteatoma have not been fully understood. In this study, comparative proteomic analysis was conducted to investigate the roles of specific proteins in the pathways regarding keratinocyte proliferation in cholesteatoma. The differential proteins were detected by comparing the two-dimension electrophoresis (2-DE maps of the epithelial tissues of 12 attic cholesteatomas with those of retroauricular skins. There were 14 upregulated proteins in the epithelial tissues of cholesteatoma in comparison with retroauricular skin. The modulation of five crucial proteins, HSP27, PRDX2, GRP75, GRP78 and GRP94, was further determined by RT-PCR, Western blot and immunohistochemistry. Phosphorylation of HSP27 at Ser-82 was identified by mass spectroscopy. The results of this study suggested that phosphorylated HSP27 is the end expression of two potential signal-transduction pathways, and together with PRDX2, they are very likely involved in the proliferation of keratinocytes in cholesteatoma. Upregulations of GRP75, GRP78 and GRP94 in keratinocytes may be able to counter endoplasmic reticulum stress, to inhibit cell apoptosis, to prevent protein unfolding and to promote cholesteatoma growth.

  14. Large capillary hemangioma of the temporal bone with a dural tail sign: A case report



    The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date.

  15. Bilateral segmental absence of the internal carotid artery with rete compensation associated with absence of basilar artery: case report.

    Kim, Myoung Soo; Lee, Seung-Joon; Lee, Chae Heuck; Park, Hyo Il


    Bilateral ICA absence is a rare lesion. Collateral circulation to the middle and anterior cerebral arteries in the absence of one or both ICAs may develop transcranial anastomoses from the external carotid system, a so-called CRM. Very rarely, theses arterial channels are observed in humans. In the following case study, a 38-year-old man presented himself. He had a headache and scalp laceration after having had an accident. A right external carotid angiography identified anastomoses to distal intracranial vessel through the internal maxillary artery, but the intracranial vessels were only faintly visible. A right ascending pharyngeal arteriography showed an abnormal course and anastomoses with the intracranial vessel. The right ICA was absent. The left external carotid angiography demonstrated a network of tortous arteries in the region of the cavernous and petrous portion of ICA. The plexus of vessels on the left side communicated with the proximal part of the cavernous segment of the ICA. Both vertebral angiographies demonstrated a sudden diminution in caliber at the level of vertebrobasilar junction. There was an anomalous arterial collateral circulation originating from vertebral muscular and meningeal branch. There was also an absence of the basilar artery (BA). This is the first case with CRM associated with bilateral segmental ICA and BA absence. The cause of this bilateral segmental ICA and BA absence may be maldevelopment of vessel connective tissue or extracellular matrix.

  16. Coexistence of intracranial epidermoid tumor and multiple cerebral aneurysms

    Yao, Pei-Sen; Lin, Zhang-Ya; Zheng, Shu-Fa; Lin, Yuan-Xiang; Yu, Liang-Hong; Jiang, Chang-Zhen; Kang, De-Zhi


    Abstract Rationale: There were a few case reports concerning epidermoid tumor coexisted with multiple cerebral aneurysms. Here, we present one case of coexistence of intracranial epidermoid tumor and multiple cerebral aneurysms and performed a literature review. Patient concerns: A 42 years old male patient was admitted to our institution with complaints of headache and dizziness. Interventions: The radiological examinations showed a hypointense lesion in the right parasellar and petrous apex region and an ipsilateral saccular aneurysm originated from the M2–M3 junction of the right middle cerebral artery (MCA) and a saccular aneurysm of the clinoid segment of right internal carotid artery (ICA). Interventions: The patients underwent a right frontotemporal approach for removal of the epidermoid tumor and clipping of the MCA aneurysm in one stage. The aneurysm located at the clinoid segment of ICA was invisible and untreated during operation. Outcomes: No postoperative complications were found in the patient. The patient's follow up after 5 years of surgical treatment was uneventful, and the untreated aneurysm remains stable. Lessons: The coexistence of intracranial epidermoid tumor and cerebral aneurysm is a rare event. The secondly inflammation in cerebral arterial wall may be responsible for the aneurysm formation. Surgical treatment of the intracranial epidermoid tumor and cerebral aneurysm repair may be an optimal scheme in one stage. PMID:28151901

  17. 岩上静脉的引流类型及其与手术入路的关系%Anatomy classifications of the superior petrosal venous and relations for surgical approaches

    杨汉兵; 陈礼刚; 李定君; 顾应江; 肖洪文


    Objective The purpose of this study was to dissect these structure existed in petrous portions of the temporal bones and the posterior fossa nearby,to measure the distence of those important stuctures around the superior petrosal venous (SPV), to propose the patterns of drainage of the SPV along the petrous ridge in relation to the Meckel cave and internal acoustic meatus (IAM) and to delineate its effect on the surgical exposures obtained in subtemporal transtentorial and retrosigmoid suprameatal approaches. Methods Ten adult cadaveric heads (20 hemispheres) were studied, and data of SPV and the structures around were measured. The patterns of drainage of the SPV along the petrous ridge were characterized according to their relation to the Meckel cave and the IAM based on an examination of 20 hemispheres. Subtemporal trans-tentorial and retrosigmoid suprameatal approaches were performed in two additional cadavers to demonstrate the effect of the drainage pattern on the surgical exposures. Result The SPV originated from the cerebellopontine angle cistern, and were multibranch. According to SPV relationship with the Meckel cave and internal acoustic meatus (IAM), the patterns of drainage of the SPV were classified into three groups. Type Ⅰ emptied into the SPS above or medial to the Meckel cave. The most common type-Type Ⅱ, emptied between the lateral limit of the trigeminal nerve at the Meckel cave and the medial limit of the facial nerve at the IAM. Type Ⅲ emptied into the SPS above and lateral to the boundaries of the IAM Conclusions The site which the SPV emptied into the superior petrosal sinus (SPS) was relationship tightly with the Meckel cave and IAM. According to SPV relationship with the Meckel cave and internal acoustic meatus (IAM). The proposed modified classification system and its effect on the surgical exposure may aid in planning the approach directed along the petrous apex and may reduce the probability of venous complications.%目的 对岩

  18. Rectal carcinoid tumor metastasis to a skull base meningioma

    Huang, Jennifer; Gupta, Amit; Badve, Chaitra; Cohen, Mark L; Wolansky, Leo J


    Carcinoid tumors are rare, slow-growing neuroendocrine tumors that most frequently develop in the gastrointestinal tract or lungs and have high potential for metastasis. Metastasis to the brain is rare, but to another intracranial tumor is extremely rare. Of the intracranial tumors, meningiomas are the most common to host metastases, which may be related to its rich vascularity and E-cadherin expression. We describe the case of a 65-year-old female with active chemotherapy-treated neuroendocrine carcinoma who presented with left-sided facial numbness, headaches, and blurry vision. Initial imaging revealed a 1 cm irregular dural-based left petrous apex mass suggestive of a meningioma that was re-imaged four months later as a rapidly enlarging, extra-axial, mass extending into the cavernous sinus, effacing Meckel’s cave that resembled a trigeminal schwannoma. Pathology revealed a carcinoid tumor metastatic to meningioma. While the mass displayed characteristic imaging findings of a schwannoma, rapid growth in the setting of known active malignancy should prompt the clinician to consider mixed pathology from metastatic disease or a more aggressive meningioma. PMID:26825133

  19. Epidermoid cyst in Meckel's cave with unusual computed tomography and magnetic resonance imaging findings. Case report.

    Arai, Atsushi; Sasayama, Takashi; Koyama, Junji; Fujita, Atsushi; Hosoda, Kohkichi; Kohmura, Eiji


    A 27-year-old woman presented with headache and occasional numbness over her right face. Computed tomography revealed a hypodense mass in the middle cranial fossa and another adjacent hyperdense mass in the posterior fossa with erosion of the right petrous apex. Magnetic resonance imaging revealed the lesion in the middle cranial fossa as iso- to hypointense on T(1)-weighted and hyperintense on T(2)-weighted imaging, with peripheral enhancement after gadolinium administration, and the adjacent lesion in the posterior fossa as hyperintense on T(1)-weighted and hypointense on T(2)-weighted imaging. During surgery, these lesions mimicking two adjacent distinct tumors were revealed to connect through Meckel's cave. The hypodense lesion in the middle cranial fossa consisted of pearly-like solid contents, and the hyperdense lesion in the posterior cranial fossa consisted of viscid dark-green materials. The tumors were gross totally resected with endoscopic assistance. Histological examination confirmed that the tumor was an epidermoid cyst. The present case cyst indicates that although the diffusion-weighted imaging sequence is useful for detection of intracranial epidermoid cysts, epidermoid cysts including viscous materials with unusual radiological findings could complicate the preoperative diagnosis.

  20. MR and CT findings of temporal bone langerhans cell histiocytosis

    Bae, Jae Ig; Lee, Hee Jung; Kim, Heung Sik [Keimyung Univ. School of Medicine, Dongsan Medical Center, Taegu (Korea, Republic of)


    To describe the MRI and CT findings of temperal bone langerhans cell histiocytosis. The MRI (n=8) and CT (n=7) findings of nine lesions of temporal bone Langerhans cell histiocytosis in six children were retrospectively reviewed. Eight lesions were pathologically confirmed and one was clinically diagnosed. The findings were analyzed for bilaterality, location, lesion extent, signal intensity, the attenuation of soft tissue lesions seen at MRI or precontrast CT, enhancement pattern at MRI or CT, and the pattern of bony destruction at CT. Bilateral involvement was present in three of six patients (50%). Lesions were most frequently located in the mastoid (n=8, 89%), followed by the petrous ridge (n=6, 67%), and the squamous portion (n=3, 33%). Seven (78%) lesions extended to the ipsilateral cavernous sinus (n=3), sphenoid bone (n=3), orbit (n=2), or epidural space (n=2). The signals of the soft tissue lesions were isointense in five cases (63%) on T1-weighted images and hyperintense in six (75%) at MRI, and homogeneous in five (71%) at CT. All lesions demonstrated bony destruction without periosteal reaction and five (71%) showed ill-defined destruction, with crossing sutures. Familiarity with findings of predominant mastoid involvement, isointense or isodense soft tissue lesions seen on T1-weighted images or at precontrast CT, with relatively homogeneous enhancement at CT, and irregular bony destruction with crossing sutures may be helpful in narrowing the diagnosis of temporal bone langerhans cell histiocytosis.

  1. Papillary thyroid microcarcinoma presenting as skull base metastasis

    YAN Bo; LIU Dian-gang; L(U) Hai-li; ZHANG Qiu-hang


    @@ Papillary thyroid carcinoma (PTC) is the most common type of well-differentiated thyroid cancer and is considered to be a relatively indolent tumor in which distant metastasis and death are rare.1 The metastasis of PTC is usually to regional lymph nodes, especially the cervical and mediastinal nodes. Metastases to the brain are rare, and constitute 0.1%-5.0% of distant metastases of papillary carcinoma.2 Skull metastasis is uncommon,and is found in 2.5%-5.8% of cases of thyroid cancer.3 Skull base metastasis of PTC is extremely rare, with only eight reported cases in the literature involving the clivus,cavernous sinus, sella turcica, and the petrous apex and ridge.4 A metastatic lesion can arise from histologically benign and silent thyroid neoplasms,5 and differential diagnosis between ectopic and metastatic thyroid cancer can be difficult,6 therefore, the management of thyroid cancer is controversial after removal of metastatic disease.Here we reported a case of papillary thyroid microcarcinoma (PTMC) that was manifested as a solitary clivus metastasis and discussed the diagnostic and therapeutic management strategies. The 73-year-old patient presented with visual impairment in the right eye,and epistaxis. The patient subsequently underwent complete total thyroidectomy after a diagnosis of papillary microcarcinoma. This finding emphasizes that clinically significant metastases can arise from thyroid papillary microcarcinoma. Total thyroidectomy and careful review of the histology are necessary to prevent delay in proper diagnosis.

  2. Large capillary hemangioma of the temporal bone with a dural tail sign: A case report.

    Yang, Guang; Li, Chenguang; Chen, Xin; Liu, Yaohua; Han, Dayong; Gao, Xin; Kawamoto, Keiji; Zhao, Shiguang


    The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date.

  3. CT evaluation of the anterior epitympanic recess; Comparison among non-inflammatory ear, chronic otitis media with central perforation and cholesteatoma

    Yamasoba, Tatsuya; Kikuchi, Shigeru; Takeuchi, Naonobu; Harada, Takehiko; Nomura, Yasuya (Tokyo Univ. (Japan). Faculty of Medicine)


    The structures of the anterior epitympanic recess and its surrounding tissues were examined among non-inflammatory ear, chronic otitis media with central perforation and cholesteatoma, using axial scans of high resolution computed tomography. The length and width of the recess, as well as the number of the slices where the cog was determined, had no significant differences among them. Thus, the bony structure of the recess was considered to be seldom influenced by inflammatory processes. In the non-inflammatory ear, the degree of pneumatization around the recess was similar to that of the petrous apex cells and lower than that of the mastoid cells. In the chronic otitis media with central perforation and cholesteatoma, the pneumatization of the whole temporal bones was suppressed and the tendency was also found that the cells around the recess were less pneumatized than the mastoid cells. When cholesteatoma invaded into the anterior epitympanic recess, the destruction of the bony protrusion of the lateral wall between the recess and the epitympanum was recognized, as well as the disappearance of the cog. The bony protrusion was considered to be an inferior extention of the cog toward the anterior tympanic spine. (author).


    Vinayachandra P H


    Full Text Available Background: Ossicular morphology and morphometric considerations play cornerstone importance in reconstructive surgeries. An attempt is made to have an insight into such morphological variations and evaluate the morphometric values of malleus in south Indian population through cadaveric dissection. Materials and methods: 25 human head specimens taken from the dissection hall, after removal of brain and duramater, subarcuate fossa and arcuate eminance of the petrous part of the temporal bone were chipped off with help of fine edged chissel and hammer. With help of bone cutter the tegmen tympani forming the remaining roof was removed, till the middle ear cavity and three ossicles are properly exposed and identified. Results: Malleus height ranged from 6.94 mm to 7.78 mm on both sides with average of 7.37mm on right and 7.51 mm on left. Weight ranged from 16.85 mg to 19.25 mg with average of 18 mg on right side and 18.52 mg on left both side. Length and weight of left malleus bones were statistically more than their right counterparts. Conclusions: Morphologically malleus showed lesser variations in comparison to stapes. The left sided malleus dominated the right sided ones in both length and weight.

  5. Three-dimensional spiral CT of craniofacial malformations in children

    Binaghi, S. [Payerne Hopital, Lausanne (Switzerland). Dept. of Radiology; Service de Radiodiagnostic et Radiologie Interventionnelle, Lausanne (Switzerland); Gudinchet, F. [Payerne Hopital, Lausanne (Switzerland). Dept. of Radiology; Rilliet, B. [Dept. of Neurosurgery, University Hospital of Lausanne (Switzerland)


    Objective. To assess the value of three-dimensional CT (3D CT) in the diagnosis and management of suspected paediatric craniofacial malformations. Materials and methods. Twenty-eight children (12 girls, 16 boys) with a mean age of 4 years, suffering from craniofacial or cervical malformations, underwent craniofacial spiral CT. 3D reformatting was performed using an independent workstation. Results. 3D CT allowed the preoperative evaluation of 16 patients with craniosynostosis and the post-surgical management of 2 patients. 3D CT clearly depicted malformations of the skull base involving the petrous bone in seven patients (four cases of Goldenhar-Gorlin syndrome, one case of Treacher-Collins syndrome and two cases of Crouzon's disease). Four patients with craniofacial clefts were also evaluated. Radiological findings were confirmed by the clinical and intraoperative findings in all patients that underwent surgical treatment. Movement artefacts and ''Lego effect'' related to abrupt change of cranial vault border were encountered and are discussed. Conclusions. 3D CT of the skull can safely and reliably identify paediatric craniofacial malformations involving bone, and it should be used as morphological mapping to help the surgeon in planning surgical treatment. (orig.)

  6. Valoración del estado de alteración de los materiales pétreos en los monumentos

    Fernández Paris, José M.


    Full Text Available Analyzed is a systematic fault, in the carrying out of tests, which permits the establishment of the possible causes which originate the alteration of stones in artistic monuments. As a result, a collection of methods is proposed, adopted by the ASTM standards and recommended by the RILEM, which permit the functioning of some specifications, introduced by the experiment, to assure an acceptable degree of durability of the petrous element considered.

    Se analiza una falta sistemática, para la realización de ensayos, que permitan establecer las posibles causas que originan la alteración de piedras en los monumentos artísticos. Como resultado, se proponen un conjunto de métodos, adoptados por las normas ASTM y aconsejados por RILEM que permiten en función de unas especificaciones, introducidas por la experiencia, asegurar con un grado aceptable de fiabilidad la situación de durabilidad del elemento pétreo considerado.

  7. Bell’s Palsy As a Rare First Presentation of Breast Cancer

    Mostafa Hosseini


    Full Text Available Background: Otalgia and Bell’s palsy are rare manifestations of metastasis and the most common presentation of an inflammatory process in the temporal bone.Case presentation: This article explains a 34-year-old woman with breast cancer who presented with cranial nerve palsy symptoms. The 7th and 8th cranial nerves were involved in the metastatic phase and then hoarseness was added to her symptoms. Brain MRI showed a petrous lesion in the temporal bone due to metastasis, which was the first clue to cancer. Her metastatic workup showed multiple bone lesions. On chest CT scan, multiple lung lesions were noted. Also, a breast mass was discovered on her chest CT scan. On breast examination an irregular mass fixed to the pectoralis muscle was found. Pathologic evaluation of samples obtained through ultrasound-guided core needle biopsy confirmed the diagnosis of invasive ductal carcinoma.Conclusion: Temporal bone metastases are rare and may be asymptomatic, or with mild symptoms mimicking mastoid infections. Physicians should consider metastatic cancer on the list of differential diagnoses in patients presenting with prolonged otologic symptoms or facial nerve disorders.

  8. Anterior Petrosectomy: Consecutive Series of 46 Patients with Attention to Approach-Related Complications.

    Van Gompel, Jamie J; Alikhani, Puya; Youssef, A Samy; Loveren, Harry R van; Boyev, K Paul; Agazzi, Sivero


    Objective Anterior petrosectomy(AP) was popularized in the 1980s and 1990s as micro-neurosurgery proliferated. Original reports concentrated on the anatomy of the approach and small case series. Recently, with the advent of additional endonasal approaches to the petrous apex, the morbidity of AP remains unclear. This report details approach-related morbidity around and under the temporal lobe. Methods A total of 46 consecutive patients identified from our surgical database were reviewed retrospectively. Results Of the 46 patients, 61% were women. Median age of the patients was 50 years (mean: 48 ± 2 years). Median follow-up of this cohort was 66 months. Most procedures dealt with intradural pathology (n = 40 [87%]). Approach-related morbidity consisted of only two patients (4%) with new postoperative seizures. There were only two significant postoperative hemorrhages (4%). Cerebrospinal fluid leakage occurred in two patients (4%) requiring reoperation. Conclusion Approach-related complications such as seizures and hematoma were infrequent in this series, < 4%. This report describes a contemporary group of patients treated with open AP and should serve as a comparison for approach-related morbidity of endoscopic approaches. Given the pathologies treated with this approach, the morbidity appears acceptable.

  9. IERAPSI project: simulation of a canal wall-up mastoidectomy.

    Neri, E; Sellari Franceschini, S; Berrettini, S; Caramella, D; Bartolozzi, C


    Among the various EU research projects concerning the medical application of virtual reality, the project Ist-1999-12175, called IERAPSI (Integrated Environment for the Rehearsal and Planning of Surgical Interventions), specifically addressed the creation of a virtual and interactive surgical field for the temporal bone using three-dimensional images derived from CT data. We report on the experience obtained in the IERAPSI project in simulating a canal wall-up mastoidectomy. A surgeon with extensive experience in surgery of the petrous bone performed the mastoidectomy. The operative field included the mastoid, with its substantial differences in density between the cortex and the pneumatized bone, together with soft tissue structures, both on the border and inside the bone. The simulation is better in the first part of the operation than in the second part, suffering from a lack of haptic feedback from soft tissue and the surgical tool in deeper contexts, and under-representation of the variability inherent in pneumatized bone. This said, the excellent representation of dust production and removal, 3D simulation through color, and very good visual and haptic feedback in the early stage of the procedure are impressive. IERAPSI represents a potential surgical planning theater for the training of students and young surgeons, but is also expected to aid expert surgeons in the preoperative planning of difficult cases.

  10. Endolymphatic sac tumor: case report and review of the literature

    Sun Yan-Hua


    Full Text Available Abstract Endolymphatic sac tumor (ELST is a rare neoplasm which can be encountered sporadically or in Von Hippel-Lindau (VHL disease. Here we report a sporadic case of ELST in 31-year-old man. Neither the symptoms nor a family history of VHL disease were found in the patient. CT imaging demonstrated an expansile lytic lesion of the mastoid process of the left petrous bone. MR scanning revealed a 5.2 cm × 4.7 cm × 4.2 cm mass which showed hyperintensity on T1- and T2-weighted images. Histologic sections showed a papillary, cystic or glandular architecture. The papillary and glandular structures were lined by a single layer of flattened cuboidal-to-columnar cells. The stroma of the papillary fronds was richly vascularized and chronically inflamed. The tumor showed diffusely positive reactivity with cytokeratin (Pan, cytokeratin 19, cytokeratin 5/6, cytokeratin 7, EMA, vimentin, CD56, and NSE and also showed variable reactivity with glial fibrillary acidic protein (GFAP and VEGF. The Ki-67 immunostain showed a proliferation index of Virtual Slides The virtual slide(s for this article can be found here:

  11. Magnetic resonance imaging of cerebellopontine angle lesions

    Pratiksha Yadav


    Full Text Available Background: Cerebellopontine angle (CPA tumors are usually benign, and they are divided into extra-axial, intra-axial, extradural, and petrous axis tumors. CPA pathologies can be asymptomatic or it may present with vertigo, tinnitus, or unilateral hearing loss depending upon the site of tumor origin and displacement of the neurovascular structure. Aim and Objectives: To evaluate the role of magnetic resonance imaging (MRI aided with contrast-enhanced MRI as an imaging modality for diagnosis of CPA lesions. Materials and Methods: Analysis of 36 patients of CPA lesions over a period of 2 years was done. MRI was performed on Siemens 1.5 Tesla MAGNETOM Avanto Machine. Conclusion: There are spectrums of pathologies, which can present with these symptoms, which includes tumors, vascular malformations, and vascular loop compressing vestibulocochlear nerve or mastoid pathology so it is important to investigate the patient by MRI. Contrast-enhanced MRI is the most sensitive investigation in the evaluation of the CPA lesions, its characteristic, and its extent.

  12. Dorello's Canal for Laymen: A Lego-Like Presentation.

    Ezer, Haim; Banerjee, Anirban Deep; Thakur, Jai Deep; Nanda, Anil


    Objective Dorello's canal was first described by Gruber in 1859, and later by Dorello. Vail also described the anatomy of Dorello's canal. In the preceding century, Dorello's canal was clinically important, in understanding sixth nerve palsy and nowadays it is mostly important for skull base surgery. The understanding of the three dimensional anatomy, of this canal is very difficult to understand, and there is no simple explanation for its anatomy and its relationship with adjacent structures. We present a simple, Lego-like, presentation of Dorello's canal, in a stepwise manner. Materials and Methods Dorello's canal was dissected in five formalin-fixed cadaver specimens (10 sides). The craniotomy was performed, while preserving the neural and vascular structures associated with the canal. A 3D model was created, to explain the canal's anatomy. Results Using the petrous pyramid, the sixth nerve, the cavernous sinus, the trigeminal ganglion, the petorclival ligament and the posterior clinoid, the three-dimensional structure of Dorello's canal was defined. This simple representation aids in understanding the three dimensional relationship of Dorello's canal to its neighboring structures. Conclusion Dorello's canal with its three dimensional structure and relationship to its neighboring anatomical structures could be reconstructed using a few anatomical building blocks. This method simplifies the understanding of this complex anatomical structure, and could be used for teaching purposes for aspiring neurosurgeons, and anatomy students.

  13. From labyrinthine aplasia to otocyst deformity

    Giesemann, Anja Maria; Goetz, Friedrich; Lanfermann, Heinrich [Hannover Medical School, Department of Diagnostic and Interventional Neuroradiology, Hannover (Germany); Neuburger, Juergen; Lenarz, Thomas [Hannover Medical School, Department of Otorhinolaryngology, Hannover (Germany)


    Inner ear malformations (IEMs) are rare and it is unusual to encounter the rarest of them, namely labyrinthine aplasia (LA) and otocyst deformity. They do, however, provide useful pointers as to the early embryonic development of the ear. LA is characterised as a complete absence of inner ear structures. While some common findings do emerge, a clear definition of the otocyst deformity does not exist. It is often confused with the common cavity first described by Edward Cock. Our purpose was to radiologically characterise LA and otocyst deformity. Retrospective analysis of CT and MRI data from four patients with LA or otocyst deformity. Middle and inner ear findings were categorised by two neuroradiologists. The bony carotid canal was found to be absent in all patients. Posterior located cystic structures were found in association with LA and otocyst deformity. In the most severe cases, only soft tissue was present at the medial border of the middle ear cavity. The individuals with otocyst deformity also had hypoplasia of the petrous apex bone. These cases demonstrate gradual changes in the two most severe IEMs. Clarification of terms was necessary and, based on these findings, we propose defining otocyst deformity as a cystic structure in place of the inner ear, with the cochlea, IAC and carotid canal absent. This condition needs to be differentiated from the common cavity described by Edward Cook. A clear definition of inner ear malformations is essential if outcomes following cochlear implantation are to be compared. (orig.)

  14. Quantitative analysis of the cochlea using three-dimensional reconstruction based on microcomputed tomographic images.

    Shin, Kang-Jae; Lee, Ju-Young; Kim, Jeong-Nam; Yoo, Ja-Young; Shin, Chuog; Song, Wu-Chul; Koh, Ki-Seok


    The aim of this study was to provide data on various dimensions of the normal cochlea using three-dimensional reconstruction based on high-resolution micro-CT images. The petrous parts of 39 temporal bones were scanned by micro-computed tomography (CT) with a slice thickness of 35 μm. The micro-CT images were used in reconstructing three-dimensional volumes of the bony labyrinth using computer software. The volumes were used to measure 12 dimensions of the cochlea, and statistical analysis was carried out. The dimensions of cochleae varied widely between different specimens. The mean height and length of the cochlea were 3.8 and 9.7 mm, respectively. The angle between the basal and middle turns was slightly larger in males than in females, while none of the other 11 dimensions differed significantly between males and females. The cochlear accessory canals were observed in about half of the cases (51.3%). Correlation analysis among measured items revealed positive correlations among several of the measured dimensions. The present study could investigate the detailed anatomy of the normal cochlea using high-resolution imaging technologies. The results of the present study could be helpful for the precise diagnosis of congenital cochlear malformations and for producing optimized cochlear implants.

  15. [A case of chondroblastoma arising from the temporal bone].

    Tsutsumi, Satoshi; Mishima, Yumiko; Nonaka, Yasuomi; Abe, Yusuke; Yasumoto, Yukimasa; Ito, Masanori


    A 33-year-old male sustained hearing disturbance in the left ear that exacerbated over a period of three years. The patient was referred to the department of otorhynolaryngology for severe stenosis of the left external auditory canal, where neuroimaging study revealed a huge tumor in the left temporal fossa. On first examination, he showed a significant facial nerve paresis and conductive hearing loss. CT scans identified a 4.5×4.5×4.5 cm mass with intralesional calcification and extensive bony destruction in the squamous and petrous parts of the temporal bone and middle cranial fossa floor. MR imaging demonstrated the tumor of heterogenous intensity on T1-and hypointensity on T2-weighted image. The patient underwent gross total resection of the lesion via frontotemporal craniotomy. The bony and ligamentous structures around the temporomandibular joint appeared mostly intact and did not need any reconstructive surgery after tumor resection. Postoperatively the patient's facial nerve paresis showed a transient exacerbation which resolved gradually, while hearing disturbance did not improve. Histological findings of the tumor were consistent with the qualities of chondroblastoma. We should assume chondroblastoma as differential diagnosis when we encounter a temporal bone tumor that is curable by surgical resection.

  16. MR imaging of solitary fibrous tumors in the head and neck

    Kim, Hyun Jeong [The Catholic University, Daejeon (Korea, Republic of); Lee, Ho Kyu; Shin, Ji Hoon; Lee, Jeong Hyun [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Seo, Jeong Jin [Chonnam National University Medical School, Kwangju (Korea, Republic of); Kim, Hyung Jim [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeong, Ae Kyung [University of Ulsan College of Medicine, Seoul (Korea, Republic of)


    Solitary fibrous tumor (SFT) is a very rare tumor. The purpose of this study is to determine the MR imaging features of SFT in the intracranial and extracranial head and neck regions. We retrospectively reviewed six MR images and two CT images of six histologically proven cases of SFT that occurred in four men and two women, and their ages ranged from 46 to 59 years. These imaging findings were correlated with the microscopic findings of their surgical specimens. Six SFTs arose in the meninges (the petrous ridge and the pituitary fossa), the parotid gland, the parapharyngeal space, the buccal space and the maxillary sinus. On the MR images, SFTs in the intracranial and extracranial head and neck regions were mostly isointense to the muscle on the T1-weighted images, they were hyperintense on the T2-weighted images and they all had intense enhancement. On the T1- and T2-weighted images, hypointense lines were observed within in five SFTs. On the CT images, the SFTs were hypodense to the muscle on the unenhanced images and they were heterogeneously enhanced on the contrast-enhanced images. An exceptional case of pituitary SFT was hypointense on the T2-weighted images and it was hyperdense on the unenhanced CT images, which correlated with the increased collagenous component and the cellular compactness. The imaging features of SFT are nonspecific; however, SFT should be included in the differential diagnosis of masses involving the intracranial and extracranial head and neck regions.

  17. Dural Arteriovenous Fistula Following Translabyrinthine Resection of Cerebellopontine Angle Tumors: Report of Two Cases

    Li, Peter M.M.C.; Fischbein, Nancy J.; Do, Huy M.; Blevins, Nikolas H.


    We describe two cases of dural arteriovenous fistula (DAVF) developing in a delayed fashion after translabyrinthine resection of cerebellopontine angle tumors. Two patients in an academic tertiary referral center, a 46-year-old woman and a 67-year-old man, underwent translabyrinthine resection of a 2-cm left vestibular schwannoma and a 4-cm left petrous meningioma, respectively. Both patients subsequently developed DAVF, and in each case the diagnosis was delayed despite serial imaging follow-up. In one patient, cerebrospinal fluid diversion before DAVF was identified as the cause of her intracranial hypertension; the other patient was essentially asymptomatic but with a high risk of hemorrhage due to progression of cortical venous drainage. Endovascular treatment was effective but required multiple sessions due to residual or recurrent fistulas. Dural arteriovenous fistula is a rare complication of translabyrinthine skull base surgery. Diagnosis requires a high index of clinical suspicion and an understanding of subtle imaging findings that may be present on follow-up studies performed for tumor surveillance. Failure to recognize this complication may lead to misguided interventions for treatment of hydrocephalus and other complications, as well as ongoing risks related to venous hypertension and intracranial hemorrhage. As this condition is generally curable with neurointerventional and/or surgical methods, timely diagnosis and treatment are essential. PMID:23984203

  18. CT of petrou bone. Utility to cholesteatoma location. Study of 28 cases. TC de peasco. Utilidad para la localizacion preoperativa del colesteatoma. Estudio de 28 casos

    Ferrer, M.D.; Espinos, M.A.; Molina, A.; Martinez-Rodrigo, J.; Galant, J. (Hospital Dr. Peset. Servicio de Diagnostico por la imagen. Valencia (Spain))


    Twenty-eight patients with cholesteatoma were studied preoperatively by means of CT petrous bone to determine the localization and extension of their lesion. All the patients underwent survey and the intraoperative findings were compared with those resulting from CT. The reading was carried out with no knowledge of the intraoperative data. The following results were obtained: localization of cholesteatoma in attic, antrum and posterior tympanic cavity had a sensitivity of 0.91 and a specificity of 0.57, with a Fisher's p value less than 0.0005. When the erosion produced by the cholesteatoma was studied in the different structures, the accuracy was greatest with the stape, the septum and prussak's space; the highest number of false negatives corresponded to the tympanic membrane. The false positives were produced in the assessment of the facial canal, tegmen tympani and the labyrinthine fistula. The reliability of CT was very high for the diagnosis of ossicular destruction and displacement of the small bones, as well as for the state of the mastoid cells and congenital variations. In conclusion, we point out the importance of performing a CT study prior to surgery for cholesteatoma due to its elevated sensitivity in locating the lesion, and we stress the value of the knowledge of the erosion of the different structures since it constitutes a guide for intraoperative exploration and assessment. (Author)

  19. Non-echoplanar diffusion-weighted MRI in children and adolescents with cholesteatoma: reliability and pitfalls in comparison to middle ear surgery

    Kalle, Thekla von [Olgahospital Klinikum Stuttgart, Pediatric Radiology, Radiologisches Institut, Stuttgart (Germany); Amrhein, Peter; Koitschev, Assen [Olgahospital Klinikum Stuttgart, Division of Pediatric Otorhinolaryngology and Otology, Department of Otorhinolaryngology, Stuttgart (Germany)


    Currently, there is only limited and contradictory evidence of the role of diffusion-weighted MRI (DW-MRI) in the management of children with cholesteatoma. To provide surgically controlled data that may allow to replace second-look surgery by non-echoplanar DW-MRI in children. Fifty-five children and adolescents with a median age of 8.6 years (2.2-17.7 years) underwent 61 preoperative half-Fourier acquisition single-shot turbo spin-echo (HASTE) DW-MRI of their petrous bone. Surgical interventions followed within 24 h (79%), within 5 months (20%) or at 18 months (1 case). Surgery detected a cholesteatoma or retraction pocket in 41 of 61 cases (67%). In 49 cases (80%), the MR result was confirmed by surgical findings. Two MR findings were false-positive and 10 false-negative (including cholesteatomas <4 mm). HASTE DW-MRI alone had a sensitivity of 76% and a specificity of 90%. The positive predictive value was 94%, the negative predictive value 64%. In combination with preoperative otoscopy, sensitivity was 90% and negative predictive value 82%. DW-MRI correctly detected the majority of lesions but could not reliably exclude small cholesteatomas and empty retraction pockets. We would therefore not generally recommend MR as a substitute for second-look surgery. (orig.)

  20. A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

    Haruka Miyabe


    Full Text Available Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

  1. Apicectomia con obturación retrograda e injerto óseo para el tratamiento de una lesión apical

    Antonio Diaz Caballero


    lesion and overfilling root system, describes the surgical technique of apicectomy and retrograde filling with bone graft as a better alternative for bone regeneration.Keywords: Apicoectomy; Sealing retrograde; bone graft. 

  2. Endodontic surgery prognostic factors.

    Azarpazhooh, Amir; Shah, Prakesh S


    Medline, (PubMed) and the Cochrane databases together with hand searching of the following journals: Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology (name changed to Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics in 1995), Endodontics and Dental Traumatology (name changed to Dental Traumatology in 2001), Journal of Oral and Maxillofacial Surgery, and International Journal of Oral and Maxillofacial Surgery. Clinical studies evaluating apical surgery with placement of a root-end filling were included. Studies on apical surgery with orthograde root canal filling or about apicectomy alone without root-end filling were excluded, as were experimental and animal studies. Only studies with ≥ ten patients with a minimum six month follow-up period and clearly defined radiographic and clinical healing criteria, with healing reported for at least two categories of a specific prognostic factor were accepted. Studies reporting in English, German, French, Spanish, Italian, Portuguese and Scandinavian languages were included. All studies were assessed separately by two of the three authors, with disagreements resolved by discussion. Prognostic factors were divided into patient related, tooth-related or treatment-related factors. The reported percentages of healed teeth were pooled per category. The statistical method of Mantel-Haenszel was applied to estimate the odds ratios and their 95% confidence intervals. Homogeneity was assessed using Woolf's test. With regard to tooth-related factors, the following were identified as predictors of healing: absence of preoperative pain or signs, good density of the root canal filling and a periapical lesion size of ≤ 5 mm. With regard to treatment-related factors, teeth treated with the use of an endoscope tended to have higher healed rates than teeth treated without the use of an endoscope. Although the clinician may be able to control treatment

  3. Changes of Root Length and Root-to-Crown Ratio after Apical Surgery: An Analysis by Using Cone-beam Computed Tomography.

    von Arx, Thomas; Jensen, Simon S; Bornstein, Michael M


    Apical surgery is an important treatment option for teeth with post-treatment periodontitis. Although apical surgery involves root-end resection, no morphometric data are yet available about root-end resection and its impact on the root-to-crown ratio (RCR). The present study assessed the length of apicectomy and calculated the loss of root length and changes of RCR after apical surgery. In a prospective clinical study, cone-beam computed tomography scans were taken preoperatively and postoperatively. From these images, the crown and root lengths of 61 roots (54 teeth in 47 patients) were measured before and after apical surgery. Data were collected relative to the cementoenamel junction (CEJ) as well as to the crestal bone level (CBL). One observer took all measurements twice (to calculate the intraobserver variability), and the means were used for further analysis. The following parameters were assessed for all treated teeth as well as for specific tooth groups: length of root-end resection and percentage change of root length, preoperative and postoperative RCRs, and percentage change of RCR after apical surgery. The mean length of root-end resection was 3.58 ± 1.43 mm (relative to the CBL). This amounted to a loss of 33.2% of clinical and 26% of anatomic root length. There was an overall significant difference between the tooth groups (P < .05). There was also a statistically significant difference comparing mandibular and maxillary teeth (P < .05), but not for incisors/canines versus premolars/molars (P = .125). The mean preoperative and postoperative RCRs (relative to CEJ) were 1.83 and 1.35, respectively (P < .001). With regard to the CBL reference, the mean preoperative and postoperative RCRs were 1.08 and 0.71 (CBL), respectively (P < .001). The calculated changes of RCR after apical surgery were 24.8% relative to CEJ and 33.3% relative to CBL (P < .001). Across the different tooth groups, the mean RCR was not significantly different (P = .244 for

  4. Horizontal vestibuloocular reflex evoked by high-acceleration rotations in the squirrel monkey. I. Normal responses

    Minor, L. B.; Lasker, D. M.; Backous, D. D.; Hullar, T. E.; Shelhamer, M. J. (Principal Investigator)


    The horizontal angular vestibuloocular reflex (VOR) evoked by high-frequency, high-acceleration rotations was studied in five squirrel monkeys with intact vestibular function. The VOR evoked by steps of acceleration in darkness (3,000 degrees /s(2) reaching a velocity of 150 degrees /s) began after a latency of 7.3 +/- 1.5 ms (mean +/- SD). Gain of the reflex during the acceleration was 14.2 +/- 5.2% greater than that measured once the plateau head velocity had been reached. A polynomial regression was used to analyze the trajectory of the responses to steps of acceleration. A better representation of the data was obtained from a polynomial that included a cubic term in contrast to an exclusively linear fit. For sinusoidal rotations of 0.5-15 Hz with a peak velocity of 20 degrees /s, the VOR gain measured 0.83 +/- 0.06 and did not vary across frequencies or animals. The phase of these responses was close to compensatory except at 15 Hz where a lag of 5.0 +/- 0.9 degrees was noted. The VOR gain did not vary with head velocity at 0.5 Hz but increased with velocity for rotations at frequencies of >/=4 Hz (0. 85 +/- 0.04 at 4 Hz, 20 degrees /s; 1.01 +/- 0.05 at 100 degrees /s, P < 0.0001). No responses to these rotations were noted in two animals that had undergone bilateral labyrinthectomy indicating that inertia of the eye had a negligible effect for these stimuli. We developed a mathematical model of VOR dynamics to account for these findings. The inputs to the reflex come from linear and nonlinear pathways. The linear pathway is responsible for the constant gain across frequencies at peak head velocity of 20 degrees /s and also for the phase lag at higher frequencies being less than that expected based on the reflex delay. The frequency- and velocity-dependent nonlinearity in VOR gain is accounted for by the dynamics of the nonlinear pathway. A transfer function that increases the gain of this pathway with frequency and a term related to the third power of head

  5. [Skull vibration induced nystagmus test].

    Dumas, G; De Waele, C; Hamann, K F; Cohen, B; Negrevergne, M; Ulmer, E; Schmerber, S


    To establish during a consensus meeting the fundamental basis, the validity criteria, the main indications and results of the skull vibration induced nystagmus test (SVINT) which explores the vestibule high frequencies. The SVINT is applied on the mastoid process (right and left sides) at 100 Hz during 10 seconds on a sitting upright subject. Total unilateral peripheral lesions (tUVL: operated vestibular shwannomas, vestibular neurectomies) and partial unilateral peripheral lesions (pUVL: preoperative neuromas, Meniere's disease, vestibular neuritis, chemical labyrinthectomies) were studied. Thirty-six patients had brainstem lesions and 173 normal subjects were used as controls. The SVINT is considered positive when the application of the vibrator produces a reproducible sustained nystagmus always beating in the same direction following several trials in various stimulation topographies (on the right and left mastoid). The skull vibratory nystagmus (SVN) begins and ends with the stimulation; the direction of the nystagmus has no secondary reversal. The slow phase velocity (SPV) is>2 degrees /second. In tUVL the SVINT always reveals a lesional nystagmus beating toward the safe side at all frequencies. The mean SVN SPV is 10.8 degrees /s+/-7.5 SD (N=45). The mastoid site was more efficient than the cervical or vertex sites. Mastoïd stimulation efficiency is not correlated with the side of stimulation. The SVN SPV is correlated with the total caloric efficiency on the healthy ear. In pUVL the SVINT is positive in 71 to 76% of cases; the mean SVN. SPV (6.7 degrees /s+/-4.7 SD)(N=30) is significantly lower than in tUVL (P=0.0004). SVINT is positive in 6 to 10% of the normal population, 31% of brain stem lesions and negative in total bilateral vestibular peripheral lesions. SVINT is an effective, rapid and non invasive test used to detect vestibular asymmetry between 20 to 150 Hz stimulation. This test used in important cohorts of patients during the ten last years has

  6. The pathways responsible for the characteristic head posture produced by lesions of the interstitial nucleus of Cajal in the cat.

    Fukushima, K; Fukushima, J; Terashima, T


    (1) Experiments were performed in cats to examine effects of lesion of the interstitial nucleus of Cajal (INC) on head posture and the responsible pathway. Unilateral INC lesions resulted in lateral tilt of the head to the opposite side, and bilateral INC lesions resulted in dorsiflexion of the head as reported earlier. Such characteristic head posture was produced by successful kainic acid injections as well as by electrolytic lesions, suggesting that it was not due to damage of nerve fibers passing through the INC, but was produced most probably by damage of nerve cells in the INC. Electromyographic (EMG) recordings in unilateral INC-lesioned cats showed that activity was higher in the ipsilateral than in the contralateral major dorsal neck muscles (biventer, splenius, complexus, and rectus), and also higher in the contralateral than in the ipsilateral obliquus capitis caudalis muscle. The pattern of EMG activity was basically similar either when the cats presented typical head tilt or when their head was fixed to the frame at the stereotaxic plane. Characteristic head posture resulting from INC lesions seems consistent with the head posture produced by activation of these muscles. (2) Interruption of the medial and lateral vestibulospinal tracts did not significantly influence head tilt that had been produced by INC lesions. Characteristic head tilt was produced by INC lesions after cats had received bilateral labyrinthectomies, bilateral lesions of most of the vestibular nuclei, and bilateral aspiration of the cerebellar vermis and most of the lateral vestibular nuclei, indicating that typical head tilt can be produced without the vestibular nuclei and cerebellar vermis. (3) The medial longitudinal fasciculus (MLF) was interrupted at different levels to cut the major descending fibers from the INC. MLF interruption at the caudal midbrain produced typical head tilt, although MLF cut at the caudal pons and medulla was ineffective. Bilateral parasagittal cuts

  7. 颞骨先天性胆脂瘤并发周围性面瘫的诊治%Diagnosis and Treatment of Congenital Cholesteatoma in Temporal Bone with Facial Paralysis

    马慧敏; 陈智斌; 周涵; 赵晓埝; 李芳丽; 邢光前


    Objective To study the diagnosis and the treatment of temporal bone congenital cholesteatoma with facial paralysis. Methods The clinical data of 7 patients treated in our department between April 2001 and April 2014 were re-viewed. Results All the 7 patients recovered well without postoperative complications. There is no sign of recurrence of cho-lesteatoma during the 2 months to 14 years follow-up. Facial nerve function was completely recovered in 3 patients, partially improved in 2 patients, and showed no obvious improvement in 2 patients. As for hearing function, 5 patients ended up with total deafness in the affected ear, of whom 3 were diagnosed with dead labyrinth before surgery and 2 received partial labyrin-thectomy due to inner ear invasion of cholesteatoma. In the other 2 patients, hearing improved by 15 dB in 1 patient and re-mained unchangeable in the other postoperatively. Conclusions Early detection is the key to lower incidence of facial paraly-sis in temporal bone congenital cholesteatoma and to obtain satisfactory postoperative outcomes.%目的:探讨合并面瘫的颞骨先天性胆脂瘤的诊断及治疗。方法对2001年4月至2014年4月间在我科手术治疗的7例患者的临床资料进行回顾分析。结果所有病例术后恢复良好,无并发症,随访2月-14年胆脂瘤无复发。面瘫完全恢复者3例,好转者2例,无改善2例。术后患耳全聋者5例,3例为就诊时已确诊全聋,另2例为因胆脂瘤侵入内耳而行迷路部分切除术;1例听力提高15dB;1例无变化。结论早期诊断是降低先天性胆脂瘤面瘫发生率及获得良好术后效果的重要保障。

  8. Implante coclear via fossa craniana média: uma nova técnica para acesso ao giro basal da cóclea Cochlear implantation through the middle cranial fossa: a novel approach to access the basal turn of the cochlea

    Aline Gomes Bittencourt


    the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy. RESULTS: Only the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani. CONCLUSION: The proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.

  9. A clinicopathological analysis of papillary endolymphatic sac tumor in inner ear

    LIN Yu-jing


    Full Text Available Background Endolymphatic sac tumor (ELST is a rare tumor originating fromendolymphatic epithelium of inner ear. This tumor exhibits low-grade malignancy with benign histopathological appearance and clinically destructive behavior which occurs in the skull base and frequently invades the posterior petrous bone, the mastoid, semicircular canal, cerebellopontine angle structures and cranial nerve. The presence of intracranial ELST always makes the diagnosis challenge for clinicians and pathologists. Herein we describe a case of ELST in skull base. The clinicopathology of this tumor and its differential diagnosis are discussed. Methods The clinical manifestation of a patient with primary ELST occurring in right cerebellopontine angle was presented retrospectively. Resected mass was routinely paraffin-embedded and stained with hematoxylin and eosin. Dako EnVision immunohistochemical staining system was used to detect the tumor antigen expressions, including cytokeratin (CK, vimentin (Vim, epithelial membrane antigen (EMA, carcinoembryonic antigen (CEA, synaptophysin (Syn, chromogranin A (CgA, S-100 protein (S-100, glial fibrillary acidic protein (GFAP, thyroglobulin (TG, thyroid transcription factor-1 (TTF-1 and Ki-67. Results A 32-year-old male patient presented with 20-year history of progressive hearing loss. MRI scan revealed an expansile lytic lesion of the mastoid process of the right petrous bone, measuring 4.20 cm × 3.30 cm × 2.00 cm, occupied the right cerebellopontine angle with infiltration of surrounding dura mater. But the lesion did not break the dura mater and invade the brain parenchyma. Craniotomy was performed and the tumor was removed totally. Histological examination revealed a papillary, cystic or glandular architecture in mass. The papillary and glandular structures were lined by a single layer of flattened cuboidal-to-columnar cells. The stroma of the papillary fronds was richly vascularized and chronically inflamed. There

  10. Gradenigo Syndrome: Unusual Consequence of Otitis Media

    Jennie M. Valles


    Full Text Available Introduction: In 1904, Giuseppe Gradenigo published his case series on the triad of ipsilateral abducens nerve palsy, facial pain in the trigeminal nerve distribution, and suppurative otitis media, which would subsequently be referred to as Gradenigo syndrome. Case Report: Our patient was a 36-year-old female, 23 weeks pregnant, with a 6-day history of right-sided otalgia and hearing loss and a 4-day history of purulent otorrhea, who presented with severe, holocephalic headache, meningeal signs, fever, photophobia, and mental status decline. Lumbar puncture yielded a white blood cell count of 1,559 cells/mm3 with 95% polymorphonuclear leukocytes, a red blood cell count of 111 cells/mm3, a protein level of 61 mg/dl, and a glucose level of Streptococcus pneumoniae and treated with ceftriaxone. On the second hospital day, she developed horizontal diplopia due to right abducens nerve palsy and right mydriasis. Both symptoms resolved on the third hospital day. Erosion of temporal bone and opacification of mastoid air cells was shown on CT scan. A CT venogram showed an irregularity of the left transverse and superior sagittal sinuses. She was treated with enoxaparin for possible sinus thrombosis. Discussion: This case demonstrates rare but serious sequelae of otitis media and Gradenigo syndrome. Holocephalic headache from meningitis masked trigeminal pain. Involvement of the ipsilateral petrous apex and surrounding structures on imaging and clinical improvement with antibiotic treatment supports Gradenigo syndrome over intracranial hypertension due to venous sinus thrombosis as the cause of the abducens nerve palsy.

  11. Cladistic analysis of extant and fossil African papionins using craniodental data.

    Gilbert, Christopher C


    This study examines African papionin phylogenetic history through a comprehensive cladistic analysis of extant and fossil craniodental morphology using both quantitative and qualitative characters. To account for the well-documented influence of allometry on the papionin skull, the general allometric coding method was applied to characters determined to be significantly affected by allometry. Results of the analyses suggest that Parapapio, Pliopapio, and Papio izodi are stem African papionin taxa. Crown Plio-Pleistocene African papionin taxa include Gorgopithecus, Lophocebus cf. albigena, Procercocebus, Soromandrillus (new genus defined herein) quadratirostris, and, most likely, Dinopithecus. Furthermore, S. quadratirostris is a member of a clade also containing Mandrillus, Cercocebus, and Procercocebus; ?Theropithecus baringensis is strongly supported as a primitive member of the genus Theropithecus; Gorgopithecus is closely related to Papio and Lophocebus; and Theropithecus is possibly the most primitive crown African papionin taxon. Finally, character transformation analyses identify a series of morphological transformations during the course of papionin evolution. The origin of crown African papionins is diagnosed, at least in part, by the appearance of definitive and well-developed male maxillary ridges and maxillary fossae. Among crown African papionins, Papio, Lophocebus, and Gorgopithecus are further united by the most extensive development of the maxillary fossae. The Soromandrillus/Mandrillus/Cercocebus/Procercocebus clade is diagnosed by upturned nuchal crests (especially in males), widely divergent temporal lines (especially in males), medially oriented maxillary ridges in males, medially oriented inferior petrous processes, and a tendency to enlarge the premolars as an adaptation for hard-object food processing. The adaptive origins of the genus Theropithecus appear associated with a diet requiring an increase in size of the temporalis, the optimal

  12. CT exposure from pediatric M.D.C.T.: results from the 2007-2008 S.F.I.P.P./I.S.R.N. survey; Niveaux d'exposition en tomodensitometrie multicoupes pediatrique: resultats de l'enquete dosimetrique SFIPP/IRSN 2007-2008

    Brisse, H.J. [Institut Curie, Dept. d' Imagerie, 75 - Paris (France); Aubert, B. [Institut de Radioprotection et de Surete Nucleaire (IRSN), Unite d' Expertise en Radioprotection Medicale, 92 - Clamart (France)


    Purpose. To evaluate current exposure levels from pediatric MDCT examinations in order to issue recommendations for the routine clinical practice that may be used for establishing future diagnostic reference levels (DRL). Materials and methods. A survey was conducted at hospital sites affiliated with the SFIPP (Societe Francophone d'Imagerie Pediatrique et Prenatale). Tube potential and volume computed tomography dose index (CTDI) vol. values were obtained for three age groups (1, 5 and 10 years) for typical scanning indications of eight anatomical regions. Results. Twenty of 29 sites provided us with a copy of their protocols. All ages groups combined, 97% of protocols used a tension level {<=} 120 kVp. For age groups 1, 5 and 10 years respectively, the 75. percentiles of dose distributions were: 31, 39.5 and 49.5 mGy for the 'head' protocol; 24, 22 and 24 mGy for 'head and neck'; 11, 11, and 11 mGy for 'paranasal sinuses'; 46, 71 and 87 mGy for 'petrous bone'; 3, 3.5 and 5.5 mGy for 'chest'; 2, 3 and 4 mGy for 'low dose lung'; 4, 4.5 and 7 mGy for 'abdomen-pelvis'; 7,11 and 12 mGy for 'bone'. The inter-center discrepancy for doses were still high. Conclusion. This study provided an evaluation of current practices in reference centers for pediatric imaging and allowed readjustment of MDCT dose recommendations. It could help in the development of DRLS for pediatric MDCT. (author)

  13. Maximizing the petroclival region exposure via a suboccipital retrosigmoid approach: where is the intrapetrous internal carotid artery?

    Colasanti, Roberto; Tailor, Al-Rahim A; Lamki, Tariq; Zhang, Jun; Ammirati, Mario


    Recent reports have validated the use of retrosigmoid approach extensions to deal with petroclival lesions. To describe the topographic retrosigmoid anatomy of the intrapetrous internal carotid artery (IICA), providing guidelines for maximizing the petroclival region exposure via this route. The IICA was exposed bilaterally in 6 specimens via a retrosigmoid approach in the semisitting position. Its topographic relationship with pertinent posterolateral cranial base landmarks was quantified with neuronavigation. Safe exposure of the IICA and the surrounding inframeatal/petroclival regions was accomplished in all specimens. On average, the IICA genu was 15.08 mm anterolateral to the XI nerve in the jugular foramen, 16.18 mm anteroinferolateral to the endolymphatic sac, and 10.63 mm anteroinferolateral to the internal acoustic meatus. On average, the IICA horizontal segment was 9.92 mm inferolateral to the Meckel cave, and its midpoint was 19.96 mm anterolateral to the XI nerve in the jugular foramen. The mean distance from the IICA genu to the cochlea was 1.96 mm. The genu and the midpoint of the horizontal segment of the IICA were exposed at a depth of approximately 14.50 mm from the posterior pyramidal wall with the use of different drilling angles (49.74° vs 39.54°, respectively). Knowledge of the IICA general relationship with these landmarks (combined with a careful assessment of the preoperative imaging and with the use of intraoperative navigation and micro-Doppler) may help to enhance the inframeatal/petroclival region exposure via a retrosigmoid route, maximizing safe inframeatal and suprameatal petrous bone removal while minimizing neurovascular complications.

  14. Serous otitis media revealing temporal en plaque meningioma.

    Ayache, Denis; Trabalzini, Franco; Bordure, Philippe; Gratacap, Benoit; Darrouzet, Vincent; Schmerber, Sébastien; Lavieille, Jean-Pierre; Williams, Marc; Lescanne, Emmanuel


    To present a series of temporal en plaque meningiomas involving the middle ear or mastoid, whose main symptoms suggested a serous otitis media. Multicentric retrospective study reviewing clinical records originating from eight tertiary referral centers. The clinical records of 10 patients presenting with signs and symptoms suggesting serous otitis media and whose neuroimaging studies revealed a temporal en plaque meningioma involving the middle ear or mastoid are reported. All the patients were women, ranging from 49 to 71 years old. The delay between the onset of symptoms and the diagnosis of meningioma varied from 1 to 10 years. All the patients underwent various procedures usually applied for the treatment of serous otitis media, which failed in all the cases, particularly ventilating tube placement, which was followed by severe episodes of discharge. In all cases, the computed tomographic scans showed three imaging signs: soft tissue mass filling the middle ear or mastoid, hyperostosis of the petrous bone, and hairy aspect of the intracranial margins of the affected bone. This imaging triad must alert the otologist of the possibility of intracranial meningioma. Magnetic resonance imaging was the method of choice to assess the diagnosis of intracranial meningioma involving the middle ear or mastoid. When analyzing management options, it appeared that conventional middle ear procedures were inefficient. Temporal en plaque meningioma involving the middle ear or mastoid can mimic a serous otitis media. A computed tomographic scan is recommended for cases of atypical or prolonged unilateral serous otitis media to investigate indirect signs of a meningioma, which has to be confirmed with magnetic resonance imaging.

  15. Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature

    Chan JW


    Full Text Available Jane W Chan,1,2 Jeff Albretson3 1Department of Neurology, 2Department of Ophthalmology, College of Medicine, University of Arizona, Phoenix, AZ, USA; 3University of Nevada, Las Vegas, NV, USA Purpose: The etiology of recurrent isolated sixth nerve palsies in older adults has not been well described in the literature. Sixth nerve palsies presenting with a chronic, relapsing, and remitting course are uncommon, but can herald a diagnosis of high morbidity and mortality in the older population. Patients and methods: Our method was a retrospective case series study. A review of clinical records of 782 patients ≥50 years of age diagnosed with recurrent sixth nerve palsies was performed over a 10-year period from 1995–2005 in a neuro-ophthalmology clinic in Reno, Nevada. A review of the current literature regarding similar cases was also performed on PubMed. Results: Seven patients ≥50 years of age with chronic, recurrent sixth nerve palsies were identified. Five were males and two were females. Four of seven (57% patients had structural lesions located in the parasellar or petrous apex cavernous sinus regions. One of seven (14.29% had a recurrent painful ophthalmoplegic neuropathy (International Headache Society [IHS] 13.9, previously termed ophthalmoplegic migraine; one of seven (14.29% presented with an intracavernous carotid artery aneurysm; and one of seven (14.29% presented with microvascular disease. Conclusion: The clinical presentation of an isolated recurrent diplopia from a sixth nerve palsy should prompt the neurologist or ophthalmologist to order a magnetic resonance imaging (MRI scan of the brain with and without gadolinium as part of the initial workup to rule out a non-microvascular cause, such as a compressive lesion, which can increase morbidity and mortality in adults >50 years of age. Keywords: cranial nerve palsy, skull base tumor, aneurysm, meningioma, ophthalmoplegic migraine, microvascular disease

  16. Access to the parapharyngeal space: an anatomical study comparing the endoscopic and open approaches.

    Van Rompaey, Jason; Suruliraj, Anand; Carrau, Ricardo; Panizza, Benedict; Solares, C Arturo


    A subtemporal preauricular approach to the infratemporal fossa and parapharyngeal space has been the traditional path to tumors of this region. The morbidity associated with this procedure has lead to the pursuit of less invasive techniques. Endoscopic access using a minimally invasive transmaxillary/transpterygoid approach potentially may obviate the drawbacks associated with open surgery. The anatomy of the parapharyngeal space is complex and critical; therefore, a comparison of the anatomy exposed by these different approaches could aid in the decision making toward a minimally invasive surgical corridor. Technical Note. The parapharyngeal space was accessed endonasally by removal of the medial and posterior walls of the maxillary sinus. To allow better visualization and increased triangulation of a bimanual dissection technique, a sublabial canine fossa antrostomy was created. The medial and lateral pterygoid plates were removed. Further lateral dissection exposed the relevant anatomy of the parapharyngeal space. A subtemporal preauricular infratemporal approach was also completed. The endoscopic approach provided sufficient access to the superior portion of the parapharyngeal space. The open approach also provided adequate access; however, it required a larger surgical window, causing greater injury. A significant advantage of the subtemporal approach is the improved access to the petrous portion of the internal carotid artery. Conversely, the endonasal approach provided improved access to the anterior and medial portions of the superior parapharyngeal space. Endoscopic endonasal access utilizing a transmaxillary/transpterygoid approach provides a sufficient surgical window for tumor extirpation. Utilization of this approach obviates some of the morbidity associated with an open procedure. 5. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Morphometrical Study of the Temporal Bone and Auditory Ossicles in Guinea Pig

    Ahmadali Mohammadpour


    Full Text Available In this research, anatomical descriptions of the structure of the temporal bone and auditory ossicles have been performed based on dissection of ten guinea pigs. The results showed that, in guinea pig temporal bone was similar to other animals and had three parts; squamous, tympanic and petrous .The tympanic part was much better developed and consisted of oval shaped tympanic bulla with many recesses in tympanic cavity. The auditory ossicles of guinea pig concluded of three small bones; malleus, incus and stapes but the head of the malleus and the body of incus were fused and forming a malleoincudal complex. The average of morphometric parameters showed that the malleus was 3.53 ± 0.22 mm in total length. In addition to head and handle, the malleus had two distinct process; lateral and muscular. The incus had a total length 1.23 ± 0.02mm. It had long and short crus although the long crus was developed better than short crus. The lenticular bone was a round bone that articulated with the long crus of incus. The stapes had a total length 1.38 ± 0.04mm. The anterior crus(0.86 ± 0.08mm was larger than posterior crus (0.76 ± 0.08mm. It is concluded that, in the guinea pig, the malleus and the incus are fused, forming a junction called incus-malleus, while in the other animals these are separate bones. The stapes is larger and has a triangular shape and the anterior and posterior crus are thicker than other rodents. Therefore, for otological studies, the guinea pig is a good lab animal.

  18. Surgical considerations and safety of cochlear implantation in otitis media with effusion.

    Cevizci, Rasit; Dilci, Alper; Celenk, Fatih; Karamert, Recep; Bayazit, Yildirim


    To evaluate the effects of otitis media with effusion on surgical parameters, patient safety, perioperative and postoperative complications. Total 890 children who underwent cochlear implantation between 2006 and 2015 were included. The ages ranged from 12 months to 63 months (mean: 32 months). The patients were divided into two groups according to the presence or absence of otitis media with effusion; otitis media with effusion group and non-otitis media group. Of 890 children, 105 had otitis media with effusion prior to surgery. In non-otitis media with group, there were 785 children. The average duration of surgery was 60min (ranged from 28 to 75min) in non-otitis media group, and 90min (ranged from 50 to 135min) in otitis media with effusion group (potitis media with effusion during the surgery. There was no significant difference between the complications of groups with or without otitis media with effusion (p>0.05). In 5 of 105 patients, there was a ventilation tube inserted before cochlear implantation, which did not change the outcome of implantation. There is no need for surgical treatment for otitis media with effusion before implantation since otitis media with effusion does not increase the risks associated with cochlear implantation. Operation duration is longer in the presence of otitis media with effusion. However, otitis media with effusion leads to intraoperative difficulties like longer operation duration, bleeding, visualization of the round window membrane, cleansing the middle ear granulations as well as mastoid and petrous air cells. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. CT findings of acoustic neuroma

    Sim, Do Choul; Lee, Jae Mun; Shinn, Kyung Sub; Bahk, Yong Whee [Catholic Univ., Seoul (Korea, Republic of)


    Computed Tomography (CT) is very accurate in evaluating the location, size, shape and extension of acoustic neuroma. We analysed CT findings of 23 acoustic neuromas seen at Department of Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the period of from January 1981 to June 1987. 1. Five (22%) were men and 18 (78%) were women with the high incidence occurring in the 4th and 5th decades. 2. Twenty two cases were diagnosed satisfactorily by CT examinations which included axial, coronal and reconstruction images. One with the smallest dimension of 8 mm in diameter could not be detected by the conventional CT scan. But is could be seen after metrizamide cisternography. mean size of the tumor masses was estimated 3.6 cm in diameter. 3. The shape of the tumor was oval in 50%, round in 27% and lobulated in 23%. The masses were presented as hypodense in 50%, isodense in 32% and hyperdense in 18%. All tumors were extended from the internal acoustic and toward the cerebellopontine angle. The internal acoustic canal was widened in 77%. Hydrocephalus was associated in 45%. Widening of cerebellopontine angle cistern was noted in 50%. 4. After contrast infusion the tumors were enhanced markedly in 45%, moderately in 32% and mildly in 23%. The enhanced pattern was homogeneous in 41%, mixed in 41% and rim in 18%. The margin of the tumors was sharply defined in 82%. The tumors were attached to the petrous bone with acute angle in 73%. Cystic change within the tumor was found in 27%. The peritumoral edema was noted in 45%. In conclusion, CT is of most effective modalities to evaluate size, shape, extent and internal architecture of acoustic neuroma as well as relationship with adjacent anatomic structures including the internal acoustic canal.

  20. Carotid and cranial nerve reconstruction after removal of cavernous sinus lesions.

    Sekhar, L N; Sen, C N; Lanzino, G; Pomonis, S


    During the last 7 years, approximately 170 neoplasms, and 35 vascular lesions involving the cavernous sinus were treated by the first two authors. During the treatment of such lesions, the direct vein graft reconstruction of the internal carotid artery from the petrous to the supraclinoid or infraclinoid ICA was performed in 23 patients. Graft occlusion occurred in 3 patients and in one of these, it was successfully salvaged by placing a long venous graft from the extracranial ICA to the M3 segment of the middle cerebral artery. The latter 3 patients were neurologically normal. One patient with significant atherosclerotic disease suffered the dissection of the distal internal carotid artery with the graft being patent. The suturing technique. This patient eventually died. Two patients with severely compromised collateral circulation suffered minor strokes due to the temporary occlusion of the ICA. This has been avoided in the more recent patients by the adoption of brain protection techniques such as moderate hypothermia, induced hypertension, and barbiturate coma. Low dose heparin therapy during grafting and high dose intravenous steroids prior to the grafting also appear to be beneficial. Direct vein graft reconstruction of the intracavernous carotid artery is a valuable tool during the management of cavernous sinus lesions. The advantages and disadvantages of this technique as well as the pros and cons of other revascularization techniques will be discussed. During microsurgical removal of cavernous sinus lesions, the cranial nerves III-VI were reconstructed by direct resuture or by nerve grafting in 16 patients. In the majority of these patients, recovery of cranial nerve function was observed, which was very encouraging.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Operative management of tumors involving the cavernous sinus.

    Sekhar, L N; Møller, A R


    In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

  2. Percutaneous transluminal angioplasty for atherosclerotic stenosis of the intracranial cerebral arteries. initial results and long-term follow-up.

    Hyodo, A; Kato, N; Nakai, Y; Anno, I; Sato, H; Okazaki, M; Matsumaru, Y; Nose, T


    Percutaneous transluminal angioplasty (PTA) was carried out 52 times for 49 lesions in 47 cases of atheroscrelotic stenosis of the intracranial or skull base cerebral arteries. The stenotic lesions involved the middle cerebral artery in 21 cases, the basilar artery in eight cases, the internal carotid artery (petrous-supraclinoid portion) in 15 cases, and the intracranial vertebral artery in five cases. Nearly all cases were symptomatic, such as TIA or stroke, and the degree of stenosis ranged from 70 to 99 percent, with a mean of 80 percent. PTA was performed using a STEALTH balloon angioplasty catheter. In these trials, PTA was successfully performed (as indicated by a residual stenosis under 50%) 41 times. The initial success rate was 79% and stenosis was reduced from 80% to 25%. Clinical follow-up was performed from 7 to 84 months with a mean of 44 months. During this period, death due to myocardial infarction or pneumonia occurred in five cases, stroke related to previous PTA occurred ih one case (due to re-stenosis) and stroke unrelated tl? previous PTA occurred in two cases. Angiographic follow-up was performed in 31 cases after 41 successful PTA procedures. Re-stenosis was seen in 20% of the cases, symptomrltic complications occurred in 6%, and asymptomatic complications occurred in 6% of the cases. One case suffered severe subarachnoid hemorrhage just after the PTA due to preexisting aneurysm rupture and he died a week after the PTA. So mortality in this series was 2%. From the results described here, we may conclude that PTA of the intracranial or skull base cerebral artery is technically feasible, and it can be performed with relatively low risk. From our results, it may be a useful method and effective for long-term survival of patients. But results from a larger number of patients and more long-term follow-up data are still necessary in order to evaluate the safety and usefulness of this method.

  3. Percutaneous transluminal angioplasty and stenting for severe stenosis of the intracranial extradural internal carotid artery causing transient ischemic attack or minor stroke.

    Ko, Jun Kyeung; Choi, Chang Hwa; Cha, Seung Heon; Choi, Byung Kwan; Cho, Won Ho; Kang, Tae Ho; Sung, Sang Min; Cho, Han Jin; Lee, Tae Hong


    The purpose of this study is to assess the technical feasibility and clinical efficacy of percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic stenosis of the intracranial extradural (petrous and cavernous) internal carotid artery (ICA).Review of medical records identified 26 consecutive patients who underwent PTAS using a balloon-expandable coronary stent (n = 15, 57.7%) or a Wingspan self-expandable stent (n = 11, 42.3%) for treatment of severe stenosis (>70%) involving the intracranial extradural ICA. The inclusion criteria were transient ischemic attack with an ABCD(2) score of ≥3 (n = 12, 46.2%) or minor stroke with an NIHSS score of ≤4 (n = 14, 53.8%). Technical success rates, complications, and angiographic and clinical outcomes were analyzed retrospectively.PTAS was technically successful in all patients. The mean stenosis ratio decreased from 77.1% to 10.0% immediately after PTAS. The overall incidence of procedural complications was 23.1%, and the postoperative permanent morbidity/mortality rate was 7.7%. A total of 22 patients were tracked over an average period of 29.9 months. During the observation period, 20 patients (90.9%) had no further cerebrovascular events and stroke recurrence occurred in two patients (9.1%), resulting in an annual stroke risk of 3.7%. Two cases (11.1%) of significant in-stent restenosis (>50%) were found on follow-up angiography (n = 18).PTAS for severe stenosis (>70%) involving the intracranial extradural ICA showed a good technical feasibility and favorable clinical outcome in patients with transient ischemic attack or minor stroke.

  4. Degradation of the Bragg peak due to inhomogeneities.

    Urie, M; Goitein, M; Holley, W R; Chen, G T


    The rapid fall-off of dose at the end of range of heavy charged particle beams has the potential in therapeutic applications of sparing critical structures just distal to the target volume. Here we explored the effects of highly inhomogeneous regions on this desirable depth-dose characteristic. The proton depth-dose distribution behind a lucite-air interface parallel to the beam was bimodal, indicating the presence of two groups of protons with different residual ranges, creating a step-like depth-dose distribution at the end of range. The residual ranges became more spread out as the interface was angled at 3 degrees, and still more at 6 degrees, to the direction of the beam. A second experiment showed little significant effect on the distal depth-dose of protons having passed through a mosaic of teflon and lucite. Anatomic studies demonstrated significant effects of complex fine inhomogeneities on the end of range characteristics. Monoenergetic protons passing through the petrous ridges and mastoid air cells in the base of skull showed a dramatic degradation of the distal Bragg peak. In beams with spread out Bragg peaks passing through regions of the base of skull, the distal fall-off from 90 to 20% dose was increased from its nominal 6 to well over 32 mm. Heavy ions showed a corresponding degradation in their ends of range. In the worst case in the base of skull region, a monoenergetic neon beam showed a broadening of the full width at half maximum of the Bragg peak to over 15 mm (compared with 4 mm in a homogeneous unit density medium). A similar effect was found with carbon ions in the abdomen, where the full width at half maximum of the Bragg peak (nominally 5.5 mm) was found to be greater than 25 mm behind gas-soft-tissue interfaces. We address the implications of these data for dose computation with heavy charged particles.

  5. Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment

    Sogabe, Shu; Satomi, Junichiro; Tada, Yoshiteru; Kanematsu, Yasuhisa; Kuwayama, Kazuyuki; Yagi, Kenji; Yoshioka, Shotaro; Mizobuchi, Yoshifumi; Mure, Hideo; Yamaguchi, Izumi; Kitazato, Keiko T.; Nagahiro, Shinji [Tokushima University Graduate School, Department of Neurosurgery, Tokushima (Japan); Abe, Takashi; Harada, Masafumi [Tokushima University Graduate School, Department of Radiology, Tokushima (Japan); Yamamoto, Nobuaki; Kaji, Ryuji [Tokushima University Graduate School, Department of Clinical Neurosciences, Institute of Biomedical Biosciences, Tokushima (Japan)


    Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site. (orig.)

  6. [Computed tomography and magnetic resonance imaging of congenital abnormalities of the temporal bone].

    Czerny, C; Gstöttner, W; Imhof, H


    Congenital abnormalities of the temporal bone are mostly accompanied by conductive or sensori-neural hearing loss. Before any therapeutic procedures are done high resolution CT (HRCT) and magnetic resonance imaging (MRI) should be performed to establish the correct diagnosis and to plan the potentially surgical intervention. HRCT best depicts osseous changes especially those of the external auditory canal and the middle ear containing the ossicles and the osseous structures of the temporal bone and the petrous bone containing the inner ear. MRI excellently shows soft tissue changes of the inner ear especially on the high resolution 3DT2-weighted sequences which give a superb contrast between the nerves and the cerebro-spinal fluid. Malformations of the external auditory canal consists of aplasia or hypoplasia and those of the middle ear range form extreme hypoplasia or aplasia to very mild deformations of the ossicles. Malformations of the inner ear also range form complete aplasia to very mild hypoplasia of the organs of the inner ear as well as malformations concerning the nerves in the internal auditory canal range from aplasia to hypoplasia. Malformations of the temporal bone can either occur isolated or in combination in which malformations of the external and middle ear may be accompanied by those of the inner ear. Furthermore, malformations of the temporal bone may also occur in otofacial, otocervical or otoskeletal syndromes. These syndromes may be accompanied by certain malformations of the temporal bone. HRCT and MRI are both excellent methods to depict congenital abnormalities of the temporal bone and of the inner ear and should be used as complementary methods because HRCT best depicts osseous changes and MRI superbly depicts soft tissue changes. Both methods are important to establish the correct diagnosis to plan the therapeutic procedures.

  7. Diagnosis and Differential Diagnosis of the Dyke-Davidoff-Masson Syndrome by CT and MRI: Report of 3 Cases and Literature Review%戴克-大卫杜夫-梅森综合征CT、MRI诊断及鉴别诊断(附3例报告并文献复习)

    熊伟; 蒋秋燕; 欧波; 龙从杰


    Objective To discuss the clinical and imaging findings of Dyke-Davidoff-Masson syndrome(DDMS).Methods The clinical and imaging features of DDMS in 3 patients were analyzed retrospectively with literature review.Results 3 patients suffered from cerebral hemiatrophy with ipsilateral ventricular dilatation and displacement of the midline structures, 2 cases with encephalomalacia and porencephaly,one case with thalamus hypoplasia and lentiform nucleus hypoplasia were found.Unilateral calvarial thickening was seen in 3 cases.There were hyperpneumatization of paranasal sinuses in 2 cases,hypoplasia of the cranial fossa in 2 cases,hyperpneumatization of mastoid cells and elevation of the petrous ridge in one case.Conclusion DDMS displays relatively the typical imaging features,and it can be diagnosed correctly according to imaging findings in combination with clinical characters.%目的 探讨戴克-大卫杜夫-梅森综合征(Dyke-Davidoff-Masson syndrome,DDMS)的临床及影像学表现.方法 回顾性分析3例DDMS患者的临床及影像学资料并作文献复习.结果 3例均出现单侧大脑萎缩,同侧侧脑室扩大,中线结构向患侧偏移,1例出现脑软化及脑穿通畸形,1例出现丘脑及豆状核萎缩.3例出现患侧颅骨增厚,2例出现鼻窦过度发育,2例颅窝缩小,1例乳突窦增大及岩骨嵴抬升.结论 DDMS具有比较典型的影像学表现,结合临床表现影像学可以正确诊断.

  8. Pneumatization of the sphenoid sinus in Chinese: the differences from Caucasian and its application in the extended transsphenoidal approach.

    Lu, Yuntao; Pan, Jun; Qi, Songtao; Shi, Jin; Zhang, Xi'an; Wu, Kuncheng


    In recent years, the transsphenoidal approach has been extensively used surgically to treat parasellar, suprasellar, clival, and even petrous lesions. Extended pneumatization of the sphenoid sinus (SS) is considered an indispensable element for the extended transsphenoidal (ETS) approach. Because most anatomical studies of the ETS approach use Caucasian subjects, the present study aims to clarify the pneumatic extension types in Chinese individuals as well as any differences from those in Caucasians and analyze these differences with respect to the application of the ETS approach. A total of 200 computed tomography (CT) images of SSs and 18 adult cadaveric heads were selected for observation and measurement. The conchal, presellar, and sellar types comprised 6, 28.5, and 65.5% of subjects, respectively; according to the extra extension, the prevalence of the lateral, clival, lesser wing, and combined extension sinus types was 11.4, 21.4, 0.8, and 48.1% of subjects, respectively. The percentages of pneumatization of the anterior and posterior clinoid processes, pterygoid process, and optic strut were 5.0, 1.0, 22.3, and 7.0%, respectively. Onodi cells were observed in 61.1% of the sides of the cadaveric heads, including 30.6% with good pneumatization with identifiable optical or ICA bulges. These features were related to poor lateral and clival gasification in Chinese compared with Caucasians, which might make extended surgery more dangerous. However, the anterior pneumatization, especially the higher presentation of Onodi cells, ensures that the anterior ETS approach can be performed safely in Chinese patients. In general, measurements showing smaller sinus volumes and thicker bones with identifiable bone landmarks that are hard to find compared with those in Caucasians suggest increased surgical risks in the Chinese population. In this situation, carefully analysis of presurgical CT and magnetic resonance imaging scans is important. Furthermore, in the ETS

  9. CT Scan of Thirteen Natural Mummies Dating Back to the XVI-XVIII Centuries: An Emerging Tool to Investigate Living Conditions and Diseases in History.

    Enrico Petrella

    Full Text Available To correlate the radiologic findings detected with computed tomography scan with anthropological data in 13 naturally mummified bodies discovered during works of recovery of an ancient church in a crypt in Roccapelago, in the Italian Apennines.From a group of about sixty not-intentionally mummified bodies, thirteen were selected to be investigated with volumetric computed tomography (CT. Once CT scan was performed, axial images were processed to gather MPR and Volume Rendering reconstructions. Elaborations of these images provided anthropometric measurements and a non-invasive analysis of the residual anatomical structures. For each body the grade of preservation and the eventual pathological changes were recorded. Furthermore, in order to identify nutritional and occupational markers, radiologic signs of bone tropism and degenerative changes were analysed and graded.Mummies included seven females and six males, with an estimated age ranging from 20 to 60 years. The first relevant finding identified was a general low grade of preservation, due to the lack of anatomic tissues different from bones, tendons and dehydrated skin. The low grade of preservation was related to the natural process of mummification. Analysing bone degenerative changes on CT scan, the majority of the bodies had significant occupational markers consisting of arthritis in the spine, lower limbs and shoulders even in young age. Few were the pathological findings identified. Among these, the most relevant included a severe bilateral congenital hip dysplasia and a wide osteolytic lesion involving left orbit and petrous bone that was likely the cause of death.Although the low grade of preservation of these mummies, the multidisciplinary approach of anthropologists and radiologists allowed several important advances in knowledge for the epidemiology of Roccapelago. First of all, a profile of living conditions was delineated. It included occupational and nutritional conditions

  10. Radiologic assessment of maxillofacial, mandibular, and skull base trauma

    Schuknecht, Bernhard [University Hospital of Zurich, Institute of Neuroradiology, Zurich (Switzerland); MRI-Medizinisch Radiodiagnostisches Institut, Zurich (Switzerland); Graetz, Klaus [University Hospital of Zurich, Department of Maxillofacial Surgery, Zurich (Switzerland)


    Cranio-maxillofacial injuries affect a significant proportion of trauma patients either in isolation or concurring with other serious injuries. Contrary to maxillofacial injuries that result from a direct impact, central skull base and lateral skull base (petrous bone) fractures usually are caused by a lateral or sagittal directed force to the skull and therefore are indirect fractures. The traditional strong role of conventional images in patients with isolated trauma to the viscerocranium is decreasing. Spiral multislice CT is progressively replacing the panoramic radiograph, Waters view, and axial films for maxillofacial trauma, and is increasingly being performed in addition to conventional films to detail and classify trauma to the mandible as well. Imaging thus contributes to accurately categorizing mandibular fractures based on location, into alveolar, mandibular proper, and condylar fractures - the last are subdivided into intracapsular and extracapsular fractures. In the midface, CT facilitates attribution of trauma to the categories central, lateral, or combined centrolateral fractures. The last frequently encompass orbital trauma as well. CT is the imaging technique of choice to display the multiplicity of fragments, the degree of dislocation and rotation, or skull base involvement. Transsphenoid skull base fractures are classified into transverse and oblique types; lateral base (temporal bone) trauma is subdivided into longitudinal and transverse fractures. Supplementary MR examinations are required when a cranial nerve palsy occurs in order to recognize neural compression. Early and late complications of trauma related to the orbit, anterior cranial fossa, or lateral skull base due to infection, brain concussion, or herniation require CT to visualize the osseous prerequisites of complications, and MR to define the adjacent brain and soft tissue involvement. (orig.)

  11. 珊瑚羟基磷灰石与异体脱细胞真皮基质联合修复牙根尖周组织缺损%Acellular dermal matrix allograft combined with coralline hydroxyapatite repair periapical tissue defects

    徐隽; 王进涛; 李刚; 史芳川; 钟良军


      结果与结论:修复1个月后,实验组患者异体脱细胞真皮基质全部存活,因修整瘘管口周围炎性的肉芽组织导致的牙龈组织缺损已经愈合。在修复12个月后,实验组患者的修复有效率明显高于对照组(P <0.05)。实验组患者修复6个月后骨缺损区阴影基本消失,珊瑚羟基磷灰石颗粒间的透射影减小,出现有一定致密度的影像,提示有新骨长入;12个月后珊瑚羟基磷灰石颗粒密度已接近正常的骨组织密度,与正常骨组织之间有密度移行改变,逐渐与牙槽骨形成骨融合。异体脱细胞基质与珊瑚羟基磷灰石的生物相容性良好。提示异体脱细胞真皮基质与珊瑚羟基磷灰石联合修复根尖周组织缺损具有良好的临床疗效。%Chronic periapical periodontitis often causes periapical tissue defects and ultimately leads to the loss of teeth if the inflammation is not promptly cleared to terminate bone resorption and destruction of gingival tissue. Acelular dermal matrix alograft and coraline hydroxyapatite are the common materials to repair periodontal injury. To evaluate clinical efficacy of acelular dermal matrix alograft combined with coraline hydroxyapatite in repairing periapical tissue defects. A total of 76 patients of chronic apical periodontitis were randomly divided into two groups, with 38 cases in each group. In the experimental group, periapical tissue defects were treated with acelular dermal matrix alograft and coraline hydroxyapatite. In the control group, tissue defects were not treated. Al the involved patients underwent apicectomy and retrograde filing. Clinical parameters and radiographic film were recorded at 1 week, 6 months and 3 years folow-up visits to evaluate the repairing effects. After 1 month of treatment, al acelular dermal matrix alografts survived, and the defect of gingival tissues that caused by repairing fistula had been healed. After 3 years, the repairing

  12. MS Non-Pharmacological Countermeasure to Decrease Landing Sickness and Improve Functional Performance While Disorientad

    Rosenberg, M. J. F.; Kreutzberg, G. A.; Galvan-Garza, R. C.; Mulavara, A. P.; Reschke, M. F.


    Upon return from spaceflight, a majority of crewmembers experience motion sickness (MS) symptoms. The interactions between crewmembers' adaptation to a gravitational transition, the performance decrements resulting from MS and/or use of promethazine (PMZ), and the constraints imposed by mission task demands could significantly challenge and limit an astronaut's ability to perform functional tasks during gravitational transitions. No operational countermeasure currently exists to mitigate the risks associated with these sensorimotor disturbances. Stochastic resonance (SR) can be thought of simply as "noise benefit" or an increase in information transfer by a system when in the presence of a non-zero level of noise. We have shown that low levels of stochastic vestibular stimulation (SVS) improve balance and locomotor performance due to SR (Goel et al. 2015, Mulavara et al. 2011, 2015). Additionally, a study in a 6-hydroxydopamine (6-OHDA) hemi-lesioned rat model of Parkinson's disease demonstrated improvements in locomotor activity after low-level SVS delivery possibly due to an increase in nigral gamma-aminobutyric acid (GABA) release in a dopamine independent way (Samoudi et al. 2012). SVS specifically increased GABA release on the lesioned, but not the intact side. These results suggest that SVS can cause targeted alterations of GABA release to affect performance of functional tasks. Activation of the GABA pathway is important in modulating MS and promoting adaptability (Cohen 2008). Magnusson et al. (2000) supported this finding by showing that the administration of a GABAB agonist caused a reversal of the symptoms that is normally seen after unilateral labyrinthectomy. Thus, GABA could play a significant role in reducing MS and promoting adaptability. We have taken advantage of the SR mechanism as a modulator of neurotransmitters to develop a unique SVS countermeasure system to mitigate MS symptoms and improve functional performance after landing. Healthy

  13. Dopamine Modulates Motor Control in a Specific Plane Related to Support.

    Marc Herbin

    Full Text Available At the acute stage following unilateral labyrinthectomy (UL, rats, mice or guinea pigs exhibit a complex motor syndrome combining circling (HSCC lesion and rolling (utricular lesion. At the chronic stage, they only display circling, because proprioceptive information related to the plane of support substitutes the missing utricular information to control posture in the frontal plane. Circling is also observed following unilateral lesion of the mesencephalic dopaminergic neurons by 6- hydroxydopamine hydrobromide (6-OHDA rats and systemic injection of apomorphine (APO rats. The resemblance of behavior induced by unilateral vestibular and dopaminergic lesions at the chronic stage can be interpreted in two ways. One hypothesis is that the dopaminergic system exerts three-dimensional control over motricity, as the vestibular system does. If this hypothesis is correct, then a unilateral lesion of the nigro-striatal pathway should induce three-dimensional motor deficits, i.e., circling and at least some sort of barrel rolling at the acute stage of the lesion. Then, compensation could also take place very rapidly based on proprioception, which would explain the prevalence of circling. In addition, barrel rolling should reappear when the rodent is placed in water, as it occurs in UL vertebrates. Alternatively, the dopaminergic network, together with neurons processing the horizontal canal information, could control the homeostasis of posture and locomotion specifically in one and only one plane of space, i.e. the plane related to the basis of support. In that case, barrel rolling should never occur, whether at the acute or chronic stage on firm ground or in water. Moreover, circling should have the same characteristics following both types of lesions. Clearly, 6-OHDA and APO-rats never exhibited barrel rolling at the acute stage. They circled at the acute stage of the lesion and continued to do so three weeks later, including in water. In contrast, UL

  14. Dopamine Modulates Motor Control in a Specific Plane Related to Support

    Herbin, Marc; Simonis, Caroline; Revéret, Lionel; Hackert, Rémi; Libourel, Paul-Antoine; Eugène, Daniel; Diaz, Jorge; de Waele, Catherine; Vidal, Pierre-Paul


    At the acute stage following unilateral labyrinthectomy (UL), rats, mice or guinea pigs exhibit a complex motor syndrome combining circling (HSCC lesion) and rolling (utricular lesion). At the chronic stage, they only display circling, because proprioceptive information related to the plane of support substitutes the missing utricular information to control posture in the frontal plane. Circling is also observed following unilateral lesion of the mesencephalic dopaminergic neurons by 6- hydroxydopamine hydrobromide (6-OHDA rats) and systemic injection of apomorphine (APO rats). The resemblance of behavior induced by unilateral vestibular and dopaminergic lesions at the chronic stage can be interpreted in two ways. One hypothesis is that the dopaminergic system exerts three-dimensional control over motricity, as the vestibular system does. If this hypothesis is correct, then a unilateral lesion of the nigro-striatal pathway should induce three-dimensional motor deficits, i.e., circling and at least some sort of barrel rolling at the acute stage of the lesion. Then, compensation could also take place very rapidly based on proprioception, which would explain the prevalence of circling. In addition, barrel rolling should reappear when the rodent is placed in water, as it occurs in UL vertebrates. Alternatively, the dopaminergic network, together with neurons processing the horizontal canal information, could control the homeostasis of posture and locomotion specifically in one and only one plane of space, i.e. the plane related to the basis of support. In that case, barrel rolling should never occur, whether at the acute or chronic stage on firm ground or in water. Moreover, circling should have the same characteristics following both types of lesions. Clearly, 6-OHDA and APO-rats never exhibited barrel rolling at the acute stage. They circled at the acute stage of the lesion and continued to do so three weeks later, including in water. In contrast, UL-rats, exhibited

  15. Procedures for restoring vestibular disorders

    Walther, Leif Erik


    Full Text Available This paper will discuss therapeutic possibilities for disorders of the vestibular organs and the neurons involved, which confront ENT clinicians in everyday practice. Treatment of such disorders can be tackled either symptomatically or causally. The possible strategies for restoring the body's vestibular sense, visual function and co-ordination include medication, as well as physical and surgical procedures. Prophylactic or preventive measures are possible in some disorders which involve vertigo (bilateral vestibulopathy, kinetosis, height vertigo, vestibular disorders when diving (Tables 1 and 2. Glucocorticoid and training therapy encourage the compensation of unilateral vestibular loss. In the case of a bilateral vestibular loss, it is important to treat the underlying disease (e.g. Cogan's disease. Although balance training does improve the patient's sense of balance, it will not restore it completely.In the case of Meniere's disease, there are a number of medications available to either treat bouts or to act as a prophylactic (e.g. dimenhydrinate or betahistine. In addition, there are non-ablative (sacculotomy as well as ablative surgical procedures (e.g. labyrinthectomy, neurectomy of the vestibular nerve. In everyday practice, it has become common to proceed with low risk therapies initially. The physical treatment of mild postural vertigo can be carried out quickly and easily in outpatients (repositioning or liberatory maneuvers. In very rare cases it may be necessary to carry out a semicircular canal occlusion. Isolated disturbances of the otolith function or an involvement of the otolith can be found in roughly 50% of labyrinth disturbances. A specific surgical procedure to selectively block the otolith organs is currently being studied. When an external perilymph fistula involving loss of perilymph is suspected, an exploratory tympanotomy involving also the round and oval window niches must be carried out. A traumatic rupture of the

  16. A radiographic study on the mucosal cyst of the maxillary sinus

    Park, Eun Chun; Kim, Jae Duck [Dept. of Oral Radiology, College of Dentistry, Chosun University, Kwangju (Korea, Republic of)


    posterior portion of the floor of the maxillary sinus were superimposed with the petrous portion of the skull.

  17. [Paratrigeminal epidermoid originated in the meckel's cave (author's transl)].

    Miyasaka, Y; Morii, S; Tachibana, S; Saito, T; Ohwada, T


    We have reported a case of paratrigeminal epidermoid originated in the Meckel's cave. A 30 years old man was admitted to the department of neurosurgery with chief complaints of continuous right facial pain and numbness of entire right side of the face of three years duration. The positive neurological findings were hypesthesia over the distribution of the right trigeminal nerve, absence of the right corneal reflex and nystagmus on left lateral gaze. Caloric response was absent on the right side, however the audiogram showed normal. Cerebrospinal fluid examination was within normal limit. Electromyography showed giant spike in the right masseter and temporal muscles. Radiogram of the skull revealed a bone-destroying lesion over the medial florr of the right middle fossa involving the apex of the petrous bone (Fig 1). Right carotid angiography showed straightening and forward displacement of C4- C5 portion of the carotid siphon in the lateral view, and vertebral angiography showed displacement of basilar artery to the left side, upward displacement of the right posterior cerebral and superior cerebellar artery in the frontal view (Fig. 2, 3). At the time of operation, an epidermoid was identified in the Meckel's cave and totally removed microsurgically. Small amount of the tumor extending into the posterior fossa was also removed (Fig. 4, 5, 6, 7). Postoperative course was uneventfull except for an episode of headache and high fever of short duration, suggesting the signs of meningial irritation. Two months postoperativelly patient was relived of facial pain and was discharged with sensory impairment of the right trigeminal nerve distribution. Only 11 cases of paratrigeminal epidermoid, including the cases localized in the Meckel's cave have been reported in the past literatures (Table 1). In this paper we have discussed about the symptomatology and clinical data of paratrigeminal epidermoid and compared with those of trigeminal neurinoma, and meningioma originated

  18. Aneurysmal Bone Cyst of the Skull Base in a 17-Year-Old Boy Who Was Referred with Unusual Presentation

    Leila Aghaghazvini


    Full Text Available Aneurismal Bone Cyst (ABC is an osteolytic lesion"ncommonly observed in the first and second decades of"nlife more in females. They typically involve the long"nbones. Skull base involvement is rare. We describe"na 17-year-old boy with ABC of the skull base with"nforamen Jugular symptoms. Our case presented with a"nhistory of hoarseness for 2 years and facial asymmetry"nand left sided hearing loss from 5 months ago with no"nhistory of trauma or surgery. On physical examination,"nhe had left-sided sensorineural hearing loss with left"njugular foramen syndrome. The exam was otyherwise"nunremarkable. On MRI sequences an iso signal"nAbstracts"nIran J Radiol 2011, 8 (Supp.1 S61"nlobulated well defied mass containing few high signal"nareas in T1W and heterogeneous high signal (T2W"nand Flair was noted arising from the jugular foramen"nextending to the inferior cerebello-pontine angle"nwhich showed severe enhancement containing low"nsignal areas. No fluid-fluid level or enhancing septa was"nnoted. On CT scan a lytic expansile mass was detected"non the left side of foramen magnum and clivus with"ninvolvement of petrous apex and the internal auditory"ncanal. According to MRI findings, glomus jugular,"nschwannomas and meningiomas, but based on CT"nscan and MRI findings giant cell tumor and based on"nthe patient;s age ABC were our differential diagnosis."nThe lesion was only resected (without radiotherapy"nand histopathology confirmed an ABC. No recurrence"nwas observed after 6 months. Our case was interesting"nbecause of its rarity; not only the clinical jugular"nforamen syndrome but also the unusual radiological"npresentations such as severe enhancement, lack of"nfluid level and multi osseous involvement."nKeywords: Aneurysmal Bone Cyst, Foramen Jugular,"nPetros, Skull bBase, Clivus

  19. Adaptive fractionated stereotactic Gamma Knife radiotherapy of meningioma using integrated stereotactic cone-beam-CT and adaptive re-planning (a-gkFSRT).

    Stieler, F; Wenz, F; Abo-Madyan, Y; Schweizer, B; Polednik, M; Herskind, C; Giordano, F A; Mai, S


    The Gamma Knife Icon (Elekta AB, Stockholm, Sweden) allows frameless stereotactic treatment using a combination of cone beam computer tomography (CBCT), a thermoplastic mask system, and an infrared-based high-definition motion management (HDMM) camera system for patient tracking during treatment. We report on the first patient with meningioma at the left petrous bone treated with adaptive fractionated stereotactic radiotherapy (a-gkFSRT). The first patient treated with Gamma Knife Icon at our institute received MR imaging for preplanning before treatment. For each treatment fraction, a daily CBCT was performed to verify the actual scull/tumor position. The system automatically adapted the planned shot positions to the daily position and recalculated the dose distribution (online adaptive planning). During treatment, the HDMM system recorded the intrafractional patient motion. Furthermore, the required times were recorded to define a clinical treatment slot. Total treatment time was around 20 min. Patient positioning needed 0.8 min, CBCT positioning plus acquisition 1.65 min, CT data processing and adaptive planning 2.66 min, and treatment 15.6 min. The differences for the five daily CBCTs compared to the reference are for rotation: -0.59 ± 0.49°/0.18 ± 0.20°/0.05 ± 0.36° and for translation: 0.94 ± 0.52 mm/-0.08 ± 0.08 mm/-1.13 ± 0.89 mm. Over all fractions, an intrafractional movement of 0.13 ± 0.04 mm was observed. The Gamma Knife Icon allows combining the accuracy of the stereotactic Gamma Knife system with the flexibility of fractionated treatment with the mask system and CBCT. Furthermore, the Icon system introduces a new online patient tracking system to the clinical routine. The interfractional accuracy of patient positioning was controlled with a thermoplastic mask and CBCT.


    LIU Wei; GUO Rui; Rask Andersen Helge


    Object To explore the procedures in per-operative harvesting and management of fresh human cochlear specimens for research. Methods During trans-cochlear surgery to remove large petro-clival meningiomas causing life-threatening compression on the brainstem, cochleae are normally destroyed and drilled away in order to reach the apical petrous and clivus region. Instead the cochlea can be dissected out after ethical per-mission was obtained from the local ethical committee (EPN) and allowance gained from the patients. Sur-gery is performed by a team consisting of oto-and neurosurgeons as a two-day procedure with total petro-sectomy in combination with an inferior re-routing of the facial nerve. Fixation of the cochleae was done in the operating room as soon as the specimens had been separated from the temporal bones. Decalcification began after hours’to overnight’s fixation for 4 weeks. Sectioning parallel to the modiolus (mid-modiolus) was performed with a cryostat microtome. The sections were subjected to immunofluorescence (IF). Results Using freshly prepared 4%paraformaldehyde (PFD) solution, adequate fixation of fine inner ear structures was achieved with hours’immersion of the cochlear specimens. Decalcification in 6.2% ethylene di-amine-tetracetic acid (EDTA) solution for 4 weeks yielded a thoroughly decalcified cochlea. Experiences in processing 14 human cochleae and analysing main landmarks in five human inner ear plastic/silicone casts showed that the oval window/stapes footplate are backward tilted, at an angle about 15 degrees, from the plane perpendicular to the modiolar axis. The distance from the modiolar apex to the anterior border of the oval window/footplate in these inner ear casts measured between 4 and 5 mm. High quality IF staining was obtained. Conclusion Surgically obtained human cochlear specimen, when properly processed, contains ide-ally preserved antigenicity for immunohistochemical study. Adequate orientation during sectioning helps

  1. A study on secondary images in panoramic radiograph

    Cho, Dai Hee; Kim, Han Pyong [Department of Dental Science, Yonsei University, Seoul (Korea, Republic of)


    This study was performed to observe the secondary images and to analyse the relationships between the primary and secondary images in panoramic radiograph. Using the Morita's Panex-EC panoramic x-ray machine and the human dry skull, the author analysed 17 radiographs which were selected from 65 radiographs of the dry skull that attached the radiopaque materials, and the attached regions of the radiopaque materials were the normal anatomical structures which were important and selected as a region for the evaluation of the secondary images effectively. The results were as follows; 1. The cervical vertebrae showed three images. The midline image was the most distorted and less clear, and bilateral images were slightly superimposed over the posterior border of the mandibular ramus. 2. In mandible, the secondary image of the posterior border of the ramus was superimposed on the opposite ramus region, and this image was elongated from the anterior border of the ramus to the lateral side of the posterior border of the ramus. The secondary image of the condyle was observed on the upper area of the coronoid process, the sigmoid notch and the condyle in opposite side. 3. In maxilla, the posterior region of the hard palate showed the secondary image on the lower part of the nasal cavity and the medial wall of the maxillary sinus. 4. The primary images of the occipital condyle and the mastoid process appeared on the same region, and only the secondary image of the occipital condyle was observed symmetrically on the opposite side with similar shape to the primary one. 5. In the cranial base, the anatomical structures of the midsagittal portions like a inferior border of the frontal sinus, sella turcica, inferior border of the sphenoid sinus and inferior border of the posterior part of the occipital bone showed the similar shape between the primary and secondary images symmetrically. 6. The petrous portion of the temporal bone showed the secondary image of the lateral side

  2. Skull Base Erosion in Nasopharyugeal Careinoma: Detection by MRI%鼻咽癌颅底侵犯的MRI

    汪若弟; 毛明伟


    Objective To study MRI characteristics and value in the diagnosis of nasopharyngeal carcinoma with skull base erosion. Methods 86 cases of nasopharygeal carcinoma with positive nasopharyngeal pathology and symptoms of skull base erosion were selected. Axial T1WI, T2WI and coronal, sagital T1WI were performed. 47 cases had axial, coronal and sagital T1WI examination post Gd-DTPA injection. Results Areas of skull base involvement were as follow: 56 cases with pterygoid process, 54 with clivus, 28 with foramen ovale (including sphenoid wing), 27 with petrous apex, 1 with occiptal bone. 71 cases had more than one area involvement. There are four patterns in our group: ①Defect in the signal avoid cortex of skull base; ②High signal intensity of marrow was replaced by tumor; ③Contrast enhancement in abnormal bone; ④String like enhancement passing nerve foramen in skull base. 44 cases included intracranial abnormal. Conclusion MRI is the preferred technique in dementstrating skull base involvemetn of nasopharyngeal carcinoman.%目的探讨鼻咽癌颅底侵犯的MRI表现形式及诊断价值。方法选择经鼻咽部病理证实,并有明确颅底或颅神经受损症状的鼻咽癌患者86例。经颅底及鼻咽部轴位T1WI,T2WI和冠位、矢位T1WI扫描。47例行增强后轴、冠、矢位T1WI扫描。结果侵犯翼突者56例,斜坡54例,卵圆孔(包括蝶骨大翼)28例,岩尖27例,枕骨1例。71例有2处以上联合病变。表现形式有:①正常颅底骨皮质无信号带中断;②骨髓内T1高信号脂肪影被肿瘤信号代替;③骨内病灶强化;④穿过颅底神经孔的条状强化影。有颅内侵犯者44例。结论MRI是诊断鼻咽癌颅底侵犯的首选技术。

  3. Imaging features of trigeminal schwannoma and the relationship between its classification and surgical approaches%三叉神经鞘瘤影像学特点和分型与手术入路的关系

    胡可明; 罗秋红; 苏凯; 李春宏; 李家志


    Objective To explore the imaging features of trigeminal schwannoma and the relationship between its classification and surgical approaches. Methods The imaging features and the classification and the surgical approaches of trigeminal schwannoma confirmed by pathology in 15 cases were analyzed retrospectively. Results In 15 cases, the tumors located in middle cranial fossa in 3 cases, in posterior cranial fossa in 2 cases, in middle and posterior cranial fossa in 7 cases, in infratemporal fossa in 1 case, in pterygopalatine fossa in 1 case and in orbita in 1 case. The imaging features were as following: ① The tumors located in petrous apex, Meckel's cave enlarged and petrous bone absorbed; ②The tumors located in the cistern of pontocerebellar trigone and connected with the root of trigeminal nerve; ③The tumors grew along trigeminal nerve and acrossed middle and posterior cranial fossa with dumbbell appearance; ④ The tumors of infratemporal fossa and pterygopalatine fossa grew up to middle cranial fossa, foramen ovale and foramen rotundum enlarged; ⑤ The tumor was between rectus superior and orbita, superior orbital fissure expended; ⑥ The tumors showed inhomogeneous e-qual and low density on CT, inhomogeneous hypo-intense and iso-intense signal on T1WI , inhomogeneous iso-intense and hyper-intense signal on T2WI and inhomogeneous enhancement with clear edge. These cases were divided into six types: type of middle cranial fossa in 3 cases, type of posterior cranial fossa in 2 cases, type of middle and posterior cranial fossa in 7 cases, type of infratemporal fossa in 1 case, type of pterygopalatine fossa in 1 case, and type of orbita in 1 case. The different approaches were used to remove the tumors according to the type of tumor. 3 cases were through frontotemporal with zygomatic osteomy approach, 2 cases through sigmoid sinus approach, 4 cases through extended middle cranial fossa approach, 2 cases through temproromandibular cerebelli tentorium approach

  4. Resection of petroclival meningiomas via suboccipital retrosigmoid trans-suprameatal approach%经枕下乙状窦后-内听道上结节入路切除岩斜区脑膜瘤

    陈立华; 陈凌; A Samii; M Samii; 凌锋


    cavernous sinus, Meckel's cave. Six patients displayed central brainstem compression, three patients had bony changes at the petrous apex, and five patients displayed total or partial encasement of the vertebrobasilar artery and its major branches.Results Radical tumor resection (Simpson Grade Ⅰ or Ⅱ) was achieved in 8 of 11 patients and the rate of total removal was 72.7%. Three patients underwent subtotal resection (Simpson Grade Ⅲ) and all of three patients underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. Nine of the series had serviceable hearing before the operation, 1 patient lost hearing after the operation, and this hearing loss occurred in the huge petroclival meningioma. At the last follow-up examination, facial nerve function was GradeⅠ in 7 patients, Grade II in 3 patients, and Grade Ⅲ in 1 patient. There was no mortality and severe complications or decrease in Karnofsky performance score in this series; all patients did well postoperatively and being independent at the time of their last follow-up examinations. Neurological deficits included facial paresis in 1 patient and worsening of hearing in 2 patients.Conclusion The suboccipital retrosigmoid trans-suprameatal approach is a safe and useful modification of the retrosigmoid approach, and can produce good results. Removing the suprameatal tubercle and surrounding bone can increase the petroclival exposure and the degree of tumor resection, especially in the area of the petroclival junction, middle clivus, apical petrous bone, posterior cavernous sinus, and Meckel's cave, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time-consuming. So it should be considered for patients who have a large petroclival meningioma in the posterior fossa which extends into the middle fossa in the region of Meckel's cave.

  5. Etiología del colesteatoma ótico Etiology of otic cholesteatoma

    Julianis Loraine Quintero Noa


    Full Text Available El colesteatoma es una estructura quística caracterizada por la presencia de epitelio escamoso productor de queratina, que sustituye o recubre la mucosa normal en la hendidura del oído medio y ápex petroso, y puede ser causa de hipoacusia irreversible, destrucción ósea y graves complicaciones por su crecimiento expansivo. Clásicamente se describen los colesteatomas en congénitos y adquiridos. La etiología de su formación es multifactorial y continúa siendo poco claro y controversial. Se reportan diferentes teorías que han tratado de explicar el colesteatoma congénito, la transición de un bolsillo de retracción hasta la aparición del colesteatoma adquirido primario, y otras en la génesis del colesteatoma adquirido secundario. Se describe la presencia de algunas citoquinas dentro del colesteatoma que inducen la hiperproliferación e invasión incoordinada de los queratinocitos de la piel del conducto auditivo externo y la pars fláccida, más agresiva en el colesteatoma adquirido pediátrico, y que desempeñan un papel fundamental en la proliferación y en la apoptosis del queratinocito. En cultivo in vitro de una muestra de tejido colesteatomatoso, se ha identificado recientemente que el TNF-a estimula la producción de la IL-8. Se considera de interés ofrecer esta revisión sobre la etiología del colesteatoma, que aún se mantiene en el campo de la investigación y continúa siendo un reto para los otocirujanos por su alta incidencia de recidivas y posibles complicaciones.Cholesteatoma is a cystic structure characterized by presence of squamous epithelium producing keratin substituting or recovering the normal mucosa in the groove of middle ear and petrous apex and may to be caused by irreversible hypoacusia, bone destruction and severe complications due to its expansive growth. Typically the cholesteatomas are described as congenital and acquired. The etiology of its formation is multifactor and still remains a subject not

  6. Adaptive fractionated stereotactic Gamma Knife radiotherapy of meningioma using integrated stereotactic cone-beam-CT and adaptive re-planning (a-gkFSRT)

    Stieler, F.; Wenz, F.; Abo-Madyan, Y.; Schweizer, B.; Polednik, M.; Herskind, C.; Giordano, F.A.; Mai, S. [University of Heidelberg, Department of Radiation Oncology, University Medical Center Mannheim, Mannheim (Germany)


    The Gamma Knife Icon (Elekta AB, Stockholm, Sweden) allows frameless stereotactic treatment using a combination of cone beam computer tomography (CBCT), a thermoplastic mask system, and an infrared-based high-definition motion management (HDMM) camera system for patient tracking during treatment. We report on the first patient with meningioma at the left petrous bone treated with adaptive fractionated stereotactic radiotherapy (a-gkFSRT). The first patient treated with Gamma Knife Icon at our institute received MR imaging for preplanning before treatment. For each treatment fraction, a daily CBCT was performed to verify the actual scull/tumor position. The system automatically adapted the planned shot positions to the daily position and recalculated the dose distribution (online adaptive planning). During treatment, the HDMM system recorded the intrafractional patient motion. Furthermore, the required times were recorded to define a clinical treatment slot. Total treatment time was around 20 min. Patient positioning needed 0.8 min, CBCT positioning plus acquisition 1.65 min, CT data processing and adaptive planning 2.66 min, and treatment 15.6 min. The differences for the five daily CBCTs compared to the reference are for rotation: -0.59 ± 0.49 /0.18 ± 0.20 /0.05 ± 0.36 and for translation: 0.94 ± 0.52 mm/-0.08 ± 0.08 mm/-1.13 ± 0.89 mm. Over all fractions, an intrafractional movement of 0.13 ± 0.04 mm was observed. The Gamma Knife Icon allows combining the accuracy of the stereotactic Gamma Knife system with the flexibility of fractionated treatment with the mask system and CBCT. Furthermore, the Icon system introduces a new online patient tracking system to the clinical routine. The interfractional accuracy of patient positioning was controlled with a thermoplastic mask and CBCT. (orig.) [German] Das Gamma Knife Icon (Elekta AB, Stockholm, Schweden) ermoeglicht die stereotaktische Behandlung von Patienten mittels Cone-beam-Computertomographie (CBCT

  7. Microsurgical Treatment of 90 Cases of Petroclival Meningioma%90例岩斜区脑膜瘤的显微手术治疗

    石磊; 卢明; 彭立辉; 陈静; 赵振宇


    【目的】总结切除岩斜区脑膜瘤显微手术经验和技巧。【方法】回顾分析本院1991年1月至2012年12月收治和手术证实岩斜区脑膜瘤90例患者的临床资料,中上斜坡向幕上发展者采用经幕上下联合入路35例,中下斜坡向幕下发展者采用幕下经乙状窦入路50例,上斜坡向岩尖及海绵窦发展者采用颞下小脑幕岩骨入路5例。【结果】90例93次手术,其中术后再出血第二次手术3例,肿瘤镜下全切除72例(80.0%),次全切除11例(12.2%),大部分切除7例(7.8%)。临床痊愈恢复正常工作70例,生活需要照顾18例,死亡2例。【结论】选择正确的手术入路,精巧的显微手术技巧,加强术后观察和积极处理并发症有助于提高岩斜区脑膜瘤的全切除,减少死亡和病残率。%Objective To summarize clinical experiences and microsurgical technique for the excision of petroclival meningiomas .[Methods]Clinical data of 90 patients with petroclival meningioma confirmed by sur-gery in our hospital from Jan .1991 to Dec .2012 was analyzed retrospectively .Of these patients ,35 patients with meningioma extending to supratentorium from mid-superior clivus underwent the surgery through the combined supratentorial-infratentorial approach ,and 50 patients with meningioma extending to infratentorium from mid-inferior clivus underwent the surgery through infratentorial sigmoid sinus approach .Five patients with meningioma extending to petrous apex and cavernous sinus underwent the surgery through subtemporal transpetrosal-transtentorial approach .[Results] Of 93 patients(93 operations) ,3 patients underwent re-oper-ation due to postoperative hemorrhage .Endoscopic total resection of the tumor was achieved in 72 patients (80% ) ,and subtotal resection was achieved in 11 patients(12% ) ,and partial resection was achieved in 8 pa-tients(8% ) .The 70 patients got clinical cure and recovered their normal

  8. 经扩大乙状窦后人路手术切除大型岩斜区脑膜瘤%Extended retrosigmoid approach for surgery of large petroclival meningiomas

    张岩松; 刘宏毅; 常义; 刘翔; 胡新华; 杨坤; 何升学


    Objective To evaluate the extended retrosigmoid approach for surgery of large petroclival meningiomas.Methods We retrospectively analyzed our experience in 6 patients with large petroclival meningiomas treated by extended retrosigmoid approach.The maximum diameter of tumors ranged from 3.4 to 6.7cm(mean,4.5cm).The sigmoid sinus and the transverse sinus were thoroughly exposed with the bone removal including mastoid and occipital bones.The stay sutures of the dura flaps were performed to pull the sigmoid sinus anteriorly and the transverse sinus upward to widen the opening into the infratentorial space and the posterior surface of the petrous bone.Results Gross total resection of the tumors was achieved in 3 cases,subtotal resection in 2 cases and partial resection in 1 case.No patients died.The neurological deficits improvement Was found in 1 case,unchanged in 3 cases,and 2patients were found to have new cranial nerves palsy.There Was no CSF leakage and infections after operations.There was no tumor recurrence or growth by MRI scanning during the follow-up period of 6 to 58 months in all patients.Conclusion The extended retrosigmoid approach can enhance the snrgical exposure,enlarge the operative view,cut the blood supply of tumor earlier,and avoid the excessive retraction on cerebellum,as well as facilitate the protection of these vital cranial nerves and vessels around brain stem.%目的 探讨扩大乙状窦后入路在显微手术切除大型岩斜区脑膜瘤巾的应用.方法 采用扩大乙状窦后入路的手术方式,显微切除人刑岩斜区脑膜瘤6例,肿瘤最大直径3.4~6.7 cm,平均4.5 cm,术中切除枕骨和乳突.完全显露横安和乙状窦,通过悬吊硬脑膜将它们分别向上方和前方牵开,有效地减少了两个粗大的静脉窦对小脑幕下方和岩骨背面的遮挡,手术视野明显增大,能够充分暴露小脑幕和岩骨背面.结果 本组肿瘤全切除3例,次全切除2例.大部切除1例,无手术死

  9. Microsurgical anatomy of the region of Dorello's canal%Dorello管区显微外科解剖学研究

    朱国臣; 韩卉; 牛朝诗


    目的为临床Dorello管区手术提供显微解剖学基础。方法在手术显微镜下对15例(30侧)成人头颅标本Dorello管区结构进行观测。结果①Dorello管由Gruber韧带、岩尖及上斜坡外侧缘三者构成的一个骨纤维管道。Dorello管顶主要由Gruber韧带构成,Dorello管顶至底间最大垂直距离为2.14 mm±0.70 mm。②展神经经过Dorello管外1/3(56.7%)或中1/3(43.3%)。展神经伴行动脉为脑膜背侧动脉的分支,83.3%以单干形式经过展神经内侧。③展神经入海绵窦点距颈内动脉后升部后壁3.97 mm±1.83 mm,在Meckel腔内侧3.11 mm±0.95 mm。结论在Dorello管区展神经及其伴行动脉位置恒定,手术中应予保护。%Objective To provide microanatomic basis for direct microsurgical operation on the region of Dorello's canal. Methods The structures of the region of Dorellos canal were observed and measured on 30 sides of adult cadaverical heads under microscope. Results ①Dorello's canal was an osteofibrous canal composed of Gruber ligament, petrous apex and the lateral border of the upper part of clivus. The roof of Dorello's canal was mainly composed of Gruber ligament. The maximal distance from roof to bottom of Dorello's canal was 2.14 mm±0.70 mm. ②Abducens nerves passed through the lateral 1/3(56.7%) or intermedial 1/3(43.3%) of Dorello's canal to the cavernous sinus. The nutrient arteries of abducens nerves were originated from the dorsal meningeal arteries, and 83.3% of them traversed Dorello's canal by one stem, medially to abducens nerves. ③The point of abducens nerves entering cavernous sinus was 3.97 mm±1.83 mm posterior to the ascending portion of intracavernous carotid artery, 3.11 mm±0.95 mm medial to the Meckel's cave. Conclusion In the region of Dorello's canal, the positions of abducens nerves and their nutrient arteries are steady, and they should be protected during operation.

  10. Value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia%射频热凝术前磁共振B-FFE序列三叉神经成像评估

    胡芸; 金朝林; 王翔; 张树桐; 蔡毅


    目的:探讨 CT 定位射频温控热凝治疗原发性三叉神经痛术前,磁共振平衡式快速梯度回波(B-FFE)序列三叉神经成像检查的必要性和临床意义。方法采用B-FFE 序列扫描63例拟行射频温控热凝治疗的原发性三叉神经痛患者的患侧三叉神经,观察三叉神经脑池段、半月神经节及其三大分支的解剖形态、走行方式,半月神经节与卵圆孔之间的位置关系,指导术中CT定位穿刺。结果本研究63例患者中,23例(37%)病变侧三叉神经跨岩骨尖时呈聚拢束状,40例(63%)病变侧三叉神经跨岩骨尖时呈三支分散状。眼神经走行于前内侧,下颌神经走行于后外方,上颌神经则走行于两者之间。三叉神经跨岩骨尖角度(150.11±8.32)°。卵圆孔至半月神经节距离(12.37±3.21) cm。结论三叉神经痛射频热凝温控治疗术前行磁共振B-FFE 序列三叉神经成像检查,明确相应解剖结构关系,可以提高术中 CT 定位的准确性,缩短手术时间,减低手术风险,具有较高的临床实用价值。%Objective To analyze the value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia..Methods The B-FFE Sequence were performed on 63 patients with primary trigeminal neuralgia before CT-guided radiofrequency thermocoagulation..MR images were analyzed to identify the relationship between trigeminal nerves and surrounding vessels,.the anatomy of trigeminal ganglion in Meckel′s caves and their branches,.the relationship between the trigeminal semilunar ganglion and the oval foramen..Results The affected trigeminal nerve roots were bundled (23/63, 37%) or divided (40/63, 63%) at (150.11±8.32) angle at the petrous apex before entering the Meckel′s caves. The ophthalmic division travelled anteromedially,.maxillary division in the middle,.and mandibular division posterolaterally

  11. Computed tomography and magnetic resonance imaging of congenital abnormalities of the temporal bone; Computertomographie und Magnetresonanztomographie kongenitaler Veraenderungen des aeusseren Ohrs, Mittel- und Innenohrs sowie des inneren Gehoergangs

    Czerny, C.; Imhof, H. [Abteilung fuer Osteologie, Univ.-Klinik fuer Radiodiagnostik, Wien (Austria); Gstoettner, W. [Univ.-Klinik fuer Hals-Nasen-Ohren-Heilkunde, Frankfurt/Main (Germany)


    Congenital abnormalities of the temporal bone are mostly accompanied by conductive or sensori-neural hearing loss. Before any therapeutic procedures are done high resolution CT (HRCT) and magnetic resonance imaging (MRI) should be performed to establish the correct diagnosis and to plan the potentially surgical intervention. HRCT best depicts osseous changes especially those of the external auditory canal and the middle ear containing the ossicles and the osseous structures of the temporal bone and the petrous bone containing the inner ear. MRI excellently shows soft tissue changes of the inner ear especially on the high resolution 3DT2-weighted sequences which give a superb contrast between the nerves and the cerebro-spinal fluid. Malformations of the external auditory canal consists of aplasia or hypoplasia and those of the middle ear range form extreme hypoplasia or aplasia to very mild deformations of the ossicles. Malformations of the inner ear also range form complete aplasia to very mild hypoplasia of the organs of the inner ear as well as malformations concerning the nerves in the internal auditory canal range from aplasia to hypoplasia. Malformations of the temporal bone can either occur isolated or in combination in which malformations of the external and middle ear may be accompanied by those of the inner ear. Furthermore, malformations of the temporal bone may also occur in otofacial, otocervical or otoskeletal syndromes. These syndromes may be accompanied by certain malformations of the temporal bone. HRCT and MRI are both excellent methods to depict congenital abnormalities of the temporal bone and of the inner ear and should be used as complementary methods because HRCT best depicts osseous changes and MRI superbly depicts soft tissue changes. Both methods are important to establish the correct diagnosis to plan the therapeutic procedures. (orig.) [German] Angeborene Missbildungen des Schlaefenbeins sind oft mit Schwerhoerigkeit bis Taubheit

  12. Anatomic features of the the Dorello's canal and its clinical significance%Dorello管区的解剖学特点及其临床意义

    张毅; 虞昊; 金国华; 陈霞


    目的 为颅底外科提供Dorello管区的解剖学资料. 方法 50例头颅标本进行血管灌注红、蓝乳胶或硅橡胶,对Dorello管区的构成、毗邻关系、内容物等进行观察和测量.对岩斜段展神经进行苏木精-伊红染色,研究该段展神经硬脑膜鞘的构成.结果 Dorello管由Gruber韧带、颞骨岩部尖端、上斜坡外缘构成,管内走行脑膜背侧动脉、展神经及其硬脑膜鞘.展神经硬脑膜鞘由硬脑膜和蛛网膜构成.Gruber韧带可以分为6型:Y-型,蝴蝶型,三角型,镰型,爪型和复干(条索状)型.展神经存在多种变异,复干型展神经出现率为16%,双侧都为复干型展神经的出现率为5%.展神经在Dorello管区出现转折,按转折的程度分为:重型(<120°)占60%(60侧),中型(120°~150°)占36%(36侧),轻型(150°~180°)占4%(4侧).结论 Dorello管区结构复杂,展神经变异多,对Dorello管区的研究有助于在手术中减少神经、血管的损伤,同时阐明展神经损伤的机理.%Objective To provide microanatomical data of the Dorello's canal for the skull base surgery. Methods The microsurgical anatomy of the Dorello's canal and its structures, adjacent structures and contents were observed and measured in each side of 50 adult cadaveric heads fixed in formalin, in which the arteries and veins were injected red and blue latex. HE staining of the abducens nerve in the petroclival segment was taken to observe the construction of dural sheath of the nerve. Results Dorello's canal was composed of Gruber's ligament, petrous apex and the lateral border of the upper part of clivus. The dorsal meningeal artery, abducens nerve and a dural sheath of the abducens nerve entered the Dorello's canal. The abducens nerve was surrounded by a sheath which consists of dura mater and arachnoid. Gruber's ligament was found in six patterns: Y-shaped, butterfly-shaped, triangular-shaped, falciform-shaped, claw-shaped, and duplicate (iunicular

  13. Clinicopathologic features of endolymphatic sac tumor at cerebellopontine angle%桥脑小脑角区内淋巴囊肿瘤五例临床病理分析及鉴别诊断

    杜江; 王军梅; 崔云; 李桂林


    ObjectiveTo study the clinicopathologic features and immunophenotype of endolymphatic sac tumor (ELST) and normal endolymphatic sac. Methods The clinical and histologic features were evaluated in 5 cases of ELST. Eight cases of choroid plexus papilloma at cerebellopontine angle and 2 cases of normal endolymphatic sac were used as controls. Immunohistochemical study for vimentin,AE1/AE3, CK8/18, CK5/6, EMA, GFAP, synaptophysin, S-100 protein, CEA, TTF-1, VEGF, D2-40,calponin, calretinin and Ki-67 was carried out. Results The age of onset of ELST ranged from 23 to 35years ( median =24 years ). The male-to-female ratio was 2 ∶ 3. The clinical presentation was tinnitus,otalgia, hearing loss, otorrhagia with effusion and headache. The duration of symptoms ranged from 6 months to 10 years. Local recurrences were noted in 3 cases. Radiologically, the tumors were located at cerebellopontine angle and demonstrated petrous bone destruction. Histologic examination showed that the tumors had a papillary-glandular pattern. The papillae were covered by a single layer of low cuboidal cells. The tumor cells had distinct cell borders and contained eosinophilic to clear cytoplasm. The nuclei were slightly atypical and sometimes apically located. Focal dilated glandular structures with colloid-like material were also identified. The surrounding stroma was vascularized. All of the 5 cases had dural or petrous bone infiltration. Immunohistochemical study showed that all of the 5 cases were positive for AE1/AE3, CK8/18,CK5/6 and VEGF, 4 cases for EMA, 3 cases for calponin (focal) , 2 cases for vimentin, 2 cases for S-100protein, 1 case for GFAP and 1 case for synaptophysin (focal and weak). The Ki-67 index measured less than 1%. The staining for D2-40, calretinin, CEA and TTF-1 was negative. The 2 cases of the normal endolymphatic sac were positive for AE1/AE3 and CK8/18, and negative for CK5/6, EMA, S-100 protein,GFAP and synaptophysin. The 8 cases of choroid plexus papilloma were

  14. Combined supra-and infra tentorial surgical keyhole approach to petroclival region:microanatomy%幕上下锁孔联合入路岩斜区显微解剖

    单明; 程宏伟; 冯春国; 李长元; 李志范; 张科


    , suprasellar regions and the middle cranial fossa could be obtained via subtemporal approach. Incision of the tentorium exposed the inferior part of prepontine cistern and ambient cistern. A way to the cerebellopontine angle cistern could not be acquired due to the blocking effect of petrous apex. The volume mean of exposing to petroclival region was 3. 38 cm3 . ② Suboccipito-retrosigmoid sinus approach has a good view to cerebellopontine angel cistern, posterior ambient cistern and prepontine cistern, and its exposed volume mean was 2. 27 cm . ③ The space from the posterior part of the cavernous sinus to the opening of Meckel's cave was a blind angle for combined approach and its volume mean was 0. 89 cm3 , which could be exposed with neuroendoscopy. Conclusion ① The two approaches mentioned above have good complementation. ② The space from the posterior part of the cavernous sinus to the opening of Meckel's cave is a blind angel and it covers small space. ③ The blind angle could be exposed under neuroendoscopy, on which the operation feasibility still needs to be discussed due to small space. Gamma knife is safe and effective for small tumor remnants.

  15. 内窥镜配合显微镜微血管减压治疗三叉神经痛%Endoscopic-assisted Microvascular Decompression for Trigeminal Neuralgia

    陆川; 孙军; 陈献东


    Objective To summarize our experience in endoscopic-assisted microvascular decompression for trigeminal neuralgia. Methods Since March 2008 to March 2011, we performed endoscopic-assisted microvascular decompression on totally 41 patients with trigeminal neuralgia. By endoscopy, we explored the cisternal segment of the trigeminal nerve, and then the root entry zone and Meckel' s cave to identify the vessels compressing or touching the root of the trigeminal nerve. The vessels were cut by electrocoagulation (veins) or separated with Teflon felt ( arteries). Results Among the patients, the trigeminal nerves were compressed by arteries alone in 29 cases, by veins alone in 6, and by both arteries and veins in the other 6. The involved arteries included the superior cerebellar artery (25 cases) , anterior inferior cerebellar artery (5 cases) , posterior inferior cerebellar artery (3 cases) , basilar artery (2 cases) , and twisted vertebral artery (2 cases) ; in two of these patients, two arteries were involved in two cases. The involved vein was the branch of the petrous vein (12 cases). After the operation, immediate pain extinction was achieved in 34 patients, delayed complete pain alleviation was reported by 5 cases in two weeks (4 patients) or one month (1 patient) , in the other two patients, the pain was not relieved. The effective rate of the procedure was 95. 1% (39/41). Postoperative complications included mild facial paralysis and tinnitus (1 case) , and facial numbness (1 case) , both the symptoms disappeared in three weeks. The 39 effective cases were followed up for a mean of 21.4 months (6 months to 3 years, > 12 months in 31 patients) , during which no patient had recurrence. Conclusions Microvascular decompression is effective for trigeminal neuralgia. We recommend endoscopic-assisted technique to decrease the rate of surgical complications and trauma, and avoid missing any involved arteries.%目的 总结采用内窥镜配合显微镜微血管减压术

  16. 岩上静脉的解剖学研究%Anatomical Study of Superior Petrosal Vein and its Clinical Significance

    王圆庆; 田继辉; 张福强; 刘仲涛; 何鹏; 刘文庆; 陈鹏飞


    Objective To investigate anatomical characteristics of the superior petrosal vein and to provide anatomical basis of superior petrosal vein for operation with in cellelumpontine angle.Methods The morphology,course,entrance location and the surrounding tissue markers distance relationship of the superior petrosal vein(SPV) were observed in 10 cases (20 sides) adult headspecimens,which were fixed in 10% formalin and irrigation colorful silicone.Results In the 20 side specimens,the superior petrosal vein were found in 19 side,a total of 25 branches.①Superior petrosal vein usually imported 2/3 of the petrosal sinus along the petrous ridge.Superior petrosal vein was variation in the individual.②The length of Superior petrosal vein was (11.15 ± 4.36) mm,and the outer diameter was (3.83 ± 0.97) mm.③The stem of the SPV,according to injected petrosal sinus,was divided into:single-stem type had 12 sides(63.16%),double-stem type had 5 sides(26.32%),triple-stem type 1 sides(5.26%) and Lack of such as 1 side(5.26%).The branch of SPV was divided into:single branch 2 side (10.53%),double type 12 side (63.16%),the three 4 side (21.05%) and four type 1 side (5.26%).④According to SPV relationship With the Meckel's cave and internal acoustic meatus(IAM),the patterns of drainage of the SPV were classified into three groups.Type Ⅰ had 4 roots (16%),Type Ⅱ had 16 roots (64%),Type Ⅲ had 5 roots(20%).Conclusion The site which the SPV emptied into the superior petrosal sinus had relationship tightly with the MC and IAM,and located in between the two.Familiar with the SPV microsurgical anatomy and drainage type,it is of clinical significance for clinical surgery involved in the vein of the cerebellopontine angle area.%目的 通过对岩上静脉(SPV)进行应用解剖学研究,为临床桥小脑角区手术提供解剖学参考资料.方法 10例(20侧)甲醛固定并经彩色硅胶灌注的成人头颅湿标本,解剖并观测SPV的形态、行径

  17. 自发性脑动脉夹层致脑梗死临床及影像分析%A analysis for clinical and imaging feature of spontaneous cerebral infarction caused by cerebrovascular dissections

    胡珏; 赵志鸿; 陈海


    Objective To explore the clinical and imaging feature of cerebral infarction caused by spontaneous cerebrovascular dissections. Methods The clinical, cerebrovascular ultrasonography and imaging date from seven patients with cerebral infarction caused by spontaneous cerebrovascular dissections confirmed by digital subtraction angiography were analyzed retrospectively. Results There were three male and four female cases aged from 33 to 52 years with average of 42.9 ±6.6. Six patients had pain in homolateral head and neck as first symptom . Two patients had TIA before cerebral infarction. Four patients with anterior-circulation infarction showed hemiparalysis , among which one showed paroxysmal blurred vision of right eye. Three patients with posterior - circulation infarction. Two complained with dizziness, and speech unclealy while one showed Wallenberg syndrome. Computed tomography angiogram were finished in two cases and the severe stenosis accompanied localized extension of the right ICA or the left VA were shown respectively. One case had a cervical vertebrae MRI scanning and the right vertebral artery appeared as a linear filling defect with a double lumen. Internal cervical artery dissections occurred in cervical segment (three case) and petrous segment (one case). The sites of vertebral artery (VA) dissections were V2 segment in two cases and V4 segment in one case. DSA showed severe stenosis (string sign) with localized extension, a flame-shaped occlusion, a dissecting aneurysm, a segmental stenosis proximal to a dissecting aneurysm (string-and-pearl sign) . Anticoagulant therapy was given in 5 patients and antiplatelet treatment was given in 2. NIHSS was from 0 score to 9 scores ( average score 2.9 ± 3.3 ) on the admission and from 0 score to 6 scores (average score 1.1 ±2.3) on discharge. After follow up of 3 ~ 12 months, Modified Rankin Scale scores were 0 in five cases and 1 in one case and 2 in one case. Conclusion Cerebral infarction caused by

  18. Sydenham's chorea in western Pennsylvania.

    Zomorrodi, Arezoo; Wald, Ellen R


    mean age of presentation was 9.8 years (range: 5-14.5 years). Chorea was unilateral in 23 (30%) patients. Family history of ARF existed in 30% of patients. Neurologic symptoms of SC included behavior change (46%), dysarthria (67%), gait change (51%), deterioration of handwriting (29%), and headache (11%). Nonneurologic manifestations of ARF were carditis (44%), arthritis (11%), erythema marginatum (3%), and subcutaneous nodules (0%). Antecedent group A streptococcal infection was documented in 99% of patients who were tested by an elevated antistreptolysin O titer (n = 53), an elevated anti-deoxyribonuclease B titer (n = 7), a positive streptozyme (n = 53), or acute throat infection with Streptococcus pyogenes (n = 19). A total of 52 neuroimaging tests were obtained from 46 patients with SC. In patients with SC, brain MRI was abnormal in 8 of 32 patients, and brain computed tomography was abnormal in 1 of 20 patients. Abnormalities did not aid in diagnosis and included nonspecific increased signal (n = 2), nonspecific punctate lesions (n = 2), asymmetry of the hippocampal fissures, unrelated petrous bone anomaly, Arnold Chiari malformation, and medulloblastoma in a macrocephalic patient. Three patients with chorea that was not attributed to ARF had atypical presentations: 1 developed chorea after a perioperative hypoxic/ischemic central nervous system insult; 1 had an episode of disorientation, aphasia, and transient facial droop (angiography showed basal ganglia infarct); and 1 with hemichorea had basal ganglion infarct seen on MRI. Ninety-six percent of children who had acute chorea and presented to a large children's hospital in an area that is endemic for ARF had SC. These patients had characteristic demographic and clinical features of SC. The most common concurrent major Jones criterion was carditis. Arthritis, erythema marginatum, and subcutaneous nodules were uncommon in this population. Neuroimaging was obtained in 58% of patients with SC and did not aid in

  19. Peritonite meconial como diagnóstico diferencial de ascite fetal: relato de caso Meconium peritonitis in the differential diagnosis of fetal ascites: a case report

    Melania Maria Ramos de Amorim


    include fetal ascites and intra-abdominal calcifications. Evidence suggests that prenatal diagnosis can improve postnatal prognosis. Case Report: R.C.M.S., 22 years, II pregnancy O para, presented ultrasound (12/02/98 with diagnosis of fetal ascites. Investigation for hydrops fetalis was performed and immune and nonimmune causes were excluded. Severe fetal ascites persisted on subsequent ultrasound examinations, without calcifications. Vaginal delivery occurred at 36 weeks (01/02/99, with polyhydramnios. Female neonate weighing 2,670 g, with signs of respiratory distress, abdominal distension and petechiae. Abdominal distension worsened progressively, with palpation of a petrous tumor in the right upper quadrant and elimination of white mucus at rectal examination. Radiological findings (01/04/99 were disseminated abdominal calcifications, intestinal dilatation and absence of gas at rectal ampulla. Exploratory laparotomy was indicated with diagnosis of meconium peritonitis. A giant meconium cyst and ileal atresia were observed and lysis of adhesions and ileostomy were performed. Initial postoperative evolution was satisfactory but was subsequently complicated by sepsis and neonatal death occurred (01/09/99. Conclusion: meconium peritonitis should be remembered at differential diagnosis of fetal ascites. In the present case, surgical indication could be anticipated if prenatal diagnosis were established, with improvement of neonatal evolution.

  20. Sectional Anatomy and MRI of Trigeminal Nerve%三叉神经颅内段横断层解剖与 MRI

    陈光平; 刘树伟; 孙博; 汤煜春; 林祥涛; 葛海涛; 梁长虎; 冯蕾; 刘书涛; 田广平


    of the cavernous sinus and sent out ophthalmic nerve which entered the orbital cavity by the superior orbital fissure after passing through the lateral wall of cavernous sinus;On the cross section through carotid canal , trigeminal ganglion sent out maxillary nerve and mandibular nerve, which was in the rear of petrous bone , clips between the section of sphenoid body and temporal lobe;On the cross section through foramen oval , there were foramen oval and foramen spinosum on the greater wing of sphenoid bone through which the mandibular nerve and the middle meningeal artery passed respectively .The i-dentification of the trigeminal nerve on the transverse MRI scanning was corresponding with the horizontal sec -tional specimen.Conclusions:The serial transverse sectional specimens combining with 3D-CISS MRI has ad-vantages on displaying the course , morphology and adjacent relationships of the cisternal segment , the ganglion segment and the skull base segment of the trigeminal nerve .