A Case of Endonasal Endoscopic Surgery for Intraorbital Metastasis of Gastric Ring Cell Carcinoma.

Gastric signet ring cell carcinoma has well-known metastatic features, including peritoneal dissemination and carcinomatous lymphangitis of the lung, but no intraorbital metastases were reported previously. A woman in her 60s developed left eye pain, sudden vision loss, and headache 12 years after gastric cancer treatment. Symptoms did not improve despite steroid pulses. Craniotomy showed no malignant findings. The patient was referred to our department for symptomatic relief and biopsy due to the lack of a definitive diagnosis and no improvement in her ocular pain. Endonasal endoscopic surgery was performed for diagnostic purposes and to relieve symptoms through orbital decompression. Preoperative computed tomography examination revealed a tumor at the left medial orbit, extending to the orbital apex. Orbital decompression through the open left medial orbital wall was performed with biopsy of the intraorbital tumor. Pathological findings were consistent with metastatic signet ring cell carcinoma. Pain and subjective improvement of visual acuity were noted the day after surgery. Twelve months postoperatively, diplopia remains, but there has been no worsening of symptoms.

The resected area of the posterior wall of the external auditory canal during transcanal endoscopic ear surgery for cholesteatoma.

OBJECTIVE: The aim of this study was to evaluate part of the area of the posterior wall of the external auditory canal (EAC) that is resected during transcanal endoscopic ear surgery (TEES) for cholesteatomas that extend to the mastoid cavity, and to determine whether TEES is a minimally invasive surgical procedure for cholesteatoma. METHODS: This was a retrospective study involving 25 patients with cholesteatoma that extended to the mastoid cavity, and who underwent surgery between October 2014 and October 2015. The patients' cholesteatomas were removed using TEES. In this procedure, the superoposterior wall of the EAC was resected in order to access the deepest part of the cholesteatoma. We made a paper template by tracing the shape of the resected EAC and then reconstructed the resultant defect with a piece of cartilage, the size of which was based on the size of the template. We evaluated the size and greatest dimension of the resected part of the EAC by measuring the template. Preoperatively, we also evaluated the volume of each cholesteatoma on computed tomography (CT) images. RESULTS: The median size of the resected region was 37.3 (14.7-68.4)mm2. The median length of the greatest dimension of the resected area was 8.7 (5.1-15.9)mm. The median cholesteatoma volume was 417 (43-1399)mm3. The correlation coefficient (R2) obtained using a two-thirds order approximation curve for the relationship between the resected tissue area and the cholesteatoma volume (0.617) was higher than that obtained by linear approximation (0.387). CONCLUSION: These results suggest that the resected area was minimal and of an appropriate size relative to the volume of the cholesteatoma.

Gadolinium-enhanced inner ear magnetic resonance imaging for evaluation of delayed endolymphatic hydrops, including a bilateral case.

CONCLUSION: The data suggests that gadolinium-enhanced inner ear MR imaging is useful for diagnosis of delayed endolymphatic hydrops (DEH) because it is independent of inner ear function, and the size of the affected endolymphatic space is clearly enlarged. OBJECTIVE: This study was performed to semi-quantitatively evaluate the endolymphatic space in patients with all types of DEH using gadolinium-enhanced inner ear magnetic resonance (MR) imaging. PATIENTS AND METHODS: Seven patients (age range = 21-77 years; five female, two male) with ipsilateral DEH (n = 5), contralateral DEH (n = 1), and bilateral DEH (n = 1). All patients underwent 3T MR imaging 4 h after intravenous injection of gadolinium. Software was used to determine the size of the endolymphatic space. Pure tone audiometry and caloric testing using an electronystagmogram were carried out. RESULTS: One side of the endolymphatic space was dominantly extended in patients with ipsilateral DEH, and both sides of the space were extended in patients with contralateral and bilateral DEH. In patients with ipsilateral DEH, the volume ratio of endolymph to vestibule was 2.5-4.3-times that in the unaffected ear. The volume ratio of endolymph to vestibule was nearly equal in patients with contralateral and bilateral DEH.