Spontaneous CSF fistula as a manifestation of idiopathic intracranial hypertension

INTRODUCTION

Spontaneous cerebrospinal fluid (CSF) fistula, of unknown origin, is a rare condition whose aetiology is increasingly related to idiopathic intracranial hypertension (IIH). This study tries to raise awareness that they should not be considered as two different processes, but that fistulas can be a form of debut, requiring a study and subsequent treatment. Repair techniques are described, as well as the study of HII.

RESULTS

We treated 8 patients, 5 women and three men, aged between 46 and 72 years, with a diagnosis of spontaneous CSF fistula, four nasal and four otics who underwent surgical treatment. After repair, a diagnostic study was performed for IIH by MRI and Angio-MRI, presenting in all cases a transverse venous sinus stenosis. The intracranial pressure values obtained by lumbar puncture showed values of 20mm Hg or higher. All patients were diagnosed with HII. The one-year follow-up did not reveal any recurrence of the fistulas, maintaining a control of the HII.

CONCLUSION

Despite their low frequency of both cranial CSF fistula and IIH, an association of both conditions should be considered by continuing the study and surveillance of these patients after fistula closure.

Radioanatomical study of the extended free nasal floor mucosal graft and its clinical applications

OBJECTIVES

To perform a radio-anatomical evaluation of the nasal cavity floor free mucosal graft (endonasal extended mucoplasty, EEM) to repair mucosal defects after an extended ethmoid-sphenoidotomy.

METHODS

A human cadaveric study (radiological and anatomical dissection) and an in vivo study in surgical patients with CRSwNP were performed. The EEM areas were compared between 3D reconstruction from CT scans and anatomical/surgical dissections, both in cadaver specimens and in patients. Feasibility was assessed by correlation between the EEM area on CT scans and when harvested in cadavers and when grafted in patients. Usefulness was assessed by the degree of coverage of the EEM in the surface exposed after an extended ethmoid-sphenoidotomy. Both feasibility and usefulness were assessed in cadaveric specimens (n = 15) and patients (n = 4).

RESULTS

Fifteen cadaveric specimens and 4 patients with bilateral CRSwNP were included. The mean (SD) areas obtained in the cadaveric radiological and anatomical studies were 9.44 (2.07) cm2 and 8.03 (1.36) cm2, respectively (intraclass correlation coefficient 0.59, moderate correlation), and in 3D reconstruction for operated patients were 10.32 (0.98) cm2 and 11.27 (2.44) cm2, respectively. The coverage of the ethmoidal roof in the cadaveric dissection study was 100%, from the anterior ethmoidal artery to the posterior ethmoidal artery, covering the planun sphenoidale up to 75% in the case series. In 87.5% of the cases, up to 50% of the papiracea lamina was covered.

CONCLUSION

The EEM have shown to be a feasible and useful grafting technique to repair skull base defects after performing an extended ethmoid-sphenoidotomy during surgery for CRSwNP.

LEVEL OF EVIDENCE

NA.

[Carcinoma on pleomorphic adenoma in cervical salivary heteropia. Handling of one case and literature review]

The presence of salivary tissue outside of the salivary glands, a term called "salivary heterotopia," is not very common. The co-existence of carcinoma expleomorphic adenoma in a salivary heterotopia in the upper third of the neck can be considered unusual. We present an infrequent and clinically unsuspected case of carcinoma expleomorphic adenoma in the upper third of the neck and independent of the salivary glands. The tumour developed within heterotopic salivary tissue, with the histopathological study of the surgical extract being decisive for its diagnosis. The cervical salivary embryogenesis of heterotopias and their oncogenesis is analyzed. Their clinical signs are reviewed to indicate the difficulty in distinguishing the different types of diagnosis from other primary or metastatic tumours so as to assist in choosing the therapy to follow.

[Inhibition of invasion and multiplication of Toxoplasma gondii in human colonic epithelial cells by a monoclonal antibody against protein SAG2]

By an bromodeoxyuridine (BrdU) incorporation assay, it was proved hat an IgG 1 subclass, murine monoclonal antibody to surface protein SAG2 of Toxoplasma gondii is capable of reducing the invasion and multiplication of the parasites in highly differentiated mucine secretory HT29-18N2 line cells from a human colon adenocarcinoma. This result shows the importance of surface protein SAG2 of T.gondii in invasion and further multiplication of parasites in the host cell.

Reconstruction of orbital fractures with dehydrated human dura mater

PURPOSE

The best method for reconstructing the fractured orbital floor remains controversial. This article evaluates the usefulness of dehydrated human dura mater for orbital floor reconstruction after facial trauma.

PATIENTS AND METHODS

A retrospective analysis of 55 patients who had undergone surgical repair of orbital fractures was performed. The dura mater was used when the disruption was less than 2 cm in diameter. Fractures were divided into 3 types: type I (blow-out), type II (orbitozygomatic fracture), and type III (midfacial fracture). The patients were followed-up at least 1 year after surgery, and the cosmetic and functional results were reviewed.

RESULTS

A 7% complication rate was noted. No implant migration or infection resulted. One year postsurgery, all patients showed a complete resolution of their diplopia.

CONCLUSION

The safety and biocompatibility of dehydrated human dura mater support its use in orbital defects less than 2 cm in diameter.