Spontaneous clivus hematoma: case report and literature review.

A spontaneous extra-axial hematoma extending from the dorsum sella to the foramen magnum is described. Although two cases of clivus epidural hematomas have been reported previously, review of the literature failed to reveal any case reports of spontaneous hematomas in this region.

MR of intracranial epidermoid tumors: correlation of in vivo imaging with in vitro 13C spectroscopy.

We analyzed the MR findings of five patients with benign intracranial epithelial tumors, commonly called epidermoids. The neoplasms were categorized into two groups on the basis of T1-weighted MR signal intensity (relative to brain): high-signal-intensity masses (short T1) and low-signal-intensity masses (long T1). Surgical specimens were obtained and analyzed by means of 13C MR spectroscopy. Epidermoids with short T1 values (white epidermoids) had a high lipid content comprising mixed triglycerides containing unsaturated fatty acid residues. Epidermoids with long T1 values (black epidermoids) exhibited a much reduced lipid content with no triglycerides or fatty acids. There was evidence of trace amounts of cholesterol in the black epidermoids. Our data indicate that epidermoids are a heterogeneous group of neoplasms that behave differently with T1-weighted MR imaging and 13C MR spectroscopy. The combination of MR imaging and spectroscopy holds the potential of further elucidating the nature of epidermoids as well as of other forms of neoplasms.

Management of petrous apex lesions.

Advancements in imaging pose new diagnostic and therapeutic dilemmas as smaller lesions in the relatively inaccessible regions of the petrous apex and clivus are identified. Differentiation of true pathology from artifact and anatomic variants is critical in management of these lesions. We describe our experience with five patients diagnosed with petrous apex lesions: three, cholesteatomas; one, cholesterol granuloma; and one, false-positive. Soft-tissue obliteration of the temporal bone defect with postoperative follow-up using high-resolution computed tomographic scanning and magnetic resonance imaging is proposed as an alternative to exteriorization.

CT of laryngeal tumors.

CT is the radiographic procedure of choice in evaluating laryngeal neoplasia. CT not only is easily tolerable and relatively noninvasive for the patient but also assesses deep and extralaryngeal pathology. It allows tumor staging and, therefore, treatment planning to be more intelligently performed.

Effect of bromocriptine and pergolide on pituitary tumor size and serum prolactin.

Forty-two patients with elevated serum prolactin were treated in a randomized, open-label trial with the conventional ergot bromocriptine, or a new ergot pergolide. Before treatment, the patients underwent thorough endocrine evaluation and computed tomographic scan. All patients had prolactin levels greater than 25 ng/ml, and 27 patients had a pituitary mass. Follow-up studies performed after 6 months of treatment showed both drugs effectively reduced prolactin levels to normal, though pergolide effects were more rapid. There was no change in the contents of the pituitary fossa in the 10 patients with hyperprolactinemia but without pituitary mass. Sixty percent of patients with pituitary mass had diminution of tumor size. Pergolide appears to be an effective medical treatment for hyperprolactinemia and pituitary tumor and offers a possible alternative to bromocriptine and surgical treatment.

Radiographic management of juvenile angiofibromas.

Juvenile angiofibromas are benign, vascular, locally aggressive neoplasms that are preferably treated by surgical resection, or irradiation if surgery is not possible. Adequate surgery in the past has been limited by incomplete knowledge of the anatomy of the tumor and technical difficulties related to the vascularity. To better define the tumor, 12 patients with juvenile angiofibroma have been studied by axial and coronal high resolution computed tomography (CT). The extent of the neoplasm was better demonstrated by CT than by other techniques. Based on the CT findings, we propose an anatomic classification that is helpful in determining treatment methods. Nine patients were considered operable, and eight of these underwent preoperative embolization with Silastic spheres and Gelfoam. The preoperative embolization significantly reduced operative difficulty and the necessity for blood transfusions. Based on these cases, we believe the current radiographic management of juvenile angiofibromas should consist of plain films, CT, angiography and, in surgical cases, preoperative embolization.