Endoscopic Endonasal Transpterygoid Approach Using Pedicled Nasoseptal Flap for Petrous Apex Cholesterol Granuloma With Intraoperative Video.

With the development of minimally invasive endoscopic surgery and image-guided navigation systems, the endoscopic endonasal approach to petrous apex lesions has become more favorable. In this case, a petrous apex cholesterol granuloma was successfully treated with an endoscopic endonasal transpterygoid approach. A navigation system was used, and a contralateral nasoseptal flap and silicone tube stent were applied to maintain the cholesterol granuloma drainage pathway. The authors describe the endoscopic endonasal transpterygoid approach using a pedicled nasoseptal flap for petrous apex cholesterol granuloma and provide an intraoperative video and a literature review.

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

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.

Primary intra-diploic meningioma in a child.

BACKGROUND: Primary intra-diploic meningiomas are uncommon in childhood and, at the clinical onset, may be confused with other and more frequent bone tumours because they lack specific clinical and radiological characteristics. Surgery is indicated not only to remove the lesion but also to obtain an accurate histological diagnosis. CASE REPORT: We report the case of a young girl who presented with a recently developed subcutaneous hard mass in the left pterional region. Neuroradiological investigations revealed an intra-osseous lytic mass with a sclerotic reaction. Diagnosis was possible only after the total removal of the tumour and its histological examination.

[Infralabyrinthine approach for cholesterol granuloma of the petrous apex]. / Granulomes à cholestérine de l'apex pétreux : intérêt du drainage par voie infra-labyrinthique.

Cholesterol granuloma of the petrous apex are cystic lesions, revealed by otologic and/or cranial nerve palsies, and diagnosed with the help of computed tomography and magnetic resonance imaging. Surgical treatment is not the complete removal of the lesion, but a conservative approach requiring drainage of the cyst and re-establishment of a correct aeration of the cavity. Three cases of cholesterol granuloma of the petrous apex were treated through a transmastoid infralabyrinthine procedure. Through a postauricular approach, a simple mastoidectomy was performed. The third portion of the facial nerve was identified. The posterior and lateral semicircular canals, and the jugular bulb were skeletonized. In two cases, a high diverticulum of the jugular bulb was impacted downwards with wax. The cystic lesion was then opened, and evacuated. The opening must be large to permit a correct aeration of the cavity and prevent stenosis of the drainage site. Hearing and the facial function were preserved in all cases. In conclusion, conservative approach to cholesterol granuloma of the petrous apex provides satisfactory drainage of this intrapetrous deep seated lesion with preservation of hearing and facial nerve function.