Mid-term outcomes of mastoid obliteration with biological hydroxyapatite versus bioglass: a radiological and clinical study.

PURPOSE: Radiological assessment of osseointegration of mastoid grafts: biological hydroxyapatite (Bio-Oss®) (BHA) versus bioglass S53P4 (Bonalive®) (BG). METHODS: Retrospective (10 ± 4 months post-surgery) monocentric high resolution computed tomography (CT) scan assessment (November 2018 and October 2020) by two independent radiologists (R1, R2), blinded to patient allocation. All patients who had undergone a total mastoid obliteration were eligible. Excluded: complications namely otological acute or chronic infections, unbalanced metabolic disease, long-term cortico-steroid therapy, auto-immune disease, history of allergy to grafting materials and post-surgery CT scan in other centers (n = 8). PRIMARY OUTCOMES: the ratio between two regions of interests (ROI) (graft to otic capsule). SECONDARY OUTCOMES: resorption of mastoid grafts and assessment of clinical tolerance. RESULTS: Included 21 patients (mean age: 29 ± 21 years; 5 females, 16 males). Significantly higher osseointegration for BHA vs. BG (R1 p = 0.043; R2 p = 0.004); almost perfect inter-reader agreement k = 0.922). The ROI ratios for BHA and BG to that of the otic capsule were 0.57 ± 0.11 (R1) and 0.59 ± 0.14 (R2); 0.43 ± 0.11 (R1) and 0.43 ± 0.08 (R2), respectively. Density increased significantly by 399 ± 261 Hounsfield units (HU) (p = 0.008) and decreased by 464 ± 161 HU (p < 0.001) for BHA vs. BG. Resorption rates were 24.1 ± 21.0% and 66.7 ± 15.1% (p = 0.076), respectively. No significant difference in clinical tolerance was observed. CONCLUSION: Post-operative CT scan of mastoid obliteration seems reliable in assessment of biomaterial graft's mid-term feasibility and stability: BHA seems to provide a more optimal osseointegration versus BG with no significant differences in graft resorption and clinical tolerance.

High-resolution computed tomography of isolated congenital anomalies of the stapes: a pictural review using oblique multiplanar reformation in the "axial stapes" plane.

PURPOSE: Isolated congenital anomalies of the stapes are infrequent but highly variable. The goal of this study is to present the numerous observed anomalies based on a large number of cases, and to describe anatomical variations and malformations of the stapes using high-resolution computed tomography (CT), after proper reorientation in the "axial stapes" plane. MATERIALS AND METHODS: The 1805 CT of temporal bones performed during the past 5 years have been retrospectively studied. After reconstructing the images in the stapes axial plane, the ears presenting a congenital anomaly of the stapes were included in this study. All the ears with acquired lesions were excluded. The anomalies have been sorted according to the affected part of the stapes: the superstructure, the footplate or the obturator foramen. Two neuroradiologists classified the anomalies as either anatomical variation, malformation, or undetermined. RESULTS: Sixty-one stapes in 47 patients were found to have one or more congenitally abnormal shapes (bilateral anomalies were found in 14 of these patients). The abnormal part of the stapes was the superstructure in 17 cases, the footplate in 13 cases, the obturator foramen in 19 cases (with a high frequency of "double stapes" shape) while in 12 cases multiple parts were affected. CONCLUSION: The use of ossicle reconstructions in the "axial stapes" plane with current multislice CT allows analyzing even minor congenital anomalies of the stapes. The boundaries between normal variations and malformations are sometimes difficult to set, especially when anomalies are minor. Malformations are more easily diagnosed when multiple parts of the stapes are affected.

Temporomandibular joint: a methodology of magnetic resonance imaging 3-D reconstruction.

OBJECTIVE: The aim of this study was to develop a new method for the 3-dimensional reconstruction of the temporomandibular joint (TMJ) images by means of magnetic resonance imaging (MRI). In a preliminary study, this modality of 3-D representation was tested to evaluate the joint motion. STUDY DESIGN: Sagittal MRI slices were obtained from a healthy subject. Acquisitions were realized by a spin-echo sequence, with a proton-density weighting and a 2-mm slice thickness. A 3-D reconstruction of the TMJ images was performed. RESULTS: Three-dimensional representations of the temporomandibular joint were obtained. The depiction of the principal anatomical elements of this joint was realized. A study of TMJ dynamics was also carried out. In this case, movements of the right and left disks and condyles were measured. CONCLUSION: This 3-D reconstruction methodology allowed a more understandable anatomical description than 2-D images of the TMJ and offered possibilities for joint functional analysis.

Retrospective study of 19 patients with intramedullary spinal cord metastasis.

OBJECT: Intramedullary spinal cord metastasis (ISCM) is a rare but devastating complication of cancer. Due to both widespread MRI availability and longer survival of cancer patients, the probability of discovering an ISCM during the course of the disease has increased and raised issues regarding the management of these patients, and particularly the place of surgery. In this study, we assess predictive factors for surgical outcome and survival. PATIENTS AND METHODS: We retrospectively reviewed a series of 19 patients consecutively admitted in our institution from 1993 to 2006 for ISCM, representing the second largest series published in the literature. MRI was performed on all patients. Thirteen underwent microsurgical excision of ISCM. Functional outcome was evaluated and factors influencing survival were statistically analyzed. RESULTS: Median survival was statistically longer when surgery was performed (7.4 vs. 2.6 months). Preoperative neurological status, nature of primary cancer, presence of systemic and/or CNS metastases influenced survival, but differences were without statistical significance. Neurological status improved in 58% (11/19) of operated patients. CONCLUSIONS: Optimal management of patients with ISCM is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Diagnosis should be made as early as possible and surgical resection should be considered as the primary treatment whenever feasible, particularly in the case of rapidly progressive neurological deficits and when a clear cleavage plane exists. Our study shows that surgery could result in both increased survival rate and significant improvement of neurological function.