Association of Extent of Transverse Sinus Stenosis With Cerebral Glymphatic Clearance in Patients With Idiopathic Intracranial Hypertension.

BACKGROUND AND OBJECTIVES: Idiopathic intracranial hypertension (IIH) is a neurologic disorder characterized by symptoms of elevated intracranial pressure in the absence of a clear cause. There is a developing theory that IIH may, in part, be related to abnormal cerebral glymphatic clearance. In addition, transverse sinus stenosis (TSS) is a common finding in IIH of unclear pathophysiologic significance. Similarly, whether or not TSS is associated with glymphatic outflow in IIH is unknown. The aim of this investigation was to explore the possible association between glymphatic outflow and extent of TSS in patients with IIH. METHODS: The study cohort consisted of patients with IIH and healthy controls who were retrospectively identified from our tertiary care institution located in upstate New York from 2016 to 2023. Patients with IIH were included if they had brain MRIs completed with sufficient sequences for analysis. Brain MRIs were computationally analyzed using diffusion tensor imaging analysis along the perivascular space technique to quantify the glymphatic function in patients with IIH. Glymphatic clearance, the primary outcome, was then correlated with the degree of TSS on MR venography using 2 different scoring systems, the 'Farb score' and 'Carvalho score.' RESULTS: Overall, 81 patients with IIH (70 [86%] female, mean age 29.8 years [SD: 8.2 years], mean BMI 41 [SD: 8.4]) and 10 normal controls were identified with sufficient imaging. Based on the Carvalho TSS score, IIH patients without TSS had significantly lower glymphatic clearance than healthy controls (mean ALPS index: 1.196 [SD: 0.05] vs 1.238 [SD: 0.04], respectively; p = 0.018). Furthermore, IIH patients with TSS had significantly lower glymphatic outflow than healthy controls (1.129 [SD: 0.07] vs 1.238 [SD: 0.04], respectively; p < 0.0001) and IIH patients without TSS (1.129 [SD: 0.07] vs 1.196 [SD: 0.05], respectively; p < 0.0001). In addition, there was a significant association between increasing extent of TSS and declining glymphatic clearance (p < 0.0001, R = 0.62). Finally, IIH patients with severe TSS had significantly lower glymphatic flow than IIH patients with mild stenosis (1.121 [SD: 0.07] vs 1.178 [SD: 0.05], respectively; p < 0.0001). These findings were similarly recapitulated using the Farb TSS scoring system. DISCUSSION: These preliminary findings suggest that the extent of TSS is associated with the degree of glymphatic clearance in IIH, providing novel insights into IIH pathophysiology. Further research is required to clarify the possible causal relationship between TSS and impaired glymphatic clearance in IIH.

Imaging of cerebrovascular complications from blunt skull base trauma.

Cerebrovascular complications from blunt trauma to the skull base, though rare, can lead to potentially devastating outcomes, emphasizing the importance of timely diagnosis and management. Due to the insidious clinical presentation, subtle nature of imaging findings, and complex anatomy of the skull base, diagnosing cerebrovascular injuries and their complications poses considerable challenges. This article offers a comprehensive review of skull base anatomy and pathophysiology pertinent to recognizing cerebrovascular injuries and their complications, up-to-date screening criteria and imaging techniques for assessing these injuries, and a case-based review of the spectrum of cerebrovascular complications arising from skull base trauma. This review will enhance understanding of cerebrovascular injuries and their complications from blunt skull base trauma to facilitate diagnosis and timely treatment.

Efficacy of transvenous embolization of CSF-venous fistula in spontaneous intracranial hypotension: Case-series.

BACKGROUND: Spontaneous intracranial hypotension is a debilitating neurological condition which can be caused by a cerebrospinal fluid-venous fistula. Transvenous embolization is a promising technique to provide minimally invasive yet durable treatment. METHODS: A retrospective single-center case series was performed on all patients who underwent transvenous embolization of a cerebrospinal fluid (CSF)-venous fistula. Clinical and radiographic parameters, including Bern score, were reported preoperatively and at 3-month follow-up. RESULTS: Six patients underwent embolization of a CSF-venous fistula. All fistulae were located in the thoracic spine and technical success was achieved in all cases. Three patients had symptom resolution, two had significant improvement, and one had stable symptoms on follow-up. The mean Bern score was 6.83 (SD = 1.47) preoperatively and 1.83 (SD = 1.64) postoperatively with a mean improvement in Bern score of 5.0 (SD = 1.9, p = 0.0013). CONCLUSIONS: CSF-venous fistulas are an increasingly recognized clinical entity which may be treated with transvenous embolization. This case series serves to further validate this technique and suggests it can be performed with similar outcomes in lower volume centers.

Development of Anterior Cranial Fossa Dural Arteriovenous Fistula and Supraclinoid Internal Carotid Artery Pseudoaneurysm Following Frontobasal Trauma: A Case Report and Literature Review.

Cerebrovascular injuries resulting from frontobasal head trauma represent a range of imaging and clinical presentations. Severe cerebrovascular injuries such as vessel transection commonly present with profound neurological deficits and are often easily identified with routine imaging. However, small intimal injuries and dissections may be challenging to detect and may be clinically silent or masked by additional injuries in the setting of polytrauma. The onset of symptoms and complications from cerebrovascular injuries may be delayed from the time of initial presentation, and failure to recognize and diagnose these injuries may result in devastating outcomes if management is delayed. In this case report, we present a case of frontobasal craniofacial trauma that resulted in an anterior cranial fossa dural arteriovenous fistula (ACF-dAVF) and supraclinioid segment internal carotid artery (ICA) pseudoaneurysm.

Prevalence of SLEC-negative spontaneous intracranial hypotension in patients with spinal nerve root sleeve diverticula on MRI.

PURPOSE: While there is thought to be an association between spinal nerve root diverticula (NRD) and spontaneous intracranial hypotension (SIH) without a spinal longitudinal epidural collection (SLEC), it remains unclear what the overall prevalence of SLEC-negative SIH is in patients with NRD on MRI. METHODS: Spine MRI imaging reports from our single institution were electronically screened for instances of NRD over a 9-year period (2016-2023). From these cases, patients with brain MRIs consistent with SIH were also identified. Subsequently, the overall proportion of SLEC-negative SIH was determined as a function of total cases with NRD based on spinal level. RESULTS: In total, 83,843 patients with spinal MRIs were screened which identified 4174 (4.97%) with NRD. From these, there were 1203 cervical, 622 thoracic, and 2979 lumbosacral spine MRIs. In total, 16 patients (0.38%; Standard Error [SE]: 0.48%-0.28%) had a brain MRI compatible with SLEC-negative SIH and met ICHD-3 criteria. Patients with cervical NRD had SIH in 2 cases (0.16%; SE: 0.27%-0.05%). SLEC-negative SIH was present in 11 patients with lumbosacral NRD (0.34%; SE: 0.44%-0.24%). In patients with diverticula in the thoracic spine, 14 (2.3%; SE: 2.8%-1.8%) had SLEC-negative SIH. SLEC-negative SIH was significantly more prevalent in patients with thoracic diverticula compared to those with cervical (p<.0001) or lumbosacral NRD (p<.0001). CONCLUSION: In patients with spinal NRD, concurrent SLEC-negative SIH is present in approximately 0.38% of patients, suggesting that in the vast majority of cases, they are an incidental finding. However, SIH is present in approximately 2.3% of patients with thoracic NRD and may be more specific for leak localization.

Direct percutaneous puncture versus transarterial embolization for head and neck paragangliomas: A systematic review and meta-analysis.

INTRODUCTION: Embolization of head and neck paragangliomas (HNPs) is a well-established treatment strategy and adjunctive therapy. However, the optimal mode of intervention, whether by direct percutaneous puncture (DP) or via transarterial embolization (TAE), remains unclear. METHODS: The aim of this study was to complete a systematic literature review and meta-analysis to compare the safety and efficacy of DP versus TAE for HNP embolization. The Cochrane Library and MEDLINE databases were used to identify studies describing the clinical outcomes of either DP or TAE for HNP embolization. Outcome measures included: complete angiographic devascularization, major complications, and minor complications. Pooled rates were calculated for each variable which were then compared with meta-regression using a random effects model. RESULTS: Thirty-one retrospective studies met inclusion criteria, detailing 394 patients with 411 HNPs. Overall, DP was associated with a higher rate of complete devascularization (91.5%, 95% confidence interval [CI]: 85.6% to 97.4%; I2 = 0%) when compared to TAE technique (40.1%, CI: 27.2% to 58.9%; I2 = 93%). However, there was no difference regarding major complication rates between DP (6%, CI:1.3% to 10.8%; I2 = 0%) and TAE for HNP embolization (3.3%, CI: 1.4% to 5.3%; I2 = 0%) (p = 0.370), nor in minor complications between the techniques (p = 0.211). Subgroup analysis of TAE embolic agents revealed that particle embolics were associated with a significantly lower rate of major complications (2.5%; 0.4% to 4.6%; I2 = 0%) when compared to liquid embolics (10.6%, CI:4% to 17.3%; I2 = 48%; p = 0.022). CONCLUSIONS: A DP approach for HNP embolization results in a higher rate of complete devascularization and with a similar complication profile when compared to TAE. These findings also suggest that particle embolics are associated with fewer major complications compared to liquid embolics when TAE is utilized.

Transverse sinus pathologies, vestibular migraine and intracranial hypertension without papilledema.

BACKGROUND: In the absence of papilledema, the presentation of migraine and idiopathic intracranial hypertension (IIH) is very similar. In this respect, an IIH could be presented as a vestibular migraine. Our main objective in this case report is to demonstrate the similarities between IIH and vestibular migraine. CASES: This is a report of 14 patients who have IIH without papilledema presented as vestibular migraine to the clinic and followed from 2020 to 2022. RESULTS: The common presentation of patients was ear-facial pain, dizziness, and frequent pulsatile tinnitus. One-fourth of the patients reported episodes of true episodic vertigo. The average age was 37.8, the average BMI was 37.4, and the average lumbar puncture-opening pressure was 25.6 cm H2O. Transverse sinus venous flow alterations caused neuroimaging findings of sigmoid sinus dehiscence, empty sella, or tonsillar ectopia. Most patients improved with carbonic anhydrase inhibitors, and one patient was treated with a dural sinus stent. CONCLUSION: A transverse sinus stenosis, even in the non-dominant site, may elevate the CSF pressure in obese individuals. This stenosis causes dural sinus-related pulsatile tinnitus with characteristics different from those of an arterial origin. Dizziness is a common complaint in patients with IIH, just like VM. In our opinion, episodic vertigo in these patients is the direct effect of CSF flow alterations into the inner ear's vestibule. Patients with mild elevations will be presented to the clinic, similar to migraines with or without the presence of pulsatile tinnitus. Treatment requires lowering intracranial pressure and managing migraine symptoms.

CT hyperdense cerebral artery sign reflects distinct proteomic composition in acute ischemic stroke thrombus.

BACKGROUND: Hyperdense cerebral artery sign (HCAS) is an imaging biomarker in acute ischemic stroke (AIS) that has been shown to be associated with various clinical outcomes and stroke etiology. While prior studies have correlated HCAS with histopathological composition of cerebral thrombus, it is unknown whether and to what extent HCAS is also associated with distinct clot protein composition. METHODS: Thromboembolic material from 24 patients with AIS were retrieved via mechanical thrombectomy and evaluated with mass spectrometry in order to characterize their proteomic composition. Presence (+) or absence (-) of HCAS on preintervention non-contrast head CT was then determined and correlated with thrombus protein signature with abundance of individual proteins calculated as a function HCAS status. RESULTS: 24 clots with 1797 distinct proteins in total were identified. 14 patients were HCAS(+) and 10 were HCAS(-). HCAS(+) were most significantly differentially abundant in actin cytoskeletal protein (P=0.002, Z=2.82), bleomycin hydrolase (P=0.007, Z=2.44), arachidonate 12-lipoxygenase (P=0.004, Z=2.60), and lysophospholipase D (P=0.007, Z=2.44), among other proteins; HCAS(-) clots were differentially enriched in soluble N-ethylmaleimide-sensitive factor (NSF) attachment protein (P=0.0009, Z=3.11), tyrosine-protein kinase Fyn (P=0.002, Z=2.84), and several complement proteins (P<0.05, Z>1.71 for all), among numerous other proteins. Additionally, HCAS(-) thrombi were enriched in biological processes involved with plasma lipoprotein and protein-lipid remodeling/assembling, and lipoprotein metabolic processes (P<0.001), as well as cellular components including mitochondria (P<0.001). CONCLUSIONS: HCAS is reflective of distinct proteomic composition in AIS thrombus. These findings suggest that imaging can be used to identify mechanisms of clot formation or maintenance at the protein level, and might inform future research on thrombus biology and imaging characterization.

Mechanical Thrombectomy for Ischemic Stroke Secondary to Large Vessel Occlusions in Patients on Extracorporeal Membrane Oxygenation.

INTRODUCTION: The use of short-term mechanical circulatory support (MCS) devices and procedures for function- and life-sustaining therapy is becoming a routine practice at many centers. Concomitant with the increasing use of MCS is the increasing recognition of acute brain injuries, including acute ischemic stroke, which may be caused by a myriad of MCS-driven factors. The aim of this case series was to document our experience with mechanical thrombectomy (MT) for ischemic stroke in extracorporeal membrane oxygenation (ECMO) patients. METHODS: We retrospectively reviewed a prospectively maintained database of patients undergoing endovascular thrombectomy for large vessel occlusion at our institution. We identified patients that were on ECMO and underwent thrombectomy. Baseline demographics and procedural and functional outcomes were collected. RESULTS: Three patients on ECMO were identified to have a large vessel occlusion and underwent thrombectomy. Two patients had an internal carotid artery terminus occlusion and one had a basilar artery occlusion. An mTICI 3 recanalization was achieved in all patients without postoperative hemorrhagic complications. Two patients achieved a 3-month mRS of 1, while one had mRS 4. CONCLUSION: Ischemic stroke can be associated with significant morbidity in MCS patients. We demonstrate that MT can be safely performed in this patient population with good outcomes.

Observation versus intervention for Borden type I intracranial dural arteriovenous fistula: A pooled analysis of 469 patients.

BACKGROUND: While it is thought that Borden Type I intracranial dural arteriovenous fistula (dAVF) have a benign clinical course, their management remains controversial. METHODS: A comparative meta-analysis was completed to evaluate the outcomes of intervention verses observation of Borden Type I intracranial dAVF. Outcome measures included: grade progression, worsening symptoms, death due to dAVF, permanent complications other than death, functional independence (mRS 0-2), and rate of death combined with permanent complication, were evaluated. Risk differences (RD) were determined using a random effects model. RESULTS: Three comparative studies combined with the authors' institutional experience resulted in a total of 469 patients, with 279 patients who underwent intervention and 190 who were observed. There was no significant difference in dAVF grade progression between the intervention and observation arms, 1.8% vs. 0.7%, respectively (RD: 0.01, 95% CI: -0.02 to 0.04, P = 0.49), or in symptom progression occurring in 31/279 (11.1%) intervention patients and 11/190 (5.8%) observation patients (RD: 0.03, CI: -0.02 to 0.09, P = 0.28). There was also no significant difference in functional independence on follow up. However, there was a significantly higher risk of dAVF related death, permanent complication from either intervention or dAVF related ICH or stroke in the intervention group (11/279, 3.9%) compared to the observation group (0/190, 0%) (RD: 0.04, CI: 0.1 to 0.06, P = 0.007). CONCLUSION: Intervention of Borden Type I dAVF results in a higher risk of death or permanent complication, which should be strongly considered when deciding on management of these lesions.

Management of postoperative cervical pseudomeningocele with percutaneous aspiration and epidural blood patch.

INTRODUCTION: While epidural blood patch can be an effective management option in lumbar pseudomeningoceles in certain clinical settings, its utility in the cervical spine is unclear. The aim of this study was to evaluate the safety and effectiveness of percutaneous aspiration and autologous blood patch for post-operative durotomy related pseudomeningoceles within the cervical spine. METHODS: A single institution retrospective review detailing 3 patients with durotomy related pseudomeningocele following posterior cervical spine surgery was completed. RESULTS: In all three cases, aspiration with subsequent injection of autologous epidural blood patch successfully treated each pseudomeningocele. One patient required more than one intervention, while the other two were successfully treated after one procedure. All three patients improved clinically without need for additional surgery. CONCLUSION: Percutaneous aspiration and epidural blood patch can be used to safely manage post-operative pseudomeningoceles within the posterior cervical spine.

Open tracheostomy training: a nationwide survey among Otolaryngology-Head and Neck Surgery residents.

The aim of this study was to examine the training methods and needs of Otolaryngology-Head and Neck Surgery (OTO-HNS) residents to independently perform open tracheostomy (OT). An anonymous 26-items questionnaire pertaining to OT teaching aspects was distributed to all 93 Israeli OTO-HNS residents during March-June 2016. Residents were categorized as 'juniors,' if they were in their post-graduate year (PGY)-1 and PGY-2; 'mid-residency' (PGY-3 and PGY-4); or 'seniors' (PGY-5 and PGY-6). Response rate was 74% (n = 69). There were 25 'juniors' (36%), 24 'mid-residency' (35%) and 20 'seniors' (29%). Overall, the responses of the 3 groups were similar. Forty-seven (68%) residents estimated that there are ≥ 50 tracheostomies/year in their hospital, which roughly corresponds to an exposure of ~ 8 tracheostomies/year/resident. There was an inconsistency between the number of teaching hours given and the number of hours requested for OT training (23% received ≥ 5 h, but 82% declared they needed ≥ 5 h). Eighty-two percentage reported that their main training was conducted during surgery with peer residents or senior physicians. Forty-five (65%) feel competent to perform OT, including juniors. Due to the need to perform OT in urgent scenarios, the competency of OTO-HNS resident is crucial. Training for OT in Israeli OTO-HNS residency programs is not well structured. Yet, residents reported they feel confident to perform OT, already in the beginning of their residency. Planned educational programs to improve OT training should be done in the beginning of the residency and may include designated 'hands-on' platforms; objective periodic surgical competence assessments; and specialist's feedback, using structured assessment forms.

Role of computerized dynamic posturography in evaluating sinugenic vertigo.

OBJECTIVES: Vertigo associated with rhinosinusitis has seldom been reported, and the pathophysiologic mechanism is still vague. Our aim was to evaluate sinugenic vertigo with computerized dynamic posturography (CDP) and suggest a possible pathophysiologic mechanism. METHODS: We conducted a prospective study of 16 patients with a clinical and radiologic diagnosis of rhinosinusitis made between January 2007 and December 2008. All patients underwent CDP on the first 2 days after diagnosis. Patients with abnormal CDP results and/or complaints of vertigo underwent follow-up CDP when healthy. RESULTS: Five patients complained of a new onset of vertigo. The CDP demonstrated a combined disorder in 3 of them, even though the vestibular signs were intact. On follow-up examination, all 3 patients were asymptomatic, and the follow-up CDP values were normal. CONCLUSIONS: We report a surprising 20% prevalence of sinugenic vertigo associated with abnormal results on CDP. Our results might possibly indicate that the somatosensory system of the paranasal sinuses plays a major role in the pathophysiologic mechanism of sinugenic vertigo.

The estrogen receptors in the papillary carcinoma of the thyroid gland.

In this study, the objective was to evaluate the presence of estrogen receptors alpha and beta (ERalpha and ERbeta) in cases of papillary carcinoma of the thyroid gland and to assess the practicality of this test. Immunohistochemical stains were performed for both ERalpha and ERbeta, for evaluation of immunoreactivity in 90 papillary carcinomas. Three variables were evaluated in each sample: the intensity of the staining both nuclear and cytoplasmatic, and the spread of the stain over the sample. None of the histological samples showed immunoreactivity for ERalpha. Positive immunoreactivity results for ERbeta were found in tissue samples in 66.6% (60 cases). The study shows that ERbeta has no significant specification for differentiation between papillary carcinoma and other malignant lesions of the thyroid, while ERalpha is undetectable in this lesion. The ER testing in cases of papillary carcinoma of the thyroid gland is nonspecific and might be not necessary.

Diagnostic value of estrogen receptors in thyroid lesions.

BACKGROUND: The objective of this study was to evaluate the presence of estrogen receptors (ER) alpha and beta in various thyroid lesions and to assess the practicality of this test. MATERIAL/METHODS: Immunohistochemical stains were performed for both ERalpha and ERbeta, for evaluation of immunoreactivity in 296 thyroid tissue samples that consisted of 150 goiters, 90 papillary carcinomas, 19 follicular adenomas, 15 Hurtle cell adenomas, 6 Hashimoto thyroiditis, 5 anaplastic carcinomas, 4 medullary carcinomas, 4 follicular carcinomas, 2 Hurtle cell carcinomas, and 1 squamous cell carcinoma of the thyroid. Three variables were evaluated in each sample: The intensity of the staining both nuclear (1) and cytoplasmic (2), and the spread of the stain over the sample (3). RESULTS: None of the histologic samples showed immunoreactivity for ERalpha. Positive immunoreactivity results for ERbeta were found in tissue samples from all of the different groups of diagnoses, both benign and malignant lesions as well as in normal thyroid tissue. No significant difference was found between the various thyroid lesions. CONCLUSIONS: The study shows that ERbeta is the only ER detectable in thyroid tissue. However, ERbeta expression has no significant specifications for differentiation between benign and malignant lesions of the thyroid. ERalpha is undetectable in the thyroid. Further investigations are necessary mainly in the laboratory immunohistochemical workup.

Management implications of diagnosing orbital abscess as subperiosteal orbital abscess.

OBJECTIVE: Orbital complications of rhinosinusitis can be life-threatening. Accurate diagnosis by computerized tomography (CT) scanning, immediate administration of intravenous antibiotics and surgical drainage are the recommended management strategy. Faulty diagnosis by CT scan may lead to visual deterioration, intracranial complications and even fatality. The purpose of this study is to increase the awareness of the possibility of misdiagnosing orbital abscess (OA) as subperiosteal orbital abscess (SPOA) and propose a novel surgical technique to overcome this surgical circumstance. MATERIALS AND METHODS: Three cases of OA and 29 of SPOA cases that were surgically managed between 1998 and 2008 were retrospectively reviewed. RESULTS: Three cases of OA diagnosed by CT scan as SPOA were primarily medically treated by intravenous antibiotics. Once the therapeutic management failed to resolve the condition, endonasal endoscopic surgery (EES) was carried out, upon which the diagnosis of OA was made and drainage successfully achieved. CONCLUSION: Whenever SPOA is diagnosed by CT scan and no purulent discharge is evidenced after removal of the lamina papyracea, OA should be suspected and incisions along the orbital periosteum should be made to release the pus from the orbit. The EES approach in cases of OS and SPOA can confirm an accurate diagnosis.

Are estrogen receptors alpha detectable in normal and abnormal thyroid tissue?

The aims of this study is to evaluate the presence of estrogen receptors alpha (ERα) in thyroid lesions and to assess the practicality of this test in view of numerous disagreements on the subject. Immunohistochemical stains were performed for ERα, for the evaluation of immunoreactivity in 296 pathological thyroid tissue samples. We evaluated the intensity of the nuclear and cytoplasmatic staining and the spread of the stain over the sample. Thirty cases of the breast cancer served as a control group. None of the histological thyroid samples showed immunoreactivity for ERα. No difference was found between the various lesions in regard to this absence. The ERα rate of expression in the breast cancer samples was 60%. The ERα is undetectable in the histological samples of benign and malignant thyroid lesions. Further investigation is necessary in the laboratory immunohistochemical workup in order to exclude a possibility of non-specific staining.

Hypothyroidism following partial thyroidectomy.

OBJECTIVE: To compare rates of hypothyroidism following three types of partial thyroidectomy for multinodular goiter. STUDY DESIGN AND METHODS: All cases of partial thyroidectomies (hemi-, near-total, or subtotal) carried out at one Israeli and one Russian medical center (1990-2006) were retrospectively studied to determine the incidence of hypothyroidism after each procedure. RESULTS: There were 881 near-total, 1538 subtotal, and 1051 hemithyroidectomies (total 3470). Postoperative follow-up was 2 to 15 years. Twenty-eight percent of the hemithyroidectomy patients suffered permanent hypothyroidism compared to 100% of the near-total and 87% of the subtotal patients. Forty-six percent of the hemithyroidectomy patients suffered temporary hypothyroidism compared to 100% of the near-total and 93% of the subtotal patients. CONCLUSION: Subtotal and near-total thyroidectomies produced a rate of hypothyroidism close to that of total thyroidectomy compared to 28% after hemithyroidectomy. SIGNIFICANCE: Partial thyroidectomies provide no decisive advantage over total thyroidectomies in terms of subsequent requirements of supplemental hormone therapy.

Microbiology of peritonsillar abscess as an indication for tonsillectomy.

No conclusive data are available regarding the influence of the microbial content of a peritonsillar abscess (PTA) on the development of recurrence. We conducted the current study to evaluate the effect of microbiologic growth on the recurrence rate of PTA and the need for tonsillectomy. Of 469 patients with PTA, 295 patients who underwent bacteriologic studies were subdivided into 2 groups, nonrecurrent group (273 patients) and recurrent group (22 patients), and their results were compared. A higher rate of anaerobic growth (10 anaerobic pathogens, 57.1% of total pathogens found) was identified in the recurrent PTA group compared with the nonrecurrent group (39 anaerobic pathogens, 45.8%), with a higher rate of anaerobic growth in the recurrent group in the first episode (60% vs. 45.8% in the nonrecurrent group) (odds ratio, 1.76; sensitivity, 80%; specificity, 45%). Anaerobic bacterial growth correlates with a higher rate of recurrence, and may serve as an additional relative indicator for tonsillectomy.

Conservative treatment in rhinosinusitis orbital complications in children aged 2 years and younger.

OBJECTIVE: Orbital complications (OC) secondary to acute rhinosinusitis (ARS) in children are uncommon, but can result in severe morbidity and mortality if not treated appropriately. These complications are more common in older children. We evaluate the disease and its management in children aged 2 and under. MATERIAL AND METHODS: Fifty-two records of children aged 2 and younger with OC secondary to ARS between 1993 and 2002 were reviewed retrospectively. Parameters recorded included age, gender, clinical symptoms and signs, CT findings, duration of hospitalization, treatment before and during admission, cultures and outcome. RESULTS: Forty-eight children were diagnosed with periorbital cellulitis, 4 with subperiosteal abscess and none with orbital abscess or cavernous sinus thrombosis. All were managed conservatively except 1 who underwent surgery. CT scan performed in 8 children revealed sinusitis in only 7. Average length of hospitalization was 3.6 days for preseptal cellulitis and 6.5 for postseptal cellulitis. CONCLUSION: SOC secondary to ARS mandates meticulous multidisciplinary follow-up in hospital. CT scan and surgery are indicated in cases of ophthalmoplegia, proptosis, decreased visual acuity or failure of conservative treatment within 48 hours. However, most children aged 2 and younger respond well to conservative treatment and no surgical intervention is required.