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2.
Artigo em Chinês | MEDLINE | ID: mdl-33794612

RESUMO

Objective:To investigate the relationship between the pneumatization degree of paranasal sinuses and skull base and the incidence of spontaneous cerebrospinal fluid rhinorrhea (SCSFR). Methods:Date of 107 patients with SCSFR were reviewed retrospectively. Using CT scans, investigator evaluated the pneumatization degree of paranasal sinuses and skull base, and compared classifications of various imaging characteristics between SCSFR group(case group) and nasal septum deviation group(control group), including frontal cells, Onodi cell, lateral recess of sphenoid sinus (LRSS), pneumatization of anterior clinoid process and pneumatization of posterior clinoid process. Results:One hundred and eight fistulas are found among 107 cases. The most common site of the fistulas is found in ethmoid sinus (38.89%), followed by olfactory cleft(37.04%), sphenoid sinus (21.30%) and frontal sinus (2.77%).The incidence of Onodi cell was significantly different between case and control group(χ²=4.755, P<0.05), and the classification of Onodi cell has a linear effect on the occurrence of SCSFR (Z=3.345, P<0.05), which suggests the increasing level of Onodi cell can increase the probability in occurrence of SCSFR. The incidence of type Ⅲ LRSS in the case group is significantly higher than in the control group(χ²=18.725, P<0.05),a linear correlation is found between the classification of LRSS and the incidence of SCSFR (Z=3.578, P<0.05).There was no significant difference in the incidence of frontal cells between the two groups(χ²=0.672, P>0.05), nor was there a linear relationship between the classification of frontal cells and the incidence of SCSFR (Z=0.503, P>0.05). Pneumatization of anterior clinoid process and posterior clinoid process were no significant difference between case and control (P>0.05),nor were there linear relationships between their classifications and SCSFR (P>0.05). Conclusion:The most common site of SCSFR is ethmoid sinus, followed by olfactory cleft,the hyperpneumatization of the LRSS and Onodi cell are closely related to its pathogenesis.


Assuntos
Rinorreia de Líquido Cefalorraquidiano , Seios Paranasais , Rinorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Humanos , Seios Paranasais/diagnóstico por imagem , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem
4.
Am J Orthod Dentofacial Orthop ; 159(3): 343-351.e1, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641815

RESUMO

INTRODUCTION: The aim of this investigation was to evaluate the reproducibility of a voxel-based 3-dimensional superimposition method and the effect of segmentation error on determining soft tissue surface changes. METHODS: A total of 15 pairs of serial cone-beam computed tomography images (interval: 1.69 ± 0.37 years) from growing subjects (initial age: 11.75 ± 0.59 years) were selected from an existing digital database. Each pair was superimposed on the anterior cranial base, in 3 dimensions with Dolphin 3D software (version 2.1.6079.17633; Dolphin Imaging & Management Solutions, Chatsworth, Calif). The reproducibility of superimposition outcomes and surface segmentation were tested with intra- and interoperator comparisons. RESULTS: Median differences in inter- and intrarater measurements at various areas presented a range of 0.08-0.21 mm. In few instances, the differences were larger than 0.5 mm. In areas where T0-T1 changes were increased, the error did not appear to increase. However, the method error increased the farther the measurement area was from the superimposition reference structure. For individual images, the median soft tissue segmentation error ranged from 0.05 to 0.06 at various areas and in no subject exceeded 0.13 mm. CONCLUSIONS: The presented voxel-based superimposition method was efficient and well reproducible. The segmentation process was a minimal source of error; however, there were a few cases in which the total error was more than 0.5 mm and could be considered clinically significant. Therefore, this method can be used clinically to assess 3-dimensional soft tissue changes during orthodontic treatment in growing patients.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Imageamento Tridimensional , Criança , Face/diagnóstico por imagem , Humanos , Reprodutibilidade dos Testes , Base do Crânio
7.
J Laryngol Otol ; 135(3): 217-223, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33593449

RESUMO

OBJECTIVE: This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. METHOD: The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. RESULTS: In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. CONCLUSION: The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.


Assuntos
Osteomielite/microbiologia , Palmitatos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Base do Crânio/cirurgia , Infecção da Ferida Cirúrgica/microbiologia , Ceras/efeitos adversos , Adulto , Aspergilose/microbiologia , Aspergillus flavus , Basidiomycota , Abscesso Encefálico/microbiologia , Ângulo Cerebelopontino , Feminino , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Tricosporonose/microbiologia , Adulto Jovem
8.
Am J Orthod Dentofacial Orthop ; 159(3): e253-e273, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33541785

RESUMO

INTRODUCTION: The purpose of this research was to compare mandibular growth rotation relative to the cranial base in different vertical facial patterns on the basis of multiple 2-dimensional (2D) and 3-dimensional (3D) superimposition methods. METHODS: Cone-beam computed tomography (CBCT) images taken at a mean interval of 54.8 ± 16.8 months were assessed from a sample of 70 growing patients. Three mandibular superimposition methods were compared against Björk's structural method: (1) a 2D landmark method (2D-M1), (2) a voxel-based 3D method based on a previously reported method (3D-M1), and (3) a voxel-based 3D method incorporating symphyseal structures as references (3D-M2). After superimposition, the relative change in cranial base lines as depicted in sagittal views were measured for true mandibular rotation. Agreement between methods was assessed with Lin's concordance correlation coefficient, Bland-Altman's limits of agreement, and the Bradley-Blackwood test. RESULTS: Lin's concordance correlation coefficients ranged between 0.924 for the 2D-M1 method, 0.695 for the 3D-M1 method, and 0.965 for the 3D-M2 method. Bland-Altman limits of agreement were wide for all but the 3D-M2 method. Finally, the Bradley-Blackwood test of equality of means and variances was significant in all except the 3D-M2 method. CONCLUSIONS: For time intervals between CBCT volume acquisitions >3 years, the use of the 2D-M1 and 3D-M1 methods is not recommended. There was a high concordance between the 3D-M2 method and Björk's structural method when assessing mandibular growth rotation using relative changes in cranial base lines. The high concordance was displayed across all vertical facial types and for all time differences between first and second CBCT data acquisitions.


Assuntos
Imageamento Tridimensional , Mandíbula , Tomografia Computadorizada de Feixe Cônico , Humanos , Mandíbula/diagnóstico por imagem , Reprodutibilidade dos Testes , Base do Crânio/diagnóstico por imagem
9.
J Stroke Cerebrovasc Dis ; 30(4): 105611, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33461023

RESUMO

BACKGROUND: Hybrid and endovascular procedures maybe effective and less invasive alternatives to open surgery for treatment of extracranial carotid artery aneurysm (ECAA), but the optimal management of juxta-skullbase ECAA is controversial. OBJECTIVE: This study evaluated the long-term effects of hybrid and endovascular procedures in treating juxta-skullbase ECAA. METHODS: The records of 9 consecutive patients who underwent hybrid or endovascular interventions for juxta-skullbase ECAA in a single center from April 2014 to May 2020 were retrospectively reviewed. RESULTS: Four patients presented with a pulsating mass, 1 with dysphagia, 1 with pain in the left temporal region, 1 with dizziness and headache, 1 with cerebral infarction, and 1 with dizziness and cerebral infarction. Seven true aneurysms, 1 false aneurysm, and 1 dissecting aneurysm were diagnosed with CTA in the 9 patients (mean age, 50.8±20.3 years; 1 male). The aneurysms were divided into two subgroups: 4 type I, and 5 type IIb according to a recent classification. Per schedule, 7 patients (4 type I and 3 type IIb) were treated with endovascular intervention, and 2 (type IIb) were treated with hybrid procedures. The technique success rate was 88.9%. One patient (type IIb) who was scheduled to be treated with an endovascular procedure was transferred to a hybrid procedure because of failure of the endovascular procedure. Eleven covered stents were implanted to exclude the aneurysms. During follow-up (mean duration 31.2±23.2 months), all aneurysms were proven excluded, no significant complication occurred, and preoperative symptoms resolved. One patient (type I) in the endovascular group had occlusion of the internal carotid artery but no symptoms; the internal carotid artery was patent in the other 8 patients. CONCLUSIONS: Hybrid and endovascular procedures were found effective and durable alternatives to open operation for treatment of extracranial juxta-skullbase carotid aneurysm.


Assuntos
Aneurisma/terapia , Implante de Prótese Vascular , Doenças das Artérias Carótidas/terapia , Procedimentos Endovasculares , Adulto , Idoso , Aneurisma/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Doenças das Artérias Carótidas/diagnóstico por imagem , Criança , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Base do Crânio , Stents , Fatores de Tempo , Resultado do Tratamento
10.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431445

RESUMO

A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.


Assuntos
Trombose do Corpo Cavernoso/diagnóstico , Corpos Estranhos no Olho/complicações , Mucormicose/diagnóstico , Osteomielite/diagnóstico , Base do Crânio/microbiologia , Adulto , Anfotericina B/uso terapêutico , Animais , Seio Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/tratamento farmacológico , Trombose do Corpo Cavernoso/etiologia , Besouros/microbiologia , Drenagem , Quimioterapia Combinada , Enoxaparina/uso terapêutico , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/microbiologia , Corpos Estranhos no Olho/terapia , Evolução Fatal , Feminino , Humanos , Hifas/isolamento & purificação , Imagem por Ressonância Magnética , Meropeném/uso terapêutico , Mucorales/isolamento & purificação , Mucormicose/microbiologia , Mucormicose/terapia , Osteomielite/microbiologia , Osteomielite/terapia , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Base do Crânio/cirurgia , Vancomicina/uso terapêutico
11.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462005

RESUMO

We present a rare case of sarcoidosis with extensive bony destruction of the maxillofacial and skull base bones. A 65-year-old woman was referred with an asymptomatic, non-healing dental socket. Examination revealed an oroantral fistula that was biopsied and repaired under general anaesthesia. Investigations included plain and cross-sectional imaging. Serological tests, in particular ACE, were normal. Histology showed benign florid granulomatous inflammation. At 6 months, the patient remained asymptomatic. She was re-referred 3 years later with further bony destruction of her maxilla and mandible. Repeat imaging showed intrathoracic lymphadenopathy and skull base involvement. Repeat biopsy confirmed granulomatous inflammation. Given the pulmonary, histological and radiological findings, a sarcoidosis diagnosis was made. Following multidisciplinary team meetings, the patient was treated with methotrexate and arrangements made for close monitoring. This case highlights the need for a consensus in identifying, treating and developing a follow-up protocol in such patients.


Assuntos
Doenças Ósseas/diagnóstico , Ossos Faciais , Sarcoidose/diagnóstico , Base do Crânio , Idoso , Doenças Ósseas/patologia , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/patologia , Feminino , Humanos , Sarcoidose/patologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia
12.
BMC Surg ; 21(1): 58, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485359

RESUMO

BACKGROUND: Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. METHODS: The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. RESULTS: The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). CONCLUSIONS: Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.


Assuntos
Adenoma , Hipófise , Neoplasias Hipofisárias , Base do Crânio , Cirurgia Assistida por Computador , Cirurgia Endoscópica Transanal , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Idoso , Feminino , Humanos , Imageamento Tridimensional , Período Intraoperatório , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuronavegação/métodos , Projetos Piloto , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Cirurgia Endoscópica Transanal/métodos
14.
Artigo em Chinês | MEDLINE | ID: mdl-33472297

RESUMO

Objective: To evaluate the feasibility of the endoscopic transnasal approach (ETA) and to analyze the outcomes and factors of this surgical technique in the management of the tumor invading the anterior skull base. Methods: A retrospective analysis was performed on 42 patients (31 males and 11 females, with mean age of 49 years) with sinonasal tumor invading the anterior skull base, who underwent ETA from June 2015 to April 2019 in Eye, Ear, Nose and Throat Hospital of Fudan University. Pathologically, there were 15 cases of squamous carcinoma (14 patients with T4bN0M0 and 1 patient with T4bN1M0) and 27 of olfactory neuroblastomas with Kadish stage C. Anterior skull base reconstruction was performed using the vascular pedicled nasoseptal mucoperiosteal flap and fascia lata. Brain non-contrast-enhanced CT was performed on the first postoperative day to exclude massive pneumocephalus, relevant brain edema and subarachnoid hemorrhage. Sinonasal contrast-enhanced MR was performed to assess the extent of the tumor removal. Kaplan-Meier analysis was used to calculate the overall survival (OS) and Cox multivariate regression analysis was used to determine the prognostic factors. Results: The mean duration of the surgery was 452 minutes. Total resection was performed in 36 patients (85.7%), subtotal resection in 2 patients (4.8%) with orbital involvement, partial resection in one patient (2.4%) with injury of the internal carotid artery. One patient (2.4%) underwent the second resection because of the tumor residual, two patients (4.8%) with unsure tumor residual. Mean follow-up was 20 months, with 17 months of median follow-up. One-, two-and three-year overall survival was 86.5%, 76.9% and 64.5%, respectively. For squamous carcinoma, one-, two-and three-year overall survival was 86.2%, 86.2% and 57.4%, respectively. For olfactory neuroblastomas, One-, two-and three-year overall survival was 86.9%, 75.3% and 67.8%, respectively. Multivariate analysis showed that tumor residual (P=0.001) and recurrence (P<0.01) were independent prognostic factors for survival. Conclusions: The ETA is safe and feasible in selected patients with sinonasal tumor invading the anterior skull base. Tumor residual and recurrence are independent prognostic factors for survival.


Assuntos
Neoplasias Nasais , Neoplasias da Base do Crânio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Recidiva Local de Neoplasia , Neoplasias Nasais/cirurgia , Estudos Retrospectivos , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/cirurgia
15.
Artigo em Chinês | MEDLINE | ID: mdl-33472298

RESUMO

Objective: To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. Methods: The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Results: Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Conclusions: Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.


Assuntos
Artéria Carótida Interna , Aneurisma Intracraniano , Adolescente , Adulto , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Adulto Jovem
16.
Artigo em Chinês | MEDLINE | ID: mdl-33472299

RESUMO

Objective: To investigate the diagnosis and surgical treatment of patients with soft tissue necrosis of cranial base after radiotherapy for nasopharyngeal carcinoma (NPC). Methods: The clinical data of 7 NPC patients with soft tissue necrosis but not bone necrosis after radiotherapy were retrospectively analyzed.They were treated in Xiangya Hospital from 2015 to 2019. The clinical manifestations, diagnosis, treatment and prognosis were analyzed. The major clinical symptoms of the 7 patients were headache in 7 cases, hearing loss in 7 cases, long-term nasal malodor in 5 cases and epistaxis in 2 cases. All patients underwent high-resolution CT, MR and magnetic resonance angiography (MRA) before operation. All cases were treated with extended transnasal endoscopic approach under general anesthesia for resection of necrotic tissue. Five cases had their affected cartilaginous segments of the eustachian tubes partially or completely resected, 7 cases were treated with myringotomy and tube insertion, and 1 case was treated with pansinusectomy. Anti-inflammatory treatment were carried out during the perioperative period. The recovery of patients was observed and recorded through regular follow-up (from 6 months to 3 years) after the operation. Results: Nasopharynx soft tissue lesions can be seen in seven patients with bone cortex integrity by CT, and small bubble shadow can be seen at junction area between skull base soft tissue lesions and skull base bone surface.MR and MRA examination showed extensive inflammatory changes of nasopharynx. Parapharyngeal irregular necrotic cavity was found in 6 cases without central enhancement, demonstrating edema of surrounding soft tissue. The necrotic tissue of all 7 patients was surgically removed. Postoperative pathological examinations confirmed that all of them were necrotic soft and cartilaginous tissue, without tumor recurrence. The symptoms of all patients were significantly alleviated after operation. Headache was cured in 5 cases and relieved in 2 cases. Nasal malodor was cured in 4 cases and alleviated in 1 case. During the follow-up period, 5 patients survived, and 2 patients who had their eustachian tube reserved died. One of them died of nasopharyngeal hemorrhage caused by recurrent nasopharyngeal necrosis 3 months after the operation. Another case died of severe intracranial infection 6 months after operation. Conclusions: The diagnosis of skull base soft tissue necrosis after radiotherapy for nasopharyngeal carcinoma needs comprehensive analysis of radiotherapy history, clinical manifestations and imaging examination. High resolution CT, MR and MRA of skull base are very important for diagnosis. Early active removal of large-scale necrotic lesions under endoscope and partial or total resection of eustachian tube cartilage according to the involvement of eustachian tube cartilage is effective means of controling skull base soft tissue necrosis after radiotherapy. The effective means of necrosis can improve the quality of life of patients.


Assuntos
Neoplasias Nasofaríngeas , Qualidade de Vida , Humanos , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/cirurgia , Necrose , Recidiva Local de Neoplasia , Estudos Retrospectivos , Base do Crânio
17.
Artigo em Chinês | MEDLINE | ID: mdl-33472300

RESUMO

Objective: To evaluate the application of combination use of endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically in skull base tumor with intra and extra-cranial involvement. Methods: A total of 7 patients (4 males and 3 females, aging from 27 to 65 years old, with a medium age of 48) undergone complicated skull base surgeries via endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically from May 2016 to January 2018 were reviewed respectively. The patients included 2 cases of recurrent invasive pituitary adenoma, 3 cases of basal skull meningiomas, 1 case of clivus chondrosarcoma, and 1 case of recurrent nasopharyngeal carcinoma. The lesion extensively infiltrated nasal cavity, extending to the paranasal sinus, bilateral cavernous sinus, sellar region, suprasellar, superior clivus, temporal lobe, pterygopalatine fossa, infratemporal fossa and important intracranial vessels. All the 7 patients were treated under general anesthesia by endoscopic endonasal approach combined with frontotemporal orbitozygomatic approach under the microscope. Total excision rate, intraoperative and postoperative complications and postoperative curative effect were observed. All of them were followed up for 6 to 12 months. The Glasgow Outcome Scale (GOS) was used to evaluate the prognosis. Result: Total tumor removal was performed in 5 cases, subtotal removel in 2 cases. There was no complication during the operation. Postoperative severe complications occurred in 2 cases, including 1 case of cerebrospinal fluid rhinorrhea and intracranial infection, which was cured by lumbar cistern drainage and intrathecal injection; 1 case occurred oculomotor nerve paralysis, which recovered during follow-up. Postoperative complications occurred in 1 case of trochlear nerve dysfunction, 2 cases of facial numbness, and 1 case of tinnitus. During follow-up, all patients recovered to varying degrees. There was no bleeding and death after the operation. No tumor recurred during the follow-up period. All patients were recovered well with GOS grade Ⅳ-Ⅴ. Conclusions: Endoscopic transnasal approach combined with microscopic frontotemporal orbitozygomatic approach can remove tumors in one stage, reduce surgical complications and improve surgical effect. It has good application prospects and is suitable for excising complex intracranial and extracranial communicating tumors of widely involving sellar, clivus and petrous apex area.


Assuntos
Neoplasias Meníngeas , Meningioma , Neoplasias da Base do Crânio , Adulto , Idoso , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fossa Pterigopalatina , Estudos Retrospectivos , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/cirurgia
18.
Artigo em Chinês | MEDLINE | ID: mdl-33472305

RESUMO

Objective: To evaluate the value of Hadad-Bassagasteguy flap (HBF) in endoscopic endonasal approaches (EEA) skull base reconstruction by radioanatomic measurements on CT of the skull base of Chinese adults. The following data in terms of anterior skull base defect and reconstruction, sphenoid platform area and middle skull base defect and reconstruction including sphenoid platform and sella area, clivus area defect and reconstruction, and HBF were collected and assessed. Methods: CT image data of 42 Chinese adults were selected to obtain radioanatomic measurement data related to HBF, anterior skull base defect and reconstruction, middle skull base defect and reconstruction, and defect and reconstruction of clivus area. SPSS 26.0 software was used to analyze the data. Results: The radioanatomic measurement data about HBF and skull base of 42 Chinese adults were obtained. The width of the leading edge of HBF [(37.49±2.86) mm] was 6 mm more than the anterior skull base width at the level of the anterior ethmoidal artery [(30.87±8.61) mm], and the width of the trailing edge of HBF [(42.61±3.95) mm] was also 6 mm more than the anterior skull base width at the level of the sphenoethmoidal junction [(26.79±2.79) mm]. The total length of HBF including the pedicle [(79.68±4.96) mm] was 6 mm more than the length of the anterior skull base reconstruction [(54.06±8.67) mm], and the length of HBF without pedicle [(46.27±3.14)] mm was 6 mm more than the length of anterior skull base defect [(30.87±8.61) mm]. The trailing edge width was 6 mm more than the planum sphenoidal width at the level of the optic strut [(30.87±8.61) mm]. The total length of HBF including the pedicle was 6 mm more than the length of the planum sphenoidal, and the sella reconstruction [(64.44±10.25) mm], also was 6 mm more than the length of the planum sphenoidal reconstruction [(73.61±8.28) mm]. The length of HBF without pedicle was 6 mm more than the length of the planum sphenoidal, and the sella defect [(27.88±3.74) mm], also was 6 mm more than the length of the planum sphenoidal defect [(15.50±3.38) mm]. The width of the leading edge of HBF and the width of the trailing edge were both 6 mm more than the width of clivus reconstruction at the level of the foramen lacerum [(21.68±2.30) mm]. The total length of HBF including pedicles was 6 mm more than the clivus reconstruction length [(67.09±5.44) mm], while the length of HBF without pedicles was also 6 mm more than the clivus defect length [(37.19±3.80) mm]. Conclusions: In this study, the radiosanatomic measurements ensured that HBF could provide sufficient tissue flap for the reconstruction of the anterior skull base and sphenoid plateau and extend the reconstruction area to sella and clivus. Preoperative radiosanatomic measurement can be used to predict the size of HBF required for skull base reconstruction, which provides important guidance for flap harvest.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Base do Crânio , Adulto , Endoscopia , Humanos , Nariz/diagnóstico por imagem , Nariz/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Osso Esfenoide , Retalhos Cirúrgicos
19.
Am J Orthod Dentofacial Orthop ; 159(1): e49-e58, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33357762

RESUMO

INTRODUCTION: The midsagittal plane (MSP) is the foundation for 3-dimensional (3D) cephalometric analyses. This article aimed to provide a protocol to construct a reliable and accurate MSP for 3D cephalometric craniofacial analysis. METHODS: Cone-beam computed tomography data of 16 adult patients without obvious bilateral asymmetry were collected. The model of the anterior cranial base and sphenoid bone was constructed, and the candidate MSP was determined on the basis of the symmetry of this model. Intraclass correlation coefficients were used to assess intra- and interexaminer reliability of the candidate MSP. To investigate the accuracy of this candidate MSP, we constructed a true plane of symmetry of craniomaxillofacial structure and a control plane on the basis of 3 cranial midline points. We then compared these with the candidate MSP. RESULTS: This candidate MSP resembled the true plane of symmetry with all the mean absolute errors <1 mm, and all the absolute errors for the candidate MSP were significantly smaller than the control plane (P ≤0.002). The relative intra- and interexaminer reliability for this candidate MSP was almost perfect (intraclass correlation coefficients >0.9). CONCLUSIONS: The candidate MSP constructed using this method was thought to be reliable and accurate for 3D cephalometric analysis in patients without obvious cranial asymmetry.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Imageamento Tridimensional , Adulto , Pontos de Referência Anatômicos/diagnóstico por imagem , Cefalometria , Humanos , Reprodutibilidade dos Testes , Base do Crânio/diagnóstico por imagem
20.
Rev. esp. cir. oral maxilofac ; 42(4): 175-178, oct.-dic. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-199140

RESUMO

Pseudotumoral calcinosis is a rare entity, which is usually located in joints such as hips or elbows and is extremely infrequent in the head and neck. It might be associated to metabolic diseases or renal failure but can also be hereditary or idiopathic. We report a case of pseudotumoral calcinosis in the anterior cranial base and we describe the surgical technique, assisted by intraoperative navigation and surgical 3D in-house printed guides


La calcinosis pseudotumoral es una entidad infrecuente, que suele presentarse en regiones periarticulares, siendo excepcional en cabeza y cuello. Puede estar asociada a enfermedades metabólicas o renales o presentarse de forma hereditaria o idiopática. Presentamos un caso clínico de una pseudocalcinosis tumoral en base anterior de cráneo y la técnica quirúrgica de resección mediante asistencia con navegación intraoperatoria y guías de corte impresas en 3D


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Base do Crânio/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Tomografia Computadorizada por Raios X , Imagem por Ressonância Magnética
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