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Meltzer EO, Charous BL, Busse WW, Zinreich SJ, Lorber RR, Danzig MR. Added relief in the treatment of acute recurrent sinusitis with adjunctive mometasone furoate nasal spray. The Nasonex Sinusitis Group. J Allergy Clin Immunol 2000; 106:630-7. [PMID: 11031332 DOI: 10.1067/mai.2000.109056] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intranasal glucocorticoids are effective in the treatment of allergic rhinitis. Their effectiveness as an anti-inflammatory adjunct in the treatment of acute recurrent sinusitis has not been adequately established in a controlled clinical study. OBJECTIVE The purpose of this study was to test the hypothesis that intranasal corticosteroid treatment produces additional relief in the treatment of acute sinusitis with oral antibiotics. METHODS Patients who were 12 years old and older with a history of recurrent sinusitis were treated while experiencing a new episode of acute sinusitis, which was diagnosed by symptoms and confirmed by computed tomography scan of the paranasal sinuses. Patients were treated for 21 days with amoxicillin clavulanate potassium and randomized to receive concurrent mometasone furoate nasal spray (MFNS; Nasonex [400 microg, twice daily]; n = 200 patients) or placebo spray (twice daily; n = 207 patients). Symptom scores for headache, facial pain, congestion, purulent rhinorrhea, postnasal drip, and cough were recorded at baseline and throughout treatment. RESULTS Baseline symptom scores showed a moderate level of symptom severity comparable in both groups. Patient-recorded twice daily symptom scores showed that adjunctive treatment with MFNS caused a significantly greater decrease in total symptom score (primary efficacy variable) and in individual scores of inflammatory symptoms associated with the obstruction process (headache, congestion, and facial pain) compared with placebo. Symptoms associated with the secretory processes were improved to a lesser degree. Therapy-related local adverse events were not significantly different between groups. CONCLUSION The addition of intranasal corticosteroid, MFNS 400 microg twice daily, to antibiotics significantly reduces symptoms of acute sinusitis compared with antibiotic treatment alone.
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Gotwald TF, Zinreich SJ, Schocke M, Frede T, Bellmann R, Zur Nedden D. CT and MR imaging of orbital metastasis from islet cell carcinoma of the pancreas. AJR Am J Roentgenol 2000; 175:475-6. [PMID: 10915697 DOI: 10.2214/ajr.175.2.1750475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ahn NU, Sponseller PD, Ahn UM, Nallamshetty L, Kuszyk BS, Zinreich SJ. Dural ectasia is associated with back pain in Marfan syndrome. Spine (Phila Pa 1976) 2000; 25:1562-8. [PMID: 10851107 DOI: 10.1097/00007632-200006150-00017] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional age- and sex-matched study comparing the prevalence and size of dural ectasia in two groups of patients with Marfan syndrome. Group I comprised patients with moderate to severe back pain and Group II comprised patients without back pain. OBJECTIVES To determine whether the presence and size of dural ectasia is associated with back pain in patients with Marfan syndrome. SUMMARY OF BACKGROUND DATA Dural ectasia is present in more than 60% of patients with Marfan syndrome. Moderate to severe back pain is present in more than 50% of patients with Marfan syndrome. Most cases of significant low back pain in patients with Marfan syndrome do not have a clear cause. It would be useful for the clinician to know whether dural ectasia may be a cause of back pain in patients with Marfan syndrome with no other source. METHODS Thirty two volunteers aged 30-50 with Marfan syndrome were enrolled as age- and sex-matched pairs with significant back pain (Group I) and without back pain (Group II). A completed questionnaire, physical examination, and magnetic resonance image of the lumbosacral spine were obtained. Dural volume caudal to L5 was calculated from the magnetic resonance data by specially designed software. RESULTS Dural ectasia was present in 76% of the patients in Group I, and 41% of the patients in Group II. The proportion of patients with dural ectasia was significantly higher in Group I. Furthermore, the mean dural volume was significantly higher in Group I, and a significant correlation between dural volume and Oswestry pain score was noted. CONCLUSIONS The presence and size of dural ectasia are associated with back pain in the Marfan syndrome. However, a high prevalence of dural ectasia (41%) exists even in patients with Marfan syndrome without back pain. The mere presence of dural ectasia therefore does not necessarily mean the patient will be symptomatic even though the two are associated.
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Ahn NU, Sponseller PD, Ahn UM, Nallamshetty L, Rose PS, Buchowski JM, Garrett ES, Kuszyk BS, Fishman EK, Zinreich SJ. Dural ectasia in the Marfan syndrome: MR and CT findings and criteria. Genet Med 2000; 2:173-9. [PMID: 11256662 DOI: 10.1097/00125817-200005000-00003] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To create criteria for detecting dural ectasia on MR or CT images in adult Marfan patients. METHODS Images were analyzed using a workstation. Parameters that predicted dural ectasia were included in our criteria. RESULTS Major criteria include: (1) width of dural sac below L5 > width above L4; (2) anterior sacral meningocele. Minor criteria include: (1) L5 nerve root sleeve diameter > 6.5 mm and (2) S1 scalloping > 3.5. Dural ectasia exists if 1 major or 2 minor criteria are present. CONCLUSION MR and CT diagnose dural ectasia with high specificity and sensitivity. Our criteria accurately diagnose dural ectasia in adult Marfan patients.
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Leopold D, Zinreich SJ, Simon BA, Cullen MM, Marcucci C. Xenon-enhanced computed tomography quantifies normal maxillary sinus ventilation. Otolaryngol Head Neck Surg 2000; 122:422-4. [PMID: 10699821 DOI: 10.1016/s0194-5998(00)70059-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the applicability, safety, and normal parameters of a xenon-enhanced CT technique to quantify maxillary sinus ventilation. PATIENTS AND METHODS Nine healthy subjects inhaled a xenon-oxygen-air mixture through their noses while repeated CT scans were performed through the same section of their sinuses. Images were obtained every 1 to 3 minutes and analyzed to measure the density of the gas in the maxillary sinus as a function of time. RESULTS Individual nasal cavity time constants ranged from 0.5 to 18 minutes. Studies performed after decongestion showed poorer sinus ventilation. CONCLUSIONS The xenon-CT washin/washout technique is safe, effective, and gives representative data.
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Kyriacou SK, Davatzikos C, Zinreich SJ, Bryan RN. Nonlinear elastic registration of brain images with tumor pathology using a biomechanical model. IEEE TRANSACTIONS ON MEDICAL IMAGING 1999; 18:580-592. [PMID: 10504092 DOI: 10.1109/42.790458] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A biomechanical model of the brain is presented, using a finite-element formulation. Emphasis is given to the modeling of the soft-tissue deformations induced by the growth of tumors and its application to the registration of anatomical atlases, with images from patients presenting such pathologies. First, an estimate of the anatomy prior to the tumor growth is obtained through a simulated biomechanical contraction of the tumor region. Then a normal-to-normal atlas registration to this estimated pre-tumor anatomy is applied. Finally, the deformation from the tumor-growth model is applied to the resultant registered atlas, producing an atlas that has been deformed to fully register to the patient images. The process of tumor growth is simulated in a nonlinear optimization framework, which is driven by anatomical features such as boundaries of brain structures. The deformation of the surrounding tissue is estimated using a nonlinear elastic model of soft tissue under the boundary conditions imposed by the skull, ventricles, and the falx and tentorium. A preliminary two-dimensional (2-D) implementation is presented in this paper, and tested on both simulated and patient data. One of the long-term goals of this work is to use anatomical brain atlases to estimate the locations of important brain structures in the brain and to use these estimates in presurgical and radiosurgical planning systems.
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Abstract
Standard radiographs are suboptimal in the display of the regional morphology in the nasal cavity and paranasal sinuses, especially the ethmoid sinus. The preferred radiographic modality for the evaluation of the nasal cavity and paranasal sinuses is computed tomography (CT). Coronal CT imaging perpendicular to the bony palate affords the best display of the ostiomeatal channels and facilitates the surgeon's perception of this regional morphology because it most closely resembles the endoscopic view. The purpose of this article is to familiarize the reader with the regional anatomy of the nasal cavity and paranasal sinuses, specifically the 14 anatomic structures the examiner must understand and systematically check in the evaluation of this morphologic area. A description of the most commonly found anatomic variations that influence the patency of the ostiomeatal channels as well as specific relationships between the paranasal sinuses, the orbits, and the intracranial compartment are also detailed. Although less helpful in the display of paranasal sinus chronic inflammatory disease, magnetic resonance imaging is beneficial in the diagnosis of fungal disease, neoplastic disease, and the display of inflammatory extension into the intracranial and intraorbital compartments.
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Driben JS, Bolger WE, Robles HA, Cable B, Zinreich SJ. The reliability of computerized tomographic detection of the Onodi (Sphenoethmoid) cell. AMERICAN JOURNAL OF RHINOLOGY 1998; 12:105-11. [PMID: 9578928 DOI: 10.2500/105065898781390325] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Optic nerve injury is a devastating potential complication of endoscopic sinus surgery. Anatomic variations of the posterior ethmoid sinus are certainly contributing factors. In the most well described posterior ethmoid anatomical variant, the sphenoethmoid or Onodi cell, the optic nerve is placed at risk during sinus surgery. Improving preoperative and intraoperative identification of the sphenoethmoid (Onodi) cell could decrease the risk of optic nerve injury. The purpose of this investigation was to assess the reliability of computerized tomography (CT) in detecting the sphenoethmoid (Onodi) cell, and further our understanding of this clinically relevant anatomic variant. A total of 41 sinonasal complexes from 21 human adult cadaveric heads were studied with a standard coronal and axial plane CT, and subsequent endoscopic dissection. The prevalence of the sphenoethmoid (Onodi) cell was determined by CT and endoscopic dissection, as were other anatomic characteristics of the posterior ethmoid anatomy. In our study, CT identified a sphenoethmoid (Onodi) cell in 3/41 (7%) of the sphenoethmoid complexes. However, anatomic dissection identified a sphenoethmoid (Onodi) cell in 16/41 (39%) complexes. Coronal orientation of the anterior sphenoid wall was never associated with a sphenoethmoid (Onodi) cell. Conversely, oblique or horizontal orientations were present in all cases of sphenoethmoid (Onodi) cells. Current CT scanning protocols for the paranasal sinuses did not reliably detect the Onodi cell. Endoscopic dissection indicates that the sphenoethmoid (Onodi) cell is a more frequent anatomic variant than previously appreciated. Awareness of anterior sphenoid wall orientation may assist surgeons in identifying the Onodi cell, thereby reducing the risk of optic nerve trauma.
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Hong SC, Leopold DA, Oliverio PJ, Benson ML, Mellits D, Quaskey SA, Zinreich SJ. Relation between CT scan findings and human sense of smell. Otolaryngol Head Neck Surg 1998; 118:183-6. [PMID: 9482549 DOI: 10.1016/s0194-5998(98)80008-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Symptom questionnaires were obtained from 106 patients immediately before nasal and sinus computed tomography scans at the Johns Hopkins Outpatient Center. Their scans were analyzed by two otolaryngologists and three neuroradiologists by using a semiobjective rating system of the size and opacity of 36 anatomic areas. Patients estimated their own left and right sense of smell as excellent, diminished, or absent. Results of the data are as follows: (1) There is no correlation between smell ability and size of the nasal and sinus structures. This indicates that there is no gross effect of the bulging of sinuses into the nasal airway; (2) As a rule, opacity of only left-sided anatomic structures was correlated with both left and right sense of smell (p < 0.01). This suggests that our subjects were using their left smell receptors preferentially, to the exclusion of and in place of the right smell receptors; and (3) Total, not partial, opacity of the left olfactory cleft, frontal recess, or ethmoidal infundibulum was correlated with decreased sense of smell. This suggests that these anterior structures in the region of the olfactory cleft do affect airflow, but complete obstruction of these spaces is needed. Possible explanations for the effect of opacified sinuses on the sense of smell include (1) The presence of fluid or thickened mucosa in the sinuses may interfere with perceived olfactory ability by changing nasal airflow patterns or odorant access to receptors; (2) There may be olfactory receptors inside the sinuses; and (3) There may be a relation between the trigeminal receptors in the sinuses and the olfactory system.
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Abstract
In the past 20 years, CT and MR imaging have emerged as the primary modalities for the evaluation of orbital disease. One can safely say that plain films have no role in the detailed evaluation of disorders of this morphological area. Given the bony enclosure, small size, soft tissue and fat content of this region, as well as globe movement, obtaining high-quality images of the orbit can be technically challenging. Our aim in this article, is to provide specific parameters for properly evaluating the orbit with CT and MRI.
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Zinreich SJ. Rhinosinusitis: Radiologic Diagnosis. Otolaryngol Head Neck Surg 1997; 117:S27-34. [PMID: 9334785 DOI: 10.1016/s0194-59989770004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Anon JB, Klimek L, Mosges R, Zinreich SJ. Computer-assisted endoscopic sinus surgery. An international review. Otolaryngol Clin North Am 1997; 30:389-401. [PMID: 9162124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Computer-assisted technology provides the surgeon with accurate guidance during endonasal sinus procedures. This article reviews early experiences in Europe and the United States. Various types of probe technology and their accuracy and ease of use are examined.
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Ménache MG, Hanna LM, Gross EA, Lou SR, Zinreich SJ, Leopold DA, Jarabek AM, Miller FJ. Upper respiratory tract surface areas and volumes of laboratory animals and humans: considerations for dosimetry models. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH 1997; 50:475-506. [PMID: 9140466 DOI: 10.1080/00984109708984003] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To facilitate the development of regional respiratory tract dosimetry comparisons between laboratory animal species and humans, published surface area (SA) and volume (VOL) data for the upper respiratory tract (URT) were reviewed. The review of the literature revealed that (1) different studies used different techniques to prepare specimens and make measurements, (2) different areas of the URT were measured, and (3) URT surface areas and volumes have been reported for a limited number of individual subjects within a species but for a relatively wide range of species. The published data are summarized in tables in this article. New measurements made in an F344 rat and in a female human subject are also presented. Despite the differences in experimental protocols, it was possible to fit allometric scaling equations to the data: In(SA, cm2) = -0.34 + 0.52 In(body weight, g) and In(VOL, cm3) = 1.70 + 0.78 In(body weight, g). Separate scaling equations were also fitted for rats alone. To illustrate the use of these scaling equations in quantitative human health risk assessment, two dose metrics (fractional absorption/cm2 URT SA and fractional absorption/g body weight) for predicted URT uptake in laboratory animals and humans were calculated for acrolein and epichlorohydrin. Expressed as an animal-to-human ratio, the 95% confidence interval for URT SA could change the predicted dose ratio by up to a factor of 2. Additional studies are needed to describe the entire URT (from the nares through the larynx) quantitatively and to decrease variability in scaling equation predictions as well as to develop additional species-specific scaling equations. Three-dimensional imaging techniques provide a noninvasive method to obtain URT surface areas and volumes in humans and the larger laboratory animals. Comparisons of magnetic resonance image (MRI) and computed tomography (CT) scans made as part of this study suggest that the greater clarity of the mucosal-air interface in the CT image provides better resolution for the study of anatomic features. Because there is no radiation exposure associated with MRI imaging, however, it is more safely used than CT scans in making repeated measurements in a subject to elucidate changes in URT geometry associated with normal nasal cycling or other physiological changes.
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Benson ML, Oliverio PJ, Zinreich SJ. Nasal and paranasal sinus imaging. JOURNAL BELGE DE RADIOLOGIE 1997; 80:89-91. [PMID: 9237421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Functional endoscopic sinus surgery has become the surgical treatment of choice in many patients with inflammatory sinus disease refractory to medical treatment. Coronal CT scanning is the imaging modality of choice as it provides initial screening, contributes to surgical planning, and provides an operative "roadmap". The authors stress that close cooperation between the radiologist and the surgeon is mandatory both for evaluation and treatment of paranasal disorders.
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Pretorius ES, Fishman EK, Zinreich SJ. CT of hemorrhagic complications of anticoagulant therapy. J Comput Assist Tomogr 1997; 21:44-51. [PMID: 9022769 DOI: 10.1097/00004728-199701000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anticoagulant therapy is commonly used in patients at risk for, or known to have, thromboembolic disease. Although complications of therapy are uncommon in most patients, in others it may result in complications with substantial morbidity and occasionally may be life threatening. This essay reviews the role of anticoagulant therapy and defines the potential complications that may occur in the chest, abdomen, musculoskeletal system, and CNS. Specific pitfalls in diagnosis as well as complications of the bleeding process are discussed and illustrated. The role of CT scanning in the diagnosis and triage of these patients is clearly defined through select cases and clinical dilemmas.
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Snyderman CH, Anon JB, Carrau RL, Zinreich SJ. Computer assisted endoscopic sinus surgery: Clinical applications. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s1043-1810(96)80038-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sipos EP, Tebo SA, Zinreich SJ, Long DM, Brem H. In vivo accuracy testing and clinical experience with the ISG Viewing Wand. Neurosurgery 1996; 39:194-202; discussion 202-4. [PMID: 8805161 DOI: 10.1097/00006123-199607000-00048] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE A frameless stereotactic system (the Viewing Wand; Elekta Instruments, Atlanta, GA) has been developed for use with preoperative computed tomography, magnetic resonance imaging, and positron emission tomography as an adjunct for surgical planning and intraoperative navigation. This clinical study was designed to evaluate the safety, efficacy, and accuracy of the Viewing Wand in a variety of intracranial procedures. METHODS We used this system in 250 patients undergoing a wide range of neurosurgical procedures from July 1990 to July 1994, to assess its clinical usefulness and safety. In a subset of 45 neurosurgical patients studied between March 1993 and March 1994, a battery of objective accuracy measurements was obtained before and during surgery. RESULTS In this series, there were no instances of adverse outcomes attributable to the use of this system. A comparison of two alternative patient-image registration techniques established that the fiducial-fit method was slightly more accurate than the surface-fit method (geometric means = 2.51 and 3.03 mm, respectively). The clinical accuracy achieved with magnetic resonance imaging was nearly equivalent to that with computed tomography. CONCLUSIONS On the basis of this clinical series, recommendations are made regarding preoperative scanning parameters, registration techniques, and methods for reestablishing registration if needed during the course of surgery. The primary clinical benefits of the wand in this series were improved intraoperative navigation and surgical safety. For most cases, the wand was also useful in planning the location and size of the scalp incision, craniotomy, or corticotomy, as well as the extent of surgical resection.
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DeLano MC, Fun FY, Zinreich SJ. Relationship of the optic nerve to the posterior paranasal sinuses: a CT anatomic study. AJNR Am J Neuroradiol 1996; 17:669-75. [PMID: 8730186 PMCID: PMC8337258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To delineate the relationship between the optic nerves and the posterior paranasal sinuses using CT data. METHODS Direct coronal sinus CT scans of 150 consecutive patients with chronic inflammatory sinus disease were reviewed by two radiologists. Axial oblique reconstructions along the course of the optic nerve were obtained for the first 100 patients. The direct relationship between the optic nerve and the posterior ethmoid and sphenoidal sinuses was recorded, as were identations into the sinus wall, course of the nerve through the sinus region, pneumatization of the anterior clinoid process, and bone dehiscence. RESULTS The relationship of the optic nerve to the posterior paranasal sinus fell into one of four discrete categories, type 1 through type 4. All 300 nerves were intimately related to the sphenoidal sinus. A small minority (3%) were in contact with the posterior ethmoidal sinus. Only type 4 nerves had contact with the posterior ethmoid air cell. Type 1 nerves course adjacent to the sphenoid sinus without indentation of the wall (228 nerves, 76%). Type 2 nerves course adjacent to the sphenoidal sinus, causing indentation of the sinus wall (44 nerves, 15%). Type 3 nerves course through the sphenoid sinus (19 nerves, 6%). Type 4 nerves course immediately adjacent to the sphenoidal sinus and the posterior ethmoidal air cell (9 nerves, 3%). Bone dehiscence over the optic nerve was found in 24% of the nerves; 4% of the optic nerves in our study had an associated pneumatized anterior clinoid process and 77% of these had an associated dehiscence over the optic canal. CONCLUSIONS In all our cases the course of the optic nerve was adjacent to the sphenoidal sinus. Only 3% were in contact with the posterior ethmoidal sinus. Anatomic configurations that predispose the optic nerve to injury include type 2 or 3 optic nerves, bone dehiscence over the nerve, and pneumatization of the anterior clinoid process. These configurations are common and should be routinely sought out so that devastating complications from sinus surgery can be avoided.
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Benson ML, Oliverio PJ, Yue NC, Zinreich SJ. Primary craniosynostosis: imaging features. AJR Am J Roentgenol 1996; 166:697-703. [PMID: 8623653 DOI: 10.2214/ajr.166.3.8623653] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In 1851, Virchow introduced the term craniosynostosis to describe a variety of abnormalities in calvarial growth. These skull deformities are usually apparent in infancy. When an abnormal calvarial configuration is detected, a radiologic evaluation is necessary to characterize the deformity and to guide the corrective surgical procedure. Affected children are believed to have an improved outcome when diagnosis and surgical intervention occur at an early age. CT with three-dimensional reconstruction optimally evaluates the presence and degree of sutural involvement and assesses associated facial and intracranial abnormalities. This pictorial essay illustrates the imaging findings, nomenclature, and associated abnormalities of the various types of primary craniosynostosis.
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Melhem ER, Oliverio PJ, Benson ML, Leopold DA, Zinreich SJ. Optimal CT evaluation for functional endoscopic sinus surgery. AJNR Am J Neuroradiol 1996; 17:181-8. [PMID: 8770274 PMCID: PMC8337972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the optimal parameters for the CT examination of patients who are having functional endoscopic sinus surgery. METHODS CT scanning was performed on two fresh cadaveric heads in the direct coronal plane, varying the section thickness, intersection gap, scanner gantry angle, and amperage. The nasal cavity and paranasal sinuses were examined independently in a blinded fashion by four staff neuroradiologists and a staff otolaryngologist with special attention to 10 anatomic landmarks within the ostiomeatal unit that are considered important for preoperative planning. A score of 0 (nonvisualization/incomplete visualization) or 1 (clear/complete visualization) was assigned to each of these 10 landmarks. Analysis of variance was used in which reader, subject, and side were simultaneously controlled by "blocking." Multiple comparison methods (ie, Bonferroni) were used to compare the different protocols. RESULTS We found a significant reduction in the delineation, and therefore the perception, of the ostiomeatal unit structures when the section thickness was greater than 5mm, any intersection gap was used, and the gantry angle was greater than 10 degrees from the plane perpendicular to the hard palate. However, a reduction in the radiation exposure from 200 mA to 80 mA did not affect the display of the anatomic landmarks. CONCLUSION We found the optimal screening CT protocol for the paranasal sinuses to be a section thickness of 3 mm, no intersection gap, and a section angle within 10 degrees from the plane perpendicular to the palate. Also, owing to inherent contrast between air, soft tissue, and bone in the paranasal sinuses, a reduction in the radiation exposure parameter to 80 mA did not affect image quality.
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Baroody FM, Hughes CA, McDowell P, Hruban R, Zinreich SJ, Naclerio RM. Eosinophilia in chronic childhood sinusitis. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 1995; 121:1396-402. [PMID: 7488370 DOI: 10.1001/archotol.1995.01890120054010] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To quantify eosinophilia in sinus tissues obtained from children with chronic sinusitis and to correlate the degree of eosinophilia with history of asthma, allergy, cystic fibrosis, and preoperative computed tomographic (CT) scans. DESIGN Examination of surgical specimens from children who underwent functional endoscopic sinus surgery and controls. SETTING Tertiary care medical center. PATIENTS Thirty-four children who underwent functional endoscopic sinus surgery for chronic sinusitis refractory to medical treatment were divided into three groups: 13 with asthma, 11 without asthma, and 10 with cystic fibrosis. Normal sphenoid sinus mucosa was also obtained from six adults undergoing transsphenoidal hypophysectomies. MAIN OUTCOME MEASURES Number of lamina propria and intraepithelial eosinophils in surgical specimens, allergic status, presence or absence of asthma, and CT scans obtained preoperatively. RESULTS There were significantly more lamina propria and intraepithelial eosinophils in the tissue of children with chronic sinusitis compared with normal sphenoid sinus mucosa. More eosinophils were counted in the tissues of patients with asthma and cystic fibrosis compared with patients without concomitant disease, but this did not reach statistical significance. Allergy status did not affect the degree of tissue eosinophilia. Eosinophilia did not correlate with severity of mucosal disease as assessed by CT scans. CONCLUSIONS Tissue eosinophilia is a characteristic histologic feature of chronic sinusitis in children, especially those with asthma. The presence of allergy does not predict tissue eosinophilia. Furthermore, the degree of tissue eosinophilia does not correlate with the severity of mucosal thickening seen on CT scans.
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Anon JB, Rontal M, Zinreich SJ. Computer-assisted endoscopic sinus surgery—Current experience and future developments. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/s1043-1810(06)80007-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zinreich SJ, Boyd JH, Musits B, Kavanagh KT. 10:15 a.m. to 12:00 noon; Room D 3MINISEMINAR: COMPUTER-ASSISTED SURGERY. Otolaryngol Head Neck Surg 1995. [DOI: 10.1016/s0194-5998(05)80878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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