Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immun...Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immunocompromised individuals and the elderly, particularly those with a history of diabetes mellitus. Diagnosis is challenging because of non-specific symptoms that lead to late detection and complications. This report discusses a case of SBO with multiple bilateral cranial nerve abnormalities and highlights the diagnostic and management challenges in high-risk individuals with subtle clinical signs. Case presentation: This report describes a 63-year-old patient with hypertension and diabetes who underwent surgical debridement of the left ear due to malignant otitis externa 4 months prior to presentation. The patient presented with significant dysarthria, dysphagia, ptosis of the left eye with double vision, and hearing impairment in the left ear. Examination revealed bilateral CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI revealed a pathological process in the base of the skull involving bony structures and cranial nerves bilaterally, which helped diagnose SBO. The patient was subsequently discharged with oral voriconazole and continued his usual medications. The patient requested further management abroad, because he did not notice resolution of his symptoms. Surgical treatment was employed abroad to relieve his symptoms, as he recovered slowly. Conclusion: This case report underscores the importance of a multidisciplinary approach to address SBO. Collaboration between specialists in infectious diseases, otolaryngology, radiology, and neurology plays a pivotal role in achieving an accurate diagnosis and developing a tailored treatment plan. Although SBO may be infrequent, this case report highlights the need to maintain heightened clinical suspicion in high-risk individuals.展开更多
The extremely complex anatomic relationships among bone, tumor, blood vessels and cranial nervesremains a big challenge for cranial base tumor surgery. Therefore, a good understanding of the patient specific anatomy a...The extremely complex anatomic relationships among bone, tumor, blood vessels and cranial nervesremains a big challenge for cranial base tumor surgery. Therefore, a good understanding of the patient specific anatomy and a preoperative planning are helpful and crucial for the neurosurgeons. Three dimensional （3-D） visualization of various imaging techniques have been widely explored to enhance the comprehension of volumetric data for surgical planning.展开更多
This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recom...This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recommended but he never completed this management. He then presented about eight years later with a mass from his left external auditory canal. It was reported that two years prior another surgeon operated on the left ear for a cholesteatoma. CT temporal bone showed complete opacification of left EAC, mastoid bowl, and remaining mastoid air cells. In addition, there were irregular bony/hyperostotic changes seen within the left sphenoid and temporal bone. There was dural thickening within the middle fossa adjacent to the previously described hyperostotic bony changes. A mastoidectomy and excision of mass revealed extensive adhesive tissue throughout the middle ear, and mastoid up to the tegmen. Pathology of the portions that were resected confirmed Grade 1 meningioma. Stereotactic gamma knife radiation was completed to the area to prevent further growth. This case highlights extracranial meningioma that did not have definitive management for prior middle fossa floor meningioma. It also highlights the need to think of less common pathology in the middle ear and external auditory canal.展开更多
目的:探讨神经内镜联合颅底显微神经外科手术(cranial base micro neurosurgery,CBM)对脑肿瘤患者的影响。方法:选取2018年1月—2022年12月灵山县人民医院收治的60例脑肿瘤患者。根据单双号将其平分为试验组和对照组,各30例。对照组实施...目的:探讨神经内镜联合颅底显微神经外科手术(cranial base micro neurosurgery,CBM)对脑肿瘤患者的影响。方法:选取2018年1月—2022年12月灵山县人民医院收治的60例脑肿瘤患者。根据单双号将其平分为试验组和对照组,各30例。对照组实施CBM治疗,试验组实施神经内镜联合CBM治疗。比较两组肿瘤切除情况及围手术期指标,术前、术后神经功能及日常生活能力、相关指标,并发症及治愈率。结果:试验组完全切除率为96.67%,高于对照组的80.00%,手术时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术后,试验组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分低于对照组,日常生活能力量表(activities of daily living,ADL)评分高于对照组,差异有统计学意义(P<0.05)。术后,试验组白细胞介素-6(interleukin-6,IL-6)、S-100β蛋白(S-lfln protein 100β,S100β)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均低于对照组,差异有统计学意义(P<0.05)。试验组并发症发生率低于对照组,治愈率高于对照组,差异有统计学意义(P<0.05)。结论:神经内镜联合CBM可以提高脑肿瘤无全切除率,改善其神经功能及生活能力,降低炎症因子水平,治愈率高,并发症少,住院时间短,预后好,安全性高。展开更多
Objectives/Hypothesis: The introduction of intranasal pedicled flaps has reduced the incidence of postoperative cerebrospinal fluid (CSF) leaks to less than 5%. Nevertheless, in malignant tumors those flaps are not al...Objectives/Hypothesis: The introduction of intranasal pedicled flaps has reduced the incidence of postoperative cerebrospinal fluid (CSF) leaks to less than 5%. Nevertheless, in malignant tumors those flaps are not always available because of nasal septum invasion. Minimally invasive pericranial flaps (PCF) are associated with minimal adverse effects and good cosmetic appearance. In spite of that, there are only a few reports of this reconstructive technic limited to short surgical series and radio-anatomical analysis. Clinical results of a surgical cohort are presented. Study Design: Cohort prospective study. Methods: Clinical data, including age, gender, stage, histopathological findings, rate of complications and appearance of PCF at fifth day and two months postoperative were recorded. Postoperative morbidities were recorded as wound abnormalities, nasosinusal, orbital and central nervous system complications. Chi-squared test was used to correlate qualitative variables and Student-t-test to correlated qualitative and quantitative variables. Items were considered statistically significant with a p value of less than 0.05 (confidence Interval of 95%). Results: Thirty patients (18 males and 12 females) were registered. Mean age was 51.5 years ± 23.0 and range between 20 and 71 years. Most common histologic subtypes were adenocarcinoma, epidermoid carcinoma and squamous cell carcinoma. Complete resection of the tumor was achieved in all patients including surgical margins. Length of the PCF varies between 9.9 cm and 13.9 cm with a mean of 11.8 cm. There was an association between length of the flaps and the covering structure with the nose apex relation. None patient experienced postoperative cerebrospinal fluid (CSF) leak, frontal sinusitis or other complications. Conclusions: Minimally invasive PCF constitute a good and inexpensive reconstructive option in patients with malignant anterior cranial base tumors in whose nasoseptal flap was not a feasible option.展开更多
目的:比较容积CT剂量指数(volume CT dose index,CTDI_(VOL))及基于水当量直径的体型特异性剂量估计值(size-specific dose estimate based on water equivalent diameter,SSDE_(WED))在衡量儿童头颅CT辐射剂量中的差异性,并分析CTDI_(V...目的:比较容积CT剂量指数(volume CT dose index,CTDI_(VOL))及基于水当量直径的体型特异性剂量估计值(size-specific dose estimate based on water equivalent diameter,SSDE_(WED))在衡量儿童头颅CT辐射剂量中的差异性,并分析CTDI_(VOL)、SSDE_(WED)与曝光量、水当量直径(water equivalent diameter,WED)的相关性,以为临床检查中儿童头颅CT辐射剂量衡量提供参考。方法:回顾性分析2021年1—12月于某院进行头颅CT检查的1297例患儿的临床资料,根据年龄将患儿分为≤1个月组、>1个月~4岁组、>4~10岁组、>10~15岁组。记录患儿的曝光量、年龄、CTDI_(VOL)、剂量长度乘积,并计算WED、转换因子及SSDE_(WED)。比较CTDI_(VOL)与SSDE_(WED)的差异;建立CTDI_(VOL)、SSDE_(WED)与曝光量、WED的回归模型,并采用Pearson分析CTDI_(VOL)、SSDE_(WED)与曝光量、WED之间的相关性;对比国内诊断参考水平(diagnostic reference level,DRL)、欧盟DRL及本医疗机构诊断参考水平(local diagnostic reference level,LDRL)的差异。采用SPSS 25.0统计学软件进行分析。结果:患儿头颅CT的CTDI_(VOL)为(9.22±1.63)mGy,SSDE_(WED)为(8.14±0.84)mGy,CTDI_(VOL)较SSDE_(WED)高13.27%,差异有统计学意义(t=47.66,P<0.001)。CTDI_(VOL)、SSDE_(WED)与曝光量、WED均呈正相关关系(P<0.001);CTDI_(VOL)、SSDE_(WED)与曝光量、WED回归模型拟合性较强(R^(2)为0.58~0.99)。与国内DRL及欧盟DRL比较,LDRL均处于较低水平。结论:在儿童头颅CT辐射剂量衡量中,相较于CTDI_(VOL),SSDE_(WED)对辐射剂量的衡量更准确。同时定期对医疗机构的DRL值进行统计更新并优化检查参数,是减少辐射剂量的重要方式。展开更多
Here we report a patient with uncontrolled diabetes, who presented with giddiness and fall due to an episode of seizure. On evaluation with CT and MRI scans, he was found to have pan sinusitis with erosions of the sku...Here we report a patient with uncontrolled diabetes, who presented with giddiness and fall due to an episode of seizure. On evaluation with CT and MRI scans, he was found to have pan sinusitis with erosions of the skull base in the floor of sphenoid near lateral recess. PET-CT showed evidence of increased metabolism. He was operated upon by functional endoscopic sinus surgery and debridement of lesion near skull base. The histopathological examination revealed evidence of inflammation with no granulomas or fungal elements or tubercle bacilli. No organisms were grown in microbiological cultures. He started on empirical antibiotics for 3 months and showed improvement. We are reporting this case due to rarity to skull base osteomyelitis.展开更多
文摘Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immunocompromised individuals and the elderly, particularly those with a history of diabetes mellitus. Diagnosis is challenging because of non-specific symptoms that lead to late detection and complications. This report discusses a case of SBO with multiple bilateral cranial nerve abnormalities and highlights the diagnostic and management challenges in high-risk individuals with subtle clinical signs. Case presentation: This report describes a 63-year-old patient with hypertension and diabetes who underwent surgical debridement of the left ear due to malignant otitis externa 4 months prior to presentation. The patient presented with significant dysarthria, dysphagia, ptosis of the left eye with double vision, and hearing impairment in the left ear. Examination revealed bilateral CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI revealed a pathological process in the base of the skull involving bony structures and cranial nerves bilaterally, which helped diagnose SBO. The patient was subsequently discharged with oral voriconazole and continued his usual medications. The patient requested further management abroad, because he did not notice resolution of his symptoms. Surgical treatment was employed abroad to relieve his symptoms, as he recovered slowly. Conclusion: This case report underscores the importance of a multidisciplinary approach to address SBO. Collaboration between specialists in infectious diseases, otolaryngology, radiology, and neurology plays a pivotal role in achieving an accurate diagnosis and developing a tailored treatment plan. Although SBO may be infrequent, this case report highlights the need to maintain heightened clinical suspicion in high-risk individuals.
文摘The extremely complex anatomic relationships among bone, tumor, blood vessels and cranial nervesremains a big challenge for cranial base tumor surgery. Therefore, a good understanding of the patient specific anatomy and a preoperative planning are helpful and crucial for the neurosurgeons. Three dimensional （3-D） visualization of various imaging techniques have been widely explored to enhance the comprehension of volumetric data for surgical planning.
文摘This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recommended but he never completed this management. He then presented about eight years later with a mass from his left external auditory canal. It was reported that two years prior another surgeon operated on the left ear for a cholesteatoma. CT temporal bone showed complete opacification of left EAC, mastoid bowl, and remaining mastoid air cells. In addition, there were irregular bony/hyperostotic changes seen within the left sphenoid and temporal bone. There was dural thickening within the middle fossa adjacent to the previously described hyperostotic bony changes. A mastoidectomy and excision of mass revealed extensive adhesive tissue throughout the middle ear, and mastoid up to the tegmen. Pathology of the portions that were resected confirmed Grade 1 meningioma. Stereotactic gamma knife radiation was completed to the area to prevent further growth. This case highlights extracranial meningioma that did not have definitive management for prior middle fossa floor meningioma. It also highlights the need to think of less common pathology in the middle ear and external auditory canal.
文摘目的:探讨神经内镜联合颅底显微神经外科手术(cranial base micro neurosurgery,CBM)对脑肿瘤患者的影响。方法:选取2018年1月—2022年12月灵山县人民医院收治的60例脑肿瘤患者。根据单双号将其平分为试验组和对照组,各30例。对照组实施CBM治疗,试验组实施神经内镜联合CBM治疗。比较两组肿瘤切除情况及围手术期指标,术前、术后神经功能及日常生活能力、相关指标,并发症及治愈率。结果:试验组完全切除率为96.67%,高于对照组的80.00%,手术时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术后,试验组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分低于对照组,日常生活能力量表(activities of daily living,ADL)评分高于对照组,差异有统计学意义(P<0.05)。术后,试验组白细胞介素-6(interleukin-6,IL-6)、S-100β蛋白(S-lfln protein 100β,S100β)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均低于对照组,差异有统计学意义(P<0.05)。试验组并发症发生率低于对照组,治愈率高于对照组,差异有统计学意义(P<0.05)。结论:神经内镜联合CBM可以提高脑肿瘤无全切除率,改善其神经功能及生活能力,降低炎症因子水平,治愈率高,并发症少,住院时间短,预后好,安全性高。
文摘Objectives/Hypothesis: The introduction of intranasal pedicled flaps has reduced the incidence of postoperative cerebrospinal fluid (CSF) leaks to less than 5%. Nevertheless, in malignant tumors those flaps are not always available because of nasal septum invasion. Minimally invasive pericranial flaps (PCF) are associated with minimal adverse effects and good cosmetic appearance. In spite of that, there are only a few reports of this reconstructive technic limited to short surgical series and radio-anatomical analysis. Clinical results of a surgical cohort are presented. Study Design: Cohort prospective study. Methods: Clinical data, including age, gender, stage, histopathological findings, rate of complications and appearance of PCF at fifth day and two months postoperative were recorded. Postoperative morbidities were recorded as wound abnormalities, nasosinusal, orbital and central nervous system complications. Chi-squared test was used to correlate qualitative variables and Student-t-test to correlated qualitative and quantitative variables. Items were considered statistically significant with a p value of less than 0.05 (confidence Interval of 95%). Results: Thirty patients (18 males and 12 females) were registered. Mean age was 51.5 years ± 23.0 and range between 20 and 71 years. Most common histologic subtypes were adenocarcinoma, epidermoid carcinoma and squamous cell carcinoma. Complete resection of the tumor was achieved in all patients including surgical margins. Length of the PCF varies between 9.9 cm and 13.9 cm with a mean of 11.8 cm. There was an association between length of the flaps and the covering structure with the nose apex relation. None patient experienced postoperative cerebrospinal fluid (CSF) leak, frontal sinusitis or other complications. Conclusions: Minimally invasive PCF constitute a good and inexpensive reconstructive option in patients with malignant anterior cranial base tumors in whose nasoseptal flap was not a feasible option.
文摘Here we report a patient with uncontrolled diabetes, who presented with giddiness and fall due to an episode of seizure. On evaluation with CT and MRI scans, he was found to have pan sinusitis with erosions of the skull base in the floor of sphenoid near lateral recess. PET-CT showed evidence of increased metabolism. He was operated upon by functional endoscopic sinus surgery and debridement of lesion near skull base. The histopathological examination revealed evidence of inflammation with no granulomas or fungal elements or tubercle bacilli. No organisms were grown in microbiological cultures. He started on empirical antibiotics for 3 months and showed improvement. We are reporting this case due to rarity to skull base osteomyelitis.
