RESUMEN
OBJECTIVE: Cholesterol granulomas are benign lesions that sometimes occur on the petrous apex (PA). We report our experience using an endoscopic endonasal approach to remove PA cholesterol granulomas. MATERIAL AND METHODS: A retrospective patient chart analysis was conducted at a tertiary care university hospital. RESULTS: Four patients (3 females, 1 male) were included in this study. Patients' ages ranged from 27 to 78 years. Computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis and computer-assisted navigation were performed. The most common symptom was abducens nerve palsy. The largest granuloma measured 5 x 2 cm and was located on the left side. An endoscopic endonasal approach was chosen and navigation was applied (3/4 patients) to identify the optimal area for opening the granuloma. No complications occurred, and patients were free from recurrence during the follow-up period. CONCLUSION: The endoscopic endonasal approach to PA cholesterol granulomas is feasible and safe. Intra-operative navigation is recommended to identify the position of the internal carotid artery and determine the safest area for opening the granuloma without damaging the artery. Another advantage of this approach is an easier follow-up through diagnostic nasal endoscopy.
Asunto(s)
Enfermedades Óseas/cirugía , Colesterol , Drenaje/métodos , Endoscopía/métodos , Granuloma de Cuerpo Extraño/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Hueso Petroso/cirugía , Adulto , Anciano , Enfermedades Óseas/diagnóstico , Diagnóstico Diferencial , Femenino , Granuloma de Cuerpo Extraño/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The course of the visual pathway as far as the sulcus temporalis superior is described and the change in the shape of the receptive fields is pointed out. The transformation of action potentials into conscious perception is interpreted as it was by Eccles. A connection is made between the problem of learning and the plasticity of the spine synapses, the capacity of which can be considerably increased. In conclusion, it is pointed out that in cases of macular disease it is possible to stimulate peripheral areas of the visual field by special training and thus to help the visual field by special training and thus to help the patient.