This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral ang...This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.展开更多
Intralabyrinthine schwannomas(ILS)are rare benign tumors,often responsible for hearing loss.MRI is important in establishing the diagnosis.We present the example of a 48-year-old lady who reported a 3-years history of...Intralabyrinthine schwannomas(ILS)are rare benign tumors,often responsible for hearing loss.MRI is important in establishing the diagnosis.We present the example of a 48-year-old lady who reported a 3-years history of right-sided sensorineural deafness.MRI demonstrated a loss of the normal hypersignal of the second turn of the right cochlea compatible with intracochlear schwannoma.展开更多
Susceptibility weighted imaging(SWI) is a recently developed magnetic resonance imaging(MRI) technique that is increasingly being used to narrow the differential diagnosis of many neurologic disorders. It exploits the...Susceptibility weighted imaging(SWI) is a recently developed magnetic resonance imaging(MRI) technique that is increasingly being used to narrow the differential diagnosis of many neurologic disorders. It exploits the magnetic susceptibility differences of various compounds including deoxygenated blood, blood products, iron and calcium, thus enabling a new source of contrast in MR. In this review, we illustrate its basic clinical applications in neuroimaging. SWI is based on a fully velocity-compensated, high-resolution, three dimensional gradientecho sequence using magnitude and phase images either separately or in combination with each other, in order to characterize brain tissue. SWI is particularly useful in the setting of trauma and acute neurologic presentations suggestive of stroke, but can also characterize occult low-flow vascular malformations, cerebral microbleeds, intracranial calcifications, neurodegenerative diseases and brain tumors. Furthermore, advanced MRI post-processing technique with quantitative susceptibility mapping, enables detailed anatomical differentiation based on quantification of brain iron from SWI raw data.展开更多
Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, he...Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial workup of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.展开更多
AIM: To evaluate the image quality of hepatic multidetector computed tomography(MDCT) with dynamic contrast enhancement. METHODS: It uses iodixanol 270 mg/m L(Visipaque 270) and 80 kVp acquisitions reconstructed with ...AIM: To evaluate the image quality of hepatic multidetector computed tomography(MDCT) with dynamic contrast enhancement. METHODS: It uses iodixanol 270 mg/m L(Visipaque 270) and 80 kVp acquisitions reconstructed with sinogram affirmed iterative reconstruction(SAFIRE?) in comparison with a standard MDCT protocol. Fiftythree consecutive patients with known or suspected hepatocellular carcinoma underwent 55 CT examinations, with two different four-phase CT protocols. The first group of 30 patients underwent a standard 120 kVp acquisition after injection of Iohexol 350 mg/m L(Accupaque 350~?) and reconstructed with filtered back projection. The second group of 25 patients underwent a dual-energy CT at 80-140 kVp with iodixanol 270. The 80 kVp component of the second group was reconstructed iteratively(SAFIRE?-Siemens). All hyperdense and hypodense hepatic lesions ≥ 5 mm were identified with both protocols. Aorta and portal vessels/liver parenchyma contrast to noise ratio(CNR) in arterial phase, hypervascular lesion/liver parenchyma CNR in arterial phase, hypodense lesion/liver parenchyma CNR in portal and late phase were calculated in both groups.RESULTS: Aorta/liver and focal lesions altogether/liver CNR were higher for the second protocol(P = 0.0078 and 0.0346). Hypervascular lesions/liver CNR was not statistically different(P = 0.86). Hypodense lesion/liver CNR in the portal phase was significantly higher for the second group(P = 0.0107). Hypodense lesion/liver CNR in the late phase was the same for both groups(P = 0.9926).CONCLUSION: MDCT imaging with 80 kVp with iterative reconstruction and iodixanol 270 yields equal or even better image quality.展开更多
The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors...The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been in-troduced, including an operating microscope in the late 1950 s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging(DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging(DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resec-tion cavity and thus overcome this remaining uncer-tainty of intraoperative MRI in high grade brain tumor resection.展开更多
Head and neck cancer(HNC) ranks as the 6th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma(HNSCC). The majority of patients present with complicated locally advanced di...Head and neck cancer(HNC) ranks as the 6th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma(HNSCC). The majority of patients present with complicated locally advanced disease(typically stage Ⅲ and Ⅳ) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Somepatients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography(CT) or magnetic resonance imaging(MRI). 18F-2-fluoro-2-deoxyD-glucose positron emission tomography/CT(18F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning.展开更多
AIM To describe the development and validation of a novel neuronavigation-based method, which allows the quan-tification of the anatomical features that define an approach, as well as real-time visualization of the su...AIM To describe the development and validation of a novel neuronavigation-based method, which allows the quan-tification of the anatomical features that define an approach, as well as real-time visualization of the surgical pyramid. METHODS The method was initially developed with commerciallyavailable hardware for coordinate collection(a digitizer and a frameless navigation system) and software for volume rendering; dedicated neuronavigation software(ApproachV iewer, part of GTx-UHN) was then developed. The accuracy of measurements and the possibility of volumetric rendering of surgical approaches simulated in a phantom were compared among three different methods and commercially-available radiological software. In the anatomy laboratory, ApproachV iewer was applied to the comparative quantitative analysis of multiple neurosurgical approaches and was used by many surgeons who were untrained for the research method.RESULTS The accuracy of ApproachV iewer is comparable to commercially-available radiological software. In the anatomy laboratory, the method appears versatile. The system can be easily used after brief training. ApproachV iewer allows for real-time evaluation and comparison of surgical approaches, as well as post-dissection analyses of collected data. The accuracy of the method depends on the navigation registration: with a 1-2 mm registration error, it is adequate for evaluation and comparison of most neurosurgical approaches.CONCLUSION This new research method and software allows semiautomated visualization, quantification, and comparison of neurosurgical approaches in the anatomy laboratory.展开更多
The pneumatization of regions such as the apex of the temporal crag, the mastoid cells and the perilaberytic region is considered physiological in adults. The process of craniocervical pneumatization in unhealthy adul...The pneumatization of regions such as the apex of the temporal crag, the mastoid cells and the perilaberytic region is considered physiological in adults. The process of craniocervical pneumatization in unhealthy adults derives from a dysfunction at the level of the eustachian tube, which provides a valve effect causing an increase in pressure at the level of the middle ear, forcing the entry of air into the dome of the skull through the opening of the occipitomastoidal suture. The process of standard pneumatization of the temporal bones, begins in the final weeks preceding birth, characterized by a decrease in the embryonic mesenchyme at the antrum level and progresses through childhood until adolescence, when the stone portion at the level of the rock is pneumatized;Normal variants have been reported, such as pneumatization that extends from the temporal scale to behind the sigmoid sinus. With regard to the process of hyperneumatization, several etiologies have been proposed that a congenital process versus an acquired process to develop this condition should be compared. The present illustrative case is a seventy-three years old male presented to the outpatient clinic with chronic recurrent occipital headache, already investigated by general practitioner for elevated blood pressure which was excluded. We had checked him to exclude the cervical spinal origin of the occipital headache which was then excluded too. This case scenario demonstrates the debate about how to deal with such cases and thus the review will bring the attention of those who take care of such radiological findings to keep in mind the possible causes and complications according to the reported cases till now. We concluded that the hyperpneumatization of the craniocervical junction is an uncommon radiological finding that is usually asymptomatic although it can entail serious complications in some instances, especially when it enlarges progressively, which may be due to an acquired process. Thus, craniocervical hyperpneumatization deserves highlighting for the managing team to gain fluent treatment and better patient outcome.展开更多
Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma(HNSCC). Imaging studies such as contrast-enhanced computed t...Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma(HNSCC). Imaging studies such as contrast-enhanced computed tomography(CT), magnetic resonance imaging(MRI) and ^(18)F-2-fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography(^(18)F-FDG PET/CT) are widely used to determine the presence and extent of tumors and metastatic disease, both before and after treatment. Advances in PET/CT imaging have allowed it to emerge as a superior imaging modality compared to both CT and MRI, especially in detection of carcinoma of unknown primary, cervical lymph node metastasis, distant metastasis, residual/recurrent cancer and second primary tumors, often leading to alteration in management. PET/CT biomarker may further provide an overall assessment of tumor aggressiveness with prognostic implications. As new developments emerged leading to better understanding and use of PET/CT in head and neck oncology, the aim of this article is to review the roles of PET/CT in both pre- and post-treatment management of HNSCC and PET-derived parameters as prognostic indicators.展开更多
Introduction: Giant cell tumor of the larynx is an uncommon entity with only 42 reported cases in the literature, of which 32 involved the thyroid cartilage. These tumors most commonly occur in the epiphysis of the lo...Introduction: Giant cell tumor of the larynx is an uncommon entity with only 42 reported cases in the literature, of which 32 involved the thyroid cartilage. These tumors most commonly occur in the epiphysis of the long bones of female patients in the third decade. Case Report: We present a 57-year-old man with hoarseness and a growing anterior neck mass for the past 5 months. Endoscopic examination revealed a submucosal swelling of the left supraglottic area. CT and MRI of the larynx showed a large, expansive mass at the left thyroid cartilage. The anterior neck mass was biopsied and histopathological analysis showed mononuclear cells and homogeneously distributed multinucleated giant cells. A giant cell tumor of the larynx was suspected. The patient underwent a supracricoid subtotal laryngectomy. Conclusion: Giant cell tumor of the larynx is an uncommon entity, with very few cases reported in the literature. These tumors should be included in the differential diagnosis of a patient with hoarseness and anterior neck swelling. There is no consensus regarding the management, although surgical excision is the most frequently employed treatment with excellent outcomes.展开更多
A 54-year-old diabetic male, with idiopathic CD4 + lymphocytopenia, was presented with a two-month history of headache and periocular pain followed by vertigo, left hypoacusia and left peripheral facial palsy and hypo...A 54-year-old diabetic male, with idiopathic CD4 + lymphocytopenia, was presented with a two-month history of headache and periocular pain followed by vertigo, left hypoacusia and left peripheral facial palsy and hypoesthesia. More than a month after admission, a palate ulcer appeared and Infectious Diseases consultation was required. Mucormycosis was suspected and the diagnosis was confirmed by histologic examination. Despite early surgery and combination antifungal therapy, the patient did not survive. This case report illustrates the difficulty in diagnosing a rare condition with non-specific clinical manifestations and underlines the importance of a timely multidisciplinary approach in order to recognise this highly fatal disease earlier. It also describes a previously non-reported situation of mucormycosis in a patient with idiopathic CD4 + lymphocytopenia.展开更多
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major oppo...Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major opportunistic infection associated with HIV infection. We report a case of a previously healthy patient who was diagnosed with PML.展开更多
Background and purpose The safety and effectiveness of endovascular treatment for non-Galenic pial arteriovenous fistula(NGPAVF)is inadequately known.The aim of this study is to explore the role of endovascular emboli...Background and purpose The safety and effectiveness of endovascular treatment for non-Galenic pial arteriovenous fistula(NGPAVF)is inadequately known.The aim of this study is to explore the role of endovascular embolisation for curative treatment of NGPAVF.Materials and methods Patients with NGPAVF underwent endovascular treatment from January 2011 to November 2019 in our institution were retrospectively reviewed.Demographics,clinical information,treatment details and clinical outcomes were collected.Factors associated with clinical outcomes were statistically analysed.Results Twenty patients were included,with a total of 22(2 patients have 2 fistulas)lesions.A total of 25 procedures were performed and 5 patients underwent 2 procedures.Follow-up ranged from 3 to 84 months(mean=34.5 months).Thirteen(59.1%)lesions in 12(60.0%)patients acquired immediate occlusion after initial treatment(immediately occluded group)and follow-up confirmed the complete obliteration.A total of 17(77.3%)lesions in 15(75.0%)patients were cured at last follow-up.The maximal diameter of feeding arteries(p=0.04)and the maximal diameter of the varix(p=0.01)in immediately occluded group was smaller than non-immediately occluded group.The number of feeding artery(p=0.004)and the maximal diameter of the varix(p<0.001)were much smaller in curative group than non-curative group.Seven patients suffered procedure-related complications.No patients had an increased Modified Rankin Scale(mRS)and all patients had favourable clinical outcome(mRS≥2)at last follow-up.Conclusions Endovascular therapy plays an important role in curative treatment of NGPAVF.Patients with less feeding arteries and small varix may be easier to be cured by endovascular embolisation.展开更多
文摘This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.
文摘Intralabyrinthine schwannomas(ILS)are rare benign tumors,often responsible for hearing loss.MRI is important in establishing the diagnosis.We present the example of a 48-year-old lady who reported a 3-years history of right-sided sensorineural deafness.MRI demonstrated a loss of the normal hypersignal of the second turn of the right cochlea compatible with intracochlear schwannoma.
文摘Susceptibility weighted imaging(SWI) is a recently developed magnetic resonance imaging(MRI) technique that is increasingly being used to narrow the differential diagnosis of many neurologic disorders. It exploits the magnetic susceptibility differences of various compounds including deoxygenated blood, blood products, iron and calcium, thus enabling a new source of contrast in MR. In this review, we illustrate its basic clinical applications in neuroimaging. SWI is based on a fully velocity-compensated, high-resolution, three dimensional gradientecho sequence using magnitude and phase images either separately or in combination with each other, in order to characterize brain tissue. SWI is particularly useful in the setting of trauma and acute neurologic presentations suggestive of stroke, but can also characterize occult low-flow vascular malformations, cerebral microbleeds, intracranial calcifications, neurodegenerative diseases and brain tumors. Furthermore, advanced MRI post-processing technique with quantitative susceptibility mapping, enables detailed anatomical differentiation based on quantification of brain iron from SWI raw data.
文摘Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial workup of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.
文摘AIM: To evaluate the image quality of hepatic multidetector computed tomography(MDCT) with dynamic contrast enhancement. METHODS: It uses iodixanol 270 mg/m L(Visipaque 270) and 80 kVp acquisitions reconstructed with sinogram affirmed iterative reconstruction(SAFIRE?) in comparison with a standard MDCT protocol. Fiftythree consecutive patients with known or suspected hepatocellular carcinoma underwent 55 CT examinations, with two different four-phase CT protocols. The first group of 30 patients underwent a standard 120 kVp acquisition after injection of Iohexol 350 mg/m L(Accupaque 350~?) and reconstructed with filtered back projection. The second group of 25 patients underwent a dual-energy CT at 80-140 kVp with iodixanol 270. The 80 kVp component of the second group was reconstructed iteratively(SAFIRE?-Siemens). All hyperdense and hypodense hepatic lesions ≥ 5 mm were identified with both protocols. Aorta and portal vessels/liver parenchyma contrast to noise ratio(CNR) in arterial phase, hypervascular lesion/liver parenchyma CNR in arterial phase, hypodense lesion/liver parenchyma CNR in portal and late phase were calculated in both groups.RESULTS: Aorta/liver and focal lesions altogether/liver CNR were higher for the second protocol(P = 0.0078 and 0.0346). Hypervascular lesions/liver CNR was not statistically different(P = 0.86). Hypodense lesion/liver CNR in the portal phase was significantly higher for the second group(P = 0.0107). Hypodense lesion/liver CNR in the late phase was the same for both groups(P = 0.9926).CONCLUSION: MDCT imaging with 80 kVp with iterative reconstruction and iodixanol 270 yields equal or even better image quality.
文摘The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been in-troduced, including an operating microscope in the late 1950 s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging(DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging(DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resec-tion cavity and thus overcome this remaining uncer-tainty of intraoperative MRI in high grade brain tumor resection.
文摘Head and neck cancer(HNC) ranks as the 6th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma(HNSCC). The majority of patients present with complicated locally advanced disease(typically stage Ⅲ and Ⅳ) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Somepatients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography(CT) or magnetic resonance imaging(MRI). 18F-2-fluoro-2-deoxyD-glucose positron emission tomography/CT(18F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning.
基金Supported by Fondazione"Giuseppe Alazio",via Torquato Tasso,22,90144 Palermo,Italy(to Doglietto F)
文摘AIM To describe the development and validation of a novel neuronavigation-based method, which allows the quan-tification of the anatomical features that define an approach, as well as real-time visualization of the surgical pyramid. METHODS The method was initially developed with commerciallyavailable hardware for coordinate collection(a digitizer and a frameless navigation system) and software for volume rendering; dedicated neuronavigation software(ApproachV iewer, part of GTx-UHN) was then developed. The accuracy of measurements and the possibility of volumetric rendering of surgical approaches simulated in a phantom were compared among three different methods and commercially-available radiological software. In the anatomy laboratory, ApproachV iewer was applied to the comparative quantitative analysis of multiple neurosurgical approaches and was used by many surgeons who were untrained for the research method.RESULTS The accuracy of ApproachV iewer is comparable to commercially-available radiological software. In the anatomy laboratory, the method appears versatile. The system can be easily used after brief training. ApproachV iewer allows for real-time evaluation and comparison of surgical approaches, as well as post-dissection analyses of collected data. The accuracy of the method depends on the navigation registration: with a 1-2 mm registration error, it is adequate for evaluation and comparison of most neurosurgical approaches.CONCLUSION This new research method and software allows semiautomated visualization, quantification, and comparison of neurosurgical approaches in the anatomy laboratory.
文摘The pneumatization of regions such as the apex of the temporal crag, the mastoid cells and the perilaberytic region is considered physiological in adults. The process of craniocervical pneumatization in unhealthy adults derives from a dysfunction at the level of the eustachian tube, which provides a valve effect causing an increase in pressure at the level of the middle ear, forcing the entry of air into the dome of the skull through the opening of the occipitomastoidal suture. The process of standard pneumatization of the temporal bones, begins in the final weeks preceding birth, characterized by a decrease in the embryonic mesenchyme at the antrum level and progresses through childhood until adolescence, when the stone portion at the level of the rock is pneumatized;Normal variants have been reported, such as pneumatization that extends from the temporal scale to behind the sigmoid sinus. With regard to the process of hyperneumatization, several etiologies have been proposed that a congenital process versus an acquired process to develop this condition should be compared. The present illustrative case is a seventy-three years old male presented to the outpatient clinic with chronic recurrent occipital headache, already investigated by general practitioner for elevated blood pressure which was excluded. We had checked him to exclude the cervical spinal origin of the occipital headache which was then excluded too. This case scenario demonstrates the debate about how to deal with such cases and thus the review will bring the attention of those who take care of such radiological findings to keep in mind the possible causes and complications according to the reported cases till now. We concluded that the hyperpneumatization of the craniocervical junction is an uncommon radiological finding that is usually asymptomatic although it can entail serious complications in some instances, especially when it enlarges progressively, which may be due to an acquired process. Thus, craniocervical hyperpneumatization deserves highlighting for the managing team to gain fluent treatment and better patient outcome.
文摘Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma(HNSCC). Imaging studies such as contrast-enhanced computed tomography(CT), magnetic resonance imaging(MRI) and ^(18)F-2-fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography(^(18)F-FDG PET/CT) are widely used to determine the presence and extent of tumors and metastatic disease, both before and after treatment. Advances in PET/CT imaging have allowed it to emerge as a superior imaging modality compared to both CT and MRI, especially in detection of carcinoma of unknown primary, cervical lymph node metastasis, distant metastasis, residual/recurrent cancer and second primary tumors, often leading to alteration in management. PET/CT biomarker may further provide an overall assessment of tumor aggressiveness with prognostic implications. As new developments emerged leading to better understanding and use of PET/CT in head and neck oncology, the aim of this article is to review the roles of PET/CT in both pre- and post-treatment management of HNSCC and PET-derived parameters as prognostic indicators.
文摘Introduction: Giant cell tumor of the larynx is an uncommon entity with only 42 reported cases in the literature, of which 32 involved the thyroid cartilage. These tumors most commonly occur in the epiphysis of the long bones of female patients in the third decade. Case Report: We present a 57-year-old man with hoarseness and a growing anterior neck mass for the past 5 months. Endoscopic examination revealed a submucosal swelling of the left supraglottic area. CT and MRI of the larynx showed a large, expansive mass at the left thyroid cartilage. The anterior neck mass was biopsied and histopathological analysis showed mononuclear cells and homogeneously distributed multinucleated giant cells. A giant cell tumor of the larynx was suspected. The patient underwent a supracricoid subtotal laryngectomy. Conclusion: Giant cell tumor of the larynx is an uncommon entity, with very few cases reported in the literature. These tumors should be included in the differential diagnosis of a patient with hoarseness and anterior neck swelling. There is no consensus regarding the management, although surgical excision is the most frequently employed treatment with excellent outcomes.
文摘A 54-year-old diabetic male, with idiopathic CD4 + lymphocytopenia, was presented with a two-month history of headache and periocular pain followed by vertigo, left hypoacusia and left peripheral facial palsy and hypoesthesia. More than a month after admission, a palate ulcer appeared and Infectious Diseases consultation was required. Mucormycosis was suspected and the diagnosis was confirmed by histologic examination. Despite early surgery and combination antifungal therapy, the patient did not survive. This case report illustrates the difficulty in diagnosing a rare condition with non-specific clinical manifestations and underlines the importance of a timely multidisciplinary approach in order to recognise this highly fatal disease earlier. It also describes a previously non-reported situation of mucormycosis in a patient with idiopathic CD4 + lymphocytopenia.
文摘Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major opportunistic infection associated with HIV infection. We report a case of a previously healthy patient who was diagnosed with PML.
基金supported by the National Key Research and Development Program of China(Grant No.2017YFB1304400)。
文摘Background and purpose The safety and effectiveness of endovascular treatment for non-Galenic pial arteriovenous fistula(NGPAVF)is inadequately known.The aim of this study is to explore the role of endovascular embolisation for curative treatment of NGPAVF.Materials and methods Patients with NGPAVF underwent endovascular treatment from January 2011 to November 2019 in our institution were retrospectively reviewed.Demographics,clinical information,treatment details and clinical outcomes were collected.Factors associated with clinical outcomes were statistically analysed.Results Twenty patients were included,with a total of 22(2 patients have 2 fistulas)lesions.A total of 25 procedures were performed and 5 patients underwent 2 procedures.Follow-up ranged from 3 to 84 months(mean=34.5 months).Thirteen(59.1%)lesions in 12(60.0%)patients acquired immediate occlusion after initial treatment(immediately occluded group)and follow-up confirmed the complete obliteration.A total of 17(77.3%)lesions in 15(75.0%)patients were cured at last follow-up.The maximal diameter of feeding arteries(p=0.04)and the maximal diameter of the varix(p=0.01)in immediately occluded group was smaller than non-immediately occluded group.The number of feeding artery(p=0.004)and the maximal diameter of the varix(p<0.001)were much smaller in curative group than non-curative group.Seven patients suffered procedure-related complications.No patients had an increased Modified Rankin Scale(mRS)and all patients had favourable clinical outcome(mRS≥2)at last follow-up.Conclusions Endovascular therapy plays an important role in curative treatment of NGPAVF.Patients with less feeding arteries and small varix may be easier to be cured by endovascular embolisation.
