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Guyodo H, Rizzo A, Diab F, Noury F, Mironov S, de Tayrac M, David V, Odent S, Dubourg C, Dupé V. Impact of Sonic Hedgehog-dependent sphenoid bone defect on craniofacial growth. Clin Exp Dent Res 2024; 10:e861. [PMID: 38558491 PMCID: PMC10982674 DOI: 10.1002/cre2.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES The main objective of this study was to evaluate how an apparently minor anomaly of the sphenoid bone, observed in a haploinsufficient mouse model for Sonic Hedgehog (Shh), affects the growth of the adult craniofacial region. This study aims to provide valuable information to orthodontists when making decisions regarding individuals carrying SHH mutation. MATERIALS AND METHODS The skulls of embryonic, juvenile and adult mice of two genotypes (Shh heterozygous and wild type) were examined and measured using landmark-based linear dimensions. Additionally, we analysed the clinical characteristics of a group of patients and their relatives with SHH gene mutations. RESULTS In the viable Shh+/ - mouse model, bred on a C57BL/6J background, we noted the presence of a persistent foramen at the midline of the basisphenoid bone. This particular anomaly was attributed to the existence of an ectopic pituitary gland. We discovered that this anomaly led to premature closure of the intrasphenoidal synchondrosis and contributed to craniofacial deformities in adult mice, including a longitudinally shortened skull base. This developmental anomaly is reminiscent of that commonly observed in human holoprosencephaly, a disorder resulting from a deficiency in SHH activity. However, sphenoid morphogenesis is not currently monitored in individuals carrying SHH mutations. CONCLUSION Haploinsufficiency of Shh leads to isolated craniofacial skeletal hypoplasia in adult mouse. This finding highlights the importance of radiographic monitoring of the skull base in all individuals with SHH gene mutations.
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Affiliation(s)
- Hélène Guyodo
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
| | - Aurélie Rizzo
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
| | - Farah Diab
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), “Maladies génétiques d'expression pédiatrique”ParisFrance
| | - Fanny Noury
- Faculté des Sciences Pharmaceutiques et BiologiquesUniv Rennes, INSERM, LTSI ‐ UMR 1099RennesFrance
| | - Svetlana Mironov
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
| | - Marie de Tayrac
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
- Service de Génétique Moléculaire et Génomique, CHURennesFrance
| | - Véronique David
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
| | - Sylvie Odent
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
- Service de Génétique Clinique, CHURennesFrance
| | - Christèle Dubourg
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
- Service de Génétique Moléculaire et Génomique, CHURennesFrance
| | - Valérie Dupé
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
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Digilli Ayaş B, Çiçekcibaşı AE, Gökşan AS, Açar G, Aydoğdu D. Clinically relevant morphometric analysis of pterygopalatine fossa and its volumetric relationship with adjacent paranasal sinuses: a CT-based study. Oral Radiol 2024; 40:285-294. [PMID: 38236559 DOI: 10.1007/s11282-023-00735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES This study aimed to perform morphometric measurements of the pterygopalatine fossa (PPF), the transition zone to critical neurovascular structures. The second aim was to investigate the relationship between the volumes of the PPF and the paranasal sinuses and the effect of nasal septum deviation (NSD) types on all these measurements. METHODS We performed PPF's morphometry and all volume measurements on the CT images of 260 patients (130 male and 130 female, age range 18-79). RESULTS All volumetric measurements and the angle between foramen rotundum (FR) and pterygomaxillary fissure (PMF) were significantly higher in males than females. In contrast, the distance between sphenopalatine foramen (SPF) and PMF was considerably higher in females than in males. The PPF volume, the distance between the pterygoid canal (PC) and maxillary sinus, and the angle between FR and PMF were significantly higher on the right side than on the left. In contrast, the angle between PC and SPF and between greater palatine canal and PPF were considerably higher on the left side than on the right. The angle between PC and SPF decreased markedly with age. Only sphenoidal sinus volume was significantly smaller on the same side as the septal deviation. There was no correlation between PPF volume with maxillary and sphenoid sinus volumes from adjacent paranasal sinuses. CONCLUSIONS Volumetric and morphometric data obtained from PPF and paranasal sinuses can aid clinicians in diagnosing and treating patients by guiding them in selecting the right surgical approach or tools, especially in endoscopic procedures.
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Affiliation(s)
- Betül Digilli Ayaş
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey.
| | - Aynur Emine Çiçekcibaşı
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
| | - Ahmet Safa Gökşan
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
| | - Gülay Açar
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
| | - Demet Aydoğdu
- Department of Radiology, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey
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Al-Shuaili A, Al-Ajmi E, Mogali SR, Al-Qasmi S, Al-Mufargi Y, Kariyattil R, Sirasanagandla SR. Computed-tomography evaluation of parietal foramen topography in adults: a retrospective analysis. Surg Radiol Anat 2024; 46:263-270. [PMID: 38280004 DOI: 10.1007/s00276-023-03284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/13/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND The parietal foramen (PF) of the skull is a variable anatomic feature with important implications for venous drainage, infection, and injury. Its topography is clinically relevant for neurosurgeons for intracranial navigation and preoperative planning. METHODS PF topography was investigated in a series of 440 head computed-tomography scans of Omani subjects at Sultan Qaboos University Hospital. The mean age of the patients was 52 ± 17 years and there were 160 males and 280 females. The topography features of the PF, including frequency, diameter, patency, and relative position in relation to the superior sagittal sinus (SSS), were recorded. Additionally, sex and laterality differences in PF parameters were analyzed using a Chi-square test. RESULTS The overall prevalence of PF was 72.3% (318/440). The bilateral presence of PF was identified in 34% of skulls. Unilateral right-side prevalence was 18.2%, while left prevalence was 13.2% (p = 0.62). The prevalence of unilateral accessory PF on the right side was 1.8%, while it was 1.1% on the left (p = 0.69). PF within the sagittal suture/or intra-sutural PF was observed in 6.8% of skulls, with a frequency of 9.4% in men and 5.4% in women (p = 0.29). The diameter of the PF was 1.45 ± 0.74 mm on the right side, and 1.54 ± 0.99 mm on the left side (p = 0.96). There were 2% of incomplete PF. The PF was located over the SSS in 70.3% on the right side and 53.8% on the left side. No significant differences were observed between the PF topography parameters and sex or laterality. CONCLUSION The present study for the first time reports the baseline data of PF topography in a large sample of CT scans in the Arab population. The geography and race influence the PF topography differences. PF may be used as a reliable landmark of SSS. The morphological characteristics and distribution of PF reported in this study have clinical implications for imaging diagnosis, intracranial navigation of vascular disorders, and treatment.
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Affiliation(s)
- Anwar Al-Shuaili
- Radiology Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Eiman Al-Ajmi
- Department of Radiology and Molecular Imaging, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Sara Al-Qasmi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Rajeev Kariyattil
- Department of Surgery, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Srinivasa Rao Sirasanagandla
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khoudh 123, Muscat, Oman.
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Damante MA, Magill ST, Kreatsoulas D, McGahan BG, Hardesty D, Carrau RL, Prevedello DM. Endoscopic Endonasal Transpterygoid Approach and the Need for Myringotomy. Laryngoscope 2024; 134:1203-1207. [PMID: 38087873 DOI: 10.1002/lary.31221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE The expanded endonasal transpterygoid approach (EETA) is used to access the middle and posterior fossa through the pterygoid process. Traditionally, the eustachian tube (ET) was resected during EETA, which often required subsequent myringotomy for inner ear drainage. Anterolateral transposition of the ET was proposed to decrease potential morbidity associated with resection. However, a comparison of resection versus transposition regarding the need for subsequent myringotomy has not been reported. METHODS This is a retrospective cohort study of patients who underwent an EETA. Patient demographics, tumor characteristics, management of ET with resection versus transposition, and need for subsequent myringotomy were collected. Analysis was performed with JMP software in standard fashion and univariate and multivariate logistic regression analysis performed with a p < 0.05 was considered significant. RESULTS Ninety-one patients underwent EETA for various malignant and benign tumors. Twenty-seven patients required myringotomy, with tumors of the pterygopalatine fossa accounting for the most common location (n = 8). Malignant pathology had the highest myringotomy rate compared to benign tumors (48.9% vs. 10.9%, p < 0.001), as did receiving postoperative radiation (p < 0.001), ET resection (p < 0.001), and increasing CPK class. Multivariate analysis of these variables suggests that only ET resection significantly correlated with the need for myringotomy (LR 7.97, p = 0.005). CONCLUSIONS ET resection during EETA can lead to ET dysfunction and require myringotomy post-operatively, and patients should be counseled of this risk. Radiation treatment, malignant pathology, and CPK class, all reflecting situations where more extensive surgery was needed, were associated with the need for myringotomy on univariate analysis but did not reach significance with multivariate analysis. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1203-1207, 2024.
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Affiliation(s)
- Mark A Damante
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Daniel Kreatsoulas
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
| | - Ben G McGahan
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
| | - Douglas Hardesty
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
- Department of Otolaryngology, The Ohio State University Medical Center, Columbus, Ohio, U.S.A
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
- Department of Otolaryngology, The Ohio State University Medical Center, Columbus, Ohio, U.S.A
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Yanarates G, Ozdemir F, Salim H, Ari B. A comprehensive morphometric analysis of pterygospinous and pterygoalar bars on computed tomography images. Medicine (Baltimore) 2024; 103:e37267. [PMID: 38394520 DOI: 10.1097/md.0000000000037267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
This study is aimed to determine the prevalence and morphometric characteristics of the pterygospinous (Ps) and pterygoalar (Pa) bars using computed tomography (CT) images on an extensive study sample of the Anatolian population. The CT images of 700 patients (350 males, 350 females) were analyzed for morphological characteristics and Pa and Ps bars. Ps and Pa bars were classified as complete or incomplete (partial) depending on the degree of ossification. The complete Ps and Pa bars' anteroposterior diameter and craniocaudal diameter were measured. The closest distance between both bony prominences was measured in incomplete Ps and Pa bars. Sex-dependent statistical analysis of the data was performed by the SPSS package program (version 25.0). The prevalence of Ps was 6.57%, and unilateral incomplete Ps was the most frequent Ps type at 5%. The prevalence of Pa was 16.28%, and unilateral incomplete Pa was the most common Pa type at 6.71%. The prevalence of unilateral Ps, unilateral, and bilateral Pa was more common in males (P = .014, P = .006, and P = .032, respectively). Although Ps were less frequently encountered, both anatomic variations were relatively common within the population. The prevalence and morphometric characteristics of Ps and Pa bars obtained in this study could serve as guiding insights for the practices of surgeons, anesthesiologists, dentists, and radiologists.
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Affiliation(s)
- Gurbet Yanarates
- Department of Radiology, Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Fikri Ozdemir
- Department of Anatomy, Hitit University, Faculty of Medicine, Çorum, Turkey
| | - Hande Salim
- Department of Anatomy, Hitit University, Faculty of Medicine, Çorum, Turkey
| | - Bahadir Ari
- Faculty of Medicine, Department of Anatomy, Erciyes University, Kayseri, Turkey
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Fadda GL, Urbanelli A, Petrelli A, Trossarello M, Nitro L, Saibene AM, De Corso E, Gned D, Panfili M, Cavallo G. Type IV optic nerve and Onodi cell: is there a risk of injury during sphenoid sinus surgery? Acta Otorhinolaryngol Ital 2024; 44:36-41. [PMID: 38165204 PMCID: PMC10914358 DOI: 10.14639/0392-100x-n2462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/13/2023] [Indexed: 01/03/2024]
Abstract
Objective This study aims to determine the prevalence and types of Onodi cells through computed tomography and investigate the relationship between Onodi cell and the surrounding structures, paying particular attention to the risky proximity to the optic nerve canal. Methods In this study, 430 computed tomography scans of paranasal sinuses were analysed to establish the prevalence and different types of Onodi cells. Furthermore, the relationship between Onodi cell and different patterns of sphenoid sinus pneumatisation and surrounding structures were investigated. Special attention was paid to the relationship between Onodi cell and the optic nerve canal, particularly in cases when the optic nerve canal was bulging by more than 50% into the Onodi cell (Type IV). Results The Onodi cell was detected in 21.6% of cases, with the most common being Type I (48.5% right, 54.3% left). Type IV bulging of the optic nerve canal into the Onodi cell was observed in 47.1% of cases on the right side, 41.2% on the left side and bilateral in 11.7% of cases. Conclusions In our series, we observed a high prevalence of Type IV optic nerve bulging into the Onodi cell. For this reason, we suggest that clinicians should always try to identify it in a pre-operative setting with computed tomography to avoid catastrophic consequences during endoscopic sinus surgery approaching the sphenoid area.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Anastasia Urbanelli
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Marta Trossarello
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Letizia Nitro
- Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eugenio De Corso
- Otorhinolaryngology, “A. Gemelli” Unversitary Hospital IRCCS, Rome, Italy
| | - Dario Gned
- Department of Diagnostic Imaging, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Marco Panfili
- Unit of Radiology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
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Filho ÍTO, Botelho RV. The role of sphenoid bone in basilar invagination pathophysiology. Neurosurg Rev 2023; 46:322. [PMID: 38040961 DOI: 10.1007/s10143-023-02227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Basilar invagination (BI) is characterized by rostral dislocation of the cervical spine toward the skull base. The craniometrics of the skull base have shown significant differences among craniocervical junction malformations. The sphenoid bone is the center of the skull base; however, no study has evaluated this bone in cases of BI. This was a cross-sectional study of MRI databanks from two institutions of the author's practice between 1985 and 2020. The craniometrics of the sphenoid bone were measured in BI patients and controls. Fifty-eight MRIs were selected, including 28 BI patients and 30 controls. The mean sphenoid crest-clivus length was 32.66 ± 4.7 mm in the BI group and 29.98 ± 3.0 mm in the control group (p = 0.01). The mean sphenoid planum-top of Dorsum sellae length was 28.53 ± 3.7 mm in the BI group and 26.45 ± 3.2 mm in the control group (p = 0.02). The mean tuberculum sellae-sphenoid floor height was 18.52 ± 4.4 mm in the BI group and 21.32 ± 2.9 mm in the control group (p = 0.00). The mean sella turcica-sphenoid floor height was 10.35 ± 3.8 mm in the BI group and 12.24 ± 3.5 mm in the control group (p = 0.05). The mean clivus length was 29.81 ± 6.3 mm in the BI group and 40.86 ± 4.2 mm in the control group (p = 0.00). The mean sphenoid length was 58.34 ± 7.4 mm in the BI group and 67.31 ± 6.0 mm in the control group (p = 0.00). The mean sphenoid angle was 116.33 ± 8.7° in the BI group and 112.36 ± 6.9° in the control group (p = 0.05). The BI sphenoid bone has shorter vertical dimensions and longer horizontal measures. This morphology promotes a flattening of the sphenoid angle. The sphenoid bone is significantly altered in BI, favoring the congenital hypothesis in the pathophysiology of this disease.
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Affiliation(s)
- Ítalo T Oliveira Filho
- Health Sciences Post-Graduation Program, Instituto de Assistência Médica ao Servidor Público Estadual - IAMSPE, Av. Ibirapuera, 91. 2nd Floor, Vila Clementino, São Paulo, SP, 04029-000, Brazil
| | - Ricardo V Botelho
- Health Sciences Post-Graduation Program, Instituto de Assistência Médica ao Servidor Público Estadual - IAMSPE, Av. Ibirapuera, 91. 2nd Floor, Vila Clementino, São Paulo, SP, 04029-000, Brazil.
- Department of Neurosurgery, Hospital Mandaqui, São Paulo, Brazil.
- Department of Neurosurgery, Hospital Servidor Público Estadual - HSPE, São Paulo, Brazil.
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Baussart B, Gaillard S. Endoscopic endonasal access to the lateral recess of the sphenoid sinus. Acta Neurochir (Wien) 2023; 165:4113-4119. [PMID: 37889336 DOI: 10.1007/s00701-023-05856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The standard endoscopic endonasal approach gives access to the median sphenoid sinus, but not to its lateral part. We propose an endoscopic technique for lesions in the lateral sphenoid sinus. METHOD Based on our experience with 28 patients, we have developed a less invasive approach to the lateral recess of the sphenoid sinus, limiting the opening of the maxillary sinus while avoiding resection of the inferior turbinate and ethmoidal cells. The technique is described. CONCLUSION The proposed endoscopic approach is reliable and safe to treat CSF leak or tumours located within the lateral recess of the sphenoid sinus.
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Affiliation(s)
- Bertrand Baussart
- Department of Neurosurgery, La Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
- CNRS, INSERM, Institut Cochin, Université Paris Cité, F-75014, Paris, France.
| | - Stephan Gaillard
- Department of Neurosurgery, La Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
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Kim DH, Jeong JU, Kim S, Kim ST, Han GC. Bilateral Orbital Apex Syndrome Related to Sphenoid Fungal Sinusitis. Ear Nose Throat J 2023; 102:NP618-NP620. [PMID: 34281412 DOI: 10.1177/01455613211024768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Orbital apex syndrome (OAS) is a rare condition that usually occurs due to damage to surrounding inner and surrounding bone tissue. Orbital apex syndrome may result from a variety of conditions that cause damage to the superior orbital fissure and to the optic canal leading to optic nerve (II) dysfunction. We recently experienced a rare case of sphenoidal Aspergillosis, which damaged the adjacent cavernous sinus structures and led to the definite symptom of bilateral OAS in a 77-year-old male. We present this rare case with a brief review of these disease's entities.
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Affiliation(s)
- Dong Hyun Kim
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
- 21st Marine Battalion, 2nd Marine Brigade, 1st Marine Division, Republic of Korea Marine Corps, Pohang, Korea
| | - Jin Uk Jeong
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
| | - Seul Kim
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
| | - Seon Tae Kim
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
| | - Gyu Cheol Han
- Department of Otolaryngology-Head & Neck Surgery, Gachon University, College of Medicine, Gil Medical Center, Incheon, Korea
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Gawlikowska-Sroka A, Stocki Ł, Szczurowski J, Nowaczewska W. Topography of the infraorbital foramen in human skulls originating from different time periods. Folia Morphol (Warsz) 2023; 82:875-884. [PMID: 37957943 DOI: 10.5603/fm.97440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The infraorbital foramen (IOF) is present on the maxilla under the infraorbital margin. Its identification is essential in various surgical procedures. The main aim of this study was the morphometric assessment of the position of the right and left infraorbital foramina in relation to specific structural elements of the facial skeleton, their width and direction, and also the determination of the location of these foramina above maxillary teeth in examined male skulls (belonging to European populations) dated to the beginning of the 20th century and the medieval and post-medieval period. This aim concerned also the assessment of the symmetry of the examined foramina (their location and size). An additional goal was to determine differences between the cranial samples concerning the analysed traits. MATERIALS AND METHODS The six metric and two non-metric traits concerning the IOF were collected from the male cranial samples including modern skulls (n = 87), the medieval and post-medieval skulls (from 13th centuries and 15-17th centuries, respectively; n = 47) obtained from archaeological excavations in Wroclaw, and the sample of the medieval skulls (11-13th centuries, n = 100) from Sypniewo. The sex and age of the specimens were determined using the standard methodology. The appropriate statistical analysis was performed. RESULTS Significant differences were established for three traits (taken from the left and right side) in the case of modern skulls (diameter of IOF, its distance to the midline, and zygomaticomaxillary suture) and one in the case of medieval skulls from Sypniewo (distance to the midline). In all of the cranial samples IOF most frequently occurred above the first upper molar. The greater diameter of IOF and its shorter distance to the alveolar crest and nasal notch were observed in non-modern skulls compared to modern skulls. CONCLUSIONS The results of this study provide new additional data on the topography of IOF and its asymmetry, confirm the presence of both geographical and chronological differences between populations, and can be used in dental practice, and forensic odontology in the analysis of archaeological bone materials.
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Affiliation(s)
| | - Ł Stocki
- Orion Dental Wawrzyniak and Stocki Dental Clinic, Szczecin, Poland
| | - J Szczurowski
- Department of Anthropology, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - W Nowaczewska
- Department of Human Biology, University of Wroclaw, Poland
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Abstract
BACKGROUND Topical sinus irrigation plays a critical role in the management of sinonasal diseases. Yet, the penetration of irrigant to targeted sinuses may be highly variable and difficult to predict. Here, we investigate the use of 3D printing as a planning tool to optimize outcomes. METHODS Eight post-operative models were 3D printed with a FormLabs Form3 printer based on individual CT scans. Irrigations were performed and video recorded with a squeeze bottle attached via silicon water-tight seal, in 4 head positions: 45° to-the-side, 90° to-the-side, 45° forward and 45° to-the-side, and 90° forward, with irrigation fluid entering the upper (conventional) or lower (backfill) nostrils. RESULTS Significant individual variations were observed in sinus penetration as a function of head position. In general, the maxillary sinus was the easiest to irrigate in most head positions (P < .05), followed by frontal and ethmoid, with sphenoid being the most difficult. Both the 90°-to-the-side and the 90°-forward positions were significantly more effective than the others (P < .05), with 90°-forward better for frontal sinuses and 90°-to-the-side superior for all other sinuses. The backfill was significantly superior to conventional technique in head positions involving a side tilt (P < .05). CONCLUSION Variations in technique and position significantly impacted irrigation outcome. Backfill irrigation that pushes fluid against gravity to pool around the ostium, seems to provide overall better outcomes. This study demonstrates the advantage of 3D printing as a rapid planning tool to guide irrigation strategies.
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Affiliation(s)
- Thomas J. Lepley
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kanghyun Kim
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Melissa Ardizzone
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kathleen M. Kelly
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Bradley A. Otto
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kai Zhao
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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12
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Zhang ZK, Wang YJ, Liu JF. [Arrested pneumatization of the sphenoid sinus: imaging characteristics]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 58:986-991. [PMID: 37767655 DOI: 10.3760/cma.j.cn115330-20230301-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Objective: To explore and analyze the imaging features of arrested pneumatization of the sphenoid sinus, so as to provide reference for identifying sphenoid lesions. Methods: From May 2018 to September 2019, a retrospective analysis was conducted on 350 patients (183 males and 167 females, aged between 18 and 73 years) who had been completed the sinus CT examination in the outpatient department of Beijing Chaoyang Hospital Affiliated to Capital Medical University. Their imaging data were collected and the CT/MRI characteristics of the sphenoid body were observed. SPSS 26.0 software was used for statistical analysis. Results: The rate of arrested pneumatization of the sphenoid sinus was 2.0% (7/350), which occurred in the pteroid process, the slope region, and the sphenoid sinus body, respectively. CT showed a nondilated mixed-density lesion (7/7) in the pneumatizable sphenoid body. Within these regions, both fat and soft tissue density (7/7) were present. Internal curve calcification was observed in part of the region (3/7). The skull base canal structure was not affected (7/7). MRI showed a clear non-dilated lesion with an adipose signal, and none of the lesions showed medulla dilation or cortical destruction. Conclusions: Arrested pneumatization of the sphenoid sinus is a normal anatomic variation. When non-dilated lesions with clear bony boundaries and internal fatty components are encountered in the vaporizable region of the sphenoid sinus, the possibility of arrested pneumatization of the sphenoid sinus should be considered.
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Affiliation(s)
- Z K Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Y J Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - J F Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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13
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Badran KH, Tarifi A, Shatarat A, Badran D. Frontal sinus pneumatisation: an isolated finding or a sign of concomitant anatomical variation? J Laryngol Otol 2023; 137:1097-1101. [PMID: 35522072 DOI: 10.1017/s0022215122000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the association between frontal sinus pneumatisation and concomitant anatomical variations in paranasal sinuses as seen on computed tomography. METHODS A total of 403 patients who underwent paranasal sinus computed tomography were allocated to three groups according to the degree of frontal sinus pneumatisation (type 1 - hypoplasia; type 2 - medium size; and type 3 - hyperplasia). In this unique model, the prevalence of ipsilateral variations on paranasal sinuses on each side of the head were analysed separately within each pneumatisation group. RESULTS The type 3 frontal sinus pneumatisation group showed a greater association with ipsilateral variations of the sphenoid bone. Variations included pneumatisation of the anterior clinoid process, lateral sphenoid recess, pterygoid process and greater wing, and exposure of Vidian canal. This group also showed significant associations with male gender, and the presence of frontal and Onodi cells. CONCLUSION Interpretation of the paranasal sinus variations is imperative for pre-operative evaluation in functional endoscopic sinus surgery, particularly in patients with frontal sinus hyperplasia. Attention to variation on the ipsilateral side is informative.
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Affiliation(s)
- K H Badran
- Department of Otolaryngology Head and Neck Surgery, Hashemite University, Zarqa, Jordan
| | - A Tarifi
- Department of Otolaryngology Head and Neck Surgery, Hashemite University, Zarqa, Jordan
| | - A Shatarat
- Department of Anatomy and Histology, University of Jordan, Amman, Jordan
| | - D Badran
- Department of Anatomy and Histology, University of Jordan, Amman, Jordan
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14
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Hameed N, Manogaran RS, Dubey A, Bhuskute GS, Arora K, Keshri A, Mehrotra A, Jaiswal AK, Das KK, Bhaisora KS, Srivastava AK, Kumar R, Virk RS. The Feasibility of Transposition of Pterygopalatine Fossa Contents in Transpterygoid Approach to Type III Sphenoid Lateral Recess CSF Leak. Neurol India 2023; 71:667-670. [PMID: 37635494 DOI: 10.4103/0028-3886.383811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Nazrin Hameed
- Department of Neurosurgery, Neuro Otology Unit, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Ravi Sankar Manogaran
- Department of Neurosurgery, Neuro Otology Unit, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Abhishek Dubey
- Department of Neurosurgery, Neuro Otology Unit, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Govind S Bhuskute
- Department of Neurosurgery, Neuro Otology Unit, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Kanika Arora
- Department of Neurosurgery, Neuro Otology Unit, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Amit Keshri
- Department of Neurosurgery, Neuro Otology Unit, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Kuntal K Das
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | | | - Raj Kumar
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Ramandeep S Virk
- Department of Otolaryngology Head and Neck Surgery, PGIMER, Chandigarh, India
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15
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Goksel S, Unsal G, Cakir Karabas H, Erturk AF, Ozcan I, Orhan K. Association of accessory sphenoidal septum with protrusions of sphenoid sinus. Eur Arch Otorhinolaryngol 2023; 280:2323-2329. [PMID: 36534215 DOI: 10.1007/s00405-022-07780-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Accessory sphenoidal septum (ASS) is a septal variation that exists in addition to the primary septum of the sphenoid sinus and can be found in or near anatomically essential structures. This study aimed to investigate the relationships between protrusions of vital structures around the sphenoid sinus and the ASSs. METHODS This cross-sectional retrospective study is based on the analysis of CBCT scans of 314 patients in axial, coronal, and sagittal planes with 0.2-0.3 slice thicknesses. Optic nerve (ON), internal carotid artery (ICA), both ON and ICA, maxillary nerve (MN), vidian canal (VN) and ASSs were detected, and the relationship between protrusions of these vital anatomical structures and ASS was evaluated. RESULTS Statistically significant relationship was observed between the right Type 1 ON protrusion (p < 0.05) and left Type 1 ON protrusion (p = 0.001); left Type 3 ON protrusion (p < 0.05); right Type 4 ON protrusion (p < 0.05) and ASS. Statistically significant relationship was also observed between the right ICA protrusion and ASS (p < 0.05). The right Type 1 VN protrusion (p = 0.001); left Type 2 VN protrusion (p < 0.001); right and left Type 3 VN protrusions (p < 0.001) were found to be significantly associated with the ASS. CONCLUSIONS ASSs have significant associations with some protrusions, and they tend to cause potentially severe complications in endoscopic sinus surgery. This variability requires a comprehensive understanding of regional sphenoid sinus anatomy with detailed three-dimensional tomographic imaging.
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Affiliation(s)
- Sevde Goksel
- Tepebasi Oral and Dental Health Hospital, Ankara, Turkey
| | - Gurkan Unsal
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Hulya Cakir Karabas
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Ahmet Faruk Erturk
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Biruni University, Topkapı, 34010, Istanbul, Turkey.
| | - Ilknur Ozcan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Biruni University, Topkapı, 34010, Istanbul, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
- Medical Design Application, and Research Center (MEDITAM), Ankara University, Ankara, Turkey
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, Lublin, Poland
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16
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Okafor L, Malhotra R. Pneumatization of the Greater Wing of Sphenoid Utilization for Lateral Wall Decompression. Ophthalmic Plast Reconstr Surg 2023; 39:e58-e60. [PMID: 36867771 DOI: 10.1097/iop.0000000000002321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
The goal of orbital decompression for thyroid orbitopathy is to expand the orbital space for the contents with various techniques described. Deep lateral wall decompression is a procedure that expands the orbit by removing bone from the greater wing of sphenoid however its effectiveness is dependent on the volume of bone removed. Pneumatization of the greater wing of sphenoid is defined as an extension of the sinus beyond the VR line (a straight line crossing the medial edges of the vidian canal and the foramen rotundum) which is a demarcation between the sphenoid body and the lateral parts of the sphenoid bone, including the greater wings and pterygoid process. We present a case of complete pneumatization of the greater wing of sphenoid affording a greater volume of bony decompression in a patient with significant proptosis and globe subluxation as a result of thyroid eye disease.
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Affiliation(s)
- Linda Okafor
- Corneoplastic Unit, Holtye Road, Queen Victoria Hospital, East Grinstead, United Kingdom
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17
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Zdilla MJ, Pancake JP, Russell ML, Koons AW. Ontogeny of the human fetal, neonatal, and infantile basioccipital bone: Traditional and extended eigenshape geometric morphometric analysis. Anat Rec (Hoboken) 2022; 305:3230-3242. [PMID: 34825511 PMCID: PMC9130339 DOI: 10.1002/ar.24838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022]
Abstract
The basioccipital bone is an essential developmental component to the occipital bone, occipital condyles, foramen magnum, clivus, and cranial base. The basioccipital bone joins each exoccipital bone with a basiexoccipital synchondrosis and the basisphenoid/sphenoid bone with a spheno-occipital synchondrosis. The basioccipital is found intermediate to the petrous temporal bones and forms the bilateral petrooccipital/petroclival fissures otherwise known as the petrooccipital complex. Thus, the basioccipital bone is a central component to the developing cranial base. Despite the importance of basioccipital development in cranial ontogeny, there has been limited study of basioccipital ontogeny. This study assessed 98 disarticulated human basioccipital bones from a perinatal population ranging in age-at-death from 5-months intrauterine to 5-months post-natal development. Size and shape of basioccipital bones were assessed with traditional and extended eigenshape geometric morphometric analysis. The results of this study demonstrate that the basioccipital bone grows in width at a faster rate than it grows in length. The maximum basioccipital width surpassed the midsagittal length at approximately 7-months intrauterine development. Canonical variate analysis revealed statistically significant shape change occurring from a relatively narrow/elongate (anterior-to-posterior) basiocciput shape with mild concavity at the foramen magnum in the fifth and sixth intrauterine months to a relatively broad/stout basiocciput shape with more pronounced concavity in the postnatal months. Likewise, growth rate in total length was greater than midsagittal length, demonstrating enlargement of concavity in the anterior foramen magnum over time. This report provides insight into cranial development and aids in estimating age-at-death among fetuses and infants.
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Affiliation(s)
- Matthew J. Zdilla
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, WV, USA
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
- Department of Graduate Health Sciences, West Liberty University, West Liberty, WV, USA
| | - Jacob P. Pancake
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
- West Virginia University School of Dentistry, Morgantown, WV, USA
| | - Michelle L. Russell
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Aaron W. Koons
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
- The Ohio State University College of Optometry, Columbus, OH, USA
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18
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Kang YJ, Cho JH, Kim DH, Kim SW. Relationships of sphenoid sinus pneumatization with internal carotid artery characteristics. PLoS One 2022; 17:e0273545. [PMID: 36006952 PMCID: PMC9409539 DOI: 10.1371/journal.pone.0273545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
We explored the clinical significances of the relationships among sphenoid sinus aeration, intersphenoid sinus septum (ISS), and internal carotid artery (ICA).
Methods
We retrospectively reviewed the preoperative paranasal sinus computed tomography scans and the medical charts of 490 patients who were treated by the endoscopic endonasal transsphenoidal approach. We analyzed sphenoid sinus pneumatization, number of ISS, and positional relationships between the ICA and ISS (including ICA prominence and the thickness of surrounding bone).
Results
ISS were often present in the ICAs of patients with presellar pneumatization (36.2%; p = 0.042). Sphenoid sinus pneumatization status significantly differed according to number of ISS (p < 0.001), ICA prominence (p < 0.001), ISS insertion into the ICA (p = 0.042), and distance from ISS to ICA (p = 0.004). When sphenoid sinus aeration was poor, the ICA was not prominent, and the ISS were attached to or lay close to the paraclival ICA.
Conclusions
Patients with presellar pneumatization exhibited less prominent ICAs, and more ISS attached to or near the paraclival ICA, than did other patients. Therefore, particular caution is required when using the endoscopic endonasal transsphenoidal approach to treat patients with poor sphenoid sinus aeration.
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Affiliation(s)
- Yun Jin Kang
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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19
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Liu J, Wang Y, Yan Z, Yang Y. Anatomical identification of supraseptal posterior ethmoid cells and its significance for endoscopic sinus surgery. Folia Morphol (Warsz) 2022; 82:696-703. [PMID: 35607871 DOI: 10.5603/fm.a2022.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND To investigate the anatomical imaging characteristics of supraseptal posterior ethmoid cells (SPEC). MATERIALS AND METHODS Paranasal sinus computed tomography scans of 153 inpatients from February 2019 to September 2021 were reviewed, and the anatomical characteristics of SPEC in the scans were collected. RESULTS Supraseptal posterior ethmoid cells are posterior ethmoid (PE) cells extending medially and superiorly to the posterior superior of the nasal septum and into the sphenoid body but not close to the optic canal. The SPEC, Onodi cell, and sphenoidal sinus (SS) may appear in the posterior superior of the nasal septum, but the occurrence rate of the SPEC (5.88%; 9/153 cases) was significantly lower than that of the SS (22.88%) and Onodi cell (21.57%). The anterior SPEC is adjacent to the cribriform plate, the perpendicular plate of the ethmoid bone and the posterior ethmoidal artery (PEA). The posterior SPEC is adjacent to the SS and PE (6/9 cases), the SS and Onodi cell (2/9 cases) or the PE only (1/9 cases). CONCLUSIONS The SPEC is a rare pneumatization that occurs in the posterior superior area of the nasal septum. Care should be taken to protect the skull base, cribriform plate and PEA when opening the SPEC during endoscopic sinus surgery.
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Affiliation(s)
- J Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P.R. China.
| | - Y Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P.R. China
| | - Z Yan
- Department of Otorhinolaryngology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, P.R. China
| | - Y Yang
- Department of Otolaryngology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
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20
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Padilla-Lichtenberger F, Massa DS, Plou P, Campero A, Ajler P. Surgical Management of a Superior Orbital Fissure Cavernous Hemangioma. Neurol India 2022; 70:992-995. [PMID: 35864630 DOI: 10.4103/0028-3886.349630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cavernous sinus hemangiomas (CSHs) are intracranial extradural benign, well-demarcated neoplasms arising within dural sinuses. The orbital apex and superior orbital fissure (SOF) are common locations for these lesions. Because of the complex anatomy of this area and potential morbidity, SOF CSH surgical management is challenging. OBJECTIVE Describe a case of a SOF CSH and review of literature. MATERIAL AND METHODS We present the case of a 44-year-old female with a 2-month history of right eye visual disturbances. A contrast-enhanced magnetic resonance imaging showed a right orbital apex nodular formation. A pterional craniotomy with a middle fossa mini peeling was performed. RESULTS Gross total resection was accomplished. No recurrences were observed 2 years after surgery. CONCLUSION SOF CSH should be included in a differential diagnosis in cases of space-occupying orbital apex lesions with atypical features. Surgery is the gold standard treatment. Radiosurgery is a valid option for tumor remnants.
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Affiliation(s)
| | - Daniela S Massa
- Neurosurgical Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pedro Plou
- Neurosurgical Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alvaro Campero
- Neurosurgical Department, Hospital A. Padilla, Tucumán, Argentina
| | - Pablo Ajler
- Neurosurgical Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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21
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Kumar S, Phang CA, Ni H, Diamond T. A patient with an ectopic sphenoid bone TSH secretory adenoma: Case report and review of the literature. Front Endocrinol (Lausanne) 2022; 13:961256. [PMID: 36004344 PMCID: PMC9393506 DOI: 10.3389/fendo.2022.961256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Ectopic thyroid-stimulating hormone (TSH)oma located outside the sella turcica is exceedingly rare and can be associated with significant diagnostic delay. The clinical presentation depends on the anatomical location and size of the ectopic tumor and the degree of thyrotoxicosis. A 71-year-old woman presented with goiter and thyrotoxicosis. Initial investigations revealed elevated free thyroxine (fT4) and tri-iodothyronine (fT3) with inappropriately high-normal TSH. Assay interference was unlikely, pituitary magnetic resonance imaging (MRI) scan was reported as "normal," and germline sequencing was negative for thyroid hormone receptor ß pathogenic variants. One year later, total thyroidectomy for enlarging symptomatic goiter and suspicious nodule revealed multifocal microscopic papillary thyroid carcinoma. Six years later, she presented to an ear, nose, and throat surgeon with nasal congestion, and a sphenoid bone mass was discovered on nasoendoscopy and imaging. Ectopic TSHoma was confirmed on surgical resection, and a review of the initial pituitary MRI scan revealed the mass which had initially been missed. This is the first reported case of an ectopic TSHoma located in the sphenoid bone. Ectopic TSHoma should be considered in patients with inappropriate TSH secretion when more common differentials are excluded including thyroid hormone resistance or pituitary TSHoma.
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22
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Marcus HJ, Khan DZ, Borg A, Buchfelder M, Cetas JS, Collins JW, Dorward NL, Fleseriu M, Gurnell M, Javadpour M, Jones PS, Koh CH, Layard Horsfall H, Mamelak AN, Mortini P, Muirhead W, Oyesiku NM, Schwartz TH, Sinha S, Stoyanov D, Syro LV, Tsermoulas G, Williams A, Winder MJ, Zada G, Laws ER. Pituitary society expert Delphi consensus: operative workflow in endoscopic transsphenoidal pituitary adenoma resection. Pituitary 2021; 24:839-853. [PMID: 34231079 PMCID: PMC8259776 DOI: 10.1007/s11102-021-01162-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Surgical workflow analysis seeks to systematically break down operations into hierarchal components. It facilitates education, training, and understanding of surgical variations. There are known educational demands and variations in surgical practice in endoscopic transsphenoidal approaches to pituitary adenomas. Through an iterative consensus process, we generated a surgical workflow reflective of contemporary surgical practice. METHODS A mixed-methods consensus process composed of a literature review and iterative Delphi surveys was carried out within the Pituitary Society. Each round of the survey was repeated until data saturation and > 90% consensus was reached. RESULTS There was a 100% response rate and no attrition across both Delphi rounds. Eighteen international expert panel members participated. An extensive workflow of 4 phases (nasal, sphenoid, sellar and closure) and 40 steps, with associated technical errors and adverse events, were agreed upon by 100% of panel members across rounds. Both core and case-specific or surgeon-specific variations in operative steps were captured. CONCLUSIONS Through an international expert panel consensus, a workflow for the performance of endoscopic transsphenoidal pituitary adenoma resection has been generated. This workflow captures a wide range of contemporary operative practice. The agreed "core" steps will serve as a foundation for education, training, assessment and technological development (e.g. models and simulators). The "optional" steps highlight areas of heterogeneity of practice that will benefit from further research (e.g. methods of skull base repair). Further adjustments could be made to increase applicability around the world.
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Affiliation(s)
- Hani J Marcus
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | - Danyal Z Khan
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Anouk Borg
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Justin S Cetas
- Department of Neurosurgery, Oregon Health & Science University, Portland, USA
| | - Justin W Collins
- Department of Uro-Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil L Dorward
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Maria Fleseriu
- Department of Neurosurgery, Oregon Health & Science University, Portland, USA
- Departments of Medicine (Endocrinology), Oregon Health & Science University, Portland, USA
| | - Mark Gurnell
- Division of Clinical Endocrinology & NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Mohsen Javadpour
- Department of Neurosurgery, National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
| | - Pamela S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Chan Hee Koh
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Hugo Layard Horsfall
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Adam N Mamelak
- Department of Neurosurgery and Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Pietro Mortini
- Department of Neurosurgery, San Raffaele University Health Institute Milan, Milan, Italy
| | - William Muirhead
- Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Nelson M Oyesiku
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine (Endocrinology), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA
| | - Saurabh Sinha
- Department of Neurosurgery, Royal Hallamshire Hospital & Sheffield Children's Hospital, Sheffield, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Luis V Syro
- Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin-Grupo Quirónsalud, Medellin, Colombia
| | - Georgios Tsermoulas
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Adam Williams
- Department of Neurosurgery, Southmead Hospital Bristol, Bristol, UK
| | - Mark J Winder
- Department of Neurosurgery, St Vincent's Public and Private Hospitals, Sydney, Australia
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women's Hospital, BTM 4, 60 Fenwood Road, Boston, USA
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Yamamoto M, Jin Z, Hayashi S, Rodríguez‐Vázquez JF, Murakami G, Abe S. Association between the developing sphenoid and adult morphology: A study using sagittal sections of the skull base from human embryos and fetuses. J Anat 2021; 239:1300-1317. [PMID: 34268732 PMCID: PMC8602018 DOI: 10.1111/joa.13515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/27/2022] Open
Abstract
The developing sphenoid is regarded as a median cartilage mass (basisphenoid [BS]) with three cartilaginous processes (orbitosphenoid [OS], ala temporalis [AT], and alar process [AP]). The relationships of this initial configuration with the adult morphology are difficult to determine because of extensive membranous ossification along the cartilaginous elements. The purpose of this study was therefore to evaluate the anatomical connections between each element of the fetal sphenoid and adult morphology. Sagittal sections from 25 embryos and fetuses of gestational age 6-34 weeks and crown-rump length 12-295 mm were therefore examined and compared with horizontal and frontal sections from the other 25 late-term fetuses (217-340 mm). The OS was identified as a set of three mutually attached cartilage bars in early fetuses. At all stages, the OS-post was continuous with the anterolateral part of the BS. The BS included the notochord and Rathke's pouch remnant in embryos and early fetuses. The dorsum sellae was absent from embryos, but it protruded from the BS in early fetuses before a fossa for the hypophysis became evident. Although not higher than the hypophysis at midterm, the dorsum sellae elongated superiorly after gestational age 25 weeks. In early fetuses, the AP was located on the side immediately anterior to the otic capsule. The AT developed on the side immediately posterior to the extraocular rectus muscles. At late term, the greater wing was formed by membranous bones from the AT and AP. The AT and AP formed a complex bridge between the BS and the greater wing. A small cartilage, future medial pterygoid process (PTmed) was located inferior to the AT in early fetuses. At midterm, one endochondral bone and multiple membranous bones formed the PTmed. The lateral pterygoid process (PTlat) was formed by a single membranous bone plate. Therefore, we connected fetal elements and the adult morphology as follows. (1) Derivative of the OS makes not only the lesser wing but also the anterior margin of the body of the sphenoid. (2) Derivatives of the BS are the body of the sphenoid including the sella turcica and the dorsum sellae. (3) Most of the greater wing including the foramen rotundum and the foramen oval originate from the AT and AP and multiple membranous bones. (4) The PTmed originate from endochondral bones and multiple membranous bones, while the PTlat derive from a single membranous bone.
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Affiliation(s)
| | - Zhe‐Wu Jin
- Department of AnatomyWuxi School of MedicineJiangnan UniversityWuxiChina
| | - Shogo Hayashi
- Department of AnatomySchool of MedicineInternational University of Health and WelfareNaritaJapan
| | | | - Gen Murakami
- Division of Internal MedicineCupid‐Fair ClinicIwamizawaJapan
| | - Shinichi Abe
- Department of AnatomyTokyo Dental CollegeTokyoJapan
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Abstract
PURPOSE To review the imaging features of the broad range of nonmeningioma lesions of the greater wing of the sphenoid (GWS) bone and adjacent orbit to assist clinicians in differentiating these lesions from each other and from the most common lesion of the GWS and adjacent orbit, meningioma. METHODS We reviewed 32 cases of spheno-orbital lesions involving the GWS from our own practice, as well as 109 published cases (total 141), with emphasis on available imaging features on computerized tomography (CT) and MRI. Features that might assist in differentiating meningioma from its mimics were analyzed for each lesion, including the presence of an osteoblastic or hyperostotic response, bone erosion or osteolysis, homogeneous hypo- or hyperintensity on T2-weighted MRI, leptomeningeal involvement, and the absence of a "dural tail" on contrast-enhanced MRI. The clinical and imaging features were also briefly summarized for each diagnostic group. RESULTS The largest diagnostic group was metastasis (67 cases, 47.5%). The most useful imaging features that helped differentiate meningioma from its mimics were the presence of bone erosion and the absence of a "dural tail." Other features were helpful in a small minority of cases only. Metastatic prostate cancer was the largest single group (21 cases), and 18 (85.7%) of these were osteoblastic and most closely mimicked meningioma. Prostate cancer patients were generally older than males with GWS meningioma. Almost all other (44/46, or 95.7%) metastatic lesions showed evidence of bone erosion. Almost half (30 of 61, 49.2%) of patients with metastasis presented without a known diagnosis of malignancy. Among children 16 years of age and less, Langerhans cell histiocytosis (10 cases), dermoid cyst (5), and Ewing's sarcoma (5) were the most common diagnoses. CONCLUSIONS A combination of a careful history and both CT and MRI gives information, which can best guide the management of patients with spheno-orbital lesions. Metastatic prostate cancer to the GWS most closely mimics GWS meningioma but can in most cases be differentiated on clinical and imaging features. Older males with hyperostotic lesions of the GWS should be investigated for prostate cancer. Other metastatic lesions and primary tumors of the GWS, as well as benign and structural lesions can readily be differentiated from meningioma on clinical and imaging features.
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Affiliation(s)
- Alan A McNab
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital
- Centre for Eye Research Australia, University of Melbourne
| | - Randall S Jones
- Department of Radiology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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Chen PF, Yip CM, Lin YH. Endoscopic transpterygoid approach to repair lateral sphenoid recess cerebrospinal fluid leak by multilayered reconstruction. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 4:135-136. [PMID: 34246589 DOI: 10.1016/j.anorl.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/23/2021] [Accepted: 06/04/2021] [Indexed: 11/15/2022]
Abstract
Cerebrospinal fluid (CSF) leak and encephalocele from the middle cranial fossa into the sphenoid sinus lateral recess (SSLR) is a rare condition. It is often associated with obesity, female sex, well-pneumatized sinus, and prolonged intracranial hypertension. Endoscopic repair has emerged as the mainstay treatment with a success rate increasing to over 90% by refining reconstruction methods and controlling intracranial pressure. Here, we describe how a female with SSLR CSF leak and encephalocele successfully managed with endoscopic transpterygoid approach and multilayered repair. The defect was closed using four indifferent tissues, including the duragen patch, sinus mucosal flaps, the middle turbinate bone, and free mucosa flap, from the inside out. The patient had an uneventful postsurgical course and remained disease-free during the 9-month follow-up. To conclude, the technique of using sinus mucosal flaps in the context of multilayered reconstruction might be a useful method to repair CSF leak.
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Affiliation(s)
- P-F Chen
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, 813 Kaohsiung, Taiwan, Republic of China
| | - C-M Yip
- Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Y-H Lin
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, 813 Kaohsiung, Taiwan, Republic of China; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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26
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Tang H, Liu P, Liu X, Hou Y, Chen W, Zhang L, Guo J. Skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) in young adults. Angle Orthod 2021; 91:301-306. [PMID: 33492395 DOI: 10.2319/052920-491.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To observe skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) and determine the possible factors that may affect the postexpansion changes using cone-beam computed tomography (CBCT) in young adults. MATERIALS AND METHODS Thirty-one patients (mean age 22.14 ± 4.76 years) who were treated with MARME over 1 year were enrolled. Four mini-implants were inserted in the midpalatal region, and the number of activations ranged from 40 to 60 turns (0.13 per turn). CBCT was performed before MARME (T0), after activation (T1), and after 1 year of retention (T2). The mean period between T1 and T0 was 6 ± 1.9 months and between T2 and T1 was 13 ± 2.18 months. A paired t-test was performed to compare T0, T1, and T2. The correlations between the postexpansion changes and possible contributing factors were analyzed by Pearson correlation analysis. RESULTS The widths increased significantly after T1. After T2, the palatal suture width decreased from 2.50 mm to 0.75 mm. From T1 to T2, decreases recorded among skeletal variables varied from 0.13 mm to 0.41 mm. This decrease accounted for 5.75% of the total expansion (2.26 mm) in nasal width (N-N) and 19.75% at the lateral pterygoid plate. A significant correlation was found between postexpansion change and palatal cortical bone thickness and inclination of the palatal plane (ANS-PNS/SN; P < .05). CONCLUSIONS Expanded skeletal width was generally stable after MARME. However, some amount of relapse occurred over time. Patients with thicker cortical bone of the palate and/or flatter palatal planes seemed to demonstrate better stability.
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27
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Vale F, Francisco I, Lucas A, Roseiro A, Caramelo F, Sobral A. Timing of Spheno-Occipital Synchondrosis Ossification in Children and Adolescents with Cleft Lip and Palate: A Retrospective Case-Control Study. Int J Environ Res Public Health 2020; 17:ijerph17238889. [PMID: 33260492 PMCID: PMC7731241 DOI: 10.3390/ijerph17238889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022]
Abstract
Background: Cleft lip and palate (CLP) can affect the development of the maxilla; which may create a midfacial deficiency as well as an interference of the facial growth pattern and dentofacial esthetics. Objective: This study aimed to estimate the chronological age of complete fusion of the spheno-occipital synchondrosis (SOS) in cleft lip and palate patients and a control group; using cone beam computed tomography (CBCT) images. Methods: In this retrospective study; 125 patients were enrolled (cleft lip and palate group (n = 91); control group (n = 34)). Age comparison was made with a chi-square test; and a Kaplan–Meier analysis determined the median time to reach complete fusion of the spheno-occipital synchondrosis (p < 0.05). Results: The experimental group showed statistically significant differences in the median time for complete ossification between males and females (p = 0.019). The median time for complete ossification of the spheno-occipital synchondrosis was; for males; 15.0 years in both groups; for females; it was 14.0 years and 13.0 years in the experimental group and in the control group; respectively. Both for males and females; there were no statistically significant differences between experimental and control groups (p = 0.104). Conclusions: The present study showed no differences in the ossification of the spheno-occipital synchondrosis between individuals with and without cleft lip and/or palate.
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Affiliation(s)
- Francisco Vale
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.F.); (A.L.); (A.R.); (A.S.)
- Correspondence:
| | - Inês Francisco
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.F.); (A.L.); (A.R.); (A.S.)
| | - António Lucas
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.F.); (A.L.); (A.R.); (A.S.)
| | - Ana Roseiro
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.F.); (A.L.); (A.R.); (A.S.)
| | - Francisco Caramelo
- Faculty of Medicine, Institute of Clinical and Biomedical Research of Coimbra (iCBR), University of Coimbra, 3000-075 Coimbra, Portugal;
| | - Adriana Sobral
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.F.); (A.L.); (A.R.); (A.S.)
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Hiramatsu M, Sugiu K, Hishikawa T, Haruma J, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Shimazu Y, Fujii K, Kameda M, Kurozumi K, Date I. Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery. AJNR Am J Neuroradiol 2020; 41:2082-2087. [PMID: 33004344 DOI: 10.3174/ajnr.a6790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/15/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions. MATERIALS AND METHODS This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder. RESULTS We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder. CONCLUSIONS Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.
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Affiliation(s)
- M Hiramatsu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Sugiu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - T Hishikawa
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - J Haruma
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Takahashi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - S Murai
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Nishi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Yamaoka
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Shimazu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Fujii
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - M Kameda
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Kurozumi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Neurosurgery (K.K.), Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - I Date
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Hwang JY, Aum DJ, Chicoine MR, Dacey RG, Osbun JW, Rich KM, Zipfel GJ, Klatt-Cromwell CN, McJunkin JL, Pipkorn P, Schneider JS, Silverstein JM, Kim AH. Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery. Pituitary 2020; 23:389-399. [PMID: 32388803 DOI: 10.1007/s11102-020-01045-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Endoscopic transsphenoidal surgery (ETSS) is a well-established treatment for patients with nonfunctioning pituitary adenomas (NFPAs). Data on the rates of pituitary dysfunction and recovery in a large cohort of NFPA patients undergoing ETSS and the predictors of endocrine function before and after ETSS are scarce. This study is purposed to analyze the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA. METHODS A retrospective review of 601 consecutive patients who underwent ETSS between 2010 and 2018 at one institution was performed. Recovery or development of new hypopituitarism was analyzed in 209 NFPA patients who underwent ETSS. RESULTS Patients with preoperative endocrine deficits (59.8%) in one or more pituitary axes had larger tumor volumes (P = 0.001) than those without preoperative deficits. Recovery of preoperative pituitary deficit occurred in all four axes, with overall mean recovery of 29.7%. The cortisol axis showed the highest recovery whereas the thyroid axis showed the lowest, with 1-year cumulative recovery rates of 44.3% and 6.1%, respectively. Postoperative hypopituitarism occurred overall in 17.2%, most frequently in the thyroid axis (24.3%, 27/111) and least frequently in the cortisol axis (9.7%, 16/165). Axis-specific predictors of post-operative recovery and deficiency were identified. CONCLUSIONS Dynamic alterations in pituitary hormones were observed in a proportion of patients following ETSS in NFPA patients. Postoperative endocrine vulnerability, recovery, and factors that predicted recovery or loss of endocrine function depended on the hormonal system, necessitating an axis-specific surveillance strategy postoperatively.
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Affiliation(s)
- Jenie Y Hwang
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Diane J Aum
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael R Chicoine
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ralph G Dacey
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua W Osbun
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Keith M Rich
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Cristine N Klatt-Cromwell
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathan L McJunkin
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie M Silverstein
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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30
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Bteich F, El Khoury L, Nohra G, Trak V, Yazbek S, Akiki M. Pituitary Adenoma and Papillary Craniopharyngioma: A Rare Case of Collision Tumor and Review of the Literature. World Neurosurg 2020; 139:63-69. [PMID: 32298831 DOI: 10.1016/j.wneu.2020.03.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pituitary adenomas are the most common lesion of the sellar region. Very few cases in the literature have described their association with craniopharyngiomas in the same anatomic compartment, an entity defined as collision tumors of the sella. CASE DESCRIPTION A 35-year-old man presented with headaches and progressive visual disturbances. Radiographic imaging initially highlighted the presence of a pituitary craniopharyngioma. An endoscopic transsphenoidal pituitary approach was performed, during which the tumor was partially resected. The pathology report was positive for 2 entities: a nonfunctioning pituitary adenoma and a papillary craniopharyngioma. This was an unexpected diagnosis based on the surgical and initial radiologic findings. CONCLUSIONS To our knowledge, this is the first documented case of a collision tumor of the sella comprising a pituitary adenoma and a craniopharyngioma of the papillary type.
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Affiliation(s)
- Fred Bteich
- Neurosurgery Department, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon.
| | - Lea El Khoury
- Pathology Departments, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon
| | - Georges Nohra
- Neurosurgery Department, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon
| | - Viviane Trak
- Pathology Departments, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon
| | - Sandrine Yazbek
- Neurosurgery Department, Hotel-Dieu de France Hospital, Achrafieh, Lebanon; Faculty of Medicine, Saint Joseph University, Achrafieh, Lebanon
| | - Mira Akiki
- Pathology Departments, Hotel-Dieu de France Hospital, Achrafieh, Lebanon
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von Arx T, Lozanoff S, Bornstein MM. Extraoral anatomy in CBCT – a literature review. Part 3: Retromaxillary region. Swiss Dent J 2020; 130:216-228. [PMID: 32162855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this review about extraoral anatomy as depicted by cone beam computed tomography, the retromaxillary region is discussed. A medium-sized (6 x 6 cm) or large (≥ 8 x 8 cm) field of view of the maxilla will inevitably depict the retromaxillary region that can be considered a «transition» zone between the viscerocranium and the neurocranium. Major structures of the region include the sphenoid bone and the pterygopalatine fossae. The sphenoid bone is a single but complex bone located between the maxilla and the brain. It is composed of a central body, bilateral greater and lesser wings, and pterygoid processes. Important neurovascular structures pass through the sphenoid bone: the optic nerve and the ophthalmic artery via the optic canal, the maxillary nerve via the foramen rotundum, and the pterygoid nerve via the Vidian canal. The central body of the sphenoid bone also contains the highly variable sphenoid sinus that is the most posteriorly located paranasal sinus. The bilateral pterygopalatine fossae behind the maxillary sinuses contain several important neurovascular structures that supply the maxilla and the midface.
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Affiliation(s)
- Thomas von Arx
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Switzerland
| | - Scott Lozanoff
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Michael M. Bornstein
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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Tomomatsu N, Kurohara K, Nakakuki K, Yoshitake H, Kanemaru T, Yamaguchi S, Yoda T. Influence of the anatomical form of the posterior maxilla on the reliability of superior maxillary repositioning by Le Fort I osteotomy. Int J Oral Maxillofac Surg 2018; 48:612-619. [PMID: 30503635 DOI: 10.1016/j.ijom.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022]
Abstract
Certain patients with facial deformities require superior repositioning of the maxilla via Le Fort I osteotomy; however, the magnitude of superior repositioning of the maxilla is often less than expected. In this study, the correlation between the accuracy of superior repositioning of the maxilla and the anatomical form of the maxillary posterior region was examined. Seventy-five patients who underwent Le Fort I osteotomy without forward movement of the maxilla but with superior repositioning of the maxilla were included in this study. The bone volume around the descending palatine artery (DPA), the angle of the junction between the pterygoid process and the tuberosity, and the distance between the upper second molar and the pterygoid process were measured via three-dimensional analysis. A significant negative correlation (r=-0.566) was found between the bone volume around the DPA and the ratio of repositioning (actual movement divided by expected movement). It is possible that the superior repositioning of the maxilla expected prior to surgery was not sufficiently attained because of the large volume of bone around the DPA. The results of this study show that in some patients, superior repositioning was not achieved at the expected level because of bone interference attributable to the anatomical form of the maxillary posterior region.
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Affiliation(s)
- N Tomomatsu
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kurohara
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - K Nakakuki
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yoshitake
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kanemaru
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Yamaguchi
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Yoda
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
3 cases of spheno-occipital chordoma with rhinopharingeal involvement have been morphologically and histochemically studied. The derivation from the notochord is stated.
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Krogh J, Kistorp CN, Jafar-Mohammadi B, Pal A, Cudlip S, Grossman A. Transsphenoidal surgery for pituitary tumours: frequency and predictors of delayed hyponatraemia and their relationship to early readmission. Eur J Endocrinol 2018; 178:247-253. [PMID: 29263154 DOI: 10.1530/eje-17-0879] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/20/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A major cause of readmission after transsphenoidal surgery (TSS) is delayed hyponatraemia. The purpose of this study was to identify predictors of hyponatraemia one week post surgery and predictors of 30-day readmissions for hyponatraemia. DESIGN A retrospective cohort study including patients who had TSS performed for pituitary lesions. METHOD The risk of readmission for hyponatraemia was assessed in consecutive patients between January 2008 and March 2016. The risk of hyponatraemia one week post surgery was assessed in patients admitted for TSS between July 2011 and March 2016. RESULTS Of all included patients, 56/522 (10.7%) were readmitted within 30 days. Hyponatraemia was found in 14/56 (25%) of 30-day readmissions. We did not identify any predictive variable for hyponatraemia on readmission. The number of patients with hyponatraemia on the seventh post-operative day was 26/314 (8.3%). The risk of hyponatraemia one week post surgery was increased by an odds ratio of 2.40 (95% CI: 1.06-5.40) in patients with a tumour abutting the optic chiasm and by an odds ratio of 1.16 (1.04-1.31) per mmol/L decrease in sodium levels on the first post-operative day. CONCLUSIONS Hyponatraemia occurred in 25% of readmissions; however, we did not identify any predictive variable for readmission with hyponatraemia. One week post surgery, 8.9% had hyponatraemia. Tumours pressing on the optic chiasm as well as a fall in sodium levels on the first post-operative day were associated with an increased risk of hyponatraemia one week post surgery. We suggest that a day 7 serum sodium <130 nmol/L should lead to concern and the provision of patient advice.
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Affiliation(s)
- Jesper Krogh
- Department of EndocrinologyHerlev University Hospital, Copenhagen, Denmark
| | - Caroline N Kistorp
- Department of EndocrinologyHerlev University Hospital, Copenhagen, Denmark
| | - Bahram Jafar-Mohammadi
- Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
| | - Aparna Pal
- Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
| | - Simon Cudlip
- Department of NeurosurgeryJohn Radcliffe, Hospital, Oxford, UK
| | - Ashley Grossman
- Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
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Spinou C, McGarry GW. Periorbital Cellulitis with Breast Cancer. J R Soc Med 2017; 96:573. [PMID: 14594980 PMCID: PMC539648 DOI: 10.1177/014107680309601129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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HERMANN K, HALL IS. Sphenoidal mucocele as a cause of the ophthalmoplegic migraine syndrome. Trans Ophthalmol Soc U K 2017; 64:154-164. [PMID: 21024417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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PERL T, ECKER A. Radiologically Controlled Injections through the Foramen Ovale for Relief of TIC Douloureux and of Parkinsonism. ACTA ACUST UNITED AC 2016; 1:901-12. [PMID: 14044724 DOI: 10.1177/028418516300100344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Conrad J, Ayyad A, Wüster C, Omran W, Weber MM, Konerding MA, Müller-Forell W, Giese A, Oertel J. Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study. J Neurosurg 2016; 125:334-45. [PMID: 26722858 DOI: 10.3171/2015.6.jns142637] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved. METHODS Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented. RESULTS In the clinical evaluation, 0° optics were optimal in the nasal and sphenoidal phase of surgery for both techniques. For detection of tumor remnants, 30° optics were superior. The binostril approach was significantly more time consuming than the mononostril technique. The nasal retractor limited maneuverability of instruments during mononostril approaches in 5 of 20 patients. Endocrinological pituitary function, control of excessive hormone secretion, ophthalmological outcome, residual tumor, and rates of adverse events, such as CSF leaks and diabetes insipidus, were similar in both groups. In the cadaver study, there was no significant difference in the time required for dissection via the binostril or mononostril technique. The panoramic view was superior in the binostril group; this was due to the possibility of wider opening of the sella in the craniocaudal and horizontal directions, but the need for removal of more of the nasal septum was disadvantageous. CONCLUSIONS Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar expansion and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area.
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Affiliation(s)
| | - Ali Ayyad
- Neurochirurgische Klinik und Poliklinik
| | | | | | | | - Moritz A Konerding
- Institut für Anatomie und Zellbiologie, Fachbereich Medizin, Johannes Gutenberg-Universität Mainz
| | | | - Alf Giese
- Neurochirurgische Klinik und Poliklinik
| | - Joachim Oertel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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Abstract
PURPOSE Transsphenoidal pituitary surgery can be carried out with either an operating microscope or with an endoscope, but the relative frequency of both techniques is unknown. METHODS All microscopic and endoscopic transsphenoidal pituitary surgeries were extracted from the Centers for Medicare and Medicaid Services Part B data files between the years 2003 and 2013. National and state-level trends were compared over time. RESULTS Endoscopic surgery significantly increased and microscopic surgery significantly decreased over the years 2003-2013. Thirty-eight of 48 states increased their use of endoscopic surgery, while 38 of 48 states decreased their use of microscopic surgery. CONCLUSIONS Nationwide data show a clear trend for an increasing use of endoscopic transsphenoidal surgery at the expense of microscopic surgery. The underlying causes of these trends are unknown, but clearly deserve further investigation.
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Affiliation(s)
- John D Rolston
- California Center for Pituitary Disorders and Center for Minimally Invasive Skull Base Surgery, Department of Neurological Surgery, University of California, 505 Parnassus Ave., M779, San Francisco, CA, 94143, USA.
| | - Seunggu J Han
- California Center for Pituitary Disorders and Center for Minimally Invasive Skull Base Surgery, Department of Neurological Surgery, University of California, 505 Parnassus Ave., M779, San Francisco, CA, 94143, USA
| | - Manish K Aghi
- California Center for Pituitary Disorders and Center for Minimally Invasive Skull Base Surgery, Department of Neurological Surgery, University of California, 505 Parnassus Ave., M779, San Francisco, CA, 94143, USA
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Chohan MO, Levin AM, Singh R, Zhou Z, Green CL, Kazam JJ, Tsiouris AJ, Anand VK, Schwartz TH. Three-dimensional volumetric measurements in defining endoscope-guided giant adenoma surgery outcomes. Pituitary 2016; 19:311-21. [PMID: 26843023 DOI: 10.1007/s11102-016-0709-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Maximum two-dimensional (2D) diameter has been used to define giant pituitary adenoma (GPA) surgery outcomes as has volume using an ellipsoid approximation of volumetrics. Cross sectional length can be measured in several different planes. We sought to compare the accuracy of different 2D cross sectional measurements with the 3D volumetric measurements for predicting GPA surgery outcomes. METHODS Retrospective analysis was performed on a prospectively collected database. Tumors with >3 cm diameter were identified and classified based on maximal cross sectional measurements in three separate co-axial planes, i.e. transverse (TV), antero-posterior (AP) and cranio-caudal (CC). Volume was calculated using both MRI-guided volumetrics and an ellipsoid approximation (TV × AP × CC/2). Univariate and multivariate analysis was used to evaluate the relationship between cross sectional and volumetric data and extent of resection (EOR). RESULTS In 62 subjects, median tumor volume using 3D volumetrics was 13.74 cm(3), which was overestimated by 16 % by the ellipsoid calculation (p = 0.0029), particularly for tumors >20 cm(3). Gross total resection (GTR) was 46.7 % and median EOR was 99.57 %. At 22-month follow-up, visual and anterior pituitary functions were stable (90 %) or improved (87 %). Pre-operative tumor volume >10 cm(3) (p = 0.02) and Knosp grade 3-4 (p = 0.04) were independent predictors of EOR. Knosp grade 3-4 (p < 0.0001), TV measurement >4 cm (p = 0.007) and maximum cross sectional length >4 cm (p = 0.04) were predictors of not achieving GTR. Only TV measurement (p = 0.02) predicted permanent diabetes insipidis. The smallest significant thresholds for predicting decreased GTR were TV measurement >25 mm, AP measurement >35 mm and volume >19 cm(3). CONCLUSION We propose a new volumetric threshold of 20 cm(3) as most accurate for predicting GTR in the EEA era. CC measurement is the least useful predictor. Cavernous sinus invasion remains the best predictor of incomplete resection.
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Affiliation(s)
- Muhammad Omar Chohan
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA.
| | - Ariana M Levin
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Ranjodh Singh
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Zhiping Zhou
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Carlos L Green
- Department of Neuroradiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Jacob J Kazam
- Department of Neuroradiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Apostolos J Tsiouris
- Department of Neuroradiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Vijay K Anand
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, New York, NY, USA
- Department of Neurological Surgery and Neuroscience, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
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Abstract
OBJECTIVE This article describes a surgical approach that has been applied to managing primary tumors in the pterygopalatine fossa and secondary tumors involving the pterygopalatine fossa. PATIENTS AND METHODS The Barbosa approach was modified by adding a lateral incision in the mandibular gingivobuccal fold from the canine tooth to the retromolar area. This technique was applied to nine patients with primary and secondary tumors in the pterygopalatine fossa. All patients had been observed by clinical examinations, MRI, and CT examinations. RESULTS: This technique allowed a large, inferiorly based flap to be raised, which includes the parotid gland. The masseter and temporalis muscles were divided horizontally, and the ascending ramus of the mandible was osteotomied between the mandibular angle and the sigmoid notch and reflected to expose the tumor in the pterygopalatine fossa and maxillary sinus. We have applied this technique in 9 patients. Of the 9 patients in our study, 5 (55%) were male and 4 (45%) were female. The median age of the patients at the time of operation for primary and secondary tumors in the pterygopalatine fossa was 49.5 years (range, 19–66 years). Four of the 9 patients had primary tumors in the pterygopalatine fossa. One patient had a tumor in the pterygoaplatine fossa extending into the maxillary sinus, 2 patients had tumors occurring in the maxilla involving the pterygopalatine fossa, 2 patients had tumors from the deep lobe of the parotid gland to the pterygopalatine fossa, and 1 patient had extracranial meningioma. Nine patients have been followed up from 3 months to 9 years and 6 months, and 1 patient had recurrence 2 years and 2 months postoperatively. CONCLUSION: This technique is especially useful to tumors in the pterygopalatine fossa and tumors in the pterygopalatine fossa extending into the maxillary sinus.
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Affiliation(s)
- Xin-Chun Jian
- Department of Cranio-Maxillo-facial Surgery, Xiang Ya Hospital, Xiang Ya Medical College, Central South University, Changsha, Hunan, People's Republic of China.
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Lüdecke DK, Herrmann HD, Schulte FJ. Special problems with neurosurgical treatments of hormone-secreting pituitary adenomas in children. Prog Exp Tumor Res 2015; 30:362-70. [PMID: 3628819 DOI: 10.1159/000413695] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kobayashi T, Nakane T, Kageyama N. Combined trans-sphenoidal and intracranial surgery for craniopharyngioma. Prog Exp Tumor Res 2015; 30:341-9. [PMID: 3628816 DOI: 10.1159/000413692] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Ma S, Chen S, Hu Y, Qi J, Li Z, Cun E, Wang L, Shi X, Yang J. [Application of virtual reality system for individualized preoperative planning of sphenoidal ridge meningioma]. Zhonghua Yi Xue Za Zhi 2014; 94:3562-3566. [PMID: 25622834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the usefulness of virtual reality (VR) technique for individualized preoperative planning of sphenoidal ridge meningioma. METHODS Multiple imaging data of CTA/MR were acquired from 41 surgical patients with sphenoidal ridge meningioma during the period from July 2009 to June 2013 were transferred into the Dextroscope system. A suite of built-in 3D tools enabled users to obtain measurement and simulated intraoperative viewpoint about the lesion and adjacent anatomic structures. A sophisticated preoperative plan was defined.Operative duration, total resection rate, complication rate and KPS scores were compared with control group undergoing routine operation (n = 27). RESULTS 3D stereoscopic VR images in accordance with reality were reconstructed for 41 cases. As compared with control group,VR preoperative plan could shorten operative duration and reduce complication rate (P < 0.05). However, there was no improvement in total resection rate or KPS score (P > 0.50). CONCLUSION VR technique of Dextroscope system offers comprehensive information of sphenoidal ridge and related neurovascular anatomical structure. Thus it may aid surgical planning and facilitate individualized operation.
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Affiliation(s)
- Shunchang Ma
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Suhua Chen
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Yeshuai Hu
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Jianfa Qi
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Zhiqiang Li
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Enhao Cun
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Liguo Wang
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Xiang'en Shi
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Jun Yang
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing 100038, China.
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Hattori T, Kabeya R, Maruwaka M, Tosaki F, Kajiura D. [A case of transverse-sigmoid sinus dural arteriovenous fistula that became symptomatic after removal of coexisting sphenoid ridge meningioma]. No Shinkei Geka 2014; 42:723-729. [PMID: 25087760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Here, we describe a case with a transverse-sigmoid sinus(TSS)dural arteriovenous fistula(DAVF)with sinus occlusion at its proximal and distal ends;the TSS DAVF turned symptomatic after removal of a coexisting symptomatic sphenoid ridge meningioma. The patient was a 70-year-old man presenting with decreased daily activities and mentation due to dysphasia. Magnetic resonance imaging revealed a large, left sphenoid ridge meningioma. Angiography revealed a tumor stain and a coexisting left TSS DAVF with sinus occlusion at its proximal and distal ends. Cortical venous reflux(CVR)into the temporal veins was observed. After successful tumor removal, the superficial middle cerebral vein was arterialized intraoperatively. However, the patient showed worsened consciousness and dysphasia after the operation. Repeated angiography revealed CVR into the superficial middle cerebral vein through a sphenopetrosal sinus. Transvenous embolization was performed via the contralateral inferior petrosal and intercavernous sinus, which allowed access to the ipsilateral superior petrosal sinus(SPS);the procedure successfully eliminated CVR, while preserving the SPS. The patient demonstrated full recovery. This case exemplifies a coexisting TSS DAVF after tumor resection, and superficial middle cerebral vein decompression due to the sphenopetrosal sinus, an alternate drainage pathway for the superficial middle cerebral vein.
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Affiliation(s)
- Tomoji Hattori
- Department of Neurosurgery, Ichinomiya Municipal Hospital
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Oyakawa Barcelli Y, García Durruti P, Enes Romero P, Martín Frías M, Barrio Castellanos R. Morning glory syndrome associated with transsphenoidal encephalocele and panhypopituitarism. Endocrinol Nutr 2014; 61:222-224. [PMID: 24418230 DOI: 10.1016/j.endonu.2013.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/16/2013] [Accepted: 11/20/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Yoko Oyakawa Barcelli
- Unidad de diabetes pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Patricia Enes Romero
- Unidad de diabetes pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Martín Frías
- Unidad de diabetes pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
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Nian W, Wang H, Gao Q, Liu Z. [A case of multiple abscess cyst of sphenoid]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 49:246-247. [PMID: 24820501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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48
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Robertson H, Palacios E, Rincon S, Shah KR. Diffuse sphenoid bone cavernous hemangioma presenting during pregnancy. Ear Nose Throat J 2013; 92:E17. [PMID: 24170470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
We present a case of diffuse sphenoid bone cavernous hemangioma in a 22-year-old primigravid woman. Her disease first manifested clinically as progressively decreasing vision in her left eye during her third trimester of pregnancy. We also discuss the known causes and some theoretical causes of cavernous hemangioma enlargement during pregnancy.
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Affiliation(s)
- Hugh Robertson
- Department of Radiology, Louisiana State University School of Medicine, New Orleans, LA, USA
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Zhang QQ, Wang Y, Wang Q, Wang L. [A case report of Kaino-syndrome after a large sphenoid sinus cyst operation]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 48:767-768. [PMID: 24330882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Yannick N, Patrick F, Samuel M, Erwan F, Pierre-Jean P, Michel J, Stéphane V. Predictive factors for visual outcome after resection of spheno-orbital meningiomas: a long-term review. Acta Ophthalmol 2012; 90:e663-5. [PMID: 22520148 DOI: 10.1111/j.1755-3768.2012.02419.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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