Multiple-revolution spiral osteotomy for cranial reconstruction. Technical note.

Various combinations of cranial remodeling techniques are used in an attempt to provide optimal cosmetic results and to reduce possible sequelae associated with craniosynostosis. One element of deformity that is difficult to correct directly is an overly flattened area such as that found in the parietal area in sagittal synostosis, unilaterally in lambdoid synostosis, or even in severe positional molding. The authors present a novel application for recontouring cranial bone, namely the multiple-revolution spiral osteotomy. The advantages of this technique include the avoidance of large areas of craniectomy and immediate correction of the cranial deformity. The surgical procedure, illustrative cases, early results, and apparent benefits of this technique are discussed.

Lemierre syndrome: magnetic resonance imaging and computed tomographic appearance.

Lemierre syndrome consists of septic thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection, usually with Fusobacterium necrophorum. Septic metastatic emboli and distant infection are characteristic. We describe the imaging appearance of Lemierre syndrome in an adolescent female by both magnetic resonance imaging and computed tomography. This case illustrates the rapid onset and characteristic progression of the rare syndrome of Lemierre. In addition, we used magnetic resonance imaging to effectively distinguish between inflammatory venous thrombosis and abscess, thus avoiding surgery in our patient. Early directed antibiotic therapy is mandatory to ensure good outcome.

An unusually large, solid tumor of the parotid gland.

Of the parotid gland tumors, benign pleomorphic adenomas are the most commonly encountered. Although occurring relatively frequently in the general population, it is rare for the surgical community to encounter one that weighs more than a few ounces. The authors report a woman who avoided early surgical intervention and eventually presented with an extraordinarily large parotid gland tumor. This is the largest solid (without cystic change), benign pleomorphic adenoma of the parotid gland in the English medical literature, weighing 8.03 kg.

Morning Glory syndrome. MR imaging.

We present two cases of the Morning Glory Syndrome (MGS), with the most detailed MR images to date of this rare congenital optic nerve dysplasia. Though the embryology of this syndrome remains controversial, we feel the MR appearance can be diagnostic of the non-familial syndrome and be reliably distinguished from the similar appearing optic disc coloboma, which may be genetically inherited. MR imaging also allows the most sensitive detection and characterization of any associated intracranial anomalies, thus enabling more accurate determination of prognosis for the patient and their family.

Cranial polyneuropathies in multiple sclerosis: case report and literature review.

Although cranial neuropathies are common disorders in multiple sclerosis patients, multiple cranial nerve involvement is an unusual occurrence. Correlation of clinical symptoms with magnetic resonance imaging evidence of demyelinating central nervous system lesions can confirm the diagnosis. The authors report on the case of a 43-year-old woman who initially was thought to have suffered a brainstem infarct but, in fact, had developed multiple cranial nerve functional deficits. Treatment of multiple sclerosis remains primarily supportive in nature, with corticosteroids used for acute exacerbations and chronic progression.

Ultrasonographic appearance of malignant fibrous histiocytoma of the spermatic cord: a case report.

A case of malignant fibrous histiocytoma of the spermatic cord with ultrasound features is presented. The tumor rarely affects the spermatic cord. Our case is only the second reported in the literature with ultrasound correlation; in addition, our sonographic findings differ from the first reported case and more closely approximate the sonographic appearance of this tumor elsewhere in the body.