Tension Pneumocephalus With Acute Cerebellar Symptoms Due to an Intradiploic Epidermoid Cyst Eroding the Mastoid Bone.

This case report presents a unique presentation of an intradiploic epidermoid cyst (IDEC) in a 55-year-old female. She presented with acute cerebellar symptoms triggered by a Valsalva maneuver. IDECs are a rare type of intracranial epidermoid cysts. They are benign and have a slow growth pattern that translates into progressively developing symptoms instead of acute symptoms. Symptoms include local deformities, focal neurologic deficits, and pain. This patient developed acute cerebellar symptoms due to erosion of the mastoid bone that created a pathway between the eustachian tube and the intracranial space via the mastoid air cells. Consequently, tension pneumocephalus emerged via a ball-valve effect that caused a significant mass effect in the posterior fossa. Surgical resection of the IDEC and closing of the mastoid air cells resulted in symptom relief by restoring the integrity of the intracranial-extracranial barrier. This case highlights that a higher level of vigilance is warranted for an IDEC in the proximity of aerated bone structures, such as the mastoid air cells and the paranasal sinuses, and that a more proactive approach is advocated.

A Glomus Tumor Presenting on the Ventromedial Aspect of the Little Finger Causing Bony Erosion: A Rare Case From India.

Glomus tumors are rare neoplasms originating from the glomus body that predominantly manifest in the subungual region of the digits and are distinguished by severe pain and a heightened sensitivity to cold. Bony erosion associated with glomus tumors is a rare phenomenon. Here, we present a unique case of a glomus tumor situated on the ventromedial aspect of the little finger, leading to notable bony erosion. A 42-year-old female from India presented with a chief complaint of severe and localized pain in the ventromedial region of her right little finger, exacerbated by exposure to cold temperatures. Radiological investigations demonstrated focal bone erosion at the site of the tumor. Surgical excision of the lesion was performed. A fish-mouth incision was made on the ventromedial aspect of the little finger, which was extended to the tip of the finger. The nail bed was kept intact. The tumor was excised using small forceps. The patient experienced complete resolution of symptoms postoperatively and reported no recurrence during the follow-up period. This case report highlights the exceptional presentation of a glomus tumor causing bony erosion on the ventromedial aspect of the little finger, a manifestation rarely encountered in clinical practice. Furthermore, this case contributes to the limited body of literature on this combination of uncommon clinical entities, shedding light on its diagnosis and management.

Diffuse Tenosynovial Giant Cell Tumor Encircling the First Metatarsal Bone Remodeling after Resection. A Case Report.

Introduction: The term tenosynovial giant cell tumor encompasses a group of rare soft-tissue tumors. A new classification divides the group in localized and diffuse type, depending on the involvement of the surrounding tissues. Due to the unclear origin and heterogeneity in extend of the diffuse-type giant cell tumors, there is only limited evidence on the tumor-specific treatment. Thus, every case report has an added value toward setting disease-specific guidelines. Case Report: Presentation of a diffuse type tenosynovial giant cell tumor encircling the first metatarsal. The tumor had mechanically eroded the plantar aspect of the distal metaphysis, with no signs of tumor spread. After an open biopsy, resection of the mass was performed without debriding or resecting the first metatarsal. Repeat imaging postoperatively showed no recurrence at 4-year follow-up and a bony remodeling of the lesion. Conclusion: Bone remodeling is possible after complete resection of diffuse tenosynovial giant cell tumor when the erosion is caused by mechanical pressure and no intraosseous expansion of the tumor is present.

Osteolytic sarcoidosis of the orbit without pulmonary involvement.

A 69-year-old woman with a history of a left orbital mass presented to the emergency room with progressive breakthrough pain in her left orbit despite medical therapy. On examination, there was extraocular motility restriction with diplopia upon left supraduction. Computed tomography (CT) scan of the orbits revealed soft tissue thickening of the left medial and superior periorbita and left lacrimal fossa; bony erosion of the left frontal bone, left orbital roof, and left lamina papyracea; and bilateral mass-like enlargement of the extraocular muscles. An orbitotomy with incisional biopsy was performed, and histopathological examination revealed non-caseating granulomatous inflammation consistent with sarcoidosis. Chest imaging demonstrated no sequela of pulmonary sarcoidosis, and her serum angiotensin converting enzyme (ACE) level was within normal range. She was treated with high-dose oral steroids with resolution of her symptoms. Her pain returned at the conclusion of the steroid taper, and it was controlled with chronic subcutaneous methotrexate and adalimumab injections.

PMMA-Cement-PLIF Is Safe and Effective as a Single-Stage Posterior Procedure in Treating Pyogenic Erosive Lumbar Spondylodiscitis-A Single-Center Retrospective Study of 73 Cases.

BACKGROUND: Surgical treatment for erosive pyogenic spondylodiscitis of the lumbar spine is challenging as, following debridement of the intervertebral and bony abscess, a large and irregular defect is created. Sufficient defect reconstruction with conventional implants using a posterior approach is often impossible. Therefore, we developed the "Cement-PLIF", a single-stage posterior lumbar procedure, combining posterior lumbar interbody fusion (PLIF) with defect-filling using antibiotic-loaded polymethylmethacrylate (PMMA). This study first describes and evaluates the procedure's efficacy, safety, and infection eradication rate. Radiological implant stability, bone-regeneration, sagittal profile reconstruction, procedure-related complications, and pre-existing comorbidities were further analyzed. METHODS: A retrospective cohort study analyzing 73 consecutive patients with a minimum of a one-year follow-up from 2000-2017. Patient-reported pain levels and improvement in infectious serological parameters evaluated the clinical outcome. Sagittal profile reconstruction, anterior bone-regeneration, and posterior fusion were analyzed in a.p. and lateral radiographs. A Kaplan-Meier analysis was used to determine the impact of pre-existing comorbidities on mortality. Pre-existing comorbidities were quantified using the Charlson-Comorbidity Index (CCI). RESULTS: Mean follow-up was 3.3 (range: 1-16; ±3.2) years. There was no evidence of infection persistence in all patients at the one-year follow-up. One patient underwent revision surgery for early local infection recurrence (1.4%). Five (6.9%) patients required an early secondary intervention at the same level due to minor complications. Radiological follow-up revealed implant stability in 70/73 (95.9%) cases. Successful sagittal reconstruction was demonstrated in all patients (p < 0.001). There was a significant correlation between Kaplan-Meier survival and the number of pre-existing comorbidities (24-months-survival: CCI ≤ 3: 100%; CCI ≥ 3: 84.6%; p = 0.005). CONCLUSIONS: The Cement-PLIF procedure for pyogenic erosive spondylodiscitis is an effective and safe treatment as evaluated by infection elimination, clinical outcome, restoration, and maintenance of stability and sagittal alignment.

"Craniotomy Within Craniotomy" Technique for Safe Resection of an Intracranial Arteriovenous Malformation With Frontal Bony Erosion: 2-Dimensional Operative Video.

Surgical resection is one option in the treatment of large high-grade brain arteriovenous malformations (AVMs). Resection of AVMs with skull-eroding components can be challenging due to the risk of excessive bleeding from these components during craniotomy and bone flap removal. We present a case of a 25-yr-old woman who presented with an acute onset right-sided frontal headache. She was found to have a large, frontal Spetzler-Martin grade IV AVM with an associated dural AVM. The AVM had caused focal erosions of the right frontal bone by a venous varix traversing the region of the calvarial defect. An elective staged endovascular embolization followed by surgical resection was recommended considering the patient's young age and the large size of the AVM located in a noneloquent area. Given the high risk of intraoperative hemorrhage during the craniotomy portion of the procedure, a "craniotomy within craniotomy" approach was planned. During this approach, a small rectangle of bone, including the portion eroded by the venous varix, was left in place, while the larger bone flap surrounding it was removed for an initial approach to the AVM. The small bony piece was safely removed at later stages of resection once the arterial feeders had been reasonably obliterated. Immediate postoperative catheter angiogram demonstrated good filling of the intracranial vascular territories with no residual AVM. The patient developed mild left facial and left hand weakness postoperatively, which resolved after 2 wk of follow-up. The patient remained neurologically intact on further follow-up.

Bony orbital changes in allergic fungal sinusitis are reversible after treatment.

Allergic fungal sinusitis (AFS) arises from a host hypersensitivity reaction to fungi residing within the sino-nasal tract. Computed tomography imaging may show heterogenous sinus opacification with bony erosion and expansion into the orbits. With advanced orbital involvement there is a risk of optic neuropathy and irreversible vision loss. We present a patient with AFS who presented with bilateral proptosis and early optic neuropathy. Radiologically, there was evidence of bony erosion and orbital wall compression. Following oral corticosteroids and full-house endoscopic sinus surgery, these changes reversed considerably. This case shows that bony and anatomical orbital changes from AFS are reversible with adequate surgical treatment.

[Imaging charateristics of bony erosion and fungal culture analysis in allergic fungal rhinosinusitis].

Objective:To investigate the imaging characteristics of bony erosion, fungal culture and related factors in allergic fungal rhinosinusitis (AFRS). Method:Sixty cases of AFRS were reviewed in this study. The characteristics of Computed Tomography and Magnetic Resonance Imaging including positive rate of bony erosion, eroded sites, disease extension and sinus expansion were summarized. Fungal culture and identification of nasal secretion were done. The correlation between the degree of sinus expansion, species of fungi and bony erosion was evaluated by statistical analysis. Result:Of the 60 patients, 18 (30%) had bony erosion. There was a significant difference in the proportion of bone erosion among the sinuses (P<0.05). The most commonly eroded site was the ethmoid sinus. The orbit were the most common adjacent anatomic spaces to exhibit disease extension, and anterior cranial fossa is the second most common. Statistical analysis revealed a significant association(P<0.05)of bone erosion with sinus expansion. The positive rate of fungal culture was 51.3%, among which the most common is Aspergillus. Statistical analysis shows no association(P>0.05)of bone erosion with specific fungi. Conclusion:Bone erosion is an important imaging feature of AFRS. Bone erosion may cause by sinus expansion. Extension of disease into the orbit or intracranial cavity results from a natural progression of disease after erosion occurs. Specific fungal species that can cause bone erosion was found.

Schwannoma of the hard palate.

Schwannomas are benign encapsulated perineural tumors. The head and neck region is the most common site. Intraoral origin is seen in only 1% of cases, tongue being the most common site; its location in the palate is rare. We report a case of hard-palate schwannoma with bony erosion which was immunohistochemically confirmed. The tumor was excised completely intraorally. After two months of follow-up, the defect was found to be completely covered with palatal mucosa.

The clinical outcome of childhood malignant lymphoma with bony erosion / 中国癌症杂志

Purpose:To study the clinical and imaging characteristics of childhood malignant lymphoma with bony erosion, and explore the treatment protocol and prognosis.Methods:Through pathologic tests, immunohistochemical studies and imaging analyses, 6 patients were diagnosed as malignant lymphoma with bony infiltration. The 6 cases were treated and followed up. Results:There were different kinds of bony involvement in CT and MIRI imaging in 6 patients. All cases were type B as to immunology classification. Following treatment by protocol MCP, 1 case was dead and the others are in constant compete remission (CCR). Conclusions:The childhood malignant lymphoma with bony involvement is rarely seen, it is relatively easy to diagnose by CT/MRI and pathologic tests. The prognosis is related to clinical classification. It can be treated by protocol MCP.

Spindle cell hemangioendothelioma: a case report

Spindle cell hemangioendothelioma is a rare vascular tumor which is presented with subcutaneous nodules and follows a benign indolent course but has a recurrent tendency, and is histologically resembling a cavernous hemangioma and Kaposi's sarcoma. We present a case of spindle cell hemangioendothelioma possessing clinical aggressiveness with painful bony erosion, histologic pleomorphism and mitoses. A 20-year-old man presented with a recurrent painful mass on the left ankle. The mass was dark brown and firm with irregular margins and measured 1.5 cm in diameter, which affected and eroded the underlying medial malleolus of the left tibia. Microscopically, the tumor was composed of cavernous endothelial-lined blood spaces and spindle cellular areas mimicking Kaposi's sarcoma. The spindle cells intermingled with plump epithelioid cells and showed a moderate degree of pleomorphism with occasional mitoses. Immunohistochemically, the spindle cells were focally positive for factor VIII-associated antigen and vimentin, and negative for S-100 protein, desmin, and epithelial membrane antigen.