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Sample records for posterior fossa tumors

  1. Posterior fossa tumor

    MedlinePlus

    ... of the posterior fossa, it can block the flow of spinal fluid and cause increased pressure on the brain and ... the cancer early. A total blockage in the flow of spinal fluid can be life threatening. If tumors are found ...

  2. Trigeminal neuralgia secondary to posterior fossa tumor.

    PubMed

    Agrawal, Mamta; Agrawal, Vikrant; Agrawal, Rajiv; Pramod, D S R

    2010-01-01

    Trigeminal neuralgia (TN) is by no means an uncommon entity presenting as typical or atypical pain syndrome with a standard treatment protocol consisting of medical and surgical therapies. The diagnosis of TN is mainly dependent on the characteristics of symptoms conveyed by the patient and the clinical presentation. Careful history taking, proper interpretation of the signs and symptoms and cranial nerve assessment are necessary for proper diagnosis. Here, we report a case of TN, treated for dental problems and then for neuralgia with only short-term relief. Subsequently, the patient underwent neuroimaging and was found to be having an uncommon space-occupying lesion in the posterior cranial fossa. PMID:22442556

  3. Intensity-Modulated Arc Therapy for Pediatric Posterior Fossa Tumors

    SciTech Connect

    Beltran, Chris; Gray, Jonathan; Merchant, Thomas E.

    2012-02-01

    Purpose: To compare intensity-modulated arc therapy (IMAT) to noncoplanar intensity-modulated radiation therapy (IMRT) in the treatment of pediatric posterior fossa tumors. Methods and Materials: Nine pediatric patients with posterior fossa tumors, mean age 9 years (range, 6-15 years), treated using IMRT were chosen for this comparative planning study because of their tumor location. Each patient's treatment was replanned to receive 54 Gy to the planning target volume (PTV) using five different methods: eight-field noncoplanar IMRT, single coplanar IMAT, double coplanar IMAT, single noncoplanar IMAT, and double noncoplanar IMAT. For each method, the dose to 95% of the PTV was held constant, and the doses to surrounding critical structures were minimized. The different plans were compared based on conformity, total linear accelerator dose monitor units, and dose to surrounding normal tissues, including the entire body, whole brain, temporal lobes, brainstem, and cochleae. Results: The doses to the target and critical structures for the various IMAT methods were not statistically different in comparison with the noncoplanar IMRT plan, with the following exceptions: the cochlear doses were higher and whole brain dose was lower for coplanar IMAT plans; the cochleae and temporal lobe doses were lower and conformity increased for noncoplanar IMAT plans. The advantage of the noncoplanar IMAT plan was enhanced by doubling the treatment arc. Conclusion: Noncoplanar IMAT results in superior treatment plans when compared to noncoplanar IMRT for the treatment of posterior fossa tumors. IMAT should be considered alongside IMRT when treatment of this site is indicated.

  4. Neurobehavioral alterations in an adolescent following posterior fossa tumor resection.

    PubMed

    Baillieux, Hanne; De Smet, Hyo Jung; Lesage, Geoffrey; Paquier, Philippe; De Deyn, Peter P; Mariën, Peter

    2006-01-01

    The posterior fossa syndrome (PFS) consists of a variety of symptoms, including cerebellar mutism, behavioral disturbances and personality changes. We report longitudinal clinical, neuroradiological and neurobehavioral findings in a 19-year-old left-handed patient, diagnosed with attentional deficit hyperactivity disorder (ADHD) at the age of 12, who underwent posterior fossa tumor resection. Although the patient did not develop cerebellar mutism after surgery, marked apathy and emotional indifference, urinary retention, eye-lid apraxia and visual hallucinosis became apparent after a brief interval of normal functioning. Based on these findings it is argued that the PFS might be considered a semiological heterogeneous condition with variable clinical expressions. Long-term follow-up investigations revealed subtle, but significant cognitive and affective deficits, resembling the cerebellar cognitive affective syndrome in adults. As demonstrated by functional neuroimaging studies with SPECT, symptoms were associated with perfusional deficits in the anatomoclinically suspected supratentorial regions, reflecting the distant impact of the cerebellum on cognitive and affective functions. PMID:17134992

  5. Supratentorial Neurometabolic Alterations in Pediatric Survivors of Posterior Fossa Tumors

    SciTech Connect

    Rueckriegel, Stefan M.; Driever, Pablo Hernaiz; Bruhn, Harald

    2012-03-01

    Purpose: Therapy and tumor-related effects such as hypoperfusion, internal hydrocephalus, chemotherapy, and irradiation lead to significant motor and cognitive sequelae in pediatric posterior fossa tumor survivors. A distinct proportion of those factors related to the resulting late effects is hitherto poorly understood. This study aimed at separating the effects of neurotoxic factors on central nervous system metabolism by using H-1 MR spectroscopy to quantify cerebral metabolite concentrations in these patients in comparison to those in age-matched healthy peers. Methods and Materials: Fifteen patients with World Health Organization (WHO) I pilocytic astrocytoma (PA) treated by resection only, 24 patients with WHO IV medulloblastoma (MB), who additionally received chemotherapy and craniospinal irradiation, and 43 healthy peers were investigated using single-volume H-1 MR spectroscopy of parietal white matter and gray matter. Results: Concentrations of N-acetylaspartate (NAA) were significantly decreased in white matter (p < 0.0001) and gray matter (p < 0.0001) of MB patients and in gray matter (p = 0.005) of PA patients, compared to healthy peers. Decreased creatine concentrations in parietal gray matter correlated significantly with older age at diagnosis in both patient groups (MB patients, p = 0.009, r = 0.52; PA patients, p = 0.006, r = 0.7). Longer time periods since diagnosis were associated with lower NAA levels in white matter of PA patients (p = 0.008, r = 0.66). Conclusions: Differently decreased NAA concentrations were observed in both PA and MB groups of posterior fossa tumor patients. We conclude that this reflects a disturbance of the neurometabolic steady state of normal-appearing brain tissue due to the tumor itself and to the impact of surgery in both patient groups. Further incremental decreases of metabolite concentrations in MB patients may point to additional harm caused by irradiation and chemotherapy. The stronger decrease of NAA in MB

  6. Typical trigeminal neuralgia associated with posterior cranial fossa tumors.

    PubMed

    Puca, A; Meglio, M

    1993-10-01

    A clinical diagnosis of typical trigeminal neuralgia does not rule out the possibility of a space-occupying lesion compressing the nerve along its course from the brainstem to Meckel's cave. 4 cases of typical trigeminal neuralgia, treated medically for several years and seen here recently before a space-occupying lesion was found in the posterior cranial fossa, point up the need for thorough neurological and neuroradiological examination of all patients with the typical symptoms. Lesion removal resulted in total relief from pain in 3 patients. In the fourth patient the pain was controlled by percutaneous surgery with thermocoagulation of the gasserian ganglion. PMID:8282526

  7. Pathology, treatment and management of posterior fossa brain tumors in childhood

    SciTech Connect

    Bonner, K.; Siegel, K.R.

    1988-04-01

    Brain tumors are the second most common childhood malignancy. Between 1975 and 1985, 462 newly diagnosed patients were treated at the Children's Hospital of Philadelphia; 207 (45%) tumors arose in the posterior fossa and 255 (55%) appeared supratentorially. A wide variety of histological subtypes were seen, each requiring tumor-specific treatment approaches. These included primitive neuroectodermal tumor (n = 86, 19%), astrocytoma (n = 135, 30%), brainstem glioma (n = 47, 10%), anaplastic astrocytoma (n = 32, 7%), and ependymoma (n = 30, 6%). Because of advances in diagnostic abilities, surgery, radiotherapy, and chemotherapy, between 60% and 70% of these patients are alive today. Diagnostic tools such as computed tomography and magnetic resonance imaging allow for better perioperative management and follow-up, while the operating microscope, CO/sub 2/ laser, cavitron ultrasonic aspirator and neurosurgical microinstrumentation allow for more extensive and safer surgery. Disease specific treatment protocols, utilizing radiotherapy and adjuvant chemotherapy, have made survival common in tumors such as medulloblastoma. As survival rates increase, cognitive, endocrinologic and psychologic sequelae become increasingly important. The optimal management of children with brain tumors demands a multidisciplinary approach, best facilitated by a neuro-oncology team composed of multiple subspecialists. This article addresses incidence, classification and histology, clinical presentation, diagnosis, pre-, intra- and postoperative management, long-term effects and the team approach in posterior fossa tumors in childhood. Management of specific tumor types is included as well. 57 references.

  8. Functional and neuropsychological late outcomes in posterior fossa tumors in children.

    PubMed

    Lassaletta, Alvaro; Bouffet, Eric; Mabbott, Donald; Kulkarni, Abhaya V

    2015-10-01

    Tumors of the posterior fossa (PF) account for up to 60 % of all childhood intracranial tumors. Over the last decades, the mortality rate of children with posterior fossa tumors has gradually decreased. While survival has been the primary objective in most reports, quality of survival increasingly appears to be an important indicator of a successful outcome. Children with a PF tumor can sustain damage to the cerebellum and other brain structures from the tumor itself, concomitant hydrocephalus, the consequences of treatment (surgery, chemotherapy, radiotherapy), or a combination of these factors. Together, these contribute to long-term sequelae in physical functioning, neuropsychological late outcomes (including academic outcome, working memory, perception and estimation of time, and selective attention, long-term neuromotor speech deficits, and executive functioning). Long-term quality of life can also be affected by endocrinological complication or the occurrence of secondary tumors. A significant proportion of survivors of PF tumors require long-term special education services and have reduced rates of high school graduation and employment. Interventions to improve neuropsychological functioning in childhood PF tumor survivors include (1) pharmacological interventions (such as methylphenidate, modafinil, or donepezil), (2) cognitive remediation, and (3) home-based computerized cognitive training. In order to achieve the best possible outcome for survivors, and ultimately minimize long-term complications, new interventions must be developed to prevent and ameliorate the neuro-toxic effects experienced by these children. PMID:26351237

  9. Late effects of treatment on the intelligence of children with posterior fossa tumors

    SciTech Connect

    Duffner, P.K.; Cohen, M.E.; Thomas, P.

    1983-01-15

    This retrospective pilot study was undertaken to evaluate the late effects of treatment on intelligence in a population of children with posterior fossa tumors. Ten children with posterior fossa tumors treated with radiation and chemotherapy received intellectual evaluations at least one year following diagnosis. Six children had medulloblastomas, one child had a fourth ventricular ependymoma, two children had brainstem gliomas, and one child had a recurrent cerebellar astrocytoma. Children with supratentorial tumors were specifically excluded from the study in order to eliminate the possible influence of the tumor on intellectual functioning. Four children had had intelligence testing in school prior to treatment of their tumor. In each case results following treatment revealed a deterioration of full scale IQ of at least 25 points. Six children did not have prior testing; of these, two had IQ's less than 20. Overall, 50% of the patients had IQ's of less than 80 and 20% had IQ's of greater than 100. Furthermore, four children with normal intelligence (IQ greater than 80) have learning problems requiring special classes. Thus, of the ten children evaluated, all have either dementia, learning disabilities, or evidence of intellectual retardation. This study suggests that aggressive treatment of children with brain tumors may improve survivals but may be associated with significant long-term disabilities.

  10. Cranial magnetic resonance imaging findings of leptomeningeal contrast enhancement after pediatric posterior fossa tumor resection and its significance.

    PubMed

    Loree, Jonathan; Mehta, Vivek; Bhargava, Ravi

    2010-07-01

    In this report, the authors illustrate the potential shortfalls of early postoperative MR imaging following resection of a posterior fossa tumor. The authors present the cases of a 10-month-old boy and a 14-year-old boy with posterior fossa tumors that were surgically resected and monitored immediately postoperatively with MR imaging. The MR imaging study obtained immediately postresection while the children were still anesthetized revealed enhancing elements in both patients, which were suggestive of leptomeningeal metastases. When this signal was followed on subsequent MR images, it was no longer visible. The patients are both recurrence free at the time of this publication. These cases demonstrate that early postoperative MR imaging findings for leptomeningeal metastases may be unreliable after excision of posterior fossa tumors and may have potential implications for intraoperative MR imaging techniques currently under development. PMID:20593993

  11. Multifractal modeling, segmentation, prediction, and statistical validation of posterior fossa tumors

    NASA Astrophysics Data System (ADS)

    Islam, Atiq; Iftekharuddin, Khan M.; Ogg, Robert J.; Laningham, Fred H.; Sivakumar, Bhuvaneswari

    2008-03-01

    In this paper, we characterize the tumor texture in pediatric brain magnetic resonance images (MRIs) and exploit these features for automatic segmentation of posterior fossa (PF) tumors. We focus on PF tumor because of the prevalence of such tumor in pediatric patients. Due to varying appearance in MRI, we propose to model the tumor texture with a multi-fractal process, such as a multi-fractional Brownian motion (mBm). In mBm, the time-varying Holder exponent provides flexibility in modeling irregular tumor texture. We develop a detailed mathematical framework for mBm in two-dimension and propose a novel algorithm to estimate the multi-fractal structure of tissue texture in brain MRI based on wavelet coefficients. This wavelet based multi-fractal feature along with MR image intensity and a regular fractal feature obtained using our existing piecewise-triangular-prism-surface-area (PTPSA) method, are fused in segmenting PF tumor and non-tumor regions in brain T1, T2, and FLAIR MR images respectively. We also demonstrate a non-patient-specific automated tumor prediction scheme based on these image features. We experimentally show the tumor discriminating power of our novel multi-fractal texture along with intensity and fractal features in automated tumor segmentation and statistical prediction. To evaluate the performance of our tumor prediction scheme, we obtain ROCs and demonstrate how sharply the curves reach the specificity of 1.0 sacrificing minimal sensitivity. Experimental results show the effectiveness of our proposed techniques in automatic detection of PF tumors in pediatric MRIs.

  12. Diffusion tensor imaging in evaluation of posterior fossa tumors in children on a 3T MRI scanner

    PubMed Central

    Assis, Zarina Abdul; Saini, Jitender; Ranjan, Manish; Gupta, Arun Kumar; Sabharwal, Paramveer; Naidu, Purushotham R

    2015-01-01

    Context: Primary intracranial tumors in children are commonly located in the posterior fossa. Conventional MRI offers limited information regarding the histopathological type of tumor which is essential for better patient management. Aims: The purpose of the study was to evaluate the usefulness of advanced MR imaging techniques like diffusion tensor imaging (DTI) in distinguishing the various histopathological types of posterior fossa tumors in children. Settings and Design: DTI was performed on a 3T MRI scanner in 34 untreated children found to have posterior fossa lesions. Materials and Methods: Using third party software, various DTI parameters [apparent diffusion coefficient (ADC), fractional anisotropy (FA), radial diffusivity, planar index, spherical index, and linear index] were calculated for the lesion. Statistical Analysis Used: Data were subjected to statistical analysis [analysis of variance (ANOVA)] using SPSS 15.0 software. Results: We observed significant correlation (P < 0.01) between ADC mean and maximum, followed by radial diffusivity (RD) with the histopathological types of the lesions. Rest of the DTI parameters did not show any significant correlation in our study. Conclusions: The results of our study support the hypothesis that most cellular tumors and those with greater nuclear area like medulloblastoma would have the lowest ADC values, as compared to less cellular tumors like pilocytic astrocytoma. PMID:26752824

  13. No-glucose strategy influences posterior cranial fossa tumors' postoperative course: introducing the Glycemic Stress Index.

    PubMed

    Pietrini, Domenico; Di Rocco, Concezio; Di Bartolomeo, Rossella; Conti, Giorgio; Ranelletti, Franco O; De Luca, Daniele; Tosi, Federica; Mensi, Sonia; D'Arrigo, Sonia; Piastra, Marco

    2009-07-01

    In a selected patient population, we evaluated the glycemic response to different infusional policies in the management of posterior cranial fossa tumor (PFT) removal. We analyzed the perioperative course, prospectically collected, of 137 children undergoing 150 surgical procedures. Patients were divided in two groups according to different intraoperative fluids (group A, 2.5% glucose; group B, crystalloids). In group B glycemia remained below 125 mg dl(-1), while group A showed persistently supranormal glycemic plasma values, reaching statistical significance at the end of surgery (P < 0.018). As no perioperative mortality occurred and no differences were found between groups regarding PICU respiratory or infectious complications, PICU length of stay (LOS) was assumed as the main outcome indicator. LOS was not influenced by group A or B inclusion, while a new indicator, namely the Glycemic Stress Index (GSI), representing both glycemic intraoperative change and procedure length, showed significantly different results in the study groups (P = 0.004). Our clinical experience suggests that both intraoperative glucose-free solutions are safe, and GSI can be a useful tool to identify prolonged PICU stay patients. PMID:19199005

  14. Triad of torticollis, photophobia and epiphora in a child with a posterior fossa tumor

    PubMed Central

    Buijsrogge, Michiel; Dauwe, Caroline; Delbeke, Patricia

    2014-01-01

    A 7-month-old Caucasian girl presented with an acquired, spasmodic torticollis to the right side with the head tilted downwards, photophobia and epiphora. Diagnostic work-out revealed a posterior fossa pilocytic astrocytoma. The symptoms improved after surgical resection. There is evidence of internuclear connections between cranial nerves II, V and VII acting as important mechanisms in this triad (Okamoto et al. 2010).

  15. Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology.

    PubMed

    Pollack, I F; Polinko, P; Albright, A L; Towbin, R; Fitz, C

    1995-11-01

    MUTISM AND A variety of other neurobehavioral symptoms have been reported anecdotally after the removal of posterior fossa mass lesions. To determine the incidence and clinical spectrum of this syndrome, a detailed review was performed of patients undergoing resection of infratentorial tumors at our institution during the last 9 years; 12 of 142 patients (8.5%) manifested this syndrome, the largest series of such patients reported to date. Each child had a lesion that involved the vermis; seven had medulloblastomas, three had astrocytomas, and two had ependymomas. The incidence among children with vermian neoplasms was 13%. Ten children underwent division of the inferior vermis during tumor resection, and three had a superior vermian incision; one child underwent both superior and inferior vermian incisions. In 10 children, mutism developed in a delayed fashion postoperatively. The speech disturbance was associated with poor oral intake in 9 children, urinary retention in 5, long-tract signs in 6, and bizarre personality changes, emotional lability, and/or decreased initiation of voluntary movements in all 12. Neuropsychiatric testing, performed in seven children, confirmed impairments not only in speech but also in initiation of other motor activities. Ten children regained normal speech, bladder control, and neurological functioning, other than ataxia and mild dysarthria, within 1 to 16 weeks; two children had significant residual deficits. Characteristically, affect and oral intake returned to their preoperative baseline before the speech difficulties began to resolve. A detailed radiological review of these cases in parallel with 24 cases of vermian tumors without mutism identified only one factor that was significantly associated with the mutism syndrome, bilateral edema within the brachium pontis (P < 0.01). Neither the size of the tumor nor the length of vermian incision was associated with the development of mutism. The clinical features of this syndrome in

  16. Stereolithography for Posterior Fossa Cranioplasty

    PubMed Central

    Agner, Celso; Dujovny, Manuel; Evenhouse, Raymond; Charbel, Fady T.; Sadler, Lewis

    1998-01-01

    Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17171056

  17. Posterior fossa lesions associated with neuropsychiatric symptomatology.

    PubMed

    Pollak, L; Klein, C; Rabey, J M; Schiffer, J

    1996-11-01

    We reviewed 7 cases with posterior fossa structural abnormalities (3 tumors, 2 megacisterna magna and 2 Dandy-Walker syndrome) presenting with neuropsychiatric symptomatology. Derangement in the balance of dopamine, serotonin and noradrenergic networks has been implicated in the pathogenesis of schizophrenia, affective and even personality disorders. Disruption of the cerebellar output to mesial dopaminergic areas, locus coeruleus and raphe nuclei, or deafferentation of the thalamolimbic circuits by a cerebellar lesion may lead to behavioral changes. Seven patients (pts) (comprising 4 men and 3 women with mean age 22 years) were diagnosed as suffering from psychosis (2 pts), major depression (1 pt), personality disorders (2 pts) and somatoform disorders (2 pts) (DSM-IV criteria). Brain CT scan (7 pts) and MRI (4 pts) revealed tumors of the posterior fossa (2 pts), megacisterna magna (2 pts) and Dandy-Walker variant (2 pts). In one patient a IVth ventricle tumor was removed in childhood. PMID:9003973

  18. Post-operative intra-spinal subdural collections after pediatric posterior fossa tumor resection: Incidence, imaging and clinical features

    PubMed Central

    Harreld, Julie H; Mohammed, Noryati; Goldsberry, Grant; Li, Xingyu; Li, Yimei; Boop, Frederick; Patay, Zoltan

    2015-01-01

    Purpose Post-operative intra-spinal subdural collections (PISC) in children after posterior fossa tumor resection may temporarily hinder metastasis detection by MRI or CSF analysis, potentially impacting therapy. We investigated incidence, imaging and clinical features, predisposing factors and time course of PISC after posterior fossa tumor resection. Materials and Methods Retrospective IRB-approved review of post-operative spine MRIs in 243 children (5.5±4.6 years) from our clinical database post-resection of posterior fossa tumors from October 1994-August 2010 yielded 37 (6.0±4.8 years old) PISC+ subjects. Extent and signal properties of PISC were recorded for post-operative (37/37), pre-operative (15/37) and follow-up spine MRIs (35/37). Risk factors were compared to age-matched internal controls (n=37, 5.9±4.5 years). Associations of histology, hydrocephalus and cerebellar tonsillar herniation and post-operative intracranial subdural collections with PISC were assessed by Fisher’s exact test or Chi-square test. Association between pre-operative tumor volume and PISC was assessed by Wilcoxon rank sum test. Results The overall incidence of PISC was 37/243 (15.2%), greatest ≤7 days post-operatively (36%). 97% of PISC were seen 0–41 days post-operatively (12.9±11.0 days). PISC were T2 hyper-intense, iso-intense to CSF on T1WI, homogeneously enhanced and resolved on follow-up MRI (35/35). None were symptomatic. PISC were associated with intracranial subdural collections (p=0.0011) and pre-operative tonsillar herniation (p=0.0228). Conclusion PISC are infrequent, clinically silent and resolve spontaneously, and have a distinctive appearance. Pre-operative tonsillar herniation appears to be a predisposing factor. In this series, repeat MRI by 4 weeks documented improvement or resolution of PISC in 88%. PMID:25614472

  19. Congenital basis of posterior fossa anomalies

    PubMed Central

    Cotes, Claudia; Bonfante, Eliana; Lazor, Jillian; Jadhav, Siddharth; Caldas, Maria; Swischuk, Leonard

    2015-01-01

    The classification of posterior fossa congenital anomalies has been a controversial topic. Advances in genetics and imaging have allowed a better understanding of the embryologic development of these abnormalities. A new classification schema correlates the embryologic, morphologic, and genetic bases of these anomalies in order to better distinguish and describe them. Although they provide a better understanding of the clinical aspects and genetics of these disorders, it is crucial for the radiologist to be able to diagnose the congenital posterior fossa anomalies based on their morphology, since neuroimaging is usually the initial step when these disorders are suspected. We divide the most common posterior fossa congenital anomalies into two groups: 1) hindbrain malformations, including diseases with cerebellar or vermian agenesis, aplasia or hypoplasia and cystic posterior fossa anomalies; and 2) cranial vault malformations. In addition, we will review the embryologic development of the posterior fossa and, from the perspective of embryonic development, will describe the imaging appearance of congenital posterior fossa anomalies. Knowledge of the developmental bases of these malformations facilitates detection of the morphological changes identified on imaging, allowing accurate differentiation and diagnosis of congenital posterior fossa anomalies. PMID:26246090

  20. Trans aqueductal, third ventricle – Cervical subarachnoid stenting: An adjuvant cerebro spinal fluid diversion procedure in midline posterior fossa tumors with hydrocephalus: The technical note and case series

    PubMed Central

    Teegala, Ramesh

    2016-01-01

    Background: Persistent or progressive hydrocephalus is one of the complex problems of posterior fossa tumors associated with hydrocephalus. The author evaluated the effectiveness of single-stage tumor decompression associated with a stent technique (trans aqueductal third ventricle – Cervical subarachnoid stenting) as an adjuvant cerebro spinal fluid (CSF) diversion procedure in controlling the midline posterior fossa tumors with hydrocephalus. Materials and Methods: Prospective clinical case series of 15 patients was evaluated from July 2006 to April 2012. Fifteen clinicoradiological diagnosed cases of midline posterior fossa tumors with hydrocephalus were included in this study. All the tumors were approached through the cerebello medullary (telo velo tonsilar) fissure technique. Following the excision of the posterior fossa tumor, a sizable stent was placed across the aqueduct from the third ventricle to the cervical subarachnoid space. Results: There were nine male and six female patients with an average age of 23 years. Complete tumor excision could be achieved in 12 patients and subtotal excision with clearance of aqueduct in remaining three patients. Hydrocephalus was controlled effectively in all the patients. There were no stent-related complications. Conclusions: This study showed the reliability of single-stage tumor excision followed by placement of aqueductal stent. The success rate of this technique is comparable to those of conventional CSF diversion procedures. This is a simple, safe, and effective procedure for the management of persistent and or progressive hydrocephalus. This technique may be very useful in situations where the patient's follow-up is compromised and the patients who are from a poor economic background. Long-term results need further evaluation to assess the overall functioning of this stent technique. PMID:27366254

  1. Differences in Supratentorial Damage of White Matter in Pediatric Survivors of Posterior Fossa Tumors With and Without Adjuvant Treatment as Detected by Magnetic Resonance Diffusion Tensor Imaging

    SciTech Connect

    Rueckriegel, Stefan Mark; Driever, Pablo Hernaiz; Blankenburg, Friederike; Luedemann, Lutz; Henze, Guenter; Bruhn, Harald

    2010-03-01

    Purpose: To elucidate morphologic correlates of brain dysfunction in pediatric survivors of posterior fossa tumors by using magnetic resonance diffusion tensor imaging (DTI) to examine neuroaxonal integrity in white matter. Patients and Methods: Seventeen medulloblastoma (MB) patients who had received surgery and adjuvant treatment, 13 pilocytic astrocytoma (PA) patients who had been treated only with surgery, and age-matched healthy control subjects underwent magnetic resonance imaging on a 3-Tesla system. High-resolution conventional T1- and T2-weighted magnetic resonance imaging and DTI data sets were obtained. Fractional anisotropy (FA) maps were analyzed using tract-based spatial statistics, a part of the Functional MRI of the Brain Software Library. Results: Compared with control subjects, FA values of MB patients were significantly decreased in the cerebellar midline structures, in the frontal lobes, and in the callosal body. Fractional anisotropy values of the PA patients were not only decreased in cerebellar hemispheric structures as expected, but also in supratentorial parts of the brain, with a distribution similar to that in MB patients. However, the amount of significantly decreased FA was greater in MB than in PA patients, underscoring the aggravating neurotoxic effect of the adjuvant treatment. Conclusions: Neurotoxic mechanisms that are present in PA patients (e.g., internal hydrocephalus and damaged cerebellar structures affecting neuronal circuits) contribute significantly to the alteration of supratentorial white matter in pediatric posterior fossa tumor patients.

  2. Evaluation of posterior fossa lesions by computer assisted tomography (CAT).

    PubMed

    Lott, T; El Gammal, T; Volcan, I

    1977-07-01

    Valuable neuroradiologic information can be obtained with routine examination of the posterior fossa by computer assisted tomography (CAT). The diagnosis can be difficult in the posterior fossa due to the relatively small size of the compartment and its proximities to large bony masses and air in the mastoid cells. However, many lesions can be accurately diagnosed when close attention is given to anatomic detail and the frequent use of contrast enhancement. We introduced a new CAT classification of posterior fossa neoplasms. PMID:877637

  3. Isolated Posterior Fossa Involvement in Posterior Reversible Encephalopathy Syndrome

    PubMed Central

    Shimizu, Yukie; Tha, Khin Khin; Iguchi, Akihiro; Cho, Yuko; Yoshida, Atsushi; Fujima, Noriyuki; Tsukahara, Akiko; Shirato, Hiroki; Terae, Satoshi

    2013-01-01

    Summary Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic edema affecting the subcortical white matter of bilateral occipital and parietal lobes. We describe a case of isolated posterior fossa involvement of PRES which occurred during remission induction chemotherapy for T-cell acute lymphoblastic leukemia. Both the brainstem and cerebellum were extensively involved, but the supratentorial structures were completely spared. The follow-up magnetic resonance images revealed reversibility of most lesions. The knowledge of atypical radiological features of PRES is essential for prompt diagnosis. PMID:24199811

  4. Neurothekeoma in the Posterior Fossa: Case Report and Literature Review

    PubMed Central

    Alexandru, Daniela; Satyadev, Radha; So, William

    2012-01-01

    Neurothekeoma is a benign nerve sheath tumor, also known as nerve sheath myxoma. It arises from the cutaneous nerves of the head and neck region. In certain cases, neurothekeoma has been reported in the breast, oral cavity, tongue, maxilla, and spinal intradural space. Intracranial neurothekeoma, however, is an extremely rare entity, with only three cases reported in the literature: one in the parasellar region, one in the deep white matter, and another one in the cerebellopontine angle. We present the case of a 40-year-old man with a very large neurothekeoma present in the posterior fossa who had no neurologic deficit on presentation. PMID:23012602

  5. Costello syndrome: Analysis of the posterior cranial fossa in children with posterior fossa crowding

    PubMed Central

    D’Apolito, Gabriella; Panfili, Marco; Zampino, Giuseppe; Tartaglione, Tommaso; Colosimo, Cesare

    2015-01-01

    This study aimed to assess changes in the posterior cranial fossa (PCF) to shed light on the mechanism of cerebellar herniation in children with Costello syndrome (CS) and posterior fossa crowding. We performed a morphovolumetric PCF analysis on brain magnetic resonance imaging (MRI) in seven children with CS (mean age 31 ± 16 months) comparing the MRI scans with those of seven age-matched healthy subjects. PCF volume (PCFV), PCF brain volume (PCFBV) and cerebellar volume (CeV) were assessed on axial T2-weighted MRI. Morphometric parameters (diameters of the foramen magnum, tentorial angle, basiocciput, supraocciput, basisphenoid and exocciput lengths) were measured on sagittal T1-weighted MRI. The volume of the cerebrospinal fluid (CSF) spaces was calculated as PCFV minus PCFBV. Five out of seven CS children showed tonsillar herniation in the upper cervical canal; no child had hydrocephalus but three out of seven children showed ventriculomegaly. In addition, the PCFV/PCFBV ratio, PCFV, CSF spaces volume, basiocciput, basisphenoid and exocciput lengths and latero-lateral and antero-posterior diameters of the foramen magnum were significantly reduced, whereas no significant changes were found in supraocciput length, PCFBV, CeV or hindbrain volume The volumetric reduction of the PCF due to bony posterior fossa hypoplasia is a predisposing factor for developing cerebellar tonsillar herniation through the foramen magnum in children with CS. The altered anatomy of the foramen magnum and upward expansion of the PCF secondary to an increased tentorial slope serves to explain the possible mechanism of cerebellar herniation in patients with CS. PMID:26246091

  6. Hypertrophic olivary degeneration resulting from posterior fossa masses and their treatments☆,☆☆,★

    PubMed Central

    Hirano, Miki; Hatzoglou, Vaios; Karimi, Sasan; Young, Robert J.

    2016-01-01

    Purpose Characterize hypertrophic olivary degeneration (HOD) that develops from posterior fossa masses and their treatments. Methods Retrospectively reviewed MR images and clinical data of 10 patients with posterior fossa masses and HOD. Results Eight patients had cerebellar lesions, and two patients had pontine lesions. Lesions consisted of tumors, demyelination, and nonspecific necrosis. MRI showed T2 hyperintense signal in the inferior olive a median 86 days after the diagnosis of a posterior fossa lesion. HOD presented prior to surgery (n=2), after surgery (n=3), after surgery/radiation therapy (n=4), or without treatment (n=1). Conclusions HOD may develop from posterior fossa masses and surgical and/or radiation therapy. PMID:26104225

  7. Tumors of the Infratemporal Fossa

    PubMed Central

    Tiwari, Rammohan; Quak, Jasper; Egeler, Saskia; Smeele, Ludi; Waal, Isaac v.d.; Valk, Paul v.d.; Leemans, Rene

    2000-01-01

    Neoplastic processes involving the infratemporal fossa may originate from the tissues in the region, but more often are the result of extension from neighboring structures. Metastatic lesions located in the region are rarely encountered. Because of its concealed localization, tumors may remain unnoticed for some time. Clinical signs and symptoms often arise late, are insidious, and may be mistakenly attributed to other structures. The close proximity of the area to the intracranial structures, the orbit, the paranasal sinuses, the nasopharynx, and the facial area demands careful planning of surgical excision and combined procedures may be called for. Modern imaging techniques have made three-dimensional visualization of the extent of the pathology possible. Treatment depends on the histopathology and staging of the tumor. Several surgical approaches have been developed over the years. Radical tumor excision with preservation of the quality of life remain the ultimate goal for those tumors where surgery is indicated. Experience over a decade with various pathologies is presented. ImagesFigure 1p6-bFigure 2Figure 3 PMID:17171095

  8. [The blood vessels of the posterior cranial fossa. anatomy, pathophysiology, clinic--a survey (author's transl)].

    PubMed

    Helms, J

    1978-04-20

    Pathophysiology and tomography of the blood vessels of the posterior cranial fossa gain clinical interest in treatment of diseases of the inner ear, complications of middle ear inflammations, tumors of the pyramid and cerebello-pontine angle. Numerous variations in the arterial venous system restrict neuroradiological procedures. Techniques to treat a thrombosis of the sinuses were developed 50 years ago. Surgical procedures to remove glomus tumors of the pyramid could be improved by new anatomical and surgical experiences. Unilateral neck dissection occasionally alters the blood flow in the sinuses of the posterior cranial fossa causing serious complications. PMID:350206

  9. Treatment and survival of supratentorial and posterior fossa ependymomas in adults.

    PubMed

    Nuño, Miriam; Yu, Jeffrey J; Varshneya, Kunal; Alexander, Julia; Mukherjee, Debraj; Black, Keith L; Patil, Chirag G

    2016-06-01

    Ependymoma is a rare primary brain or spinal cord tumor that arises from the ependyma, a tissue of the central nervous system. This study analyzed a large cohort of adult supratentorial and posterior fossa ependymoma tumors in order to elucidate factors associated with overall survival. We utilized the USA National Cancer Database to study adult World Health Organization grade II/III supratentorial and posterior fossa ependymoma patients treated between 1998 and 2011. Overall survival was estimated by the Kaplan-Meier method and factors associated with survival were determined using a multivariate Cox proportional hazards model. Among 1318 patients, 1055 (80.0%) had grade II and 263 (20.0%) anaplastic tumors located in the posterior fossa (64.3%) and supratentorial region (35.7%). Overall average age was 44.3years, 48.0% of patients were female, 86.5% were Caucasian, and 36.8% underwent near/gross total surgical resection. Radiotherapy was given to 662 patients (50.8%) and 75 (5.9%) received chemotherapy. Older age at diagnosis (hazard ratio [HR] 1.51, p<0.0001), high tumor grade (HR 1.82, p=0.005), and large tumor size (HR 1.66, p=0.008) were associated with poor survival. Females compared to males (HR 0.67, p=0.03) and patients with posterior fossa tumors versus supratentorial (HR 0.64, p=0.04) had a survival advantage. Our study showed that older patients, with supratentorial tumors, and high histological grade had an increased risk of mortality. A survival benefit was captured in females and patients with posterior fossa tumors. Adjuvant radiotherapy and chemotherapy did not confer a survival benefit among all patients, even after stratification by tumor grade or anatomical location. PMID:26810473

  10. CT of perineural tumor extension: pterygopalatine fossa

    SciTech Connect

    Curtin, H.D.; Williams, R.; Johnson, J.

    1985-01-01

    Tumors of the oral cavity and paranasal sinuses can spread along nerves to areas apparently removed from the primary tumor. In tumors of the palate, sinuses, and face, this perineural spread usually involves the maxillary division of the trigeminal nerve. The pterygopalatine fossa is a pathway of the maxillary nerve and becomes a key landmark in the detection of neural metastasis by computed tomography (CT). Obliteration of the fat in the fossa suggests pathology. Case material illustrating neural extension is presented and the CT findings are described.

  11. Rapid Visual Deterioration Caused by Posterior Fossa Arachnoid Cyst.

    PubMed

    Shin, Chang Jin; Rho, Myeongho; Won, Yu Sam; Kim, Si On

    2016-05-01

    Posterior fossa is a site next to the middle fossa where arachnoid cyst frequently occurs. Generally, most arachnoid cysts are asymptomatic and are found incidentally in most cases. Although arachnoid cysts are benign and asymptomatic lesions, patients with posterior fossa arachnoid cysts often complain of headaches, gait disturbance, and ataxia due to the local mass effects on the cerebellum. We observed a patient with a posterior fossa arachnoid cyst who had visual symptoms and a headache, but did not have gait disturbance and ataxia. We recommended an emergency operation for decompression, but the patient refused for personal reasons. After 7 days, the patient revisited our hospital in a state of near-blindness. We suspected that the arachnoid cyst induced the hydrocephalus and thereby the enlarged third ventricle directly compressed optic nerves. Compressed optic nerves were rapidly aggravated during the critical seven days; consequently, the patient's vision was damaged despite the operation. Considering the results of our case, it is important to keep in mind that the aggravation of symptoms cannot be predicted; therefore, symptomatic arachnoid cysts should be treated without undue delay. PMID:27226868

  12. Rapid Visual Deterioration Caused by Posterior Fossa Arachnoid Cyst

    PubMed Central

    Shin, Chang Jin; Rho, Myeongho; Won, Yu Sam

    2016-01-01

    Posterior fossa is a site next to the middle fossa where arachnoid cyst frequently occurs. Generally, most arachnoid cysts are asymptomatic and are found incidentally in most cases. Although arachnoid cysts are benign and asymptomatic lesions, patients with posterior fossa arachnoid cysts often complain of headaches, gait disturbance, and ataxia due to the local mass effects on the cerebellum. We observed a patient with a posterior fossa arachnoid cyst who had visual symptoms and a headache, but did not have gait disturbance and ataxia. We recommended an emergency operation for decompression, but the patient refused for personal reasons. After 7 days, the patient revisited our hospital in a state of near-blindness. We suspected that the arachnoid cyst induced the hydrocephalus and thereby the enlarged third ventricle directly compressed optic nerves. Compressed optic nerves were rapidly aggravated during the critical seven days; consequently, the patient's vision was damaged despite the operation. Considering the results of our case, it is important to keep in mind that the aggravation of symptoms cannot be predicted; therefore, symptomatic arachnoid cysts should be treated without undue delay. PMID:27226868

  13. Delayed supratentorial intracerebral hemorrhage following posterior fossa surgery

    PubMed Central

    Salunke, Pravin; Malik, Vinod; Kovai, Priyamvadha; Aggarwal, Ashish; Khandelwal, Niranjan K.

    2016-01-01

    Delayed supratentorial intracerebral hematoma after posterior fossa surgery is uncommon. Only few cases have been reported in the past. The cause has been attributed to sitting position leading to changes in intracranial arterial and venous pressures. We report two cases of delayed intracerebral hematoma following posterior fossa surgery, none of which were operated in sitting position. MR venogram done in one patient showed venous sinus thrombosis. Intracererbal hematoma following infratentorial surgery is uncommon and is possibly due to venous sinus thrombosis leading to venous hypertension. Control of bleeding from venous sinuses due to avulsion of emissary veins during craniotomy/craniectomy possibly induces sinus thrombosis that may propagate antegrade or retrograde, leading to venous hypertension and parenchymal bleed. PMID:27366274

  14. Bony wall damage in the region of the middle and posterior cranial fossa observed during otosurgery

    PubMed Central

    Wiatr, Maciej; Składzień, Jacek; Tomik, Jerzy; Stręk, Paweł; Przeklasa-Muszyńska, Anna

    2012-01-01

    Summary Background Bony wall damages in the region of the middle and posterior cranial fossa are usually observed in cases of chronic otitis media. These defects can also be congenital, post-traumatic, iatrogenic or due to tumors. They can potentially lead to the development of intracranial complications. Material/Methods We analyzed patients who were diagnosed as having bony wall damage in the region of the middle and/or posterior cranial fossa. We also discuss methods of reconstruction during otosurgery. The analysis involves patients who underwent middle ear operations in the Department of Otolaryngology at the Jagiellonian University of Krakow between 2004 and 2008; 495 otosurgeries were performed during this period of time. Results In 70% of patients the reason for otosurgery was chronic otitis media. In 20%, bone defects occurred simultaneously with otosclerosis. Less than 10% underwent otosurgery for other reasons. Bony wall damage in the region of the middle and posterior cranial fossa were diagnosed in 46 patients who underwent surgery. In patients with bony wall damage, otogenic intracranial complications were described in 14 cases. Conclusions The performed reconstruction methods for bony wall damage, which used the fascia, strengthened with the pedicle muscle flap for larger defects and with either bone lamella or cartilage in specific cases, proved successful. Nearly 80% of bony wall damages in the region of the middle and posterior cranial fossa remain asymptomatic and are discovered incidentally during middle ear surgery. The above observations emphasize the significant role of pre-operative imaging diagnostics. PMID:22648242

  15. Morphometric analysis of posterior fossa in Indian CP angle acoustic schwannoma patients

    PubMed Central

    Patibandla, Mohana Rao; Panigrahi, Manas K.; Gurram, Paniraj L.; Thotakura, Amit Kumar; Kulkarni, Dilip

    2016-01-01

    Aim: To study the morphometry of posterior fossa in Indian CP angle schwannoma patients in order to know its influence on the extent of excision of the CP angle acoustic schwannomas. Materials and Methods: One hundred cases of cerebellopontine angle schwannomas treated surgically by the senior author and 20 controls between January 2006 and June 2011 were consecutively investigated with computed tomography (CT) using the high-resolution CT bone windows before surgery. Evaluation of anatomic parameters of the petrous bone and posterior fossa cavity were done in all patients and controls. Data were entered in Excel software and were analyzed using NCSS software. All possible regression analysis was done to select the important variables to be included in the model to predict the excision of tumor with these variables. A prediction model was developed defining the binary outcome as total excision or subtotal excision as dependent variable and the morphometric data and grading of tumor as independent variables. Results: Interpetrous distance (IP) is the distance between the two petrous apices. Sigmoid distance (IS) distance is the distance between the two sigmoid points. Sigmoid point is the point at which the scalloped impression of the sigmoid sinus straightens to join the occipital bone posteriorly. SAG is the distance between the mid IP point and the mid-point on the inner wall of the occipital bone. The PM angle was 47.8±4.14 degrees (38-58), the PA angle was 42.68±4.47 degrees (34-53), the IP distance was 2.07±0.13 cm (1.5-2.8), the sagittal diameter of posterior fossa was 6.22±0.73 cm (5.1-9.8) and the intersigmoid distance was 9.45±0.73 cm (7.4-11). There was no significant gender difference in the posterior fossa morphometry between patients and controls. Inter-sigmoid distance and the petrous-apex angle were more in the Indians when compared to the European population mentioned in the Mathies and Samii study. Conclusions: The posterior fossa

  16. Posterior fossa and spinal gangliogliomas form two distinct clinicopathologic and molecular subgroups

    PubMed Central

    2014-01-01

    Background Gangliogliomas are low-grade glioneuronal tumors of the central nervous system and the commonest cause of chronic intractable epilepsy. Most gangliogliomas (>70%) arise in the temporal lobe, and infratentorial tumors account for less than 10%. Posterior fossa gangliogliomas can have the features of a classic supratentorial tumor or a pilocytic astrocytoma with focal gangliocytic differentiation, and this observation led to the hypothesis tested in this study - gangliogliomas of the posterior fossa and spinal cord consist of two morphologic types that can be distinguished by specific genetic alterations. Results Histological review of 27 pediatric gangliogliomas from the posterior fossa and spinal cord indicated that they could be readily placed into two groups: classic gangliogliomas (group I; n = 16) and tumors that appeared largely as a pilocytic astrocytoma, but with foci of gangliocytic differentiation (group II; n = 11). Detailed radiological review, which was blind to morphologic assignment, identified a triad of features, hemorrhage, midline location, and the presence of cysts or necrosis, that distinguished the two morphological groups with a sensitivity of 91% and specificity of 100%. Molecular genetic analysis revealed BRAF duplication and a KIAA1549-BRAF fusion gene in 82% of group II tumors, but in none of the group I tumors, and a BRAF:p.V600E mutation in 43% of group I tumors, but in none of the group II tumors. Conclusions Our study provides support for a classification that would divide infratentorial gangliogliomas into two categories, (classic) gangliogliomas and pilocytic astrocytomas with gangliocytic differentiation, which have distinct morphological, radiological, and molecular characteristics. PMID:24529209

  17. Hypertrophic olivary degeneration with gadolinium enhancement after posterior fossa surgery in a child with medulloblastoma.

    PubMed

    Nowak, Johannes; Alkonyi, Balint; Rutkowski, Stefan; Homola, György A; Warmuth-Metz, Monika

    2014-05-01

    Hypertrophic olivary degeneration (HOD) is a rare transsynaptic form of degeneration occurring secondary to the disruption of the dentato-rubro-olivary pathway ("Guillain-Mollaret triangle"). HOD can be caused by ischemic, hemorrhagic, traumatic, or neoplastic lesions, and it can also occur following posterior fossa surgery. MRI characteristics of HOD include T2 signal increase and hypertrophy. To date, blood–brain barrier disruption has not been reported in HOD. Here, we present the first case of HOD with temporary gadolinium enhancement in a 10-year-old child 7 months after resection of a posterior fossa medulloblastoma. The recognition of gadolinium enhancement as a radiological feature of HOD may help to distinguish between this benign secondary condition and tumor recurrence. PMID:24122017

  18. Identifying quantitative imaging features of posterior fossa syndrome in longitudinal MRI.

    PubMed

    Spiteri, Michaela; Windridge, David; Avula, Shivaram; Kumar, Ram; Lewis, Emma

    2015-10-01

    Up to 25% of children who undergo brain tumor resection surgery in the posterior fossa develop posterior fossa syndrome (PFS). This syndrome is characterized by mutism and disturbance in speech. Our hypothesis is that there is a correlation between PFS and the occurrence of hypertrophic olivary degeneration (HOD) in structures within the posterior fossa, known as the inferior olivary nuclei (ION). HOD is exhibited as an increase in size and intensity of the ION on an MR image. Longitudinal MRI datasets of 28 patients were acquired consisting of pre-, intra-, and postoperative scans. A semiautomated segmentation process was used to segment the ION on each MR image. A full set of imaging features describing the first- and second-order statistics and size of the ION were extracted for each image. Feature selection techniques were used to identify the most relevant features among the MRI features, demographics, and data based on neuroradiological assessment. A support vector machine was used to analyze the discriminative features selected by a generative k-nearest neighbor algorithm. The results indicate the presence of hyperintensity in the left ION as the most diagnostically relevant feature, providing a statistically significant improvement in the classification of patients ([Formula: see text]) when using this feature alone. PMID:26835496

  19. ECG artefacts mimicking atrial flutter in posterior fossa surgery.

    PubMed

    Rudigwa, Priya; Elakkumanan, Lenin Babu; Rajan, Sakthi P; Prakash, M V Satya

    2015-01-01

    ECG artefacts are defined as abnormalities in the monitored ECG, which result from measurement of cardiac potentials on the body surface and are not related to the electrical activity of the heart. In the operation theatre, the use of various types of electrical equipment may interfere with ECG interpretation. We describe our experience with artefacts resembling atrial fibrillation when a nerve integrity monitoring device was used on a patient undergoing posterior fossa surgery for epidermoid tumour. These artefacts resemble serious arrhythmias and may result in unwanted interventions. To enable better identification of such artefacts, a 12-lead ECG should be considered as it will display rhythm in all the leads; while artefacts will present in only a few leads, true arrhythmia will be present in all the 12 leads. Our case report aims to increase awareness regarding ECG artefacts and to explain how to distinguish them from actual arrhythmias. PMID:26021382

  20. Cerebellar medulloblastoma: the importance of posterior fossa dose to survival and patterns of failure

    SciTech Connect

    Silverman, C.L.; Simpson, J.R.

    1982-11-01

    Fifty patients with biopsy-proven cerebellar medulloblastoma were retrospectively analyzed for prognostic factors, survival and patterns of failure. Five- and ten-year actuarial survivals for the entire group were 51% and 42%. Survival and local control were significantly better for the 21 patients who received doses greater than 5000 rad to the posterior fossa (85% and 80% respectively) than for the remaining patients (38% and 38%, respectively). Significant prognostic factors included achievement of local control in the posterior fossa (p = .0001) and dose to the posterior fossa (p = .0005). Sex, age, duration of symptoms, extent of surgery and initial T-stage of disease were not significant. Posterior fossa was the predominant site of failure (71% of failures), but 10% of patients failed in the cerebrum and 12% outside the CNS. This experience confirms that survival rates of 70-80% are achievable with current treatment policies but accurate and consistent dose delivery to the posterior fossa is essential.

  1. Cerebellar medulloblastoma: the importance of posterior fossa dose to survival and patterns of failure

    SciTech Connect

    Silverman, C.L.; Simpson, J.R.

    1982-11-01

    Fifty patients with biopsy-proven cerebellar medulloblastoma were retrospectively analyzed for prognostic factors, survival and patterns of failure. Five- and ten-year actuarial survivals for the entire group were 51% and 42%. Survival and local control were significantly better for the 21 patients who received doses greater that 5000 rad to the posterior fossa (85% and 80% respectively) than for the remaining patients (38% and 38%, respectively). Significant prognostic factors included achievement of local control in the posterior fossa (p = .0001) and dose to the posterior fossa (p = .0005). Sex, age, duration of symptoms, extent of surgery and initial T-stage of disease were not significant. Posterior fossa was the predominant site of failure (71% of failures), but 10% of patients failed in the cerebrum and 12% outside the CNS. This experience confirms that survival rates of 70-80% are achievable with current treatment policies but accurate and consistent dose delivery to the posterior fossa is essential.

  2. Incidence, Risks, and Sequelae of Posterior Fossa Syndrome in Pediatric Medulloblastoma

    SciTech Connect

    Korah, Mariam P.; Esiashvili, Natia; Mazewski, Claire M.; Hudgins, Roger J.; Tighiouart, Mourad; Janss, Anna J.; Schwaibold, Frederick P.; Crocker, Ian R.; Curran, Walter J.; Marcus, Robert B.

    2010-05-01

    Purpose: To investigate the incidence, risks, severity, and sequelae of posterior fossa syndrome (PFS) in children with medulloblastoma. Methods and Materials: Between 1990 and 2007, 63 children with medulloblastoma at Emory University and Children's Healthcare of Atlanta were treated with craniectomy followed by radiation. Fifty-one patients were assigned to a standard-risk group, and 12 patients were assigned to a high-risk group. Five patients had <1.5-cm{sup 2} residual tumor, 4 had >=1.5-cm{sup 2} residual tumor, and the remainder had no residual tumor. Eleven patients had disseminated disease. Patients received craniospinal irradiation at a typical dose of 23.4 Gy or 36 Gy for standard- or high-risk disease, respectively. The posterior fossa was given a total dose of 54 or 55.8 Gy. Nearly all patients received chemotherapy following cooperative group protocols. Results: Median follow-up was 7 years. PFS developed in 18 patients (29%). On univariate analysis, brainstem invasion, midline tumor location, younger age, and the absence of radiographic residual tumor were found to be predictors of PFS; the last two variables remained significant on multivariate analysis. From 1990 to 2000 and from 2001 to 2007, the proportions of patients with no radiographic residual tumor were 77% and 94%, respectively. During the same eras, the proportions of patients with PFS were 17% and 39%. Only 4 patients had complete recovery at last follow-up. Conclusions: The incidence of PFS increased in the latter study period and is proportional to more aggressive surgery. Children with midline tumors exhibiting brainstem invasion are at increased risk. With the increased incidence of PFS and the permanent morbidity in many patients, the risks and benefits of complete tumor removal in all patients need to be reexamined.

  3. 3-D simulation of posterior fossa reduction in Chiari I.

    PubMed

    Fernandes, Yvens Barbosa; Perestrelo, Pedro Fábio Mendonça; Noritomi, Pedro Yoshito; Mathias, Roger Neves; Silva, Jorge Vicente Lopes da; Joaquim, Andrei Fernandes

    2016-05-01

    We proposed a 3D model to evaluate the role of platybasia and clivus length in the development of Chiari I (CI). Using a computer aided design software, two DICOM files of a normal CT scan and MR were used to simulate different clivus lengths (CL) and also different basal angles (BA). The final posterior fossa volume (PFV) was obtained for each variation and the percentage of the volumetric change was acquired with the same method. The initial normal values of CL and BA were 35.65 mm and 112.66º respectively, with a total PFV of 209 ml. Ranging the CL from 34.65 to 29.65 - 24.65 - 19.65, there was a PFV decrease of 0.47% - 1.12% - 1.69%, respectively. Ranging the BA from 122.66º to 127.66º - 142.66º, the PFV decreased 0.69% - 3.23%, respectively. Our model highlights the importance of the basal angle and clivus length to the development of CI. PMID:27191237

  4. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    PubMed Central

    Tang, Chaoliang; Chai, Xiaoqing; Kang, Fang; Huang, Xiang; Hou, Tao; Tang, Fei; Li, Juan

    2015-01-01

    Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P < 0.05 versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery. PMID:26273146

  5. Posterior fossa giant tumefactive perivascular spaces: 8-year follow-up in an adolescent

    PubMed Central

    Branch, Byron C.; Tantiwongkosi, Bundhit; Altmeyer, Wilson; Bartanusz, Viktor

    2015-01-01

    Background: Cystic masses in the posterior fossa are ominous appearing lesions with broad differential diagnosis. Giant tumefactive perivascular spaces (GTPS) are rarely occurring pathological findings in the posterior fossa with unclear etiology and ill-defined long-term prognosis. Case Description: We present a case of a 15-year-old male diagnosed with posterior fossa GTPS. The patient remained asymptomatic during the 8-year follow-up after diagnosis with the serial magnetic resonance imaging (MRI) showing no change in the size and morphology of the lesion. Conclusion: This case supports prior literature on supratentorial GTPS suggesting that the natural history of GTPS is mostly benign. Identification of GTPS in the posterior fossa could prevent the patient from unnecessary surgery or other aggressive treatment modalities. PMID:25657855

  6. Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

    PubMed Central

    Lobo, Bjorn; Lim, Joshua; Sade, Burak; Oya, Soichi; Lee, Joung H.

    2016-01-01

    Objective Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. Methods We conducted a retrospective review of operations performed by the senior author from 2004–2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. Results Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). Conclusion When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery. PMID:26885286

  7. Multiple supratentorial intraparenchymal hemorrhage after posterior fossa surgery

    PubMed Central

    de Albuquerque, Lucas Alverne Freitas; Dourado, Jules Carlos; Almeida, João Paulo; Costa, Bruno Silva

    2015-01-01

    Background: The intraparenchymal supratentorial hemorrhages after interventions of the posterior fossa is a very rare complication, with very little literature and its precise incidence is unknown (range of 0.4–1.6%). It possesses potentially an etiology diverse from that associated with other postoperative bleeding. Case Description: A white, 23-year-old female, with no history of coagulation disorders or other diseases, was referred to our hospital with a large ependymoma, which extended from the floor of the fourth ventricle, emerged from the foramen of Magendie and descended to the C2 level. The patient was submitted to surgical treatment and during resection of the lesion, when near the vagal trigone, the patient presented great pressure lability. In the immediate postoperative period, the patient did not have a level of consciousness sufficient to tolerate extubation. Brain computed tomography (CT) was carried out, which showed multiple supratentorial hemorrhages. On the ninth day of the postoperative period, there was a sudden neurological worsening and anisocoria. A new brain CT was carried out [Figure 4], which demonstrated a diffuse cerebral edema. In spite of the introduction of clinical measures for the control of diffuse cerebral edema, the patient evolved to brain death. Conclusions: The principal measures in the management of these cases include early diagnosis, detection of possible coagulation disorders, continual monitoring, and maintenance of adequate cerebral perfusion. Surgical treatment is recommended in cases of the presence of mass effect or diffuse edema not yielding to clinical treatment. High rates of mortality and morbidity are observed. PMID:25883853

  8. Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

    PubMed Central

    Srinivasan, Uddanapalli Sreeramulu; Lawrence, Radhi

    2015-01-01

    Introduction and Aim: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC. Materials and Methods: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973–2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years. Results: In 6 cases the PFAC was located in the midline. In the 7th case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making. Discussion: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst. PMID:25767579

  9. Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery

    PubMed Central

    Heymanns, Verena; Oseni, Abidemi W.; Alyeldien, Ameer; Maslehaty, Homajoun; Parvin, Richard; Scholz, Martin

    2016-01-01

    Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature. PMID:27478578

  10. Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery.

    PubMed

    Heymanns, Verena; Oseni, Abidemi W; Alyeldien, Ameer; Maslehaty, Homajoun; Parvin, Richard; Scholz, Martin; Petridis, Athanasios K

    2016-04-26

    Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature. PMID:27478578

  11. Dural-based infantile hemangioma of the posterior fossa: Case report

    PubMed Central

    Shakir, Hakeem J.; McBride, Paul; Reynolds, Renée M.

    2016-01-01

    Background: The authors present the unique case of a dural-based, infantile hemangioma located in the posterior fossa of a 15-day-old infant. Case Description: The patient presented with hydrocephalus. The lesion was identified by magnetic resonance imaging and was subsequently resected. Diagnosis of the lesion was confirmed with immunohistochemistry staining. The patient's hospital course was complicated by transverse sinus thrombosis and a cerebrospinal fluid leak that were treated with anticoagulation therapy and ventriculoperitoneal shunt placement, respectively. Conclusion: Although hemangiomas are benign entities, our patient's lesion was in the posterior fossa causing compression and hydrocephalus that necessitated resection. We encourage others to consider the possibility of hemangioma in the differential diagnosis of dural-based posterior fossa lesions in infants. PMID:27213106

  12. Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery

    PubMed Central

    Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

    2016-01-01

    Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. PMID:26951144

  13. Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery.

    PubMed

    Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

    2016-01-01

    Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. PMID:26951144

  14. Prevalence, associations, and predictors of apathy in adult survivors of infantile (<5 years of age) posterior fossa brain tumors†

    PubMed Central

    Carroll, Cliodhna; Watson, Peter; Spoudeas, Helen A.; Hawkins, Michael M.; Walker, David A.; Clare, Isabel C. H.; Holland, Anthony J.; Ring, Howard A.

    2013-01-01

    Background Apathy is associated with pervasive and disadvantageous effects on daily functioning. It has been observed transiently in some children after surgery for posterior fossa tumors. In this study, our objective was to examine prevalence, associations, and predictors of apathy in adult survivors of an infantile posterior fossa brain tumor (PFT). Methods One hundred seventeen adult survivors of a childhood PFT diagnosed before age 5 years and 60 of their siblings were assessed in a cross-sectional study a mean of 32 years (range, 18–53 years) after survivors' initial tumor diagnoses, using the Marin Apathy Evaluation Scale (AES), the Weschler Abbreviated Scale of Intelligence and the Composite International Diagnostic Interview for psychiatric disorders. Results Marin Apathy Evaluation Scale, the Weschler Abbreviated Scale of Intelligence reached or exceeded a criterion score for clinically significant apathy in 35% of survivors, compared with 18% in a sibling comparison group. In both siblings and survivors, apathy was associated with lower verbal and full-scale IQ and, among survivors, with having undergone partial rather than total tumor resection (independent of irradiation status). Apathy was not related to presence of concurrent International Classification of Diseases, 10th Revision, depression. Female sex was associated with late apathy after a PFT, with increased likelihood of women reaching the apathy criterion relative to men if they were survivors. Conclusions Clinically significant and potentially treatable apathy occurs relatively commonly in adult survivors of an infantile childhood PFT, particularly women. Clinicians, including those managing posterior fossa pathology in very young children, should be aware of this association, and future research should clarify whether specific treatment-related variables are implicated in increasing this risk of apathy. PMID:23502428

  15. A Cognitive and Affective Pattern in Posterior Fossa Strokes in Children: A Case Series

    ERIC Educational Resources Information Center

    Kossorotoff, Manoelle; Gonin-Flambois, Coralie; Gitiaux, Cyril; Quijano, Susana; Boddaert, Nathalie; Bahi-Buisson, Nadia; Barnerias, Christine; Dulac, Olivier; Brunelle, Francis; Desguerre, Isabelle

    2010-01-01

    Aim: Posterior fossa strokes account for about 10% of ischaemic strokes in children. Although motor and dysautonomic symptoms are common, to our knowledge cognitive and affective deficits have not been described in the paediatric literature. Our aim, therefore, was to describe these symptoms and deficits. Method: In a retrospective study, we…

  16. An extremely rare case of a glomus tumor in the popliteal fossa.

    PubMed

    Kawanami, Katsuhisa; Matsuo, Toshihiro; Deie, Masataka; Izuta, Yasunori; Wakao, Norimitsu; Kamiya, Mitsuhiro; Hirasawa, Atsuhiko

    2016-12-01

    Glomus tumors are the benign perivascular tumors that typically present with hypersensitivity to cold, paroxysmal severe pain, and pinpoint tenderness. This tumor is usually subungual lesions and accounts for 1.6% of all soft-tissue tumors. However, extradigital glomus tumors are extremely rare and can be difficult to diagnose, as they typically have a diameter of less than about 1 cm. We report a glomus tumor in the popliteal fossa of a 17-year-old male patient who experienced severe posterior knee pain while playing sports. A physical examination did not reveal a mass, although a glomus tumor was identified in the popliteal fossa using magnetic resonance imaging. We successfully performed open excision to remove the tumor, and the patient achieved a restored postoperative gait and could perform sports activities with no pain. These tumors are extremely rare in the knee area, and typically have a diameter of less than about 1 cm, which can complicate their diagnosis and treatment, despite the presence of severe pain. Therefore, we recommend that clinicians be aware of extradigital glomus tumors, as careful imaging can facilitate an early diagnosis and treatment. PMID:27408511

  17. Sleep Apnea Syndrome after Posterior Fossa Surgery: A Case of Acquired Ondine's Curse

    PubMed Central

    Faraji rad, Elnaz; Faraji rad, Mohammad; Amini, Shahram; Zare, Reza

    2015-01-01

    Introduction: Ondine’s Curse is a catastrophic but rare condition in adults. It is referred to as a congenital or acquired condition, in which the patient cannot breathe automatically while asleep. Acquired causes of this disease can be any cause affecting the ventrolateral part of the medulla, which is considered to be the breathing center in humans.  Case Report: A 51-year-old woman, with ataxia and the symptoms and signs of rising Intra-Cranial Pressure, who underwent ventriculoperitoneal shunting and removal of tumour, developed episodic apnea during sleep after surgery and hypercapnia when awake. In her post-operative CT scan, some fine spots of hypodensity in the left lateral part of the medulla were observed. She was managed pharmacologically and underwent tracheotomy. After 50 days, she was discharged from the hospital when she was able to breathe normally. Conclusion: Having experience with this condition after resection of a fourth ventricle tumor, it was found that Ondine’s Curse can be considered as one of the complications of posterior fossa surgery and is curable by proper management. PMID:25745613

  18. Congenital dermal sinuses, dermoid and epidermoid cysts of the posterior fossa.

    PubMed

    Schijman, E; Monges, J; Cragnaz, R

    1986-01-01

    Dermal sinuses are abnormal communications between the skin and deeper tissues. Seven cases are presented of occipital dermal sinuses associated with dermoid or epidermoid cysts of the posterior fossa. The cysts were interdural, subdural and intracerebellar. Although they are benign lesions, there is a high incidence of complications, especially infections such as bacterial or aseptic meningitis and cerebellar abscess. The clinical features, radiological and tomographical characteristics, and the relationship to meningeal structures, dural sinuses and cerebellar parenchyma are described. PMID:3731173

  19. The use of wavelet filters for reducing noise in posterior fossa Computed Tomography images

    SciTech Connect

    Pita-Machado, Reinado; Perez-Diaz, Marlen Lorenzo-Ginori, Juan V. Bravo-Pino, Rolando

    2014-11-07

    Wavelet transform based de-noising like wavelet shrinkage, gives the good results in CT. This procedure affects very little the spatial resolution. Some applications are reconstruction methods, while others are a posteriori de-noising methods. De-noising after reconstruction is very difficult because the noise is non-stationary and has unknown distribution. Therefore, methods which work on the sinogram-space don’t have this problem, because they always work over a known noise distribution at this point. On the other hand, the posterior fossa in a head CT is a very complex region for physicians, because it is commonly affected by artifacts and noise which are not eliminated during the reconstruction procedure. This can leads to some false positive evaluations. The purpose of our present work is to compare different wavelet shrinkage de-noising filters to reduce noise, particularly in images of the posterior fossa within CT scans in the sinogram-space. This work describes an experimental search for the best wavelets, to reduce Poisson noise in Computed Tomography (CT) scans. Results showed that de-noising with wavelet filters improved the quality of posterior fossa region in terms of an increased CNR, without noticeable structural distortions.

  20. Endoscopic Endonasal Approach to Ventral Posterior Fossa Meningiomas: From Case Selection to Surgical Management.

    PubMed

    Beer-Furlan, André; Vellutini, Eduardo A S; Balsalobre, Leonardo; Stamm, Aldo C

    2015-07-01

    Clival, petroclival, and foramen magnum meningiomas are challenging lesions to manage independently of the selected surgical approach. The expanded endoscopic endonasal approach (EEA) provided a safe alternative on the armamentarium of skull base approaches. There is a paucity of literature regarding endoscopic management of meningiomas because of certain limiting factors, including rarity of the pathologic condition, technical challenges, expertise of the surgical team, and available resources. The surgical technique, possible complications, and postoperative care are described in detail. This article highlights the important aspects in choosing this surgical approach and managing ventral posterior fossa meningiomas through the EEA. PMID:26141360

  1. Bilateral posterior fossa chronic subdural hematoma treated with craniectomy: Case report and review of the literature

    PubMed Central

    Takemoto, Yushin; Matsumoto, Jun; Ohta, Kazutaka; Hasegawa, Shu; Miura, Masaki; Kuratsu, Jun-ichi

    2016-01-01

    Background: Posterior chronic subdural hematomas (pCSHs) are rare. Their diagnosis and treatment are difficult. Description: A 69-year-old woman was admitted to our hospital with nausea, headache, and mild consciousness disturbance. Computed tomography and magnetic resonance imaging showed bilateral pCSH. To prevent further neurological deterioration, we performed surgery under general anesthesia by midline suboccipital craniectomy. Unexpected bleeding from a developed circuitous occipital sinus was stopped with hemoclips. After hematoma removal, she recovered and was transferred to a rehabilitation hospital. By the 19th postoperative day, she had developed no neurologic deficits. Conclusion: This experience demonstrates the risk of blind surgical therapy in patients with pCSH. In such patients, posterior fossa craniectomy may be preferable in terms of diagnosis and safe treatment. PMID:27213111

  2. Superficial siderosis of the central nervous system associated with incomplete dural closure following posterior fossa surgery: report of 3 cases.

    PubMed

    Kumar, Ravi; Jacob, Jeffrey T; Welker, Kirk M; Cutrer, Fred M; Link, Michael J; Atkinson, John L D; Wetjen, Nicholas M

    2015-11-01

    This report reviews a series of 3 patients who developed superficial siderosis following posterior fossa operations in which dural closure was incomplete. In all 3 patients, revision surgery and complete duraplasty was performed to halt the progression of superficial siderosis. Following surgery, 2 patients experienced resolution of their CSF xanthochromia while 1 patient had reduced CSF xanthochromia. In this paper the authors also review the etiology, pathophysiology, diagnosis, and treatment of this condition. The authors suggest that posterior fossa dural patency and pseudomeningocele are risk factors for the latent development of superficial siderosis and recommend that revision duraplasty be performed in patients with posterior fossa pseudomeningoceles and superficial siderosis to prevent progression of the disease. PMID:26067619

  3. Life-threatening macroglossia after posterior fossa surgery: a surgical positioning problem?

    PubMed

    Vermeersch, G; Menovsky, T; De Ridder, D; De Bodt, M; Saldien, V; Van de Heyning, P

    2014-01-01

    A 55-year-old woman was operated in the lateral park bench position with significant neck flexion and oral packing. Macroglossia was noticed immediately postoperatively after endotracheal extubation. The patient was reintubated for 13 days and subsequently required a tracheostoma. After the placement of the tracheostoma and the removal of the endotracheal tube, the congestion of the tongue decreased markedly within 24 hours. Macroglossia is a rare complication following posterior fossa procedures with few cases reported so far. It can cause airway obstruction, which could be a life-threatening complication, and it therefore requires prompt treatment. The aetiology of postoperative macroglossia remains uncertain and has been attributed to arterial, venous and lymphatic compression, mechanical compression, or neurogenic causes. This article describes new insights into aetiology and also describes preventive measures and possible treatment. PMID:25654956

  4. Role of Cerebellum in Fine Speech Control in Childhood: Persistent Dysarthria after Surgical Treatment for Posterior Fossa Tumour

    ERIC Educational Resources Information Center

    Morgan, A. T.; Liegeois, F.; Liederkerke, C.; Vogel, A. P.; Hayward, R.; Harkness, W.; Chong, K.; Vargha-Khadem, F.

    2011-01-01

    Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen…

  5. Declarative and procedural learning in children and adolescents with posterior fossa tumours

    PubMed Central

    Quintero-Gallego, Eliana A; Gómez, Carlos M; Casares, Encarnación Vaquero; Márquez, Javier; Pérez-Santamaría, Fco Javier

    2006-01-01

    Background This quasi-experimental study was designed to assess two important learning types – procedural and declarative – in children and adolescents affected by posterior fossa tumours (astrocytoma vs. medulloblastoma), given that memory has an important impact on the child's academic achievement and personal development. Methods We had three groups: two clinical (eighteen subjects) and one control (twelve subjects). The learning types in these groups were assessed by two experimental tasks evaluating procedural-implicit and declarative memory. A Serial Reaction-Time Task was used to measure procedural sequence learning, and the Spanish version [1] of the California Verbal Learning Test-Children's Version- CVLT- [2] to measure declarative-explicit learning. The learning capacity was assessed considering only the blocks that represent learning, and were compared with MANOVA in clinical and normal subjects. The Raven, simple reaction-time, finger-tapping test, and grooved pegboard tests were used to assess the overall functioning of subjects. The results were compared with those from a control group of the same age, and with Spanish norm-referenced tools where available Results The results indicate the absence of procedural-implicit learning in both clinical groups, whereas declarative-explicit learning is maintained in both groups. Conclusion The clinical groups showed a conservation of declarative learning and a clear impairment of procedural learning. The results support the role of the cerebellum in the early phase of procedural learning. PMID:16539720

  6. Longitudinal MRI assessment: the identification of relevant features in the development of Posterior Fossa Syndrome in children

    NASA Astrophysics Data System (ADS)

    Spiteri, M.; Lewis, E.; Windridge, D.; Avula, S.

    2015-03-01

    Up to 25% of children who undergo brain tumour resection surgery in the posterior fossa develop posterior fossa syndrome (PFS). This syndrome is characterised by mutism and disturbance in speech. Our hypothesis is that there is a correlation between PFS and the occurrence of hypertrophic olivary degeneration (HOD) in lobes within the posterior fossa, known as the inferior olivary nuclei (ION). HOD is exhibited as an increase in size and intensity of the ION on an MR image. Intra-operative MRI (IoMRI) is used during surgical procedures at the Alder Hey Children's Hospital, Liver- pool, England, in the treatment of Posterior Fossa tumours and allows visualisation of the brain during surgery. The final MR scan on the IoMRI allows early assessment of the ION immediately after the surgical procedure. The longitudinal MRI data of 28 patients was analysed in a collaborative study with Alder Hey Children's Hospital, in order to identify the most relevant imaging features that relate to the development of PFS, specifically related to HOD. A semi-automated segmentation process was carried out to delineate the ION on each MRI. Feature selection techniques were used to identify the most relevant features amongst the MRI data, demographics and clinical data provided by the hospital. A support vector machine (SVM) was used to analyse the discriminative ability of the selected features. The results indicate the presence of HOD as the most efficient feature that correlates with the development of PFS, followed by the change in intensity and size of the ION and whether HOD occurred bilaterally or unilaterally.

  7. Normobaric Hyperoxia for Treatment of Pneumocephalus after Posterior Fossa Surgery in the Semisitting Position: A Prospective Randomized Controlled Trial

    PubMed Central

    Hong, Bujung; Biertz, Frank; Raab, Peter; Scheinichen, Dirk; Ertl, Philipp; Grosshennig, Anika; Nakamura, Makoto; Hermann, Elvis J.; Lang, Josef M.; Lanfermann, Heinrich; Krauss, Joachim K.

    2015-01-01

    Background Supratentorial pneumocephalus after posterior fossa surgery in the semisitting position may lead to decreased alertness and other symptoms. We here aimed to prove the efficacy of normobaric hyperoxia on the absorption of postoperative pneumocephalus according to a standardized treatment protocol. Methods and Findings We enrolled 44 patients with postoperative supratentorial pneumocephalus (> 30 ml) after posterior fossa surgery in a semisitting position. After randomisation procedure, patients received either normobaric hyperoxia at FiO2 100% over an endotracheal tube for 3 hours (treatment arm) or room air (control arm). Routine cranial CT scans were performed immediately (CT1) and 24 hours (CT2) after completion of surgery and were rated without knowledge of the therapy arm. Two co-primary endpoints were assessed: (i) mean change of pneumocephalus volume, and (ii) air resorption rate in 24 hours. Secondary endpoints were subjective alertness (Stanford Sleepiness Scale) postoperatively and attention (Stroop test), which were evaluated preoperatively and 24 hours after surgery. The mean change in pneumocephalus volume was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.001). The air resorption rate was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.0015). Differences were more pronounced in patients aged 52 years and older. No difference between patients in treatment arm and control arm was observed for the Stroop test. The distribution of scores in the Stanford Sleepiness Scale differed in the treatment arm as compared to the control arm, and there was a difference in mean values (p = 0.015). Conclusions Administration of normobaric hyperoxia at FiO2 100% via an endotracheal tube for 3 hours is safe and efficacious in the treatment of pneumocephalus after posterior fossa surgery in the semisitting position. Largest benefit was found in elderly patients and particularly

  8. The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors.

    PubMed

    Tihan, Tarik; Zhou, Tianni; Holmes, Emi; Burger, Peter C; Ozuysal, Sema; Rushing, Elisabeth J

    2008-02-01

    We performed a retrospective analysis of 96 pediatric posterior fossa ependymomas in order to determine the prognostic value of histological grade based on the current WHO grading scheme. The patients were selected among Children's Oncology Group (previously Pediatric Oncology Group-POG) patients enrolled in clinical trials, and on the basis of central pathology review, location, and age. We excluded entities such as sub-ependymoma, myxopapillary, or clear-cell ependymoma, after a consensus diagnosis by three neuropathologists. A total of 66 males and 30 females with a median age of 48 months were identified. The group was analyzed to determine the effects of histological grade, age, gender, and extent of resection on event-free and overall survival. Our results showed that extent of resection, age, and histological grade were independent prognostic variables for event-free survival. The relative risk for extent of resection and histological grade was calculated as 3.59 (P<0.001) and 3.58 (P<0.001), respectively. Overall survival significantly correlated with extent of resection and age, but not with histological grade. We compared our results with peer-reviewed publications on pediatric intracranial ependymomas in the English language between 1990 and 2005. Selection criteria identified 32 manuscripts involving 1444 patients. Extent of resection was a significant factor in 21, age in 12, and histological grading in nine of these studies. Other factors reported to be significant by more than one study included tumor location and radiation treatment. Our findings suggest that histological grade (WHO Grade II vs III) is an independent prognostic indicator for event-free survival, but may not be so for overall survival in pediatric posterior fossa ependymomas. We believe that an accurate assessment of the prognostic value of histological grade depends on the selection of a well-characterized clinical cohort of sufficient size, and the inclusion of relevant

  9. Clinical studies of photodynamic therapy for malignant brain tumors: facial nerve palsy after temporal fossa photoillumination

    NASA Astrophysics Data System (ADS)

    Muller, Paul J.; Wilson, Brian C.; Lilge, Lothar D.; Varma, Abhay; Bogaards, Arjen; Fullagar, Tim; Fenstermaker, Robert; Selker, Robert; Abrams, Judith

    2003-06-01

    In two randomized prospective studies of brain tumor PDT more than 180 patients have been accrued. At the Toronto site we recognized two patients who developed a lower motor neuron (LMN) facial paralysis in the week following the PDT treatment. In both cases a temporal lobectomy was undertaken and the residual tumor cavity was photo-illuminated. The surface illuminated included the temporal fossa floor, thus potentially exposing the facial nerve to the effect of PDT. The number of frontal, temporal, parietal, and occipital tumors in this cohort was 39, 24, 12 and 4, respectively. Of the 24 temporal tumors 18 were randomized to Photofrin-PDT. Of these 18 a temporal lobectomy was carried out exposing the middle fossa floor as part of the tumor resection. In two of the 10 patients where the lobectomy was carried out and the fossa floor was exposed to light there occurred a postoperative facial palsy. Both patients recovered facial nerve function in 6 and 12 weeks, respectively. 46 J/cm2 were used in the former and 130 J/cm2 in the latter. We did not encounter a single post-operative LMN facial plasy in the 101 phase 2 patients treated with Photofrin-PDT. Among 688 supratentorial brain tumor operations in the last decade involving all pathologies and all locations no case of early post-operative LMN facial palsy was identified in the absence of PDT. One further patient who had a with post-PDT facial palsy was identified at the Denver site. Although it is possible that these patients had incidental Bell's palsy, we now recommend shielding the temporal fossa floor during PDT.

  10. Intraoperative somatosensory evoked potential recovery following opening of the fourth ventricle during posterior fossa decompression in Chiari malformation: case report.

    PubMed

    Grossauer, Stefan; Koeck, Katharina; Vince, Giles H

    2015-03-01

    The most appropriate surgical technique for posterior fossa decompression in Chiari malformation (CM) remains a matter of debate. Intraoperative electrophysiological studies during posterior fossa decompression of Type I CM (CM-I) aim to shed light on the entity's pathomechanism as well as on the ideal extent of decompression. The existing reports on this issue state that significant improvement in conduction occurs after craniotomy in all cases, but additional durotomy contributes a further improvement in only a minority of cases. This implies that craniotomy alone might suffice for clinical improvement without the need of duraplasty or even subarachnoid manipulation at the level of the craniocervical junction. In contrast to published data, the authors describe the case of a 32-year-old woman who underwent surgery for CM associated with extensive cervicothoracic syringomyelia and whose intraoperative somatosensory evoked potentials (SSEPs) did not notably improve after craniotomy or following durotomy; rather, they only improved after opening of the fourth ventricle and restoration of CSF flow through the foramen of Magendie. Postoperatively, the patient recovered completely from her preoperative neurological deficits. To the authors' knowledge, this is the first report of significant SSEP recovery after opening the fourth ventricle in the decompression of a CM-I. The electrophysiological and operative techniques are described in detail and the findings are discussed in the light of available literature. The authors conclude that there might be a subset of CM-I patients who require subarachnoid dissection at the level of the craniocervical junction to benefit clinically. Prospective studies with detailed electrophysiological analyses seem warranted to answer the question regarding the best surgical approach in CM-I decompression. PMID:25526275

  11. [A Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Associated with Acute Subdural Hematoma, Extending from the Interhemispheric Space to the Posterior Fossa].

    PubMed

    Otsuka, Hiroaki; Fukuda, Yuhtaka; Yoshimura, Shouta; Somagawa, Chika; Hiu, Takeshi; Ono, Tomonori; Ushijima, Ryujirou; Toda, Keisuke; Tsutsumi, Keisuke

    2016-06-01

    A 69-year-old woman was admitted to our hospital because of a sudden severe headache without a history of head trauma. CT and MRI revealed an acute subdural hematoma (ASDH) extending from the right interhemispheric space to the posterior fossa bilaterally, with a small amount of subarachnoid hemorrhage that was predominantly localized to the left side of the basal cistern. CT angiogram demonstrated a long protruding ruptured aneurysm at the junction of the right internal carotid and posterior communicating arteries (IC/PC AN) with a posteroinferior projection, associated with a small bleb located near the tentorial edge close to the ipsilateral posterior clinoid process, for which she received clipping surgery. Though rare, IC/PC AN could cause pure or nearly pure ASDH in the above-mentioned distribution. Therefore, in patients with such ASDH, especially without a history of head injury or precise information regarding the situation at the time of onset, urgent imaging evaluation and early intervention are essential to prevent devastating re-rupture events. PMID:27270151

  12. Successful reconstruction after resection of malignant skin tumor on triangular fossa using anterior auricular bilobed flap.

    PubMed

    Fujioka, Masaki; Hayashida, Kenji; Morooka, Sin; Saijo, Hiroto

    2015-10-01

    Reconstruction of surgical defects is challenging, especially when they are localized in an anterior surface. The authors present two patients with a malignant skin neoplasm localized in the triangular fossa. Each tumor was removed and the cartilage-exposing wound was reconstructed using an anterior auricular bilobed flap. The donor site of the flap was primarily closed. The viability of the flap was favorable without complications and with excellent esthetic results. There are various surgical procedures for reconstruction of the anterior auricle. Among them, an anterior auricular bilobed flap can be performed quickly, has minimal associated morbidity and yields a favorable outcome. We believe that this technique is an effective option, especially for the triangular fossa skin defect resurfacing. PMID:25893369

  13. Chromosome 1q gain and tenascin-C expression are candidate markers to define different risk groups in pediatric posterior fossa ependymoma.

    PubMed

    Araki, Asuka; Chocholous, Monika; Gojo, Johannes; Dorfer, Christian; Czech, Thomas; Heinzl, Harald; Dieckmann, Karin; Ambros, Inge M; Ambros, Peter F; Slavc, Irene; Haberler, Christine

    2016-01-01

    Intracranial classic (WHO grade II) and anaplastic (WHO grade III) ependymomas are among the most common tumors in pediatric patients and have due to frequent recurrences and late relapses a relatively poor outcome. The impact of histopathological grading on patient outcome is controversial and therefore, molecular prognostic and predictive markers are needed to improve patient outcome. To date, the most promising candidate marker is chromosome 1q gain, which has been associated in independent studies with adverse outcome. Furthermore, gene expression and methylation profiles revealed distinct molecular subgroups in the supratentorial and posterior fossa (PF) compartment and Laminin alpha-2 (LAMA2) and Neural Epidermal Growth Factor Like-2 (NELL2) were suggested as surrogate markers for the two PF subgroups PF-EPN-A and PF-EPN-B. PF-EPN-A tumors were also characterized by tenascin-C (TNC) expression and tenascin-C has been suggested as candidate gene on 9q, involved in tumor progression. Therefore, we have analyzed the status of chromosome 1q, TNC, LAMA2, and NELL2 expression in a series of pediatric PF ependymomas in terms of their frequency, associations among themselves, and clinical parameters, as well as their prognostic impact. We confirm the negative prognostic impact of 1q gain and TNC expression and could classify PF ependymomas by these two markers into three molecular subgroups. Tumors with combined 1q gain and TNC expression had the poorest, tumors without 1q gain and TNC expression had a favorable and TNC positive 1q non-gained cases had an intermediate outcome. We found also differences in age and tumor grade in the three subgroups and thus, provide evidence that PF pediatric ependymomas can be divided by chromosome 1q status and TNC expression in three molecular subgroups with distinct clinico-pathological features. These analyses require only few amounts of tumor tissue, are broadly available in the routine clinical neuropathological setting and

  14. Preoperative radiotherapy in the management of posterior fossa choroid plexus papillomas.

    PubMed

    Carrea, R; Polak, M

    1977-01-01

    Although primary radical removal is the procedure of choice in the treatment of choroid plexus papillomas, the age of the child, the size and/or location of the tumor and an above average surgical risk can make advisable the use of a first stage shunt operation, with section of the tentorium if there are signs of upwards tentorial herniation. The present two observations clearly demonstrate that radiotherapy shrinks the vascular stroma of these tumors, thus reducing its size and vascularity making possible the postponement of radical surgery and greatly simplifying the final radical removal of the lesion. Preoperative radiotherapy as well as shunt operations and tentorial section can be considered as first stage procedures for the surgical management of choroid plexus neoplasms in certain cases. PMID:844343

  15. Clinical and methodological confounders in assessing the cerebellar cognitive affective syndrome in adult patients with posterior fossa tumours.

    PubMed

    Omar, Dashne; Ryan, Tracy; Carson, Alan; Bak, Thomas H; Torrens, Lorna; Whittle, Ian

    2014-12-01

    The cerebellar cognitive affective syndrome (CCAS) was first described by Schmahmann and Sherman as a constellation of symptoms including dysexecutive syndrome, spatial cognitive deficit, linguistic deficits and behavioural abnormalities in patients with a lesion in the cerebellum with otherwise normal brain. Neurosurgical patients with cerebellar tumours constitute one of the cohorts in which the CCAS has been described. In this paper, we present a critical review of the literature of this syndrome in neurosurgical patients. Thereafter, we present a prospective clinical study of 10 patients who underwent posterior fossa tumour resection and had a detailed post-operative neuropsychological, neuropsychiatric and neuroradiological assessment. Because our findings revealed a large number of perioperative neuroradiological confounding variables, we reviewed the neuroimaging of a further 20 patients to determine their prevalence. Our literature review revealed that study design, methodological quality and sometimes both diagnostic criteria and findings were inconsistent. The neuroimaging study (pre-operative, n = 10; post-operative, n = 10) showed very frequent neuroradiological confounding complications (e.g. hydrocephalus; brainstem compression; supratentorial lesions and post-operative subdural hygroma); the impact of such features had largely been ignored in the literature. Findings from our clinical study showed various degree of deficits in neuropsychological testing (n = 1, memory; n = 3, verbal fluency; n = 3, attention; n = 2, spatial cognition deficits; and n = 1, behavioural changes), but no patient had full-blown features of CCAS. Our study, although limited, finds no robust evidence of the CCAS following surgery. This and our literature review highlight a need for guidelines regarding study design and methodology when attempting to evaluate neurosurgical cases with regard to the potential CCAS. PMID:24881640

  16. [Orbitozygomatic approaches to skull base tumors spreading into the orbit, paranasal sinuses, nasal cavity, and pterygopalatine and infratemporal fossae].

    PubMed

    Cherekaev, V A; Gol'bin, D A; Belov, A I; Radchenkov, N S; Vinokurov, A G; Bekyashev, A Kh; Spallone, A

    2015-01-01

    The paper analyzes application of orbitozygomatic approaches at the Department of Skull Base and Craniofacial Surgery of the Burdenko Neurosurgical Institute for a 14-year period. During this time, 723 patients were operated on using the orbitozygomatic approach, which has become the workhorse of surgery for skull base tumors spreading into the orbit, paranasal sinuses, and pterygopalatine and infratemporal fossae. The authors describe seven major modifications of the orbitozygomatic approach that they have used in their practice. PMID:26528608

  17. Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa

    PubMed Central

    Nishizaki, Takafumi; Ikeda, Norio; Nakano, Shigeki; Sakakura, Takanori; Abiko, Masaru; Okamura, Tomomi

    2011-01-01

    Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI) revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve. PMID:24765294

  18. Microanatomical study of the extradural middle fossa approach to the petroclival and posterior cavernous sinus region: description of the rhomboid construct.

    PubMed

    Day, J D; Fukushima, T; Giannotta, S L

    1994-06-01

    The extradural middle fossa transpetrosal approach has been used to access lesions of the petroclival and posterior cavernous sinus regions by several neurosurgical groups, including our own. This is a technically demanding approach that provides a relatively wide extradural corridor interposed between the 5th cranial nerve and the cranial nerve VII-VIII complex, which minimizes brain retraction. We performed a microanatomical study to determine the limits of this exposure and in particular how the removal of the petrous bone could be maximized through this approach. Dissection of 15 fixed human cadaveric heads and 8 isolated temporal bones was performed to yield 38 sides studied. We identified a rhomboid-shaped construct of middle fossa landmarks that serve as a guide to maximally removing the petrous apex. The points defining this construct are as follows: 1) the junction of the greater superficial petrosal nerve and the trigeminal nerve; 2) the lateral edge of the porus trigeminus; 3) the intersection of the petrous ridge and arcuate eminence; and 4) the intersection of the lines extended along the axes of the greater superficial petrosal nerve and arcuate eminence. A morphometric analysis determined the average lengths of the respective sides of the complex to be 13.2 mm +/- 2.6 x 22.2 mm +/- 2.8 x 16.4 mm +/- 3.4 x 16.6 mm +/- 1.5 (beginning at "1" and proceeding sequentially), with an approximate area of the construct equal to 2.9 square centimeters.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8084385

  19. Clinical significance of changes in pB-C2 distance in patients with Chiari Type I malformations following posterior fossa decompression: a single-institution experience.

    PubMed

    Bonney, Phillip A; Maurer, Adrian J; Cheema, Ahmed A; Duong, Quyen; Glenn, Chad A; Safavi-Abbasi, Sam; Stoner, Julie A; Mapstone, Timothy B

    2016-03-01

    OBJECT The coexistence of Chiari malformation Type I (CM-I) and ventral brainstem compression (VBSC) has been well documented, but the change in VBSC after posterior fossa decompression (PFD) has undergone little investigation. In this study the authors evaluated VBSC in patients with CM-I and determined the change in VBSC after PFD, correlating changes in VBSC with clinical status and the need for further intervention. METHODS Patients who underwent PFD for CM-I by the senior author from November 2005 to January 2013 with complete radiological records were included in the analysis. The following data were obtained: objective measure of VBSC (pB-C2 distance); relationship of odontoid to Chamberlain's, McGregor's, McRae's, and Wackenheim's lines; clival length; foramen magnum diameter; and basal angle. Statistical analyses were performed using paired t-tests and a mixed-effects ANOVA model. RESULTS Thirty-one patients were included in the analysis. The mean age of the cohort was 10.0 years. There was a small but statistically significant increase in pB-C2 postoperatively (0.5 mm, p < 0.0001, mixed-effects ANOVA). Eleven patients had postoperative pB-C2 values greater than 9 mm. The mean distance from the odontoid tip to Wackenheim's line did not change after PFD, signifying postoperative occipitocervical stability. No patients underwent transoral odontoidectomy or occipitocervical fusion. No patients experienced clinical deterioration after PFD. CONCLUSIONS The increase in pB-C2 in patients undergoing PFD may occur as a result of releasing the posterior vector on the ventral dura, allowing it to relax posteriorly. This increase appears to be well-tolerated, and a postoperative pB-C2 measurement of more than 9 mm in light of stable craniocervical metrics and a nonworsened clinical examination does not warrant further intervention. PMID:26613273

  20. Multi-Institution Prospective Trial of Reduced-Dose Craniospinal Irradiation (23.4 Gy) Followed by Conformal Posterior Fossa (36 Gy) and Primary Site Irradiation (55.8 Gy) and Dose-Intensive Chemotherapy for Average-Risk Medulloblastoma

    SciTech Connect

    Merchant, Thomas E. Kun, Larry E.; Krasin, Matthew J.; Wallace, Dana; Chintagumpala, Murali M.; Woo, Shiao Y.; Ashley, David M.; Sexton, Maree; Kellie, Stewart J.; Ahern, Verity M.B.B.S.; Gajjar, Amar

    2008-03-01

    Purpose: Limiting the neurocognitive sequelae of radiotherapy (RT) has been an objective in the treatment of medulloblastoma. Conformal RT to less than the entire posterior fossa (PF) after craniospinal irradiation might reduce neurocognitive sequelae and requires evaluation. Methods and Materials: Between October 1996 and August 2003, 86 patients, 3-21 years of age, with newly diagnosed, average-risk medulloblastoma were treated in a prospective, institutional review board-approved, multi-institution trial of risk-adapted RT and dose-intensive chemotherapy. RT began within 28 days of definitive surgery and consisted of craniospinal irradiation (23.4 Gy), conformal PF RT (36.0 Gy), and primary site RT (55.8 Gy). The planning target volume for the primary site included the postoperative tumor bed surrounded by an anatomically confined margin of 2 cm that was then expanded with a geometric margin of 0.3-0.5 cm. Chemotherapy was initiated 6 weeks after RT and included four cycles of high-dose cyclophosphamide, cisplatin, and vincristine. Results: At a median follow-up of 61.2 months (range, 5.2-115.0 months), the estimated 5-year event-free survival and cumulative incidence of PF failure rate was 83.0% {+-} 5.3% and 4.9% {+-} 2.4% ({+-} standard error), respectively. The targeting guidelines used in this study resulted in a mean reduction of 13% in the volume of the PF receiving doses >55 Gy compared with conventionally planned RT. The reductions in the dose to the temporal lobes, cochleae, and hypothalamus were statistically significant. Conclusion: This prospective trial has demonstrated that irradiation of less than the entire PF after 23.4 Gy craniospinal irradiation for average-risk medulloblastoma results in disease control comparable to that after treatment of the entire PF.

  1. Resection of Posterior Mediastinal Tumors by Video Assisted Thoracic Surgery.

    PubMed

    Ali, Taimur Asif; Fatimi, Saulat Hasnain; Naeem, Syed Saad

    2015-07-01

    This case report illustrates successful Video Assisted Thoracic Surgery (VATS) performed on a 45-year-old woman and 52-year-old man presenting with a mass in left and right paravertebral space on the CT scan respectively. VATS has many benefits over traditional open operation (thoracotomy), resulting in less pain and shorten recovery time. However, VATS has higher equipment cost but when an experienced surgeon performs the surgery, better outcomes are achieved. VATS is not common in Pakistan's surgical setup as it is an expensive method of eradicating mediastinal pathologies and not every patient undergoes VATS. The primary objective of presenting these cases is to promote the use of VATS specifically for removal of posterior mediastinal tumors and improve the surgical outcomes. PMID:26208561

  2. Medusae Fossae

    NASA Technical Reports Server (NTRS)

    2002-01-01

    [figure removed for brevity, see original site] (Released 31 July 2002) This image crosses the equator at about 155 W longitude and shows a sample of the middle member of the Medusae Fossae formation. The layers exposed in the southeast-facing scarp suggest that there is a fairly competent unit underlying the mesa in the center of the image. Dust-avalanches are apparent in the crater depression near the middle of the image. The mesa of Medusae Fossae material has the geomorphic signatures that are typical of the formation elsewhere on Mars, but the surface is probably heavily mantled with fine dust, masking the small-scale character of the unit. The close proximity of the Medusae Fossae unit to the Tharsis region may suggest that it is an ignimbrite or volcanic airfall deposit, but it's eroded character hasn't preserved the primary depositional features that would give away the secrets of formation. One of the most interesting feature in the image is the high-standing knob at the base of the scarp in the lower portion of the image. This knob or butte is high standing because it is composed of material that is not as easily eroded as the rest of the unit. There are a number of possible explanations for this feature, including volcano, inverted crater, or some localized process that caused once friable material to become cemented. Another interesting set of features are the long troughs on the slope in the lower portion of the image. The fact that the features keep the same width for the entire length suggests that these are not simple landslides.

  3. Primary brain tumors and posterior reversible encephalopathy syndrome

    PubMed Central

    Kamiya-Matsuoka, Carlos; Cachia, David; Olar, Adriana; Armstrong, Terri S.; Gilbert, Mark R.

    2014-01-01

    Background Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state associated with reversible cerebral vasogenic edema. It is an increasingly recognized occurrence in the oncology population. However, it is very uncommon in patients with primary brain tumors (PBTs). The aim of this study was to analyze the clinicoradiological features and report the clinical outcomes of PRES in PBT patients. Methods We identified 4 cases with PBT who developed PRES at MD Anderson Cancer Center (MDACC) between 2012 and 2014. Clinical and radiological data were abstracted from their records. In addition, we also solicited 8 cases from the literature. Results The median age at PRES onset was 19 years, male-to-female ratio was 1:1, and the syndrome occurred in patients with ependymoma (n = 4), glioblastoma (n = 3), diffuse intrinsic pontine glioma (DIPG; n = 3), juvenile pilocytic astrocytoma (n = 1), and atypical meningioma (n = 1). Two glioblastomas and 2 DIPG cases received bevacizumab and vandetanib before the onset of symptoms, respectively. The most common clinical presentation was seizures (n = 7). Three MDACC patients recovered completely in 3–4 weeks after the onset of symptoms. One patient died due to active cancer and several comorbidities including PRES. Conclusions Hypertension seems to be the most important coexisting risk factor for development of PRES; however, the potential effects of chemotherapeutic agents in the pathogenesis of PRES should also be examined. The clinicoradiological course of PRES in PBT patients did not vary from the classical descriptions of PRES found in other causes. PRES must be considered as part of the differential diagnosis in patients with PBTs presenting with seizures or acute encephalopathy. PMID:26034631

  4. Claritas Fossae

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 20 June 2002) The Science The eastern rim of this unnamed crater in Claritas Fossae is very degraded. This indicates that this crater is very ancient and has been subjected to erosion and subsequent bombardment from other impactors such as asteroids and comets. One of these later (younger) craters is seen in the upper right of this image superimposed upon the older crater rim material. Note that this smaller younger crater rim is sharper and more intact than the older crater rim. This region is also mantled with a blanket of dust. This dust mantle causes the underlying topography to take on a more subdued appearance. The Story Not every crater on Mars has a name. The one in this image doesn't. What would you name it if you could? That's what planetary scientists ask themselves when they come across such features. If they think of a good name, they can submit it for approval to a group of world astronomers who are members of the International Astronomical Union. There are special rules, though, so not any name can be selected. The selection committee especially wants to make sure that all world cultures are represented. While this crater may not have a name, the region it lies in does. It is called Claritas Fossae. 'Claritas' is the Latin word for 'bright.' 'Fossae' are long, narrow, shallow depressions that mark the region. You can see these best in the context image to the right. You can tell just by looking at this crater that it is very ancient. Its rim is very degraded from erosion and bombardment from other impactors such as asteroids and comets. Compare its roughened rim to the smoother outline of the small crater on the rim's edge (upper right). The smoother rim of the small one means that it is considerably younger than its older, choppier neighbor. You know it was certainly created after the large crater because it lies on top of the rim. Other than the old and young generations of craters, the surface looks pretty uniform in hue and perhaps even

  5. Mangala Fossa

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 29 May 2002) The Science Today's THEMIS release captures Mangala Fossa. Mangala Fossa is a graben, which in geologic terminology translates into a long parallel to semi-parallel fracture or trough. Grabens are dropped or downthrown areas relative to the rocks on either side and these features are generally longer than they are wider. There are numerous dust devil trails seen in this image. In the lower portion of this image several dust devil tracks can be seen cutting across the upper surface then down the short stubby channel and finally back up and over to the adjacent upper surface. Some dust avalanche streaks on slopes are also visible. The rough material in the upper third of the image contains a portion of the rim of a 90 km diameter crater located in Daedalia Planum. The smooth crater floor has a graben (up to 7 km wide) and channel (2 km wide) incised into its surface. In the middle third and right of this image one can see ripples (possibly fossil dunes) on the crater floor material just above the graben. The floor of Mangala Fossa and the southern crater floor surface also have smaller linear ridges trending from the upper left to lower right. These linear ridges could be either erosional (yardangs) or depositional (dunes) landforms. The lower third of the scene contains a short stubby channel (near the right margin) and lava flow front (lower left). The floor of this channel is fairly smooth with some linear crevasses located along its course. One gets the impression that the channel floor is mantled with some type of indurated material that permits cracks to form in its surface. The Story In the Daedalia Plains on Mars, the rim of an old eroded crater rises up, a wreck of its former self (see context image at right). From the rough, choppy crater rim (top of the larger THEMIS image), the terrain descends to the almost smooth crater floor, gouged deeply by a trough, a channel, and the occasional dents of small, scattered craters. The deep

  6. Microsurgical decompression of tumor of a rare posterior third ventricular pathology.

    PubMed

    Nanda, Anil; Konar, Subhas; Kalakoti, Piyush; Maiti, Tanmoy

    2016-01-01

    Of the posterior third ventricular tumors, a papillary tumor of the pineal gland is a rare entity that originates from specialized ependymoma of the subcommissural organ. In this video narration, we present a case of a 33-year-old male with headaches and recent cognitive decline due to a posterior third ventricular lesion. The patient underwent a posterior interhemispheric approach, and a gross-total decompression was achieved with no signs of recurrence in a 2-year follow-up period. With this case we highlight the microsurgical technique employed for decompressing tumors of the posterior third ventricular region with preservation of eloquent structures and draining veins. The video can be found here: https://youtu.be/o0WbyOqmtX0 . PMID:26722689

  7. Nili Fossae

    NASA Technical Reports Server (NTRS)

    2004-01-01

    [figure removed for brevity, see original site]

    Released 9 June 2004 This image was collected June 23, 2002 during northern spring season. The local time at the image location was about 4 pm. The image shows an area in the Nili Fossae region.

    The THEMIS VIS camera is capable of capturing color images of the martian surface using its five different color filters. In this mode of operation, the spatial resolution and coverage of the image must be reduced to accommodate the additional data volume produced from the use of multiple filters. To make a color image, three of the five filter images (each in grayscale) are selected. Each is contrast enhanced and then converted to a red, green, or blue intensity image. These three images are then combined to produce a full color, single image. Because the THEMIS color filters don't span the full range of colors seen by the human eye, a color THEMIS image does not represent true color. Also, because each single-filter image is contrast enhanced before inclusion in the three-color image, the apparent color variation of the scene is exaggerated. Nevertheless, the color variation that does appear is representative of some change in color, however subtle, in the actual scene. Note that the long edges of THEMIS color images typically contain color artifacts that do not represent surface variation.

    Image information: VIS instrument. Latitude 22, Longitude 79.3 East (280.7 West). 38 meter/pixel resolution.

    Note: this THEMIS visual image has not been radiometrically nor geometrically calibrated for this preliminary release. An empirical correction has been performed to remove instrumental effects. A linear shift has been applied in the cross-track and down-track direction to approximate spacecraft and planetary motion. Fully calibrated and geometrically projected images will be released through the Planetary Data System in accordance with Project policies at a later time.

    NASA's Jet Propulsion Laboratory

  8. Tantalus Fossae

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 25 June 2002) The Science Tantalus Fossae is a set of long valleys on the eastern side of Alba Patera. These valleys are referred to as grabens and are formed by extension of the crust and faulting. When large amounts of pressure or tension are applied to rocks on timescales that are fast enough that the rock cannot respond by deforming, the rock breaks along faults. In the case of a graben, two parallel faults are formed by extension of the crust and the rock in between the faults drops downward into the space created by the extension. Numerous sets of grabens are visible in this THEMIS image, trending from north-northeast to south-southwest. Because the faults defining the graben are formed parallel to the direction of the applied stress, we know that extensional forces were pulling the crust apart in the west-northwest/east-southeast direction. The large number of grabens around Alba Patera is generally believed to be the result of extensional forces associated with the uplift of Alba Patera. Also visible in this image are a series of linearly aligned pits, called a pit chain. The pits are not the result of impact cratering, but are similar to sinkholes on Earth. Sinkholes are typically formed by the removal of rock (commonly limestone) underground by groundwater -- when enough rock is removed, the overlying rock becomes too heavy to be supported, and it collapses, forming a pit. Unlike sinkholes, however, the pit chains near Alba Patera were likely formed when empty underground lava tubes collapsed, accounting for the presence and alignment of many pits. Numerous channel features are also observed in the image, and follow the local topographic slope, which is downhill to the east-southeast. One of these, a long channel in the center of the image, nicely demonstrates the complex relations possible between geologic features. The geologist's rule of superposition says that a feature on top of (superposing) another feature, or cutting across another

  9. Tantalus Fossae

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 25 June 2002) The Science Tantalus Fossae is a set of long valleys on the eastern side of Alba Patera. These valleys are referred to as grabens and are formed by extension of the crust and faulting. When large amounts of pressure or tension are applied to rocks on timescales that are fast enough that the rock cannot respond by deforming, the rock breaks along faults. In the case of a graben, two parallel faults are formed by extension of the crust and the rock in between the faults drops downward into the space created by the extension. Numerous sets of grabens are visible in this THEMIS image, trending from north-northeast to south-southwest. Because the faults defining the graben are formed parallel to the direction of the applied stress, we know that extensional forces were pulling the crust apart in the west-northwest/east-southeast direction. The large number of grabens around Alba Patera is generally believed to be the result of extensional forces associated with the uplift of Alba Patera. Also visible in this image are a series of linearly aligned pits, called a pit chain. The pits are not the result of impact cratering, but are similar to sinkholes on Earth. Sinkholes are typically formed by the removal of rock (commonly limestone) underground by groundwater -- when enough rock is removed, the overlying rock becomes too heavy to be supported, and it collapses, forming a pit. Unlike sinkholes, however, the pit chains near Alba Patera were likely formed when empty underground lava tubes collapsed, accounting for the presence and alignment of many pits. Numerous channel features are also observed in the image, and follow the local topographic slope, which is downhill to the east-southeast. One of these, a long channel in the center of the image, nicely demonstrates the complex relations possible between geologic features. The geologist's rule of superposition says that a feature on top of (superposing) another feature, or cutting across another

  10. Two unique cases of calcifying cystic odontogenic tumor in the maxillary posterior region.

    PubMed

    Chindasombatjaroen, Jira; Poomsawat, Sopee; Boonsiriseth, Kiatanant

    2014-10-01

    A calcifying cystic odontogenic tumor (CCOT) is an uncommon odontogenic tumor with a predilection for the anterior part of the jaws. We report on 2 cases of CCOT in the posterior maxilla involving the maxillary sinus. In the first case, conventional radiography found a well-defined unilocular lesion. Internal calcification was identified on cone beam computed tomography (CBCT) images. Radiographically, the second case showed 2 large locules with a large complex odontoma and an embedded third molar. By revealing the internal calcification of the lesion, CBCT was helpful in the differential diagnosis of the first case. In both cases, CBCT illustrated the tumor extension and the relationship of the tumor to the maxillary sinus. Therefore, CBCT was an important tool for developing effective treatment plans for lesions in the posterior maxillary region. PMID:25201118

  11. Posterior Mediastinal Adenomatoid Tumor: A Case Report and Review of the Literature

    PubMed Central

    Parekh, Vishwas; Winokur, Thomas; Cerfolio, Robert J.; Stevens, Todd M.

    2016-01-01

    Adenomatoid tumor is an uncommon benign neoplasm of mesothelial differentiation that distinctively arises in and around the genital organs. In rare instances, it has been described in extragenital locations. There have been only two reports documenting its occurrence in the anterior mediastinum, and no reports documenting its occurrence in the posterior mediastinum. We report the first case of posterior mediastinal adenomatoid tumor. A 37-year-old Caucasian woman presented with symptoms of bronchitis. Imaging studies identified a 2.0 cm posterior mediastinal mass abutting the T9 vertebral body, clinically and radiologically most consistent with schwannoma. Histologic sections revealed a lesion composed of epithelioid cells arranged in cords and luminal profiles embedded in a fibrotic to loose stroma and surrounded by a fibrous pseudocapsule. Lesional cells showed vacuolated eosinophilic cytoplasm and peripherally displaced nuclei with prominent nucleoli. There was focal cytologic atypia but no mitotic figures or necrosis was identified. The lesional cells expressed cytokeratin, calretinin, and nuclear WT1 but were negative for PAX8, TTF1, p53, chromogranin, CD31, and CD34, and Ki67 showed <2% proliferation rate, diagnostic of adenomatoid tumor. Three years after resection, the patient is in good health without tumor recurrence. Thus, our encounter effectively expands the differential diagnosis of posterior mediastinal neoplastic entities. PMID:27293940

  12. [Spontaneous tension hemothorax due to rupture of a solitary fibrous tumor of the posterior mediastinum].

    PubMed

    Morita, Yohei; Ichimura, Hideo; Kikuchi, Shinji; Ozawa, Yuichiro; Inoue, Kazunari; Uchida, Atsushi; Kikuchi, Kazunori; Shiigai, Masanari; Shiotani, Seiji

    2013-10-01

    A 37-year-old man was transported by ambulance to our hospital due to abrupt chest pain. The pain began when he was practicing a combative-type sport. He denied any impact or blunt trauma. A chest radiograph revealed massive left pleural effusion with a mediastinal shift. Thoracentesis revealed a hemothorax;therefore, we performed an emergency thoracotomy. The intraoperative findings revealed a rupture of a posterior mediastinal tumor itself located between the descending aorta and the thoracic vertebra. After we identified the artery of Adamkiewicz that originates away from the tumor and evaluated the degree of tumor extension into the inter-vertebral foramen, we safely performed an elective tumor resection 1 month after the initial emergency operation. In patients with a hemothorax caused by rupture of the tumor itself, an elective tumor resection after detailed investigation should be considered if hemostasis can be achieved in the emergency thoracotomy. PMID:24105118

  13. Robotic radiosurgery vs. brachytherapy as a boost to intensity modulated radiotherapy for tonsillar fossa and soft palate tumors: the clinical and economic impact of an emerging technology.

    PubMed

    Nijdam, W; Levendag, P; Fuller, D; Schulz, R; Prevost, J-B; Noever, I; Uyl-de Groot, C

    2007-12-01

    As a basis for making decisions regarding optimal treatment for patients with tonsillar fossa and soft palate tumors, we conducted a preliminary investigation of costs and quality of life (QoL) for two modalities [brachytherapy (BT) and robotic radiosurgery] used to boost radiation to the primary tumors following external beam radiotherapy. BT was well established in our center; a boost by robotic radiosurgery was begun more recently in patients for whom BT was not technically feasible. Robotic radiosurgery boost treatment has the advantage of being non-invasive and is able to reach tumors in cases where there is deep parapharyngeal tumor extension. A neck dissection was performed for patients with nodal-positive disease. Quality of life (pain and difficulty swallowing) was established in long-term follow-up for patients undergoing BT and over a one-year follow-up in robotic radiosurgery patients. Total hospital costs for both groups were computed. Our results show that efficacy and quality of life at one year are comparable for BT and robotic radiosurgery. Total cost for robotic radiosurgery was found to be less than BT primarily due to the elimination of hospital admission and operating room expenses. Confirmation of robotic radiosurgery treatment efficacy and reduced morbidity in the long term requires further study. Quality of life and cost analyses are critical to Health Technology Assessments (HTA). The present study shows how a preliminary HTA of a new medical technology such as robotic radiosurgery with its typical hypofractionation characteristics might be based on short-term clinical outcomes and assumptions of equivalence. PMID:17994791

  14. Rehabilitation of Posterior Maxilla with Zygomatic and Dental Implant after Tumor Resection: A Case Report

    PubMed Central

    Ugurlu, Faysal; Yıldız, Coskun; Sener, B. C.; Sertgoz, Atilla

    2013-01-01

    Zygomatic implants have been used for dental rehabilitation in patients with insufficient bone in the posterior upper jaw, due to, for example, tumor resection, trauma, or atrophy. Zygomatic implants are an alternative to complex free or vascularized bone grafting and distraction osteogenesis. A 42-year-old male patient with a severe defect in the right posterior maxilla, starting from the first canine region, which had occurred after tumor resection 3 years earlier, was referred to our department. One zygomatic implant (Brenemark System, Nobel Biocare, Goteborg, Sweden) to the zygoma and one dental implant to the canine region were placed. After a 5-month osseointegration period, a fixed denture was fabricated and adapted to the implants. Although the surgical and prosthetic procedures for zygoma implants are not easy, the final outcomes can be successful with appropriate planning. PMID:23533833

  15. [Complete resection of a posterior mediastinal tumor after preoperative identification of artery of Adamkiewicz].

    PubMed

    Shiiya, Haruhiko; Tanaka, Akihiko; Sakuraba, Motoki; Nakamura, Masanori; Shibayama, Yui; Tsuji, Takahiro; Fukasawa, Yuichiro

    2014-05-01

    The thoracolumbar spinal cord receives its blood supply primarily from the artery of Adamkiewicz (AA), a branch of thoracolumbar intercostal arteries. Aortic cross-clamping during operation for descending aortic aneurysms can cause paraplegia due to spinal cord ischemia secondary to low blood flow through the AA. A 69-year-old woman was diagnosed with a left posterior mediastinal tumor measuring 66 mm. The tumor was adjacent to the thoracic aorta between Th10 to Th12 vertebral levels. Preoperative 3-dimensional computed tomography (3D-CT) imaging revealed 2 AAs originated from the 10th and 11th left intercostal arteries just near the tumor. The patient underwent a left thoracotomy and the 2 intercostal arteries were carefully dissected from the encapsulated tumor. Complete resection was safely achieved with preservation of the AAs. Pathology revealed a schwannoma. There were no complications. In performing thoracic surgery for posterior mediastinal tumors, it is important to identify the AAs preoperatively and preserve them. PMID:24917281

  16. Pre-operative embolization facilitating a posterior approach for the surgical resection of giant sacral neurogenic tumors.

    PubMed

    Chen, Kangwu; Zhou, Ming; Yang, Huilin; Qian, Zhonglai; Wang, Genlin; Wu, Guizhong; Zhu, Xiaoyu; Sun, Zhiyong

    2013-07-01

    The present study aimed to assess a posterior approach for the surgical resection of giant sacral neurogenic tumors, and to evaluate the oncological and functional outcomes. A total of 16 patients with giant sacral neurogenic tumors underwent pre-operative embolization and subsequent posterior sacral resection between January 2000 and June 2010. Benign tumors were identified in 12 cases, while four cases exhibited malignant peripheral nerve sheath tumors (MPNSTs). An evaluation of the operative techniques used, the level of blood loss, any complications and the functional and oncological outcomes was performed. All tumor masses were removed completely without intra-operative shock or fatalities. The mean tumor size was 17.5 cm (range, 11.5-28 cm) at the greatest diameter. The average level of intra-operative blood loss was 1,293 ml (range, 400-4,500 ml). Wound complications occurred in four patients (25%), including three cases of cutaneous necrosis and one wound infection. The mean follow-up time was 59 months (range, 24-110 months). Tumor recurrence or patient mortality as a result of the disease did not occur in any of the patients with benign sacral neurogenic tumors. The survival rate of the patients with malignant lesions was 75% (3/4 patients) since 25 % (1/4 patients) had multiple local recurrences and succumbed to the disease. The patients with benign tumors scored an average of 92.8% on the Musculoskeletal Tumor Society (MSTS) score functional evaluation, while the patients with malignant tumors scored an average of 60.3%. A posterior approach for the surgical resection of giant sacral neurogenic tumors, combined with pre-operative embolization may be safely conducted with satisfactory oncological and functional outcomes. PMID:23946813

  17. A case of neurilemmoma in the infratemporal fossa showing the antral bowing sign.

    PubMed

    Shinohara, Y; Uchida, A; Hiromatsu, T; Hida, K; Kikuta, T

    1993-11-01

    A case is reported of a neurilemmoma which arose in the right infratemporal fossa of a 23-year-old male. A benign tumour was suspected when bowing of the posterior maxillary antral wall was observed on CT. PMID:8181651

  18. Yardangs in Medusa Fossae

    NASA Technical Reports Server (NTRS)

    2002-01-01

    [figure removed for brevity, see original site] (Released 29 July 2002) This THEMIS visible image covers a portion of the Medusa Fossae formation, near the equator of Mars. The most characteristic feature of the Medusa Fossae formation is the abundance of 'yardangs', which are erosional landforms carved by the wind. These features usually form in a linear fashion, and can be indicators of prevailing paleowind directions. On Earth, yardangs are typically found in rocks that are easily eroded, such as those that form from consolidated volcanic ash, dust-fall deposits or lake sediments. In this particular area of Medusa Fossae, the size, spacing, and orientation of the yardangs varies throughout the image. The largest form a stripe across the center of the image, while the smallest are found in the top half of the image (look closely). The small yardangs at the very top of the image are oriented NW-SE; however, the orientation changes to NE-SW near the bright ridge in the center of the image. The variation in size and orientation appears to correspond with topographic layers, and may be due either to differences in consolidation or changes in wind strength or direction as the yardangs were formed. Finally, the terrain in the lower third of the image appears etched or pitted, and was probably also formed by wind erosion.

  19. Olympica Fossae Landforms

    NASA Technical Reports Server (NTRS)

    2005-01-01

    15 June 2005 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a portion of the enigmatic valley of the Olympica Fossae region. Unknown is whether water, lava, or mud, or some combination of these things, once poured through the valley system.

    Location near: 24.2oN, 115.7oW Image width: 2 km (1.2 mi) Illumination from: lower left Season: Northern Autumn

  20. Cerberus Fossae Troughs

    NASA Technical Reports Server (NTRS)

    2004-01-01

    11 October 2004 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows portions of two of the Cerberus Fossae troughs, their dark-toned interiors, and dark wind streaks formed from material blowing out of the troughs. The wind streaks indicate winds that blew from the northeast (upper right) toward the southwest (lower left). The crust of Mars expanded and split to form the troughs. These features are located near 6.6oN, 187.2oW. The image covers an area about 3 km (1.9 mi) wide. Sunlight illuminates the scene from the lower left.

  1. Medusae Fossae Formation

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 10 April 2002) The Science This THEMIS visible image was acquired near 7o S, 172o W (188o E) and shows a remarkable martian geologic deposit known as the Medusae Fossae Formation. This Formation, seen here as the raised plateau in the upper two-thirds of the image, is a soft, easily eroded deposit that extends for nearly 1,000 km along the equator of Mars. In this region the deposit has been heavily eroded by the wind to produce a series of linear ridges called yardangs. These parallel ridges point in direction of the prevailing winds that carved them, and demonstrate the power of martian winds to sculpt the dry landscape of Mars. The Medusae Fossae Formation has been completely stripped from the surface in the lower third of the image, revealing a harder layer below that is more resistant to wind erosion. The easily eroded nature of the Medusae Fossae Formation suggests that it is composed of weakly cemented particles, and was most likely formed by the deposition of wind-blown dust or volcanic ash. Several ancient craters that were once completely buried by this deposit are being exposed, or exhumed, as the overlying Medusae Formation is removed. Very few impact craters are visible on this Formation, indicating that the surface seen today is relatively young, and that the processes of erosion are likely to be actively occurring. The Story Medusa of Greek mythology fame, the name-giver to this region, had snaky locks of hair that could turn a person to stone. Wild and unruly, this monster of the underworld could certainly wreak havoc on the world of the human imagination. As scary as she was, Medusa would have no advantage over the fierce, masterful winds blowing across Mars, which once carved the streaky, terrain at the top of this image. Wild and whipping, these winds have slowly eroded away the 'topsoil,' revealing ancient craters and other surface features they once covered. The loosely cemented particles of this 'topsoil' are likely made up of dust

  2. Memnonia Fossae (Enhanced Color)

    NASA Technical Reports Server (NTRS)

    1995-01-01

    Tharsis-centered volcanic and tectonic activity resulted in the formation of radial grabens of Memnonia Fossae, which cut materials of the ancient cratered highlands and the relatively young, highland-embaying lava flows from the Tharsis volcanoes. Center of picture is at latitude 16 degrees S., longitude 142 degrees W. The enhanced color version (following decorrelation stretch) reveals a diversity of subtle color variations; many of the color variations may be due to different lava flow units and variable amounts of weathering, possible alteration by water, and eolian redistributions. Viking Orbiter Picture Numbers 41B52 (green) 41B54 (red), and 41B56 (blue) at 198 m/pixel resolution. Picture width is 206 km. North is 119 degrees counter-clockwise from top.

  3. Medusae Fossae Formation

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 16 April 2002) The Science This THEMIS visible image was acquired near 11o N, 159o W (201o E) and shows examples of the remarkable variations that can be seen in the erosion of the Medusae Fossae Formation. This Formation is a soft, easily eroded deposit that extends for nearly 1,000 km along the equator of Mars. In this region, like many others throughout the Medusae Fossae Formation, the surface has been eroded by the wind into a series of linear ridges called yardangs. These ridges generally point in direction of the prevailing winds that carved them, and demonstrate the power of martian winds to erode the landscape of Mars. The easily eroded nature of the Medusae Fossae Formation suggests that it is composed of weakly cemented particles, and was most likely formed by the deposition of wind-blown dust or volcanic ash. Within this single image it is possible to see differing amounts of erosion and stripping of layers in the Medusae Fossae Formation. Near the bottom (southern) edge of the image a rock layer with a relatively smooth upper surface covers much of the image. Moving upwards (north) in the image this layer becomes more and more eroded. At first there are isolated regions where the smooth unit has been eroded to produce sets of parallel ridges and knobs. Further north these linear knobs increase in number, and only small, isolated patches of the smooth upper surface remain. Finally, at the top of the image, even the ridges have been removed, exposing the remarkably smooth top of hard, resistant layer below. This sequence of layers with differing hardness and resistance to erosion is common on Earth and on Mars, and suggests significant variations in the physical properties, composition, particle size, and/or cementation of these martian layers. As is common throughout the Medusae Fossae Formation, very few impact craters are visible, indicating that the surface exposed is relatively young, and that the process of erosion may be active today

  4. Medusae Fossae Formation

    NASA Technical Reports Server (NTRS)

    2002-01-01

    (Released 16 April 2002) The Science This THEMIS visible image was acquired near 11o N, 159o W (201o E) and shows examples of the remarkable variations that can be seen in the erosion of the Medusae Fossae Formation. This Formation is a soft, easily eroded deposit that extends for nearly 1,000 km along the equator of Mars. In this region, like many others throughout the Medusae Fossae Formation, the surface has been eroded by the wind into a series of linear ridges called yardangs. These ridges generally point in direction of the prevailing winds that carved them, and demonstrate the power of martian winds to erode the landscape of Mars. The easily eroded nature of the Medusae Fossae Formation suggests that it is composed of weakly cemented particles, and was most likely formed by the deposition of wind-blown dust or volcanic ash. Within this single image it is possible to see differing amounts of erosion and stripping of layers in the Medusae Fossae Formation. Near the bottom (southern) edge of the image a rock layer with a relatively smooth upper surface covers much of the image. Moving upwards (north) in the image this layer becomes more and more eroded. At first there are isolated regions where the smooth unit has been eroded to produce sets of parallel ridges and knobs. Further north these linear knobs increase in number, and only small, isolated patches of the smooth upper surface remain. Finally, at the top of the image, even the ridges have been removed, exposing the remarkably smooth top of hard, resistant layer below. This sequence of layers with differing hardness and resistance to erosion is common on Earth and on Mars, and suggests significant variations in the physical properties, composition, particle size, and/or cementation of these martian layers. As is common throughout the Medusae Fossae Formation, very few impact craters are visible, indicating that the surface exposed is relatively young, and that the process of erosion may be active today

  5. Medusae Fossae Formation

    NASA Technical Reports Server (NTRS)

    1998-01-01

    An exotic terrain of wind-eroded ridges and residual smooth surfaces are seen in one of the highest resolution images ever taken of Mars from orbit. The Medusae Fossae formation is believed to be formed of the fragmental ejecta of huge explosive volcanic eruptions. When subjected to intense wind-blasting over hundreds of millions of years, this material erodes easily once the uppermost tougher crust is breached. In the Mars Orbiter Camera (MOC) image shown on the right, the crust, or cap rock, can be seen in the upper right part of the picture. The finely-spaced ridges are similar to features on Earth called yardangs, which are formed by intense winds plucking individual grains from, and by wind-driven sand blasting particles off, sedimentary deposits.

    The MOC image was taken on October 30, 1997 at 11:05 AM PST, shortly after the Mars Global Surveyor spacecraft's 31st closest approach to Mars. The image covers an area 3.6 X 21.5 km (2.2 X 13.4 miles) at 3.6 m (12 feet) per picture element--craters only 11 m (36 feet, about the size of a swimming pool) across can be seen. The context image (left; the best Viking view of the area; VO 1 387S34) has a resolution of 240 m/pixel, or 67 times lower resolution than the MOC frame.

    Malin Space Science Systems (MSSS) and the California Institute of Technology built the MOC using spare hardware from the Mars Observer mission. MSSS operates the camera from its facilities in San Diego, CA. The Jet Propulsion Laboratory's Mars Surveyor Operations Project operates the Mars Global Surveyor spacecraft with its industrial partner, Lockheed Martin Astronautics, from facilities in Pasadena, CA and Denver, CO.

  6. Clay at Nili Fossae

    NASA Technical Reports Server (NTRS)

    2006-01-01

    This image of the Nili Fossae region of Mars was compiled from separate images taken by the Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) and the High-Resolution Imaging Science Experiment (HiRISE), two instruments on NASA's Mars Reconnaissance Orbiter. The images were taken at 0730 UTC (2:30 a.m. EDT) on Oct. 4, 2006, near 20.4 degrees north latitude, 78.5 degrees east longitude. CRISM's image was taken in 544 colors covering 0.36 to 3.92 micrometers, and shows features as small as 18 meters (60 feet) across. HiRISE's image was taken in three colors, but its much higher resolution shows features as small as 30 centimeters (1 foot) across.

    CRISM's sister instrument on the Mars Express spacecraft, OMEGA, discovered that some of the most ancient regions of Mars are rich in clay minerals, formed when water altered the planet's volcanic rocks. From the OMEGA data it was unclear whether the clays formed at the surface during Mars' earliest history of if they formed at depth and were later exposed by impact craters or erosion of the overlying rocks. Clays are an indicator of wet, benign environments possibly suitable for biological processes, making Nili Fossae and comparable regions important targets for both CRISM and HiRISE.

    In this visualization of the combined data from the two instruments, the CRISM data were used to calculate the strengths of spectral absorption bands due to minerals present in the scene. The two major minerals detected by the instrument are olivine, a mineral characteristic of primitive igneous rocks, and clay. Areas rich in olivine are shown in red, and minerals rich in clay are shown in green. The derived colors were then overlayed on the HiRISE image.

    The area where the CRISM and HiRISE data overlap is shown at the upper left, and is about 5 kilometers (3 miles) across. The three boxes outlined in blue are enlarged to show how the different minerals in the scene match up with different landforms. In the image

  7. [A solitary neurofibroma arising from the temporal fossa].

    PubMed

    Tian, Xiaoyan; Luo, Gui; Zhu, Xinhua

    2014-07-01

    Neurofibromas are benign nerve sheath tumors that arise from the nonmyelinating Schwann cells. Generally, neurofibromas can be categorized into dermal and plexiform subtypes. The former subtype is usually associated with a lone peripheral nerve in the integumentary system, while plexiform tumors are associated with many nerve bundles and can originate internally. Rarely, the plexiform tumors can undergo malignant transformation. Neurofibromas are usually found in individuals with neurofibromatosis, which is an autosomal dominant disease. On occasion, an isolated neurofibroma can transpire without being associated with neurofibromatosis. Mostly, these solitary tumors tend to occur in the gastrointestinal system, and neurofibromas of the head and neck are not uncommon, but very rarely they have been reported to occur in the temporal fossa. In this report, we describe a case of a solitary neurofibroma arising from the temporal fossa. PMID:25248275

  8. Nili Fossae Crater

    NASA Technical Reports Server (NTRS)

    2004-01-01

    [figure removed for brevity, see original site]

    Released 17 May 2004 This image of a crater near Nili Fossae was acquired July 31, 2002, during northern spring.

    The THEMIS VIS camera is capable of capturing color images of the martian surface using its five different color filters. In this mode of operation, the spatial resolution and coverage of the image must be reduced to accommodate the additional data volume produced from the use of multiple filters. To make a color image, three of the five filter images (each in grayscale) are selected. Each is contrast enhanced and then converted to a red, green, or blue intensity image. These three images are then combined to produce a full color, single image. Because the THEMIS color filters don't span the full range of colors seen by the human eye, a color THEMIS image does not represent true color. Also, because each single-filter image is contrast enhanced before inclusion in the three-color image, the apparent color variation of the scene is exaggerated. Nevertheless, the color variation that does appear is representative of some change in color, however subtle, in the actual scene. Note that the long edges of THEMIS color images typically contain color artifacts that do not represent surface variation.

    Image information: VIS instrument. Latitude 21.2, Longitude 75.6 East (284.4 West). 38 meter/pixel resolution.

    Note: this THEMIS visual image has not been radiometrically nor geometrically calibrated for this preliminary release. An empirical correction has been performed to remove instrumental effects. A linear shift has been applied in the cross-track and down-track direction to approximate spacecraft and planetary motion. Fully calibrated and geometrically projected images will be released through the Planetary Data System in accordance with Project policies at a later time.

    NASA's Jet Propulsion Laboratory manages the 2001 Mars Odyssey mission for NASA's Office of Space Science, Washington

  9. Mandibular fossa morphology in the Ngandong and Sambungmacan fossil hominids.

    PubMed

    Durband, Arthur C

    2008-10-01

    There has been debate in recent years concerning the significance of the mandibular fossa morphology in the Ngandong and Sambungmacan hominids. These fossils lack a postglenoid process and their squamotympanic fissure runs along the apex of the fossa for its entire length. This configuration differs from that seen in other fossil and modern humans, which have a prominent postglenoid process and a squamotympanic fissure that takes a more posterior course that does not lie in the apex of the fossa. Some recent studies have suggested that the Ngandong and Sambungmacan hominids are not unique in their expression of these characteristics, and that they can also be found in other fossil crania from Africa and Indonesia. The present study reexamines these morphologies in an effort to better understand their distribution in the hominid fossil record. The results confirm that the lack of a prominent postglenoid process in combination with a squamotympanic fissure that lies wholly in the apex of the mandibular fossa along its entire length is indeed autapomorphic for the Ngandong and Sambungmacan fossils. This finding, in conjunction with work on other nonmetric features in these hominids, suggests that at least two hominid morphs, possibly representing separate species, were present on Java during the Pleistocene. In addition, if this apparent autapomorphy is confirmed, then it is also unlikely that the Ngandong hominids contributed to the gene pool of modern humans. PMID:18521904

  10. Tumors of the posterior third ventricular region in pediatric patients: The Indian perspective and a review of literature

    PubMed Central

    Behari, Sanjay; Jaiswal, Sushila; Nair, Prakash; Garg, Pallav; Jaiswal, Awadhesh K.

    2011-01-01

    Background: Diverse tumors in the posterior third ventricular region (TPTVR) frequently occur in children. A decade's experience with pediatric TPTVR is presented, focusing on the Indian perspective. Materials and Methods: 25 children (age range: 3-18 years; mean age: 13.32 years; presentation range: 7 days-2.5 years) had clinico-radiological assessment with contrast computed tomography (CT) and magnetic resonance imaging (MRI). The ventricular/lumbar cerebrospinal fluid (CSF) alpha feto protein (AFP)/beta human chorionic gonadotrophin (HCG) estimation was done when radiological suspicion of a germ cell tumor was present. Extent of resection was deemed partial when some tumor mass remained at the end of surgery, near total when <10% was retained over vital neurovascular structures, and total when complete resection was attained. Results: Operations included infratentorial supracerebellar approach (n = 12), occipito-transtentorial approach (n = 2), endoscopic biopsy and third ventriculostomy (n = 1), frontal parasagittal craniotomy, interhemispheric transcallosal subchoroidal approach (n = 2), middle temporal gyrus transcortical transventricular approach (n = 1), fronto-temporo-zygomatic combined transylvian and subtemporal approach (n = 1) and right ventriculoperitoneal shunt and stereotactic biopsy (n = 1). Only CSF diversion was performed for five patients with a small TPTVR. CSF diversion was required in 12 (48%) patients. Tumor pathology included pinealoblastoma (n = 4; one with pineocytic differentiation), nongerminomatous germ cell tumor (NGGCT; n = 3), germinoma (n = 3), pilocytic astrocytoma (n = 2), epidermoid (n = 3) and primitive neuroectodermal tumor (PNET), fibrillary astrocytoma, glioblastoma, teratoma, and meningioma (n = 1, respectively). A patient with neurocysticercosis was diagnosed solely on MRI (four did not undergo biopsy). Fractionated radiotherapy was administered in 13 patients with primary pineal tumors, PNET, NGGCT, fibrillary astrocytoma

  11. The Middle Fossa Transpetrous Approach

    PubMed Central

    Nassif, Paul S.; Hankinson, Hal L.; Horn, Karl L.

    1997-01-01

    Surgical access to lesions of the temporal bone anterior to the internal auditory canal and medial to the petrous carotid artery has concerned surgeons for nearly a century. A variety of approaches have been developed to gain access to this region. We report our experience with the middle fossa transpetrous approach for the treatment of a variety of petroclival and/or prepontine lesions. Tentorial transection and the retrolabyrinthine approach to extend this technique is also discussed. In properly selected cases, the middle fossa transpetrous approach is successful in maintaining hearing, labyrinthine and facial function without compromising surgical exposure. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11 PMID:17171001

  12. Extradural Dermoid Cyst of the Anterior Infratemporal Fossa. Case Report

    PubMed Central

    Watanabe, Kentaro; Filomena, Carol A.; Nonaka, Yoichi; Matsuda, Masahide; Zomorodi, Ali R.; Friedman, Allan H.; Fukushima, Takanori

    2015-01-01

    Dermoid cysts are rare in the skull base. There have been 10 reported cases of dermoid cysts in the cavernous sinus, two in the petrous apex, and one in the extradural Meckel cave. This is the first case report of a dermoid cyst in the anterior infratemporal fossa attached to the anterior dura of the foramen ovale. The clinical presentation, radiologic findings, histologic features, tumor origin, and operative technique are described along with a review of the literature. PMID:26623226

  13. Giant hydatid cyst in the posterior fossa of a child

    PubMed Central

    Fakhouri, Fakhr; Ghajar, Abdelwahed; Mahli, Nihad; Shoumal, Nihad

    2015-01-01

    The hydatid cyst (HC) is endemic in Mediterranean region including Syria. The central nervous system is involved in 2–3% of cases. HC in cerebellum is very rare. We report a case that presented as an emergency for high intracranial pressure and deteriorating Glascow coma scale. Close monitoring and precise surgical management using Dowling's technique resulted in very good outcome with full recovery. We highlight the need for very careful surgical treatment because cyst rupture and secondary hydatidosis due to spillage of the cyst contents can dramatically worsen the outcome. HC should be taken into consideration in countries where hydatid infestation is endemic. PMID:26425166

  14. A rare case of racemose neurocysticercosis of the posterior fossa

    PubMed Central

    Karegowda, Lakshmikanth Halegubbi; Shenoy, Poonam Mohan; Prakashini, Koteshwara; Karur, Gauri

    2014-01-01

    A 43-year-old man presented with a 3 month history of headache, vertigo and swaying while walking. MRI of the brain showed cystic lesions involving the cerebellopontine angle cisterns, the right perimedullary cistern, the fourth ventricle and bilateral foramen of Luschka with resultant obstruction to cerebrospinal fluid outflow and hydrocephalus. The patient underwent right retromastoid craniotomy with endoscopic third ventriculostomy for cyst excision. The postoperative period was uneventful and he was able to carry out routine activities within a month. This case report stresses on the clinical importance, unique characteristics and imaging features of racemose neurocysticercosis. PMID:24862421

  15. Posterior Reversible Encephalopathy Syndrome after Surgical Resection of a Giant Vestibular Schwannoma: Case Report and Literature Review.

    PubMed

    Sorour, Mohammad; Sayama, Christina; Couldwell, William T

    2016-05-01

    Background Posterior reversible encephalopathy syndrome (PRES) is a constellation of neurologic symptoms-seizures, headaches, altered mental status, and visual changes-associated with characteristic brain magnetic resonance imaging findings seen on T2 and fluid-attenuated inversion recovery sequences. Classically, this condition is caused by hypertension, but several other risk factors have been described. The development of PRES after surgical resection of posterior fossa tumors has mostly been linked to the pediatric neurosurgical practice. Case Report We report the first case of PRES after resection of a giant vestibular schwannoma in an adult patient. This 57-year-old female patient underwent a retrosigmoid approach for total resection of her left-sided giant tumor. On the second postoperative day, she developed the classic clinical and radiologic characteristics of PRES. She was treated aggressively with antihypertensive and anticonvulsant medications and showed complete recovery without sequelae. Conclusion PRES is a potential yet rare complication of surgeries to posterior fossa tumors that are compressing the brainstem. Rapid diagnosis and aggressive management are essential for achieving the best outcome. PMID:26091111

  16. Complete Recovery of Visual Disorder Following Surgical Resection of Adenoid Cystic Carcinoma Arising in the Pterygopalatine Fossa

    PubMed Central

    Du, Wei; Cui, Meng; Li, Peng; Wang, Jiheng; Luo, Ruihua; Qi, Jinxing; Zhao, Ming; Lou, Weihua

    2015-01-01

    Abstract Adenoid cystic carcinoma (ACC) arising in the pterygopalatine fossa was rare, only 3 cases have been reported. In previous literature, few authors reported whether the visual deficit could be resolved following the resection of the tumor. One patient with visual dysfunction induced by ACC arising in the pterygopalatine fossa was reported. Complete visual recovery was achieved following the operation. And the patient was satisfied with the appearance and the functional results in the follow-up. Visual loss contributed by the tumor in the pterygopalatine fossa could recover in selected patients. PMID:26039119

  17. Memnonia Fossae, Approximately Natural Color

    NASA Technical Reports Server (NTRS)

    1995-01-01

    Tharsis-centered volcanic and tectonic activity resulted in the formation of radial grabens of Memnonia Fossae, which cut materials of the ancient cratered highlands and the relatively young, highland-embaying lava flows from the Tharsis volcanoes. Center of picture is at latitude 16 degrees S., longitude 142 degrees W. Natural color version shows albedo variations and uniform colors. The enhanced color version (PIA00151, following decorrelation stretch), however, reveals a diversity of subtle color variations; many of the color variations may be due to different lava flow units and variable amounts of weathering, possible alteration by water, and eolian redistributions. Viking Orbiter Picture Numbers 41B52 (green), 41b54 (red), and 41B56 (blue) at 198 m/pixel resolution. Picture width is 206 km. North is 119 degrees counter-clockwise from top.

  18. Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach.

    PubMed

    Lau, Darryl; Chou, Dean

    2015-08-01

    OBJECT Spinal metastases most commonly affect the vertebral bodies of the spinal column, and spinal cord compression is an indication for surgery. Commonly, an open posterior approach is employed to perform a transpedicular costotransversectomy or lateral extracavitary corpectomy. Because of the short life expectancies in patients with metastatic spinal disease, decreasing the morbidity of surgical treatment and recovery time is critical. One potential approach to decreasing morbidity is utilizing minimally invasive surgery (MIS). Although significant advances have been made in MIS of the spine, data supporting the utility of MIS are still emerging. This study compared outcomes of patients who underwent mini-open versus traditional open transpedicular corpectomy for spinal metastases in the thoracic spine. METHODS A consecutive cohort from 2006 to 2013 of 49 adult patients who underwent thoracic transpedicular corpectomies for spinal metastases was retrospectively identified. Patients were categorized into one of 2 groups: open surgery and mini-open surgery. Mini-open transpedicular corpectomy was performed with a midline facial incision over only the corpectomy level of interest and percutaneous instrumentation above and below that level. The open procedure consisted of a traditional posterior transpedicular corpectomy. Chi-square test, 2-tailed t-test, and ANOVA models were employed to compare perioperative and follow-up outcomes between the 2 groups. RESULTS In the analysis, there were 21 patients who had mini-open surgery and 28 patients who had open surgery. The mean age was 57.9 years, and 59.2% were male. The tumor types encountered were lung (18.3%), renal/bladder (16.3%), breast (14.3%), hematological (14.3%), gastrointestinal tract (10.2%), prostate (8.2%), melanoma (4.1%), and other/unknown (14.3%). There were no significant intergroup differences in demographics, comorbidities, neurological status (American Spinal Injury Association [ASIA] grade

  19. An Unusual Cause of Posterior Elbow Impingement: Detachment of a Hypertrophied Posterior Fat Pad

    PubMed Central

    Hamada, Daisuke; Matsuura, Tetsuya; Sugiura, Kosuke; Higuchi, Tadahiro; Suzue, Naoto; Goto, Tomohiro; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    We report a case of a 47-year-old woman who developed posterior impingement of the elbow due to detachment of a hypertrophied posterior fat pad. She reported acute left elbow pain after leaning back onto a hard object with her hand and subsequently experienced a “catching” sensation. Comparison with the magnetic resonance images of a normal elbow revealed a hypertrophied posterior fat pad interposed between the olecranon and olecranon fossa in both elbows, with the fat pad in the left elbow located more inferiorly than that in the right elbow. Elbow arthroscopy showed the olecranon fossa covered by the fat pad, a portion of which was detached from the rest of the pad. Debridement of the detached portion was performed until no impingement was evident. Postoperatively, full extension of the elbow did not elicit pain. Clinicians should include this pathology among the differential diagnoses for posterior elbow pain. PMID:26613057

  20. An Unusual Cause of Posterior Elbow Impingement: Detachment of a Hypertrophied Posterior Fat Pad.

    PubMed

    Hamada, Daisuke; Matsuura, Tetsuya; Sugiura, Kosuke; Higuchi, Tadahiro; Suzue, Naoto; Goto, Tomohiro; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    We report a case of a 47-year-old woman who developed posterior impingement of the elbow due to detachment of a hypertrophied posterior fat pad. She reported acute left elbow pain after leaning back onto a hard object with her hand and subsequently experienced a "catching" sensation. Comparison with the magnetic resonance images of a normal elbow revealed a hypertrophied posterior fat pad interposed between the olecranon and olecranon fossa in both elbows, with the fat pad in the left elbow located more inferiorly than that in the right elbow. Elbow arthroscopy showed the olecranon fossa covered by the fat pad, a portion of which was detached from the rest of the pad. Debridement of the detached portion was performed until no impingement was evident. Postoperatively, full extension of the elbow did not elicit pain. Clinicians should include this pathology among the differential diagnoses for posterior elbow pain. PMID:26613057

  1. Applied anatomy of the anterior cranial fossa: what can fracture patterns tell us?

    PubMed

    Stephens, J R; Holmes, S; Evans, B T

    2016-03-01

    The skull base is uniquely placed to absorb anteriorly directed forces imparted either via the midfacial skeleton or cranial vault. A variety of skull base fracture classifications exist. Less well understood, however, is fracture extension beyond the anterior cranial fossa (ACF) into the middle and posterior cranial fossae. The cases of 81 patients from two UK major trauma centres were studied to examine the distribution of fractures across the skull base and any relationship between the vector of force and extent of skull base injury. It was found that predominantly lateral force to the craniofacial skeleton produced a fracture that propagated beyond the ACF into the middle cranial fossa in 77.4% of cases, significantly more (P<0.001) than for predominantly anterior force (12.0%). Fractures were significantly more likely to propagate into the posterior fossa with a lateral vector of impact compared to an anterior vector (P=0.049). This difference in energy transfer across the skull base may, in part, be explained by the local anatomy. The more delicate central ACF acts as a 'crumple zone' in order to absorb force. Conversely, no collapsible interface exists in the lateral aspect of the ACF, thus the lateral ACF behaves like a 'buttress', resulting in increased energy transfer. PMID:26589135

  2. Nili Fossae Resource and Science ROIs

    NASA Astrophysics Data System (ADS)

    Markle, L. M.

    2015-10-01

    The Nili Fossae region presents multiple resource and science ROIs for establishing a permanent colony on Mars. Water ice appears to cover a large are and multiple geological formations provide opportunity for science missions.

  3. Striae in the popliteal fossa (image)

    MedlinePlus

    Striae in the popliteal fossa: Striae or stretch marks result from stretching of the skin, or other influences such as Cushing's syndrome. Most pregnant women experience striae at some point during their ...

  4. Craniotomy for anterior cranial fossa meningiomas: historical overview.

    PubMed

    Morales-Valero, Saul F; Van Gompel, Jamie J; Loumiotis, Ioannis; Lanzino, Giuseppe

    2014-04-01

    The surgical treatment of meningiomas located at the base of the anterior cranial fossa is often challenging, and the evolution of the surgical strategy to resect these tumors parallels the development of craniotomy, and neurosurgery in general, over the past century. Early successful operations to treat these tumors were pioneered by prominent figures such as Sir William Macewen and Francesco Durante. Following these early reports, Harvey Cushing made significant contributions, allowing a better understanding and treatment of meningiomas in general, but particularly those involving the anterior cranial base. Initially, large-sized unilateral or bilateral craniotomies were necessary to approach these deep-seated lesions. Technical advances such as the introduction of electrosurgery, the operating microscope, and refined microsurgical instruments allowed neurosurgeons to perform less invasive surgical procedures with better results. Today, a wide variety of surgical strategies, including endoscopic surgery and radiosurgery, are used to treat these tumors. In this review, the authors trace the evolution of craniotomy for anterior cranial fossa meningiomas. PMID:24684326

  5. Bilambdoid and posterior sagittal synostosis: the Mercedes Benz syndrome.

    PubMed

    Moore, M H; Abbott, A H; Netherway, D J; Menard, R; Hanieh, A

    1998-09-01

    A consistent pattern of craniosynostosis in the sagittal and bilateral lambdoid sutures is described in three patients. The external cranial ridging associated with fusion of these sutures produces a characteristic triradiate, or "Mercedes Benz," appearance to the posterior skull. Locally marked growth restriction is evident in the posterior fossa with compensatory secondary expansion of the anterior fossa manifesting a degree of frontal bossing which mimics bicoronal synostosis. Although this appearance could lead to inadvertent surgery in the frontal region, attention to the occipital region with wide early suture excision and vault shaping is indicated. PMID:9780908

  6. Giant cell tumor of cervicothoracic region treated by triple corpectomy from posterior only approach: A case report with review of literature

    PubMed Central

    Mahajan, Rajat; Chhabra, Harvinder Singh; Tandon, Vikas; Venkatesh, Raghavendra

    2015-01-01

    Giant cell tumor (GCT) is a benign aggressive tumor, which affects axial as well as a peripheral skeleton. It affects epiphysis of long bones and can result in pathological fractures. GCT affects cervical spine rarely and has been known to affect almost all vertebra in the human body. It has a predilection for fixed spine, that is, sacrum though it can affect mobile spine as well. GCT of cervicothoracic region poses a challenge for the surgeon because of the difficulty in approaching this region anteriorly. This situation is further compounded when GCT involves multiple contiguous vertebral bodies in this region and has already spread beyond the confines of its capsule. We report a case of GCT involving three vertebral bodies C7, D1, and D2 at cervicothoracic region who presented to us and was treated with triple corpectomy from the posterior only approach. This is the first ever case report of triple corpectomy and anterior reconstruction by a posterior only approach for GCT at the cervicothoracic junction to the best of author's knowledge. PMID:26692702

  7. Ependymoma: a heterogeneous tumor of uncertain origin and limited therapeutic options.

    PubMed

    Dorfer, Christian; Tonn, Joerg; Rutka, James T

    2016-01-01

    Ependymomas are tumors that typically occur with an age-based site preference, with adults harboring supratentorial and spinal tumors and pediatric tumors being mainly in the posterior fossa. Despite their similar histologic appearance, the prognosis varies significantly by age and tumor location, with a better prognosis in increasing age. The mainstay of treatment remains surgical excision with or without radiation therapy as the tumor biology is poorly understood and chemotherapy is generally considered to be ineffective. More recently, molecular biology data have increased our understanding of the genetic and epigenetic changes that drive these tumors, but still it will take a lot of effort to find effective chemotherapeutic regimens. Currently, we are trying to define a subset of tumors, for which radiation therapy can be avoided. PMID:26948369

  8. Dermoid cyst of the infratemporal fossa.

    PubMed

    Uppal, Harpreet S; D'Souza, Alwyn R; De, Ranit; Irving, Richard M

    2002-02-01

    Dermoid cysts are rare benign tumours, they represent the simplest form of teratoma. Approximately seven per cent affect the head and neck region, within this region they are frequently encountered in the area of the lateral eyebrow, the orbit and the nose. A case of a 17-year-old girl who developed a rapidly growing facial swelling due to an infratemporal fossa dermoid cyst is presented. A review of the literature using Medline has not revealed any previous reports of similar cases. The lesion was completely excised using a lateral approach to the infratemporal fossa. PMID:11827596

  9. The histologic changes of the olecranon fossa membrane in primary osteoarthritis of the elbow.

    PubMed

    Suvarna, S Kim; Stanley, David

    2004-01-01

    Eight randomly selected patients undergoing the Outerbridge-Kashiwagi (ulnohumeral arthroplasty) debridement procedure for primary osteoarthritis of the elbow had fenestration of the olecranon fossa by use of a bone trephine. The cores of bone removed were compared histologically with age- and sex-matched controls derived from necropsy samples with no history of osteoarthritis. All components of the olecranon fossa membrane (anterior cortical bone, medullary cavity, posterior cortical bone, and anterior and posterior fibrous tissue) were noted to be of increased thickness in those patients with osteoarthritis of the elbow when compared with the control group. With the exception of the anterior surface fibrous tissue, these differences were of statistical significance by use of the Wilcoxon signed rank test (anterior cortical bone, P =.01; medullary cavity, P =.01; posterior cortical bone, P =.02; and posterior surface fibrous tissue, P =.01). Bone volume was also measured in the two groups and was statistically greater in the patients with osteoarthritis compared with the control group (P =.01). PMID:15383814

  10. ["Fossa" carcinoma - a relapse or "rest" carcinoma of the kidney?].

    PubMed

    Panchev, P; Ianev, K; Georgiev, M; Kirilov, S; Kumanov, Kh

    2000-01-01

    The local relapse represents a unique variant of the advanced stage of a disease (A Esrig et 1992). Presumably, "fossa" carcinoma may result from incomplete resection or persisting tumor in the regional contiguous lymph nodes (JB D Kernion 1978). The average time interval for a relapse to occur is 31 months after nephrectomy, and in most patients it becomes manifest with symptoms, such as losing weight, fatigability and lumbar discomfort (D Esrig et al 1992). In cases with local recurrence a long-term survivorship may be attained by resorting to aggressive surgical intervention (S Tanguag et al 1996). This is a report on twenty-three patients with "fossa" carcinoma covering the period 1994 through 1999, with a total of 425 patients with renal carcinoma operated during the same period of time. All patients undergo operation--lumbar access is used in 22 cases, and transperitoneal--in one. In one patients resection of colon is necessitated, whereas in five the neoplastic mass hardly lends itself to complete excision, with enucleation alone being done. At follow-up study the survival terms are as follows: up to 1 year--18 patients, up to 3 year--16 patients, up to 5 year--12 patients. PMID:11692915

  11. Neural Underpinnings of Working Memory in Adult Survivors of Childhood Brain Tumors.

    PubMed

    King, Tricia Z; Na, Sabrina; Mao, Hui

    2015-08-01

    Adult survivors of childhood brain tumors are at risk for cognitive performance deficits that require the core cognitive skill of working memory. Our goal was to examine the neural mechanisms underlying working memory performance in survivors. We studied the working memory of adult survivors of pediatric posterior fossa brain tumors using a letter n-back paradigm with varying cognitive workload (0-, 1-, 2-, and 3-back) and functional magnetic resonance imaging as well as neuropsychological measures. Survivors of childhood brain tumors evidenced lower working memory performance than demographically matched healthy controls. Whole-brain analyses revealed significantly greater blood-oxygen level dependent (BOLD) activation in the left superior / middle frontal gyri and left parietal lobe during working memory (2-back versus 0-back contrast) in survivors. Left frontal BOLD response negatively correlated with 2- and 3-back working memory performance, Auditory Consonant Trigrams (ACT), and Digit Span Backwards. In contrast, parietal lobe BOLD response negatively correlated with 0-back (vigilance task) and ACT. The results revealed that adult survivors of childhood posterior fossa brain tumors recruited additional cognitive control resources in the prefrontal lobe during increased working memory demands. This increased prefrontal activation is associated with lower working memory performance and is consistent with the allocation of latent resources theory. PMID:26234757

  12. [Cochlear implantation through the middle fossa approach].

    PubMed

    Szyfter, W; Colletti, V; Pruszewicz, A; Kopeć, T; Szymiec, E; Kawczyński, M; Karlik, M

    2001-01-01

    The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding. PMID:11766315

  13. Supratentorial arterial ischemic stroke following cerebellar tumor resection in two children.

    PubMed

    Catsman-Berrevoets, Coriene E; van Breemen, Melanie; van Veelen, Marie Lise; Appel, Inge M; Lequin, Maarten H

    2005-01-01

    We describe two children who developed ischemic strokes in the territory of the middle cerebral artery, one 7 days and one 11 days after resection of a cerebellar tumor. In the first child, another infarction occurred in the territory of the contralateral middle cerebral artery 5 days after the first stroke. No specific cause or underlying risk factor other than the surgical procedure was found. The subacute clinical course at stroke onset resembled that of the 'posterior fossa syndrome', suggesting a common underlying mechanism. PMID:16088257

  14. MR-Guided Laser-Induced Thermotherapy of the Infratemporal Fossa and Orbit in Malignant Chondrosarcoma via a Modified Technique

    SciTech Connect

    Vogl, Thomas J.; Mack, Martin G.; Straub, Ralf; Eichler, Katrin; Zangos, Stephan

    2001-12-15

    A 76-year-old patient presented with a recurrent mass of a malignant chondrosarcoma in the right infratemporal fossa and in the left maxillary sinus with orbital invasion. The patient was treated with a palliative intention with MR-guided laser-induced thermotherapy using a modified applicator technique. Following treatment clinical symptoms improved and MRI revealed complete laser-induced tumor necrosis.

  15. Assessment of mandibular posterior regional landmarks using cone-beam computed tomography in dental implant surgery.

    PubMed

    de Souza, Lílian Azevedo; Souza Picorelli Assis, Neuza Maria; Ribeiro, Rosangela Almeida; Pires Carvalho, Antônio Carlos; Devito, Karina Lopes

    2016-05-01

    The aim of this study has been to evaluate and correlate the anatomical features of the posterior mandibular region (submandibular fossa depth, bone height and thickness, and mandibular canal corticalization) to improve accident prevention and allow safe planning in implantology. Four parasagittal sections of cone-beam computed tomography (CBCT) from 100 patients were bilaterally analyzed. Linear measurements of the submandibular fossa depth, bone height and thickness were performed. The submandibular fossa was also classified into non-influential undercuts and influential undercuts for implant placement. Mandibular canal corticalization was also evaluated and classified according to the visualization. Data on patient age and gender were also collected. Forty-one scans (41%) were from male patients, and 59 (59%) were from female patients. Patient age ranged between 18 and 84 years, with an average age of 51.37 years. The submandibular fossa depth and implant bone thickness had a significant effect on the variability of the sample (46.1% and 22.3%, respectively). The submandibular fossa depth was quite variable, and the highest values were observed in the posterior regions. In 18.27% of the cases, the presence of the fossa directly influenced implant placement, considering a bone height of 10mm (standard implant). A significant correlation was observed between fossa depth and bone thickness. Thus, greater attention should be paid to thick ridges; although thick ridges are favorable, they may be associated with deeper submandibular fossae. The mandibular canal was the most influential anatomical structure in the premolar region due to the reduced bone height in this region and the greater difficulty in viewing the canal, and the submandibular fossa was the most influential structure in the molar region due to lower bone height leading up to the fossa and the greater fossa depth in this region. Therefore, CBCT is an important tool for assessing the mandibular region

  16. Maxillary tooth displacement in the infratemporal fossa

    PubMed Central

    Roshanghias, Korosh; Peisker, Andre; Zieron, Jörg Olaf

    2016-01-01

    Wisdom tooth operations are sometimes accompanied by complications. This case report shows complications during upper jaw third molar removal. Expectable problems during oral surgery should be planned to be solved in advance. Displacement of the third molar during oral surgeries as a considerable complication is rarely discussed scientifically. A good design of flap, adequate power for extraction, and clear view on the surgical field are crucial. Three-dimensional radiographic diagnostics in terms of cone beam computed tomography is helpful after tooth displacement into the infratemporal fossa.

  17. Maxillary tooth displacement in the infratemporal fossa.

    PubMed

    Roshanghias, Korosh; Peisker, Andre; Zieron, Jörg Olaf

    2016-01-01

    Wisdom tooth operations are sometimes accompanied by complications. This case report shows complications during upper jaw third molar removal. Expectable problems during oral surgery should be planned to be solved in advance. Displacement of the third molar during oral surgeries as a considerable complication is rarely discussed scientifically. A good design of flap, adequate power for extraction, and clear view on the surgical field are crucial. Three-dimensional radiographic diagnostics in terms of cone beam computed tomography is helpful after tooth displacement into the infratemporal fossa. PMID:27605997

  18. [Linear accelerator-based stereotactic radiation treatment of patients with medial middle fossa meningiomas].

    PubMed

    Golanov, A V; Cherekaev, V A; Serova, N K; Pronin, I N; Gorlachev, G E; Kotel'nikova, T M; Podoprigora, A E; Kudriavtseva, P A; Galkin, M V

    2010-01-01

    Medial middle fossa meningiomas are challenging for neurosurgical treatment. Invasion of cranial nerves and vessels leads to high risk of complications after removal of such meningiomas. Currently methods of conformal stereotactic radiation treatment are applied wider and wider for the discussed lesions. During a 3.5-year period 80 patients with medial middle fossa meningiomas were treated in Burdenko Moscow Neurosurgical Institute using linear accelerator "Novalis". In 31 case radiation treatment was preceded by surgical resection. In majority of patients symptoms included cranial nerve dysfunction: oculomotor disturbances in 62.5%, trigeminal impairment--in 37.5%, visual deficit--in 43.8%, facial nerve palsy--in 1.25%. 74 patients underwent radiotherapy with classical fractioning, 2--in hypofractionated mode and 4 received radiosurgery. In cases of classical fractioning mean marginal dose reached 46.3 Gy during 28-33 fractions, in hypofractioning (7 fractions)--31.5 Gy, in radiosurgery--16.25 Gy. Mean follow-up period was 18.4 months (6-42 months). Control of tumor growth was achieved in 97.5% of cases (78 patients): in 42 (52.5%) lesion shrinked, in 36 (45%) stabilization was observed. Clinical examination revealed improvement of visual function in 15 patients (18%) and deterioration in 2 (2.5%). No new neuropathies were found. Stereotactic radiation treatment is the method of choice for medial anterior and middle fossa meningiomas due to effective control of tumor progression and minimal rate of complications. PMID:20429360

  19. Resection of sphenoidal crest, orbit and infratemporal fossa communicative meningioma through fronto-tempo-preauricular approach

    NASA Astrophysics Data System (ADS)

    Wu, Yue; Song, Xueming; An, Yihua; Hu, Shaoshan; Shi, Huaizhang; Wu, Huailan; Yang, Guoming; Cao, Xiangyi

    1999-09-01

    We reported our experience using diode laser under microscope to resect a sphenoidal crest, orbit and infratemporal fossa communicative meningioma through fronto-tempo-preauricular approach. We used contacting, un-contacting and inserting methods and the power was in the range of 5 - 30 watt. The tumor was totally removed and the patient received radiotherapy post- operation. Follow up showed that the patient survived for two years after operation. The result showed that combination of laser application during surgery and radiotherapy post-operation was an effective method to delay or prevent tumor recurrence.

  20. Endoscopic transmaxillary drainage of an infratemporal fossa abscess

    PubMed Central

    Sundaram, Sreetharan Sivapatha; Rajan, Philip; Balasubramanian, Anusha

    2014-01-01

    Infratemporal fossa abscess is a rare and challenging condition to diagnose and manage. A few reported cases have been mostly due to odontogenic infections and were managed by external or intraoral drainage. This is the first reported case of an infratemporal fossa abscess that was successfully managed by endoscopic drainage via a transmaxillary approach. PMID:24980993

  1. Technical Note: Intrafractional changes in time lag relationship between anterior–posterior external and superior–inferior internal motion signals in abdominal tumor sites

    SciTech Connect

    Regmi, Rajesh; Lovelock, D. Michael; Zhang, Pengpeng; Pham, Hai; Xiong, Jianping; Yorke, Ellen D.; Mageras, Gig S.; Goodman, Karyn A.; Wu, Abraham J.

    2015-06-15

    Purpose: To investigate constancy, within a treatment session, of the time lag relationship between implanted markers in abdominal tumors and an external motion surrogate. Methods: Six gastroesophageal junction and three pancreatic cancer patients (IRB-approved protocol) received two cone-beam CTs (CBCT), one before and one after treatment. Time between scans was less than 30 min. Each patient had at least one implanted fiducial marker near the tumor. In all scans, abdominal displacement (Varian RPM) was recorded as the external motion signal. Purpose-built software tracked fiducials, representing internal signal, in CBCT projection images. Time lag between superior–inferior (SI) internal and anterior–posterior external signals was found by maximizing the correlation coefficient in each breathing cycle and averaging over all cycles. Time-lag-induced discrepancy between internal SI position and that predicted from the external signal (external prediction error) was also calculated. Results: Mean ± standard deviation time lag, over all scans and patients, was 0.10 ± 0.07 s (range 0.01–0.36 s). External signal lagged the internal in 17/18 scans. Change in time lag between pre- and post-treatment CBCT was 0.06 ± 0.07 s (range 0.01–0.22 s), corresponding to 3.1% ± 3.7% (range 0.6%–10.8%) of gate width (range 1.6–3.1 s). In only one patient, change in time lag exceeded 10% of the gate width. External prediction error over all scans of all patients varied from 0.1 ± 0.1 to 1.6 ± 0.4 mm. Conclusions: Time lag between internal motion along SI and external signals is small compared to the treatment gate width of abdominal patients examined in this study. Change in time lag within a treatment session, inferred from pre- to post-treatment measurements is also small, suggesting that a single measurement of time lag at the session start is adequate. These findings require confirmation in a larger number of patients.

  2. Technical Note: Intrafractional changes in time lag relationship between anterior–posterior external and superior–inferior internal motion signals in abdominal tumor sites

    PubMed Central

    Regmi, Rajesh; Lovelock, D. Michael; Zhang, Pengpeng; Pham, Hai; Xiong, Jianping; Yorke, Ellen D.; Goodman, Karyn A.; Wu, Abraham J.; Mageras, Gig S.

    2015-01-01

    Purpose: To investigate constancy, within a treatment session, of the time lag relationship between implanted markers in abdominal tumors and an external motion surrogate. Methods: Six gastroesophageal junction and three pancreatic cancer patients (IRB-approved protocol) received two cone-beam CTs (CBCT), one before and one after treatment. Time between scans was less than 30 min. Each patient had at least one implanted fiducial marker near the tumor. In all scans, abdominal displacement (Varian RPM) was recorded as the external motion signal. Purpose-built software tracked fiducials, representing internal signal, in CBCT projection images. Time lag between superior–inferior (SI) internal and anterior–posterior external signals was found by maximizing the correlation coefficient in each breathing cycle and averaging over all cycles. Time-lag-induced discrepancy between internal SI position and that predicted from the external signal (external prediction error) was also calculated. Results: Mean ± standard deviation time lag, over all scans and patients, was 0.10 ± 0.07 s (range 0.01–0.36 s). External signal lagged the internal in 17/18 scans. Change in time lag between pre- and post-treatment CBCT was 0.06 ± 0.07 s (range 0.01–0.22 s), corresponding to 3.1% ± 3.7% (range 0.6%–10.8%) of gate width (range 1.6–3.1 s). In only one patient, change in time lag exceeded 10% of the gate width. External prediction error over all scans of all patients varied from 0.1 ± 0.1 to 1.6 ± 0.4 mm. Conclusions: Time lag between internal motion along SI and external signals is small compared to the treatment gate width of abdominal patients examined in this study. Change in time lag within a treatment session, inferred from pre- to post-treatment measurements is also small, suggesting that a single measurement of time lag at the session start is adequate. These findings require confirmation in a larger number of patients. PMID:26127033

  3. Gallbladder Fossa Abscess Masquerading as Cholecystitis After Cholecystectomy.

    PubMed

    Rodrigue, Paul; Fakhri, Asif; Baumgartner, Andrew

    2015-12-01

    We present a case of a 59-y-old woman who had undergone cholecystectomy and was subsequently found to have an abscess within the gallbladder fossa. A hepatobiliary scan using (99m)Tc-diisopropyliminodiacetic acid demonstrated the characteristic rim sign, a photopenic defect surrounded by a rim of mildly increased activity immediately adjacent to the gallbladder fossa. The rim sign was thought to be the result of reactive inflammation in the hepatic tissue adjacent to a postoperative abscess within the gallbladder fossa. PMID:26111711

  4. Atypical Isolated Infections of the Infratemporal Fossa: A Diagnostic Challenge

    PubMed Central

    Tan, Sien Hui; Chong, Aun Wee; Prepageran, Narayanan

    2015-01-01

    Introduction: Atypical infratemporal fossa infections are rare and potentially fatal. Case Report: A case of an aspergillosis localized in the infratemporal fossa and another case of tuberculosis of the infratemporal fossa originating from the maxillary sinus, is described. The first patient was immunocompromised and showed symptoms of facial numbness; whereas the other was an immunocompetent man who complained of trigeminal neuralgia type pain. It was difficult to differentiate between infection and tumour despite the utilization of computed tomography scans and magnetic resonance imaging. Conclusion: These cases illustrate the need for a high index of suspicion; in addition to endoscopic confirmation and histopathology to establish precise diagnosis and early intervention. PMID:26568944

  5. Mineral Spectra from Nili Fossae, Mars

    NASA Technical Reports Server (NTRS)

    2008-01-01

    Spectra collected by the Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) indicate the presence of three distinct minerals. The graphed information comes from an observation of terrain in the Nili Fossae area of northern Mars. CRISM is one of six science instruments on NASA's Mars Reconnaissance Orbiter.

    Iron-magnesium smectite clay is formed through alteration of rocks by liquid water and is characterized by distinctive absorptions at 1.4, 1.9, and 2.3 micrometers due to water (H2O) and OH in the atomic structure of the mineral. Olivine is an iron magnesium silicate and primary igneous mineral, and water is not in its structure. Its spectrum is characterized by a strong and broad absorption at 1.0 micrometer due to ferrous iron (Fe2+). Carbonate is an alteration mineral identified by the distinctive paired absorptions at 2.3 and 2.5 micrometers. The precise band positions at 2.31 and 2.51 micrometers identify the carbonate at this location as magnesium carbonate. The broad 1.0 micrometer band indicates some small amount of ferrous iron is also present and the feature at 1.9 micrometers indicates the presence of water. CRISM researchers believe the magnesium carbonate found in the Nili Fossae region formed from alteration of olivine by water.

    The data come from a CRISM image catalogued as FRT00003E12. The spectra shown here are five-pixel-by-five-pixel averages of CRISM L-detector spectra taken from three different areas within the image that have then been ratioed to a five-pixel-by-five-pixel common denominator spectrum taken from a spectrally unremarkable area with no distinctive mineralogic signatures. This technique highlights the spectral contrasts between regions due to their unique mineralogy. The spectral wavelengths near 2.0 micrometers are affected by atmospheric absorptions and have been removed for clarity.

    NASA's Jet Propulsion Laboratory, a division of the California Institute of Technology, Pasadena, manages the Mars

  6. 5-Fluorouracil and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) followed by hydroxyurea, misonidazole, and irradiation for brain stem gliomas: a pilot study of the Brain Tumor Research Center and the Childrens Cancer Group

    SciTech Connect

    Levin, V.A.; Edwards, M.S.; Wara, W.M.; Allen, J.; Ortega, J.; Vestnys, P.

    1984-06-01

    Twenty-eight evaluable children with the diagnosis of brain stem glioma were treated with 5-fluorouracil and CCNU before posterior fossa irradiation (5500 rads); during irradiation, the children received hydroxyurea and misonidazole. The treatment was well tolerated, and minimal toxicity was produced. The median relapse-free survival was 32 weeks, and the median survival was 44 weeks. Analysis of covariates showed that, in patients between the ages of 2 and 19 years, survival was longest in the older children (P less than 0.02). Tumor histology, sex, extent of operation (if any), Karnofsky score, and radiation dose did not correlate with survival.

  7. Medusae Fossae Formation - High Resolution Image

    NASA Technical Reports Server (NTRS)

    1998-01-01

    An exotic terrain of wind-eroded ridges and residual smooth surfaces are seen in one of the highest resolution images ever taken of Mars from orbit. The Medusae Fossae formation is believed to be formed of the fragmental ejecta of huge explosive volcanic eruptions. When subjected to intense wind-blasting over hundreds of millions of years, this material erodes easily once the uppermost tougher crust is breached. The crust, or cap rock, can be seen in the upper right part of the picture. The finely-spaced ridges are similar to features on Earth called yardangs, which are formed by intense winds plucking individual grains from, and by wind-driven sand blasting particles off, sedimentary deposits.

    The image was taken on October 30, 1997 at 11:05 AM PST, shortly after the Mars Global Surveyor spacecraft's 31st closest approach to Mars. The image covers an area 3.6 X 21.5 km (2.2 X 13.4 miles) at 3.6 m (12 feet) per picture element--craters only 11 m (36 feet, about the size of a swimming pool) across can be seen. The best Viking view of the area (VO 1 387S34) has a resolution of 240 m/pixel, or 67 times lower resolution than the MOC frame.

    Malin Space Science Systems (MSSS) and the California Institute of Technology built the MOC using spare hardware from the Mars Observer mission. MSSS operates the camera from its facilities in San Diego, CA. The Jet Propulsion Laboratory's Mars Surveyor Operations Project operates the Mars Global Surveyor spacecraft with its industrial partner, Lockheed Martin Astronautics, from facilities in Pasadena, CA and Denver, CO.

  8. The Age of the Medusae Fossae Formation

    NASA Astrophysics Data System (ADS)

    Kerber, L.; Head, J. W.

    2008-09-01

    Introduction The Medusae Fossae Formation (MFF) is a complicated and discontinuous formation located in the southern parts of Elysium Planitia and Amazonis Planitia (130°-230°E and 12°S-12°N), covering an area of approximately 2.1 x 106 km2 and having an estimated volume of 1.4 x 106 km3 [1]. It is thought to have been deposited during the Amazonian period [2,3]. However, much of the cratering record may have been erased as friable units were eroded and long-buried terrains exhumed [4-6]. The formation is characterized by large accumulations of fine-grained, friable deposits and evidence of large amounts of erosion. There are many theories regarding the emplacement of this formation; recently the literature has focused on three possibilities: ignimbrites, ash fall, and aeolian dust. Some modified and inverted fluvial channels have been found within the deposit [7,8], (Fig. 1), indicating that there was some fluvial activity during or after the emplacement of the MFF. If the MFF is among the youngest surficial deposits on Mars [9], it is implied that meandering, channelized flow must have extended into the Amazonian, a significant constraint when considering the atmospheric evolution of the planet through time. Because of the wide implications that these findings have for the evolution of Mars and the Martian atmosphere, it is instructive to re-examine the evidence for the Amazonian age of the MFF. The initial conclusion comes from two main arguments: the relatively few superposed craters on the unit, and the superposition of the MFF on young lowland lava deposits [1, 9]. Using new high resolution data, we reexamine the relationships both within the MFF and with respect to adjacent units. Cratering Record The cratering record of the MFF and other easily eroded units has often been deemed unreliable [4, 10, 12], but it continues to be cited as evidence for the formation's young age. Throughout the MFF, pedestal craters, inverted craters, and remnant knobs can be

  9. CT and angiography of primary extradural juxtasellar tumors

    SciTech Connect

    Moore, T.; Ganti, S.R.; Mawad, M.E.; Hilal, S.K.

    1985-09-01

    The computed tomographic and angiographic features of 15 histologically proven primary extradural juxtasellar tumors were retrospectively reviewed. Five chordomas were characterized by prominent bone erosion and a significant posterior fossa component. Four trigeminal nerve neuromas each demonstrated bone erosion centered about Meckel's cave and moderate to marked contrast enhancement. Two cavernous sinus meningiomas revealed moderate contrast enhancement, expansion of the cavernous sinus, and moderate angiographic stain. Two cavernous hemangiomas of the cavernous sinus were intensely enhancing and demonstrated angiographic stain. Opacification of the sphenoid sinus with prominent bone destruction and lack of contrast enhancement was characteristic of a sphenoid sinus mucocele. The dural reflection could be directly visualized or indirectly inferred in each case.

  10. Dural-Based Cavernoma of the Posterior Cranial Fossa Mimicking a Meningioma: A Case Report

    PubMed Central

    Cruz, Aurora S; Jeyamohan, Shiveindra; Tubbs, R. Shane; Page, Jeni; Chamiraju, Parthasarathi; Tkachenko, Lara; Rostad, Steven; Newell, David W.

    2016-01-01

    Cavernous angiomas usually occur in the parenchyma of both the supra and infratentorial compartments. At times, they can both clinically and radiologically mimic other dural-based lesions. We present a case of a patient with chronic occipital headaches, initially thought to have a meningioma, but proven to be a cavernoma with histological analysis. PMID:27190725

  11. Beware of arteria lusoria during lymph node dissection of the right paratracheal fossa for lung cancer surgery

    PubMed Central

    Pan, Daniel; Cufari, Maria Elena

    2014-01-01

    An asymptomatic elderly woman presented with a solitary right upper lobe mass revealed to be non-small cell lung cancer following routine surveillance post mastectomy. Upon review of CT with contrast in preparation for rigid bronchoscopy and right upper lobectomy, we noticed that the patient had a rare case of arteria lusoria. This is the presence of an aberrant right subclavian artery extending from the left side of the aortic arch, crossing posteriorly across the midline to supply the upper limb. We suggest that with a documented 100% diagnostic sensitivity on 64 multislice computed tomography, the presence of arteria lusoria within the posterior paratracheal fossa may cause life-threatening complications in the unaware during systematic lymph node dissection for non-small cell lung cancer (NSCLC). PMID:25590005

  12. Fossa navicularis magna detection on cone-beam computed tomography.

    PubMed

    Syed, Ali Z; Mupparapu, Mel

    2016-03-01

    Herein, we report and discuss the detection of fossa navicularis magna, a close radiographic anatomic variant of canalis basilaris medianus of the basiocciput, as an incidental finding in cone-beam computed tomography (CBCT) imaging. The CBCT data of the patients in question were referred for the evaluation of implant sites and to rule out pathology in the maxilla and mandible. CBCT analysis showed osseous, notch-like defects on the inferior aspect of the clivus in all four cases. The appearance of fossa navicularis magna varied among the cases. In some, it was completely within the basiocciput and mimicked a small rounded, corticated, lytic defect, whereas it appeared as a notch in others. Fossa navicularis magna is an anatomical variant that occurs on the inferior aspect of the clivus. The pertinent literature on the anatomical variations occurring in this region was reviewed. PMID:27051639

  13. Fossa navicularis magna detection on cone-beam computed tomography

    PubMed Central

    Mupparapu, Mel

    2016-01-01

    Herein, we report and discuss the detection of fossa navicularis magna, a close radiographic anatomic variant of canalis basilaris medianus of the basiocciput, as an incidental finding in cone-beam computed tomography (CBCT) imaging. The CBCT data of the patients in question were referred for the evaluation of implant sites and to rule out pathology in the maxilla and mandible. CBCT analysis showed osseous, notch-like defects on the inferior aspect of the clivus in all four cases. The appearance of fossa navicularis magna varied among the cases. In some, it was completely within the basiocciput and mimicked a small rounded, corticated, lytic defect, whereas it appeared as a notch in others. Fossa navicularis magna is an anatomical variant that occurs on the inferior aspect of the clivus. The pertinent literature on the anatomical variations occurring in this region was reviewed. PMID:27051639

  14. Discovery of Olivine in the Nili Fossae Region of Mars

    USGS Publications Warehouse

    Hoefen, T.M.; Clark, R.N.; Bandfield, J.L.; Smith, M.D.; Pearl, J.C.; Christensen, P.R.

    2003-01-01

    We have detected a 30,000-square-kilometer area rich in olivine in the Nili Fossae region of Mars. Nili Fossae has been interpreted as a complex of grabens and fractures related to the formation of the Isidis impact basin. We propose that post-impact faulting of this area has exposed subsurface layers rich in olivine. Linear mixture analysis of Thermal Emission Spectrometer spectra shows surface exposures of 30% olivine, where the composition of the olivine ranges from Fo30 to Fo70.

  15. Endoscopic Removal of a Bullet in Rosenmuller Fossa: Case Report

    PubMed Central

    Burks, Joshua D.; Glenn, Chad A.; Conner, Andrew K.; Bonney, Phillip A.; Sanclement, Jose A.; Sughrue, Michael E.

    2016-01-01

    Fractures of the anterior skull base may occur in gunshot victims and can result in traumatic cerebrospinal fluid (CSF) leak. Less commonly, CSF leaks occur days or even weeks after the trauma occurred. Here, we present the case of a 21-year-old man with a delayed-onset, traumatic CSF leak secondary to a missile injury that left a bullet fragment in the Rosenmuller fossa. The patient was treated successfully with endoscopic, endonasal extraction of the bullet, and repair with a nasal septal flap. Foreign bodies lodged in Rosenmuller fossa can be successfully treated with endoscopic skull base surgery. PMID:27330924

  16. Endovascular Management of Anterior Cranial Fossa Dural Arteriovenous Malformations

    PubMed Central

    Mack, W.J; Gonzalez, N.R.; Jahan, R.; Vinuela, F.

    2011-01-01

    Summary Dural arteriovenous fistulas (dAVFs) of the anterior cranial fossa have traditionally been treated by open surgical disconnection. Safe navigation through the ophthalmic artery or fragile cortical veins has historically provided a barrier to effective endovascular occlusion of these lesions. Using current microcatheter technology and embolic materials, safe positioning within the distal ophthalmic artery, beyond the origin of the central retinal artery, is achievable. We describe two cases in which anterior cranial fossa dAVFs were treated by exclusively endovascular strategies, and highlight the pertinent technical and anatomic considerations. We discuss the clinical symptoms resulting from the differing venous drainage patterns. PMID:21561565

  17. Bezoar: an unusual palpable mass in the right iliac fossa.

    PubMed

    Armstrong, A; Coulston, J; Mackey, P; Saxby, C; Eyre-Brook, I

    2015-02-01

    A 64-year-old gentleman presented with a 12-h history of right iliac fossa pain. On examination, the patient had a tender 8 × 6 cm mass in the right iliac fossa with localised peritonitis. The working diagnosis at this time was an appendix mass or caecal cancer. A computed tomography scan revealed the characteristic 'bird's nest' appearance of a bezoar. On further questioning, the patient confessed to regularly 'binging' on grapes. The patient described passing the mass and his symptoms completely resolved. This appears to be the only documented case of a bezoar affecting the ascending colon. PMID:25829720

  18. [Research advances of posterior reversible encephalopathy syndrome in children].

    PubMed

    Liu, Jing; Qin, Jiong

    2016-08-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological entity affecting the posterior brain, i.e. occipital and parietal lobes. The syndrome are characterized by headaches, altered mental status, seizures, and visual disturbances. Although the pathogenesis remains unclear, endothelial dysfunction may be a key factor. The basic disease may play a crucial role in the incidence of PRES. In most cases, PRES resolves spontaneously and patients show both clinical and radiological improvements. In severe forms, PRES might cause substantial morbidity with sequel and even mortality, as a result of acute hemorrhage or massive posterior fossa edema causing obstructive hydrocephalus or brainstem compression. Early identification, active and appropriate treatment is very important. PMID:27530801

  19. The diagnostic dilemma of the posterior mediastinal thymus: CT manifestations

    SciTech Connect

    Cohen, M.D.; Weber, T.R.; Sequeira, F.W.; Vane, D.W.; King, H.

    1983-03-01

    Extension of the normal thymus into the posterior mediastinum is rare. The CT appearance of this anomaly in an infant is presented. A mass of soft-tissue density extended from the anterior mediastinum to the posterior chest wall. The absence of any tissue-cleavage plane in the lesion and a smooth continuous lateral margin are signs of posterior extension of the thymus, and they help to distinguish this from a normal anterior thymus being present with a posterior tumor.

  20. A Comparison between splenic fossa and subhepatic fossa auxiliary partial heterotopic liver transplantation in a porcine model.

    PubMed

    Ai, Lemin; Liang, Xiao; Wang, Zhifei; Shen, Jie; Yu, Feiyan; Xie, Limei; Pan, Yongming; Lin, Hui

    2016-06-01

    To test the alternative possible locations for the placement of a liver graft and the relevant surgical technique issues, we developed a porcine model of auxiliary partial heterotopic liver transplantation (APHLT) and evaluated the difference between 2 styles of liver transplantation, either subhepatic fossa or splenic fossa APHLT, by comparing survival and biochemical indexes. Thirty-eight miniature pigs were randomly divided into 2 groups. A left hemihepatic graft without the middle hepatic vein (HV) was procured from the living donor. In group A (n = 9), an 8 mm diameter polytetrafluoroethylene (PTFE) graft approximately 2.5 cm long was connected to the left HV while another PTFE graft of the same size was connected to the left portal vein (PV). The liver graft was implanted in the right subhepatic fossa following splenectomy and right nephrectomy. In group B (n = 10), a PTFE graft of the same size was connected to the left HV while the liver graft was implanted in the splenic fossa following splenectomy and left nephrectomy. Survival rate and complications were observed at 2 weeks after transplantation. Data were collected from 5 animals in group A and 6 animals in group B that survived longer than 2 weeks. The liver function and renal function of the recipients returned to normal at 1 week after surgery in both groups. Eighty-eight percent (14/16) of the PTFE grafts remained patent at 2 weeks after surgery, but 44% of the PTFE grafts (7/16) developed mural thrombus. No significant differences in the survival rate and biochemistry were found between the 2 groups. In conclusion, the splenic fossa APHLT can achieve beneficial outcomes similar to the subhepatic fossa APHLT in miniature pigs, although it also has a high morbidity rate due to hepatic artery thrombosis, PV thrombosis, and PTEF graft mural thrombus formation. Liver Transplantation 22 812-821 2016 AASLD. PMID:26785299

  1. Fretted Terrain Valley in Coloe Fossae Region

    NASA Technical Reports Server (NTRS)

    2006-01-01

    [figure removed for brevity, see original site] Figure 1 Click on image for larger version

    The image in figure 1 shows lineated valley fill in one of a series of enclosed, intersecting troughs known as Coloe (Choloe) Fossae. Lineated valley fill consists of rows of material in valley centers that are parallel to the valley walls. It is probably made of ice-rich material and boulders that are left behind when the ice-rich material sublimates. Very distinct rows can be seen near the south (bottom) wall of the valley. Lineated valley fill is thought to result from mass wasting (downslope movement) of ice-rich material from valley walls towards their centers. It is commonly found in valleys near the crustal dichotomy that separates the two hemispheres of Mars. The valley shown here joins four other valleys with lineated fill near the top left corner of this image. Their juncture is a topographic low, suggesting that the lineated valley fill from the different valleys may be flowing or creeping towards the low area (movement towards the upper left of the image). The valley walls appear smooth at first glance but are seen to be speckled with small craters several meters in diameter at HiRISE resolution (see contrast-enhanced subimage). This indicates that at least some of the wall material has been stable to mass wasting for some period of time. Also seen on the valley wall are elongated features shaped like teardrops. These are most likely slightly older craters that have been degraded due to potentially recent downhill creep. It is unknown whether the valley walls are shedding material today. The subimage is approximately 140 x 400 m (450 x 1280 ft).

    Image PSP_001372_2160 was taken by the High Resolution Imaging Science Experiment (HiRISE) camera onboard the Mars Reconnaissance Orbiter spacecraft on November 11, 2006. The complete image is centered at 35.5 degrees latitude, 56.8 degrees East longitude. The range to the target site was 290.3 km (181

  2. A case of symptomatic mass in the right iliac fossa: a Bermuda Triangle which often lies the right diagnosis.

    PubMed

    Panarese, Alessandra; Pironi, Daniele; Pontone, Stefano; Vendettuoli, Maurizio; De Cristofaro, Flaminia; Antonelli, Manila; Romani, Annamaria; Filippini, Angelo

    2014-01-01

    Disease of the iliac fossa can often be accompanied by non-specific symptoms and some of these are exclusively caused by the compression of bulky masses of other neighboring structures. In young women a differential diagnosis is a non trivial task as several possible causes have to be taken into account. Thus, intraligamentary tumors, which are extremely rare finding, are frequently confused with uterus, ovary or intestinal tumors. Even if myomas are the most benign tumors of the female genital tract, broad ligament leiomyomas are an unusual finding in women of reproductive age. These tumors are often asymptomatic until they reach a volume likely to cause symptoms related to the mass pressure. An accurate patient's anamnesis and examination serve as a guide to further examinations. Ultrasound is the first line imaging as it can show ovarian or other pelvic mass and doesn't involve exposure to radiations in young patients, who can be pregnant. We describe the clinical presentation and imaging features of a broad ligament leiomyoma, which presented as an inguinal mass in a patient with a right iliac fossa pain. We also report our diagnostic process performing the differential diagnosis with other potential pathologies of RIF. In these cases, a preoperative disease classification discriminating the benign or malignant tumor nature is closely linked to the proper patient management. PMID:24566476

  3. Microsurgical Localization of the Cochlea in the Extended Middle Fossa Approach

    PubMed Central

    Forbes, Jonathan A.; Rivas, Alejandro; Tsai, Betty; Ehtesham, Moneeb; Zuckerman, Scott; Wanna, George; Weaver, Kyle

    2012-01-01

    Objective In the extended middle fossa approach, a portion of the petrous bone known as Kawase's rhomboid can be drilled to expose the posterior fossa through a middle fossa corridor. During this bony resection, the cochlea is placed at risk. The objective of this study was to objectively detail the position of the cochlea in relation to reliable surgical landmarks. Methods Eleven cadaveric specimens were dissected—including six cadaveric heads and five dry temporal bones by means of an anterior petrosectomy with skeletonization of the cochlea. Three anatomic measurements describing the location of the cochlea in relation to the extrapolated intersection of the greater superficial petrosal nerve (GSPN) and facial nerve were recorded. These measurements were then correlated with thin-cut temporal bone computed tomography scans from 25 patients with morphologically normal inner ears. Results In the cadaveric specimens, the anterior border of the membranous basal turn of the cochlea was located an average of 7.56 mm (6.4 to 8.9 mm) anterior to the extrapolated junction of the GSPN and facial nerve, as measured along the course of the GSPN. The medial border of the membranous cochlea (medial margin of basal turn) was located an average of 8.2 mm (6.9 to 8.9 mm) medial to the extrapolated junction of the GSPN and facial nerve, as measured along the course of the facial nerve. The average maximum distance from the extrapolated junction of the GSPN and facial nerve to the membranous cochlea was 9.3 mm (8.2 to 10.3 mm). These anatomic measurements correlated well with radiologic measurements of the same parameters. Conclusion When drilling Kawase's rhomboid, it is useful to locate the extrapolated junction of the GSPN and the facial nerve. Drilling of the anteromedial petrous bone outside of a radius of 12.5 mm from the extrapolated junction of GSPN and facial nerve appears to be associated with a low degree of risk to the cochlear apparatus. PMID

  4. Tumor

    MedlinePlus

    ... be removed because of their location or harmful effect on the surrounding normal brain tissue. If a tumor is cancer , possible treatments may include: Chemotherapy Radiation Surgery Targeted cancer therapy Biologic therapy Other treatment options

  5. Actinomyces infection causing acute right iliac fossa pain

    PubMed Central

    Govindarajah, Narendranath; Hameed, Waseem; Middleton, Simon; Booth, Michael

    2014-01-01

    This is a case of a 75-year-old man being admitted to the on-call surgical department with acute abdominal pain. On arrival he was clinically dehydrated and shocked with localised pain over McBurney's point and examination findings were suggestive of appendiceal or other colonic pathology. Full blood testing revealed a white cell count of 38×109/L and a C reactive protein (CRP) of 278 mg/L. A CT scan revealed a gallbladder empyema that extended into the right iliac fossa. This case highlights the potential for a hyperdistended gallbladder empyema to present as acute right iliac fossa pain with blood tests suggestive of complicated disease. Further analysis confirmed Actinomyces infection as the underlying aetiology prior to a laparoscopic subtotal cholecystectomy. This case serves to remind clinicians of this as a rare potential cause of atypical gallbladder pathology. PMID:24872493

  6. Cerberus Fossae, Elysium, Mars: A source for lava and water

    USGS Publications Warehouse

    Plescia, J.B.

    2003-01-01

    Cerberus Fossae, a long fracture system in the southeastern part of Elysium, has acted as a conduit for the release of both lava and water onto the surface. The southeastern portion of the fracture system localized volcanic vents having varying morphology. In addition, low shields occur elsewhere on the Cerberus plains. Three locations where the release of water has occurred have been identified along the northwest (Athabasca and Grjota' Vallis) and southeast (Rahway Vallis) portions of the fossae. Water was released both catastrophically and noncatastrophically from these locations. A fluvial system that extends more than 2500 km has formed beginning at the lower flank of the Elysium rise across the Cerberus plains and out through Matte Vallis into Amazonis Planitia. The timing of the events is Late Amazonian. ?? 2003 Elsevier Inc. All rights reserved.

  7. Cerberus Fossae, Elysium, Mars: a source for lava and water

    NASA Astrophysics Data System (ADS)

    Plescia, J. B.

    2003-07-01

    Cerberus Fossae, a long fracture system in the southeastern part of Elysium, has acted as a conduit for the release of both lava and water onto the surface. The southeastern portion of the fracture system localized volcanic vents having varying morphology. In addition, low shields occur elsewhere on the Cerberus plains. Three locations where the release of water has occurred have been identified along the northwest (Athabasca and Grjota' Vallis) and southeast (Rahway Vallis) portions of the fossae. Water was released both catastrophically and noncatastrophically from these locations. A fluvial system that extends more than 2500 km has formed beginning at the lower flank of the Elysium rise across the Cerberus plains and out through Marte Vallis into Amazonis Planitia. The timing of the events is Late Amazonian.

  8. Langerhans' cell histiocytosis of the temporal fossa: A case report

    PubMed Central

    LIANG, CHEN; LIANG, QIANLEI; DU, CHANGWANG; ZHANG, XIAODONG; GUO, SHIWEN

    2016-01-01

    Langerhans' cell histiocytosis (LCH) is a rare disease with a wide spectrum of clinical manifestations, varying from an isolated lesion to systemic involvement. The etiology of this disease remains to be elucidated. The present study reports a case of LCH with temporal fossa localization in an 8-year-old male patient, who had exhibited left temporal pain and headache for 1 month. Physical examination revealed slight exophthalmos and conjunctival hemorrhage in the patient's left eye, and non-contrast computed tomography imaging of the head revealed a soft tissue mass with unclear margins located in the left temporal fossa, as well as a wide bony defect. Magnetic resonance imaging revealed a heterogeneously contrast-enhanced mass near the left temporal pole, which eroded into the patient's left orbit and maxillary sinus. The lesion was totally excised and confirmed to be LCH through biopsy. PMID:27073529

  9. Pancreatic polypeptide-rich islets in the posterior portion of the pancreatic head--a tumor mimic in somatostatin receptor scintigraphy.

    PubMed

    Albers, Max Benjamin; Maurer, Elisabeth; Klöppel, Günter; Bartsch, Detlef Klaus

    2014-05-01

    A 74-year-old man with recurrent duodenal ulcers underwent somatostatin receptor scintigraphy (SRS) in suspicion of gastrinoma. A 2-cm area of focal uptake was visualized within the pancreatic head. Serum chromogranin A levels were elevated, but serum gastrin levels and the secretin test were normal. Computed tomography and endoscopic ultrasonography were not conclusive. After partial duodenopancreatectomy, pathological examination failed to reveal any neuroendocrine tumor. Instead, the dorsal portion of the pancreatic head was found to be densely populated by pancreatic polypeptide cell-rich islets. This area correlated with the site of tracer uptake seen on SRS. Thus, pancreatic polypeptide cell-rich islets in elderly patients should be kept in mind when interpreting SRS results to avoid unnecessary major pancreatic resections. PMID:24713672

  10. Antecubital Fossa Solitary Osteochondroma with Associated Bicipitoradial Bursitis

    PubMed Central

    Ng, Colin; Bibiano, Luigi; Grech, Stephan; Magazinovic, Branko

    2015-01-01

    Antecubital fossa lesions are uncommon conditions that present to the orthopaedic clinic. Furthermore, the radius bone is an uncommonly reported location for an osteochondroma, especially when presenting with a concurrent reactive bicipitoradial bursitis. Osteochondromas are a type of developmental lesion rather than a true neoplasm. They constitute up to 15% of all bone tumours and up to 50% of benign bone tumours. They may occur as solitary or multiple lesions. Multiple lesions are usually associated with a syndrome known as hereditary multiple exostoses (HME). Malignant transformation is known to occur but is rare. Bicipitoradial bursitis is a condition which can occur as primary or secondary (reactive) pathology. In our case, the radius bone osteochondroma caused reactive bicipitoradial bursitis. The differential diagnosis of such antecubital fossa masses is vast but may be narrowed down through a targeted history, stepwise radiological investigations, and histological confirmation. Our aim is to ensure that orthopaedic clinicians keep a wide differential in mind when dealing with antecubital fossa mass lesions. PMID:26413363

  11. Middle fossa approach: Applications in temporal bone lesions.

    PubMed

    Domenech Juan, Iván; Cruz Toro, Paula; Callejo Castillo, Ángela; Moya, Rafael; Merán Gil, Jorge L; Bartel, Ricardo

    2016-01-01

    The middle fossa approach is a surgical technique that is very useful for lateral skull base surgery. However, it is true that it has limited surgical indications and implementation due to its technical complexity. We present our experience in 10 patients in whom the middle fossa approach was the treatment of choice because of the extent of the injury and complexity of the lesion or process. Despite the complexity of the cases, there was no mortality associated with surgery. Postoperative complications were found in 2 patients who presented an epidural hematoma and a cortico-subcortical hematoma. Hearing function was preserved in 5 patients out of the 7 who had adequate hearing at the time of surgery. House/Brackmann I-II facial nerve function was achieved in 8 patients; the remaining 2 had no deterioration of the nerve function. In 9 out of 10 patients, the surgery achieved complete solution of the lesion. The middle fossa approach is a safe and reliable surgical technique. It gives us great control and exposure of different skull base processes. We consider its knowledge of great importance, because it may be the only viable surgical alternative in some specific patients. That is the reason why it is important to learn this approach and know about it in our specialty. PMID:26452620

  12. The Pursuit of a Cholesteatoma by Harvey Cushing: Staged Approach to a Complex Skull Base Tumor

    PubMed Central

    Malekpour, Mahdi; Cohen-Gadol, Aaron A.

    2014-01-01

    Objective The evolution of neurosurgical techniques during Harvey Cushing's practice was immense. The authors illustrate this evolution using archived historical records from Harvey Cushing. Setting Historical patient records retained by the Cushing Center at Yale University Department of Neurosurgery. Design The authors present the case of one of Cushing's patients with a cholesteatoma. Results Cushing's surgical treatment of a cholesteatoma extending into the skull base is an example of his meticulous documentation and accelerated surgical techniques. Conclusions This case demonstrates how neurosurgical techniques advanced in the management of complex skull base tumors via a staged approach through the middle and posterior fossae at a time long before the development of modern skull base surgery. PMID:25276599

  13. Posterior foss avenous angiomas with drainage through the brain stem

    SciTech Connect

    Damiano, T.R.; Truwit, C.L. ); Dowd, C.F. ); Symonds, D.L. )

    1994-04-01

    To describe 11 cases of posterior fossa venous angiomas with drainage through the brain stem. Eleven cases of posterior fossa venous angioma with drainage through the brain stem were evaluated using MR. Correlation with known routes of venous drainage for the cerebellum and brain stem is made. Six of the 11 venous angiomas were found in the cerebellum, four in the brain stem; one involved both the cerebellum and brain stem. The cerebellar venous angiomas drained to subependymal veins about the fourth ventricle and dorsal pons. These then connected with an enlarged transmesencephalic or transpontine vein, to drain anteriorly to the anterior pontine veins. The brain stem angiomas had variable drainage depending on location. Evidence of hemorrhage was seen in five cases. Cerebellar and brain stem venous angiomas have several potential routes of drainage, including an enlarged vein traversing the pons, midbrain, or medulla. A knowledge of the normal venous anatomy of this region helps to understand the occurrence of these uncommon routes of venous drainage. 15 refs., 8 figs., 1 tab.

  14. Resection of large epidermoid tumors ventral to the brainstem: techniques to expand the operative corridor across the basilar artery.

    PubMed

    Cohen-Gadol, Aaron A

    2014-01-01

    Epidermoid tumors comprise about 1% of all intracranial tumors. They are congenital lesions that arise from paramedian cisterns within the posterior fossa. These tumors present as heterogeneous hyperintense lesions on FLAIR and homogenous hyperintense lesions on DWI. Surgical resection remains the most accepted form of therapy, but epidermoid tumors may recur. These tumors are well exposed through a traditional retrosigmoid approach. The tumor can be removed relatively easily as it is avascular. However, the propensity of this tumor type to fill the small spaces within basal cisterns and attach to cranial nerves may make its complete resection challenging. Tumors resection has to preserve the surrounding arachnoid membranes encasing the cranial nerves. The author presents the case of a 42-year-old woman with a 1-year history of imbalance and nystagmus. An MRI revealed a large right-sided CP angle epidermoid tumor filling the ventral brainstem cistern and extending to the contralateral side, compressing the brainstem. The accompanying video illustrates resection of this mass through an extended (exposing the sigmoid sinus) retrosigmoid approach. The author removed the tumor piecemeal while protecting the cranial nerves. Small pieces of affected arachnoid covering the cranial nerves were not significantly manipulated. To excise the tumor along the contralateral paramedian cistern, the author used the space between the V and VII/VII cranial nerves to expose the space contralateral to the basilar artery and remove additional tumor. This maneuver allowed gross total resection of the tumor without a need to employ a more elaborate skull base approach such as petrosectomy. At 3-month follow-up visit after surgery, the patient's neurological exam returned to normal. The video can be found here: http://youtu.be/CzRb-GUvhog . PMID:24380510

  15. Endolymphatic sac tumor with von Hippel-Lindau disease: report of a case with atypical pathology of endolymphatic sac tumor.

    PubMed

    Yang, Xiang; Liu, Xue-Song; Fang, Yuan; Zhang, Xiu-Hui; Zhang, Yue-Kang

    2014-01-01

    The authors described a case of a patient with co-existing endolymphatic sac tumor (ELST) and hemangioblastoma in the posterior cranial fossa, which belonged to a subtype of Von Hippel-Lindau (VHL) disease confirmed by the test of VHL-gene. The signs in this 42-year-old female included intermittent headache and dizziness. Imaging revealed a giant mass in the right cerebellopontine angle (CPA) region and another lesion in the left cerebellar hemisphere. The results of biopsy after two operations confirmed the diagnosis respectively. Both of the tumors were resected totally. Nevertheless, we had to confess the misdiagnosis as vascular tumor instead of ELST at the initial diagnosis because of the rarity of ELST associated with atypical histological characteristics. The purposes we reported this case were to describe the atypical pathological feature of ELST and the mutation of germline VHL not mentioned in previously literature, furthermore, to foster understanding of ELSTs with the avoidance of the similar misdiagnosis as far as possible in future. PMID:24966975

  16. Anatomic measurements of the posterior tympanum related to the round window vibroplasty in congenital aural atresia and stenosis patients.

    PubMed

    Chen, Keguang; Yin, Dongming; Lyu, Huiying; Yang, Lin; Zhang, Tianyu; Dai, Peidong

    2016-05-01

    Conclusions With the aggravation of the external auditory canal malformation, the size of extra-niche fossa became smaller, providing concrete data and valuable information for the better design, selecting and safer implantation of the transducer in the area of round window niche. Three-dimensional measurements and assessments before surgery might be helpful for a safer surgical approach and implantation of a vibrant soundbridge. Objectives The aim of this study was to investigate whether differences exist in the morphology of the posterior tympanum related to the round window vibroplasty among congenital aural atresia (CAA), congenital aural stenosis (CAS), and a normal control group, and to analyze its effect on the round window implantation of vibrant soundbridge. Methods CT images of 10 normal subjects (20 ears), 27 CAS patients (30 ears), and 25 CAA patients (30 ears) were analyzed. The depth and the size of outside fossa of round window niche related to the round window vibroplasty (extra-niche fossa)and the distances between the center of round window niche and extra-niche fossa were calculated based on three-dimensional reconstruction using mimics software. Finally, the data were analyzed statistically. Results The size of extra-niche fossa in the atresia group was smaller than in the stenosis group (p < 0.05); furthermore, the size of extra-niche fossa in the stenosis group was smaller than that of the control group (p < 0.05). There was no statistically significant difference of the depth of extra-niche fossa among different groups. PMID:27052964

  17. Pediatric Odontogenic Tumors.

    PubMed

    Abrahams, Joshua M; McClure, Shawn A

    2016-02-01

    Pediatric odontogenic tumors are rare, and are often associated with impacted teeth. Although they can develop anywhere in the jaws, odontogenic tumors mainly occur in the posterior mandible. This article discusses the diagnosis and treatment of the most common pediatric odontogenic tumors, such as ameloblastoma, keratocystic odontogenic tumor, odontoma, and cementoblastoma. PMID:26614700

  18. Hesperian age for western Medusae Fossae Formation, Mars.

    PubMed

    Zimbelman, James R; Scheidt, Stephen P

    2012-06-29

    The Medusae Fossae Formation (MFF) on Mars is an intensely eroded deposit north of the cratered highlands. It is widely thought that MFF materials were emplaced through ignimbrite eruptions. Recent geologic mapping of western MFF identified outliers of MFF materials well beyond the previously mapped western extent for the deposit, including outliers close to Gale crater. We report counts of impact craters on the MFF units that have implications for our understanding of the general history of MFF and the uppermost layered materials on the Gale crater mound. PMID:22628559

  19. Endoscopic Removal of a Bullet Penetrating the Middle Cranial Fossa

    PubMed Central

    Hatch, Neal U.; Riley, Kristen O.; Woodworth, Bradford A.

    2011-01-01

    Reports of intracranial retained foreign bodies are relatively rare in the literature. Such objects can cause numerous complications requiring removal, such as infection, persistent cerebrospinal fluid (CSF) leak, or new-onset seizures. The transnasal endoscopic approach provides an excellent alternative to craniotomy for repairing middle cranial fossa (MCF) defects. We describe a case of a 57-year-old woman with a self-inflicted bullet piercing the MCF, creating a persistent CSF leak. The details regarding the removal of this penetrating foreign body from the MCF, including the unique management in the setting of a contralateral spontaneous CSF leak, are discussed. PMID:23984202

  20. [Posterior capsule opacification].

    PubMed

    Milazzo, S; Grenot, M; Benzerroug, M

    2014-12-01

    Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology. PMID:25455552

  1. Crustal extension in the Ceraunius Fossae, Northern Tharsis Region, Mars

    NASA Astrophysics Data System (ADS)

    Borraccini, F.; Lanci, L.; Wezel, F. C.; Baioni, D.

    2005-06-01

    We investigated the Ceraunius Fossae area, Northern Tharsis, in order to obtain quantitative information on the tectonic extension affecting this area. Tectonic structures of the Ceraunius Fossae area have been previously described using Viking images and interpreted as extensional structures. Laser altimetry data (MOLA) can be used to quantitatively investigate these structures with a better resolution. We developed a method to obtain E-W oriented profiles (perpendicular to the main tectonic structures) with a sufficiently high resolution to analyze tectonic structures in spite of the low data density in this direction. We interpreted all the recognizable extensional structures along the profiles, and using a simplified structural model, we estimated tectonic extension along these transects. The extension calculated over the entire profiles is 36 km (e24 = (l1 - l0)/l0 = (910 km - 874 km)/874 km = 0.041) and 42 km (e26 = (730 km - 688 km)/688 km = 0.061) along profile 24 and profile 26, respectively. In the most deformed area, extension reaches the value of 22 km (emax = (l1 - l0)/l0 = (186 km - 164 km)/164 km = 0.134). Since the extension accounted by the topographic doming is negligible, a significant horizontal crustal motion is required to explain the observed extension.

  2. Posterior Tibial Tendon Dysfunction

    MedlinePlus

    ... when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be ... repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time. ...

  3. Posterior ankle impingement syndrome.

    PubMed

    Maquirriain, Javier

    2005-10-01

    Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. The pain may be acute as a result of trauma or chronic from repetitive stress. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but it also may result from flexor hallucis longus tenosynovitis, ankle osteochondritis, subtalar joint disease, and fracture. Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion or push-off maneuvers, such as may occur during dancing, kicking, or downhill running. Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination. Radiography, scintigraphy, computed tomography, and magnetic resonance imaging depict associated bone and soft-tissue abnormalities. Symptoms typically improve with nonsurgical management, but surgery may be required in refractory cases. PMID:16224109

  4. Neuropsychologic function in children with brain tumors. III. Interval changes in the six months following treatment

    SciTech Connect

    Mulhern, R.K.; Kun, L.E.

    1985-01-01

    Twenty-six children with primary brain tumors were studied prospectively with regard to their sensorimotor, intellectual, academic, and emotional status. Serial evaluations were conducted after surgery (pre-irradiation) and six months after the completion of radiation therapy. The timing of the second evaluation was chosen so as to antedate the late effects of irradiation. Children over 6 years old displayed significant improvement of intellectual function over time, with only 11% exhibiting deterioration on one or more cognitive parameters. In contrast, 68% of younger children clinically deteriorated in one or more areas of intellectual functioning, with prominent difficulties in memory and selective attention for age. Children under 6 years old with supratentorial tumors were less likely than those with posterior fossa tumors to improve their cognitive performance. At the second evaluation, 23% of the patients were functioning below normal (IQ less than 80) intellectually, with 50% of the younger children and 11% of the older children receiving special educational assistance. Approximately 40-50% of the patients manifested emotional adjustment problems at each evaluation. The results are discussed in terms of the clinical need to follow similar patient populations with formal psychological assessments over time, and in terms of the difficulties involved in defining factors that determine the functional status of children surviving brain tumors.

  5. Distal urethroplasty for fossa navicularis and meatal strictures

    PubMed Central

    Dielubanza, Elodi J.; Han, Justin S.

    2014-01-01

    Distal urethral strictures involving the fossa navicularis and meatus represent a unique subset of urethral strictures that are particularly challenging to reconstructive urologists. Management of distal urethral strictures must take into account not only maintenance of urethral patency but also glans cosmesis. A variety of therapeutic approaches exist for the management of distal urethral strictures, including dilation, meatotomy, extended meatotomy, flap urethroplasty, and substitution grafting. Common etiologies for distal urethral strictures include lichen sclerosus, instrumentation, and prior hypospadias repair. Proper patient selection is paramount to the ultimate success and durability of the treatment, which should be individualized and include an assessment of the stricture etiology, location, and burden, and patient-centered goals of care. PMID:26816765

  6. Bilateral posterior sternoclavicular dislocation.

    PubMed

    Baumann, Matthias; Vogel, Tobias; Weise, Kuno; Muratore, Tim; Trobisch, Per

    2010-07-01

    Posterior sternoclavicular dislocations are a rare injury, representing <5% of all sternoclavicular dislocations and 1 in 1600 shoulder girdle injuries. Proper imaging with computed tomography and prompt diagnosis are essential steps in preventing potentially lethal complications observed in approximately 3% of all posterior sternoclavicular dislocations. Surgical treatment is necessary if closed reduction fails. With the medial clavicular epiphysis being the last to close (between ages 22 and 25), children and adolescents typically present with epiphyseal fractures rather than joint dislocations. If closed reduction fails, open reduction and internal fixation (ORIF) should be considered in fractures, whereas complex reconstructions with tendon graft procedures have been recommended for joint dislocations. This article presents a case of a traumatic bilateral posterior sternoclavicular dislocation due to an epiphyseal fracture in a 15-year-old boy. To our knowledge, this is the first reported case of a bilateral posterior sternoclavicular dislocation. Attempted closed reduction failed with redislocation after 2 days. The patient subsequently required ORIF. This article describes our technique with anterior retraction of the medial clavicle, closure of the posterior periosteum, and ORIF using nonabsorbable sutures. Postoperative shoulder mobilization was started on day 1. At final follow-up, the patient was completely asymptomatic. PMID:20608625

  7. Fascicular Involvement of the Posterior Tibial Nerve as a Result of Perineural Ganglion Cyst at the Posterior Tibial Nerve in the Calf: A Case Report and Review of Literature.

    PubMed

    Patel, Chilvana; Vishnubhakat, Surya Murthy; Narayan, Raj

    2015-12-01

    We report a 19-year-old woman with a 6-month history of nontraumatic left foot numbness associated with intermittent weakness. Nerve conduction studies and electromyography localized the lesion to the posterior tibial nerve, below the innervation to the soleus and medial gastrocnemius muscles. MRI of the left leg revealed a multiloculated cystic collection near the proximal tibiofibular joint. Surgical excision and pathology confirmed the diagnosis of a ganglion cyst, in an atypical location distal to the popliteal fossa. We believe this is the first reported case of fascicular posterior tibial nerve involvement by a ganglion cyst in the calf. PMID:26583496

  8. Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.

    PubMed

    Fantry, Amanda; Lareau, Craig; Vopat, Bryan; Blankenhorn, Brad

    2016-01-01

    Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures. PMID:26991573

  9. Fossa Navicularis Strictures Due to 22F Catheters Used in Robotic Radical Prostatectomy

    PubMed Central

    Ahlering, Thomas E.; Gelman, Joel; Skarecky, Douglas W.

    2007-01-01

    Background and Objectives: Fossa navicularis strictures following radical prostatectomy are reported infrequently. We recently experienced a series of fossa strictures following robot-assisted laparoscopic radical prostatectomy. Fossa strictures are usually procedure-induced, arising from urethral trauma or infection; catheter size has not been reported as a factor. We describe herein our experience to determine and prevent fossa navicularis stricture development. Methods: From June 2002 until February 2005, 248 patients underwent robot-assisted laparoscopic prostatectomy with the da Vinci surgical system at our institution. Fossa strictures were diagnosed based on acute onset of obstructive voiding symptoms, IPSS and flow pattern changes, and bougie calibration. During our series, we switched from an 18F to a 22F catheter to avoid inadvertent stapling of the urethra when dividing the dorsal venous complex. All patients had an 18F catheter placed after the anastomosis for 1 week. Parameters were evaluated using Fisher's exact test and the Student t test for means. Results: The 18F catheter group (n=117) developed 1 fossa stricture, whereas the 22F catheter group (n=131) developed 9 fossa strictures (P=0.02). The fossa stricture rate in the 18F group was 0.9% versus 6.9% in the 22F group. The 2 groups had no differences in age, body mass index, cardiovascular disease, International Prostate Symptom Score, urinary bother score, SHIM score, preoperative PSA, operative time, estimated blood loss, cautery use, prostate size, or catheterization time. Conclusions: Using a larger urethral catheter size during intraoperative dissection appears to increase the risk 8-fold for fossa stricture as compared with the 18F catheter. The pneumoperitoneum and prolonged extreme Trendelenberg position could potentially contribute to local urethral ischemia. PMID:17931514

  10. Craniofacial access to the anterior and middle cranial fossae and skull base.

    PubMed

    Lello, G; Statham, P; Steers, J; McGurk, M

    1997-12-01

    A profusion of surgical approaches to gain access to the anterior and middle cranial fossa and skull base have been described. An attempt has been made to simplify the position by suggesting a classification of surgical approaches and to describe a standard approach (of at most 4 defined osteotomies, or at least 2) to give a craniofacial approach to the anterior and middle cranial fossae, the infratemporal fossa, the orbit and the superior nasal cavity. The full extent of the osteotomies have been likened to an ancient Corinthian face mask, or to the stylized face-mask worn by the comic book hero, Batman. PMID:9504303

  11. Nili Fossae in Natural Color and Across the Spectrum

    NASA Technical Reports Server (NTRS)

    2007-01-01

    The Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) took this image of the Nili Fossae region at 0643 UTC (2:43 a.m. EDT) on June 21, 2007, near 21.15 degrees north latitude, 74.24 degrees east longitude. CRISM's image was taken in 544 colors covering 0.36-3.92 micrometers, and shows features as small as 20 meters (66 feet) across. The region covered is just over 10 kilometers (6.2 miles) wide at its narrowest point, and is one of several dozen that CRISM has taken to map the minerals at candidate landing sites for the Mars Science Laboratory (MSL) mission, which will launch in 2010.

    The Nili Fossae region is critical to understanding the history of water on Mars and whether water ever formed environments suitable for life, because the region is underlain by a layer of phyllosilicate (clay) minerals. This type of mineralogy formed where water was in contact with Mars' crustal rocks for very long periods, altering the silicates in volcanic rocks. In addition, phyllosilicates can encapsulate and preserve organic chemicals associated with life (if life was present). Its rocky record of an ancient wet environment makes Nili Fossae a top contender among the 30-plus landing sites being considered for MSL, whose objectives include measuring the chemistry preserved in an ancient wet environment.

    This series of four different versions of the same 544-color image illustrates the mineral-mapping capability that comes from moving beyond the wavelength range of the human eye, and into infrared wavelengths where minerals leave distinct 'fingerprints' in reflected sunlight. At upper left, more than three dozen of the distinct wavelengths measured by CRISM were combined to mimic how the human eye would see the image. The subtle shading comes from the Sun's position high in Mars' sky when the image was taken, creating few shadows. The bland, butterscotch color comes from the dust coating nearly all of the Martian surface to some degree. At upper right

  12. Phyllosilicate and Olivine around a Fracture in Nili Fossae

    NASA Technical Reports Server (NTRS)

    2007-01-01

    The Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) took this observation of part of the Nili Fossae region at the western margin of the Isidis impact basin at 3:07 (UTC) on December 12, 2006, near 21.9 degrees north latitude, 78.2 degrees east longitude. The image was taken in 544 colors covering 0.36-3.92 micrometers, and shows features as small as 18 meters (60 feet) across. The image is about 11 kilometers (7 miles) wide at its narrowest point.

    The Isidis basin resulted from a gigantic impact on the surface of Mars early in the planet's history. The image of the Isidis basin at the top left is the colored elevation data from the Mars Orbiter Laser Altimeter (MOLA) overlain on a digital image mosaic from the Viking mission. Reds represent higher elevations, and blue lower elevations. The western rim of the Isidis basin has numerous, concentric troughs (or 'fossae') which may have formed during faulting associated with the impact event. Since then, the Nili Fossae region has since been heavily eroded, and is one of the most mineralogically diverse spots on Mars.

    This CRISM image targets one of region's smaller fractures. The image is shown overlain on the Viking digital image mosaic at lower left. The lower right CRISM image was constructed from three visible wavelengths (0.71, 0.60 and 0.53 microns in the red, green and blue image planes, respectively) and is close to what the human eye would see. The blue on the right of the image is an artifact from light scattering in the atmosphere. The upper right image was constructed from three infrared channels (2.38, 1.80 and 1.15 microns in the red, green and blue image planes, respectively) to highlight the mineralogy of the area. The bright green areas are rich in 'phyllosilicates,' a category of minerals including clays. The purple material along the walls of the fracture likely contains small amounts of the iron- and magnesium-rich mineral pyroxene. The yellow-brown material contains the

  13. Polygonal Dike Networks in the Medusae Fossae Formation

    NASA Astrophysics Data System (ADS)

    Kerber, L.; Dickson, J. L.; Forget, F.; Head, J. W.; Grosfils, E. B.

    2013-09-01

    1. Introduction 1.1 The Medusae Fossae Formation The Medusae Fossae Formation (MFF) is a widespread and voluminous formation which covers 2.1 x 106 km2 between 130-230ºE and 12ºS-12ºN [1-3]. As a fine-grained, friable deposit, its surface is dominated by aeolian features such as yardangs [3-5] and a large number of both fresh and indurated transverse aeolian ridges [TARs] [5]. The deposition of the MFF began at the latest in the Hesperian [6], and over time it has been recognized that, by virtue of its fine-grained nature, the MFF may preserve an important record of Martian history, most directly as a result of the burial and exhumation of channels found in the Zephyria region of the formation [7]. In order to better document the occurrence of smallscale features of interest within the MFF, we examined 427 High Resolution Imaging Science Experiment (HiRISE) images spread across the formation, during which the occurrence of features of interest were mapped [8]. HiRISE images were supplemented by Mars Reconnaissance Orbiter Context Imager (CTX), Mars Express High Resolution Stereo Camera (HRSC) and Mars Global Surveyor Mars Orbiter Camera (MOC) images where needed. Here we describe the occurrence and characteristics of several polygonal networks of rectilinear ridges. 1.2 Rectilinear Ridges on Mars Rectilinear ridges have been recognized in several different areas on Mars. Long, linear to slightly curving or en echelon ridges hypothesized to be exhumed magmatic dikes have been found in a variety of environments on Mars [9-13], particularly in formerly glaciated terrains where magma may have been emplaced into an icy substrate. A network of rectilinear ridges was described in detail in an unnamed crater on the dichotomy boundary [14]. These chaotic, intersecting ridges, forming irregular polygons ~1 km across, are hypothesized to be brecciated dikes emplaced during the process of crater formation [14]. A group of intersecting rectilinear ridges, informally known as

  14. Integrated proteomic platforms for the comparative characterization of medulloblastoma and pilocytic astrocytoma pediatric brain tumors: a preliminary study.

    PubMed

    Martelli, Claudia; Iavarone, Federica; D'Angelo, Luca; Arba, Morena; Vincenzoni, Federica; Inserra, Ilaria; Delfino, Daniela; Rossetti, Diana Valeria; Caretto, Marta; Massimi, Luca; Tamburrini, Gianpiero; Di Rocco, Concezio; Caldarelli, Massimo; Messana, Irene; Castagnola, Massimo; Sanna, Maria Teresa; Desiderio, Claudia

    2015-06-01

    A top-down/bottom-up integrated proteomic approach based on LC-MS and 2-DE analysis was applied for comparative characterization of medulloblastoma and pilocytic astrocytoma posterior cranial fossa pediatric brain tumor tissues. Although rare, primary brain tumors are the most frequent solid tumors in the pediatric age. Among them the medulloblastoma is the prevalent malignant tumor in childhood while pilocytic astrocytoma is the most common, rarely showing a malignant progression. Due to the limited availability of this kind of sample, the study was applied to pooled tumor tissues for a preliminary investigation. The results showed different proteomic profiles of the two tumors and evidenced interesting differential expression of several proteins and peptides. Top-down proteomics of acid-soluble fractions of brain tumor homogenates ascribed a potential biomarker role of malignancy to β- and α-thymosins and their truncated proteoforms and to C-terminal truncated (des-GG) ubiquitin, resulting exclusively detected or over-expressed in the highly malignant medulloblastoma. The bottom-up proteomics of the acid-soluble fraction identified several proteins, some of them in common with 2-DE analysis of acid-insoluble pellets. Peroxiredoxin-1, peptidyl-prolyl cis-trans isomerase A, triosephosphate isomerase, pyruvate kinase PKM, tubulin beta and alpha chains, heat shock protein HSP-90-beta and different histones characterized the medulloblastoma while the Ig kappa chain C region, serotransferrin, tubulin beta 2A chain and vimentin the pilocytic astrocytoma. The two proteomic strategies, with their pros and cons, well complemented each other in characterizing the proteome of brain tumor tissues and in disclosing potential disease biomarkers to be validated in a future study on individual samples of both tumor histotypes. PMID:25909245

  15. Cerebellar liponeurocytoma: a rare intracranial tumor with possible familial predisposition. Case report.

    PubMed

    Wolf, Amparo; Alghefari, Huda; Krivosheya, Daria; Staudt, Michael D; Bowden, Gregory; Macdonald, David R; Goobie, Sharan; Ramsay, David; Hebb, Matthew O

    2016-07-01

    The biological origin of cerebellar liponeurocytomas is unknown, and hereditary forms of this disease have not been described. Here, the authors present clinical and histopathological findings of a young patient with a cerebellar liponeurocytoma who had multiple immediate family members who harbored similar intracranial tumors. A 37-year-old otherwise healthy woman presented with a history of progressive headaches. Lipomatous medulloblastoma had been diagnosed previously in her mother and maternal grandfather, and her maternal uncle had a supratentorial liponeurocytoma. MRI revealed a large, poorly enhancing, lipomatous mass emanating from the superior vermis that produced marked compression of posterior fossa structures. An uncomplicated supracerebellar infratentorial approach was used to resect the lesion. Genetic and histopathological analyses of the lesion revealed neuronal, glial, and lipomatous differentiation and confirmed the diagnosis of cerebellar liponeurocytoma. A comparison of the tumors resected from the patient and, 22 years previously, her mother revealed similar features. Cerebellar liponeurocytoma is a poorly understood entity. This report provides novel evidence of an inheritable predisposition for tumor development. Accurate diagnosis and reporting of clinical outcomes and associated genetic and histopathological changes are necessary for guiding prognosis and developing recommendations for patient care. PMID:26613167

  16. Previously Undiagnosed Malignant Brain Tumor Discovered During Examination of a Patient Seeking Chiropractic Care

    PubMed Central

    Anderson, Brian

    2016-01-01

    Objective This case report describes the diagnosis of a malignant brain tumor in a patient requesting chiropractic care for headaches after a motor vehicle accident. Clinical Features A 30-year-old man presented with numbness and tingling in all extremities, lower extremity muscle weakness, and a recent increase in headaches with the loss of ability to concentrate. He was involved in a high-speed motor vehicle collision approximately 4 months before the onset of symptoms. Examination showed slow gait with a lack of arm swing, bilateral hip flexors and knee extensors were all graded as 4/5 on muscle testing, and cranial nerve examination was unremarkable with the exception of 2 beats of nystagmus on left lateral eye movement. Because of these findings and a family history of multiple sclerosis, the patient was referred for a brain magnetic resonance imaging scan. Intervention and Outcome Imaging showed a craniocervical junction mass centered at the floor of the fourth ventricle with obstruction of foramina and marked impingement on the medulla. A posterior fossa craniotomy and tumor removal procedure was performed by a neurosurgeon, followed by 34 sessions of radiation therapy. The final diagnosis was a grade II glioma with features of ependymoma. Conclusions This report describes the clinical presentation, examination, and medical management of a 30-year-old man presenting to a chiropractic practice with an unsuspected malignant brain tumor. PMID:27069431

  17. Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following foramen magnum decompression for Chiari malformation Type I.

    PubMed

    Bahuleyan, Biji; Menon, Girish; Hariharan, Easwer; Sharma, Mridul; Nair, Suresh

    2011-02-01

    Symptomatic subdural hygroma due to foramen magnum decompression for Chiari malformation Type I is extremely rare. The authors present their experience with 2 patients harboring such lesions and discuss treatment issues. They conclude that the possibility of subdural hygromas should be considered in all patients presenting with increased intracranial tension following foramen magnum decompression for Chiari malformation Type I. Immediate neuroimaging and appropriate surgical intervention provides a good outcome. PMID:20849216

  18. Unusual Ventilatory Response to Exercise in Patient with Arnold-Chiari Type 1 Malformation after Posterior Fossa Decompression

    PubMed Central

    Smith, Keely; Gomez-Rubio, Ana M.; Harris, Tomika S.; Brooks, Lauren E.

    2016-01-01

    We present a case of a 17-year-old Hispanic male with Arnold-Chiari Type 1 [AC-Type 1] with syringomyelia, status post decompression, who complains of exercise intolerance, headaches, and fatigue with exertion. The patient was found to have diurnal hypercapnia and nocturnal alveolar hypoventilation. Cardiopulmonary testing revealed blunting of the ventilatory response to the rise in carbon dioxide (CO2) resulting in failure of the parallel correlation between increased CO2 levels and ventilation; the expected vertical relationship between PETCO2 and minute ventilation during exercise was replaced with an almost horizontal relationship. No new pathology of the brainstem was discovered by MRI or neurological evaluation to explain this phenomenon. The patient was placed on continuous noninvasive open ventilation (NIOV) during the day and CPAP at night for a period of 6 months. His pCO2 level decreased to normal limits and his symptoms improved; specifically, he experienced less headaches and fatigue during exercise. In this report, we describe the abnormal response to exercise that patients with AC-Type 1 could potentially experience, even after decompression, characterized by the impairment of ventilator response to hypercapnia during exertion, reflecting a complete loss of chemical influence on breathing with no evidence of abnormality in the corticospinal pathway. PMID:27418995

  19. Cementoblastoma of posterior maxilla involving the maxillary sinus

    PubMed Central

    Dadhich, Anuj S.; Nilesh, Kumar

    2015-01-01

    Cementoblastoma is a rare neoplasm, representing <1% of all odontogenic tumors. It usually occurs in the posterior mandible and is associated with roots of a mandibular first molar or second premolar. This paper presents a rare case of cementoblastoma in the maxillary posterior region involving the maxillary sinus, in a young female patient. The clinical, radiological, and histopathological features of the lesion are discussed along with a review of previously reported cases in the literature. PMID:26389052

  20. Protuberance or fossa on the lateral surface of the mandible in primates.

    PubMed

    Kondo, Shintaro; Naitoh, Munetaka; Matsuno, Masanobu; Kanazawa, Eisaku; Takai, Masanaru

    2016-01-01

    In order to clarify the morphological characteristics and function of the protuberance and/or fossa on the lateral surface of the mandible, we examined 778 mandibles of 9 genera, 19 species of non-human primates. Both protuberance and fossa were found in Macaca, Chlorocebus, and Cercocebus at frequencies ranging from 0% to 60%. The protuberance was composed of compact bone and was similar to the mandibular torus in humans. A well-developed protuberance extended from the fourth premolar to third molar region, and was situated at the central part of the mandibular body, or continued on the oblique line. Sometimes the protuberance localized on the mandibular base. A deep and large fossa was found in all individuals of Papio, Theropithecus, and Mandrillus, and the bone width was thin in the center of the fossa. The fossa extended from the third premolar to the second molar region, and the deepest area was the first molar region. In Macaca, Chlorocebus, and Cercocebus, the curvature of the external table of the mandible created a fossa. In Colobus, and Hylobates, the external surface of the mandible looked concave because of the thickened mandibular base. These concavo-convex structures have some biological functions and represent an adaptive change for mastication. PMID:25817174

  1. Ossification of the Posterior Petroclinoid Dural Fold: A Cadaveric Study with Neurosurgical Significance.

    PubMed

    Kimball, David; Kimball, Heather; Matusz, Petru; Tubbs, R Shane; Loukas, Marios; Cohen-Gadol, A Aaron

    2015-08-01

    Objectives The roof of the porus trigeminus, composed of the posterior petroclinoid dural fold, is an important landmark to the skull base surgeon. Ossification of the posterior petroclinoid dural fold is an anatomical variation rarely mentioned in the literature. Such ossification results in the trigeminal nerve traversing a bony foramen as it enters Meckel cave. The authors performed this study to better elucidate this anatomical variation. Design Fifteen adult cadaveric head halves were subjected to dissection of the middle cranial fossa. Microdissection techniques were used to examine the posterior petroclinoid dural folds. Skull base osteology was also studied in 71 dry human skulls with attention paid to the attachment point of the posterior petroclinoid dural folds at the trigeminal protuberances. Setting Cadaver laboratory Main Outcome Measures Measurements were made using a microcaliper. Digital images were made of the dissections. Results Completely ossified posterior petroclinoid folds were present in 20% of the specimens. Of the 142 dry skull sides examined, 9% had large trigeminal protuberances. Conclusions Based on this study, the posterior petroclinoid dural fold may completely ossify in adults that may lead to narrowing of the porus trigeminus and potential compression of the trigeminal nerve at the entrance to Meckel cave. PMID:26225315

  2. Regression of posterior uveal melanomas following cobalt-60 plaque radiotherapy

    SciTech Connect

    Cruess, A.F.; Augsburger, J.J.; Shields, J.A.; Brady, L.W.; Markoe, A.M.; Day, J.L.

    1984-12-01

    A method has been devised for evaluating the rate and extent of regression of the first 100 consecutive patients with a posterior uveal melanoma that had been managed by Cobalt-60 plaque radiotherapy at Wills Eye Hospital. It was found that the average posterior uveal melanoma in the series did not regress rapidly to a flat, depigmented scar but shrank slowly and persisted as a residual mass approximately 50% of the thickness of the original tumor at 54 months following Cobalt-60 plaque radiotherapy. The authors also found that the rate and extent of regression of the tumors in patients who subsequently developed metastatic melanoma were not appreciably different from the rate and extent of regression of the tumors in patients who remained well systemically. These observations indicate that the rate and extent of regression of posterior uveal melanomas following Cobalt-60 plaque radiotherapy are poor indicators of the prognosis of the affected patients for subsequent development of clinical metastatic disease.

  3. Posterior Urethral Strictures.

    PubMed

    Gelman, Joel; Wisenbaugh, Eric S

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  4. Posterior Tibial Tendon Transfer.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Cameron, Jordan D; Vazales, Ryan

    2016-01-01

    When performed correctly with the right patient population, a tibialis posterior muscle/tendon transfer is an effective procedure. Many different methods have been established for fixating the tendon, each of which has its' own indications. Passing through the interosseous membrane is the preferred and recommended method and should be used unless this is not possible. Good surgical planning based on patient needs and expectations, along with excellent postoperative care including early range of motion and physical therapy minimizes risk of complications and allows for the optimal outcome to be achieved. PMID:26590722

  5. Posterior Urethral Strictures

    PubMed Central

    Gelman, Joel; Wisenbaugh, Eric S.

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  6. Posterior Cortical Atrophy

    PubMed Central

    Crutch, Sebastian J; Lehmann, Manja; Schott, Jonathan M; Rabinovici, Gil D; Rossor, Martin N; Fox, Nick C

    2013-01-01

    Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterized by a progressive decline in visuospatial, visuoperceptual, literacy and praxic skills. The progressive neurodegeneration affecting parietal, occipital and occipito-temporal cortices which underlies PCA is attributable to Alzheimer's disease (AD) in the majority of patients. However, alternative underlying aetiologies including Dementia with Lewy Bodies (DLB), corticobasal degeneration (CBD) and prion disease have also been identified, and not all PCA patients have atrophy on clinical imaging. This heterogeneity has led to diagnostic and terminological inconsistencies, caused difficulty comparing studies from different centres, and limited the generalizability of clinical trials and investigations of factors driving phenotypic variability. Significant challenges remain in identifying the factors associated with both the selective vulnerability of posterior cortical regions and the young age of onset seen in PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-and disease-level classifications are required in order to improve diagnostic accuracy, research study design and clinical management. PMID:22265212

  7. Congenital cholesteatoma of the infratemporal fossa with congenital aural atresia and mastoiditis: a case report

    PubMed Central

    2012-01-01

    Background Congenital cholesteatoma may be expected in abnormally developed ear, it may cause bony erosion of the middle ear cleft and extend to the infratemporal fossa. We present the first case of congenital cholesteatoma of the infratemporal fossa in a patient with congenital aural atresia that has been complicated with acute mastoiditis. Case presentation A sixteen year old Egyptian male patient presented with congenital cholesteatoma of the infratemporal fossa with congenital aural atresia complicated with acute mastoiditis. Two weeks earlier, the patient suffered pain necessitating hospital admission, magnetic resonance imaging revealed a soft tissue mass in the right infratemporal fossa. On presentation to our institute, Computerized tomography was done as a routine, it proved the diagnosis of mastoiditis, pure tone audiometry showed an air-bone gap of 60 dB. Cortical mastoidectomy was done for treatment of mastoiditis, removal of congenital cholesteatoma was carried out with reconstruction of external auditory canal. Follow-up of the patient for 2 years and 3 months showed a patent, infection free external auditory canal with an air-bone gap has been reduced to 35db. One year after the operation; MRI was done and it showed no residual or recurrent cholesteatoma. Conclusions Congenital cholesteatoma of the infratemporal fossa in cases of congenital aural atresia can be managed safely even if it was associated with mastoiditis. It is an original case report of interest to the speciality of otolaryngology. PMID:22731118

  8. Is Mandibular Fossa Morphology and Articular Eminence Inclination Associated with Temporomandibular Dysfunction?

    PubMed Central

    Paknahad, Maryam; Shahidi, Shoaleh; Akhlaghian, Marzieh; Abolvardi, Masoud

    2016-01-01

    Statement of the Problem Finding a significant relationship between temporomandibular joint (TMJ) morphology and the incidence of temporomandibular dysfunction (TMD) may help early prediction and prevention of these problems. Purpose The purpose of the present study was to determine the morphology of mandibular fossa and the articular eminence inclination in patients with TMD and in control group using cone beam computed tomography (CBCT). Materials and Method The CBCT data of bilateral TMJs of 40 patients with TMD and 23 symptom-free cases were evaluated. The articular eminence inclination, as well as the glenoid fossa depth and width of the mandibular fossa were measured. The paired t-test was used to compare these values between two groups. Results The articular eminence inclination and glenoid fossa width and depth were significantly higher in patients with TMD than in the control group (p < 0.05). Conclusion The articular eminence inclination was steeper in patients with TMD than in the control group. Glenoid fossa width and depth were higher in patients with TMD than that in the control group. This information may shed light on the relationship between TMJ morphology and the incidence of TMD. PMID:27284559

  9. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

  10. Delayed removal of a maxillary third molar from the infratemporal fossa.

    PubMed

    Gómez-Oliveira, Guillermo; Arribas-García, Ignacio; Alvarez-Flores, Modesto; Gregoire-Ferriol, Johanna; Martínez-Gimeno, Carlos

    2010-05-01

    Removal of an impacted superior third molar is usually a simple and uncomplicated procedure for an Oral and Maxillofacial Surgeon. Nevertheless, complications are possible and include infection, facial swallowing, trismus, wound dehiscence, root fracture or even orosinusal fistula. Iatrogenic displacement into the infratemporal fossa is frequently mentioned but rarely reported. This anatomical fossa includes several important structures such as the internal maxillary artery, the venous pterygoid plexus, the sphenopalatine nerve, the coronoid process of the mandible and the pterygoid muscles. Recommended treatment includes immediate surgical removal if possible or initial observation and secondary removal, as necessary, because of infection, limited mandibular movement, inability to extract the tooth, or the patient's psychological unease. Sometimes, the displaced tooth may spontaneously migrate inferiorly and becomes accessible intraorally. This report describes the location and secondary surgical removal of a left maxillary third molar displaced into the infratemporal fossa, two weeks after first attempt at extraction. PMID:20038889

  11. Synovial chondromatosis of the right side temporomandibular joint extending to the middle cranial fossa: A case report with 7-year postoperative follow up and expression of a biomarker of cell proliferative activity

    PubMed Central

    Yoshitake, Hiroyuki; Kayamori, Kou; Wake, So; Sato, Fumiaki; Kino, Koji; Harada, Kiyoshi

    2016-01-01

    Introduction Synovial chondromatosis of the temporomandibular joint (TMJ) with cranial extension is rare. Here, we report 7-year follow-up of a case with immunohistochemical examination of cell proliferative activity. Presentation of case The patient was a 72-year-old man. Severe bone resorption of the glenoid fossa was apparent on CT images. Pathological findings by biopsy led to diagnosis of synovial chondromatosis of the right side TMJ. Extirpation of the tumor was performed via temporopreauricular incision under general anesthesia. PCNA expression was examined by immunohistochemical analysis. The lesion had penetrated into the middle cranial fossa, but the cranial dura mater was intact. Expression of PCNA was confirmed. Discussion The PCNA expression suggested that growth activity caused expansion of the lesion to the skull base. Conclusion We were able to follow up this case for a long period without recurrence postoperatively. PMID:26855075

  12. Olfactory fossa of Tremacebus harringtoni (platyrrhini, early Miocene, Sacanana, Argentina): implications for activity pattern.

    PubMed

    Kay, Richard F; Campbell, Victoria M; Rossie, James B; Colbert, Matthew W; Rowe, Tim B

    2004-11-01

    CT imaging was undertaken on the skull of approximately 20-Myr-old Miocene Tremacebus harringtoni. Here we report our observations on the relative size of the olfactory fossa and its implications for the behavior of Tremacebus. The endocranial surface of Tremacebus is incomplete, making precise estimate of brain size and olfactory fossa size imprecise. However, olfactory fossa breadth and maximum endocranial breadth measured from CT images of one catarrhine species and eight platyrrhine species for which volumes of the olfactory bulb and brain are known show that the osteological proxies give a reasonably accurate indication of relative olfactory bulb size. Nocturnal Aotus has the largest relative olfactory fossa breadth and the largest olfactory bulb volume compared to brain volume among extant anthropoids. Tremacebus had a much smaller olfactory fossa breadth and, by inference, bulb volume--within the range of our sample of diurnal anthropoids. Variations in the relative size of the olfactory bulbs in platyrrhines appear to relate to the importance of olfaction in daily behaviors. Aotus has the largest olfactory bulbs among platyrrhines and relies more on olfactory cues when foraging than Cebus, Callicebus, or Saguinus. As in other examples of nocturnal versus diurnal primates, nocturnality may have been the environmental factor that selected for this difference in Aotus, although communication and other behaviors are also likely to select for olfactory variation in diurnal anthropoids. Considering the olfactory fossa size of Tremacebus, olfactory ability of this Miocene monkey was probably not as sensitive as in Aotus and counts against the hypothesis that Tremacebus was nocturnal. This finding accords well with previous observations that the orbits of Tremacebus are not as large as nocturnal Aotus. PMID:15481092

  13. Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

    PubMed Central

    Lee, Sang Hyun; Lee, Dae Sung; Lee, Soo Yong; Hwang, Jongmin; Chon, Min Ku; Hwang, Ki Won; Kim, Jeong Su; Park, Yong Huyn; Kim, June Hong

    2016-01-01

    Background and Objectives Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization. In the present study, we evaluated the feasibility of right cardiac catheterization via the antecubital fossa vein in Korean patients. Subjects and Methods The medical records of all patients who underwent right heart catheterization at our hospital between January 2003 and December 2014 were reviewed retrospectively. Right cardiac catheterizations via the antecubital fossa vein and the femoral vein were compared in terms of demographic data (age, sex, weight, height, and body mass index), indications for right cardiac catheterization, and procedural and outcome data (initial success rate, procedure time, compression to ambulation time, and complications). Results We reviewed 132 cases (antecubital fossa vein approach, n=37; femoral vein approach, n=95). The demographic data, initial success rate (100% vs. 100%) and procedure time (21.6±16.8 min vs. 25.6±12.6 min, p=0.14) were similar in both groups. The antecubital fossa vein group had a shorter mean compression to ambulation time than the femoral vein group (0.0 min vs. 201.2±48.1 min, p<0.01). No complications were observed in either group. Conclusion Our study indicated the ease of performance of right cardiac catheterization via the antecubital fossa vein. Thus, the antecubital fossa vein can be an alternative access site for right cardiac catheterization in Korean patients. PMID:27014351

  14. Gossypiboma mimicking posterior urethral stricture

    PubMed Central

    Kumar, Bindey; Kumar, Prem; Sinha, Sanjay Kumar; Sinha, Neelam; Hasan, Zaheer; Thakur, Vinit Kumar; Anand, Utpal; Priyadarshi, Rajiv Nayan; Mandal, Manish

    2013-01-01

    INTRODUCTION Foreign bodies in the urogenital tract are not uncommon. Hairpins, glass rods, umbilical tapes, ball point pen are described in lower urogenital tract. Retained gauze piece (gossypiboma) in posterior urethra may cause diagnostic dilemma. Symptoms and investigations may mimic stricture of posterior urethra. PRESENTATION OF CASE Two cases of retained gauze pieces in the urethra are described here. The micturating cystourethrogram was suggestive of posterior urethral stricture. DISCUSSION Two cases described here had retained gauze piece as a cause of filling defect and abnormal appearance in the micturating cystourethrogram. Gossypiboma may be a possibility where posterior urethral stricture are seen after previous surgery in paediatric age group. CONCLUSION In the setting of previous urogenital surgery gossypiboma should be kept in the differential diagnosis where posterior urethral stricture are seen in the paediatric age group. PMID:23500749

  15. [Posterior reversible encephalopathy syndrome].

    PubMed

    Fischer, M; Schmutzhard, E

    2016-06-01

    Posterior reversible encephalopathy syndrome refers to a neurological disorder characterized by headache, disorders of consciousness, visual disturbances, epileptic seizures, and subcortical vasogenic edema. About two thirds of patients develop neurological symptoms, which are associated with blood pressure fluctuations. One hypothesis is that hypertensive episodes cause autoregulatory failure, and values above the upper limit of cerebral autoregulation result in a breakthrough followed by hyperperfusion and blood-brain barrier dysfunction. In another hypothesis, endothelial dysfunction triggered by numerous factors including preeclampsia, immunosuppressive agents, chemotherapeutics, sepsis, or autoimmune disorders is thought to be the key pathomechanism. Endo- or exogenic toxic agents including pharmacological substances, cytokines, or bacterial toxins are supposed to trigger endothelial activation and dysfunction resulting in the release of vasoconstrictors, pro-inflammatory mediators, and vascular leakage. Diagnosis is usually based on clinical and neuroimaging findings that frequently show a bilateral, symmetric, and parietooccipital pattern. However, the diagnosis can often only be confirmed during the course of disease after excluding important differential diagnoses. Currently, there is no specific treatment available. Lowering of arterial blood pressure and eliminating the underlying cause usually leads to an improvement of clinical and neuroradiological findings. Admission to a critical care unit is required in about 40 % of patients due to complicating conditions including status epilepticus, cerebral vasoconstriction, ischemia, or intracerebral hemorrhage. Prognosis is favorable; in the majority of patients neurological deficits and imaging findings resolve completely. PMID:27272329

  16. Radiographic Response to Yttrium-90 Radioembolization in Anterior Versus Posterior Liver Segments

    SciTech Connect

    Ibrahim, Saad M.; Lewandowski, Robert J.; Ryu, Robert K.; Sato, Kent T.; Gates, Vanessa L.; Mulcahy, Mary F.; Kulik, Laura; Larson, Andrew C.; Omary, Reed A.; Salem, Riad

    2008-11-15

    The purpose of our study was to determine if preferential radiographic tumor response occurs in tumors located in posterior versus anterior liver segments following radioembolization with yttrium-90 glass microspheres. One hundred thirty-seven patients with chemorefractory liver metastases of various primaries were treated with yttrium-90 glass microspheres. Of these, a subset analysis was performed on 89 patients who underwent 101 whole-right-lobe infusions to liver segments V, VI, VII, and VIII. Pre- and posttreatment imaging included either triphasic contrast material-enhanced CT or gadolinium-enhanced MRI. Responses to treatment were compared in anterior versus posterior right lobe lesions using both RECIST and WHO criteria. Statistical comparative studies were conducted in 42 patients with both anterior and posterior segment lesions using the paired-sample t-test. Pearson correlation was used to determine the relationship between pretreatment tumor size and posttreatment tumor response. Median administered activity, delivered radiation dose, and treatment volume were 2.3 GBq, 118.2 Gy, and 1,072 cm{sup 3}, respectively. Differences between the pretreatment tumor size of anterior and posterior liver segments were not statistically significant (p = 0.7981). Differences in tumor response between anterior and posterior liver segments were not statistically significant using WHO criteria (p = 0.8557). A statistically significant correlation did not exist between pretreatment tumor size and posttreatment tumor response (r = 0.0554, p = 0.4434). On imaging follow-up using WHO criteria, for anterior and posterior regions of the liver, (1) response rates were 50% (PR = 50%) and 45% (CR = 9%, PR = 36%), and (2) mean changes in tumor size were -41% and -40%. In conclusion, this study did not find evidence of preferential radiographic tumor response in posterior versus anterior liver segments treated with yttrium-90 glass microspheres.

  17. The role of scintiangiography in suspected acute cholecystitis: The hyperemic gallbladder fossa

    SciTech Connect

    Colletti, P.; Ralls, P.W.; Siegel, M.E.; Halls, J.

    1984-01-01

    Gallbladder hyperemia in acute cholecystitis (AC) has been described pathologically and angiographically. The authors' purpose is to evaluate the use of scintiangiography for the detection of this hypernia as a supporting sign of AC. Ten mCi of Tc 99m disofenin were injected by bolus technique in 64 patients with suspected AC. Sequential 3 second images were obtained with a 500K blood pool image at one minute. Routine images to 60 minutes were performed followed by delayed views. The scintiangiogram was positive if there was focal increased activity in the gallbladder fossa greater than liver and separate from right kidney during the preportal arterial phase. The location of the gallbladder fossa was determined by superimposition with the early hepatocyte phase. AC was confirmed surgically and normals confirmed clinically. Increased flow to the gallbladder fossa was demonstrated in 23/32 cases of AC and in 2/33 normals (72% sensitivity, 94% specificity). Accuracy is 54/65 (83%). Positive predictive value is 23/25 (92%). All patients with both a positive scintiangiogram and cholescintigram had AC, while 3 with pericholecystic abscess and false negative cholescintigram had positive scintiangiograms. Increased perfusion to the gallbladder fossa during scintiangiography is a sign of AC. This along with gallbladder nonvisualization by cholescintigraphy was able to predict AC in 100% of cases where both findings occurred. Scintiangiography may help select our patients with a very high likelihood of AC and may potentially shorten chole-scintigraphy examinations.

  18. Using acetabular fossa as a guide for anticipated inclination of uncemented cup in total hip replacement

    PubMed Central

    Li, Junwei; Gao, Xu; Yang, Guanghui; Zhang, Yanru

    2015-01-01

    Positions of acetabular implant generally are considered to be major causative factors of dislocation. Accurate and consistent achievement of the preoperatively anticipated orientation of the acetabular cup is a great challenge in total hip replacement (THR). In the present study, we investigated the surgical application of acetabular fossa as a guide for anticipated inclination of uncemented cup, and evaluated its accuracy as an anatomic reference for achieving the preoperatively anticipated abduction of the acetabular cup in comparison with traditional device method on cadaveric specimens. Sixteen normal adult pelvic cadaveric specimens were collected. On each of the sixteen normal adult pelvic cadaveric specimens, acetabular fossa related anatomic sites were marked and studied on pelvic radiographs. Our results showed that there is close correlation between most medial aspect of acetabular sourcil and central axis of the acetabular cup at anticipated inclination of 40° ± 5°. And the fossa group can achieve the preoperatively anticipated cup abduction more accurately than the device group. The current results demonstrated that acetabular fossa can be a reasonable alternative, or as a complement to the currently used methods guiding total hip replacement. PMID:25784987

  19. Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma.

    PubMed

    Struewer, Johannes; Kiriazidis, Ilias; Figiel, Jens; Dukatz, Thomas; Frangen, Thomas; Ziring, Ewgeni

    2012-07-01

    Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma due to anatomical and biomechanical factors. Owing to the proximity of the temporal glenoid fossa to the middle meningeal artery, there is the risk of serious sequelae in case of trauma. The authors report the case of a 36-year-old male patient, who was beaten up in a family dispute and presented with complex mandibular and maxillofacial fractures, including mandibular condyle intrusion into the middle cranial fossa causing extensive meningeal bleeding. The patient underwent immediate surgery, with evacuation of the epidural haematoma via a temporal approach. In addition open reduction and reconstruction of the temporal glenoid fossa via anatomic reduction of the fragments was performed. A functional occlusion was re-established via miniplate reconstruction of the complex mandibular body and ramus fractures. Prompt diagnosis and a multidisciplinary approach are essential to minimize the complications. Advanced imaging modalities of computed tomography are indicated. Treatment options should be individualized in particular in case of suspected neurological injury. PMID:21862340

  20. Small-Scale Features of the Medusae Fossae Formation: Do They Support a Volcanic Origin?

    NASA Astrophysics Data System (ADS)

    Kerber, L.

    2013-12-01

    The Medusae Fossae Formation is a widespread and voluminous fine-grained deposit that lies just north of the Martian equator along the dichotomy boundary. It is thought to consist of pyroclastic deposits, either in the form of pyroclastic flows or ashfall, though numerous other possibilities have been suggested, including wind-blown loess and icy dust. For this work a survey was conducted of 427 High Resolution Imaging Science Experiment (HiRISE) images spread across the Medusae Fossae Formation. From these images maps were created of small-scale features which can aid in distinguishing between formation hypotheses for the deposit, including rootless cones, jointing, layering, and exposed dikes. Relationships between the Medusae Fossae Formation and adjacent lava plains and volcanoes were also carefully examined using HiRISE, Mars Reconnaissance Orbiter Context Imager (CTX), Mars Express High Resolution Stereo Camera (HRSC), and Mars Global Surveyor Mars Orbital Camera (MOC) images. The interactions between the Medusae Fossae Formation and nearby lava flows can inform us about the chronology of the deposit as well as how it has eroded over time. Certain diagnostic volcanic features were found, but mostly close to deposit boundaries where there are lava flows. The morphologies of the formation are compared with those of terrestrial pyroclastic deposits, terrestrial loess deposits, and other icy dust deposits on Mars. It is found that while the deposit is morphologically unlike icy layered deposits in most places, distinguishing between pyroclastic flow morphologies and reworked aeolian morphologies is more ambiguous.

  1. Geomorphic Mapping and Analysis of the Eastern Medusae Fossae Region of Mars

    NASA Technical Reports Server (NTRS)

    Takagi, M.; Zimbelman, J. R.

    2001-01-01

    A geomorphic map of the MC-8SE quadrangle on Mars is used to examine hypotheses of origin for the Medusae Fossae Formation, as well as to characterize the regional setting of these enigmatic materials. Additional information is contained in the original extended abstract.

  2. MOLA Topography of Small Volcanoes in Tempe Terra and Ceraunius Fossae, Mars: Implications for Eruptive Styles

    NASA Technical Reports Server (NTRS)

    Wong, M. P.; Sakimoto, S. E. H.; Garvin, J. B.

    2001-01-01

    We use Mars Orbiter Laser Altimeter (MOLA) data to measure small volcanoes in the Tempe Terra and Ceraunius Fossae regions of Mars. We find that previous geometry estimates based on imagery alone are inaccurate, but MOLA data support image-based interpretations of eruptive style. Additional information is contained in the original extended abstract.

  3. Structural characterization of the cerberus fossae and implications for paleodischarge of Athabasca Valles, Mars

    NASA Astrophysics Data System (ADS)

    Runyon, Kirby D.

    Mechanically interacting fault systems on Earth are often associated with groundwater flow (e.g. Curewitz and Karson, 1997) by facilitating water storage and flow through fracture conduits before, during, and after seismic events (e.g. Sibson, 1975). Similar associations between interacting fault segments and fluid flow are present on Mars (Davatzes and Gulick, 2007a). The Cerberus Fossae compose a system of elongate topographic lows, a portion of which coincides with the source region of the outflow channel Athabasca Valles. The Cerberus Fossae and source area were mapped using Thermal Emission Imaging System (THEMIS) daytime IR mosaics and Context camera (CTX) images to establish spatial relations of structural features. Mars Orbiter Laser Altimeter (MOLA) elevation data were plotted to construct the depth profiles of the fossae to test the hypothesis that the Cerberus Fossae are normal fault-bounded graben. High Resolution Imaging Science Experiment (HiRISE) images were mapped for fractures within the fault damage zones with the degree of fracture plotted as a function of distance along strike. This plot established the spatial relations between fractures, mechanically interacting fossae segments, and Athabasca Valles. The depth profiles of the Cerberus Fossae are consistent with the displacement distribution of terrestrial normal faults with a surface expression consistent with fault propagation from depth and mechanical interaction among segments. Similarly, regions of interpreted mechanical interaction indicated by slip distribution and segment overlap correspond to increased fracture intensity and density. On Earth, such regions of mechanical interaction tend to have high fracture intensity (e.g. Davatzes et al., 2005), are associated with hydrothermal fluid flow (Curewitz and Karson, 1997), and have evidence of extensive long-term fluid flow as evidenced by diagenetic alterations (Eichhubl et al., 2004). Higher fracture intensities and densities near the

  4. TMJ in facial class III deformity. Condyle/fossa relations

    PubMed Central

    Muñoz, Gonzalo; Olate, Sergio; Cantín, Mario; Vásquez, Bélgica; del Sol, Mariano; Fariña, Rodrigo

    2014-01-01

    The aim of this study was to ascertain the joint space present in the TMJ of subjects diagnosed with Class III dentofacial deformity with an indication for orthognathic surgery. Fourteen subjects were recruited from the Division of Oral and Maxillofacial Surgery at the Universidad de La Frontera, Chile. All subjects were admitted to the study after signing an informed consent and undergoing cephalometric analyses to define the severity of the deformity. Then, the joint space was analyzed, studying a cone beam CT image of the TMJ, which was evaluated in the coronal and sagittal views, defining the most anterior, median and posterior joint space (sagittal view), as well as the lateral, median and medial joint space (coronal view). The data were recorded in millimeters by an observer and data were analyzed after measuring the same parameter at three different times. A student’s t-test was used for the analyses. Differences observed in both joints were not greater than 0.2 mm with spaces between 2 mm and 1.5 mm, thereby establishing the homogeneity of the sample, which presented no significant differences between the two joint spaces (right and left). It can be concluded that the joint space is symmetrical in both condyles and that no important changes are present compared to the results indicated in the international literature. PMID:25356133

  5. TMJ in facial class III deformity. Condyle/fossa relations.

    PubMed

    Muñoz, Gonzalo; Olate, Sergio; Cantín, Mario; Vásquez, Bélgica; Del Sol, Mariano; Fariña, Rodrigo

    2014-01-01

    The aim of this study was to ascertain the joint space present in the TMJ of subjects diagnosed with Class III dentofacial deformity with an indication for orthognathic surgery. Fourteen subjects were recruited from the Division of Oral and Maxillofacial Surgery at the Universidad de La Frontera, Chile. All subjects were admitted to the study after signing an informed consent and undergoing cephalometric analyses to define the severity of the deformity. Then, the joint space was analyzed, studying a cone beam CT image of the TMJ, which was evaluated in the coronal and sagittal views, defining the most anterior, median and posterior joint space (sagittal view), as well as the lateral, median and medial joint space (coronal view). The data were recorded in millimeters by an observer and data were analyzed after measuring the same parameter at three different times. A student's t-test was used for the analyses. Differences observed in both joints were not greater than 0.2 mm with spaces between 2 mm and 1.5 mm, thereby establishing the homogeneity of the sample, which presented no significant differences between the two joint spaces (right and left). It can be concluded that the joint space is symmetrical in both condyles and that no important changes are present compared to the results indicated in the international literature. PMID:25356133

  6. Disease Control and Ototoxicity Using Intensity-Modulated Radiation Therapy Tumor-Bed Boost for Medulloblastoma

    SciTech Connect

    Polkinghorn, William R.; Dunkel, Ira J.; Souweidane, Mark M.; Khakoo, Yasmin; Lyden, David C.; Gilheeney, Stephen W.; Becher, Oren J.; Budnick, Amy S.; Wolden, Suzanne L.

    2011-11-01

    Purpose: We previously reported excellent local control for treating medulloblastoma with a limited boost to the tumor bed. In order to decrease ototoxicity, we subsequently implemented a tumor-bed boost using intensity-modulated radiation therapy (IMRT), the clinical results of which we report here. Patients and Methods: A total of 33 patients with newly diagnosed medulloblastoma, 25 with standard risk, and 8 with high risk, were treated on an IMRT tumor-bed boost following craniospinal irradiation (CSI). Six standard-risk patients were treated with an institutional protocol with 18 Gy CSI in conjunction with intrathecal iodine-131-labeled monoclonal antibody. The majority of patients received concurrent vincristine and standard adjuvant chemotherapy. Pure-tone audiograms were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: Median age was 9 years old (range, 4-46 years old). Median follow-up was 63 months. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) rates for standard-risk patients who received 23.4 or 36 Gy CSI (not including those who received 18 Gy CSI with radioimmunotherapy) were 81.4% and 88.4%, respectively, at 5 years; 5-year PFS and OS rates for high-risk patients were both 87.5%. There were no isolated posterior fossa failures outside of the boost volume. Posttreatment audiograms were available for 31 patients, of whom 6%, at a median follow-up of 19 months, had developed Grade 3 hearing loss. Conclusion: An IMRT tumor-bed boost results in excellent local control while delivering a low mean dose to the cochlea, resulting in a low rate of ototoxicity.

  7. Atypical teratoid/rhabdoid tumor in sellar turcica in an adult: A case report and review of the literature

    PubMed Central

    Shitara, Satoshi; Akiyama, Yoshinori

    2014-01-01

    Background: Atypical teratoid/rhabdoid tumor (AT/RT) is a rare central nervous system tumor composed of primitive rhabdoid cells that may differentiate along neuroectodermal, mesenchymal and epithelial lineages. AT/RT in adults is rare but not completely exceptional. It generally arises from the posterior fossa of infants, but the broad majority of the reported AT/RT in adults manifested supratentorially with the exception of four cases that arose in the cerebellum and two that arose in the spinal cord. Case Description: A 44-year-old female complained of visual disturbance. We performed craniotomies twice and removed partially for each time, but any malignant cells were not found in the specimens. Finally, we determined histological diagnosis from the extended lesion. She died of respiratory failure 17 months after the initial treatment. Conclusion: AT/RT should be considered in the differential diagnosis of a sellar lesion in adult patients. However AT/RT is rare in adults, the appropriate immunohistochemical evaluation should be performed to diagnose this rare entity. PMID:24949218

  8. Decrypting the Formation Conditions of the Basement Carbonate-Bearing Rocks at Nili Fossae

    NASA Astrophysics Data System (ADS)

    Brown, A. J.

    2015-12-01

    The Nili Fossae region is the site of a number of proposed Landing Sites for the Mars 2020 Rover. A distinguishing feature of many of these sites is the access to large exposures of carbonate (Ehlmann et al. 2008). Serpentinization has been proposed as a formation mechanism of these carbonates, including carbonated (Brown et al. 2010, Viviano, et al. 2013) and low temperature, near surface serpentinization. The potential for carbonated serpentization at Nili Fossae links the region to Earth analogs in terrestrial greenstone belts such as the Pilbara in Western Australia, where talc-carbonate bearing komatiite cumulate units of the Dresser Formation overlie the siliceous, stromatolite-bearing Strelley Pool Chert unit (Van Kranendonk and Pirajno, 2004). If a similar relationship exists on Mars, investigations of rocks stratigraphically beneath the carbonate-bearing units at Nili Fossae ("the basement rocks") may provide the best chance to examine well preserved organic material from the Noachian. This hypothesis is testable by Mars 2020. In preparation for the the Mars 2020 landing site, we are examining the thermodynamic relationships that favor formation of serpentine and talc-carbonate and different pressures and temperatures in the crust (Barnes 2007). This will allow us to constrain the low grade metamorphism required to replicate the proposed models of serpentinisation and help us understand the regional metamophic gradient that is critical to furthering our knowledge of the ancient rocks of Nili Fossae. Refs:Barnes, S. J. "Komatiites: Petrology, Volcanology, Metamorphism, and Geochemistry." S.E.G. 13 (2007): 13. Brown, A. J., et al.. "Hydrothermal Formation of Clay-Carbonate Alteration Assemblages in the Nili Fossae Region of Mars." EPSL 297 (2010): 174-82. Ehlmann, B. L. et al. "Orbital Identification of Carbonate-Bearing Rocks on Mars." Science 322, no. 5909 1828-32. Van Kranendonk, M.J., and F. Pirajno. "Geochemistry of Metabasalts and Hydrothermal

  9. Long-term effects of treatment on endocrine function in children with brain tumors

    SciTech Connect

    Duffner, P.K.; Cohen, M.E.; Anderson, S.W.; Voorhess, M.L.; MacGillivray, M.H.; Panahon, A.; Brecher, M.L.

    1983-11-01

    Fourteen children with brain tumors received endocrine evaluations at least one year following completion of cranial irradiation. Treatment consisted of operation (13 patients), craniospinal irradiation (6), whole brain irradiation (5), posterior fossa irradiation (3), and chemotherapy (10). Endocrine evaluation included bone age roentgenography and measurement of growth hormone (using sequential arginine and insulin stimulation), thyroxine, thyroid-stimulating hormone, plasma cortisol, testosterone, prolactin, and urinary follicle-stimulating hormone and luteinizing hormone. Ten of 12 children (83%) had abnormal responses to both tests of growth hormone stimulation. All growth hormone-deficient patients treated prior to puberty and tested at least 2 years following completion of cranial irradiation had decelerated linear growth. Results of thyroid function tests were abnormal in 4 patients: 2 patients had evidence of primary hypothyroidism, and 2 showed secondary or tertiary hypothyroidism. Two patients had inadequate cortisol responses to insulin hypoglycemia. Urinary follicle-stimulating hormone and luteinizing hormone, serum prolactin, and serum testosterone levels were appropriate for age in all patients.

  10. Ectomesenchymal chondromyxoid tumour of the posterior tongue.

    PubMed

    Cardin, Marie-Josée; Fiset, Pierre Olivier; Zeitouni, Anthony G; Caglar, Derin

    2014-01-01

    Ectomesenchymal chondromyxoid tumor (ECMT) is a rare benign neoplasm arising in the tongue. With only 45 cases reported in the literature, there are several unique features defining this lesion. Firstly, almost all patients present with an asymptomatic slow growing mass on the anterior dorsum of the tongue. At the microscopic level, it is recognizable as a well-circumscribed unencapsulated proliferation of uniform round to fusiform cells embedded in a chondromyxoid matrix. Lastly, the immunohistochemistry profile is characterised by positivity for glial fibrillary acidic protein and frequent positivity for S-100 and cytokeratins. We report a case of a mass located on the posterior dorsum of the tongue and meeting the aforementioned morphological and immunohistochemical criteria of ECMT. PMID:24288100

  11. Iodine-125 radiation of posterior uveal melanoma

    SciTech Connect

    Packer, S.

    1987-12-01

    Twenty-eight cases of posterior choroidal melanoma were treated with iodine-125 in gold eye plaques. Eleven cases were located within 3.0 mm of the optic nerve (group A), nine were within 3.0 mm of the fovea (group B), and eight were within 3.0 mm of the optic nerve and fovea (group C). The mean follow-up of group A was 46.3 months; group B, 25.5 months; and group C, 42.7 months. Complications included macular edema, cataract and tumor growth. Visual acuity remained within two lines of that tested preoperatively for 4 of 11 patients in group A, 4 of 9 in group B, and 5 of 8 in group C. These results with iodine-125 suggest it as an appropriate treatment for patients with choroidal melanoma located near optic nerve and/or macula.

  12. Seeing past the appendix: the role of ultrasound in right iliac fossa pain

    PubMed Central

    MacDonald, L; Johnson, G; Rudralingham, V

    2013-01-01

    Acute right iliac fossa pain is a common surgical presentation. The presentation is often non-specific and encompasses a wide differential, which creates a diagnostic challenge. Ultrasound is commonly the initial cross-sectional imaging modality and can be used as a tool to triage patients appropriately; assessing for appendicitis and other salient findings, which may indicate an alternative condition. Additionally, the dynamic nature of this imaging modality enables patient interaction. Following a systematic assessment of the abdomen and pelvis, a more focused interrogation of the right iliac fossa is performed. In this pictorial review, we illustrate the sonographic features of appendicitis and other conditions that can mimic appendicitis in its presentation. This highlights that through a systematic approach, it is possible to distinguish between these different pathologies, enabling clinicians to optimally manage the patient.

  13. An Inflammatory Pseudotumor Arising from Pterygopalatine Fossa with Invasion to the Maxillary Sinus and Orbital Cavity.

    PubMed

    Yokoi, Hidenori; Yazawa, Takuya; Matsumoto, Yuma; Ikeda, Tetsuya; Fujiwara, Masachika; Ohkura, Yasuo; Kohno, Naoyuki

    2015-01-01

    We report a patient who had an inflammatory pseudotumor (IPT) that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site; this is a very rare case. The patient was an 83-year-old woman who suddenly became aware of impairment in the eyesight and visual field of the left eye. CT images showed a neoplastic lesion that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site, and also showed contrast effects. To obtain a definitive diagnosis from histopathological analysis, the lesion was biopsied, and she was diagnosed as the inflammatory pseudotumor with the immunohistochemical study and multiplex polymerase chain reaction-based clonality assays. The patient had a lymphoid-predominant lesion that responded to radiotherapy but corticosteroids were not effective. It is important to scrutinize the pathology to avoid unnecessary and mutilating surgery. PMID:26167321

  14. Unilateral renal agenesis and other causes of the solitary photopenic renal fossa

    SciTech Connect

    Howard, W.H.; Bunker, S.R.; Karl, R.D. Jr.; Ralston, T.; Hartshorne, M.F.; Cawthon, M.A.; Bauman, J.M.

    1985-04-01

    The differential diagnosis of a solitary photopenic defect in the renal fossa observed at renal scintigraphy is extensive. A case of one of the most unusual causes for this finding, renal agenesis, is presented. Additional cases that illustrate the similarity in the radionuclide appearance of other pathologic entities are also presented. Correlation with clinical findings and other imaging modalities is required to accurately distinguish these conditions.

  15. Geologic Mapping of the Medusae Fossae Formation on Mars and the Northern Lowland Plains of Venus

    NASA Technical Reports Server (NTRS)

    Zimbelman, J. R.

    2009-01-01

    This report summarizes the status of mapping projects supported by NASA grant NNX07AP42G, through the Planetary Geology and Geophysics (PGG) program. The PGG grant is focused on 1:2M-scale mapping of portions of the Medusae Fossae Formation (MFF) on Mars. Also described below is the current status of two Venus geo-logic maps, generated under an earlier PGG mapping grant.

  16. Geologic Mapping of the Medusae Fossae Formation, Mars, and the Northern Lowland Plains, Venus

    NASA Technical Reports Server (NTRS)

    Zimbelman, J. R.

    2010-01-01

    This report summarizes the status of mapping projects supported by NASA grant NNX07AP42G, through the Planetary Geology and Geophysics (PGG) program. The PGG grant is focused on 1:2M-scale mapping of portions of the Medusae Fossae Formation (MFF) on Mars. Also described below is the current status of two Venus geologic maps, generated under an earlier PGG mapping grant.

  17. Rethinking "posterior" tongue-tie.

    PubMed

    Douglas, Pamela Sylvia

    2013-12-01

    Currently, many clinicians who help with breastfeeding problems are diagnosing "posterior" tongue-tie in infants and performing or referring for frenotomy. In this "Speaking Out" article, I argue that the diagnosis of "posterior" tongue-tie has successfully raised awareness of the importance of impaired tongue function in breastfeeding difficulty. However, the diagnosis of "posterior" tongue-tie also applies a reductionist, medicalized theoretical frame to the complex problem of impaired tongue function, risking unintended outcomes. Impaired tongue function arises out of multiple interacting and co-evolving factors, including the interplay between social behaviors concerning breastfeeding and mother-infant biology. Consideration of theoretical frames is vital if we are to build an evidence base through efficient use of the scarce resources available for clinical breastfeeding research and minimize unintended outcomes. PMID:24143939

  18. Posterior polar cataract: A review

    PubMed Central

    Kalantan, Hatem

    2011-01-01

    Posterior polar cataract is a rare form of congenital cataract. It is usually inherited as an autosomal dominant disease, yet it can be sporadic. Five genes have been attributed to the formation of this disease. It is highly associated with complications during surgery, such as posterior capsule rupture and nucleus drop. The reason for this high complication rate is the strong adherence of the opacity to the weak posterior capsule. Different surgical strategies were described for the handling of this challenging entity, most of which emphasized the need for gentle maneuvering in dealing with these cases. It has a unique clinical appearance that should not be missed in order to anticipate, avoid, and minimize the impact of the complications associated with it. PMID:23960967

  19. Temporal fossa defects: techniques for injecting hyaluronic acid filler and complications after hyaluronic acid filler injection.

    PubMed

    Juhász, Margit Lai Wun; Marmur, Ellen S

    2015-09-01

    Facial changes with aging include thinning of the epidermis, loss of skin elasticity, atrophy of muscle, and subcutaneous fat and bony changes, all which result in a loss of volume. As temporal bones become more concave, and the temporalis atrophies and the temporal fat pad decreases, volume loss leads to an undesirable, gaunt appearance. By altering the temporal fossa and upper face with hyaluronic acid filler, those whose specialty is injecting filler can achieve a balanced and more youthful facial structure. Many techniques have been described to inject filler into the fossa including a "fanned" pattern of injections, highly diluted filler injection, and the method we describe using a three-injection approach. Complications of filler in the temporal fossa include bruising, tenderness, swelling, Tyndall effect, overcorrection, and chewing discomfort. Although rare, more serious complications include infection, foreign body granuloma, intravascular necrosis, and blindness due to embolization into the ophthalmic artery. Using reversible hyaluronic acid fillers, hyaluronidase can be used to relieve any discomfort felt by the patient. Injectors must be aware of the complications that may occur and provide treatment readily to avoid morbidities associated with filler injection into this sensitive area. PMID:26311237

  20. Management of the stricture of fossa navicularis and pendulous urethral strictures

    PubMed Central

    Singh, Shrawan K.; Agrawal, Santosh K.; Mavuduru, Ravimohan S.

    2011-01-01

    Objective: Management of distal anterior urethral stricture is a common problem faced by practicing urologists. Literature on urethral stricture mainly pertains to bulbar urethral stricture and pelvic fracture urethral distraction defect. The present article aims to review the management of the strictures of fossa navicularis and pendulous urethra. Materials and Methods: The literature in English language was searched from the National Library of Medicine database, using the appropriate key words for the period 1985-2010. Out of 475 articles, 115 were selected for the review based on their relevance to the topic. Results: Etiology of stricture is shifting from infective to inflammatory and iatrogenic causes. Stricture of fossa navicularis is most often caused by lichen sclerosus et atrophicus and instrumentation. Direct visual internal urethrotomy is limited to selected cases in the management of pendulous urethral stricture. With experience and identification of various prognostic factors, conservative management by dilatation and internal urethrotomy is being replaced by various reconstructive procedures, using skin flaps and grafts with high success rates. Single-stage urethroplasty is preferred over the 2-stage procedure as the latter disfigures the penis and poses sexual problems temporarily. Conclusions: Flaps or grafts are useful for single-stage reconstruction of fossa navicularis and pendulous urethral strictures. The buccal and lingual mucosa serves as a preferred resource material for providing the inner lining of the urethra. Off-the-shelf materials, such as acellular collagen matrix, are promising. PMID:22022062

  1. Middle fossa arachnoid cysts and inner ear symptoms: Are they related?

    PubMed Central

    Proimos, E; Chimona, TS; Memtsas, Z; Papadakis, CE

    2014-01-01

    Background: Arachnoid cysts most frequently occur in the middle cranial fossa and when they are symptomatic, patients present with central nervous symptoms. Nevertheless, a large proportion of arachnoid cysts are incidentally diagnosed during neuroimaging in cases with nonspecific symptoms. Report of cases: The cases of two males with middle cranial fossa arachnoid cysts with nonspecific inner ear symptoms were retrospectively reviewed. The first patient presented with mild headache, nausea, vertigo, unsteadiness, and tinnitus on the left ear while the second patient’s main complaint was left sided tinnitus. Both patients (initially managed for peripheral disorders) underwent a thorough clinical and electrophysiological evaluation. Because of the patients’ persistent clinical symptoms, and indications of CNS disorder in the first case, neuroimaging by brain MRI was performed revealing a middle cranial fossa arachnoid cyst in both patients. Conclusion: Occasionally, patients with arachnoid cysts may present with mild, atypical or intermittent and irrelevant symptoms which can mislead diagnosis. Otorhinolaryngologists should be aware of the fact that atypical, recurrent or intermittent symptoms may masquerade a CNS disorder. Hippokratia 2014; 18 (2):168-171. PMID:25336883

  2. Miocene-Pliocene mantle depletion event in the northern Fossa Magna, western NE Japan

    NASA Astrophysics Data System (ADS)

    Okamura, Satoshi; Inaba, Mitsuru; Adachi, Yoshiko; Shinjo, Ryuichi

    2016-07-01

    New isotopic and trace element data presented here imply a temporal change in magma sources and thermal conditions beneath the northern Fossa Magna of NE Japan from the Miocene to the Pliocene. Less radiogenic 176Hf/177Hf and 143Nd/144Nd, high Zr/Hf, and little or no Hf anomaly characterize the Early Miocene volcanism in the northern Fossa Magna region. The mantle wedge consisted of chemically heterogeneous mantle source. Based on out isotope proxies, we propose that during the onset of subduction, influx of hot asthenospheric mantle provided sufficient heat to partially melt newly subducting sediment. Geochemical modeling demonstrates that slab-derived melt mixed with mantle wedge produces the observed isotopic and trace elemental characteristics. In the Middle Miocene, the injection of hot and depleted asthenospheric material replaced the mantle beneath the northern Fossa Magna region of NE Japan. This caused the isotopic signature of the rocks to change from enriched to depleted. Then, the mantle wedge was gradually cooled during the Middle Miocene to the Pliocene with back-arc opening ending in the Late Miocene. Slab surface temperatures were still high enough for sediments to melt but not too high (<∼780 °C) to lose zircon as a residual phase. The Late Miocene and Pliocene volcanism at the post stage of the back-arc opening is best explained by a partial melting of subducted metasediment saturated with trace quantities of zircon and rutile.

  3. Elevated bulk-silica exposures and evidence for multiple aqueous alteration episodes in Nili Fossae, Mars

    NASA Astrophysics Data System (ADS)

    Amador, Elena S.; Bandfield, Joshua L.

    2016-09-01

    The Nili Fossae region of Mars contains some of the most mineralogically diverse bedrock on the planet. Previous studies have established three main stratigraphic units in the region: a phyllosilicate-bearing basement rock, a variably altered olivine-rich basalt, and a capping rock. Here, we present evidence for the localized alteration of the northeast Nili Fossae capping unit, previously considered to be unaltered. Both near-infrared and thermal-infrared spectral datasets were analyzed, including the application of a method for determining the relative abundance of bulk-silica (SiO2) over surfaces using thermal emission imaging system (THEMIS) images. Elevated bulk-silica exposures are present on surfaces previously defined as unaltered capping rock. Given the lack of spectral evidence for phyllosilicate, hydrated silica, or quartz phases coincident with the newly detected exposures-the elevated bulk-silica may have formed under a number of aqueous scenarios, including as a product of the carbonation of the underlying olivine-rich basalt under moderate water: rock scenarios and temperatures. Regardless of formation mechanism, the detection of elevated bulk-silica exposures in the Nili Fossae capping unit extends the history of aqueous activity in the region to include all three of the main stratigraphic units.

  4. Infratemporal fossa cellulitis caused by a remnant iatrogenic foreign body after a bimaxillary operation.

    PubMed

    Park, Do Yang; Choo, Oak-Sung; Hong, Sang Young; Kim, Hyun Jun

    2015-05-01

    Infratemporal fossa cellulitis is rare and mostly occurs because of sinusitis and dental procedures. Furthermore, cellulitis caused by iatrogenic foreign bodies is very rare. A 28-year-old woman who had previously undergone cosmetic bimaxillary operation visited our hospital complaining of left facial swelling, oppressive pain, and nasal obstruction since 2 years. She had been attending another clinic, but despite having additional procedures and taking medications, her symptoms persisted. A subsequent operation was performed, during which we found a remnant surgical gauze from the previous operation, which was decomposed and trapped around the necrotic soft tissue and had eroded the bony structure around the pterygoid fossa. The material was successfully removed by endoscopic surgery, and the necrotic tissue was debrided. After the operation, all symptoms disappeared, and the patient was discharged without sequelae. During any procedure, surgeons must meticulously check for remnant material. Additionally, physicians must carefully note patient history and perform a physical examination, even in patients without serious symptoms. We report a case of advanced infratemporal fossa cellulitis due to remnant gauze material during a previous operation that was undetected. PMID:25950522

  5. Interactive web-based programs to teach functional anatomy: the pterygopalatine fossa.

    PubMed

    Sinav, Ahmet; Ambron, Richard

    2004-07-01

    Certain areas of the body contain structures that are difficult to envision in their proper spatial orientations and whose functions are complex and difficult to grasp. This is especially true in the head, where many structures are relatively small and inaccessible. To address this problem, we are designing Web-based programs that consist of high-resolution interactive bitmap illustrations, prepared using Adobe Photoshop, and vector-based animations, prepared via Macromedia Flash. Flash action script language is used for the animations. We have used this approach to prepare a program on the pterygopalatine fossa, an important neurovascular junction in the deep face that is especially difficult to approach by dissection and to depict in static images in an atlas. The program can be viewed online at http://cds.osr.columbia.edu/anatomy/ppfossa/. A table of contents simplifies navigation through the program and a menu enables the user to identify each of the vascular and neuronal components and either to insert or to remove each from its position in the fossa. The functional anatomy of the nerves in the fossa is animated. For example, users can activate and subsequently follow action potentials as they course along axons to their targets. This high degree of interactivity helps promote learning. PMID:15278936

  6. Outcome on hearing and facial nerve function in microsurgical treatment of small vestibular schwannoma via the middle cranial fossa approach.

    PubMed

    Ginzkey, Christian; Scheich, Matthias; Harnisch, Wilma; Bonn, Verena; Ehrmann-Müller, Desiree; Shehata-Dieler, Wafaa; Mlynski, Robert; Hagen, Rudolf

    2013-03-01

    Encouraging results regarding hearing preservation and facial nerve function as well as increasing understanding of the natural behaviour of vestibular schwannomas have led to the recommendation of an early treatment in small VS. The aim of the present study was to evaluate current data on functional outcome of patients with small VS treated by middle cranial fossa (MCF) approach. A retrospective chart study of all cases treated by MCF approach between October 2007 and September 2011 was performed. Records were analyzed regarding demographical data, tumor size, hearing status, vestibular function and facial nerve function. Facial nerve function was classified according to the House-Brackmann scale (HB). Hearing status was classified according to the American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) and a modified classification of Gardner and Robertson (GR). Eighty-nine patients were included in the study; 41 % of VS was classified as intracanalicular (stage 1) and 59 % as stage 2. From 65 patients with a preoperative hearing status according to AAO-HNS A or B, 74 % still presented with A or B after surgery. Using a modified GR classification, from 70 patients categorized as class I or II prior to surgery, 70 % were still class I or II. Looking to the facial nerve function 1 week after surgery, 82 % of patients presented with HB 1 or 2. Three to twelve months later, 96 % demonstrated HB 1 or 2. A persisting facial palsy was recorded in four patients. Preoperative hearing status was evaluated as a prognostic factor for postoperative hearing, whereas no influence was detected in ABR, vestibular function and tumor length. Early diagnosis of small VS due to high-sensitive MRI requires the management of this tumor entity. Natural behaviour of VS in many cases demonstrates an increase of tumor size over time with deterioration of hearing status. The presented data underline the recommendation of an early surgical treatment in small VS as a valuable

  7. Inflammatory myofibroblastic tumor of the central nervous system and its relationship to inflammatory pseudotumor.

    PubMed

    Swain, Rebecca S; Tihan, Tarik; Horvai, Andrew E; Di Vizio, Dolores; Loda, Massimo; Burger, Peter C; Scheithauer, Bernd W; Kim, Grace E

    2008-03-01

    Inflammatory myofibroblastic tumor (IMT) is a distinctive spindle cell lesion and occurs primarily in soft tissue. Recent evidence suggests a neoplastic nature, although historically, both neoplastic and nonneoplastic processes were combined in this category. Originally described as a nonneoplastic process, the term inflammatory pseudotumor (IP) has been used synonymously with IMT. IMTs have been linked to ALK gene (2p23) rearrangements, and some have suggested an association with the human herpesvirus 8 (HHV-8). IMT in the central nervous system (CNS) is rare, its characteristics are poorly defined, and its relation to similar tumors at other sites is unclear. To better characterize IMT within the CNS, we studied clinicopathologic features of 6 IMTs and compared them with 18 nonneoplastic lesions originally classified as IP. The IMT group consisted of 2 male and 4 female patients with a median age of 29 years. Of the six IMTs, 5 occurred within the cerebral hemispheres, and one was in the posterior fossa. All tumors were composed of neoplastic spindle cells and a variable amount of inflammatory infiltrate. Eighteen IPs included in this study consisted of predominantly inflammatory masses occasionally seen in the setting of systemic diseases. Only 1 IMT and none of the IPs recurred during the follow-up period. Four IMTs had either ALK protein overexpression or 2p23 rearrangement, and 1 case demonstrated both. None of the IPs were positive for ALK. Neither IMT nor IP cases demonstrated HHV-8 expression. We suggest that IMT in the CNS is distinct from the nonneoplastic IP, and distinguishing IMT from nonneoplastic lesions should enable better decisions for patient management. PMID:18261625

  8. Neurotrophin and neurotrophin receptor proteins in medulloblastomas and other primitive neuroectodermal tumors of the pediatric central nervous system.

    PubMed Central

    Washiyama, K.; Muragaki, Y.; Rorke, L. B.; Lee, V. M.; Feinstein, S. C.; Radeke, M. J.; Blumberg, D.; Kaplan, D. R.; Trojanowski, J. Q.

    1996-01-01

    Primitive neuroectodermal tumors (PNETs) of the central nervous system (CNS) are poorly understood childhood neoplasms, and medulloblastomas are the most common pediatric PNETs. Neoplastic cells in medulloblastomas and other PNETs resemble progenitor cells of the developing central nervous system, but they also may exhibit the molecular phenotype of immature neurons or glia. As neurotrophins play a role in regulating differentiation, proliferation, and cell death in the normal developing central nervous system, and recent evidence suggests that neurotrophins may influence the behavior of medulloblastomas, we studied 29 PNET biopsy samples (27 of which were posterior fossa medulloblastomas) by immunobistochemistry using antibodies specific for each of the major high affinity neurotrophin receptor proteins, ie, TrkA, TrkB, and TrkC. A subset of these tumors also was examined by Western blot. Immunoreactive TrkA, TrkB, and TrkC were observed in neoplastic cells in 8 (27%), 18 (62%), and 14 (48%) of these PNETs, respectively. Additional immunohistochemical studies of a subset of these PNETs using antibodies to neurotrophins that primarily activate TrkB and TrkC, ie, brain-derived neurotrophic factor, neurotrophin-3, and neurotrophin-4/5, showed that immunoreactive brain-derived neurotrophic factor, neurotrophin-3, and neurotrophin-4/5 were detected in 22, 9, and 19% of these PNET biopsies, respectively. Finally, 19 pediatric brain tumors other than these PNETs also were studied here, and they expressed these neurotrophins and their receptors to a variable extent. The demonstration here that neurotrophins and their cognate receptor proteins are expressed in PNETs as well as in other pediatric brain tumors may imply that signal transduction pathways mediated by neurotrophins and/or their receptors influence the induction or progression of these common childhood neoplasms. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:8774147

  9. Case report of a posterior disc displacement without and with reduction.

    PubMed

    Huddleston Slater, James J R; Lobbezoo, Frank; Hofman, Nico; Naeije, Machiel

    2005-01-01

    This article presents the case of a patient with an acute posterior disc displacement without reduction (PDDWR), whose temporomandibular joint (TMJ) showed, after physiotherapeutic manipulation, the characteristics of a posterior disc displacement with reduction (PDDR). Opto-electronic condylar movement recordings in both the PDDR state and the PDDWR state, and magnetic resonance imaging (MRI) scans of the TMJ in the PDDR state were carried out to document the case. The first 2 physiotherapeutic manipulations were initially successful in reducing the disc, but a few days later the joint showed a relapse to the PDDWR state. From the third manipulation on, now 12 months ago, the patient has been free of symptoms of the PDDWR state. Condylar movement traces of the joint in the PDDWR state indicated that the condyle was prevented from entering the fossa completely. The downward condylar movement deflections during the early phase of closing, recorded after the second manipulation, showed the reduction of the posteriorly displaced disc during closing. The movement recordings also showed that the PDDR could be eliminated by submaximal opening and closing movements. The MRI scans, taken after the third, successful manipulation, showed the disc to be in a normal position with respect to the condyle when the mouth was closed, and to be posteriorly displaced when the mouth was maximally opened. The case shows that manipulation techniques may successfully reverse an acute PDDWR into a PDDR. The technique of MRIs and condylar movement recordings show promise in further unraveling the morphological and clinical features of posterior disc displacements. PMID:16279486

  10. Posterior Tibial Tendon Dysfunction (PTTD)

    MedlinePlus

    ... ACFAS | Información en Español Advanced Search Home » Foot & Ankle Conditions » Posterior Tibial Tendon Dysfunction (PTTD) Text Size ... the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. ...