Unsuccessful consequence of optic canal decompression for a case of craniometaphyseal dysplasia

Transmastoid Facial Nerve Decompression for Craniometaphyseal Dysplasia

OBJECTIVE

We document the first successful transmastoid surgical treatment of facial nerve palsy for a patient with craniometaphyseal dysplasia (CMD), a rare genetic disease.

PATIENT

A 9-month-old girl with bilateral facial nerve palsies and conductive hearing loss. Genetic testing made a diagnosis of CMD, and imaging showed narrowing of the facial nerve canals and ossicular fixation.

INTERVENTION

Right transmastoid facial nerve decompression and ossicular chain reconstruction.

MAIN OUTCOME MEASURE

Facial nerve function (House-Brackmann grade).

RESULTS

Facial nerve function initially worsened, then improved within 12 months from House-Brackmann grade IV-V to grade III.

CONCLUSION

Surgical cranial nerve decompression of and ossicular chain reconstruction may be effective treatments for patients with CMD.

Optical Coherence Tomography in the Management of Skull Base Fibrous Dysplasia with Optic Nerve Involvement

BACKGROUND

Fibrous dysplasia (FD) of the skull base can manifest with optic nerve compression. As most patients initially do not experience vision loss, controversy exists whether to proceed with prophylactic surgical decompression or elect for conservative observation. Optical coherence tomography (OCT), a physiologic imaging modality widely used to assess the condition of the retinal nerve fiber layer (RNFL), has been useful in monitoring compressive tumors on the optic nerve. This study evaluated potential use of OCT in management of patients with fibrous dysplasia and optic nerve involvement.

METHODS

Six patients with suspected optic nerve compression who underwent OCT imaging as part of a neuro-ophthalmic examination were reviewed over a 2-year period. Patient records were evaluated for visual examination measures, most notably the presence of optic neuropathy, and radiographic measures on computed tomography. Measures were compared by age-adjusted RNFL thickness (above or below fifth percentile) on OCT imaging.

RESULTS

Two patients were found to have mild optic neuropathy in 1 eye each. Three of 12 eyes fell below the age-adjusted fifth percentile of RNFL thickness. Presence of optic neuropathy was associated with abnormal age-adjusted RNFL thickness but not with optic nerve compression (P = 0.45).

CONCLUSIONS

Abnormal RNFL thickness as measured by OCT better predicted the presence of optic neuropathy than computed tomography alone. OCT may be a valuable imaging modality to monitor patients with fibrous dysplasia for development of optic neuropathy during periods of conservative watchful waiting.

Induced pluripotent stem cell reprogramming by integration-free Sendai virus vectors from peripheral blood of patients with craniometaphyseal dysplasia

Studies of rare genetic bone disorders are often limited due to unavailability of tissue specimens and the lack of animal models fully replicating phenotypic features. Craniometaphyseal dysplasia (CMD) is a rare monogenic disorder characterized by hyperostosis of craniofacial bones concurrent with abnormal shape of long bones. Mutations for autosomal dominant CMD have been identified in the ANK gene (ANKH). Here we describe a simple and efficient method to reprogram adherent cells cultured from peripheral blood to human induced pluripotent stem cells (hiPSCs) from eight CMD patients and five healthy controls. Peripheral blood mononuclear cells (PBMCs) were separated from 5-7 mL of whole blood by Ficoll gradient, expanded in the presence of cytokines and transduced with Sendai virus (SeV) vectors encoding OCT3/4, SOX2, KLF4, and c-MYC. SeV vector, a cytoplasmic RNA vector, is lost from host cells after propagation for 10-13 passages. These hiPSCs express stem cell markers, have normal karyotypes, and are capable of forming embryoid bodies in vitro as well as teratomas in vivo. Further differentiation of these patient-specific iPSCs into osteoblasts and osteoclasts can provide a useful tool to study the effects CMD mutations on bone, and this approach can be applied for disease modeling of other rare genetic musculoskeletal disorders.

Middle cranial fossa facial nerve decompression before two years of age

We present a case report of a 17-month old patient who underwent serial bilateral total facial nerve decompression procedures for complete bilateral facial paralysis in the setting of craniometaphyseal dysplasia via combined middle cranial fossa and transmastoid approaches. The surgical decision-making process and procedures were reviewed. The patient recovered without complications from the staged surgical procedures, and developed partial return of function of both facial nerves postoperatively, with symmetric House-Brackmann grades of II-III. Despite its technical difficulty in the setting of this particular disorder, facial nerve decompression may be appropriate in the setting of acute facial palsy in craniometaphyseal dysplasia, with the potential for return of function. Given the extremely rare nature of the disease process, variable surgical experience and the clinical condition of the patient remain our best guides for management.

Relief of severe retro-orbital pain and vision improvement after optic-nerve decompression in polyostotic fibrous dysplasia: case report and review of the literature

INTRODUCTION

We describe a case of a 9-year-old girl who developed progressive severe retro-orbital pain and partial visual loss in association with left optic-nerve compression due to polyostotic fibrous dysplasia of the skull.

MATERIALS AND METHODS

Intradural decompression of the optic nerve resulted in immediate and complete resolution of the pain as well as a vast visual improvement.

CONCLUSION

In cases of fibrous dysplasia of the skull with evidence of optic-nerve compression, relief of retro-orbital pain should be an additional consideration when deciding to proceed with surgical management.

Craniometaphyseal dysplasia: a case report and review of medical and surgical management

Craniometaphyseal dysplasia (CMD) is a genetic syndrome involving cranial and tubular bone anomalies that commonly present at a young age, often with otolaryngologic manifestations. In this paper, we report a rare case of a sporadic form of the disease resulting in an early state of hypocalcemia with secondary hyperparathyroidism. A conductive hearing loss is also documented prior to 12 months of age. The clinical aspects of CMD will be covered along with its pathogenesis. The current concepts surrounding medical and surgical treatments will be reviewed, and the management of our patient will be discussed.

Craniometaphyseal dysplasia: a case report and review of medical and surgical management

Craniometaphyseal dysplasia (CMD) is a genetic syndrome involving cranial and tubular bone anomalies that commonly present at a young age, often with otolaryngologic manifestations. In this paper, we report a rare case of a sporadic form of the disease resulting in an early state of hypocalcemia with secondary hyperparathyroidism. A conductive hearing loss is also documented prior to 12 months of age. The clinical aspects of CMD will be covered along with its pathogenesis. The current concepts surrounding medical and surgical treatments will be reviewed, and the management of our patient will be discussed.

Autosomal dominant craniometaphyseal dysplasia with atypical features

Craniometaphyseal dysplasia (CMD) is a rare genetic disorder of bone modelling characterised by hyperostosis and sclerosis of the craniofacial bones, and abnormal modelling of the metaphyses. Clinically, autosomal dominant (AD) CMD is characterised by facial distortion and cranial-nerve compression. The goals of surgical treatment for AD CMD are cosmetic recontouring of the sclerotic craniofacial bones, correction of nasal obstruction and correction or prevention of neurological manifestations. We describe the successful correction of AD CMD craniofacial manifestations in an individual with atypical findings, and outline an approach for correcting the craniofacial deformities associated with this rare disorder.

Foramen magnum decompression for cervicomedullary encroachment in craniometaphyseal dysplasia: case report

OBJECTIVE AND IMPORTANCE

Foramen magnum encroachment has been cited as a potential cause for the premature demise of patients afflicted with craniometaphyseal dysplasia (CMD). To our knowledge, the association of Chiari malformation and syringomyelia with CMD has not been previously reported. We describe our evaluation and surgical treatment of a patient presenting with CMD, foramen magnum stenosis, Chiari I malformation, and syringomyelia.

CLINICAL PRESENTATION

A 15-year-old female patient with CMD presented with severe headaches and progressive myelopathy. Evaluation by computed tomography and magnetic resonance imaging revealed mild ventriculomegaly, cervicomedullary compression secondary to Chiari I malformation and foramen magnum stenosis, and C3-T10 syringomyelia.

INTERVENTION

Foramen magnum decompression was performed via suboccipital craniectomy, C1-C2 laminectomy, and dural augmentation. Dysplastic bone was revealed to be extremely thick and mineralized. Removal required lengthy and extensive drilling. The postoperative course was complicated by prolonged intubation secondary to airway obstruction and a perforated duodenal ulcer. Airway obstruction was attributed to severe nasopharyngeal bony dysplasia and soft tissue edema. The use of steroids in the treatment of airway edema and delayed enteral feeding was thought to contribute to ulcer development. Nevertheless, neurological symptoms improved dramatically.

CONCLUSION

Foramen magnum decompression can be used to treat life-threatening cervicomedullary compression in patients with CMD. However, caution should be used because surgical intervention may be associated with a higher incidence of complications because of lengthy procedures and the spectrum of craniofacial impairments in patients with CMD.

Intracranial calcifications, epilepsy, and optic atrophy associated with metaphyseal dysplasia: a case report

A 15-year-old boy presenting with epilepsy, optic atrophy and intracranial calcifications was diagnosed as having metaphyseal dysplasia by bone X-ray examinations. The patient had no laboratory data suggesting other metabolic or endocrinologic disorders. In addition, CT scans showed unique intracranial calcifications of the corpus callosum and periventricular and subcortical white matter, which were distinct from those of previously reported disorders. This case may represent a unique subset or a new type of metaphyseal dysplasia associated with intracranial calcifications and central nervous system symptoms.