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1.
Plast Reconstr Surg ; 145(4): 790e-802e, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32221226

RESUMEN

BACKGROUND: Apert syndrome causes normal or enlarged intracranial volume overall as patients grow. This study aimed to trace the segmental anterior, middle, and posterior cranial fossae volume and structural morphology in these patients, to help discern a more focused and individualized surgical treatment plan for patients with Apert syndrome. METHODS: This study included 82 preoperative computed tomographic scans (Apert, n = 32; control, n = 50) divided into five age-related subgroups. The scans were measured using image processing and three-dimensional modeling software. RESULTS: The middle cranial fossa volume was increased and was the earliest change noted. It was increased by 45 percent (p = 0.023) compared with controls before 6 months of age and remained increased into adulthood (161 percent, p = 0.016), with gradually increasing severity. The anterior and posterior cranial fossae volumes also increased, by 35 percent (p = 0.032) and 39 percent (p = 0.007), respectively. Increased depth of cranial fossae contributed most to the increase in volumes of patients with Apert syndrome, with correlation coefficients of 0.799, 0.908, and 0.888 for anterior, middle, and posterior cranial fossa, respectively. The intracranial volume was increased 12 percent (p = 0.098) across the entire test age range (0 to 26 years old), but only had statistical significance during the age range of 6 to 18 years (22 percent, p = 0.001). CONCLUSIONS: Malformation of the middle cranial fossa is an early, perhaps the initial, pivotal cranial morphologic change in Apert syndrome. Increased cranial fossae depth is an inherent characteristic of the maldevelopment. Normalization of cranial volume and circumference overall may not achieve a normal skull structure, as it does not correct regional craniocerebral disproportion.


Asunto(s)
Acrocefalosindactilia/cirugía , Cefalometría/métodos , Desarrollo Infantil , Planificación de Atención al Paciente , Base del Cráneo/patología , Acrocefalosindactilia/diagnóstico por imagen , Acrocefalosindactilia/patología , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Recién Nacido , Masculino , Tamaño de los Órganos , Estudios Retrospectivos , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/crecimiento & desarrollo , Tomografía Computarizada por Rayos X , Adulto Joven
2.
Radiol Med ; 125(6): 585-594, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32067161

RESUMEN

PURPOSE: Among patients with isolated sagittal synostosis (ISS), the head shape varies considerably in relation to the severity of the abnormality. This study aimed to quantify skull base morphometry and intracranial volume to investigate their relationships with the severity of scaphocephaly. METHODS: We studied 66 infants with ISS identifying three groups according to the morphological severity of cranial deformity (group I: mild deformity; group II: moderate deformity; group III: severe deformity), by combining two scaphocephaly severity indices as descriptors of the relation of three morphological measurements (length, width and height) We perform a quantitative analysis using high-resolution CT images calculating following parameters: cranial fossae dimensions, supratentorial (ICV) and infratentorial (PCFV) cranial volume, supratentorial (WBV) and infratentorial (PCFBV) brain volume, ICV/WBV, PCFV/PCFBV, supratentorial and infratentorial cerebrospinal fluid (CSF). RESULTS: In all subgroups, anterior and middle skull base lengths were increased, while posterior hemifossae lengths were unchanged. In mild subgroup, ICV/WBV was significantly different and ICV, WBV and CSF supratentorial volume increased (p < 0.05). In moderate and severe subgroups, FCPV/FCPBV was significantly different and CSF infratentorial volume was reduced (p < 0.05); FCPBV was increased only in the severe subgroup (p < 0.05). CONCLUSION: This morpho-volumetric study provides new insights in understanding the compensatory changes occurring in infants at different stages of scaphocephaly severity. In particular, our study suggests that patients with severe deformity might have an earlier depletion of reserve mechanisms with a reduced compliance of the overall skull during encephalic growth and these patients might require early surgical cranial expansion.


Asunto(s)
Craneosinostosis/diagnóstico por imagen , Craneosinostosis/patología , Tomografía Computarizada por Rayos X/métodos , Femenino , Humanos , Imagenología Tridimensional , Lactante , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología
3.
J Clin Neurosci ; 72: 486-492, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31911110

RESUMEN

Gorham-Stout disease is a rare condition of uncertain aetiology characterised by lymphatic proliferation within osseous structures and subsequent massive osteolysis. This report describes the index case of a patient with multifocal Gorham-Stout disease involving the skull base with Chiari I malformation and recurrent aseptic meningitis without fistula. A five-year-old male presented following decompression of a Chiari I malformation with headaches, vomiting, and stiff neck and cerebrospinal fluid pleocytosis without growth of a pathogenic organism. Ongoing symptoms prompted a further three presentations over several months revealing persistent aseptic cerebrospinal fluid monocytic pleocytosis. Further investigation revealed multifocal osseous cystic disease and subsequent bone biopsy suggested Gorham-Stout disease. Suboccipital decompression was not repeated despite craniocervical junction re-stenosis. A literature review demonstrated the extreme rarity of Gorham-Stout disease associated with Chiari I malformation and meningitis. Potential mechanisms of these entities occurring in concert are discussed. Consideration of Gorham-Stout disease as a secondary cause for Chiari I malformation is important amid local bone changes or cerebrospinal fluid leakage prior to pursuing suboccipital decompression considering the poor outcomes reported.


Asunto(s)
Malformación de Arnold-Chiari/etiología , Malformación de Arnold-Chiari/patología , Meningitis Aséptica/etiología , Meningitis Aséptica/patología , Osteólisis Esencial/complicaciones , Osteólisis Esencial/patología , Enfermedades Óseas/patología , Infecciones del Sistema Nervioso Central/cirugía , Pérdida de Líquido Cefalorraquídeo/etiología , Preescolar , Cefalea/cirugía , Humanos , Masculino , Procedimientos Neuroquirúrgicos/efectos adversos , Base del Cráneo/patología
4.
No Shinkei Geka ; 48(1): 55-62, 2020 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-31983689

RESUMEN

Spontaneous cerebrospinal fluid(CSF)rhinorrhea may have multiple leakage sites, and occasionally, may become difficult to manage. A 46-year-old man was admitted to our hospital presenting with bacterial meningitis that occurred after CSF rhinorrhea. The CSF leak had stopped following conservative medical treatment;however, it recurred immediately. The leakage was assumed to be in the left lateral recess of the sphenoid sinus based on the location of fluid accumulation on the CT and MR images and the nasal endoscopic findings. First, we performed an endoscopic endonasal repair of the CSF leakage sites. There were multiple defects in the roof of the sphenoid sinus, including the left lateral sphenoid recess. These bone defects were repaired with abdominal fat;however, this did not stop the CSF leak. Therefore, he underwent a craniotomy and nasal endoscopy, which were performed simultaneously using a galeal flap. The galeal flap was inserted from the middle of the skull base to the sphenoid sinus to cover the bone defects, and the position was adjusted under the guidance of nasal endoscopy. Moreover, intraoperatively, another meningocele with CSF leak was discovered in the cribriform plate and was repaired using abdominal fat. The CSF leak stopped after the second surgery. It is important to be mindful of possible multiple leakage sites when treating cases of idiopathic CSF leakage;moreover, the determination of the leakage sites can be difficult. A repair surgery using a galeal flap is preferable in cases of multiple CSF leakage sites, such as in this case, because it allows for all defects to be covered and repaired simultaneously.


Asunto(s)
Pérdida de Líquido Cefalorraquídeo , Rinorrea de Líquido Cefalorraquídeo , Base del Cráneo , Pérdida de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/etiología , Endoscopía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Base del Cráneo/patología , Base del Cráneo/cirugía , Seno Esfenoidal
5.
World Neurosurg ; 134: 536-539, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31669684

RESUMEN

BACKGROUND: IgG4-related disease (IgG4-RD) is an immune-mediated, systemic, fibroinflammatory disease. IgG4-RD may manifest in almost every part of the human body. Here, we describe 3 patients with a skull base manifestation of IgG4-RD that mimicked malignancy. CASE DESCRIPTION: Patient 1, a 73-year-old male, presented with a mass in the left nasopharynx and clivus. Patient 2, a 73-year-old male, presented with a mass in the left petrous bone and clivus with involvement of the left jaw joint. Patient 3, a 50-year-old male, presented with a lytic lesion of the clivus and sphenoid bone. All patients complained of headache and hearing loss. Serum IgG4 was normal, and imaging did not show systemic manifestation. Histology established the diagnosis of IgG4-RD. Two patients were treated successfully with prednisolone, hydroxychloroquine, and radiotherapy. One patient is monitored without treatment. CONCLUSIONS: The described cases emphasize the broad clinical spectrum of IgG4-RD. The diagnostic workup may be challenging, and serum IgG4 may be normal, as demonstrated in these cases. Careful histopathologic examination of the tissues remains essential. Timely diagnosis of IgG4-RD is important to prevent secondary organ damage in patients with active disease.


Asunto(s)
Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico , Enfermedad Relacionada con Inmunoglobulina G4/patología , Base del Cráneo/patología , Anciano , Cefalea/etiología , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/complicaciones , Masculino , Persona de Mediana Edad
6.
J Cancer Res Clin Oncol ; 146(2): 429-439, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31677113

RESUMEN

PURPOSE: To compare the clinical results and functional outcomes between two-dimensional conventional radiation therapy (2DRT) and intensity-modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC) with skull-base invasion. METHODS: A total of 1258 patients were subclassified into two groups: mild skull-base invasion group (792; 63%) and severe skull-base invasion group (466; 37%). Patients were pair matched (1:1 ratio) using six clinical factors into 2DRT or IMRT groups. The Kaplan-Meier method and Cox regression model were performed to assess overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS). Toxicities were evaluated. RESULTS: IMRT significantly improved four-year OS compared with 2DRT (65.6% vs. 81.8%, P = 0.000), DFS (57.3% vs. 73.3%, P = 0.000) and LRRFS (76.5% vs. 87.5%, P = 0.003) in NPC with severe skull-base invasion, but similar results were observed in patients with mild skull-base invasion (P > 0.05). In patients with severe invasion, radiation therapy techniques were found to be an independent prognostic factor for OS (HR = 0.457, P = 0.000), DFS (HR = 0.547, P = 0.000) and LRRFS (HR = 0.503, P = 0.004). IMRT was associated with better OS. In subgroups analysis, IMRT group also had a better survival in OS, DFS (P < 0.05 for all rates) for patients received concurrent chemotherapy and sequential chemotherapy compared to 2DRT in the severe invasion group. The IMRT group displayed lower incidence of mucositis, xerostomia, trismus (< 1 cm) and temporal lobe necrosis than the 2DRT group. CONCLUSIONS: IMRT significantly improved patient survival compared with 2DRT in NPC patients with severe skull-base invasion, but a similar survival rate was noted in mild invasion patients. Chemotherapy can improve survival in NPC patients with severe invasion. Among the two therapies, IMRT significantly decreased therapy-related toxicity.


Asunto(s)
Neoplasias Óseas/radioterapia , Neoplasias Óseas/secundario , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Adolescente , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Quimioradioterapia , Estudios de Cohortes , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/tratamiento farmacológico , Carcinoma Nasofaríngeo/patología , Neoplasias Nasofaríngeas/tratamiento farmacológico , Neoplasias Nasofaríngeas/patología , Radioterapia de Intensidad Modulada , Estudios Retrospectivos , Base del Cráneo/patología , Adulto Joven
7.
Ann R Coll Surg Engl ; 102(2): e45-e47, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31538802

RESUMEN

Parapharyngeal infections carry a significant risk of extensive suppuration and airway compromise. We report the case of a patient presenting with a right paranasopharyngeal abscess, featuring atypical symptoms that made diagnosis particularly challenging. Complications included evidence of right vocal cord paralysis, likely secondary to involvement of the vagus nerve. Notably, this paralysis occurred in isolation, without involvement of cranial nerves IX or XI, which would be expected from jugular foramen encroachment. Imaging demonstrated the presence of a collection extending towards the skull base, which was drained using a transnasal endoscopic approach, avoiding the use of external incisions. Tissue biopsies from the abscess wall suggest that the underlying aetiology was minor salivary gland sialadenitis, which has not been previously reported in the literature.


Asunto(s)
Absceso/etiología , Enfermedades Faríngeas/etiología , Sialadenitis/complicaciones , Parálisis de los Pliegues Vocales/etiología , Absceso/diagnóstico , Absceso/cirugía , Adolescente , Biopsia , Drenaje , Endoscopía , Femenino , Humanos , Imagen por Resonancia Magnética , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/patología , Nasofaringe/diagnóstico por imagen , Nasofaringe/patología , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/cirugía , Nervio Laríngeo Recurrente/diagnóstico por imagen , Glándulas Salivales Menores/patología , Sialadenitis/diagnóstico , Sialadenitis/patología , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Parálisis de los Pliegues Vocales/diagnóstico
8.
J Forensic Sci ; 65(1): 193-195, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31433492

RESUMEN

The interpretation of cranial base injuries has never been investigated from a purely anthropological perspective. Very little exists in forensic literature in order to interpret the significance of cranial base fractures. We analyzed 296 cases of deaths due to skull-brain injuries. The frequency of vault fractures was 75.7% and that of base fractures was 91.9%. We observed the distribution of cases of death according to manner of death and manner of injury and number of fossae involved. These observations were analytically compared to different variables (age, sex, manner of injury, and mode of injury). The study presented the proportion of base fractures associated with vault fractures, and the frequency of absence of base fracture in subjects with no vault fractures. Interesting associations of base fractures to age and manner of death are shown.


Asunto(s)
Lesiones Encefálicas/mortalidad , Base del Cráneo/lesiones , Fracturas Craneales/epidemiología , Accidentes por Caídas/mortalidad , Accidentes de Tránsito/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Italia/epidemiología , Masculino , Persona de Mediana Edad , Abuso Físico/estadística & datos numéricos , Distribución por Sexo , Base del Cráneo/patología , Fracturas Craneales/patología , Heridas por Arma de Fuego/mortalidad , Adulto Joven
9.
BMJ Case Rep ; 12(11)2019 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-31694827

RESUMEN

Nasopharyngeal carcinoma (NPC), an uncommon malignancy in Western Countries and Radiotherapy, remains an effective treatment. Its side effects are classified as either immediate or late; postradiation necrosis is as an important late side effect with a strong impact on the prognosis in patients with NPC. We report the case of 65-year-old Caucasian man presenting with a deep necrotic ulcer of the nasopharynx and osteoradionecrosis of the skull base that appeared 3 months after radiotherapy for nasopharyngeal carcinoma. Conservative treatment was applied with surgical management of the ulcer. Clinical and radiological outcomes are presented. Radiotherapy remains a good treatment option with varying degrees of side effects, in particular, postradiation necrosis and ulcer. Multiple options of treatment have been described. However, the surgical management could be indicated in cases of deep ulcer with life-threatening prognosis.


Asunto(s)
Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Osteorradionecrosis/patología , Traumatismos por Radiación/patología , Úlcera/patología , Anciano , Endoscopía , Humanos , Masculino , Carcinoma Nasofaríngeo/patología , Neoplasias Nasofaríngeas/patología , Nasofaringe/patología , Osteorradionecrosis/cirugía , Traumatismos por Radiación/cirugía , Base del Cráneo/patología , Resultado del Tratamiento , Úlcera/cirugía
10.
Radiologe ; 59(12): 1051-1057, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31701165

RESUMEN

Glomus tumors (paragangliomas) are rare, usually benign, neuroendocrine tumors that arise from nonchromaffin cells and can be multifocal or familial. They grow slowly, often infiltratively and rarely form metastases. A distinction is made between carotid, jugular, tympanicum and vagal tumors. Depending on the location, clinical symptoms include neck swelling, hearing loss with pulse-synchronous ear noise or cranial nerve failures (IX-XI). Diagnosis is often delayed because of nonspecific symptoms. Diagnostically, tumor expansion and perfusion can be well visualized by color Doppler sonography. In the T2-weighted MRI, the tumor is hyperintense, after contrast agent administration a strong enhancement occurs due to the strong vascularization. In DSA (digital subtraction angiography), even small glomus tumors can be detected. Therapeutically, operative tumor resection after embolization with, e.g., polyvinyl alcohol particles or liquid embolization can be performed. If the patient is in poor general condition or if the tumor is inoperable, different treatment techniques (intensity-modulated radiotherapy, gamma or cyber-knife) may be considered as a conservative therapeutic alternative.


Asunto(s)
Embolización Terapéutica , Tumor Glómico , Neoplasias de Cabeza y Cuello , Angiografía de Substracción Digital , Tumor Glómico/diagnóstico , Tumor Glómico/terapia , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Humanos , Base del Cráneo/patología
11.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31537596

RESUMEN

We present an unusual case of skull base osteomyelitis in an 88-year-old woman. She presented with gradual onset unilateral headache and diplopia. On examination, there was evidence of a left-sided Horner's and ipsilateral sixth nerve palsy. In addition to persistent raised inflammatory markers, an MRI neck identified signal change in the petrous bone confirming a diagnosis of skull base osteomyelitis. Skull base osteomyelitis should be considered in presentations of subacute raised inflammatory markers in the context of ipsilateral cranial nerve signs.


Asunto(s)
Síndrome de Horner/diagnóstico , Osteomielitis/complicaciones , Hueso Petroso/microbiología , Base del Cráneo/microbiología , Enfermedades del Nervio Abducens/diagnóstico , Enfermedades del Nervio Abducens/etiología , Administración Intravenosa , Anciano de 80 o más Años , Carbapenémicos/administración & dosificación , Carbapenémicos/uso terapéutico , Diplopía/diagnóstico , Diplopía/etiología , Femenino , Cefalea/diagnóstico , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética/métodos , Osteomielitis/tratamiento farmacológico , Hueso Petroso/diagnóstico por imagen , Hueso Petroso/patología , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología , Resultado del Tratamiento
12.
Artículo en Chino | MEDLINE | ID: mdl-31550754

RESUMEN

Objective: To develop the Chinese version of anterior skull base questionnaire(ASBQ) and to verify its application in patients with anterior and middle skull base tumors. Methods: The following steps were finished including getting the permission from the author of the original English scale, translating and back-translating, tentative test, discussing the consequence and cultural debugging. From October 2016 to December 2018, 51 patients with skull base tumors from Xuanwu Hospital and China-Japan Friendship Hospital were enrolled as an experimental group, aged from 24 to 70 years old, with 19 males and 32 females, which included 27 patients with anterior skull base tumor and 24 patients with middle skull base tumor. From December 2016 to January 2018, 46 healthy volunteers were selected as a control group, aged from 18 to 36 years old, including 26 females and 20 males. The subjects in the test group and the control group were rigorously tested with official manuscripts and judged whether the manuscript was applicable. The SPSS 22.0 statistical software was used to analyze the data of the test group, the anterior skull base group, the middle skull base group and the control group to evaluate the performance of the scale. Results: Both the rate of the recovery and efficiency in experimental group, anterior skull base group and middle skull base group were 100%, with the average time of completion of (8.7±3.2), (11.2±4.0) and (7.3±2.1) min, respectively in each group. The r value of test-retest reliability was 0.96, 0.99 and 0.97 in experimental group, anterior skull base group and middle skull base group, with the split-half reliability coefficient of 0.91, 0.90 and 0.96, with the entire scale Cronbach's coefficient of 0.91, 0.95 and 0.93, respectively. The content validity and the construct validity of the scale were good enough, and the criteria validity was-0.483,-0.509 and -0.489 in experimental group, anterior skull base group and middle skull base group. The scale could well distinguish the difference of the quality of life between the preoperative and postoperative patients in experimental group and the middle skull base group. The difference of the quality of life in anterior skull base group was not found between preoperative and postoperative patients. Conclusion: The Chinese version of ASBQ has good reliability and validity, which is suitable for a wide range of Chinese patients with anterior and middle skull base tumors to assess their quality of life.


Asunto(s)
Neoplasias de la Base del Cráneo , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Reproducibilidad de los Resultados , Base del Cráneo/patología , Neoplasias de la Base del Cráneo/patología , Adulto Joven
13.
Artículo en Chino | MEDLINE | ID: mdl-31446710

RESUMEN

Objective:To summarize the clinical features, diagnosis and treatment of Langerhans histiocytosis(LCH) which first appeared in the nasal skull base. Method:Ten cases of LCH with nasal and skull base symptoms were analyzed retrospectively. The clinical characteristics of LCH with nasal and skull base symptoms were summarized. The correlation of other systems involved in LCH was analyzed. Result:Among the 10 patients, the youngest was 1 year and 5 months, and the oldest was 8 years, the average age was 3 years. The main imaging manifestations were osteolytic changes and soft tissue invasion. Seven patients were monofocal and three patients were multifocal. For localized lesions, radical resection and follow-up chemotherapy were performed, and conservative treatment was performed for patients with multiple system involvement and obvious systemic symptoms. Eight patients survived, 2 died. Conclusion:LCH occurs frequently in children and has certain clinical characteristics. Single system and single lesion surgery have a better therapeutic effect, and can achieve a greater survival rate with follow-up chemotherapy.


Asunto(s)
Histiocitosis de Células de Langerhans/patología , Base del Cráneo/patología , Niño , Preescolar , Histiocitosis de Células de Langerhans/diagnóstico , Humanos , Lactante , Nariz , Estudios Retrospectivos , Tasa de Supervivencia
14.
Curr Opin Ophthalmol ; 30(6): 454-461, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31464699

RESUMEN

PURPOSE OF REVIEW: Describe the range of infectious causes of ocular motor neuropathies, from common presentations to unusual manifestations of diseases less frequently seen in the developed world. Provide information on recent developments in diagnostic testing for pathogens that may cause ocular motor neuropathies. RECENT FINDINGS: Antigen detection in serum or CSF has improved the diagnosis of cryptococcal disease. Cartridge PCR testing for tuberculosis has increased diagnostic accuracy, though tuberculous meningitis remains difficult to diagnose. Rapid, multiplex PCR and unbiased sequencing allow for diagnosis of a wider range of organisms. SUMMARY: Infectious ocular motor neuropathies can occur anywhere along the length of cranial nerves III, IV, and VI. Characteristic clinical findings and imaging can be used to localize infections. Infectious causes may have characteristic clinical, laboratory, or imaging findings, but must still be carefully separated from inflammatory or neoplastic conditions.


Asunto(s)
Enfermedades del Nervio Abducens/microbiología , Infecciones Bacterianas del Ojo/microbiología , Enfermedades del Nervio Oculomotor/microbiología , Enfermedades del Nervio Troclear/microbiología , Enfermedades del Nervio Abducens/epidemiología , Trombosis del Seno Cavernoso/epidemiología , Infecciones Bacterianas del Ojo/epidemiología , Humanos , Encefalitis Infecciosa/epidemiología , Enfermedades del Nervio Oculomotor/epidemiología , Osteomielitis/epidemiología , Base del Cráneo/patología , Enfermedades del Nervio Troclear/epidemiología
15.
Otol Neurotol ; 40(8): e816-e819, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31348132

RESUMEN

BACKGROUND: Skull base osteomyelitis (SBO) is predominantly seen in immunocompromised patients, with diabetes mellitus being the most common underlying comorbidity. Microbial aetiology is commonly bacterial, although fungal SBO is encountered in a small fraction of patients. Treatment consists of prolonged antimicrobial therapy, control of underlying comorbidity, and surgical debridement in selected cases. Involvement of cranial nerves is a common complication and is considered a poor prognostic factor. Pseudoaneurysm of internal carotid artery caused by skull base osteomyelitis is a very rare complication, limited to few case reports only. CASE: We report the case of a 55-year-old diabetic patient with bacterial SBO who developed pseudoaneurysm of cervical-petrous part of internal carotid artery during the course of treatment. CONCLUSION: New onset symptoms or persistent symptoms in SBO suggest progressive disease and necessitate re-evaluation of the microbial aetiology and antimicrobial treatment. Skull base osteomyelitis induced aneurysm is rare but can be life threatening, if not identified and managed immediately.


Asunto(s)
Aneurisma Falso/inmunología , Infecciones Bacterianas/inmunología , Arteria Carótida Interna/patología , Complicaciones de la Diabetes/patología , Osteomielitis/inmunología , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Osteomielitis/complicaciones , Base del Cráneo/patología
16.
Eur Arch Otorhinolaryngol ; 276(9): 2465-2473, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31203383

RESUMEN

INTRODUCTION: Inflammatory pseudotumor (IPT) in the sinonasal cavity and skull base region is benign non-neoplastic inflammatory process. However, IPT can mimic malignant tumor or infectious disease and there are difficulties in confirmation of diagnosis. The aim of study is to evaluate the clinical significance of immunoglobulin G4 (IgG4) in IPT in terms of steroid response and differential diagnosis with other skull base infiltrative lesions. METHODS: Medical records were reviewed retrospectively from 1998 to 2016. Subjects diagnosed with IPT by surgical biopsy were enrolled. IgG4 positivity was defined as IgG4/IgG ratio > 0.4. Additionally, IgG4/IgG ratio was calculated in eight skull base osteomyelitis (SBO) patients. RESULTS: Twenty-six IPT patients were included and the average age was 52.3 years, and 57.7% were male and 42.3% were female. Most lesions were involved in the sinuses (88.5%) and the incidence of extension beyond the sinuses itself was as follows: the cheek/hard palate/parapharynx (15.4%), orbit (61.5%), skull base (57.7%), and dura or brain (23.1%). All IPT cases revealed IgG4 + plasma cells and IgG4/IgG ratio over 0.4 was detected in 42.3% (11/26) of cases. In case of SBO, no patients had IgG4/IgG ratio exceed 0.4. Main treatment modality was systemic steroids (61.5%) and other modalities were used: surgery (3.8%), immunosuppressant (7.7%), radiotherapy (30.8%), or a combination of these modalities (15.4%). Steroid responses were not significantly different, but IgG4-positive group tended to have better response to steroid therapy. CONCLUSIONS: IgG4-positive and IgG4-negative IPT patients revealed no differences in involvement sites, clinical course, and steroid responses. However, IgG4/IgG ratio and IgG4 + plasma cell count can provide a diagnostic clue for infiltrative skull base lesions such as IPT and a differential diagnosis of SBO.


Asunto(s)
Granuloma de Células Plasmáticas/inmunología , Inmunoglobulina G/sangre , Neoplasias Nasales/inmunología , Neoplasias de la Base del Cráneo/inmunología , Adulto , Anciano , Biopsia , Recuento de Células Sanguíneas , Niño , Diagnóstico Diferencial , Femenino , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias Nasales/diagnóstico , Neoplasias Nasales/patología , Estudios Retrospectivos , Base del Cráneo/patología , Neoplasias de la Base del Cráneo/diagnóstico , Neoplasias de la Base del Cráneo/patología
17.
Medicine (Baltimore) ; 98(23): e15980, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31169734

RESUMEN

Owing to the special growth pattern of chordomas and the limited treatment options currently available, the treatment of chordoma still remains difficult. In this study, we hope to further clarify the relationship between surgical treatment and radiotherapy of chordoma and disease progression.All patients with a primary histopathological diagnosis of clival or spinal chordomas recorded in our institution between 1976 and 2017 were examined.A total of 60 patients (location: skull base/clival, n = 24; vertebral column, n = 5; sacrum, n = 31) had a mean follow-up time of 7.7 years (range 12 months-35 years). Compared with patients who received subtotal resection (n = 5, 5-year and 10-year survival = 61% and 39%, respectively), the annual survival rate of patients who received total resection (n = 55, 5-year and 10-year survival = 67%, respectively) was significantly higher. The overall 10-year survival rate (58%) of patients treated with surgery alone was significantly different from those treated with a combination of surgery and radiation (73%). The long-term prognosis of sacral chordoma was the worst (10-year survival rate = 48%).The best treatment strategy for improved long-term survival in chordoma was a combination of surgical resection and radiation therapy. Adjuvant radiotherapy for chordoma significantly improves disease-free survival, although the long-term survival benefit remains to be determined. A worse prognosis and poor long-term survival are seen in sacral chordomas.


Asunto(s)
Cordoma/mortalidad , Neoplasias de la Base del Cráneo/mortalidad , Neoplasias de la Columna Vertebral/mortalidad , Adulto , Cordoma/terapia , Fosa Craneal Posterior/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Radioterapia Ayuvante , Sacro/patología , Base del Cráneo/patología , Neoplasias de la Base del Cráneo/terapia , Neoplasias de la Columna Vertebral/terapia , Tasa de Supervivencia , Resultado del Tratamiento
19.
World Neurosurg ; 128: 506-513, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31132485

RESUMEN

OBJECTIVE: To describe a novel bilaterally pedicled pericranial flap for anterior cranial base reconstruction after removal of complex frontobasal cancers extending to the frontal region, thus precluding the use of standard reconstructive techniques. METHODS: In selected oncologic cranial base surgeries, the use of the standard galea frontalis pericranial flap for reconstructive purposes may be precluded by tumor infiltration. In such cases, dura mater reconstruction and exclusion of frontal sinuses from the intracranial space can be performed using a large superficial temporal artery bilaterally pedicled pericranial flap obtained from both temporoparietal regions. Surgical technique, indication, contraindication, complications, and degree of resection are recorded to evaluate the efficacy of this surgical method. RESULTS: A 48-year-old man affected by a recurrence of frontobasal squamous cell carcinoma was surgically treated by combined transcranial and endoscopic endonasal resection. A large pericranial flap pedicled bilaterally on the parietal branches of the superficial temporal artery was obtained, transposed anteriorly, carefully watertight sutured to the dural defect, and used to exclude cranialized frontal sinuses as well. The reconstruction was successful, and the patient was discharged home on the tenth postoperative day without any complications and/or development of cerebrospinal fluid leak. Contrast-enhanced magnetic resonance imaging 3 months after surgery was clear from disease with consolidated surgical outcomes. CONCLUSIONS: This novel pericranial flap seems to be easily obtained and effective for anterior cranial base reconstruction when the use of a traditional galea frontalis flap is precluded for oncologic reasons and there are concerns for the possible development of contaminations and cerebrospinal fluid leaks.


Asunto(s)
Seno Frontal/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias de los Senos Paranasales/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Base del Cráneo/cirugía , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Colgajos Quirúrgicos , Fosa Craneal Anterior , Hueso Frontal , Seno Frontal/diagnóstico por imagen , Humanos , Imagenología Tridimensional , Masculino , Maxilar/cirugía , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen
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