"Extarterectomy" for tumors invading the carotid artery: an animal model.

OBJECTIVE: Carotid artery (CA) invasion by head and neck tumors is a challenging problem for the cranial base surgeon. Proposed methods for management have the disadvantage of constant or temporary interruption of the arterial blood flow and, as a consequence, cerebral ischemic complications. The objective of the study was to investigate the long-term effects of a novel technique, "extarterectomy," on the vascular wall and the arterial blood flow in an ovine model. METHODS: Wallstents were implanted bilaterally in the common CA of 5 sheep by the Seldinger technique. Six weeks after stent implantation, a segment of the arterial wall of about 2 cm in length was peeled off the external surface of the stent. Six months later, control angiography was performed. The animals were sacrificed after 18 months and the "extarterectomized" arteries were removed for the microscopic and macroscopic evaluation. RESULTS: There were no acquired neurological deficits in the study group. Extarterectomy was performed without any complication in every case. Control angiography confirmed patent CAs. Evaluation by light microscopy showed the "neointimal" layer within the interstices of the stent. CONCLUSION: Extarterectomy allows aggressive tumor removal together with the maintenance of blood flow through the CA and offers hope for those with tumors invading the CA.

HIV related toxoplasmic encephalitis mimicking multiple metastasis: case report.

We report a case of toxoplasmic encephalitis (TE) in a young woman without prior history of human immunodeficiency virus (HIV) infection. She was referred to our clinic with a diagnosis of multiple metastases following cerebral magnetic resonance imaging (MRI) revealing multiple ring-enhanced mass lesions. She had suffered from headaches for four weeks and there had been new onset of confusion and left hemiparesis. Soon after hospitalization, her neurological status rapidly deteriorated and she was operated for decompression. Pathology examination revealed TE and her blood samples were found to be HIV positive. We conclude that TE should be considered in the differential diagnosis of multiple lesions in sexually active individuals including cases without a prior history of HIV infection.

Management of Calvarial Tumors: A Retrospective Analysis and Literature Review.

AIM: Tumors of various organs that metastasize to bone do not neglect calvarium as a target. The aim of this study was to characterize the calvarial tumors. MATERIAL AND METHODS: We retrospectively reviewed 45 consecutive patients operated for calvarial masses from January 2002 till May 2012 at our hospital. Skull base tumors and patients ≤18 years were excluded. RESULTS: Three groups of lesions were found - calvarial metastases (15/45), primary tumors (5/45) and tumor-like lesions (25/45). Malignant lesions were equitable by gender distribution, higher age of onset (median age of primary =55; secondary = 60 years) and benign lesions by younger age (median = 35) and female bias (18/25). Calvarial metastases mostly presented with local swelling (10/15), local pain (6/15) and rarely neurologic deficit. There was associated dural sinus thrombosis (4/20 of malignant; 1/25 of benign lesions) and osteolysis (3/5 primary malignant, 13/15 secondary and 18/25 of benign lesions). Complete surgical excision was possible with minimal morbidity in all except one patient and nil mortality. CONCLUSION: Nearly half (20/45) of the calvarial lesions tend to be malignant with most of them presenting as silent painless masses. Surgical excision should be considered only after suitable investigation and appropriate neurosurgical set-up.

Spinal meningeal melanocytoma. Report of two cases and review of the literature.

The authors report on two patients with spinal meningeal melanocytoma and review the literature on this lesion. One case is particularly interesting because of the lesion's thoracic intramedullary localization. Meningeal melanocytoma is a benign but locally aggressive lesion and is very rarely associated with spinal localizations. This patient presented with paraparesis. Clinical and radiological examinations suggested the possibility of an intramedullary solid tumor. Thoracic laminectomy, posterior myelotomy, and tumor resection were performed; the mass was totally removed. The patient suffered no additional neurological deficit. During a 3-year follow-up period in which radiotherapy was not performed, the lesion did not recur. Total excision of the tumor is the best therapeutic option.

Facial nerve neuroma: clinical, diagnostic, and surgical features.

Facial nerve neuromas are uncommon benign tumors. The diversity of tumor locations and their proximity to vital neurovascular structures create a variety of clinical situations, and the management strategy for each case differs. Two cases with tumors located at different sites and associated with different clinical presentations are discussed in terms of diagnosis and management.

'The columellotomy modification' of transseptal hypophysectomy.

OBJECTIVE: Although the transseptal approach to the sella turcica is the most common method by which the pituitary tumors are resected, it is not suitable for the noses with narrow nostrils, precluding the placement of the neurosurgical speculum. In this paper, as a solution for this problem, 'the columellotomy modification' of the transseptal approach is suggested and described together with the results in five patients. METHODS: In five patients, the distance between the outer edges of the two blades of the neurosurgical speculum was measured after positioning the neurosurgical speculum through the hemitransfixion incision, and after positioning the neurosurgical speculum through 'the columellotomy' incision. The increase in distance after hemitransfixion incision with respect to the width of the nostril was statistically compared with the increase in distance after 'columellotomy' incision with respect to the width of the nostril. The postoperative complaints and cosmetic results were evaluated. RESULTS: By paired-samples t-test, the comparison between the values of increase revealed a statistically significant difference (P=0.011). A complaint of numbness on the columellar skin was noted in three of the five patients. Cosmetic results were satisfactory. CONCLUSION: 'The columellotomy modification' offers a wide, direct and fast exposure to the sella turcica without a cosmetic disadvantage in noses with narrow nostrils.