The angiographic features of fibrous dysplasia of the skull

Comparison of 18 F-FAPI and 18 F-FDG PET/CT in a Patient With Fibrous Dysplasia

ABSTRACT

A 16-year-old woman presented with an acute headache on the left side. A head CT scan revealed bone destruction in the skull. Subsequent 18 F-FDG and 18 F-FAPI PET/CT scans were performed within a week. The 18 F-FDG PET/CT indicated mild uptake in the regions of bone destruction, whereas the 18 F-FAPI PET/CT displayed significant tracer accumulation. The patient was ultimately diagnosed with fibrous dysplasia.

Co-existing of craniofacial fibrous dysplasia and cerebrovascular diseases: a series of 22 cases and review of the literature

Background

Craniofacial fibrous dysplasia is a fairly rare condition. Some literature have reported a few patients with craniofacial fibrous dysplasia suffering from vascular abnormalities. This study aimed to describe the possible coexistence of craniofacial fibrous dysplasia and cerebrovascular diseases for the first time.

Method

We retrospectively reviewed the 1175 patients with craniofacial fibrous dysplasia in Beijing Tiantan Hospital and the information of the 22 patients coexisted with cerebrovascular diseases were described. In addition, we performed a systematic review for cases of craniofacial fibrous dysplasia with vascular abnormalities.

Result

22 out of 1175 patients (1.9%) were diagnosed with craniofacial fibrous dysplasia and cerebrovascular diseases including 9 intracranial aneurysms, 4 venous malformations, 2 arteriovenous malformations, 1 moyamoya disease, 2 intracranial venous stenosis and 4 cerebral ischemia with a mean age of 38.18 years old. Only 2 patients were managed surgically for craniofacial fibrous dysplasia and 6 patients were treated with neurosurgery for cerebrovascular diseases. 8 patients were closely followed and only 1 patient’s symptoms worsened.

Conclusion

Craniofacial fibrous dysplasia might cause constriction of the intracranial vessels and alteration of the overall hemodynamics of the intracranial vasculature resulting in various cerebrovascular diseases. Multimodal screening and examinations seems reasonable for patients with craniofacial fibrous dysplasia for throughout treatment and prognosis evaluations.

Successful Intravascular Treatment of an Intraosseous Arteriovenous Fistula in Fibrous Dysplasia

Fibrous dysplasia (FD) is a benign bone disease characterized by expansile lesions that typically stabilize with age. Rarely, FD can undergo malignant transformation, presenting with atypical, rapid growth and destruction of adjacent bone. Other potential causes of rapid FD expansion include secondary lesions, such as aneurysmal bone cysts. We describe a case of an aggressive occipital lesion that presented with pain associated with diplopia and tinnitus, raising concern for malignant transformation. A massive intraosseous arteriovenous fistula was identified giving rise to an anomalous vein coursing to the cavernous sinus with compression of the abducens nerve. The vascular anomaly was mapped and after embolization symptoms resolved; a biopsy with extensive genetic analyses excluded malignancy. The differential diagnosis for expanding FD lesions includes aggressive FD, malignant transformation, and secondary vascular anomalies. In cases when traditional radiographic and histologic assessments are nondescript, use of additional radiographic modalities and genetic analyses are required to make an accurate diagnosis and guide treatment. When vascular anomalies are suspected, detailed angiography with embolization is necessary to define and treat the lesion. However, to rule out malignant transformation, genetic screening is recommended.

MRI features of craniofacial fibrous dysplasia

A 13-year-old female with a 4-year history of monostotic fibrous dysplasia had noticed a progressive proptosis of the right eye and diplopia on upward gaze for 4 weeks. A few years previously an incisional biopsy of the skull had verified the presumed diagnosis of fibrous dysplasia with recurrent bleeding into pathologic cystic bony structures of the skull. The patient was known to have craniofacial fibrous dysplasia with involvement of the frontal and intermediate cranial base, the posterior ethmoidal labyrinth, and the sphenoidal and maxillary sinuses. Eye examination showed a reduced visual acuity in the right eye without defects of the visual field. MR imaging showed a fluid-filled cystic cavity in the orbital frontal bone pushing the globe downwards. Four months later she developed similar symptoms on the other side while proptosis of the right eye was regressive. T2-weighted MRI revealed a large fluid-filled cystic cavity with a fluid-fluid level in the upper part of the left orbit. It is concluded that follow-up studies can be easily performed by MRI without additional exposure to radiation. The total extent of osseous involvement can be determined. Thus, MRI may be helpful in deciding between operative or conservative therapy.

Fibro-osseous lesions of the face and skull with aneurysmal bone cyst formation

Aneurysmal bone cyst engraftment on benign fibro-osseous lesions, well known to occur in the extracranial skeleton, has been reported infrequently in the craniofacial bones. When this combined lesion occurs in the skull the clinical and radiographic features often suggest an aggressive neoplasm. The clinical, radiographic, and pathologic features of five cases are presented, and this uncommon lesion of the craniofacial bones is discussed in view of these cases and those reported in the literature.

[Fibrous dysplasia of the temporal bone and cerebral occlusive vasculopathy: report of a case]

Fibrous dysplasia is a benign disease with unknown etiology. Skull attempt may cause neurological disorders. The diagnostic can be made through radiological examination. A case of a patient with right temporal bone involvement with facial palsy, right parietal lobe infarctions and elevated anticardiolipin antibody titers is presented. Cerebral angiography showed occlusion of several cerebral arteries. Post mortem examination displayed recent myocardial infarction, ischemic cerebral softening, and generalized arteriosclerosis. The simultaneous occurrence of fibrous dysplasia and a probable anticardiolipin syndrome is commented.

[Fibrous dysplasia of the skull: neurologic manifestations]

The neurological manifestations of eight patients with osseous fibrous dysplasia of skull were retrospectively studied. In this series, the frontal bone was involved in 75% of the patients, the sphenoid or temporal bones in 37.5%, and the parietal in 25%. It was observed that cranial deformities occurred in all but one case, headache was present in 87.5% of the patients, visual disturbances in 50%, proptosis in 25%, and auditive symptoms in 12.5%. Six out of the eight patients were operated on: three of the four who presented progressive visual loss had postoperative improvement. In their follow up, none presented, until now, evidence of recurrence or worsening of symptoms, confirming the benign nature of fibrous dysplasia.

Arteriovenous fistula as an unusual complication of polyostotic fibrous dysplasia of the skull

A patient who had a polyostotic fibrous dysplasia with an arteriovenous fistula is reported. A bruit was audible and a large aneurysmal sac was observed on the angiogram.

Fibrous dysplasia of the skull with increased vascularity in the angiogram

The case of a 12-year-old girl with fibrous dysplasia involving the cranial vault is presented. The external carotid angiogram demonstrated a dilated and beaded zygomatico-orbital branch of the superficial temporal artery, a faint tumor stain, and an early filling vein. The mass was moderately vascular at the operation and histological examination demonstrated no malignancy.

Monostotic fibrous dysplasia of the cranial bones: report of fourteen cases

Polyostotic fibrous dysplasia affects many bones of the skeleton and usually on one side only. In monostotic variety only one bone is affected. The condition which usually starts in early childhood is at first active, gradually becomes quiescent and finally with termination of skeletal growth becomes inactive and ceases to grow. These stages can be seen histologically as well as radiologically. The main feature is increasing calcification of the mass. In half of our cases there was an intracranial mass with signs of raised intracranial or intra-orbital pressure. In all of these cases the mass originated from the base of skull. Those growing from the vault of the skull grew outward. Pathogenesis, diagnosis and treatment are discussed.