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1.
Chinese Journal of Traumatology ; (6): 156-160, 2022.
Article in English | WPRIM | ID: wpr-928492

ABSTRACT

PURPOSE@#Auditory nerve injury is one of the most common nerve injury complications of skull base fractures. However, there is currently a lack of auxiliary examination methods for its direct diagnosis. The purpose of this study was to find a more efficient and accurate means of diagnosis for auditory nerve injury.@*METHODS@#Through retrospectively analyzing the results of brainstem auditory evoked potential (BAEP) and high-resolution CT (HRCT) in 37 patients with hearing impairment following trauma from January 1, 2018 to July 31, 2020, the role of the two inspection methods in the diagnosis of auditory nerve injury was studied. Inclusion criteria were patient had a clear history of trauma and unilateral hearing impairment after trauma; while exclusion criteria were: (1) severe patient with a Glasgow coma scale score ≤5 because these patients were classified as severe head injury and admitted to the intensive care unit, (2) patient in the subacute stage admitted 72 h after trauma, and (3) patient with prior hearing impairment before trauma. According to Goodman's classification of hearing impairment, the patients were divided into low/medium/severe injury groups. In addition, patients were divided into HRCT-positive and negative groups for further investigation with their BAEP results. The positive rates of BEAP for each group were observed, and the results were analyzed by Chi-square test (p < 0.05, regarded as statistical difference).@*RESULTS@#A total of 37 patients were included, including 21 males and 16 females. All of them were hospitalized patients with GCS score of 6-15 at the time of admission. The BAEP positive rate in the medium and severe injury group was 100%, which was significantly higher than that in the low injury group (27.27%) (p < 0.01). The rate of BEAP positivity was significantly higher in the HRCT-positive group (20/30, 66.7%) than in the HRCT-negative group (1/7, 14.3%) (p < 0.05). Twenty patients (54.05%) were both positive for BEAP and HRCT test, and considered to have auditory nerve damage. Six patients (16.22%) were both negative for BEAP and HRCT test, and 10 patients (27.03%) were BAEP-negative but HRCT-positive: all the 16 patients were considered as non-neurological injury. The rest 1 case (2.70%) was BAEP-positive but HRCT-negative, which we speculate may have auditory nerve concussion.@*CONCLUSION@#By way of BAEP combining with skull base HRCT, we may improve the accuracy of the diagnosis of auditory nerve injury. Such a diagnostic strategy may be beneficial to guiding treatment plans and evaluating prognosis.


Subject(s)
Cochlear Nerve , Evoked Potentials, Auditory, Brain Stem/physiology , Female , Hearing Loss , Humans , Male , Retrospective Studies , Skull Base/diagnostic imaging , Tomography, X-Ray Computed
2.
Rev. Hosp. Ital. B. Aires (2004) ; 41(4): 187-192, dic. 2021. ilus
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1366967

ABSTRACT

La sinusitis micótica alérgica es una enfermedad inflamatoria de la mucosa rinosinusal producida por hongos que pueden aislarse de la cavidad de nasal de individuos sanos. Se produce indirectamente por los hongos que actúan como antígeno y desencadenan una reacción inmunológica mediada por IgE que origina pólipos y una secreción mucosa espesa con detritus e hifas denominada mucina. Su presentación clínica más frecuente es una sinusitis crónica unilateral o bilateral con pólipos. Con menos frecuencia, las sustancias originadas por la desgranulación de los eosinófilos producen remodelación o destrucción ósea y la sinusitis puede simular una neoplasia. Se describe el caso clínico de un paciente que padeció una sinusitis micótica alérgica con destrucción ósea masiva de la base del cráneo y que tuvo extensión intracraneal extradural e intraorbitaria de la enfermedad. Fue tratado con éxito mediante cirugía y corticoides. (AU)


Allergic fungal sinusitis is an inflammatory disease of the rhinosinusal mucosa caused by fungi that can be isolated from the nasal cavity of healthy individuals. The pathology is produced indirectly by the fungus that acts as an antigen and triggers an IgE-mediated allergic reaction that causes polyps and a thick mucous discharge with detritus and hyphae called mucin. Its most common clinical presentation is unilateral or bilateral chronic sinusitis with polyps. Less commonly, substances originated by the degranulation of eosinophils cause bone remodeling or destruction, and sinusitis can simulate a neoplasia. We describe the clinical case of a patient who suffered from allergic fungal sinusitis with massive bone destruction of the skull base and who had intracranial, extradural and intraorbital extension of the disease. He was successfully treated with surgery and corticosteroids.Key words: allergic fungal sinusitis, intracranial extension, endoscopic surgery, transorbital transpalpebral approach. (AU)


Subject(s)
Humans , Male , Middle Aged , Sinusitis/diagnostic imaging , Skull Base/physiopathology , Rhinitis, Allergic/diagnostic imaging , Invasive Fungal Infections/diagnostic imaging , Curvularia/pathogenicity , Sinusitis/surgery , Sinusitis/drug therapy , Prednisone/administration & dosage , Skull Base/surgery , Budesonide/administration & dosage , Rhinitis, Allergic/surgery , Rhinitis, Allergic/drug therapy , Invasive Fungal Infections/surgery , Invasive Fungal Infections/drug therapy
3.
Braz. j. otorhinolaryngol. (Impr.) ; 87(6): 689-694, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1350338

ABSTRACT

Abstract Introduction: Endoscopic access to the sellar region by videoendoscopy shows a low rate of surgical complications, with findings that indicate risk factors for reducing morbidities during and after the postoperative period. Objective: To evaluate, over a nine-year period, the acquisition of skills by the anterior skull base surgical team, according to the time of elimination of nasal crusts and/or the presence of morbidities in the postoperative follow-up of individuals treated in a tertiary public hospital. Methods: After confirming the diagnosis of skull base pathologies, the individuals in this study underwent endoscopic surgery according to the rostrocaudal or coronal axis. For the skull base reconstruction, the nasoseptal flap (associated or not with fascia lata with thigh fat) or free graft was used; clinical follow-up of individuals occurred for a minimum period of 12 months. To assess the impact of the surgical approach on patient clinical evolution, qualitative data related to smoking, post-nasal discharge, nasal flow, smell, taste, clinical symptoms of headache, cranial paresthesia, comorbidities and postoperative morbidities were obtained. Results: The most frequent diagnosis was pituitary macroadenoma (84.14%). The mean absence of crusts in this cohort was 124.45 days (confidence interval 95% = 119.50-129.39). There was a low cerebrospinal fluid fistula rate (3%). Reconstruction with the nasoseptal flap with a fat graft was an independent variable that recorded the highest mean time for the elimination of nasal crusts (=145 days, confidence interval 95% = 127.32-162.68). Allergic rhinitis and smoking were shown to be the most important and independent variables that increased the mean time to eliminate nasal crusts. Conclusion: The mean time to eliminate nasal crusts did not change over the years during which the procedures were performed, demonstrating the adequate training of the surgical team. Debridement and nasal irrigation with saline solutions should be performed more frequently and effectively in patients with allergic rhinitis, smokers and those who received the nasoseptal flap and fascia lata graft with autologous fat.


Resumo Introdução: O acesso endoscópico à região selar por videoendoscopia demonstra baixo índice de complicações cirúrgicas, com achados que apontam fatores risco para reduzir as morbidades durante e após o período pósoperatório. Objetivo: Avaliar fatores morbidades no seguimento pós-operatório de indivíduos atendidos em um hospital público terciário. Método: Depois de confirmado o diagnóstico de doenças da base do crânio, os indivíduos deste estudo foram submetidos a cirurgia endoscópica conforme o eixo rostrocaudal ou coronal. Para a reconstrução da base do crânio usava-se o retalho nasoseptal (associado ou não à fáscia lata com gordura de coxa) ou enxerto livre; o seguimento clínico dos indivíduos ocorreu por um período mínimo de 12 meses. Para avaliar o impacto da abordagem cirúrgica na evolução clínica dos pacientes foram obtidos os dados qualitativos relativos ao tabagismo, descarga pós-nasal, fluxo nasal, olfato, paladar, sintomas clínicos de dor de cabeça, parestesia craniana, comorbidades e morbidades pós-operatórias. Resultados: O diagnóstico mais frequente foi o macroadenoma hipofisário (84,14%). A média da ausência de crostas nesta coorte foi de 124,45 dias (intervalo de confiança [95% CI] 119,50-129,39). Baixo índice de fístula liquórica (3%). A reconstrução com o retalho nasoseptal com enxerto de gordura apresentou-se com variável independente que necessitou de maior tempo médio para a eliminação de crostas nasais (=145 dias, 95% CI 127,32-162,68). A rinite alérgica e o tabagismo se demonstraram como as variáveis mais importantes e independentes para aumentar o tempo médio de eliminação de crostas nasais. Conclusão: O tempo médio de eliminação de crostas nasais não se alterou ao longo dos anos em que os procedimentos foram feitos. Deve-se fazer com maior frequência e eficácia o debridamento e as irrigações nasais com soluções salinas nos pacientes com rinite alérgica, tabagistas e os que usaram o retalho nasoseptal e enxerto de fáscia lata com gordura autóloga.


Subject(s)
Humans , Reconstructive Surgical Procedures , Postoperative Period , Retrospective Studies , Follow-Up Studies , Morbidity , Treatment Outcome , Skull Base/surgery , Endoscopy , Nasal Septum/surgery
4.
Article in Spanish | LILACS, COLNAL | ID: biblio-1349481

ABSTRACT

El quiste dermoide es una lesión congénita poco frecuente, secundario a una regresión incompleta de tejido ectodérmico, y su incidencia es de 1/20 000-40 000 nacidos vivos. Debe realizarse una resección quirúrgica oportuna para prevenir el compromiso intracraneal y/o las complicaciones. El estudio imagenológico determina su extensión. Se han recomendado diferentes enfoques quirúrgicos, los cuales deben cumplir con los cuatro principios de Pollock. El siguiente estudio presenta el caso de un paciente pediátrico, de nueve meses de edad, con un quiste dermoide en la base del cráneo asociado con un trayecto fistuloso a punta nasal. La resonancia magnética nuclear (RMN) contrastada evidenció una masa quística en la región anterior a la crista galli comunicada con el tracto fistuloso a la punta nasal. El paciente fue llevado a cirugía para realizar la resección del quiste mediante rinoplastia externa combinada con abordaje endoscópico transnasal. Los resultados funcionales y estéticos fueron satisfactorios, sin recurrencia. Se evidenció una fístula de líquido cefalorraquídeo intraoperatoria corregida en el mismo tiempo quirúrgico.


The dermoid cyst is a rare congenital lesion, secondary to an incomplete regression of ectodermal tissue. Its incidence is 1/20,000-40,000 live births. Timely surgical resection must be performed to prevent intracranial involvement and/or complications. Imaging study determines its extension. Different surgical approaches have been recommended; all must adhere to Pollock's 4 principles. The following study presents the case of a pediatric patient, 9 months old, with a dermoid cyst at the skull base with a fistulous path to the nasal tip. Contrasted nuclear magnetic resonance revealed a cystic mass in the region anterior to the crista galli communicated with a fistulous tract at the nasal tip. The patient was taken to surgery for cyst resection by external rhinoplasty combined with a transnasal endoscopic approach with satisfactory functional and aesthetic results, without recurrence. A Cerebrospinal fluid fistula was evidenced, as an intraoperative complication, it was corrected in the same surgical time.


Subject(s)
Humans , Dermoid Cyst , Child, Preschool , Skull Base , Nasal Cavity
5.
Repert. med. cir ; 30(suplemento): 136-141, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1361734

ABSTRACT

Objetivo: desarrollar una máscara que sea reutilizable, esterilizable, fácil de usar y económica para reducir los riesgos de transmisión del COVID-19 durante los procedimientos endoscópicos endonasales. Métodos: modelo diseñado en Autodesk Fusion 360 y Meshmixer, construido con ácido poliláctico (PLA) utilizando una impresora 3D (PRUSA IK3 MK3s, Praga, República Checa) en el laboratorio de Anatomía de la Universidad de los Andes, Bogotá, Colombia. Se ajustaron tres orificios a la mascarilla, uno para el tubo endotraqueal, otro más grande en el medio para la instrumentación quirúrgica que permite la adaptación de una membrana translúcida estéril y el superior para adaptar la punta de la succión y generar un ambiente de presión negativa dentro de la máscara. Se utilizó un colchón de silicona y tres puntos para sujetar tiras y crear un ajuste a la cabeza durante largos períodos sin causar lesiones en la piel. Se realizaron diferentes pruebas, incluida la verificación con luz ultravioleta de la propagación de la fluoresceína después de la perforación ósea, la esterilización química y por calor de la máscara, y la succión de los aerosoles producidos al fumar un cigarrillo electrónico. Ambiente: laboratorio experimental. Resultados: las pruebas demostraron una reducción del efecto aerosol y de la dispersión de las gotas cuando se usa la máscara ventilada. Se consiguió una excelente maniobrabilidad y libertad. Sin embargo, fue limitado en términos de visualización durante la entrada nasal de los instrumentos al cráneo. Conclusiones: los resultados preliminares muestran que esta máscara ventilada permite una barrera quirúrgica para disminuir la transmisión del SARS-COV-2 durante los procedimientos endoscópicos endonasales.


Objective: to develop a reusable, sterilizable, easy- to-use and low-price mask to reduce the risks of COVID-19 transmission during endonasal endoscopic procedures. Methods: a model designed using Autodesk Fusion 360 and Meshier software, made from polylactic acid (PLA) in a 3D printer (PRUSA IK3 MK3s, Prague, Czech Republic) at the anatomy laboratory of Universidad de los Andes, Bogotá, Colombia. It features three ports, one to allow passage of intubation tubing, a larger middle port for surgical tool insertion, which allows fitting a sterile translucent membrane, and an upper port for the suction tube tip to create a negative pressure environment inside the mask. A silicone cushion and three ties secure the mask to the head for long periods of time without skin injuries. Various tests were completed, ultraviolet light verification of fluorescein propagation after bone drilling, chemical and vapor sterilization, and aerosols filtration using smoke produced by an electronic cigarette. Setting: an experimental laboratory. Results: Tests showed the mask decreased aerosol effect and droplet dispersion, and allowed for excellent maneuverability and freedom. However, the mask was limited in terms of visualization during nasal approaches to the skull. Conclusions: preliminary results show that this ventilated mask allows for a surgical barrier for reducing SARS-COV-2 transmission during endonasal endoscopic procedures.


Subject(s)
Humans , Male , Skull Base , Aerosols , Endoscopy , SARS-CoV-2 , Masks
6.
Int. j. morphol ; 38(6): 1566-1570, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134479

ABSTRACT

SUMMARY: Since the asymmetry is generally accepted entity which can be detected on human skulls, the goal of this study was to evaluate the presence and degree of skull base asymmetry and analyze it in relation to sex. The study included 60 skulls. Gender identification was estimated according to the external occipital protuberance, mastoid process, supraorbital margin and glabella. The asymmetry was assessed by analyzing the distance from the bilateral foramina (foramen ovale, foramen spinosum, carotid canal, foramen stylomastoideum) to the pharyngeal tubercle. Digital data were processed in the ImageJ software. The skull base asymmetry was found in all samples. Significant difference between the sides was found for the foramen ovale (p=.01). There was no significant difference in the skull base asymmetry with respect to sex. The highest index of asymmetry (7.38 %) was found in carotid canal and the lowest (5.22%) was detected in relation to the foramen stylomastoideum. By comparing the index of asymmetry between the genders significant difference occurs for the carotid canal (p=.02). Skull base asymmetry was confirmed in our study. Oval foramen showed a significant degree of asymmetry. Knowledge of the variability of the skull base is the basis for an clinical and radiological evaluation of its changes.


RESUMEN: Debido a que la asimetría detectada en cráneos humanos es aceptada generalmente, el objetivo de este estudio fue evaluar la presencia y el grado de asimetría de la base del cráneo y analizarla en relación con el sexo. En este estudio fueron incluidos 60 cráneos. El sexo fue determinado de acuerdo con la protuberancia occipital externa, el proceso mastoideo, el margen supraorbital y la glabela. La asimetría se evaluó analizando la distancia desde los forámenes bilaterales (foramen oval, foramen espinoso, canal carotídeo, foramen estilomastoideo) hasta el tubérculo faríngeo. Los datos digitales fueron procesados en software ImageJ. La asimetría de la base de cráneo se observó en todas las muestras. Se encontró una diferencia significativa entre los lados para el foramen oval (p = ,01). No hubo diferencias significativas en la asimetría de la base de cráneo con respecto al sexo. El índice más alto de asimetría (7,38%) se encontró en el canal carotídeo y el más bajo (5,22 %) se detectó en relación con el foramen estilomastoideo. Al comparar el índice de asimetría entre los sexos, se produce una diferencia significativa en el canal carotídeo (p = 0,02). La asimetría de la base de cráneo se confirmó en nuestro estudio. El foramen oval mostró un grado significativo de asimetría. El conocimiento de la variabilidad de la base del cráneo es importante durante la evaluación clínica y radiológica.


Subject(s)
Humans , Male , Female , Skull Base/anatomy & histology , Facial Asymmetry , Cadaver , Sex Factors , Sex Characteristics , Foramen Ovale
7.
Rev. chil. radiol ; 26(2): 62-71, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1126195

ABSTRACT

Resumen: La anatomía de la base del cráneo es compleja. Numerosas estructuras neurovasculares vitales pasan a través de múltiples canales y agujeros ubicados en la base del cráneo. Con el avance de la tomografía computarizada (TC) y la resonancia magnética (RM), es posible la localización cada vez más precisa de lesiones y la evaluación de su relación con las estructuras neurovasculares adyacentes. El trayecto de los nervios craneales sigue un recorrido conocido y se transmiten a la cara y cuello por los forámenes de base de cráneo. La tomografía computada y la resonancia magnética son complementarias entre sí y, a menudo, se usan juntas para demostrar la extensión total de la enfermedad. La segunda parte de esta revisión se centra en el estudio radiológico de los nervios craneales.


Abstract: The skull base anatomy is complex. Many vital neurovascular structures course through the skull base canals and foramina. With the advancement of CT and MRI, the localization of lesions has become more precise as their relationship with adjacent neurovascular structures. There is a known course of the cranial nerves as well as their skull base exiting foramina to the head and neck. CT and MRI are complimentary modalities and are often used together to map the full extent of disease. The second article in this review focus on the radiologic study of the cranial nerves.


Subject(s)
Humans , Skull Base/innervation , Skull Base/diagnostic imaging , Cranial Nerves/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Cranial Nerves/anatomy & histology
8.
Rev. cienc. salud (Bogotá) ; 18(1): 96-107, ene.-mar. 2020. tab, graf, ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1115532

ABSTRACT

Resumen Introducción: numerosos estúdios mencionan que las variaciones del crecimiento y orientation del ángulo de la base craneal pueden alterar la posición de ambos maxilares en relación con la base craneal. En este estudio se busca relacionar el ángulo de la base craneal con las clases esqueletales, en telerradiografías laterales de pacientes adultos que acudieron a la Clínica Odontológica del Instituto Latinoamericano de Estudios Superiores, de la ciudad de Asuncion, Paraguay, entre los anos 2010 y 2018. Materiales y métodos: estudio transversal retrospectivo. Para clasificar la clase esqueletal, se utilizo el ángulo ANB de Steiner, y para determinar el ángulo de la base craneal posterior, el NSBA de Varjanne y Koski. Luego, se aplico la prueba chi-cuadrado para relacionar el ángulo de la base craneal y las clases esqueletales, con un nivel de confianza del 95 %. Resultados: formaron parte del estudio 185 telerradiografías laterales de cráneo de pacientes que acudieron a la clínica. La media del ángulo NSBa fue 128.4 ° ± 5.17 °; la clase I fue de 128.27 ° ± 5.27 °; la clase II, de 129.1 ° ± 4.7 °; y la clase III, de 127.84 ° ± 5 °. El 65.95 % posee valores del ángulo NSBa fuera de la norma, de los cuales el 87.7 % presentan un ángulo cerrado. Conclusión: el promedio del ángulo de la base craneal estaba fuera de la norma en todas las clases esqueletales, siendo más frecuente la flexion craneal, en orden decreciente para las clases III, I y II.


Abstract Introduction: Many studies mention that variations in growth and orientation of the cranial base angle can alter the position of both jaws in relation to the cranial base. This study seeks to relate the cranial base angle according to skeletal classes in adult patients who attended the Dental Clinic of the Instituto Latinoamericano de Estudios Superiores in Asuncion city in Paraguay, between 2010 and 2018, using lateral cephalometric radiographs. Materials and methods: Retrospective cross-sectional study. Skeletal classes were classified using the ANB angle and the NSBa angle of Varjanne and Koski to determine the cranial base angle. Chi-square tests were applied to associate the cranial base angle according to skeletal classes, with a confidence level of 95 %. Results: In this study, 185 lateral cephalometric radiographs were included in the study of people who attended the clinic. The mean values of NSBa angle were 128.84° ±5.17° for all classes; 128.27° ± 5.27° for class I, 129.1° ± 4.7° for class II and 127.84° ± 5° for class III. The 65.95 % of participants had NSBa angle values out of the norm, from which 87.7 % reported a small cranial base angle. Conclusion: The average cranial base angle was found to be out of the norm in every skeletal class in decreasing order for classes III, I, and II, cranial flexure being more frequent than others.


Resumo Introdução: Numerosos estudos mencionam que as variações do crescimento e orientação do ângulo da base craniana podem alterar a posição de ambos os maxilares em relação com a base craniana. Este estudo busca relacionar o ângulo da base craniana com as classes esqueléticas, em telerradiografias laterais de pacientes adultos que acudiram à Clínica Odontologica do Instituto Latino-Americano de Estudos Superiores, da cidade de Asuncion, Paraguai, nos años 2010-2018. Materiais e métodos: estudo transversal retrospectivo. Para classificar a classe esquelética utilizou-se o ângulo ANB de Steiner e para determinar o ângulo da base craniana posterior o NSBa de Varjanne e Koski. Se aplicou a prova Qhi quadrado para relacionar o ângulo da base craniana e as classes esqueléticas, com um nível de confiança do 95 %. Resultados: Formaram parte do estudo 185 telerradiografias laterais de crâneo de pacientes que acudiram à clínica. A média do ângulo NSBa foi 128.4° ± 5.17°; a classe I foi de 128.27° ± 5.27°, a classe II 129.1° ± 4.7° e classe III 127.84° ± 5°. O 65.95 % possui valores do ângulo NSBa fora da norma, dos quais o 87.7 % apresentam um ângulo fechado. Conclusão: A média do ângulo da base craniana estava fora da norma em todas as classes esqueléticas, sendo mais frequente a flexão craniana, em ordem decrescente para as classes III, I e II.


Subject(s)
Humans , Adult , Middle Aged , Cephalometry , Orthodontics , Paraguay , Skull Base , Diagnosis
9.
Rev. argent. neurocir ; 34(1): 42-44, mar. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1151249

ABSTRACT

Introducción: Debido a su ubicación anatómica, los craneofaringiomas son tumores complejos en su tratamiento. Una resección completa tiene riesgos elevados de morbimortalidad y si se opta por una resección parcial la tasa de recurrencia es alta. Según su extensión supraselar y su relación con el tallo hipofisario, pueden dividirse en preinfundibulares, transinfundibulares y retroinfundibulares. Objetivo: El objetivo de este video es describir la técnica vía endoscópica para la resección de un craneofaringioma preinfundibular. Materiales y Métodos: Se seleccionó un caso de un paciente con un craneofaringioma preinfundibular operado en el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires, por vía endoscópica transnasal. Resultados: Se realizó una exéresis completa de la masa tumoral, sin evidenciar complicaciones tales como, diabetes insípida o fistula de líquido cefalorraquídeo y con recuperación completa del déficit campimétrico. Conclusión: El tratamiento quirúrgico de los craneofaringiomas requiere un conocimiento detallado de la anatomía de base de cráneo así como de las diferentes técnicas quirurgicas. El uso de la endoscopia ha permitido un mejor acceso a éste tipo de lesiones, disminuyendo las comorbilidades en el paciente y la estadía hospitalaria. Un resultado quirúrgico satisfactorio se obtiene con la resección completa y la menor morbilidad posible para el paciente


Introduction: Due to its anatomical location, craniopharyngiomas are difficult tumors to treat. Complete resection has high morbidity and mortality and if a partial resection is chosen, the recurrence is common. According to their suprasellar extension and its relationship with stalk, it can be classified into: preinfundibular, transinfundibular and retroinfundibular. Objetive: The aim of this video is to describe the surgical technique we use for preinfundibular craniopharyngioma. Methods: We review a preinfundibular craniopharyngioma operated on the Neurosurgery Department of the Hospital Italiano de Buenos Aires, through a transnasal endoscopic approach. Results: Total removal was achived, no acute complications were found such as diabetes insipidus or cerebrospinal fluid leak and improved their visual field. Conclusion: Craniopharyngioma surgery requires detailed knowledge of skull base anatomy and approaches. The use of endoscopy has allowed better access to this type of lesions, reducing comorbidities and patient hospital stay. Complete resection with low morbidity are the treatment of this tumors


Subject(s)
Craniopharyngioma , General Surgery , Therapeutics , Skull Base , Endoscopy , Neurosurgery
10.
Rev. argent. neurocir ; 34(1): 63-64, mar. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1151255

ABSTRACT

Introducción: El hemiespasmo facial primario (HFP) se produce por la hiperexcitabilidad del nervio facial y sus núcleos de origen como consecuencia de la compresión vascular. La cirugía de descompresión neurovascular se plantea como alternativa al tratamiento médico refractario. Objetivos: Presentar nuestra experiencia respecto a esta patología. Material y métodos: Se realizó una revisión retrospectiva de pacientes operados por HPF refractarios a tratamiento médico en nuestra institución en los últimos 5 años (periodo 2014-2019). Todos fueron intervenidos vía retrosigmoidea. Se evaluaron datos demográficos, evaluación prequirúrgica y evolución postoperatoria. Resultados: Se operaron 4 pacientes bajo técnica microquirúrgica asistido por endoscopía. Edad promedio 52 años (rango 41-61) con una relación femenino masculino 3:1. El 25% (n=1) presentaba paresia facial grado 2 (HB) en el prequirúrgico. No hubo cambios en cuanto al grado de paresia facial en el postoperatorio en ningún caso. Sólo un paciente registró caída leve en la audiometría postquirúrgica. El 75% (n=3) resolvieron el HFP. Conclusión: Si bien nuestra serie es acotada a un número reducido de pacientes, la cirugía descompresiva microvascular es efectiva como alternativa al tratamiento médico refractario del HFP.


Introduction: Primary hemifacial spasm (PHS) is defined as the hyper excitability of the nerve due to the compression of the facial nerve or its nuclei, most commonly by a vascular structure. The surgical indication for microvascular decompression is resistance to pharmacological treatment or severe adverse effects. Objectives: To present our experience in the surgical treatment of this pathology with this novel technique. Materials and methods: We retrospectively reviewed all patients (n=4) with a diagnosis of PHS, who underwent endoscope-assisted microvascular decompression surgery in our institution during the last 5 years. In all the cases, we choose the retrosigmoid approach. We evaluated demographic data, preoperative evaluation, and post-operative evolution. Results: Endoscope-assisted microvascular decompression was the surgical technique in all the patients. The median age was 52 years, the female-male ratio of 3:1. Only one patient presented a grade 2 facial palsy (House-Brackmann scale) in the preoperative evaluation; there were no significant changes in the post-operative evaluation in any patient. Only one patient experienced worsening in the post-operative audiometric follow-up. The 75% (n=3) of the patients solved the HFP after the surgical treatment. Conclusion: By taking into account our experience in this small case series, we can support the concept that endoscope-assisted microvascular decompression is as effective as the open surgical treatment of the PHS.


Subject(s)
Hemifacial Spasm , Skull Base , Decompression , Endoscopy , Facial Nerve , Facial Paralysis , Microvascular Decompression Surgery
11.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 38-46, Jan.-Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090545

ABSTRACT

Abstract Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Arteries/anatomy & histology , Arteries/diagnostic imaging , Ethmoid Sinus/blood supply , Ethmoid Sinus/diagnostic imaging , Multidetector Computed Tomography/methods , Tomography, X-Ray Computed/methods , Intracranial Aneurysm/diagnostic imaging , Retrospective Studies , Skull Base/anatomy & histology , Skull Base/blood supply , Skull Base/diagnostic imaging , Contrast Media , Imaging, Three-Dimensional
12.
Article in Spanish | LILACS, COLNAL | ID: biblio-1141460

ABSTRACT

Introducción: las listas de chequeo son herramientas que buscan evitar errores y complicaciones al momento de realizar un procedimiento. El adenoma hipofisiario es la primera causa de cirugía endoscópica transnasal de la región selar, y se estima que ocurren hasta un 20 % de complicaciones derivadas de esta cirugía. Objetivo: desarrollar una lista de chequeo preoperatoria que sirva como una guía para la evaluación prequirúrgica de los pacientes a quienes se les realicen cirugías de la región selar. Metodología: se realizó una revisión de la literatura para desarrollar una lista de chequeo preliminar y una serie de declaraciones que resumían los puntos importantes de la lista. Se construyó un comité de expertos en cirugía endoscópica de la base de cráneo conformado por neurocirujanos y otorrinolaringólogos de hospitales de Bogotá. Utilizando la metodología Delphi modificada, se llegó a un consenso para la realización de la lista de chequeo final. Resultados: se describieron 15 declaraciones; de estas, hubo una discrepancia en 6 declaraciones. Por esta razón, se realizaron modificaciones en 5 declaraciones, y se llegó a un consenso entre los expertos participantes. La lista de chequeo final aprobada está compuesta por 4 ítems. Discusión/conclusiones: la cirugía para el manejo de la patología de la región selar es compleja y requiere de un equipo quirúrgico entrenado y disciplinado para lograr los mejores desenlaces posibles. Consideramos que nuestra lista de chequeo es una herramienta que permitirá a los equipos que realizan estas cirugías en Colombia tener una visión más completa del paciente y, eventualmente, ayudar a evitar errores y posibles complicaciones.


Introduction: checklists that seek to avoid errors are very useful tools for any surgical practice. Pituitary adenomas are the leading indication to perform a transnasal endoscopic surgery in the sellar region and up to 20 % complications have been reported related to this procedure. Objetive: develop a preoperative checklist, based on an expert consensus, to serve as a guide for the skull base teams to consistently evaluate preoperatively all patients with pathologies in the sellar region. Methods: a literature review was conducted to develop a preliminary checklist and a series of statements summarizing the most important items on the list. A committee of experts in endoscopic skull base surgery was summoned, made up of neurosurgeons and otolaryngologists from hospitals in Bogotá. Using the modified Delphi methodology, a consensus was reached for the completion of the final checklist. Results: fifteen statements were developed. A discrepancy was seen in six statements. Modifications were made for five statements, thus reaching a consensus among the participating experts. The final approved checklist is made up of 4 items. Conclusion: surgery for treating different pathologies in the sellar region is complex and requires a welltrained and disciplined surgical team to achieve the best possible outcomes. We consider that our preoperative checklist is a valuable resource for skull base surgical teams performing transnasal endoscopic surgery of the sellar region. This tool will allow skull base surgical teams in Colombia to have a more comprehensive view of the patient and eventually help to avoid errors and possible complications.


Subject(s)
Humans , Skull Base , Pituitary Diseases , Endoscopy , Checklist
13.
J. oral res. (Impresa) ; 8(6): 499-504, dic. 28, 2019. tab
Article in English | LILACS | ID: biblio-1224477

ABSTRACT

Background: Growth hormone plays a significant role in determining craniofacial morphology. Mutations of its receptor gene might be associated with mandibular prognathism (MP). Purpose: The aim of the current study was to evaluate growth hormone receptor (GHR) gene polymorphisms in relation to facial dimensions. Material and Method: The study enrolled 65 participants with class III profile in MP group and 60 orthognathic control participants. Genomic DNA was extracted from a blood sample from the patients and the P561T and C422F polymorphisms of GHR gene were screened by PCR-RFLP method followed by Sanger sequencing of randomly selected samples to validate the genotyping results. Chi square was used to compare distribution of polymorphism in MP and control groups (p<0.05). Results: Heterozygous P561T mutation was found in 10.77% and 8.33% of MP and control groups, respectively (p=0.644) while none of the subjects had the C422F mutation. Sanger sequencing confirmed the genotyping results from the PCR-RFLP method. P561T polymorphism was significantly associated with ramus and lower facial height in MP patients and with ramus height in orthognathic patients (p<0.05). Conclusion: The results indicate that the P561T polymorphism of the GHR gene is associated with the vertical dimension of the mandible in an Iranian population.


Antecedentes: La hormona del crecimiento desempeña un papel importante en la determinación de la morfología craneofacial. Las mutaciones de su gen receptor podrían estar asociadas con el prognatismo mandibular (PM). Propósito: El objetivo del presente estudio fue evaluar dos polimorfismos del gen del receptor de la hormona del crecimiento (RHC) en relación con las dimensiones faciales. Materiales y Métodos: El estudio incluyó a 65 participantes con perfil de clase III en el grupo MP y 60 participantes de control ortognático. El ADN genómico se extrajo de una muestra de sangre de los pacientes y los polimorfismos P561T y C422F del gen RHC se seleccionaron mediante el método PCR-RFLP seguido de la secuenciación por Sanger de muestras seleccionadas al azar para validar los resultados del genotipo por RFLP. El test chi cuadrado se utilizó para comparar la distribución del polimorfismo en el grupo MP y grupo control (p<0.05). Resultados: Se encontró mutación heterocigota P561T en 10.77% y 8.33% de los grupos PM y control, respectivamente (p=0.644) mientras que ninguno de los sujetos tenía la mutación C422F. La secuenciación de Sanger confirmó los resultados de genotipado por el método PCR-RFLP. El polimorfismo P561T se asoció significativamente con la rama y la altura facial más baja en pacientes con PM y con la altura de la rama en pacientes ortognáticos (p<0.05). Conclusión: Los resultados indican que el polimorfismo P561T del gen RHC está asociado con la dimensión vertical de la mandíbula en una población iraní.


Subject(s)
Humans , Male , Female , Cephalometry/methods , Polymorphism, Single Nucleotide/genetics , Mandible/anatomy & histology , Prognathism , Growth Hormone , Chi-Square Distribution , Prevalence , Skull Base/anatomy & histology , Genotype , Iran/ethnology , Malocclusion , Malocclusion, Angle Class III/genetics
14.
Rev. cuba. estomatol ; 56(4): e2065, oct.-dez. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1093250

ABSTRACT

RESUMEN Introducción: La determinación del ángulo SN-Frankfort ha sido una constante utilizada por muchas décadas con un valor de 7°, sin embargo, son diversas las investigaciones que han refutado esta afirmación, debido a que los factores sociodemográficos influyen en la variación de este ángulo. Asimismo, la importancia de determinarlo es pieza clave para establecer un diagnóstico certero. Objetivo: Evaluar la variación del ángulo SN-Frankfort según el biotipo facial en pacientes. Métodos: Estudio descriptivo, transversal, retrospectivo y observacional. La muestra estuvo conformada por 225 radiografías cefalométricas laterales de pacientes entre 12 a 35 años que acudieron al Servicio de Ortodoncia del Hospital Hipólito Unanue durante los años 2014-2017. Se cumplieron los criterios de inclusión y la selección se realizó de forma probabilística por el método aleatorio simple. Para la evaluación de las radiografías cefalométricas se realizó el trazado manual. El biotipo facial se determinó mediante el índice de VERT y luego se obtuvo el ángulo SN-Frankfort. Se emplearon dos métodos estadísticos para la evaluación de la concordancia y reproducibilidad: El índice de Kappa para la evaluación del biotipo facial y el coeficiente de correlación interclase para la determinación del ángulo. Resultados: El promedio del ángulo SN-Frankfort en los pacientes con biotipo dolicofacial fue de 10,46 ± 3,02°, con biotipo mesofacial 10,12 ± 3,03° y con biotipo braquifacial 10,39 ± 3,48°. Los pacientes del sexo femenino presentaron una mayor angulación SN-Frankfort (10,69 ± 3,04) en comparación con los pacientes del sexo masculino (9,73 ± 3,23); p= 0,026. Conclusiones: Existe una variación en el ángulo SN-Frankfort según el tipo de biotipo facial, sin embargo, estas diferencias no fueron significativas. De modo contrario, se encontró que existe una significativa mayor angulación de ángulo SN-Frankfort en los pacientes del sexo femenino(AU)


ABSTRACT Introduction: Determination of the SN-Frankfort angle has been a constant used for many decades with a value of 7°. However, several studies have refuted that statement, based on the influence of sociodemographic factors on the variation of this angle. On the other hand, the importance of its determination is crucial to achieve an accurate diagnosis. Objective: Evaluate the variation of the SN-Frankfort angle according to the facial biotype of patients. Methods: A descriptive cross-sectional observational retrospective study was conducted. The sample was 225 lateral cephalometric radiographs of patients aged 12-35 years attending the Orthodontics Service of Hipólito Unanue Hospital in the period 2014-2017. Inclusion criteria were complied with, and selection was made by simple random probability sampling. Manual tracing was performed to evaluate the cephalometric radiographs. Facial biotype was determined by the VERT index, and the SN-Frankfort angle was then obtained. Two statistical methods were used for agreement and reproducibility evaluation: the Kappa index for evaluation of the facial biotype and the interclass correlation coefficient for determination of the angle. Results: Average SN-Frankfort angle was 10.46 ± 3.02° for the dolichofacial biotype, 10.12 ± 3.03° for the mesofacial biotype and 10.39 ± 3.48° for the brachifacial biotype. Female patients had greater SN-Frankfort angulation (10.69 ± 3.04) than male patients (9.73 ± 3.23); p= 0.026. Conclusions: Variation was found in the SN-Frankfort angle according to the facial biotype, but those differences were not significant. Significantly greater SN-Frankfort angulation was found among female patients(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Cephalometry/methods , Skull Base , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective Studies , Observational Study
15.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(2): 207-212, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1014439

ABSTRACT

RESUMEN El lipoma intraóseo es un tumor mesenquimatoso poco frecuente que se presenta principalmente en el esqueleto apendicular. La localización dentro del cráneo, es aún más rara, y hasta la fecha solo se han descrito 6 casos en la literatura de lipomas intraóseos que comprometen la región esfenoclival. Por lo general, no presenta ningún síntoma y es un hallazgo incidental en el estudio de imágenes. Presentamos el caso de un paciente de 22 años de edad que consulta por obstrucción nasal y rinorrea mucosa de tres semanas de evolución. La tomografía computarizada y resonancia nuclear magnética evidenciaron una lesión en la región esfenoclival con características sugerentes de lipoma intraóseo. No se realiza estudio histopatológico. Con respecto al manejo, se decide hacer seguimiento radiológico. Se realizó una segunda resonancia magnética 4 meses después, sin cambios significativos.


ABSTRACT Intraosseous lipoma are a rare mesenchymal tumor that occurs primarily in the appendicular skeleton. Skull presentation is a rare finding, and only 6 cases have been described in literature so far of lipomas that compromise the sphenoclival region. In general, they are asymptomatic and occur as incidental findings in imaging studies. We present the case of a 22-year-old patient who consulted for nasal obstruction and mucous rhinorrhea of three weeks of evolution. Computed tomography and magnetic resonance imaging showed a lesion in the sphenoclival region suggestive of intraosseous lipoma. Histopathological study was not performed. Regarding management, radiological follow-up was decided. A second MRI was taken 4 months later, with no significant changes.


Subject(s)
Humans , Male , Adult , Young Adult , Brain Neoplasms/diagnostic imaging , Skull Base/diagnostic imaging , Lipoma/diagnostic imaging , Paranasal Sinuses/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Diagnosis, Differential
16.
Rev. cir. traumatol. buco-maxilo-fac ; 19(4): 34-37, out.-dez. 2019. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1253637

ABSTRACT

Introdução: A Síndrome da Fissura Orbital Superior (SFOS) é uma condição de ocorrência rara, inicialmente descrita por Hirchfield em 1858. Caracterizada pela presença de oftalmoplegia, ptose da pálpebra superior e midríase, podendo ocorrer parestesia da pálpebra superior e da região frontal, associada à lesão dos pares de nervos cranianos: oculomotor, troclear, abducente (III, IV e VI) e, por vezes, o nervo trigêmeo (V). A identificação da SFOS é importante, visto que sua incidência é rara no trauma, e sua identificação pode ajudar a direcionar o tratamento de forma mais adequada. Relato de caso: O presente trabalho descreve dois casos da SFOS associados a traumas craniofaciais, cita as possíveis etiologias relacionadas a essa síndrome e descreve a situação de trauma agudo. Considerações Finais: A avaliação das condições sistêmicas do paciente e de exames complementares, como tomografias computadorizadas, auxilia o diagnóstico diferencial entre patologias que acometem a região orbital e a base de crânio, fraturas e traumas craniofaciais. A identificação da SFOS no trauma agudo orienta a abordagem imediata ou precoce quando indicada, como nos casos de hematomas retrobulbares ou em grandes deslocamentos ósseos maxilofaciais com necessidade de redução cirúrgica. Nos casos com indicação de abordagem tardia, as fraturas craniofaciais são tratadas de forma conservadora, e o paciente é encaminhado para atendimento especializado... (AU)


Introduction: The superior orbital fissure syndrome (SOFS) is a rare condition and initially described by Hirchfield in 1858. Characterized by the presence of ophthalmoplegia, upper eyelid ptosis and mydriasis, and there may be paresthesia of the upper eyelid and forehead associated by the injury of the cranial nerves like: oculomotor, trochlear, abducens (III, IV and VI) and sometimes the trigeminal nerve (V). The identification of SOFS is important, since its incidence is rare in trauma, and its identification may help to target the treatment more adequately. Case report: The present study describes two cases of SFOS associated with craniofacial trauma, cites the possible etiologies related to this syndrome and describes the situation of acute trauma. Final considerations: The evaluation of the patient's systemic conditions and complementary exams, such as computed tomography, help the differential diagnosis between pathologies that affect the orbital region and the skull base, and fractures and traumatic head injuries. The identification of SFOS in acute trauma guides the immediate or early approach when indicated, as in cases of retrobulbar hematomas or large maxillofacial bone dislocations requiring surgical reduction. In cases with indication for late approach, craniofacial fractures are treated conservatively and the patient is referred for specialized care... (AU)


Subject(s)
Humans , Male , Female , Child , Adult , Trigeminal Nerve , Ophthalmoplegia , Cranial Nerves , Diagnosis, Differential , Craniocerebral Trauma , Orbital Diseases , Skull Base
17.
Article in English | WPRIM | ID: wpr-764940

ABSTRACT

BACKGROUND: Chordomas are aggressive bone tumors that have a predilection for the axial skeleton including the skull base and spinal/sacral bones. However, the histopathological and clinical differences between skull base chordoma (SBC) and sacral/spinal chordoma (SC) are unclear as previous studies have been focused on patient prognosis and treatment outcome. This study aimed to evaluate the clinicopathologic features and prognosis of chordoma according to its location. METHODS: Patients with chordomas were enrolled, and the histopathologic features were compared according to the tumor location. RESULTS: A total of 52 patients were enrolled. SBCs had more abundant chondroid matrix and diffuse growth pattern, while SCs had non-chondroid, myxoid matrix and a lobulating pattern, typical of chordoma. Old age and residual tumors were risk factors for shorter overall survival in SBCs. The chondroid matrix was an independent risk factor for shorter disease-free survival in the overall population. CONCLUSION: Chordomas have different histopathologic features depending on the anatomical location.


Subject(s)
Bone Neoplasms , Brain Neoplasms , Chordoma , Disease-Free Survival , Humans , Neoplasm, Residual , Notochord , Prognosis , Risk Factors , Skeleton , Skull Base , Skull Base Neoplasms , Soft Tissue Neoplasms , Treatment Outcome
18.
Article in English | WPRIM | ID: wpr-764005

ABSTRACT

PURPOSE: Fossa navicularis is a bone defect in the clivus. Familiarity with this anatomical variant is important because it is close to vital anatomical structures in the base of the skull. The aim of this study was to determine the prevalence and morphometric properties of fossa navicularis within the clivus in a Turkish subpopulation using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 168 CBCT scans (female: 96, male: 71) were evaluated. High-quality CBCT images of patients without a syndromic condition or a history of neurological disease or surgery were included in the study. The prevalence, depth, length, and width of the fossa navicularis were performed. RESULTS: The prevalence of fossa navicularis was 27.5% (n=46 patients). Sex was not associated with the depth, length, or width of the fossa navicularis (P>0.05). A significant positive correlation was found between age and length of the fossa navicularis (P>0.05). CONCLUSION: Fossa navicularis was found to be rare (27.5%). Anatomical variants of the skull base can also be clearly identified on CBCT images. The results of this study may be useful to radiologists, anatomists, and surgeons interested in the skull base.


Subject(s)
Anatomists , Cone-Beam Computed Tomography , Cranial Fossa, Posterior , Humans , Male , Prevalence , Recognition, Psychology , Skull , Skull Base , Surgeons
19.
Article in English | WPRIM | ID: wpr-763989

ABSTRACT

PURPOSE: Cone-beam computed tomography (CBCT) is widely used for 3-dimensional assessments of cranio-maxillofacial relationships, especially in patients undergoing orthognathic surgery. We have introduced, for reference in CBCT cephalometry, an anatomical mid-sagittal plane (MSP) identified by the nasion, the midpoint between the posterior clinoid processes of the sella turcica, and the basion. The MSP is an updated version of the median plane previously used at our institution for 2D posterior-anterior cephalometry. This study was conducted to test the accuracy of the CBCT measures compared to those obtained using standard posterior-anterior cephalometry. MATERIALS AND METHODS: Two operators measured the inter-zygomatic distance on 15 CBCT scans using the MSP as a reference plane, and the CBCT measurements were compared with measurements made on patients' posterior-anterior cephalograms. The statistical analysis evaluated the absolute and percentage differences between the 3D and 2D measurements. RESULTS: As demonstrated by the absolute mean difference (roughly 1 mm) and the percentage difference (less than 3%), the MSP showed good accuracy on CBCT compared to the 2D plane, especially for measurements of the left side. However, the CBCT measurements showed a high standard deviation, indicating major variability and low precision. CONCLUSION: The anatomical MSP can be used as a reliable reference plane for transverse measurements in 3D cephalometry in cases of symmetrical or asymmetrical malocclusion. In patients who suffer from distortions of the skull base, the identification of landmarks might be difficult and the MSP could be unreliable. Becoming familiar with the relevant software could reduce errors and improve reliability.


Subject(s)
Cephalometry , Cone-Beam Computed Tomography , Dimensional Measurement Accuracy , Humans , Malocclusion , Orthognathic Surgery , Sella Turcica , Skull Base
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