Cholesteatoma of the cerebellopontine angle. A case report

In this paper are recalled the most important features of this sinusal condition, its behaviour, complications and so on. Regarding the management the A. recall to the classic surgery, well done, orderly and systematically planed, which give him always good outcomes. By the way accordingly to the promising it could be, he refers to endoscopic functional sinusal approach.     

Access to the cavernous sinus through the vertebral artery: technical case report

The cavernous sinus in 3 of a series of 147 fast-flow direct carotid-cavernous fistulae was best reached through the vertebral artery. All three patients were anatomically cured without morbidity.     

A case of facial nerve neurinoma originated from cerebellopontine angle

Both the activation of protein kinase C (PKC) and the facilitation of depolarization-evoked glutamate release have been implicated in the induction of hippocampal long-term synaptic potentiation. These observations may be functionally related, since stimulation of PKC activity enhances evoked glutamate release. Recently, it was shown that arachidonic acid and the diacylglycerol analog oleoyl-acetyl-glycerol activate brain PKC in a synergistic fashion. We report the facilitation of depolarization-induced glutamate efflux from hippocampal mossy fiber synaptosomes due to a combination of arachidonic acid and oleoyl-acetyl-glycerol. The potentiating effects appeared to depend on the activation of PKC since they were attenuated by staurosporine. In addition, the effects of arachidonic acid and oleoyl-acetyl-glycerol appeared to be limited to calcium-dependent processes.     

Fenestrated oculomotor nerve caused by meningioma around the cavernous sinus: a surgical pitfall in tumor removal: case report

OBJECTIVE AND IMPORTANCE: The preservation of oculomotor nerves is one of the most significant issues regarding the resection of meningiomas around the cavernous sinus. CLINICAL PRESENTATION: We report the case of a patient whose oculomotor nerve was fenestrated, caused by a large meningioma around the cavernous sinus. The nerve function remained intact until surgery. INTERVENTION: During surgery, one trunk of the fenestrated nerve behind the tumor was sacrificed. The fenestrated shape of the nerve led us to the misjudgment that the preserved other trunk located along the upper margin of the tumor was the whole nerve. CONCLUSION: Although fenestrated oculomotor nerves may be rare, their possibility should be kept in mind during surgery around the cavernous sinus.     

Cerebellopontine angle ependymoma with internal auditory canal enlargement and pineal extension--case report

A 38-year-old male presented with a posterior fossa ependymoma with unusual extension from the cerebellopontine angle to the pineal region. Magnetic resonance imaging clearly demonstrated that these two components were continuous through the right ambient cistern. Computed tomography using a bone algorithm revealed enlargement of the right internal auditory canal. This case suggests that ependymoma can extend anywhere within the subarachnoid space along the path of least resistance.     

Giant recurrent desmoid tumor: a case report

A case of giant recurrent intra-abdominal desmoid tumor is presented. A history of childbirth, antecedent surgery, multiple episodes of recurrence, resistance to excisional and radiation therapy, represent common features of desmoid tumors. The size of the recurrence (15.4 kg), the intra-abdominal presentation of the tumor, involvement of the chest wall and focal infiltration of the small bowel are unusual features of this case.     

Combined pretemporal and endovascular approach to the cavernous sinus for the treatment of carotid-cavernous dural fistulae: technical case report

OBJECTIVE AND IMPORTANCE: The endovascular treatment of carotid-cavernous dural fistulae is becoming the prominent treatment modality for these lesions. The intractability of these lesions and their tendency to recur, especially after previous endovascular treatment sessions, exhausts the available routes and tends to present a difficulty in accessing the cavernous sinus. To avoid the risks associated with a direct surgical approach, an alternative, less invasive route to the cavernous sinus using a pretemporal extradural approach is combined with a direct endovascular approach. CLINICAL PRESENTATION: A 38-year-old woman presented with a history of right visual and ocular symptoms related to a Type D cavernous carotid dural fistula, which was fed by internal carotid and external carotid branches. The fistula was initially treated with embolization of the external carotid arterial supply. After a transient improvement, the patient's visual acuity worsened. A follow-up angiogram showed the major supply from the intracavernous internal carotid branches and draining through the inferior ophthalmic vein. The transvenous route was not accessible. An attempt to cannulate the intracavernous branches was not successful. The combined pretemporal and endovascular approach was then used. INTERVENTION: The pretemporal extradural region of the superior orbital fissure was exposed. Using microsurgical techniques and Doppler flow guidance, the anterior cavernous sinus was cannulated through the orbital venous drainage channels. Using intraoperative angiography, thrombogenic coils were deployed at the level of the fistula. Intraoperative angiography confirmed complete obliteration of the fistula. CONCLUSION: The combined pretemporal (extradural) and endovascular approach to the cavernous sinus is a less invasive alternative for the treatment of intractable carotid-cavernous dural fistulae.     

Bilateral horizontal gaze palsy with pontine cavernous hemangioma: a case report

Epilepsy is a common condition. In most cases, treatment with medications is satisfactory. When antiepileptic drugs fail to control the seizures, further evaluation may be warranted. EEG-video monitoring can allow a definitive diagnosis of epileptic seizures to be made by differentiating epileptic events from paroxysmal symptoms that can be mistaken for seizures (i.e., pseudoseizures). In addition, it usually allows one to accurately diagnose the seizure type, facilitating selection of the best possible treatment. Occasionally, surgery may be a therapeutic option in patients with intractable seizures.     

Sphenoid sinus brown tumor of secondary hyperparathyroidism: case report

OBJECTIVE AND IMPORTANCE: Brown tumor is a misnomer for a reparative cellular process caused by primary or, less commonly, secondary or tertiary hyperparathyroidism. Atypical involvement of the base of the cranium in the area of the sphenoid sinus and the orbit is exceedingly rare and may produce a neurological deficit as a primary clinical presentation. Those neurosurgeons dealing with cranial base and pituitary lesions should be aware of this disease entity, and it should be listed in the differential diagnosis. CLINICAL PRESENTATION: A 21-year-old woman with end-stage renal failure on chronic dialysis was referred to the Department of Neurosciences at King Faisal Specialist Hospital and Research Centre with a 4-month history of progressive impairment of vision, associated with headache and nausea. Computed tomography and magnetic resonance imaging demonstrated an expansive mass lesion in the sphenoid sinus with erosion of the sellar floor and posterior medial wall of the orbit causing compression of the optic nerves. The biochemical laboratory studies showed elevation of parathyroid hormone and confirmed the diagnosis of hyperparathyroidism. INTERVENTION: The transnasal-transsphenoidal approach was used for extensive microsurgical removal of the lesion. The postoperative course was uneventful, and the improvement in vision was dramatic. CONCLUSION: Brown tumor, although rare, should be listed in the differential diagnosis of expansive mass lesions in the area of the sphenoid sinus and cranial base. The management is multidisciplinary, and therapeutic options should target the underlying cause.     

Giant cell fibroblastoma associated with dermatofibrosarcoma protuberans: a case report

Umbilical cord blood (UCB) was disclosed to possess the proliferative capacity containing hematopoietic progenitors and has recently been applied for allogeneic transplantation as an attractive alternative to bone marrow or peripheral blood stem cells. UCB contains similar and higher proportions of immature hematopoietic progenitors, compared to bone marrow stem cells, although the number of collectable cells is limited. The yield of collectable UCB volume ranges from 70 to 150 ml. The colony formation of CFU-Mix of UCB was higher, but that of CFU-GM and CFU-E was lower, compared to those of bone marrow. The analyses of expression of differentiation antigens and adhesion molecules on CD34+ cells of UCB by flow cytometer, revealed that the coexpression rates of CD38 and CD44 on CD34+ cells were almost the same, but the mean fluorescence intensity of those was low compared to adult bone marrow. These results indicate that UCB contains more primitive hematopoietic progenitors. UCB transplantation has greater advantages of lower incidences of graft versus host disease, and unlimited number of donors compared with other allogeneic transplantation would widen the indication of transplantation by technical and methodological development.     

Cutaneous odontogenic sinus tract to the chin: a case report

We report a case of cutaneous odontogenic sinus tract to the chin. The patient first noticed the cutaneous condition in 1977. Inappropriate medical and dental treatment was ineffective. Correct diagnosis and treatment was completed in 1993. We offer diagnostic and treatment guidelines for the management of similar cases.     

Giant pedunculated liposarcomas of the esophagus: literature review and case report

Although liposarcoma is the second most common soft-tissue sarcoma in adults, its incidence within the gastrointestinal tract is distinctly low. Esophageal involvement is exceedingly rare and only four cases have been described so far. A fifth case is presented here along with a thorough review of the literature of polypoid lipomatous tumors of the esophagus. Diagnostic and therapeutical strategies of these tumors are discussed in detail.     

Hearing improvement after resection of cerebellopontine angle meningioma: case study of the preoperative role of transient evoked otoacoustic emissions

OBJECTIVE: The present study was initiated to investigate the validity of cadmium (Cd) and lead (Pb) in urine in comparison with the metals in blood as a biological marker of nonoccupational exposure of general populations to these metals as environmental pollutants. DESIGN: Peripheral blood samples, morning spot-urine samples, and 24-h total food duplicate samples were collected from 107 nonsmoking women (aged 30-59 years) in four urban and rural survey sites in Korea. METHODS: Portions of the samples were digested by heating in the presence of mineral acids, and the digests were analyzed for Cd and Pb by graphite furnace atomic absorption spectrophotometry. The metal concentrations in urine were adjusted for creatinine concentration and a specific gravity of 1.016. The analyte levels were evaluated on an individual basis (n = 107) and also on a group basis, i.e., in terms of geometric means for the survey sites (n = 4). RESULTS: Cd in urine correlated with Cd in blood on an individual as well as survey-site basis and tended to correlate with Cd in food duplicates on a group basis. The correlation of Pb in urine with Pb in blood was weaker than that of Cd in urine with Cd in blood when evaluated on an individual and survey-site basis. Pb in urine correlated with Pb in food duplicates either weakly or even negatively when examined on a survey-site basis. CONCLUSIONS: Cd in urine proved to be valid as a biological marker of environmental exposure of general populations, whereas less support was obtained for Pb in urine as an exposure marker.     

Cerebellopontine angle lymphoma: a case report and review of the literature

BACKGROUND: Although malignant lymphomas of the central nervous system have been reported to be increasing in frequency, cerebellopontine (CP) angle lymphoma is rare and only 13 cases have been reported previously in the literature. CASE PRESENTATION: A 63-year-old woman had progressive dizziness and nausea for 2 months. Computed tomography scanning and magnetic resonance imaging (MRI) revealed a mass lesion in the left CP angle, that was compressing the lateral-dorsal aspect of the pons and the fourth ventricle. This tumor was avascular on angiography. The tumor was surgically removed through a left lateral suboccipital approach. It was considered to arise from the subarachnoid space of the CP angle cistern. For some reason, the histologic diagnosis was not definitively made, and therefore radiation therapy was not planned. The tumor recurred within 50 days after the tumor excision. Surgical excision of the recurrent tumor was performed again. The histologic diagnosis was B-cell type malignant lymphoma. Radiation therapy was performed. In the 27 months since irradiation, a recurrent tumor has not been detected on MRI. CONCLUSIONS: Although erosion and expansion of the internal auditory canal suggest an acoustic neurinoma, CP angle lymphoma can, in rare circumstances, erode the internal auditory canal. There are three distinct patterns in which malignant lymphomas occupy the CP angle: (1) an extra-axial CP angle lymphoma, (2) an intra-axial lymphoma extending to the CP angle, and (3) a leptomeningeal lymphoma presenting as a CP angle lesion. Although malignant lymphomas rarely occupy the CP angle, it should be considered in the differential diagnosis of CP angle tumors. It is desirable to obtain a frozen section in all CP angle tumors during surgery to identify the tumor, because aggressive removal is not necessary, but radiation therapy should additionally be performed for malignant lymphomas.