RESUMO
OBJECTIVE: We report the use and benefits of the ultrasonic dissector in the resection of difficult skull base lesions. METHOD: Five case reports are presented, and the utilisation of ultrasonic dissectors in otorhinolaryngology is reviewed. RESULTS: The ultrasonic dissector was found to be a useful tool during the endoscopic resection of poorly accessible skull base tumours. Safe dissection and complete removal of all five lesions were achieved without any vascular injury. To our knowledge, this is the first report of the use of the ultrasonic dissector for the resection of sinonasal and skull base tumours. CONCLUSION: The ultrasonic dissector was found to be particularly useful during the endoscopic transnasal approach to the petrous apex. During minimally invasive endonasal surgery, benefits include the length of the instrument, speed and precision of dissection, and low risk of vascular injury.
Assuntos
Angiofibroma/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Granuloma/cirurgia , Neoplasias da Base do Crânio/cirurgia , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Adulto , Idoso , Angiofibroma/complicações , Dissecação/instrumentação , Drenagem , Embolização Terapêutica , Endoscopia , Feminino , Perda Auditiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Neoplasias de Tecido Nervoso/cirurgia , Osso Petroso/patologia , Osso Petroso/cirurgia , Fossa Pterigopalatina/patologia , Radiografia , Neoplasias da Base do Crânio/diagnóstico por imagem , Irrigação Terapêutica , Doenças do Nervo Trigêmeo/etiologia , Procedimentos Cirúrgicos Ultrassônicos/métodos , Adulto JovemRESUMO
We present four patients who had sustained a traumatic dislocation of the atlanto-occipital joint. The diagnosis was initially missed in two patients. One patient, who was neurologically intact, was treated non-operatively. The remaining three recovered neurologically after an occipitocervical fusion. Early recognition of the injury, especially in multiply-injured patients with head injuries, and timely management may improve survival and neurological recovery.
Assuntos
Articulação Atlantoccipital/lesões , Luxações Articulares/diagnóstico por imagem , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Acidentes de Trânsito , Adulto , Articulação Atlantoccipital/diagnóstico por imagem , Traumatismos Craniocerebrais/etiologia , Feminino , Humanos , Luxações Articulares/etiologia , Masculino , Radiografia , Traumatismos da Coluna Vertebral/etiologiaRESUMO
A case of Lhermitte-Duclos disease (dysplastic gangliocytoma of the cerebellum) is described. Seventeen years after the diagnosis was made, the patient developed a malignant astrocytoma of the cerebrum, an association only once previously reported. The clinical presentation and radiological features are presented.
Assuntos
Astrocitoma/complicações , Astrocitoma/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias Cerebelares/complicações , Neoplasias Cerebelares/patologia , Cerebelo/patologia , Ganglioneuroma/complicações , Lobo Occipital/patologia , Adulto , Astrocitoma/diagnóstico , Neoplasias Encefálicas/complicações , Diabetes Mellitus Tipo 1/complicações , Feminino , Ganglioneuroma/patologia , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
We report twenty-four patients with cirsoid aneurysms of the scalp. For nine patients (38%), the lesions were related to trauma. Each of the patients presented with a pulsatile scalp swelling with a bruit. No focal neurological deficits were noted in any of the patients. Scalp malformations in all patients were confirmed by selective internal and external carotid angiography, with no intracerebral component revealed in any of the patients. Twenty-one patients had the lesions surgically excised, with good results. The remaining three refused surgical intervention. Meticulous surgical technique, which includes removal of the pericranial component of the malformation, was paramount.
