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Sample records for cavernous sinus

  1. Cavernous sinus thrombosis during pregnancy.

    PubMed

    López, Fernando; Santamarta, Elena; Martínez, Patricia; Sáiz-Ayala, Antonio; Llorente, José L

    2017-04-01

    Cavernous sinus thrombosis (CST) represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. Rapid diagnosis and aggressive medical and surgical management are imperative for patients with CST. We present the case of a 24-year-old pregnant woman with intraorbital abscess and CST secondary to Streptococcus milleri. Surgical intervention included orbital abscess drainage and dental extraction, medical therapy included intravenous antibiotic, heparin, and methylprednisolone and an elective cesarean section was performed. The latter was the key point to resolution the disease.

  2. [A case of cavernous sinus aspergillosis].

    PubMed

    Hase, Tomomi; Kurita, Hideharu; Matsumoto, Eiji; Kuroda, Hajime; Hashimoto, Masaaki; Shinoda, Souji

    2013-10-01

    We reported a case of cavernous sinus aspergillosis. A 62-year-old man complained of trigeminal neuralgia in the right V1 region. Neurological examination on admission showed ptosis, loss of light reflex and ophthalmoplegia externa in the right side. MRI enhanced with gadolinium demonstrated sphenoid sinusitis and mass lesion in the right cavernous sinus. MRA revealed right internal carotid artery occlusion. An open biopsy using the extradural temporopolar approach was performed. Pus discharge was observed from the cavernous sinus and histological examination showed hypha of Aspergillus. With early voriconazole treatment, the patient had improvement in headache, ptosis and ophthalmoplegia externa. Cavernous sinus aspergillosis is often found after sphenoiditis. It results in invasion to an internal carotid artery and worsens the patient's prognosis by cerebral infarction, so early diagnosis and treatment are important. We should consider aspergillosis as one of the differential diagnoses of a mass in the cavernous sinus. The epidural approach to this lesion was available to obviate aspergillus dissemination into the medullary cavity.

  3. [Ptosis secondary to cavernous sinus meningioma].

    PubMed

    Louis, M; Goga, D; François, P; Laure, B

    2013-12-01

    Meningiomas of the cavernous sinus are often the cause of neuro-ophthalmologic manifestations. Fifty percent of affected patients present with ptosis. We report a case of ptosis acquired during the first year of life due to oculomotor nerve palsy secondary to a cavernous sinus meningioma. We then discuss the causes of third cranial nerve palsy and treatment options for ptosis associated with CN III palsy. A fifteen-year-old female patient presented with ptosis due to a third cranial nerve palsy appearing within the first year of life. Magnetic resonance imaging (MRI) revealed a cavernous sinus meningioma. The ptosis was treated by frontalis suspension using autologous temporalis fascia. The meningioma required regular follow-up. Ptosis due to third cranial nerve palsy is rare in children. The most common etiologies are congenital and represent 33 to 40% of cases in various studies. Other etiologies are traumatic, tumoral, vascular and infectious. The cause needs to be found by imaging over the entire course of the nerve. Cavernous sinus meningioma is one cause of third cranial nerve palsy. The surgical treatment of ptosis due to third cranial nerve palsy is levator resection or frontalis suspension with a strip of fascia lata or temporalis fascia. Copyright © 2013. Published by Elsevier Masson SAS.

  4. Mucosal cavernous hemangioma of the maxillary sinus.

    PubMed

    Dutta, Mainak; Kundu, Sohag; Barik, Sabyasachi; Banerjee, Shoham; Mukhopadhyay, Subrata

    2015-02-01

    Mucosal cavernous hemangiomas of maxillary sinus and the lateral nasal wall are seldom encountered and difficult to diagnose with misleading radiologic features like bone erosion and heterogeneity due to patchy contrast uptake. The overall picture mimicking sinonasal malignancy, it is unclear whether there is true breach in the bone or remodeling due to the lesion's chronicity. Interestingly, it often does not bleed as expected during surgery, questioning the use of therapeutic embolization and pre-intervention vascular shrinkage. The clinical presentation and management protocol of sinonasal cavernous hemangiomas seem greatly individualized. We here present a patient with cavernous hemangioma of maxillary sinus and discuss the distinguishing clinical, histologic and imaging characteristics and subsequent management options, and attempt to establish the findings as the basis of considering it as an important differential diagnosis of radiologically heterogeneous sinonasal mass with suspected bone erosions presenting with nasal obstruction and epistaxis, mostly in young women.

  5. Septic Cavernous Sinus Thrombosis: A Case Report

    PubMed Central

    Arian, Mahdieh; Kamali, Azadeh; Tabatabaeichehr, Mahbubeh; Arashnia, Parisa

    2016-01-01

    Introduction Septic cavernous sinus thrombosis (CST) is a rare condition that can result in high mortality and morbidity rates if not treated immediately. CST may be aseptic or septic. Less common primary sites of infection include the tonsils, soft palate, middle ear, and orbit. Reported cases of middle ear infection are very rare, and response to treatment is poor. Case Presentation The present study is a case report of acute otitis media which led to septic cavernous sinus thrombosis in a 56-year-old woman in Bojnord city, North Khorasan, Iran. Conclusions Findings of laboratory tests and magnetic resonance imaging (MRI) confirmed the clinical diagnosis. Clinical-based medical care led to successful management of the patient with broad spectrum intravenous antibiotics that prevented serious complications. PMID:27781123

  6. Cavernous sinus syndrome: need for early diagnosis

    PubMed Central

    Toro, Jaime; Burbano, Lisseth Estefania; Reyes, Saúl; Barreras, Paula

    2015-01-01

    Cavernous sinus syndrome (CSS) is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal sensory loss and Horner’s syndrome. These signs and symptoms result from the involvement of the cranial nerves passing through the cavernous sinus. We report the case of a 53-year-old man with a history of daily stabbing headache associated with dizziness, progressive blurred vision, right ocular pain, ptosis and ophthalmoplegia. After working up the patient, a meningioma was identified as the cause of the CSS. Despite advances in neuroimaging techniques, in some cases, the aetiology of CSS remains difficult to determine. We highlight the clinical and radiological features of a meningioma, one of the causes of CSS. Early diagnosis and treatment of CSS play a key role in a better prognosis. PMID:25819816

  7. Nasopharyngeal carcinoma presented as cavernous sinus tumour.

    PubMed

    Moona, Mohammad Shafi; Mehdi, Itrat

    2011-12-01

    A 32 year Libyan male presented with the complaints of headache and diplopia. He was diagnosed with a cavernous sinus meningioma on the basis of MRI findings but no initial biopsy was taken. Depending on the radiologic diagnosis the patient was treated with gamma knife surgery twice, abroad. During follow up he developed left ear deafness and left cervical lymph adenopathy. An ENT evaluation with biopsy from the nasopharynx and cervical lymph node was taken. The histopathologic diagnosis of the resected tumour showed a nasopharyngeal carcinoma with cervical lymph node metastasis (poorly differentiated lympho-epithelial carcinoma). The cavernous sinus tumour which was initially treated as a meningioma was in fact metastasis from the nasopharyngeal carcinoma, making this an interesting and rare occurrence.

  8. Primary carcinoid tumor of the cavernous sinus.

    PubMed

    Hood, Brian; Bray, Eric; Bregy, Amade; Norenberg, Michael; Weed, Donald; Morcos, Jacques J

    2014-01-01

    Intracranial carcinoid tumors belong to the class of neuroendocrine tumors and their incidence is extremely rare. The pathogenesis and clinical manifestations of carcinoid tumors of the skull base are outlined in this case report. A 61-year-old multimorbid woman presented with transient memory loss. Computed tomographic and magnetic resonance imaging scan of the brain demonstrated a left cavernous sinus mass extending into the infratemporal fossa. The lesion was biopsied using the Caldwell-Luc approach, and histology showed a low-grade neuroendocrine tumor. The tumor was subtotally resected with a neurosurgery/head and neck combined preauricular infratemporal and subtemporal extradural approaches to the cavernous sinus. Further histologic evaluation revealed that the tumor was of carcinoid differentiation with no other primary or metastatic sites detectable. Primary intracranial carcinoid tumors, though rare, should be included in the differential diagnosis of extradural and dural-based lesions. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Maxillary sinus cavernous hemangioma: a rare entity.

    PubMed

    Jammal, H; Barakat, F; Hadi, U

    2004-04-01

    Vascular lesions of the sinonasal tract are rare. These lesions do not have typical signs or symptoms. They may present insidiously with minimal symptoms. A high index of suspicion and a good preoperative evaluation are needed for diagnosis. No standard surgical approach is indicated. We report a case of cavernous hemangioma of the maxillary sinus in an adult male. We present the diagnostic work-up and discuss the differential diagnosis and potential therapeutic approaches.

  10. Cavernous sinus syndrome. Analysis of 151 cases.

    PubMed

    Keane, J R

    1996-10-01

    To characterize lesions causing cavernous sinus syndrome. Review of 26 years of personal experience in a large city hospital. Among 151 patients, tumors (45 patients, 30%) were the most frequent cause of cavernous sinus syndrome. However, when surgical causes (17 patients, 11%) were included, trauma (36 patients, 24%) became most common. Self-limited inflammation was the third frequent cause (34 patients, 23%), while carotid aneurysms and fistulas, infection, and other causes composed the remaining 12%. The age at onset varied with the cause, and patients with aneurysms (average age, 52 years) and patients with tumors (average age, 47 years) were older than those with self-limited inflammation (average age, 35 years) and trauma (average age, 29 years). Spontaneous remissions defined "self-limited inflammation" but were also seen following an acute onset of symptoms due to aneurysms and pituitary apoplexy. In an unselected series from a city hospital, tumor, trauma, and self-limited inflammation were the predominant causes of cavernous sinus syndrome, and classic causes such as aneurysm, meningioma, and bacterial infection were uncommon. Contrast-enhanced magnetic resonance imaging and watchful waiting proved the most effective diagnostic procedures.

  11. Linear accelerator radiosurgery for cavernous sinus meningiomas.

    PubMed

    Kimball, Matthew M; Friedman, William A; Foote, Kelly D; Bova, Frank J; Chi, Yueh-Yun

    2009-01-01

    In this paper, the authors review the results of a single-center experience using linear accelerator (LINAC) radiosurgery for the treatment of cavernous sinus meningiomas. This is a retrospective analysis with a median follow-up of 50 months. All patients were treated on an outpatient basis. Fifty-five patients were treated and 6 patients were lost to follow-up. Changes in preradiosurgery cranial nerve deficits and symptoms as well as actuarial local tumor control were evaluated. The actuarial local tumor control was 100% at 5 years and 98% at 10 years. One patient had enlargement of tumor. Sixty-five percent had improvement in preradiosurgery cranial nerve deficits, 31% were unchanged and 1 patient (3.5%) was worse. Only 1 patient developed a new neurologic deficit. This is the largest LINAC radiosurgery experience for cavernous sinus meningiomas reported to date. Radiosurgery appears to offer greatly superior tumor control and much lower morbidity than surgical resection of cavernous sinus meningiomas. (c) 2009 S. Karger AG, Basel.

  12. Endovascular treatment of carotid cavernous sinus fistula: A systematic review

    PubMed Central

    Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman

    2013-01-01

    Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions. PMID:23671750

  13. MR imaging of cavernous sinus lesions: Pictorial review.

    PubMed

    Nadarajah, Jeyaseelan; Madhusudhan, Kumble Seetharama; Yadav, Ajay Kumar; Chandrashekhara, Sheragaru Hanumanthappa; Kumar, Atin; Gupta, Arun Kumar

    2015-12-01

    The main purpose of this pictorial review is to highlight the important MR imaging findings of various conditions involving the cavernous sinus in addition to brief description of normal anatomy. The pathological conditions that can involve the cavernous sinus can be categorized into infective, inflammatory, granulomatous, vascular and neoplastic causes. Imaging, especially with MRI, plays an important role not only in detection but also in definition of disease extent and in characterization of the pathology. Currently, high-resolution MR images clearly show various components of cavernous sinus which help in making a proper diagnosis and thus appropriate further management.

  14. Cavernous sinus syndrome secondary to intracranial lymphoma in a cat.

    PubMed

    Guevar, Julien; Gutierrez-Quintana, Rodrigo; Peplinski, George; Helm, Jenny R; Penderis, Jacques

    2014-06-01

    Cavernous sinus syndrome is characterised by internal and external ophthalmoplegia and sensory deficits over the head due to combined deficits of the three cranial nerves (CNs) responsible for the eye movements and pupil function (CN III, IV, VI) and at least one branch of the trigeminal nerve (CN V). It has rarely been described in cats and may occur secondarily to inflammatory, infectious or neoplastic lesions within the region of the cavernous sinus on the ventral aspect of the calvarium. This report describes the clinical and magnetic resonance imaging findings in a 14-year-old domestic shorthair cat with neurological deficits compatible with cavernous sinus syndrome caused by presumptive extranodal lymphoma. Treatment with chemotherapy resulted in clinical and imaging remission. Identification of the neurological deficits in cavernous sinus syndrome allows accurate neuroanatomical localisation in order to target diagnostic imaging studies.

  15. Cavernous sinus meningiomas: imaging and surgical strategy.

    PubMed

    Sindou, Marc; Nebbal, Mustapha; Guclu, Bulent

    2015-01-01

    Cavernous sinus (CS) meningiomas which are by definition those meningiomas which originate from the parasellar region are difficult skull base tumors to deal with. For deciding the most appropriate surgical strategy, surgeons need detailed preoperative neuroimaging. The vicinity of the tumor with the vital and highly functional neurovascular structures, tumor extensions into the basal cisterns and skull base structures, and the arterial vascularization and venous drainage pathways, as they shape operative strategy, are important preoperative data to take into account. Thin section CT scan with bone windows, 3D spiral CT reconstruction, MRI, MR angiography, and DSA performed with selective arteriography including late venous phases give those required detailed informations about the tumor and its relation with neurovascular and bony structures. The type of craniotomy and complementary osteotomy and the usefulness of an extradural anterior clinoidectomy with unroofing the optic canal can be decided from preoperative neuroimaging. Data collected also help in determining whether extensive exposure of the middle cranial fossa is necessary to ensure substantial devascularization of the tumor and whether proximal control of the internal carotid artery (ICA) at its intrapetrosal portion might be useful. Study of the capacity of blood supply of the Willis circle is wise for deciding the need and way of performing an extra-intracranial bypass together with tumor removal. Currently the concept of operating only the tumors with extracavernous extensions and to limit resection to only their extracavernous portions is the most accepted way of treating these tumors. It was that strategy that was adopted in the senior author's 220-patient series.Radiosurgery or stereotactic fractionated radiotherapy may complement surgery or can be only reserved for growing remnants.

  16. Tolerance of cranial nerves of the cavernous sinus to radiosurgery

    SciTech Connect

    Tishler, R.B.; Loeffler, J.S.; Alexander, E. III; Kooy, H.M. ); Lunsford, L.D.; Duma, C.; Flickinger, J.C. )

    1993-09-20

    Stereotactic radiosurgery is becoming a more accepted treatment option for benign, deep seated intracranial lesions. However, little is known about the effects of large single fractions of radiation on cranial nerves. This study was undertaken to assess the effect of radiosurgery on the cranial nerves of the cavernous sinus. The authors examined the tolerance of cranial nerves (II-VI) following radiosurgery for 62 patients (42/62 with meningiomas) treated for lesions within or near the cavernous sinus. Twenty-nine patients were treated with a modified 6 MV linear accelerator (Joint Center for Radiation Therapy) and 33 were treated with the Gamma Knife (University of Pittsburgh). Three-dimensional treatment plans were retrospectively reviewed and maximum doses were calculated for the cavernous sinus and the optic nerve and chiasm. Median follow-up was 19 months (range 3-49). New cranial neuropathies developed in 12 patients from 3-41 months following radiosurgery. Four of these complications involved injury to the optic system and 8 (3/8 transient) were the result of injury to the sensory or motor nerves of the cavernous sinus. There was no clear relationship between the maximum dose to the cavernous sinus and the development of complications for cranial nerves III-VI over the dose range used (1000-4000 cGy). For the optic apparatus, there was a significantly increased incidence of complications with dose. Four of 17 patients (24%) receiving greater than 800 cGy to any part of the optic apparatus developed visual complications compared with 0/35 who received less than 800 cGy (p = 0.009). Radiosurgery using tumor-controlling doses of up to 4000 cGy appears to be a relatively safe technique in treating lesions within or near the sensory and motor nerves (III-VI) of the cavernous sinus. The dose to the optic apparatus should be limited to under 800 cGy. 21 refs., 4 tabs.

  17. Fat deposition in the cavernous sinus in Cushing disease

    SciTech Connect

    Bachow, T.B.; Hesselink, J.R.; Aaron, J.O.; Davis, K.R.; Taveras, J.M.

    1984-10-01

    Fat density in the cavernous sinus on computed tomography (CT) is described in 6 out of 16 (37.5%) patients with Cushing disease. This finding may aid in making a specific diagnosis in patients with a pituitary mass. It was not seen in 30 random CT studies of the sella; however, supra seller fat was incidentally noted in the patient with acromegaly.

  18. Nasopharyngeal angiofibroma with cavernous sinus involvement - An unusual presentation.

    PubMed

    Namdarian, Dinaz; Hiranandani, N L; Hathiram, Bachi; Rajeevan, C P; Agarwal, Ritu

    2003-10-01

    Juvenile nasopharyngeal angiofibrama (JNA) is a benign vascular tumour which is locally aggressive and occasionally extends intracranially. It occurs mainly in adolescent males. We report an interesting case of a targe JNA with intracranial extention encroaching on the cavernous sinus which we treated surgically by the conventional lateral rhinotomy and transpalatal approach.

  19. Carotid-cavernous fistula after functional endoscopic sinus surgery.

    PubMed

    Karaman, Emin; Isildak, Huseyin; Haciyev, Yusuf; Kaytaz, Asim; Enver, Ozgun

    2009-03-01

    Carotid-cavernous fistulas (CCFs) are anomalous communications between the carotid arterial system and the venous cavernous sinus. They can arise because of spontaneous or trauma causes. Most caroticocavernous fistulas are of spontaneous origin and unknown etiology. Spontaneous CCF may also be associated with cavernous sinus pathology such as arteriosclerotic changes of the arterial wall, fibromuscular dysplasia, or Ehler-Danlos syndrome. Traumatic CCFs may occur after either blunt or penetrating head trauma. Their clinical presentation is related to their size and to the type of venous drainage, which can lead to a variety of symptoms, such as visual loss, proptosis, bruit, chemosis, cranial nerve impairment, intracranial hemorrhage (rare), and so on. Treatment by endovascular transarterial embolization with electrolytically detachable coils is a very effective method for CCF with good outcomes. Carotid-cavernous fistulas have been rarely reported after craniofacial surgery and are uncommon pathologies in otolaryngology practice. In this study, we report a 40-year-old woman with CCF secondary to blunt trauma of functional endoscopic sinus surgery.

  20. Fractionated Proton Radiotherapy for Benign Cavernous Sinus Meningiomas

    SciTech Connect

    Slater, Jerry D.; Loredo, Lilia N.; Chung, Arthur; Bush, David A.; Patyal, Baldev; Johnson, Walter D.; Hsu, Frank P.K.; Slater, James M.

    2012-08-01

    Purpose: To evaluate the efficacy of fractionated proton radiotherapy for a population of patients with benign cavernous sinus meningiomas. Methods and Materials: Between 1991 and 2002, 72 patients were treated at Loma Linda University Medical Center with proton therapy for cavernous sinus meningiomas. Fifty-one patients had biopsy or subtotal resection; 47 had World Health Organization grade 1 pathology. Twenty-one patients had no histologic verification. Twenty-two patients received primary proton therapy; 30 had 1 previous surgery; 20 had more than 1 surgery. The mean gross tumor volume was 27.6 cm{sup 3}; mean clinical target volume was 52.9 cm{sup 3}. Median total doses for patients with and without histologic verification were 59 and 57 Gy, respectively. Mean and median follow-up periods were 74 months. Results: The overall 5-year actuarial control rate was 96%; the control rate was 99% in patients with grade 1 or absent histologic findings and 50% for those with atypical histology. All 21 patients who did not have histologic verification and 46 of 47 patients with histologic confirmation of grade 1 tumor demonstrated disease control at 5 years. Control rates for patients without previous surgery, 1 surgery, and 2 or more surgeries were 95%, 96%, and 95%, respectively. Conclusions: Fractionated proton radiotherapy for grade 1 cavernous sinus meningiomas achieves excellent control rates with minimal toxicities, regardless of surgical intervention or use of histologic diagnosis. Disease control for large lesions can be achieved by primary fractionated proton therapy.

  1. Fractionated proton radiotherapy for benign cavernous sinus meningiomas.

    PubMed

    Slater, Jerry D; Loredo, Lilia N; Chung, Arthur; Bush, David A; Patyal, Baldev; Johnson, Walter D; Hsu, Frank P K; Slater, James M

    2012-08-01

    To evaluate the efficacy of fractionated proton radiotherapy for a population of patients with benign cavernous sinus meningiomas. Between 1991 and 2002, 72 patients were treated at Loma Linda University Medical Center with proton therapy for cavernous sinus meningiomas. Fifty-one patients had biopsy or subtotal resection; 47 had World Health Organization grade 1 pathology. Twenty-one patients had no histologic verification. Twenty-two patients received primary proton therapy; 30 had 1 previous surgery; 20 had more than 1 surgery. The mean gross tumor volume was 27.6 cm(3); mean clinical target volume was 52.9 cm(3). Median total doses for patients with and without histologic verification were 59 and 57 Gy, respectively. Mean and median follow-up periods were 74 months. The overall 5-year actuarial control rate was 96%; the control rate was 99% in patients with grade 1 or absent histologic findings and 50% for those with atypical histology. All 21 patients who did not have histologic verification and 46 of 47 patients with histologic confirmation of grade 1 tumor demonstrated disease control at 5 years. Control rates for patients without previous surgery, 1 surgery, and 2 or more surgeries were 95%, 96%, and 95%, respectively. Fractionated proton radiotherapy for grade 1 cavernous sinus meningiomas achieves excellent control rates with minimal toxicities, regardless of surgical intervention or use of histologic diagnosis. Disease control for large lesions can be achieved by primary fractionated proton therapy. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. A Ruptured Dermoid Cyst of the Cavernous Sinus Extending into the Posterior Fossa

    PubMed Central

    Paik, Seung-Chull; Cheong, Jin-Hwan; Kim, Jae-Min

    2015-01-01

    Supratentorial dermoid cysts are uncommon to develop in the cavernous sinus. We present a ruptured dermoid cyst of the cavernous sinus extending into the posterior fossa. The patient was a 32-year-old female who complained occipital headache, blurred vision, and tinnitus over 4 years. Brain magnetic resonance (MR) imaging revealed an enhanced tumor in the right cavernous sinus extending into the right temporal base and the posterior fossa with findings of ruptured cyst. Surgical resection was performed, and pathological findings were confirmed to be a dermoid cyst. We report a second case with ruptured dermoid cyst of the cavernous sinus extending into the posterior fossa. PMID:26113964

  3. A Ruptured Dermoid Cyst of the Cavernous Sinus Extending into the Posterior Fossa.

    PubMed

    Paik, Seung-Chull; Kim, Choong-Hyun; Cheong, Jin-Hwan; Kim, Jae-Min

    2015-05-01

    Supratentorial dermoid cysts are uncommon to develop in the cavernous sinus. We present a ruptured dermoid cyst of the cavernous sinus extending into the posterior fossa. The patient was a 32-year-old female who complained occipital headache, blurred vision, and tinnitus over 4 years. Brain magnetic resonance (MR) imaging revealed an enhanced tumor in the right cavernous sinus extending into the right temporal base and the posterior fossa with findings of ruptured cyst. Surgical resection was performed, and pathological findings were confirmed to be a dermoid cyst. We report a second case with ruptured dermoid cyst of the cavernous sinus extending into the posterior fossa.

  4. Tuberculoma of the Cavernous Sinus and Meckel's Cave in a Child.

    PubMed

    Kumar, V R Roopesh; Madhugiri, Venkatesh S; Verma, Surendra Kumar; Barathi, S Deepak; Yadav, Awdhesh Kumar; Bidkar, Prasanna

    2013-01-01

    Tuberculous infection of the cavernous sinus and Meckel's cave is extremely rare. In this report, we describe a patient with tuberculoma of the cavernous sinus and Meckel's cave, extending to the petrous apex. The patient underwent microsurgical excision of the lesion and antitubercular chemotherapy resulting in a good outcome. We describe the diagnostic difficulties and review the relevant literature.

  5. Operative management of tumors involving the cavernous sinus.

    PubMed

    Sekhar, L N; Møller, A R

    1986-06-01

    In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

  6. Interdural cavernous sinus dermoid cyst in a child: case report.

    PubMed

    Giordano, Flavio; Peri, Giacomo; Bacci, Giacomo M; Basile, Massimo; Guerra, Azzurra; Bergonzini, Patrizia; Buccoliero, Anna Maria; Spacca, Barbara; Iughetti, Lorenzo; Donati, PierArturo; Genitori, Lorenzo

    2017-03-01

    Interdural dermoid cysts (DCs) of the cavernous sinus (CS), located between the outer (dural) and inner layer (membranous) of the CS lateral wall, are rare lesions in children. The authors report on a 5-year-old boy with third cranial nerve palsy and exophthalmos who underwent gross-total removal of an interdural DC of the right CS via a frontotemporal approach. The patient had a good outcome and no recurrence at the 12-month follow-up. To the best of the authors' knowledge this is the second pediatric case of interdural DC described in the literature.

  7. Thyrotrophin (TSH)-secreting pituitary macroadenoma with cavernous sinus invasion.

    PubMed

    Kon, Y C; Loh, K C; Tambyah, J A; Lim, L H; Marshall, J C

    2001-09-01

    Thyrotrophin (TSH)-secreting pituitary adenomas, although rare, should be recognised as a possible cause of normal or elevated serum TSH in the presence of elevated serum free thyroid hormone levels. Clinical hyperthyroidism may be mild or absent. Early recognition provides the best chance for surgical cure. We report a patient with a TSH-secreting pituitary tumour with cavernous sinus invasion. This case illustrates that multiple modalities of treatment are often necessary and complementary in achieving control of tumour growth and hormonal hypersecretion when these tumours are diagnosed late.

  8. Treatment of Cavernous Sinus Tumors with Linear Accelerator Radiosurgery

    PubMed Central

    Chang, Steven D.; Doty, James R.; Martin, David P.; Hancock, Steven L.; Adler, John R.

    1999-01-01

    Since 1989, 79 patients with benign or malignant cavernous sinus tumors, have been treated at Stanford University with linear accelerator (linac) radiosurgery. Radiosurgery has been used as (1) a planned second-stage procedure for residual tumor following surgery, (2) primary treatment for patients whose medical conditions preclude surgery, (3) palliation of malignant lesions, and (4) definitive treatment for small, well-localized, poorly accessible tumors. Mean patient age was 52 years (range, 18 to 88); there were 28 males and 51 females. Sixty-one patients had benign tumors; 18 had malignant tumors. Mean tumor volume was 6.8 cm3 (range 0.5 to 22.5 cm3) covered with an average of 2.3 isocenter (range, 1 to 5). Radiation dose averaged 17.1 Gy. Mean follow-up was 46 months. Tumor control or shrinkage, or both, varied with pathology. Radiographic tumor improvement was most pronounced in malignant lesions, with greater than 85% showing reduction in tumor size; benign tumors (meningiomas and schwannomas) had a 63% control rate and 37% shrinkage rate, with none enlarging. We concluded that stereotactic radiosurgery is a valuable tool in managing cavernous sinus tumors. There was excellent control and stabilization of benign tumors and palliation of malignant lesions. ImagesFigure 1Figure 2 PMID:17171089

  9. Cavernous sinus hemangioma: a fourteen year single institution experience.

    PubMed

    Bansal, Sumit; Suri, Ashish; Singh, Manmohan; Kale, Shashank Sharad; Agarwal, Deepak; Sharma, Manish Singh; Mahapatra, Ashok Kumar; Sharma, Bhawani Shankar

    2014-06-01

    Cavernous sinus hemangioma (CSH) is a rare extra-axial vascular neoplasm that accounts for 2% to 3% of all cavernous sinus tumors. Their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures are factors which present difficulty in excising these lesions. The authors describe their experience of 22 patients with CSH over 14 years at a tertiary care center. Patients were managed with microsurgical resection using a purely extradural transcavernous approach (13 patients) and with Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) (nine patients). Retrospective data analysis found headache and visual impairment were the most common presenting complaints, followed by facial hypesthesia and diplopia. All but one patient had complete tumor excision in the surgical series. Transient ophthalmoparesis (complete resolution in 6-8 weeks) was the most common surgical complication. In the GKRS group, marked tumor shrinkage (>50% tumor volume reduction) was achieved in two patients, slight shrinkage in five and no change in two patients, with symptom improvement in the majority of patients. To our knowledge, we describe one of the largest series of CSH managed at a single center. Although microsurgical resection using an extradural transcavernous approach is considered the treatment of choice in CSH and allows complete excision with minimal mortality and long-term morbidity, GKRS is an additional tool for treating residual symptomatic lesions or in patients with associated comorbidities making surgical resection unsuitable.

  10. Cavernous sinus thrombosis caused by a dental infection: a case report

    PubMed Central

    Yeo, Gi-Sung; Kim, Hyun Young; Kwak, Eun-Jung; Jung, Young-Soo; Park, Hyung-Sik

    2014-01-01

    Cavernous sinus thrombosis not only presents with constitutional symptoms including fever, pain and swelling but also with specific findings such as proptosis, chemosis, periorbital swelling, and cranial nerve palsies. It is known to occur secondary to the spread of paranasal sinus infections in the nose, ethmoidal and sphenoidal sinuses. However, paranasal sinus infection of dental origin is rare. The following is a case of cavernous sinus thrombosis due to the spread of an abscess in the buccal and pterygomandibular spaces via buccal mucosal laceration. PMID:25247150

  11. Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure

    PubMed Central

    Amiridze, N.; Zoarski, G.; Darwish, R.; Obuchowski, A.; Soloveychic, N.

    2009-01-01

    Summary Treatment of cavernous sinus dural arteriovenous fistula (CSDAVF) may be challenging. We describe a patient who had presented with progressive ocular symptoms due to CSDAVF requiring urgent interventional therapy. Initial attempts to embolize the fistula utilizing a transvenous approach through the inferior petrosal sinus failed because of difficult anatomy. Successful occlusion of the fistula was subsequently achieved with injection of ethylene vinyl alcohol copolymer, Onyx (EV3 Neurovascular, Irvine, CA, USA), via direct percutaneous puncture of the cavernous sinus through the superior orbital fissure. A brief period of asystole during the initial injection of Onyx may be the result of the trigeminocardiac reflex. PMID:20465896

  12. Cavernous sinus syndrome due to osteochondromatosis in a cat.

    PubMed

    Perazzi, Anna; Bernardini, Marco; Mandara, Maria T; De Benedictis, Giulia M; De Strobel, Francesca; Zotti, Alessandro

    2013-12-01

    A 1-year-old sexually intact male Korat cat was referred for ophthalmological consultation due to anisocoria. Mydriasis with external ophthalmoplegia and absence of pupillary light responses in the right eye and nasofacial hypalgesia were seen. Cavernous sinus syndrome (CSS) was suspected. Bilateral deformities of the jaw and phalangeal bones, severe spinal pain and abnormal conformation of the lumbar spine were also present. Radiographic examination revealed several mineralised masses in the appendicular and axial skeleton, indicative of multiple cartilaginous exostoses. For further investigation of the CSS-related neurological deficits, the cat underwent computed tomography (CT) examination of the skull. CT images revealed a non-vascularised, calcified, amorphous mass originating from the right lateral skull base and superimposing on the sella turcica. Based on the severity of diffuse lesions and owing to the clinical signs of extreme pain, the cat was euthanased. A diffuse skeletal and intracranial osteochondromatosis was diagnosed histologically.

  13. Endoscopic endonasal biopsy for a tumor at the cavernous sinus and pons.

    PubMed

    Wei, Wei; Qiuhang, Zhang; Hongchuan, Guo; Zhenlin, Wang

    2015-03-01

    Lesions at the cavernous sinus and brainstem can be detected by radiologic studies, but a definitive diagnosis depends on histopathologic analysis. We present the case of a 75-year-old woman with symptoms including cranial nerve palsy, hydrocephalus,seizures, and long-term coma caused by squamous cell carcinoma at the cavernous sinus and ventral pons, which was confirmed by an endoscopic endonasal biopsy.

  14. Interesting case of base of skull mass infiltrating cavernous sinuses.

    PubMed

    Singh, Achintya Dinesh; Soneja, Manish; Memon, Saba Samad; Vyas, Surabhi

    2016-11-16

    A man aged 35 years presented with chronic headache and earache of 1-year duration. He had progressive vision loss and diplopia since last 9 months. He also had pain over the face and episodic profuse epistaxis. On examination, perception of light was absent in the right eye and hand movements were detected at 4 m distance in the left eye. Imaging revealed a lobulated mass in the nasopharynx extending into the bilateral cavernous sinuses and sphenoid sinus with bony erosions. Biopsy of the nasopharyngeal mass revealed pathological features which are characteristic of IgG4 disease. His serum IgG4 levels and acute inflammatory markers were also elevated. The patient was started on oral corticosteroid therapy. Fever, headache and earache resolved early and there was gradual improvement in the vision of the left eye. After 6 months, visual acuity in the left eye was 6/9, but right eye visual acuity had no change. Follow-up imaging revealed a significant reduction in the size of the mass.

  15. A new endoscopic surgical classification and invasion criteria for pituitary adenomas involving the cavernous sinus.

    PubMed

    Ceylan, Savas; Anik, Ihsan; Koc, Kenan

    2011-01-01

    There are two major problems for the pituitary adenomas invading the Cavernous Sinus (CS); differentiation of extension and invasion and inability to demonstrate the medial wall via preoperative imaging methods. Two important corridors are defined in endoscopic cavernous sinus approaches; the lateral and medial corridor. A retrospective analysis was performed in 400 endoscopic transphenoidal approaches and 360 pituitary adenomas underwent endoscopic transphenoidal surgery in our department between September 1997 and December 2010. 48 patients affected by the tumours involving the cavernous sinus were included in this study. We performed an intraoperative evaluation of cavernous sinus invasion considering visualization of the medial wall defect, intracavernous ICA segments, minor tumour extensions through small focal pit holes of the medial wall of CS or confirming carotid segments of CS by micro-doppler. Cavernous sinus involvement was classified into three types according to the medial and lateral corridor extension of the tumor as 25 isolated medial corridor involvement (Type I), 5 isolated lateral corridor involvement (Type II) and 18 total involvement (Type III). Our classification depends on fully surgical endoscopic approach supported by neuroimaging techniques and anatomical studies and shows a good predictive value for all cavernous sinus involvement.

  16. Transorbital superior ophthalmic vein sacrifice to preserve vision in ocular hypertension from aseptic cavernous sinus thrombosis.

    PubMed

    Ladner, Travis R; Davis, Brandon J; He, Lucy; Mawn, Louise A; Mocco, J

    2014-10-29

    Aseptic cavernous sinus thrombosis (CST) is rare and may clinically masquerade as a carotid cavernous fistula. Conventional management includes oral anticoagulation, but cases of ocular hypertension affecting vision may require more aggressive intervention. We report a case of a woman with spontaneous bilaterally occluded cavernous sinuses with elevated intraocular pressure (IOP), which resolved immediately following unilateral superior ophthalmic vein (SOV) sacrifice. She was subsequently placed on oral anticoagulants. By 4 months postoperatively her IOP was normalized and her vision had improved. Repeat angiography demonstrated stable venous filling, with some mild improvement of flow through the cavernous sinus. Coil-mediated sacrifice of the SOV might be an effective means to relieve ocular hypertension and preserve vision in the setting of aseptic CST. 2014 BMJ Publishing Group Ltd.

  17. Transorbital superior ophthalmic vein sacrifice to preserve vision in ocular hypertension from aseptic cavernous sinus thrombosis.

    PubMed

    Ladner, Travis R; Davis, Brandon J; He, Lucy; Mawn, Louise A; Mocco, J

    2015-12-01

    Aseptic cavernous sinus thrombosis (CST) is rare and may clinically masquerade as a carotid cavernous fistula. Conventional management includes oral anticoagulation, but cases of ocular hypertension affecting vision may require more aggressive intervention. We report a case of a woman with spontaneous bilaterally occluded cavernous sinuses with elevated intraocular pressure (IOP), which resolved immediately following unilateral superior ophthalmic vein (SOV) sacrifice. She was subsequently placed on oral anticoagulants. By 4 months postoperatively her IOP was normalized and her vision had improved. Repeat angiography demonstrated stable venous filling, with some mild improvement of flow through the cavernous sinus. Coil-mediated sacrifice of the SOV might be an effective means to relieve ocular hypertension and preserve vision in the setting of aseptic CST. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. [A case of cavernous sinus epidermoid: anatomical classification and surgical approach].

    PubMed

    Kuroi, Yasuhiro; Yoshimura, Chika; Yokosako, Suguru; Arai, Naoyuki; Ohbuchi, Hidenori; Hirota, Kengo; Sasahara, Atsushi; Hagiwara, Shinji; Tani, Shigeru; Fujibayashi, Mariko; Kubo, Osami; Kasuya, Hidetoshi

    2014-02-01

    Epidermoid rarely appears in the cavernous sinus. We encountered a 41-year-old man with left abducens nerve palsy. A round-shaped, low-density lesion on CT was located lateral to the left cavernous sinus with a compressed and thinned lateral wall of the sphenoid sinus. We could not identify cranial nerves in the cavernous sinus, which was found to be packed with a non-enhanced, high-intensity tumor on both T1 and T2 MRI. Part of the tumor capsule and its pearly contents were removed with an intradural subtemporal approach, and an inner membranous layer with cranial nerves and a tumor capsule were seen at the bottom of the tumor cavity. Postoperatively, complete cure was achieved. Reviewing similar cases, we found 18 cavernous sinus epidermoids:extracavernous type in 5;interdural in 10;and intracavernous in 3. The interdural type could be further divided into two subtypes:superficial cavernous sinus and inner membranous types. The present case belongs to the former. Frontotemporal and subtemporal procedures via both intra- and extradural approaches are relatively safe for lesions except for the intracavernous type, because cranial nerves are not located in the lateral wall of the tumor. MRI provides more useful information on cranial nerves and aid in choosing a better treatment strategy.

  19. Cavernous sinus sampling in patients with Cushing's disease.

    PubMed

    Burkhardt, Till; Flitsch, Jörg; van Leyen, Philine; Sauer, Nina; Aberle, Jens; Grzyska, Ulrich; Lüdecke, Dieter K

    2015-02-01

    OBJECT Correct diagnosis and precise localization of adenomas in patients with Cushing's disease are essential for avoiding unsuccessful transsphenoidal pituitary exploration. In addition to the well-established inferior petrosal sinus sampling, preoperative cavernous sinus sampling (CSS) was introduced as a potentially improved way to predict adenoma lateralization. The authors present their results with CSS in a consecutive series of patients with Cushing's disease. METHODS During 1999-2014, transsphenoidal surgeries were consecutively performed in 510 patients with Cushing's disease. For most patients, suppression of cortisol in high-dose dexamethasone tests and stimulation of adrenocorticotropic hormone and cortisol after administration of corticotropin-releasing hormone were sufficient to prove the diagnosis of adrenocorticotropic hormone-dependent hypercortisolism. Of the 510 patients, 67 (13%) were referred to the department of neuroradiology for CSS according to the technique of Teramoto. The indications for CSS were unclear endocrine test results or negative MRI results. Data for all patients were retrospectively analyzed. RESULTS A central/peripheral gradient was found in 59 patients; lateralization to the left or right side was found in 51. For 8 patients with a central/peripheral gradient, no left/right gradient could be determined. For another 8 patients with equivocal test results, no central/peripheral gradient was found. No severe CSS-associated complications were encountered. Of the 51 patients who underwent transsphenoidal surgery, the predicted lateralization was proven correct for 42 (82%). CONCLUSIONS As MRI techniques have improved, the number of potential candidates for this invasive method has decreased in the past decade. However, because detecting minute adenomas remains problematic, CSS remains a useful diagnostic tool for patients with Cushing's disease.

  20. Gamma Knife radiosurgery for hemangioma of the cavernous sinus.

    PubMed

    Lee, Cheng-Chia; Sheehan, Jason P; Kano, Hideyuki; Akpinar, Berkcan; Martinez-Alvarez, Roberto; Martinez-Moreno, Nuria; Guo, Wan-Yuo; Lunsford, L Dade; Liu, Kang-Du

    2017-05-01

    OBJECTIVE Cavernous sinus hemangiomas (CSHs) are rare vascular tumors. A direct microsurgical approach usually results in massive hemorrhage and incomplete tumor resection. Although stereotactic radiosurgery (SRS) has emerged as a therapeutic alternative to microsurgery, outcome studies are few. Authors of the present study evaluated the role of SRS for CSH. METHODS An international multicenter study was conducted to review outcome data in 31 patients with CSH. Eleven patients had initial microsurgery before SRS, and the other 20 patients (64.5%) underwent Gamma Knife SRS as the primary management for their CSH. Median age at the time of radiosurgery was 47 years, and 77.4% of patients had cranial nerve dysfunction before SRS. Patients received a median tumor margin dose of 12.6 Gy (range 12-19 Gy) at a median isodose of 55%. RESULTS Tumor regression was confirmed by imaging in all 31 patients, and all patients had greater than 50% reduction in tumor volume at 6 months post-SRS. No patient had delayed tumor growth, new cranial neuropathy, visual function deterioration, adverse radiation effects, or hypopituitarism after SRS. Twenty-four patients had presented with cranial nerve disorders before SRS, and 6 (25%) of them had gradual improvement. Four (66.7%) of the 6 patients with orbital symptoms had symptomatic relief at the last follow-up. CONCLUSIONS Stereotactic radiosurgery was effective in reducing the volume of CSH and attaining long-term tumor control in all patients at a median of 40 months. The authors' experience suggests that SRS is a reasonable primary and adjuvant treatment modality for patients in whom a CSH is diagnosed.

  1. Transvenous embolization of a dural carotid-cavernous sinus fistula via the inferior ophthalmic vein.

    PubMed

    Michels, Kevin S; Ng, John D; Falardeau, Julie; Roberts, Warren G; Petersen, Bryan; Nesbit, Gary M; Barnwell, Stanley L

    2007-01-01

    A 76-year-old woman presented with an acute onset of right periocular pain, diplopia, ocular injection, progressive proptosis, and periocular swelling. She had an unremarkable past medical history, and the erythrocyte sedimentation rate and complete blood count were normal. A carotid-cavernous sinus fistula was suspected, and an MRI demonstrated enlargement of the superior ophthalmic vein posterior to the globe and enlargement of the inferior ophthalmic vein throughout its entire course. Cerebral arteriography demonstrated a dural cavernous sinus fistula. The inferior ophthalmic vein was accessed via the inferonasal orbital space and was catheterized for delivery of multiple platinum coils to the cavernous sinus fistula. Follow-up venograms demonstrated occlusion of the fistula. At 2-month follow-up, there was a residual sixth nerve palsy and resolution of symptoms, including proptosis and periocular swelling.

  2. Extrapulmonary tuberculosis presenting as a cavernous sinus syndrome: Case report with review of existing literature

    PubMed Central

    Kapadia, Shashi; Patrawalla, Amee

    2014-01-01

    Tuberculoma involving the cavernous sinus is a rare presentation of CNS disease, with only twelve cases reported in previous literature. We report a case of a 48 year old woman who presented with a right cavernous sinus syndrome of 2 months duration. MRI showed a mass in the right cavernous sinus, and serologic workup revealed an elevated sedimentation rate and positive Quantiferon®-GOLD testing. 18-FDG PET-CT demonstrated a hypermetabolic 3 cm subcarinal lymph node, and lymph node biopsy showed caseating granuloma. Culture of lymphatic tissue grew drug-sensitive M. tuberculosis. The patient was treated with a non-standard 4-drug regimen and prednisone, with rapid improvement of symptoms and radiologic abnormalities. Total length of treatment was 12 months. In addition, we review the 12 cases found in literature, and discuss clinical features, diagnostic dilemmas, and approaches to treatment. PMID:26839786

  3. The cavernous sinus in cluster headache - a quantitative structural magnetic resonance imaging study.

    PubMed

    Arkink, Enrico B; Schoonman, Guus G; van Vliet, Jorine A; Bakels, Hannah S; Sneeboer, Marjolein Am; Haan, Joost; van Buchem, Mark A; Ferrari, Michel D; Kruit, Mark C

    2017-03-01

    Background It has been hypothesized that a constitutionally narrow cavernous sinus might predispose individuals to cluster headache. Cavernous sinus dimensions, however, have never been assessed. Methods In this case-control study, we measured the dimensions of the cavernous sinus, skull base, internal carotid and pituitary gland with high-resolution T2-weighted magnetic resonance imaging in 25 episodic, 24 chronic and 13 probable cluster headache patients, 8 chronic paroxysmal hemicrania patients and 22 headache-free controls. Dimensions were compared between groups, correcting for age, sex and transcranial diameter. Results On qualitative inspection, no relevant pathology or anatomic variants that were previously associated with cluster headache or chronic paroxysmal hemicranias were observed in the cavernous sinus or paracavernous structures. The left-to-right transcranial diameter at the temporal fossa level (mean ± SD) was larger in the headache groups (episodic cluster headache: 147.5 ± 7.3 mm, p = 0.044; chronic cluster headache: 150.2 ± 7.3 mm, p < 0.001; probable cluster headache: 146.0 ± 5.3 mm, p = 0.012; and chronic paroxysmal hemicrania: 145.2 ± 9.4 mm, p = 0.044) compared with controls (140.2 ± 8.0 mm). After adjusting for transcranial diameter and correcting for multiple comparisons, there were no differences in the dimensions of the cavernous sinus and surrounding structures between headache patients and controls. Conclusion Patients with cluster headache or chronic paroxysmal hemicrania had wider skulls than headache-free controls, but the proportional dimensions of the cavernous sinus were similar.

  4. Fibrin Glue Injection for Cavernous Sinus Hemostasis Associated with Cranial Nerve Deficit: A Case Report

    PubMed Central

    Tavanaiepour, Daryoush; Jernigan, Sarah; Abolfotoh, Mohamad; Al-Mefty, Ossama

    2015-01-01

    Fibrin glue injection has been used to control intraoperative cavernous sinus (CS) venous bleeding. There have been no reported complications related to this maneuver. We present a case where a patient developed a sensory trigeminal nerve deficit after injection of fibrin glue into the posterior CS during resection of a petrosal meningioma. We believe that this deficit was due to the compression of the trigeminal ganglion similar to balloon compression procedures. Although fibrin glue injection may achieve satisfactory cavernous sinus homeostasis, the volume and rate of injection should be kept in mind to avoid a compressive lesion on traversing cranial nerves and surrounding structures, or retrograde filling of the venous tributaries. PMID:26251815

  5. Endoscopic Endonasal Approach to the Middle Cranial Fossa through the Cavernous Sinus Triangles: Anatomical Considerations

    PubMed Central

    KOMATSU, Fuminari; ODA, Shinri; SHIMODA, Masami; IMAI, Masaaki; SHIGEMATSU, Hideaki; KOMATSU, Mika; TSCHABITSCHER, Manfred; MATSUMAE, Mitsunori

    2014-01-01

    The lateral limit of endoscopic endonasal surgery has yet to be defined. The aim of this study was to investigate the lateral limit of endoscopic endonasal surgery at the level of the sphenoid sinus. Access from the sphenoid sinus to the middle cranial fossa through the cavernous sinus triangles was evaluated by cadaver dissection. Anatomical analysis demonstrated that the medial temporal dura mater was exposed through the anterior area of the clinoidal triangle, anteromedial triangle, and superior area of the anterolateral triangle, indicating potential corridors to the middle cranial fossa. This study suggests that the cavernous sinus triangles are applicable in selected cases to manage middle cranial fossa lesions by endoscopic endonasal surgery. PMID:25446385

  6. A rare case of malignant glioma suspected to have arisen from a cavernous sinus.

    PubMed

    Taomoto, Katsushi; Ohnishi, Hideyuki; Kamada, Yoshitaka; Kuga, Yoshihiro; Kohaya, Norimasa; Nakashima, Kazuya; Ichioka, Tsugumichi; Tominaga, Takashi; Nakamura, Mitsutoshi; Nakazato, Yoichi

    2007-01-01

    A 55-year-old woman presented with a right trigeminal dysfunction (dysesthesia) initially, followed by right oculomotor and abducens paresis lasting 1 month. Neuroimaging studies showed an enhanced mass in the right cavernous sinus extending to the trigeminal ganglion. The extraparenchymal tumor located around the right trigeminal ganglion was totally removed, except for an intracavernous lesion, by the orbitozygomatic approach. The solid tumor was completely separated from the brainstem and seemed to be a trigeminal schwannoma arising from the trigeminal ganglion or cavernous sinus at surgery. A histological examination, however, found a typical malignant glioma that consisted primarily of astrocytic tumor cells. Immunohistochemical staining showed the tumor cells stained intensely for GFAP, S-100 protein, and vimentin, but not for NFP, Schwann/2E, CD34, and CD68. The mean MIB-1 index was 12.4%. The tumor recurred after a short time, and then it rapidly disseminated into the subarachnoid space and left the cerebral hemisphere. The patient died 1 year after the initial symptoms in spite of aggressive surgery, radiation, and chemotherapy with temozolomide. There are no previous reports of a malignant glioma arising from either the cavernous sinus or the trigeminal ganglion. From the pathogenetic point of view, this malignant glioma is an extremely rare case that developed clinically and neuroradiologically from the cavernous sinus and was suspected be being derived from ectopic glial tissue.

  7. Pontine glioma extending to the ipsilateral cavernous sinus and Meckel's cave: MR appearance.

    PubMed

    Yuh, W T; Nguyen, H D; Mayr, N A; Follett, K A

    1992-01-01

    The authors describe an exophytic glioma of the pons that grew into the Meckel's cave and cavernous sinus in a 75-year-old man. Pontine gliomas should be included in the differential diagnosis of a hyperintense, complex cystic mass seen along the distribution of cranial nerve V.

  8. The Role of Palliative Radiosurgery When Cancer Invades the Cavernous Sinus

    SciTech Connect

    Kano, Hideyuki; Niranjan, Ajay; Kondziolka, Douglas; Flickinger, John C.; Lunsford, L. Dade

    2009-03-01

    Purpose: Involvement of the cavernous sinus by direct invasion from skull base cancer or from metastatic spread of cancers is a challenging problem. We evaluated the role of stereotactic radiosurgery (SRS) in the treatment of patients who developed cavernous sinus metastases or direct invasion. Methods and Materials: We retrospectively reviewed the data from 37 patients who had cavernous sinus metastases or had cavernous sinus invasion from adjacent skull base cancers and who underwent SRS between 1992 and 2006 at University of Pittsburgh Medical Center. The median patient age was 57.8 years. Previous adjuvant management included fractionated radiotherapy in 8, chemotherapy in 16, and both radiotherapy and chemotherapy in 5. The primary sites of metastases or invasion were nasopharyngeal carcinoma (n = 7), parotid gland carcinoma (n = 7), and metastases from systemic cancer (n = 23). The median target volume was 6.3 cm{sup 3} (range, 0.3-33.6), and the median margin dose was 14 Gy (range, 12-20). Results: At a mean of 12.9 months (range, 0.8-63.9), 32 patients had died and 5 were living. The overall survival rate after SRS was 36.6% and 19.4% at 1 and 2 years, respectively. Progression-free survival was related to a greater marginal dose. After SRS, 12 (35.3%) of 34 patients with neurologic symptoms exhibited improvement. SRS early after diagnosis was significantly associated with improvement of cranial nerve dysfunction. Conclusion: SRS is a minimally invasive palliative option for patients whose cancer has invaded the cavernous sinus. The benefits for cranial nerve deficits are best when SRS is performed early.

  9. Bilateral septic cavernous sinus thrombosis following the masticator and parapharyngeal space infection from the odontogenic origin: a case report.

    PubMed

    Kiddee, Weerawat; Preechawai, Passorn; Hirunpat, Siriporn

    2010-09-01

    Neglect of odontogenic infections can have serious consequences. If they spread through fascial planes and intracranially they can cause an abscess, orbital cellulitis, and eventually cavernous sinus thrombosis. The authors report a case of rapid progressive bilateral orbital cellulitis and cavernous sinus thrombosis that originated from dental caries. Septic cavernous sinus thrombosis is a medical emergency. Early recognition and prompt treatments direct to the underlying sources of infection are crucial. Broad-spectrum intravenous antibiotics are the mainstay of treatment to reduce morbidity and mortality from this lethal condition. Management should be based on early diagnosis and prompt management with intravenous broad-spectrum antibiotics and surgical intervention.

  10. Light and scanning electron microscopical study of the cavernous sinus of the monkey, Macaca fascicularis.

    PubMed Central

    Rajendran, K; Ling, E A

    1985-01-01

    The cavernous sinus of Macaca fascicularis is in many respects similar to the human sinus. It consists predominantly of one main venous channel that, together with the internal carotid artery, occupies a meningo-endocranial compartment lateral to the pituitary gland. Trabeculae are few and do not in any way cause the sinus to appear cavernous. They are mostly flattened in the direction of the main venous channel. Cranial nerves three, four, six and the ophthalmic division of five are all located in the lateral wall of the meningo-endocranial compartment with cranial nerve six located most medially adjacent to the internal carotid artery. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:4077687

  11. Contralateral transvenous approach and embolization with 360° guglielmi detachable coils for the treatment of cavernous sinus dural fistula

    PubMed Central

    Zenteno, Marco; Jorge, Santos-Franco; Rafael, Moscote-Salazar Luis; Raphael, AlvisMiranda Hernando; Gabriel, Alcala-Cerra; Ángel, Lee

    2015-01-01

    carotid-cavernous fistulas are spontaneours acquired connections between the carotid artery and the cavernous cavernous sinus, being classified as direct or indirect; being usually diagnosed in postmenopausal women, but are also associated with other pathoogies such as pregnancy, sinusitis and cavernous sinus thrombosis. They are clinically characterized by ophthalmological symptoms and pulsatile tinnitus. A 51-year-old woman who started her current condition about 4 years ago with pulsatile tinnitus, to which were added progressively: Pain, conjunctival erythema, right eye proptosis and the occasional headache of moderate intensity. Caotid-cavernous fistula wes diagnosed, for the technical difficulty inherent in the case was made a contralateral transvenous approach and embolization with 360° GDG coils, with successful evolution of the patient. The endovascular management of these lesions is currently possible with excellent results. PMID:25767589

  12. [Bilateral cavernous sinus non-Hodgkin's lymphoma as the presenting sign of acquired immunodeficiency syndrome: case report].

    PubMed

    Barreira Junior, Alan Kardec; Moura, Frederico Castelo; Monteiro, Mario Luiz Ribeiro

    2011-01-01

    Case report of bilateral cavernous sinus syndrome due to primary non-Hodgkin lymphoma of the central nervous system in a patient infected by the human immunodeficiency virus. A 51-year-old male patient infected by the human immunodeficiency virus but without antiretroviral treatment developed paralysis of the V and VI cranial nerves. Imaging studies were obtained to investigate an orbital apex and a cavernous sinus syndrome. A computerized tomography scan of the orbit was normal but a high-resolution magnetic resonance imaging demonstrated bilateral enlargement of the cavernous sinus. Although primary lymphoma of the central nervous system is a rare condition, it should be considered in the differential diagnosis in immunocompromised patients who develop ocular motility abnormalities and imaging signs suggestive of infiltrative cavernous sinus lesions.

  13. Association of Morbidity with Extent of Resection and Cavernous Sinus Invasion in Sphenoid Wing Meningiomas*

    PubMed Central

    Ivan, Michael E.; Cheng, Jason S.; Kaur, Gurvinder; Sughrue, Michael E.; Clark, Aaron; Kane, Ari J.; Aranda, Derick; McDermott, Michael; Barani, Igor J.; Parsa, Andrew T.

    2012-01-01

    Sphenoid wing meningiomas (SWMs) typically are histologically benign, insidious lesions, but the propensity of these tumors for local invasion makes disease control very challenging. In this review, we assess whether the degree of resection and extent of cavernous sinus invasion affects morbidity, mortality, and recurrence in patients with SWM. A comprehensive search of the English-language literature was performed. Patients were stratified according to extent of resection and extent of cavernous sinus invasion, and tumor recurrence rate, morbidity, and mortality were analyzed. A total of 23 studies and 131 patients were included. Overall recurrence and surgical mortality rate were 11% and 2%, respectively (average follow-up = 65 months). Cranial nerve III palsy was significantly associated with incompletely versus completely resected SWMs (7 to 0%) as well as meningiomas with cavernous sinus invasion versus no sinus invasion (14 vs. 0%). No significant difference in tumor recurrence rate was noted between these groups. In conclusion, complete excision of SWMs is always recommended whenever possible, but surgeons should acknowledge that there is nonetheless a chance of recurrence and should weigh this against the risk of causing cranial nerve injuries. PMID:23372999

  14. Phase II Study to Assess the Efficacy of Hypofractionated Stereotactic Radiotherapy in Patients With Large Cavernous Sinus Hemangiomas

    SciTech Connect

    Wang Xin; Liu Xiaoxia; Mei Guanghai; Dai Jiazhong; Pan Li; Wang Enmin

    2012-06-01

    Purpose: Cavernous sinus hemangioma is a rare vascular tumor. The direct microsurgical approach usually results in massive hemorrhage. Although radiosurgery plays an important role in managing cavernous sinus hemangiomas as a treatment alternative to microsurgery, the potential for increased toxicity with single-session treatment of large tumors is a concern. The purpose of this study was to assess the efficacy of hypofractionated stereotactic radiotherapy in patients with large cavernous sinus hemangiomas. Methods: Fourteen patients with large (volume >20 cm{sup 3}) cavernous sinus hemangiomas were enrolled in a prospective Phase II study between December 2007 and December 2010. The hypofractionated stereotactic radiotherapy dose was 21 Gy delivered in 3 fractions. Results: After a mean follow-up of 15 months (range, 6-36 months), the magnetic resonance images showed a mean of 77% tumor volume reduction (range, 44-99%). Among the 6 patients with cranial nerve impairments before hypofractionated stereotactic radiotherapy, 1 achieved symptomatic complete resolution and 5 had improvement. No radiotherapy-related complications were observed during follow-up. Conclusion: Our current experience, though preliminary, substantiates the role of hypofractionated stereotactic radiotherapy for large cavernous sinus hemangiomas. Although a longer and more extensive follow-up is needed, hypofractionated stereotactic radiotherapy of 21 Gy delivered in 3 fractions is effective in reducing the tumor volume without causing any new deficits and can be considered as a treatment modality for large cavernous sinus hemangiomas.

  15. Transverse and Sigmoid Sinus Dural Arteriovenous Fistula Mimicking Idiopathic Intracranial Hypertension and Carotid Cavernous Fistula.

    PubMed

    Spitze, Arielle; Gersztenkorn, David; Al-Zubidi, Nagham; Yalamanchili, Sushma; Diaz, Orlando; Lee, Andrew G

    2014-01-01

    Intracranial dural arteriovenous fistulas (dAVFs) can produce a variety of symptoms depending on fistula location, size, and venous drainage. Although cavernous sinus fistulas (CCFs) classically present with symptoms of orbital venous congestion due to retrograde venous drainage into the superior ophthalmic vein (i.e. an arterialised "red eye") (Miller NR. Neurosurg Focus 2007;23:1--15), dAVFs not localised to the cavernous sinus rarely present with a "red eye" and instead produce increased intracranial pressure, which can mimic idiopathic intracranial hypertension (IIH). The authors present a unique case of an intracranial dAVF with clinical features suggestive of both CCF and IIH. Clinicians should be aware of this possibility to avoid delayed diagnosis of the intracranial dAVF.

  16. Resolution of Trigeminal Neuralgia After Transvenous Embolization of a Cavernous Sinus Dural Arteriovenous Fistula.

    PubMed

    Fukutome, Kenji; Nakagawa, Ichiro; Park, Hun Soo; Wada, Takeshi; Motoyama, Yasushi; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2017-02-01

    Trigeminal neuralgia (TN) resulting from a dural arteriovenous fistula (DAVF) are rare. A case of cavernous sinus dural arteriovenous fistula (CSDAVF) in a patient with TN that resolved immediately after transvenous embolization (TVE) is described. A 75-year-old woman presented with continuous facial pain. On time-of-flight magnetic resonance angiography (MRA), a CSDAVF was suspected, and digital subtraction angiography (DSA) showed a CSDAVF. The TN completely resolved immediately after TVE, with no recurrence. Follow-up MRA showed complete obliteration of the fistula 13 months after TVE. The pulsatile flow at the posteromedial part of the cavernous sinus might have compressed the upper aspect of the Gasserian ganglion, causing TN. Disappearance of pulsatile flow after TVE might result in complete resolution of TN. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Linear accelerator radiosurgery for meningiomas in and around the cavernous sinus.

    PubMed

    Spiegelmann, Roberto; Nissim, Ouzi; Menhel, Janna; Alezra, Dror; Pfeffer, M Raphael

    2002-12-01

    A retrospective study to evaluate the efficacy and side effects of linear accelerator radiosurgery in the treatment of cavernous sinus meningiomas. Between 1993 and 2001, 42 patients with meningiomas involving the cavernous sinus underwent linear accelerator radiosurgery at our institution. A mean radiation dose of 14 Gy was delivered to the tumor margin. The median tumor volume was 8.2 cm3 (mean, 8.4 cm3). Median follow-up was 36 months (mean, 38 mo). Control of tumor growth was achieved in 97.5% of the patients. There was no mortality or permanent extraocular motor or pituitary dysfunction. Treatment-related complications included new trigeminal neuropathy in 4.7% and a new visual field defect in 2.8%. Two patients required shunt placement after developing hydrocephalus. One patient with symptomatic temporal lobe edema underwent partial excision of the tumor. Improvement of existing cranial neuropathies was noted in 29% of affected trigeminal nerves, in 22% of oculomotor nerves, and in 13% of Cranial Nerves IV and VI. This study indicates that linear accelerator radiosurgery can achieve a high control rate of meningiomas involving the cavernous sinus with no mortality and a low incidence of morbidity.

  18. Transarterial Onyx Embolization for Patients with Cavernous Sinus Dural Arteriovenous Fistulas Who Have Failed Transvenous Embolization.

    PubMed

    Wen, Jun; Duan, Chuan-Zhi; Huang, Li-Jing; Zhang, Xin; He, Xu-Ying; Li, Xi-Feng

    2015-09-01

    Transvenous embolization is the treatment of choice for cavernous sinus dural arteriovenous fistulas (csDAVFs) despite occasional difficulty in transvenous catheterization. We reported our experience in the treatment of csDAVFs by transarterial Onyx embolization in patients who had failed transvenous catheterization. We reviewed the clinical and radiographic records of csDAVFs patients receiving transarterial Onyx embolization after failed transvenous Onyx embolization at our institution over a period of 31 months. Success was defined as complete or near complete occlusion upon angiographic examination. In seven cases, the microcatheter failed to reach the cavernous sinus; in the remaining case, the internal jugular vein was occlusive. Eight sessions of the embolization and catheterization procedures via the arterial routes were conducted. Among them, five cases via the middle meningeal artery and the other three via the accessory meningeal artery. Angiography, immediately after embolization, revealed complete occlusion in seven cases (87.5 %) and partial occlusion in the remaining case. Angiographic follow-up (range, 6-10 months) showed that all patients achieved complete embolization. In cases where transvenous embolization of the cavernous sinus is difficult, transarterial embolization of the fistulas offers a safe and effective alternative.

  19. [Interesting radiological and pathological findings of the internal carotid artery observed in a case of cavernous sinusitis (author's transl)].

    PubMed

    Moriyama, T; Fujita, Y; Ono, H; Mori, K

    1977-06-01

    A 47-year-old man was admitted to the neurosurgical department of Nagasaki University Hospital with complaints of high fever, deteriorated conciousness and nonpulsating exophthalmus on the left side. The first carotid angiography which had been done 2 days prior to admission, showed only an irregular narrowing in the cavernous portion of the left carotid artery. The right carotid angiogram did not show any recognizable abnormality. The second angiography which was performed 4 days after the admission, revealed an cylindrical aneurysmal opacification about 0.8 cm in diameter in the left intracavernous portion. The right angiography could not be done at that time. On the 47th hospital day, the third angiogram was performed. There noted again, the aneurysmal opacification in the left carotid artery and furthermore, the right carotid artery was occluded completely at its entrance into the cavernous sinus. On post-mortem examination, the cavernous sinus was filled with coagulated blood which drived from the ruptured left internal carotid artery. Microscopic examination revealed marked invasion of leucocytes to the wall of the internal carotid artery at the cavernous portion in both sides. These findings suggested that a mycotic aneurysm which resulted from the cavernous sinusitis ruptured into the left cavernous sinus and spelled blood compressed the opposite (right) carotid artery within the carvernous sinus which resulted in occlusion of the artery.

  20. Paraclinoid and cavernous sinus regions: measurement of critical structures relevant for surgical procedure.

    PubMed

    Collignon, Frederic; Link, Michael

    2005-01-01

    Determination of the safest distance the falciform ligament can be incised from its origin to the orbital apex. Measurement of the distance between the oculomotor foramen and the IV nerve in the lateral wall of the cavernous sinus. Evaluation of the optic strut as an accurate landmark between the intradural (subarachnoid) and extradural segment of the internal carotid artery (ICA). Ten fixed human cadaver heads were examined for a total of 20 sides. A frontotemporal craniotomy, an orbito-optic osteotomy, and extradural anterior clinoidectomy were carried out followed by opening the falciform ligament, circumferentially releasing the distal dural ring and dissection of the lateral wall of the cavernous sinus under the operating microscope. We measured: 1) the distance between the entry of the III nerve and the point where the IV nerve crosses over it into the cavernous sinus; 2) the distance the falciform ligament can be incised along the optic nerve laterally until the IV nerve is encountered at the orbital apex; 3) the distance between the optic strut and the lateral part of the distal dural ring; and 4) the distance between the optic strut and the ophthalmic artery. All measurements were made in millimeters, using small calipers. The distance between the optic strut and the lateral part of the distal dural ring ranges from 3-7.5 mm (mean=5.47 mm). In all our specimens, the ophthalmic artery was found distally from the optic strut in the intradural space at a distance ranging from 0.5-7 mm (mean=3.35 mm). The distance between the entry of the third nerve and the IV nerve into the cavernous sinus ranged from 7-15 mm (mean=10.9 mm). The distance between the origin of the falciform ligament and the IV nerve at the level of the orbital apex ranged from 9-15 mm (mean=10.75 mm). The falciform ligament and the optic sheath should not be opened longer than 9 mm along the lateral optic nerve or injury to the IV nerve can occur. Starting at the oculomotor foramen, the

  1. Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas

    SciTech Connect

    Pollock, Bruce E. . E-mail: pollock.bruce@mayo.edu; Stafford, Scott L.

    2005-08-01

    Introduction: The purpose of this study was to evaluate the efficacy and safety of stereotactic radiosurgery as primary management for patients with imaging defined cavernous sinus meningiomas. Methods: Between 1992 and 2001, 49 patients had radiosurgery for dural-based masses of the cavernous sinus presumed to be meningiomas. The mean patient age was 55.5 years. The mean tumor volume was 10.2 mL; the mean tumor margin dose was 15.9 Gy. The mean follow-up was 58 months (range, 16-144 months). Results: No tumor enlarged after radiosurgery. Twelve of 38 patients (26%) with preexisting diplopia or facial numbness/pain had improvement in cranial nerve function. Five patients (10%) had new (n = 3) or worsened (n = 2) trigeminal dysfunction; 2 of these patients (4%) underwent surgery at 20 and 25 months after radiosurgery despite no evidence of tumor progression. Neither patient improved after partial tumor resection. One patient (2%) developed an oculomotor nerve injury. One patient (2%) had an ischemic stroke related to occlusion of the cavernous segment of the internal carotid artery. Event-free survival was 98%, 85%, and 80% at 1, 3, and 7 years after radiosurgery, respectively. Univariate analysis of patient and dosimetric factors found no analyzed factor correlated with postradiosurgical morbidity. Conclusions: Radiosurgery was an effective primary management strategy for patients with an imaging defined cavernous sinus meningioma. Except in situations of symptomatic mass effect, unusual clinical presentation, or atypical imaging features, surgery to confirm the histologic diagnosis is unlikely to provide clinical benefit.

  2. The treatment of cavernous sinus meningiomas: evolution of a modern approach.

    PubMed

    Klinger, Daniel R; Flores, Bruno C; Lewis, Jeremy J; Barnett, Samuel L

    2013-12-01

    Cavernous sinus meningiomas (CSMs) are challenging lesions for the skull base neurosurgeon to manage given their close association with cranial nerves II-VI and the internal carotid artery. In the 1980s and early 1990s, with advancements in microsurgical techniques, increasing knowledge of the relevant microsurgical neuroanatomy, and the advent of advanced skull base surgical approaches, the treatment of CSMs involved attempts at gross-total resection (GTR). Initial fervor for a surgical cure waned, however, as skull base neurosurgeons demonstrated the limits of complete resection in this region, the ongoing issue of potential tumor recurrences, and the unacceptably high cranial nerve and vascular morbidity associated with this strategy. The advent of radiosurgery and its documented success for tumor growth control and limited morbidity in cavernous lesions has helped to shift the treatment goals for CSMs from GTR to tumor control and symptom relief while minimizing treatment- and lesion-associated morbidity. The authors review the relevant microanatomy of the cavernous sinus with anatomical and radiographic correlates, as well as the various treatment options. A modernized, multimodality treatment algorithm to guide management of these lesions is proposed.

  3. A rare presentation of central nervous system in a pediatric patient with Hodgkin disease: cavernous sinus syndrome.

    PubMed

    Alioglu, Bulent; Ustun, Huseyin; Sonmez, Akif; Kaplan, Hacer; Arikan, Fatma Inci; Dallar, Yildiz

    2009-10-01

    Intracranial involvement by Hodgkin disease is rare. We report a pediatric patient with Hodgkin disease who had intracranial disease at presentation. The patient was referred to our hospital with a suspicion of central nervous system tumor. Although the most common presenting feature of intracranial Hodgkin disease is cranial nerve palsy with brain parenchyma being the most common intracranial site of involvement, to our best knowledge no pediatric case of Hodgkin disease presented with isolated cavernous sinus syndrome reported. We report this rare case because of its unusual presentation, in which Hodgkin disease presented with cavernous sinus syndrome. Physicians should consider the probability of Hodgkin disease in children of all ages who present with cavernous sinus syndrome.

  4. Metalloproteinases ADAM12 and MMP-14 are associated with cavernous sinus invasion in pituitary adenomas.

    PubMed

    Wang, Junwen; Voellger, Benjamin; Benzel, Julia; Schlomann, Uwe; Nimsky, Christopher; Bartsch, Jörg W; Carl, Barbara

    2016-09-15

    Invasion of tumor cells critically depends on cell-cell or cell-extracellular matrix interactions. Enzymes capable of modulating these interactions belong to the proteinase families of ADAM (a disintegrin and metalloprotease) and MMP (matrix metalloprotease) proteins. Our objective is to examine their expression levels and evaluate the relationship between expression levels and cavernous sinus invasion in pituitary adenomas. Tissue samples from 35 patients with pituitary adenomas were analyzed. Quantitative real-time polymerase chain reaction (qPCR) was employed to assess mRNA expression levels for ADAM and MMP genes. Protein levels were examined using immunohistochemistry and Western Blot. Correlation analyses between expression levels and clinical parameters were performed. By silencing ADAM12 and MMP-14 with siRNA in a mouse pituitary adenoma cell line (TtT/GF), their cellular effects were investigated. In our study, nine women and 26 men were included, with a mean age of 53.1 years (range 15-84 years) at the time of surgery. There were 19 cases with cavernous sinus invasion. The proteins ADAM12 and MMP-14 were significantly up-regulated in invasive adenomas compared to noninvasive adenomas. Both human isoforms of ADAM12 (ADAM12L and ADAM12s) were involved in tumor invasion; moreover, ADAM12L was found to correlate positively with Ki-67 proliferation index in pituitary adenomas. In TtT/GF pituitary adenoma cells, silencing of ADAM12 and MMP-14 significantly inhibited cell invasion and migration, respectively, whereas only silencing of ADAM12 suppressed cell proliferation. We conclude that ADAM12 and MMP-14 are associated with cavernous sinus invasion in pituitary adenomas, which qualifies these proteins in diagnosis and therapy.

  5. Carotid and cranial nerve reconstruction after removal of cavernous sinus lesions.

    PubMed

    Sekhar, L N; Sen, C N; Lanzino, G; Pomonis, S

    1991-12-01

    During the last 7 years, approximately 170 neoplasms, and 35 vascular lesions involving the cavernous sinus were treated by the first two authors. During the treatment of such lesions, the direct vein graft reconstruction of the internal carotid artery from the petrous to the supraclinoid or infraclinoid ICA was performed in 23 patients. Graft occlusion occurred in 3 patients and in one of these, it was successfully salvaged by placing a long venous graft from the extracranial ICA to the M3 segment of the middle cerebral artery. The latter 3 patients were neurologically normal. One patient with significant atherosclerotic disease suffered the dissection of the distal internal carotid artery with the graft being patent. The suturing technique. This patient eventually died. Two patients with severely compromised collateral circulation suffered minor strokes due to the temporary occlusion of the ICA. This has been avoided in the more recent patients by the adoption of brain protection techniques such as moderate hypothermia, induced hypertension, and barbiturate coma. Low dose heparin therapy during grafting and high dose intravenous steroids prior to the grafting also appear to be beneficial. Direct vein graft reconstruction of the intracavernous carotid artery is a valuable tool during the management of cavernous sinus lesions. The advantages and disadvantages of this technique as well as the pros and cons of other revascularization techniques will be discussed. During microsurgical removal of cavernous sinus lesions, the cranial nerves III-VI were reconstructed by direct resuture or by nerve grafting in 16 patients. In the majority of these patients, recovery of cranial nerve function was observed, which was very encouraging.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Limited endoscopic transsphenoidal approach for cavernous sinus biopsy: illustration of 3 cases and discussion.

    PubMed

    Graillon, T; Fuentes, S; Metellus, P; Adetchessi, T; Gras, R; Dufour, H

    2014-01-01

    Advances in transsphenoidal surgery and endoscopic techniques have opened new perspectives for cavernous sinus (CS) approaches. The aim of this study was to assess the advantages and disadvantages of limited endoscopic transsphenoidal approach, as performed in pituitary adenoma surgery, for CS tumor biopsy illustrated with three clinical cases. The first case was a 46-year-old woman with a prior medical history of parotid adenocarcinoma successfully treated 10 years previously. The cavernous sinus tumor was revealed by right third and sixth nerve palsy and increased over the past three years. A tumor biopsy using a limited endoscopic transsphenoidal approach revealed an adenocarcinoma metastasis. Complementary radiosurgery was performed. The second case was a 36-year-old woman who consulted for diplopia with right sixth nerve palsy and amenorrhea with hyperprolactinemia. Dopamine agonist treatment was used to restore the patient's menstrual cycle. Cerebral magnetic resonance imaging (MRI) revealed a right sided CS tumor. CS biopsy, via a limited endoscopic transsphenoidal approach, confirmed a meningothelial grade 1 meningioma. Complementary radiosurgery was performed. The third case was a 63-year-old woman with progressive installation of left third nerve palsy and visual acuity loss, revealing a left cavernous sinus tumor invading the optic canal. Surgical biopsy was performed using an enlarged endoscopic transsphenoidal approach to the decompress optic nerve. Biopsy results revealed a meningothelial grade 1 meningioma. Complementary radiotherapy was performed. In these three cases, no complications were observed. Mean hospitalization duration was 4 days. Reported anatomical studies and clinical series have shown the feasibility of reaching the cavernous sinus using an endoscopic endonasal approach. Trans-foramen ovale CS percutaneous biopsy is an interesting procedure but only provides cell analysis results, and not tissue analysis. However, radiotherapy and

  7. A PROSPECTIVE STUDY OF CAVERNOUS SINUS SURGERY FOR MENINGIOMAS AND RESULTANT COMMON OPHTHALMIC COMPLICATIONS (AN AMERICAN OPHTHLAMOLOGICAL SOCIETY THESIS)

    PubMed Central

    Newman, Steven

    2007-01-01

    Purpose Cavernous sinus surgery is considered neurosurgically feasible. A systematic review of patients undergoing cavernous sinus procedures for meningioma was undertaken to determine whether cavernous sinus surgery could be performed with an acceptable level of iatrogenic-induced dysfunction. Methods Fifty-six patients undergoing 57 cavernous sinus surgical procedures performed by a single senior neurosurgeon were systematically evaluated to determine the consequences of surgery. Quantitative assessment of afferent (acuity, fields, pupil) and efferent function was stressed. Results Five of 20 patients (25%) with preoperative optic nerve dysfunction improved, but vision worsened in 6 (30%), including 4 (20%) whose vision deteriorated to no light perception. Four (11%) of 37 patients developed newly acquired optic neuropathy. No patients with preoperative third nerve palsies (19) cleared, although one improved. All 57 patients had evidence of some cranial nerve dysfunction (III, IV, V, or VI) immediately after surgery. Eight patients with long-term follow-up had complete sixth nerve palsies (7 preoperatively), and 4 had complete third nerve dysfunction (none in patients normal preoperatively). Nine (16%) had evidence of aberrant regeneration of the third nerve, and 12 (21%) developed neurotrophic keratitis. Conclusions Cavernous sinus surgery results in transient worsening of third, fourth, fifth, and sixth cranial nerve function. Cavernous sinus surgery carries a high risk of worsening ocular motor disorders and producing new ones. Preexisting cranial nerve dysfunction (other than optic nerve) rarely improves. Patients and physicians should be aware of the potential for ophthalmic complications in addition to the more generalized risks of neurosurgery (eg, cerebrospinal fluid leak, infection, stroke). PMID:18427624

  8. Distribution of otic postganglionic and recurrent mandibular nerve fibres to the cavernous sinus plexus in monkeys.

    PubMed Central

    Ruskell, G L

    1993-01-01

    The distribution of dorsal rami of the otic ganglion was traced on one or both sides of 1 rhesus and 15 cynomolgus monkeys using interrupted serial sections. From 15 to 24 fine rami containing unmyelinated and small myelinated nerve fibres entered the cranial cavity with the mandibular nerve through the foramen ovale. Most rami contributed to a plexus positioned in the crotch of the mandibular and maxillary nerves adjacent to the trigeminal ganglion. The plexus was augmented by an accessory otic ganglion. Rami then continued dorsally on each side of or through the maxillary nerve and joined the cavernous sinus plexus. The pathway described probably gives otic parasympathetic fibres access to the cerebral arteries and may share a wider distribution in common with other nerves contributing to the cavernous sinus plexus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Figs. 13,15 Fig. 14 PMID:8376193

  9. Histiocytic sarcoma of the cavernous sinus: case report and literature review.

    PubMed

    Chen, Ching-Jen; Williams, Erik A; McAneney, Taylor E; Williams, Brian J; Mandell, James W; Shaffrey, Mark E

    2015-01-01

    Histiocytic sarcoma is a rare malignant neoplasm of hematopoietic origin composed of cells showing morphologic and immunophenotypic evidence of histiocytic differentiation. We describe the 2nd case of primary histiocytic sarcoma of the cavernous sinus/Meckel's cave, and the 8th case involving the CNS. A 61-year-old Caucasian man presented with numbness on the entire left side of his face, shooting pain in the left frontal region, and headaches. Imaging revealed an enhancing extra axial soft tissue mass located in the left cavernous sinus and left Meckel's cave. Diagnosis was established through open biopsy, after failed attempts via CT-guided trans-foramen ovale fine-needle aspiration biopsy and keyhole biopsy. The tumor was composed of large non-cohesive epithelioid cells invading nerves and ganglion cells. Tumor cells were immunopositive for CD68, CD163, and immunonegative for the anaplastic large cell lymphoma marker ALK-1 as well as other lymphoid, myeloid, and dendritic cell markers. Histiocytic sarcoma has strong potential for systemic spread; early diagnosis and treatment are important. Our patient was initially treated with radiation therapy but subsequently developed metastases.

  10. Fractionated Stereotactic Radiotherapy Treatment of Cavernous Sinus Meningiomas: A Study of 100 Cases

    SciTech Connect

    Litre, Claude Fabien Colin, Philippe; Noudel, Remy; Peruzzi, Philippe; Bazin, Arnaud; Sherpereel, Bernard; Bernard, Marie Helene; Rousseaux, Pascal

    2009-07-15

    Purpose: We discuss our experiences with fractionated stereotactic radiotherapy (FSR) in the treatment of cavernous sinus meningiomas. Methods and Materials: From 1995 to 2006, we monitored 100 patients diagnosed with cavernous sinus meningiomas; 84 female and 16 male patients were included. The mean patient age was 56 years. The most common symptoms were a reduction in visual acuity (57%), diplopia (50%), exophthalmy (30%), and trigeminal neuralgia (34%). Surgery was initially performed on 26 patients. All patients were treated with FSR. A total of 45 Gy was administered to the lesion, with 5 fractions of 1.8 Gy completed each week. Patient treatment was performed using a Varian Clinac linear accelerator used for cranial treatments and a micro-multileaf collimator. Results: No side effects were reported. Mean follow-up period was 33 months, with 20% of patients undergoing follow-up evaluation of more than 4 years later. The tumor control rate at 3 years was 94%. Three patients required microsurgical intervention because FSR proved ineffective. In terms of functional symptoms, an 81% improvement was observed in patients suffering from exophthalmy, with 46% of these patients being restored to full health. A 52% improvement was observed in diplopia, together with a 67% improvement in visual acuity and a 50% improvement in type V neuropathy. Conclusions: FSR facilitates tumor control, either as an initial treatment option or in combination with microsurgery. In addition to being a safe procedure with few side effects, FSR offers the significant benefit of superior functional outcomes.

  11. Cavernous sinus tuberculoma mimicking a neoplasm: Case report, literature review, and diagnostic and treatment suggestions for tuberculomas in rare locations

    PubMed Central

    Jaimovich, Sebastián G.; Thea, Victor Castillo; Guevara, Martin; Gardella, Javier L.

    2013-01-01

    Background: Cavernous sinus tuberculomas are extremely rare, but the increasing incidence worldwide of central nervous system (CNS) tuberculosis, mostly due to human immunodeficiency virus and poor sanitary conditions, and the ability of tuberculomas to mimic a brain neoplasm makes cavernous sinus tuberculomas a suspicious pathologic finding in the differential diagnosis of a brain space-occupying lesion. Case Description: We present an immunocompetent patient with no signs of systemic tuberculosis and an isolated right cavernous sinus space-occupying lesion. A skull base approach was performed and tumor resection achieved. The postoperative course was uneventful. Pathologic findings consisted of a tuberculoma and antituberculous treatment was immediately begun with total tumor regression after a 12-month regimen. After reviewing the literature, we propose suggestions to orient the diagnosis and a treatment algorithm for tuberculomas in rare locations. Conclusion: Tuberculomas in rare locations, as the cavernous sinus, are a challenging pathology as they have the ability to mimic a brain neoplasm. Although first line treatment are antituberculous therapy (4 drugs for at least 12 months) and adjuvant steroids, in inconclusive cases, surgical biopsy or excision is recommended for histopathologic confirmation and to reduce the mass effect, always following with antituberculous therapy and adjuvant steroids. PMID:24381801

  12. Endovascular treatment of traumatic carotid cavernous fistula with balloon-assisted sinus coiling. A technical description and initial results.

    PubMed

    Andrade, Gustavo; Ponte De Souza, Moysés L; Marques, Romero; Silva, José Laércio; Abath, Carlos; Azevedo-Filho, Hildo R C

    2013-12-01

    This study aimed to propose an alternative treatment for carotid cavernous fistula (CCF) using the balloon-assisted sinus coiling (BASC) technique and to describe this procedure in detail. Under general anesthesia, we performed the BASC procedure to treat five patients with traumatic CCF. Percutaneous access was obtained via the right femoral artery, and a 7F sheath was inserted, or alternatively, a bifemoral 6F approach was accomplished. A microcatheter was inserted into the cavernous sinus over a 0.014-inch microwire through the fistulous point; the microcatheter was placed distal from the fistula point, and a "U-turn" maneuver was performed. Through the same carotid access, a compliant balloon was advanced to cross the point of the fistula and cover the whole carotid tear. Large coils were inserted using the microcatheter in the cavernous sinus. Coils filled the adjacent cavernous sinus, respecting the balloon. Immediate complete angiographic resolution was achieved, and an early angiographic control (mean = 2.6 months) indicated complete stability without recanalization. The clinical follow-up has been uneventful without any recurrence (mean = 15.2 months). An endovascular approach is optimal for direct CCF. Because the detachable balloon has been withdrawn from the market, covered stenting requires antiplatelet therapy and its patency is unconfirmed, but cavernous sinus coiling remains an excellent treatment option. Currently, there is no detailed description of the BASC procedure. We provide detailed angiograms with suitable descriptions of the exact fistula point, and venous drainage pathways. Familiarity with these devices makes this technique effective, easy and safe.

  13. Cavernous sinus thrombosis syndrome and brainstem involvement in patient with leptospirosis: Two rare complications of leptospirosis

    PubMed Central

    Alian, Shahriyar; Taghipour, Mehrdad; Sharifian, Rayka; Fereydouni, Mohammad Amin

    2014-01-01

    Leptospirosis is a bacterial disease that is caused by pathogenic spirochetes of the genus Leptospira. It can affect humans and animals. In humans, it can lead to a wide spectrum of symptoms. It is known as the most common zoonosis in the world. The typical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Less common clinical manifestations may result from involvement of different human body systems. In many places, this disease may be under-diagnosed, especially when associated with neurological complications. Moreover, without treatment, leptospirosis can lead to organ damages, and even death. Neurological complications are uncommon and are reported in a few cases. Cavernous sinus thrombosis syndrome and brainstem involvement are rare complications of leptospirosis and are associated with a high mortality risk. To our knowledge, no such cases have been reported in the literature. PMID:25535508

  14. Cavernous sinus thrombosis syndrome and brainstem involvement in patient with leptospirosis: Two rare complications of leptospirosis.

    PubMed

    Alian, Shahriyar; Taghipour, Mehrdad; Sharifian, Rayka; Fereydouni, Mohammad Amin

    2014-09-01

    Leptospirosis is a bacterial disease that is caused by pathogenic spirochetes of the genus Leptospira. It can affect humans and animals. In humans, it can lead to a wide spectrum of symptoms. It is known as the most common zoonosis in the world. The typical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Less common clinical manifestations may result from involvement of different human body systems. In many places, this disease may be under-diagnosed, especially when associated with neurological complications. Moreover, without treatment, leptospirosis can lead to organ damages, and even death. Neurological complications are uncommon and are reported in a few cases. Cavernous sinus thrombosis syndrome and brainstem involvement are rare complications of leptospirosis and are associated with a high mortality risk. To our knowledge, no such cases have been reported in the literature.

  15. [Cranio-orbital zygomatic extradural approach for cavernous sinus or Meckel's cave tumors].

    PubMed

    Kinjo, T; Mukawa, J; Mekaru, S; Koga, H

    1996-06-01

    Direct surgery to cavernous sinus (CS) lesions has become one of the optimal treatments based on advancement in microsurgical anatomy and imaging modality, and the progress of microsurgical techniques. We have removed the CS or Meckel's cave tumors extradurally when they do not extend intradurally, using modified Al-Mefty's cranio-orbital zygomatic craniotomy. Three CS tumors; trigeminal neurofibroma, squamous cell carcinoma and chondrosarcoma, and a Meckel's cave meningioma were reported. Total removal was achieved in all but one (case 4). Postoperative complications were permanent ophthalmoplegia in one, transient ophthalmoplegia in one, subcutaneous CSF accumulation in two and trigeminal dysfunction in one. The extradural approach can be the first choice of methods for total removal of tumors when they are confined to the CS or Meckel's cave.

  16. Cavernous sinus lesions biopsy with neuronavigation and tip-cut needle

    PubMed Central

    Lorenzetti, Martin; Carvalho, Herculano; Cattoni, Maria; Gonçalves-Ferreira, Antonio; Pimentel, José; Antuñes, Joao

    2014-01-01

    Background: Transoval biopsy of cavernous sinus (CS) lesions is the last non-invasive diagnostic option in those 15% of patients in whom etiology remains unclear in spite of extensive neuroradiological imaging, clinical assessment, and laboratory evaluation. However, there are no guidelines defining indications and the most appropriate technique for this procedure. Case Description: We present four patients in whom we performed X-ray and neuronavigation-assisted transoval CS biopsies using tip-cut needles. Conclusion: The technique described allows the operator to determine the optimal angle for entering the CS, avoiding the complications due to distorted anatomy, and facilitating orientation once inside the CS. It reduces both radiation exposure as well as general anesthesia duration. PMID:25593783

  17. A review of eight cases of cavernous sinus thrombosis secondary to sphenoid sinusitis, including a12-year-old girl at the present department.

    PubMed

    Wang, Yun-Hu; Chen, Po-Yen; Ting, Pei-Ju; Huang, Fang-Liang

    2017-09-01

    Cavernous sinus thrombosis (CST) is a severe disease which can result from infection of any of the tissues drained by the cavernous sinus. We here review eight cases, including a 12-year-old girl, all secondary to sphenoid sinusitis. The clinical manifestations, laboratory data, imaging findings, pathogens, medications, surgical treatment and clinical outcomes were analyzed. All eight patients had headache and five of them fever. All cases were associated with one or more ophthalmic symptoms. In four cases, computed tomography/magnetic resonance imaging showed isolated sphenoid sinusitis. In three cases, streptococci were isolated from blood culture and two cases showed Staphylococcus aureus in blood and sinus cultures. In seven cases, surgery was undertaken. All eight subjects received antibiotics, and 5 were administered intravenous ceftriaxone and metronidazole. Six subjects received anticoagulation therapy and one received corticosteroids. No mortality was recorded. Three cases showed sequelae, including Lemierre syndrome, ophthalmic complaints, and cranial nerve paralysis. In conclusion, the management of CST should include intravenous antibiotic therapy, combined with endonasal sinus surgery.

  18. Anatomical study of the cavernous sinus emphasizing operative approaches and related vascular and neural reconstruction.

    PubMed

    Sekhar, L N; Burgess, J; Akin, O

    1987-12-01

    The efficacy of three operative approaches to the cavernous sinus (CS) and the possibilities of vascular and cranial nerve reconstruction in and around the CS were studied in 50 cadaver specimens (25 heads). The lateral operative approach was through the lateral wall, between Cranial Nerves V1 and IV, or between Cranial Nerves V1 and V2. The superior approach was through the superior wall of the CS after removing the anterior clinoid process and unroofing the optic canal. The inferior approach followed the petrous internal carotid artery (ICA) into the CS after an extradural subtemporal exposure or after a combined subtemporal and infratemporal fossa exposure. The different exposures of the spaces of the CS and of the intracavernous structures provided by the superior and the lateral approaches were complementary. The exposure provided by the inferior approach was minimal; however, the junction of the petrous and cavernous ICA was best exposed by this route. The combined subtemporal and infratemporal fossa approach exposed the petrous ICA (for proximal control or for reconstruction) with the greatest ease and with the least temporal lobe retraction. The combination of the superior and lateral approaches and the complete mobilization of the intracavernous ICA facilitated its repair after experimental lacerations. Lacerations of either the inferior and the inferomedial aspects of any portion of the cavernous ICA or of the anterior surface of the posterior vertical segment of the artery were the most difficult to repair. End-to-end anastomosis was more difficult with the posterior third of the artery than with the anterior two-thirds. A vein graft with an average length of 3.5 cm could be sutured from the petrous to the supraclinoid ICA to bypass the cavernous ICA, with an average occlusion time of 45 minutes. End-to-end technique was judged better for the proximal anastomosis, but end (graft)-to-side anastomosis was easier to perform at the distal end because of the

  19. Therapeutic Strategy for Cavernous Sinus-Invading Non-Functioning Pituitary Adenomas Based on the Modified Knosp Grading System.

    PubMed

    Hwang, Juyoung; Seol, Ho Jun; Nam, Do-Hyun; Lee, Jung-Il; Lee, Min Ho; Kong, Doo-Sik

    2016-10-01

    Non-functioning pituitary adenomas (NFPA) invading into the cavernous sinus are surgically challenging. To decrease recurrence rate, surgeon makes a strong endeavor to resect tumor gross totally. However, gross total resection (GTR) is difficult to achieve with cavernous sinus invasion. Recently, a new classification system for cavernous invasion of pituitary adenomas was suggested. The aim of this study is to validate this new classification system and to identify limitations and considerations in designing treatment strategies for patients with NFPA involving the cavernous sinus. Between January 2000 and January 2012, 275 patients who underwent operation for NFPA were enrolled in the study. Median age was 50 years (15-79 years). There were 145 males and 130 females. The median follow-up duration was 4 years (range 1-12.5 years). Related to extent of tumor removal, GTR was obtained in 184 patients (66.9%), near total resection (NTR) was obtained in 45 patients (16.3%), and sub-total resection (STR) was obtained in 46 patients (16.7%) of a total 275 patients. There were statistically significant differences between the extent of resection and the new Knosp classification (p<0.001). In the high-grade group of the new Knosp classification, there was no difference in recurrence between patients who underwent GTR or NTR only and those who underwent STR with adjuvant radiation therapy (p=0.515). In case of high risk of surgical complications, STR with adjuvant radiation therapy can be considered as an alternative strategy for safe treatment of cavernous-invading adenomas.

  20. Therapeutic Strategy for Cavernous Sinus-Invading Non-Functioning Pituitary Adenomas Based on the Modified Knosp Grading System

    PubMed Central

    Hwang, Juyoung; Seol, Ho Jun; Nam, Do-Hyun; Lee, Jung-Il

    2016-01-01

    Background Non-functioning pituitary adenomas (NFPA) invading into the cavernous sinus are surgically challenging. To decrease recurrence rate, surgeon makes a strong endeavor to resect tumor gross totally. However, gross total resection (GTR) is difficult to achieve with cavernous sinus invasion. Recently, a new classification system for cavernous invasion of pituitary adenomas was suggested. The aim of this study is to validate this new classification system and to identify limitations and considerations in designing treatment strategies for patients with NFPA involving the cavernous sinus. Methods Between January 2000 and January 2012, 275 patients who underwent operation for NFPA were enrolled in the study. Median age was 50 years (15–79 years). There were 145 males and 130 females. The median follow-up duration was 4 years (range 1–12.5 years). Results Related to extent of tumor removal, GTR was obtained in 184 patients (66.9%), near total resection (NTR) was obtained in 45 patients (16.3%), and sub-total resection (STR) was obtained in 46 patients (16.7%) of a total 275 patients. There were statistically significant differences between the extent of resection and the new Knosp classification (p<0.001). In the high-grade group of the new Knosp classification, there was no difference in recurrence between patients who underwent GTR or NTR only and those who underwent STR with adjuvant radiation therapy (p=0.515). Conclusion In case of high risk of surgical complications, STR with adjuvant radiation therapy can be considered as an alternative strategy for safe treatment of cavernous-invading adenomas. PMID:27867914

  1. Narrowing of Meckel's cave and cavernous sinus and enlargement of the optic nerve sheath in Pseudotumor Cerebri.

    PubMed

    Degnan, Andrew Joseph; Levy, Lucien M

    2011-01-01

    Pseudotumor cerebri (PTC) is a clinical entity of uncertain etiology associated with several subtle findings on magnetic resonance imaging (MRI) including posterior flattening of the globes, enlargement of the optic nerve sheath (ONS), empty sella sign. We aimed to characterize the incidence of and significance of 2 novel MRI findings: narrowing of Meckel's cave and of cavernous sinus. Forty-six patients with a condition diagnosed as PTC based on clinical history were retrospectively reviewed, and their MRI studies were assessed for previously reported imaging findings associated with PTC. The maximal diameters of the cavernous sinuses, Meckel's caves, and ONSs were measured along with those of age-matched controls on axial T2-weighted images. The Meckel's caves and cavernous sinuses are significantly (P < 0.01) narrowed in patients (mean diameters: 0.41 and 0.25 cm) versus controls (0.54 and 0.36 cm), respectively. The ONS was enlarged in patients with a mean diameter of 0.65 cm versus 0.54 cm (P < 0.01). Meckel's cave narrowing and ONS enlargement seem to be better indicators of PTC than cavernous sinus narrowing, with sensitivities of 78.3% and 86.9% and specificities of 84.8% and 76.1% versus 60.9% and 76.1%, respectively. This finding of narrowed Meckel's caves in PTC may be clinically useful as a novel imaging finding seen on routine MRI studies. Optic nerve sheath enlargement is also confirmed as an important finding in PTC.

  2. New concept in cavernous sinus dural arteriovenous fistula: correlation with presenting symptom and venous drainage patterns.

    PubMed

    Suh, Dae Chul; Lee, Jeong Hyun; Kim, Sang Joon; Chung, Sun Ju; Choi, Choong Gon; Kim, Hyun Jeong; Kim, Chang Jin; Kook, Michael; Ahn, Hyo-Sook; Kwon, Sun Uck; Kim, Jong Sung

    2005-06-01

    An extradurally located cavernous sinus dural arteriovenous fistula (CSDAVF) exhibits different clinical behavior from other dural arteriovenous fistulas (DAVFs) located between 2 dural leaves. The aim of this study is to define angiographic types of CSDAVF associated with presenting symptom (Sx) and venous drainage patterns. CSDAVFs during a mean of 23-month follow-up period of 58 patients (17 to 73 years, male:female ratio=8:50) were retrospectively analyzed. The 3 types of CSDAF, ie, proliferative (PT), restrictive (RT), and late restrictive (LRT) types, were categorized by the degrees and patterns of prominent arteriovenous shunt as well as venous flow. The status of the venous connection with CS and the presenting Sx patterns classified as orbital (OrbSxP), ocular (OcuSxP), cavernous (CavSxP), and cerebral (CerSxP) were associated with angiographic types as well as symptom onset, age, and gender. Correlations of discrete and categorical variables were statistically analyzed using the chi2 or Fisher exact test. PT (n=23) and RT (n=23) of CSDAVF were more common than LRT (n=12) (P=0.016) in patients with younger than 65 years and were related to OrbSxP (P=0.015) and CavSxP (P=0.038) in contrast to LRT to OcuSxP (P=0.004). Early onset of Sxs was related to the OrbSxP (P=0.08) and CavSxP (P<0.001). CerSxP (5%) was noted in RT or LRT. OrbSxP was related to the superior ophthalmic venous drainage (P=0.026) and CavSxP to the inferior petrosal sinus (P=0.046) and posterior fossa venous drainages (P=0.014). Seven patients revealed chronological progression of CSDAVF from PT to LRT and even to complete healing. CSDAVF presents as 3 distinctive angiographic types and is associated with presenting Sxs and venous drainage patterns.

  3. More actors, different play: sphenoethmoid cell intimately related to the maxillary nerve canal and cavernous sinus apex.

    PubMed

    Săndulescu, M; Rusu, M C; Ciobanu, Iulia Camelia; Ilie, Angela; Jianu, Adelina Maria

    2011-01-01

    The sphenoid sinus is one of the most morphologically variable and surgically important structures of the skull base. Located below the sella turcica, neighbored by parasellar regions, such as the orbital apex, pterygopalatine fossa and lateral sellar region (cavernous sinus), it is clinically related to these and surgically relevant as corridor for various approaches. Moreover, at the sphenoethmoidal junction, important variations occur, most of these related to the presence of the Onodi cells and the intrasinusal protrusions of the optic nerve. That is why any identified and previously undescribed morphological variation at that level must be added to the well-established protocols, clinical and surgical. During a retrospective CT study of the sphenoid sinus anatomical features a previously unreported morphology was encountered and is reported here. It refers to a unilateral sphenoethmoid cell (SEC), Onodi-positive, not only overriding the superior aspect of the sphenoid but also its lateral side to get intimately related to the maxillary nerve. As that SEC expanded medially to the cavernous sinus apex, it altered the usual endosinusal morphological correlations and also added itself within the limits of the Mullan's triangle. It appears so that such postero-infero-lateral extended pneumatization of an Onodi cell alters the surgical landmarks and also can blur clinical pictures, by adding maxillary and pterygopalatine signs and symptoms.

  4. Cavernous Sinus: A Comprehensive Review of its Anatomy, Pathologic Conditions, and Imaging Features.

    PubMed

    Bakan, A A; Alkan, A; Kurtcan, S; Aralaşmak, A; Tokdemir, S; Mehdi, E; Özdemir, H

    2015-06-01

    The purpose of this article was to review the anatomy of the cavernous sinus (CS), illustrate numerous lesions that can affect the CS, and emphasize the imaging characteristics for each lesion to further refine the differential diagnoses. The CS, notwithstanding its small size, contains a complicated and crucial network that consists of the carotid artery, the venous plexus, and cranial nerves. The wide-ranging types of pathologies that can involve the CS can be roughly classified as tumoral, congenital, infectious/inflammatory/granulomatous, and vascular. Conditions that affect the CS usually lead to symptoms that are similar to each other; thus, for diagnosis, imaging procedures are required. Radiological evaluations are also required to detect pre- and postoperative CS invasion. Magnetic resonance imaging, which can be supplemented with thin-section contrast-enhanced sequences, is the preferred imaging technique for evaluating the CS. For correct diagnosis of CS lesions and accurate evaluations of CS invasions, it is essential to carefully analyze the anatomical structures within the CS and to acquire precise knowledge about the imaging features of CS lesions, which may frequently overlap.

  5. Ruptured dermoid cyst of the lateral cavernous sinus wall with temporary symptoms: a case report.

    PubMed

    Kosuge, Yasushi; Onodera, Hidetaka; Sase, Taigen; Uchida, Masashi; Takasuna, Hiroshi; Ito, Hidemichi; Oshio, Kotaro; Tanaka, Yuichiro

    2016-08-12

    Dermoid cysts are non-neoplastic tumors that arise from defects in the separation of the neuroectoderm. Cyst rupture rarely occurs spontaneously and the most common symptom is headache, followed by seizure. Although many cases of ruptured dermoid cysts present with symptoms, reports of cases that are asymptomatic, or where symptoms disappear, are rare. We report the case of a 66-year-old Asian man with a history of sudden onset headache who was found to have high amounts of fat material in the subarachnoid space and a fat suppression mass in the left cavernous sinus. He underwent oral steroid therapy. Five days after starting medication his headache symptoms disappeared. Routine neurological imaging was then performed without surgical procedure. Magnetic resonance imaging revealed evidence of the remains of a static lesion 6 months after his first visit. He has remained headache free for 10 months since the initial event. Although cases of ruptured dermoid cysts presenting with consistent symptoms have been commonly reported, until now there were few reports on asymptomatic cases or cases where symptoms disappeared. We believe that surgical intervention is unnecessary for ruptured dermoid cysts with minimal symptoms.

  6. Long-Term Outcomes of Stereotactic Radiosurgery for Treatment of Cavernous Sinus Meningiomas

    SciTech Connect

    Santos, Marcos Antonio dos; Calvo, Felipe A.; Samblas, Jose; Marsiglia, Hugo

    2011-12-01

    Purpose: Patients with cavernous sinus meningiomas (CSM) have an elevated risk of surgical morbidity and mortality. Recurrence is often observed after partial resection. Stereotactic radiosurgery (SRS), either alone or combined with surgery, represents an important advance in CSM management, but long-term results are lacking. Methods and Materials: A total of 88 CSM patients, treated from January 1991 to December 2005, were retrospectively reviewed. The mean follow-up was 86.8 months (range, 17.1-179.4 months). Among the patients, 22 were followed for more than 10 years. There was a female predominance (84.1%). The age varied from 16 to 90 years (mean, 51.6). In all, 47 patients (53.4%) received SRS alone, and 41 patients (46.6%) had undergone surgery before SRS. A dose of 14 Gy was prescribed to isodose curves from 50% to 90%. In 25 patients (28.4%), as a result of the proximity to organs at risk, the prescribed dose did not completely cover the target. Results: After SRS, 65 (73.8%) patients presented with tumor volume reduction; 14 (15.9%) remained stable, and 9 (10.2%) had tumor progression. The progression-free survival was 92.5% at 5 years, and 82.5% at 10 years. Age, sex, maximal diameter of the treated tumor, previous surgery, and complete target coverage did not show significant associations with prognosis. Among the 88 treated patients, 17 experienced morbidity that was related to SRS, and 6 of these patients spontaneously recovered. Conclusions: SRS is an effective and safe treatment for CSM, feasible either in the primary or the postsurgical setting. Incomplete coverage of the target did not worsen outcomes. More than 80% of the patients remained free of disease progression during long-term follow-up.

  7. A noisy zygoma fracture--complication of carotid-cavernous sinus fistula: total recovery of monocular blindness and frozen-eye after endoarterial coil embolization.

    PubMed

    Bierenbroodspot, F; Van Damme, Ph A; Cruysberg, J R M

    2005-03-01

    A case of a patient with a zygoma fracture in combination with a carotid-cavernous sinus fistula--an arterio-venous fistula between the internal carotid artery and the cavernous sinus--is presented. The most frequent cause is trauma, but the carotid-cavernous sinus fistula itself may have been the cause of trauma. The patient showed complete loss of ocular motility and total monocular blindness. Treatment of the fistula with endoarterial coil embolization was followed by improvement of vision and ocular motility, until finally complete recovery of ocular functions, which is exceptional. In this case, careful analysis of the MRA's showed that the CCSF most likely developed in the posttraumatic phase.

  8. Usefulness of intraoperative monitoring of oculomotor and abducens nerves during surgical treatment of the cavernous sinus meningiomas.

    PubMed

    Kaspera, Wojciech; Adamczyk, Piotr; Ślaska-Kaspera, Aleksandra; Ładziński, Piotr

    2015-03-01

    We analyzed the usefulness and prognostic value of intraoperative monitoring for identification of the oculomotor (III) and the abducens (VI) nerve in patients with cavernous sinus meningiomas. 43 patients diagnosed with cavernous sinus meningiomas were divided according to their topography. Function of the nerves was scored on original clinical and neurophysiological scales. The percentage of nerves identified correctly with the monitoring was significantly higher (91% vs. 53% for nerve III and 70% vs. 23% for nerve VI, p<0.001). The fractions of nerves III and VI identified correctly by means of the monitoring were significantly higher in the case of tumors with intra- and extracavernous location (89% vs. 32%, p<0.01) and intracavernous tumors (80% vs. 20%, p<0.05), respectively. The quality of post-resection recording correlated with functional status of both the nerves determined 9 months after the surgery (R=0.51, p<0.001 for nerve III and R=0.57, p<0.01 for nerve VI). Even a trace or pathological response to the post-resection stimulation was associated with improved functional status (90% vs. 50%, p<0.05 for nerve III and 93% vs. 38%, p<0.01 for nerve VI). Neurophysiological monitoring of ocular motor nerves enables their intraoperative identification during resections of the cavernous sinus meningiomas. Intraoperative monitoring of nerve III is particularly important in the case of tumors with extra- and intracavernous location, and the monitoring of nerve VI in the case of intracavernous tumors. The outcome of the post-resection monitoring has prognostic value with regard to the clinical status of the nerves on long-term follow-up. Copyright © 2014 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  9. Efficacy of transsphenoidal surgery in achieving biochemical cure of growth hormone-secreting pituitary adenomas among patients with cavernous sinus invasion: a systematic review and meta-analysis.

    PubMed

    Briceno, Vanessa; Zaidi, Hasan A; Doucette, Joanne A; Onomichi, Kaho B; Alreshidi, Amer; Mekary, Rania A; Smith, Timothy R

    2017-05-01

    Growth hormone-secreting pituitary adenomas in adults can result in severe craniofacial disfigurement and potentially fatal medical complications. Surgical resection leading to remission of the disease is dependent on complete surgical resection of the tumor. Lesions that invade the cavernous sinus may not be safely accessible via an endonasal transsphenoidal surgery (TSS), and the rates of biochemical remission of patients with residual disease vary widely in the literature. We conducted a meta-analysis to examine the prevalence of biochemical remission after TSS among patients with growth hormone-secreting pituitary adenomas with and without cavernous sinus invasion. Embase, PubMed, and Cochrane Library databases were searched for relevant publications. Fourteen studies with 972 patients with biochemically confirmed growth hormone-secreting pituitary adenomas were included in the meta-analysis. The overall remission prevalence under a fixed-effect model was 47.6% (95% CI = 40.8-54.4%) for patients with invasive macroadenomas (I(2) = 74.6%, p < 0.01); 76.4% (95% CI = 72.2-80.1%) for patients with non-invasive macroadenomas (I(2) = 59.6%, p = 0.03); and 74.2% (95% CI = 66.3-80.7%) for patients with non-invasive microadenomas (I(2) = 36.4, p = 0.10). The significant difference among the three groups resulted from the difference between patients with or without cavernous sinus invasion (p = 0.01) and not from the size of adenomas among those without cavernous sinus invasion (p = 0.66). The prevalence of biochemical remission in patients with cavernous sinus invasion was lower than in patients without cavernous sinus invasion after TSS for acromegaly.

  10. Countercurrent transfer of dopamine from venous blood in the cavernous sinus to the arterial blood supplying the brain - the perfused rabbit head as an experimental model.

    PubMed

    Muszak, J; Krzymowski, T; Gilun, P; Stefanczyk-Krzymowska, S

    2014-10-01

    The objective of the current study was to check whether countercurrent transfer of dopamine occurs in the cavernous sinus of the rabbit and whether the rabbit can be used as an animal model to study cavernous sinus function. After exsanguination of the animal, oxygenated and warmed (37°C) Hanseneleit-Krebs buffer with autologous or homologous blood (in a 3:1 or 1:1 ratio) was pumped through both common carotid arteries into the head (60 ml/min; 80-100 mm Hg) and radiolabeled dopamine (3(H)-DA, 10 μCi) was infused into the cavernous sinus through the angular oculi vein. Cerebral blood from the basilar artery was collected from the cannulated vertebral artery during 3(H)-DA infusion and for 10 minutes after completion of infusion. Selected brain tissue samples were collected after completion of the head perfusion. It was demonstrated that dopamine can penetrate from the rabbit's cavernous sinus to the internal carotid artery supplying the brain. Dopamine permeation was greater when the rabbit head was perfused with buffer and blood in a 3:1 ratio than with 1:1 (P<0.01). When the head was perfused with buffer and blood in a 3:1 ratio, significant radioactivity was found in samples collected from the brain basilar artery during and after 3(H)-DA infusion (P<0.001). The radioactivity was identified as 34.13 ± 2.7% unmetabolized 3(H)-DA and 65.9 ± 2.7% its metabolites. Significant radioactivity was also found in some brain tissue samples in both groups (P<0.05). The concentration of free radiolabeled dopamine particles in the dialysate of blood plasma and plasma diluted with buffer did not differ significantly. Because the structures of the cavernous sinus and cavernous fragment of the internal carotid artery of the rabbit are similar to those in humans, it suggests that rabbits can serve as a model for experimental physiological studies of cavernous sinus function and retrograde dopamine transfer in the cavernous sinus should be considered as an important link in

  11. Single-Session Hematoma Removal and Transcranial Coil Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: A Technical Case Report.

    PubMed

    Akamatsu, Yosuke; Sato, Kenichi; Endo, Hidenori; Matsumoto, Yasushi; Tominaga, Teiji

    2017-08-01

    Patients with cavernous sinus dural arteriovenous fistulas (CS dAVFs) with cortical venous varix are indicated for aggressive treatment because of the associated risk for intracranial hemorrhage. We present a case of surgical transvenous embolization in an 84-year-old woman with CS dAVF who presented with massive intracerebral hematoma. Cerebral angiograms revealed the dural AVF drained only into the superficial middle cerebral vein. Because an emergent mass reduction and prevention of rebleeding were necessary, single-session hematoma removal and transcranial embolization of a CS dAVF were performed in the neurosurgical operating room, using a mobile C-arm fluoroscopy. After the right frontotemporal craniotomy, intracerebral hematoma was removed and coil packing of the affected cavernous sinus was successfully performed via the dilated superficial middle cerebral vein. The transcortical vein approach enables occlusion of CS dAVF with isolated cortical venous drainage and may be a valuable alternative approach for some cases needed emergency craniotomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations

    PubMed Central

    MITSUHASHI, Yutaka; HAYASAKI, Koji; KAWAKAMI, Taichiro; NAGATA, Takashi; KANESHIRO, Yuta; UMABA, Ryoko; OHATA, Kenji

    2016-01-01

    The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery “medial venous axis” carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves “lateral venous axis” are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves “intermediate venous axis” contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage. PMID:27063146

  13. [Depiction of the cranial nerves around the cavernous sinus by 3D reversed FISP with diffusion weighted imaging (3D PSIF-DWI)].

    PubMed

    Ishida, Go; Oishi, Makoto; Jinguji, Shinya; Yoneoka, Yuichiro; Sato, Mitsuya; Fujii, Yukihiko

    2011-10-01

    To evaluate the anatomy of cranial nerves running in and around the cavernous sinus, we employed three-dimensional reversed fast imaging with steady-state precession (FISP) with diffusion weighted imaging (3D PSIF-DWI) on 3-T magnetic resonance (MR) system. After determining the proper parameters to obtain sufficient resolution of 3D PSIF-DWI, we collected imaging data of 20-side cavernous regions in 10 normal subjects. 3D PSIF-DWI provided high contrast between the cranial nerves and other soft tissues, fluid, and blood in all subjects. We also created volume-rendered images of 3D PSIF-DWI and anatomically evaluated the reliability of visualizing optic, oculomotor, trochlear, trigeminal, and abducens nerves on 3D PSIF-DWI. All 20 sets of cranial nerves were visualized and 12 trochlear nerves and 6 abducens nerves were partially identified. We also presented preliminary clinical experiences in two cases with pituitary adenomas. The anatomical relationship between the tumor and cranial nerves running in and around the cavernous sinus could be three-dimensionally comprehended by 3D PSIF-DWI and the volume-rendered images. In conclusion, 3D PSIF-DWI has great potential to provide high resolution "cranial nerve imaging", which visualizes the whole length of the cranial nerves including the parts in the blood flow as in the cavernous sinus region.

  14. Endoscopic transsphenoidal anterior petrosal approach for locally aggressive tumors involving the internal auditory canal, jugular fossa, and cavernous sinus.

    PubMed

    Shin, Masahiro; Kondo, Kenji; Hanakita, Shunya; Hasegawa, Hirotaka; Yoshino, Masanori; Teranishi, Yu; Kin, Taichi; Saito, Nobuhito

    2017-01-01

    OBJECTIVE Reports about endoscopic endonasal surgery for skull base tumors involving the lateral part of petrous apex remain scarce. The authors present their experience with the endoscopic transsphenoidal anterior petrosal (ETAP) approach through the retrocarotid space for tumors involving the internal auditory canal, jugular fossa, and cavernous sinus. METHODS The authors performed the ETAP approach in 10 patients with 11 tumors (bilateral in 1 patient) that extensively occupied the lateral part of petrous apex, e.g., the internal auditory canal and jugular fossa. Eight patients presented with diplopia (unilateral abducens nerve palsy), 3 with tinnitus, and 1 with unilateral hearing loss with facial palsy. After wide anterior sphenoidotomy, the sellar floor, clival recess, and carotid prominence were verified. Tumors were approached via an anteromedial petrosectomy through the retrocarotid triangular space, defined by the cavernous and vertical segments of the internal carotid artery (ICA), the clivus, and the petrooccipital fissure. The surgical window was easily enlarged by drilling the petrous bone along the petrooccipital fissure. After exposure of the tumor and ICA, dissection and resection of the tumor were mainly performed under direct visualization with 30° and 70° endoscopes. RESULTS Gross-total resection was achieved in 8 patients (9 tumors). In a patient with invasive meningioma, the tumor was strongly adherent to the ICA, necessitating partial resection. Postoperatively, all 8 patients who had presented with abducens nerve palsy preoperatively showed improvement within 6 months. In the patient presenting with hearing loss and facial palsy, the facial palsy completely resolved within 3 months, but hearing loss remained. Regarding complications, 3 patients showed mild and transient abducens nerve palsy resolving within 2 weeks, 3 months, and 6 months. Postoperative CSF rhinorrhea requiring surgical repair was observed in 1 patient. No patient

  15. Successful Treatment of Dental Infection-Induced Chronic Cavernous Sinus Thrombophlebitis With Antibiotics and Low-Molecular-Weight Heparin: Two Case Reports.

    PubMed

    Li, Yuan; Zheng, Bo; Chen, Kangning; Gui, Li

    2015-08-01

    Two patients developed cavernous sinus thrombophlebitis from a tooth infection. A 36-year-old man experienced a severe headache with bilateral third and sixth cranial nerve palsies after extraction of his left upper third molar. Another 53-year-old diabetic man developed fever, headache, and bilateral complete ophthalmoplegia after a tooth infection. The brain magnetic resonance imaging scans of both patients showed bilateral cavernous sinus partial thrombosis. Broad-spectrum antibiotics plus low-molecular-weight heparin successfully resolved all symptoms. Both patients recovered fully without any recurrence at the 3-month follow-up visit. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  16. [A case of fibromuscular dysplasia presenting with Wallenberg syndrome, and developing a giant aneurysm of the internal carotid artery in the cavernous sinus].

    PubMed

    Nishiyama, K; Fuse, S; Shimizu, J; Takeda, K; Sakuta, M

    1992-10-01

    A 25-year-old man developed Wallenberg syndrome (WS). At that time his carotid angiography was normal. When he was 28 years old, he suffered from retinal artery embolism in the left eye. At the age of 30 years, he had an acute onset of abducens nerve palsy in his right eye. The carotid angiography showed a giant aneurysm at the cavernous sinus portion in the right internal carotid artery. At his age of 38, the right oculomotor, trochlear and trigeminal nerves were involved. A vertebral angiography revealed a bead-like formation, and a diagnosis of fibromuscular dysplasia (FMD) was made. An intensive angiographic examination revealed many stenotic or dilated lesions in the carotid, vertebral, coronary, renal, and hepatic arteries. A sural nerve biopsy specimen revealed that the sural vein was involved. In Japan only one case of FMD presenting with WS is known. FMD should be under consideration as an underlying disease, when WS occurred in younger patients with few risk factors. In this patient an angiography revealed no abnormality in the cavernous sinus portion of the internal carotid artery, when he suffered from WS. However, eight years later he was proved to have a giant aneurysm in the cavernous sinus portion. In conclusion, we support the hypothesis that aneurysm may originate from angiographically normal arterial wall in FMD.

  17. Sinusitis

    MedlinePlus

    ... my acute sinusitis is caused by viruses or bacteria? Acute viral sinusitis is likely if you have ... to tell if my sinusitis is caused by bacteria? Because sinusitis is treated differently based on cause. ...

  18. Ten Triangles around Cavernous Sinus for Surgical Approach, Described by Schematic Diagram and Three Dimensional Models with the Sectioned Images

    PubMed Central

    2016-01-01

    For the surgical approach to lesions around the cavernous sinus (CS), triangular spaces around CS have been devised. However, educational materials for learning the triangles were insufficient. The purpose of this study is to present educational materials about the triangles, consisting of a schematic diagram and 3-dimensional (3D) models with sectioned images. To achieve the purposes, other studies were analyzed to establish new definitions and names of the triangular spaces. Learning materials including schematic diagrams and 3D models with cadaver's sectioned images were manufactured. Our new definition was attested by observing the sectioned images and 3D models. The triangles and the four representative surgical approaches were stereoscopically indicated on the 3D models. All materials of this study were put into Portable Document Format file and were distributed freely at our homepage (anatomy.dongguk.ac.kr/triangles). By using our schematic diagram and the 3D models with sectioned images, ten triangles and the related structures could be understood and observed accurately. We expect that our data will contribute to anatomy education, surgery training, and radiologic understanding of the triangles and related structures. PMID:27510391

  19. Ten Triangles around Cavernous Sinus for Surgical Approach, Described by Schematic Diagram and Three Dimensional Models with the Sectioned Images.

    PubMed

    Chung, Beom Sun; Ahn, Young Hwan; Park, Jin Seo

    2016-09-01

    For the surgical approach to lesions around the cavernous sinus (CS), triangular spaces around CS have been devised. However, educational materials for learning the triangles were insufficient. The purpose of this study is to present educational materials about the triangles, consisting of a schematic diagram and 3-dimensional (3D) models with sectioned images. To achieve the purposes, other studies were analyzed to establish new definitions and names of the triangular spaces. Learning materials including schematic diagrams and 3D models with cadaver's sectioned images were manufactured. Our new definition was attested by observing the sectioned images and 3D models. The triangles and the four representative surgical approaches were stereoscopically indicated on the 3D models. All materials of this study were put into Portable Document Format file and were distributed freely at our homepage (anatomy.dongguk.ac.kr/triangles). By using our schematic diagram and the 3D models with sectioned images, ten triangles and the related structures could be understood and observed accurately. We expect that our data will contribute to anatomy education, surgery training, and radiologic understanding of the triangles and related structures.

  20. Heterogeneity correction for intensity-modulated frameless SRS in pituitary and cavernous sinus tumors: a retrospective study.

    PubMed

    Shields, Lisa B E; Bond, Cindy; Odom, Aaron; Sun, David A; Spalding, Aaron C

    2015-09-17

    Frameless immobilization allows for planning and quality assurance of intensity-modulated radiosurgery (IM-SRS) plans. We tested the hypothesis that IM-SRS planning with uniform tissue density corrections results in dose inaccuracy compared to heterogeneity-corrected algorithms. Fifteen patients with tumors of the pituitary or cavernous sinus underwent frameless IM-SRS. Treatment planning CT and MRI scans were obtained and fused to delineate the tumor, optic nerves, chiasm, and brainstem. The plan was developed with static gantry IM-SRS fields using a pencil beam (PB), analytical anisotropic (AAA), and Acuros XB (AXB) algorithms. We evaluated measures of target coverage as well as doses to organs at risk (OAR) for each algorithm. We compared the results of each algorithm in the cases where PTV overlapped OAR (n = 10) to cases without overlapping OAR with PTV (n = 5). Utilizing film dosimetry, we measured the dose distribution for each algorithm through a uniform density target to a rando phantom with non-uniform density of air, tissue, and bone. There was no difference in target coverage measured by DMaxPTV, DMinPTV, D95%PTV, or the isodose surface (IDS) covering 95% of the PTV regardless of algorithm. However, there were differences in dose to OAR. PB predicted higher (p < 0.05) Dmax for the brainstem, chiasm, right optic nerve, and left optic nerve. In cases of PTV overlapping an optic nerve (n = 7), PB was unable to limit dose to 8 Gy while achieving PTV coverage (PB 855 cGy vs. AAA 769 cGy, p = 0.05 vs. AXB 658 cGy, p = 0.03). Within the rando phantom, the PB and AAA algorithms over-estimated the dose delivered in the bone-tissue-air interface of the sinus (+17%), while the AXB algorithm closely predicted the actual dose delivered through the inhomogeneous tissue (+/- 1 % max, p < 0.05). Patients undergoing frameless SRS benefit from heterogeneity corrected dose plans when the lesion lies in areas of widely varying tissue density and

  1. Preoperative Lateralization Modalities for Cushing Disease: Is Dynamic Magnetic Resonance Imaging or Cavernous Sinus Sampling More Predictive of Intraoperative Findings?

    PubMed

    Sun, Hai; Yedinak, Chris; Ozpinar, Alp; Anderson, Jim; Dogan, Aclan; Delashaw, Johnny; Fleseriu, Maria

    2015-06-01

    Objective To analyze whether cavernous sinus sampling (CSS) and dynamic magnetic resonance imaging (dMRI) are consistent with intraoperative findings in Cushing disease (CD) patients. Design Retrospective outcomes study. Setting Oregon Health & Science University; 2006 and 2013. Participants A total of 37 CD patients with preoperative dMRI and CSS to confirm central adrenocorticotropic hormone (ACTH) hypersecretion. Patients were 78% female; mean age was 41 years (at diagnosis), and all had a minimum of 6 months of follow-up. Main Outcome Measures Correlations among patient characteristics, dMRI measurements, CSS results, and intraoperative findings. Results All CSS indicated presence of CD. Eight of 37 patients had no identifiable tumor on dMRI. Three of 37 patients had no tumor at surgery. dMRI tumor size was inversely correlated with age (rs = - 0.4; p = 0.01) and directly correlated to intraoperative lateralization (rs = 0.3; p < 0.05). Preoperative dMRI was directly correlated to intraoperative lateralization (rs = 0.5; p < 0.002). CSS lateralization showed no correlation with intraoperative findings (rs = 0.145; p = 0.40) or lateralization observed on preoperative dMRI (rs = 0.17; p = 0.29). Postoperative remission rate was 68%. Conclusion dMRI localization was most consistent with intraoperative findings; CSS results were less reliable. Results suggest that small ACTH-secreting tumors continue to pose a challenge to reliable preoperative localization.

  2. Cavernous and inferior petrosal sinus sampling and dynamic magnetic resonance imaging in the preoperative evaluation of Cushing's disease.

    PubMed

    Potts, Matthew B; Shah, Jugal K; Molinaro, Annette M; Blevins, Lewis S; Tyrrell, J Blake; Kunwar, Sandeep; Dowd, Christopher F; Hetts, Steven W; Aghi, Manish K

    2014-02-01

    The surgical management of Cushing's disease is often complicated by difficulties detecting corticotropic adenomas. Various diagnostic modalities are used when conventional magnetic resonance imaging (MRI) is negative or inconclusive. We sought to analyze our use of two such modalities in the surgical management of Cushing's disease: (1) cavernous/inferior petrosal sinus sampling (central venous sampling, CVS) for adrenocorticotropic hormone and (2) dynamic MRI (dMRI). We conducted a single-center, retrospective review of all patients with Cushing's disease treated by a single neurosurgeon with endonasal transsphenoidal surgery. Accuracy of adenoma localization with CVS and dMRI was analyzed. Ninety-one consecutive patients were included. Pathology confirmed an adenoma in 66. Preoperative dMRI and CVS were performed in 40 and 37 patients, respectively, with 20 undergoing both studies. Surgical pathology was positive for adenoma in 31 dMRI patients, 25 CVS patients, and 13 who underwent both. Among patients with pathology confirming an adenoma, dMRI identified a lesion in 96.8% and correctly lateralized the lesion in 89.7%, while CVS correctly lateralized in 52.2-65.2% (depending on location of sampling). Among patients with both studies, dMRI and CVS correctly lateralized in 76.9 and 61.5-69.2%, respectively. Accuracy of CVS improved if only patients with symmetric venous drainage were considered. In this mixed population of Cushing's disease patients, dMRI was more accurate than CVS at localizing adenomas, supporting the use of advance MRI techniques in the work-up of Cushing's disease. CVS, however, remains an important tool in the workup of Cushing's syndrome.

  3. An innovative technique for detecting the caudal end of occluded inferior petrosal sinus in cavernous arteriovenous fistula using intravascular ultrasonography--technical note.

    PubMed

    Yamauchi, Shigeru; Nishio, Akimasa; Takahashi, Yoshinobu; Kondo, Kimito; Kawakami, Taichiro; Terakawa, Yuzo; Mitsuhashi, Yutaka; Ohata, Kenji

    2015-08-01

    Although cavernous sinus (CS) dural arteriovenous fistulas (d-AVFs) are usually treated with transvenous embolization (TVE) via the inferior petrosal sinus (IPS), IPSs are sometimes thrombosed and angiographically invisible. In such cases, the first obstacle to TVE is detecting the entry to the IPS. We report a new technique for TVE via IPS using intravascular ultrasonography (IVUS). Three consecutive cases of CS d-AVF with ipsilateral or bilateral IPS occlusion were involved in this study. On TVE, the orifice of the IPS was investigated with IVUS placed in the jugular vein or jugular bulb. This technique has been successfully adapted in all three cases. In two of these cases, IPS was well visualized with the help of IVUS, and TVE was successfully performed. To our knowledge, this is the first report to mention the usefulness of IVUS for detecting angiographically occult IPS.

  4. Surgical Simulation of Extradural Anterior Clinoidectomy through the Trans-superior Orbital Fissure Approach Using a Dissectable Three-dimensional Skull Base Model with Artificial Cavernous Sinus.

    PubMed

    Mori, Kentaro; Yamamoto, Takuji; Nakao, Yasuaki; Esaki, Takanori

    2010-07-01

    Extradural anterior clinoidectomy via the trans-superior orbital fissure (SOF) approach can provide extensive exposure of the anterior clinoid process and safe drilling under direct view. This technique requires peeling of the dura propria of the temporal lobe from the lateral wall of the SOF. Therefore, cadaveric dissection is mandatory to acquire surgical technique. However, chances for cadaveric dissection are limited. We propose modification of our three-dimensional (3-D) skull base model made from surgically dissectable artificial bone with artificial cavernous sinus including multiple membranous layers and neurovascular structures to simulate extradural anterior clinoidectomy via the trans-SOF approach. The 3-D skull base model precisely reproduced the dura propria of the temporal lobe, periosteal bridge, and inner reticular layer in the cavernous sinus and SOF using silicone and varnish. The cranial nerves and blood vessels were made from rubber fibers and vinyl tube. Simulation of extradural anterior clinoidectomy via the trans-SOF approach could be performed on the model using a high-speed drill under the operating microscope. The steps of reconstruction of the skull base model and dissection promote clear understanding of the 3-D anatomy and techniques of extradural anterior clinoidectomy via the trans-SOF approach.

  5. Sinusitis

    MedlinePlus

    ... to decrease swelling, especially if there are nasal polyps or allergies Surgery to enlarge the sinus opening and drain the ... each year. Most fungal sinus infections need surgery. Surgery to repair ... or nasal polyps may prevent the condition from returning.

  6. Sinusitis.

    PubMed

    Morcom, Samuel; Phillips, Nicholas; Pastuszek, Andrew; Timperley, Daniel

    2016-06-01

    Acute and chronic sinusitis are common primary care presentations. They are caused by mucosal inflammation, which inhibits mucociliary function of the nose and paranasal sinuses. This article provides an overview of acute and chronic sinusitis, and a guide to workup and management in a primary care setting. Complications and other indications for referral are discussed. Sinusitis involves a wide spectrum of presentations, both acute and chronic. It is primarily a medical condition, and surgical management is reserved for complicated or refractory cases.

  7. Cavernous sinus thrombosis

    MedlinePlus

    ... Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 118. Nath A, Berger J. Brain abscess and parameningeal infection. In: Goldman ...

  8. Laser-Doppler flowmetry and Horner's syndrome in patients with complete unilateral damage to the parasellar sympathetic fibers during cavernous sinus surgery.

    PubMed

    Benedicic, Mitja; Debevc, David; Dolenc, Vinko V; Bosnjak, Roman

    2006-04-01

    To determine ocular, sudomotor, and vasomotor components of Horner's syndrome resulting from complete unilateral intraoperative damage to the parasellar sympathetic fibers during cavernous sinus surgery. Complete damage to the parasellar sympathetic fibers was found in four patients operated for central skull base lesions. Pupilometry, eyelid fissure measurement, Hertel's exophthalmometry, starch iodine sweat test, and laser-Doppler perfusion assessment of bilaterally symmetrical forehead and cheek areas were performed. Pupil diameter was smaller and the eyelid fissure was >2 mm narrower on the affected side in all four patients. Exophthalmometry after the operation never revealed >1 mm difference. Anhydrosis was localized to the medial forehead in three and to the entire forehead in one patient. Average perfusion did not significantly differ between the affected and opposite side of the forehead or cheek. The parasellar sympathetic fibers exclusively innervate the orbit and variably innervate the forehead sweat glands. No conclusion regarding their contribution to the facial vasomotor control could be established.

  9. Transcranial approach to pituitary adenomas invading the cavernous sinus: A modification of the classical technique to be used in a low-technology environment

    PubMed Central

    Spallone, Aldo; Vidal, Roberto V.; Gonzales, Justo G.

    2010-01-01

    Objective: Pituitary adenomas invading the cavernous sinus represent a therapeutic challenge. Those tumors have been traditionally treated with incomplete surgical removal, observation and/ or adjunctive medical therapy, and radiotherapy. In relatively recent years, some authors have suggested a main direct surgical approach to cavernous sinus (CS) with the aim of complete removal of the adenoma, either by a modified trans-sphenoidal route, using or not an endoscopy-assisted approach, or by a transcranial direct approach. The latter has the advantage of allowing direct exposure of the lesion with a view of the surgical field unhindered by important neurovascular structures. Materials and Methods: We report a technical modification of the classical epidural approach for CS adenoma removal. This was used in 14 patients. Surgical technique included a fronto-orbito-zygomatic craniotomy with extradural anterior clinoidectomy, and intradural approach to the Hakuba’s triangle for intracavernous dissection. The tumors were removed under direct vision. Results: Total macroscopical removal was achieved in all but one case. This patient required postoperative radiation therapy as well as adjuvant dopaminergic regime for achieving control of preoperatively increased hormonal values. No other case required radiotherapy. Hormonal and/ or clinical control was also achieved in all the remaining cases. Out of the remaining 13 cases, all appeared to be tumor free at an average postoperative observation at 78 months (34 to 90 months). Significant surgical sequels were detected in only 1 case (persistent 3rd nerve palsy and moderate hemiparesis). Conclusions: This experience, though limited, would suggest that the transcranial limited CS exposure through the Hakuba’s triangle may allow adequate removal of intracavernous pituitary adenomas with very good long-term results and acceptable complication rate. PMID:20847907

  10. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

    PubMed Central

    Demartini Jr., Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha Jr., Carlos; Santos, Alex Marques Borges; Koppe, Gelson Luis

    2015-01-01

    Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology. PMID:26955353

  11. Limestone Caverns

    ERIC Educational Resources Information Center

    Powell, Richard L.

    1970-01-01

    Describes the origin of limestone caverns, using Mammoth Cave as an example, with particular reference to the importance of groundwater information of caverns, the present condition of groundwater, and how caverns develop within fluctuating groundwater zones. (BR)

  12. Limestone Caverns

    ERIC Educational Resources Information Center

    Powell, Richard L.

    1970-01-01

    Describes the origin of limestone caverns, using Mammoth Cave as an example, with particular reference to the importance of groundwater information of caverns, the present condition of groundwater, and how caverns develop within fluctuating groundwater zones. (BR)

  13. Imaging diagnosis of dural and direct cavernous carotid fistulae*

    PubMed Central

    dos Santos, Daniela; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante

    2014-01-01

    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. PMID:25741093

  14. Laser-Doppler Flowmetry and Horner’s Syndrome in Patients with Complete Unilateral Damage to the Parasellar Sympathetic Fibers During Cavernous Sinus Surgery

    PubMed Central

    Benedičič, Mitja; Debevc, David; Dolenc, Vinko V.; Bošnjak, Roman

    2006-01-01

    Aim To determine ocular, sudomotor, and vasomotor components of Horner’s syndrome resulting from complete unilateral intraoperative damage to the parasellar sympathetic fibers during cavernous sinus surgery. Methods Complete damage to the parasellar sympathetic fibers was found in four patients operated for central skull base lesions. Pupilometry, eyelid fissure measurement, Hertel’s exophthalmometry, starch iodine sweat test, and laser-Doppler perfusion assessment of bilaterally symmetrical forehead and cheek areas were performed. Results Pupil diameter was smaller and the eyelid fissure was >2 mm narrower on the affected side in all four patients. Exophthalmometry after the operation never revealed >1 mm difference. Anhydrosis was localized to the medial forehead in three and to the entire forehead in one patient. Average perfusion did not significantly differ between the affected and opposite side of the forehead or cheek. Conclusions The parasellar sympathetic fibers exclusively innervate the orbit and variably innervate the forehead sweat glands. No conclusion regarding their contribution to the facial vasomotor control could be established. PMID:16625695

  15. COMMUNITY ACQUIRED METHICILLIN SENSITIVE STAPHYLOCCUS AUREUS CEREBRAL ABSCESS IN A PREVIOUSLY HEALTH GENTLEMAN MIMICKING SIGNS OF CAVERNOUS SINUS THROMBOSIS-A UNIQUE PRESENTATION.

    PubMed

    Aijazi, Ishma; Abdulla, Fadhil M; Ibrahim, Ahmad Elbagir

    2015-01-01

    Central Nervous System (CNS) infections like meningitis and cerebral abscess caused by Staphylococcus aureus are usually seen in patients with neurosurgical interventions or immune compromised patients or patients with cardiac vegetation's. They are extremely rare in healthy patients. We report a case of a 44 year old Indian gentleman who was perfectly healthy with no known co morbidities, which presented with fever, neck stiffness and altered mental status. He had fulminant staph bacteraemia (as evidenced by persistently positive blood cultures) with meningitis and cerebral abscess. Extensive search was made to find the source of infection, but it was inconclusive. Isolated CNS Methicillin Sensitive Staphylococcus aureus (MSSA) infection in an apparently healthy patient is very rare. This gentleman presented with altered mental status, asymmetrical exophthalmos and multiple cranial nerve palsies. This case highlights the challenge of making early diagnoses of a brain abscess; since it has symptomology mimicking cavernous sinus thrombosis .This is due to the involvement of the cerebellopontine angle and extensive brain oedema and oedema of the retro bulbar tissues.

  16. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae

    PubMed Central

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Singhara Na Ayudya, Sirintara (Pongpech)

    2016-01-01

    PURPOSE The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. METHODS We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. RESULTS Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. CONCLUSION Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow. PMID:27767958

  17. Fractionated Conformal Radiotherapy in the Management of Cavernous Sinus Meningiomas: Long-Term Functional Outcome and Tumor Control at a Single Institution

    SciTech Connect

    Metellus, Philippe; Batra, Sachin; Karkar, Siddharth; Kapoor, Sumit; Weiss, Stephanie; Kleinberg, Lawrence; Rigamonti, Danielle

    2010-11-01

    Purpose: To evaluate long-term outcome of cavernous sinus meningioma (CSM) treated with fractionated conformal radiotherapy (FCR). Patients and Methods: Fifty-three patients with CSMs (16 men [30.2%], 37 women [69.8%], aged 53 {+-} 13.0 years [mean {+-} SD]) were treated by FCR. In 28 patients (52.8%) FCR was performed as first-line treatment and in 25 patients (47.2%) as adjuvant treatment. All patients received FCR with a dose of 52.9 {+-} 1.8 Gy in 29.4 {+-} 1.0 fractions over 6 weeks. Dose per fraction was 1.9 {+-} 0.1 Gy. Radiotherapy was delivered stereotactically in 47 cases (88.7%) and conformally in 6 (11.3%) Results: The median follow-up was 6.9 years (range, 3-19 years). According to Sekhar's classification, 19 patients (35.8%) were Grade 1-2, 30 patients (56.6%) were Grade 3-4, and 4 patients (7.6%) were Grade 5. Pretreatment tumor volume was determined in 46 patients, and tumor volume was 12.6 {+-} 8.2 cm{sup 3}. In these patients, the distance between tumor and optic apparatus was 1.62 {+-} 1.2 mm. Actuarial 5- and 10-year progression-free survival rates were 98.1% and 95.8%, respectively. Clinical improvement was observed in 31 patients (58.5%), and 20 patients (37.7%) remained unchanged. Radiologic response was observed in 18 patients (30.2%), and 35 patients (66.0%) showed stable lesions. Two patients (3.8%) showed tumor progression during follow-up. Transient morbidity was observed in 3 patients (5.7%) and permanent morbidity in 1 (1.9%). Conclusion: Fractionated conformal radiotherapy affords satisfactory long-term tumor control and low treatment morbidity.

  18. IgG4-related disease with cavernous sinus and intra-orbital lesions diagnosed by nasal mucosa biopsy.

    PubMed

    Nakata, Ruka; Yoshimura, Shunsuke; Motomura, Masakatsu; Tsujino, Akira; Hayashi, Tomayoshi; Hara, Minoru

    2016-09-29

    IgG4-related disease is a systemic disease characterized by lesions with IgG4 positive plasma cell infiltration in the involved organs and a raised serum IgG4 level. We report a patient of 70-year-old male presented orbital inflammation of IgG4-related disease. The patient developed right eye pain, double vision, and reduced eye sight. MRI image revealed mild right ocular proptosis and swelling of right carvenous sinus, bilateral intraorbital extraocular muscles and right optic nerve. Right optic nerve showed ring-like enhancement. IgG4-related disease was suspected with increased serum IgG4 level of 355 mg/dl, mediastinal lymphadenopathy and prostate enlargement. Transbronchial lung biopsy and prostate needle biopsy were administered with negative results. The eye related symptoms resolved with time, but serum IgG4 continuously increased. IgG4-related disease was diagnosed by nasal mucosa biopsy, which showed IgG4 positive plasma cells within the inflammatory infiltrate. This report emphasizes the usefulness of nasal mucosa biopsy for the diagnosis of IgG4 related disease with lesions difficult to approach.

  19. SU-E-T-304: Dosimetric Comparison of Cavernous Sinus Tumors: Heterogeneity Corrected Pencil Beam (PB-Hete) Vs. X-Ray Voxel Monte Carlo (XVMC) Algorithms for Stereotactic Radiotherapy (SRT)

    SciTech Connect

    Pokhrel, D; Sood, S; Badkul, R; Jiang, H; Saleh, H; Wang, F

    2015-06-15

    Purpose: To compare dose distributions calculated using PB-hete vs. XVMC algorithms for SRT treatments of cavernous sinus tumors. Methods: Using PB-hete SRT, five patients with cavernous sinus tumors received the prescription dose of 25 Gy in 5 fractions for planning target volume PTV(V100%)=95%. Gross tumor volume (GTV) and organs at risk (OARs) were delineated on T1/T2 MRI-CT-fused images. PTV (range 2.1–84.3cc, mean=21.7cc) was generated using a 5mm uniform-margin around GTV. PB-hete SRT plans included a combination of non-coplanar conformal arcs/static beams delivered by Novalis-TX consisting of HD-MLCs and a 6MV-SRS(1000 MU/min) beam. Plans were re-optimized using XVMC algorithm with identical beam geometry and MLC positions. Comparison of plan specific PTV(V99%), maximal, mean, isocenter doses, and total monitor units(MUs) were evaluated. Maximal dose to OARs such as brainstem, optic-pathway, spinal cord, and lenses as well as normal tissue volume receiving 12Gy(V12) were compared between two algorithms. All analysis was performed using two-tailed paired t-tests of an upper-bound p-value of <0.05. Results: Using either algorithm, no dosimetrically significant differences in PTV coverage (PTVV99%,maximal, mean, isocenter doses) and total number of MUs were observed (all p-values >0.05, mean ratios within 2%). However, maximal doses to optic-chiasm and nerves were significantly under-predicted using PB-hete (p=0.04). Maximal brainstem, spinal cord, lens dose and V12 were all comparable between two algorithms, with exception of one patient with the largest PTV who exhibited 11% higher V12 with XVMC. Conclusion: Unlike lung tumors, XVMC and PB-hete treatment plans provided similar PTV coverage for cavernous sinus tumors. Majority of OARs doses were comparable between two algorithms, except for small structures such as optic chiasm/nerves which could potentially receive higher doses when using XVMC algorithm. Special attention may need to be paid on a case

  20. Extra-Axial Cavernous Hemangioma

    PubMed Central

    Kanaan, Imad; Jallu, Ashraf; Alwatban, Jehad; Patay, Zoltan; Hessler, Richard

    2001-01-01

    Two patients with extra-axial cavernous hemangioma who presented with headache and oculovisual disturbances were investigated with computed tomography and magnetic resonance imaging. The lesions masqueraded as basal meningioma, but this diagnosis was not supported by magnetic resonance spectroscopy in one patient. Cerebral angiography with embolization was indicated in one patient, but embolization was not justified in the other. Both patients underwent a pterional craniotomy. The lesions were extradural and highly vascular, necessitating excessive transfusion in one patient in whom gross total resection was achieved, and precluding satisfactory removal in the other. There was no mortality. Transient ophthalmoplegia, the only complication in one patient, was due to surgical manipulation of the cavernous sinus; it resolved progressively over 3 months. Extra-axial skull base cavernous hemangiomas are distinct entities with clinical and radiological characteristics that differ from those of intraparenchymal cavernous malformations. They can mimic meningiomas or pituitary tumors. In some cases, magnetic resonance spectroscopy may narrow the differential diagnoses. Surgical resection remains the treatment of choice, facilitated by preoperative embolization to reduce intraoperative bleeding and by the application of the principles of skull base surgery. Fractionated radiotherapy is an alternative in partial or difficult resections and in high-risk and elderly patients. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:17167631

  1. Cerebral Cavernous Malformation

    MedlinePlus

    ... cavernous malformations (CCMs) are vascular lesions comprised of clusters of tightly packed, abnormally thin-walled small blood ... cavernous malformations (CCMs) are vascular lesions comprised of clusters of tightly packed, abnormally thin-walled small blood ...

  2. Cavernous portion of the trochlear nerve with special reference to its site of entrance.

    PubMed Central

    Bisaria, K K

    1988-01-01

    In a study of 80 cavernous sinuses in 40 cadavers, the trochlear nerve entered the cavernous sinus in 87.5% of cases before the crossing, in 7.5% at the crossing and in 5.0% after the crossing of the free and the attached margins of the tentorium cerebelli. In 77.5% of specimens the trochlear nerve showed a marked bend with flattening at the site of its entrance into the cavernous sinus. The nerve ran between the superficial and deep layers of dura, partly between them, in the thickness of the deeper layer, or deep to the deep layer but adherent to it. These findings do not conform with the description of its course by other workers in the past. In 72.5% of specimens the size of the trochlear nerve was larger during its course in the cavernous sinuses but in 20.0% of specimens such an increase in thickness was noted even in the posterior cranial fossa. Only in one specimen was the trochlear nerve adherent to the ophthalmic division of the trigeminal nerve. Cases showing the trochlear nerve entering the cavernous sinus after the crossing of the two margins of tentorium cerebelli and the splitting and branching of the trochlear nerve in the cavernous sinus have not hitherto been reported. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 PMID:3248970

  3. Indocyanine green fluorescence endoscopy at endonasal transsphenoidal surgery for an intracavernous sinus dermoid cyst: case report.

    PubMed

    Hide, Takuichiro; Yano, Shigetoshi; Kuratsu, Jun-ichi

    2014-01-01

    The complete resection of intracavernous sinus dermoid cysts is very difficult due to tumor tissue adherence to important anatomical structures such as the internal carotid artery (ICA), cavernous sinus, and cranial nerves. As residual dermoid cyst tissue sometimes induces symptoms and repeat surgery may be required after cyst recurrence, minimal invasiveness is an important consideration when selecting the surgical approach to the lesion. We addressed a recurrent intracavernous sinus dermoid cyst by the endoscopic endonasal transsphenoidal approach assisted by neuronavigation and indocyanine green (ICG) endoscopy to confirm the ICA and patency of the cavernous sinus. The ICG endoscope detected the fluorescence signal from the ICA and cavernous sinus; its intensity changed with the passage of time. The ICG endoscope was very useful for real-time imaging, and its high spatial resolution facilitated the detection of the ICA and the patent cavernous sinus. We found it to be of great value for successful endonasal transsphenoidal surgery.

  4. Indocyanine Green Fluorescence Endoscopy at Endonasal Transsphenoidal Surgery for an Intracavernous Sinus Dermoid Cyst: Case Report

    PubMed Central

    HIDE, Takuichiro; YANO, Shigetoshi; KURATSU, Jun-ichi

    2014-01-01

    The complete resection of intracavernous sinus dermoid cysts is very difficult due to tumor tissue adherence to important anatomical structures such as the internal carotid artery (ICA), cavernous sinus, and cranial nerves. As residual dermoid cyst tissue sometimes induces symptoms and repeat surgery may be required after cyst recurrence, minimal invasiveness is an important consideration when selecting the surgical approach to the lesion. We addressed a recurrent intracavernous sinus dermoid cyst by the endoscopic endonasal transsphenoidal approach assisted by neuronavigation and indocyanine green (ICG) endoscopy to confirm the ICA and patency of the cavernous sinus. The ICG endoscope detected the fluorescence signal from the ICA and cavernous sinus; its intensity changed with the passage of time. The ICG endoscope was very useful for real-time imaging, and its high spatial resolution facilitated the detection of the ICA and the patent cavernous sinus. We found it to be of great value for successful endonasal transsphenoidal surgery. PMID:25446381

  5. [Treatment of carotid cavernous fistulas].

    PubMed

    Solymosi, L

    2004-11-01

    The diagnosis and treatment of carotid cavernous fistulas (CCF) is an interdisciplinary challenge for both ophthalmologists and interventional neuroradiologists. According to the clinical signs and symptoms the tentative diagnosis is made by the ophthalmologist. It is the task of the neuroradiologist to ascertain this diagnosis by intra-arterial angiography. If a fistula is suspected this invasive diagnostic procedure is indispensable, not only to establish the diagnosis but also to classify those types of fistula with an unfavourable spontaneous course possibly resulting in intracranial haemorrhage. The indication for therapy is based on the clinical symptoms and the angiographic findings. In a number of cases no therapy is required. Since a fistula may change over time, these patients have to be under close ophthalmological surveillance. In many patients a conservative therapeutic approach with manual compression of the carotid artery is sufficient as a fIrst step. Invasive treatment is performed via the endovascular approach in almost all cases. Direct CCF are predominantly treated transarterially with detachable balloons and/or coils. Recently, intracranial stents have been used increasingly. The embolisation of indirect CCF is most effective using the transvenous access with coils. There are several approaches to the cavernous sinus. The interventional occlusion of CCF is nowadays a very effective treatment associated with a comparatively high cure rate and low incidence of complications. By close cooperation between ophthalmologists and neuroradiologists the patients can be protected against visual loss, the development of a secondary glaucoma, and, most importantly, against intracranial haemorrhage.

  6. Sinus Surgery

    MedlinePlus

    ... use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an ...

  7. Postpartum Regression of a Presumed Cavernous Meningioma

    PubMed Central

    Phang, See Yung; Whitfield, Peter

    2016-01-01

    Meningiomas are known to be more common in females than males. They are also known in rare cases to grow in size during pregnancy, which can complicate its management. We describe a 31-year-old Caucasian woman who presented with blurring of her vision and diplopia during the third trimester of her pregnancy. Magnetic resonance imaging (MRI) showed a small left cavernous sinus meningioma. The patient was treated conservatively until her uncomplicated delivery. A postpartum MRI scan showed complete regression of the suspected meningioma. Currently the patient is contemplating a further pregnancy. PMID:27066285

  8. Bilateral Carotid-Cavernous Fistulas: An Uncommon Cause of Pituitary Enlargement and Hypopituitarism

    PubMed Central

    Lechan, Ronald M.

    2016-01-01

    Carotid-cavernous fistulas (CCFs) are rare, pathologic communications of the carotid artery and the venous plexus of the cavernous sinus. They can develop spontaneously in certain at risk individuals or following traumatic head injury. Typical clinical manifestations include headache, proptosis, orbital pain, and diplopia. We report a case of bilateral carotid-cavernous fistulas associated with these symptoms and also with pituitary enlargement and hypopituitarism, which improved following surgical intervention. Arterialization of the cavernous sinus and elevated portal pressure may interfere with normal venous drainage and the conveyance of inhibiting and releasing hormones from the hypothalamus, resulting in pituitary enlargement and hypopituitarism. This condition should be considered in the differential diagnosis of hypopituitarism associated with anterior pituitary enlargement. PMID:27651959

  9. Direct carotid cavernous fistula after submucous resection of the nasal septum.

    PubMed

    Bizri, A R; al-Ajam, M; Zaytoun, G; al-Kutoubi, A

    2000-01-01

    A carotid cavernous fistula (CCF) is an abnormal arteriovenous anastomosis between the carotid artery and the cavernous sinus. Etiologies of this condition reported in the literature so far include facial trauma, rupture of an intracavernous aneurysm of the carotid artery, Ehler-Danlos syndrome and fibromuscular dysplasia of the cerebral arteries. Such fistulae were reported as complications of rhinoplasty, transsphenoidal surgery, embolization of cavernous sinus meningioma, and rhinocerebral mucormycosis. CCF may also occur spontaneously in children or as a congenital malformation. However, to our knowledge, submucous resection of the nasal septum has not been reported before to cause direct carotid-cavernous fistula. CT and angiographic findings are presented and a review of the literature for reported causes of CCF is made as well as a brief discussion of the possible pathophysiology.

  10. Cerebral Cavernous Malformations (CCM)

    MedlinePlus

    ... Contact Registry Interest Form Contact Us | Login Disorder Definitions Learn More > Disorder Definitions Cerebral Cavernous Malformations (CCM) ... until it is too late to salvage vision. Routine screening is very important, even if there are ...

  11. Giant calvarial cavernous hemangioma

    PubMed Central

    Verma, Satish Kumar; Singh, Pankaj Kumar; Garg, Kanwaljeet; Satyarthee, Guru Dutta; Sharma, Mehar C.; Singh, Manmohan; Sharma, Bhawani Shankar

    2015-01-01

    Though hemangiomas of the bone are quite common, calvarial (skull) cavernous hemangiomas are relatively rare pathologies. Calvarial hemangiomas are usually small and asymptomatic. However, they may occasionally grow in size to achieve large sizes and can present as a palpable swelling. We present a child with massive temporo-parieto-occipital calvarial cavernous hemangioma, who was managed with a multimodal approach with excellent cosmetic and neurologic outcome. PMID:25878743

  12. Flow diversion in the treatment of carotid injury and carotid-cavernous fistula after transsphenoidal surgery

    PubMed Central

    Lum, Cheemum; Ahmed, Muhammad E; Glikstein, Rafael; dos Santos, Marlise P; Lesiuk, Howard; Labib, Mohamed; Kassam, Amin B

    2015-01-01

    We describe a case of iatrogenic carotid injury with secondary carotid-cavernous fistula (CCF) treated with a silk flow diverter stent placed within the injured internal carotid artery and coils placed within the cavernous sinus. Flow diverters may offer a simple and potentially safe vessel-sparing option in this rare complication of transsphenoidal surgery. The management options are discussed and the relevant literature is reviewed. PMID:26015526

  13. Endovascular Treatment in an Unusual Case of Direct Carotid Cavernous Fistula

    PubMed Central

    Chavan, Rajendra Gajanan; Kamble, Ravindra Bhimrao; Bonde, Vivek

    2014-01-01

    Summary We describe a unique and unusual case of post-traumatic direct carotid cavernous fistula (CCF) with occluded proximal internal carotid artery and CCF filling from the contralateral side with retrograde cortical venous reflux. A male patient presented with intracranial haemorrhage due to cortical venous reflux. He was treated endovascularly through a contralateral approach by coiling the cavernous sinus and occluding the distal internal carotid artery at the fistulous site with glue. PMID:24750711

  14. Transvenous embolization in spontaneous direct carotid-cavernous fistula in childhood

    PubMed Central

    Mercado, Glenna B.; Irie, Keiko; Negoro, Makoto; Moriya, Shigeta; Tanaka, Teppei; Ohmura, Masahiro; Sadato, Akiyo; Hayakawa, Motuharu; Sano, Hirotoshi

    2011-01-01

    Carotid cavernous fistula (CCF) is an abnormal arteriovenous communication in the cavernous sinus. Direct CCF results from a tear in the intracavernous carotid artery. Typically, it has a high flow and usually presents with oculo-orbital venous congestive features such as exophthalmos, chemosis, and sometimes oculomotor or abducens cranial nerve palsy. Indirect CCF generally occurs spontaneously with subtle signs. We report a rare case of spontaneous direct CCF in childhood who did not have the usual history of craniofacial trauma or connective tissue disorder but presented with progressive chemosis and exophthalmos of the right eye. This report aims also to describe the safety and success of transvenous embolization with coils of the superior ophthalmic vein and cavernous sinus through the inferior petrosal sinus. PMID:22059104

  15. Posttraumatic carotid-cavernous fistula: Pathogenetic mechanisms, diagnostic management and proper treatment. A case report

    PubMed Central

    Marín-Fernández, Ana-Belén; Román-Ramos, María; Fernandez-Solis, José; Martínez-Lara, Ildefonso

    2016-01-01

    Carotid-cavernous fistulas are an uncommon diseases characterized by abnormal communications between arteries and veins located in the cavernous sinus. According with Barrow´s classification they could be divided in two groups: direct and indirect. The typical symptoms showed by theses pathologies are: pulsating exophthalmos and orbital blow. The present study describes a case of direct posttraumatic carotid-cavernous fistula in a 26 years old man. Furthermore, we present the images that we used to make the diagnosis. In this light, we decided to treat this case with endovascular approach after considering several therapeutic options. The aim of the present report is twofold. First, we examine the importance of the proper management of the direct posttraumatic carotid-cavernous fistula. Second, we describe this rare syndrome with the goal of proposing suitable treatments. Key words:Carotid cavernous fistulas, pulsating exophthalmos, orbital blow, endovascular approach, Barrow´s classification. PMID:27034767

  16. Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment.

    PubMed

    Khalsa, Siri Sahib; Hollon, Todd C; Shastri, Ravi; Trobe, Jonathan D; Gemmete, Joseph J; Pandey, Aditya S

    2016-06-08

    Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.

  17. Gas intrusion into SPR caverns

    SciTech Connect

    Hinkebein, T.E.; Bauer, S.J.; Ehgartner, B.L.; Linn, J.K.; Neal, J.T.; Todd, J.L.; Kuhlman, P.S.; Gniady, C.T.; Giles, H.N.

    1995-12-01

    The conditions and occurrence of gas in crude oil stored in Strategic Petroleum Reserve, SPR, caverns is characterized in this report. Many caverns in the SPR show that gas has intruded into the oil from the surrounding salt dome. Historical evidence and the analyses presented here suggest that gas will continue to intrude into many SPR caverns in the future. In considering why only some caverns contain gas, it is concluded that the naturally occurring spatial variability in salt permeability can explain the range of gas content measured in SPR caverns. Further, it is not possible to make a one-to-one correlation between specific geologic phenomena and the occurrence of gas in salt caverns. However, gas is concluded to be petrogenic in origin. Consequently, attempts have been made to associate the occurrence of gas with salt inhomogeneities including anomalies and other structural features. Two scenarios for actual gas intrusion into caverns were investigated for consistency with existing information. These scenarios are gas release during leaching and gas permeation through salt. Of these mechanisms, the greater consistency comes from the belief that gas permeates to caverns through the salt. A review of historical operating data for five Bryan Mound caverns loosely supports the hypothesis that higher operating pressures reduce gas intrusion into caverns. This conclusion supports a permeability intrusion mechanism. Further, it provides justification for operating the caverns near maximum operating pressure to minimize gas intrusion. Historical gas intrusion rates and estimates of future gas intrusion are given for all caverns.

  18. Sinusitis: Overview

    MedlinePlus

    ... pressuregrowths called polyps. These can block your sinus passages.When bacteria or a virus causes sinusitis, it’s ... nasal spray. This will clean out your nasal passages and help clear congestion. Your doctor may suggest ...

  19. Acute Sinusitis

    MedlinePlus

    ... headache. Acute sinusitis is mostly caused by the common cold. Unless a bacterial infection develops, most cases resolve ... Acute sinusitis is most often caused by the common cold, which is a viral infection. In some cases, ...

  20. Pediatric Sinusitis

    MedlinePlus

    ... requests or policy questions to our media and public relations staff at newsroom@entnet.org . Your child’s sinuses ... viral upper respiratory infections in children, and the role of such medications for treatment of sinusitis is ...

  1. [Clinical features and management of cavernous and venous angiomas in the head].

    PubMed

    Tokunaga, Koji; Date, Isao

    2011-01-01

    Cerebral cavernous angiomas consist of well-circumscribed collections of thin-walled sinusoidal vascular channels lacking the intervening brain tissue. They are present in 0.4-0.8% of the population, and can occur in a sporadic or familial form. Most common symptoms are seizures, hemorrhage, and focal neurological deficits. The annual bleeding rate of the patient is reported to be 0.25%-20%. High-resolution magnetic resonance imaging (MRI) is a useful diagnostic tool with a high degree of sensitivity and specificity. Microsurgical excision of the lesion is a good treatment choice for cavernous angiomas in the brain, even in the brainstem. Although stereotactic radiosurgery may reduce the incidence of rebleeding and the frequency of seizures, its indication should be carefully investigated because of the relatively high rate of radiation-induced side effects. Less frequently, cavernous angiomas can be located at the extra-axial regions of the head, which include the cavernous sinus, the orbit, and the cranial nerves. Cavernous angiomas in the cavernous sinus pose a neurosurgical challenge due to the high vascularity and involvement of the neurovascular structures, and stereotactic radiosurgery is considered as an additional option. Surgical resection is recommended for symptomatic cavernous angiomas in the orbit; however, the rate of complications after resection is not necessarily low for cavernous angiomas within the apex. Venous angiomas are anomalies of normal venous drainage, which show characteristic appearance of the drainage system in the late phase of angiography (caput medusae). They are found either alone or in combination with other vascular malformations. Conservative treatment is recommended except for patients with a large hematoma or with a coexisting cavernous angioma.

  2. Cardiac cavernous hemangioma and multiple pulmonary cavernous hemangiomas.

    PubMed

    Yang, Lili; Dai, Jun; Xiao, Ying; Cheng, Henghui; Ruan, Qiurong

    2014-02-01

    We describe for the first time a rare coexistence of a cardiac cavernous hemangioma with multiple pulmonary cavernous hemangiomas. Computed tomography revealed bilateral pulmonary nodules, left pleural effusion, and pericardial effusion. Positron emission tomography showed a pericardial neoplasm. Pathologically, multiple large dilated vascular spaces, lined by a single layer of endothelial cells and filled with blood, were revealed in both the cardiac tumor and the pulmonary nodules. Immunohistochemical examination of the lining cells showed positivity for CD31, FLI1, FVIII, and CD34. Taken together, these findings led to the diagnosis of cardiac cavernous hemangioma and multiple pulmonary cavernous hemangiomas.

  3. Manufactured caverns in carbonate rock

    DOEpatents

    Bruce, David A.; Falta, Ronald W.; Castle, James W.; Murdoch, Lawrence C.

    2007-01-02

    Disclosed is a process for manufacturing underground caverns suitable in one embodiment for storage of large volumes of gaseous or liquid materials. The method is an acid dissolution process that can be utilized to form caverns in carbonate rock formations. The caverns can be used to store large quantities of materials near transportation facilities or destination markets. The caverns can be used for storage of materials including fossil fuels, such as natural gas, refined products formed from fossil fuels, or waste materials, such as hazardous waste materials. The caverns can also be utilized for applications involving human access such as recreation or research. The method can also be utilized to form calcium chloride as a by-product of the cavern formation process.

  4. 3-D Cavern Enlargement Analyses

    SciTech Connect

    EHGARTNER, BRIAN L.; SOBOLIK, STEVEN R.

    2002-03-01

    Three-dimensional finite element analyses simulate the mechanical response of enlarging existing caverns at the Strategic Petroleum Reserve (SPR). The caverns are located in Gulf Coast salt domes and are enlarged by leaching during oil drawdowns as fresh water is injected to displace the crude oil from the caverns. The current criteria adopted by the SPR limits cavern usage to 5 drawdowns (leaches). As a base case, 5 leaches were modeled over a 25 year period to roughly double the volume of a 19 cavern field. Thirteen additional leaches where then simulated until caverns approached coalescence. The cavern field approximated the geometries and geologic properties found at the West Hackberry site. This enabled comparisons are data collected over nearly 20 years to analysis predictions. The analyses closely predicted the measured surface subsidence and cavern closure rates as inferred from historic well head pressures. This provided the necessary assurance that the model displacements, strains, and stresses are accurate. However, the cavern field has not yet experienced the large scale drawdowns being simulated. Should they occur in the future, code predictions should be validated with actual field behavior at that time. The simulations were performed using JAS3D, a three dimensional finite element analysis code for nonlinear quasi-static solids. The results examine the impacts of leaching and cavern workovers, where internal cavern pressures are reduced, on surface subsidence, well integrity, and cavern stability. The results suggest that the current limit of 5 oil drawdowns may be extended with some mitigative action required on the wells and later on to surface structure due to subsidence strains. The predicted stress state in the salt shows damage to start occurring after 15 drawdowns with significant failure occurring at the 16th drawdown, well beyond the current limit of 5 drawdowns.

  5. Fungal Sinusitis.

    PubMed

    Raz, Eytan; Win, William; Hagiwara, Mari; Lui, Yvonne W; Cohen, Benjamin; Fatterpekar, Girish M

    2015-11-01

    Fungal sinusitis is characterized into invasive and noninvasive forms. The invasive variety is further classified into acute, chronic and granulomatous forms; and the noninvasive variety into fungus ball and allergic fungal sinusitis. Each of these different forms has a unique radiologic appearance. The clinicopathologic and corresponding radiologic spectrum and differences in treatment strategies of fungal sinusitis make it an important diagnosis for clinicians and radiologists to always consider. This is particularly true of invasive fungal sinusitis, which typically affects immuno compromised patients and is associated with significant morbidity and mortality. Early diagnosis allows initiation of appropriate treatment strategies resulting in favorable outcome. Published by Elsevier Inc.

  6. Cavernous hemangioma of rhinopharynx: our experience and review of literature

    PubMed Central

    Testa, Domenico; Motta, Sergio; Massimilla, Eva Aurora; Tafuri, Domenico; Russo, Daniela; Russo, Anna; Landolfo, Pasquale Gianluca; Mesolella, Massimo; Motta, Gaetano

    2015-01-01

    Hemangiomas are benign tumors originating in the vascular tissues of skin, mucosa, muscles, glands, and bones. Although these tumors are common lesions of the head and neck, they rarely occur in the nasal cavity and paranasal sinuses. Cavernous haemangioma of the lateral wall of the nasopharynx has not previously been reported. We examined the clinical, radiological and therapeutic management of cavernous haemangioma of nasopharynx starting from a clinical case of a 26-year-old woman with a history of recurrent and conspicuous epistaxis and left-sided nasal associated severe obstruction. Nasopharynx examination, by flexible endoscopy, showed a cystic mass borne by the left side wall of the nasopharynx, in contact with the soft palate, covered by intact and regular mucosa. Contrast-enhanced computed tomography (CT) scan, confirmed these findings and showed contextual lamellar calcifications and inhomogeneous enhancement. The nasal endoscopic approach (FESS), under general anesthesia, allowed removal of the mass, without complications, after careful hemostasis of arterial branches. It was possible to establish the precise site of origin of the tumor only during the surgical procedure. Histopathological study showed mucosa with extensive vascular proliferation, with framework of lacunar/cavernous haemangioma, also present at lamellar bone tissue level. An unusual site and an unspecific clinical appearance can make diagnosis and treatment of a cavernous hemangioma of the nasopharynx difficult. The nasal endoscopic technique proved to be reliable in terms of adequate exposure and visualization of the lesion, control of bleeding, and complete removal of the mass. PMID:28352748

  7. Cavernous hemangioma of the dura mater mimicking meningioma

    PubMed Central

    Di Vitantonio, Hambra; De Paulis, Danilo; Ricci, Alessandro; Marzi, Sara; Dehcordi, Soheila Raysi; Galzio, Renato Juan

    2015-01-01

    Background: Cavernomas are benign lesions that most commonly occur intra-parenchymally, but occasionally they have been described as arising from the dura mater. Extra-axial cavernous angiomas (or hemangiomas) account for 0.4–2% of all intracranial vascular malformations, and they usually occur in the middle cranial fossa, associated with the cavernous sinus. Other possible localizations (e.g. tentorium, convexity, anterior cranial fossa, cerebellopontine angle, Meckel's cave, sella turcica and internal auditory meatus) are rare, and they account only for 0.2–0.5%. Case Description: We report a case of a 30-year-old female presenting with a 2 years history of headache unresponsive to drug therapy. The magnetic resonance imaging showed a dural-based lesion in the left frontal region; the lesion size was: 1.5 cm × 3.5 cm. The appearance suggested a convexity meningioma. A left frontal craniotomy was performed, and the histopathological diagnosis deposed for a cavernous hemangioma of the dura mater. The follow-up at 1-year was good without any neurologic deficit. Conclusions: Dural-based cavernous hemangiomas of the convexity are uncommon lesions. Up to now, only 13 cases have been described in the literature. The authors have discussed clinical aspects, radiological features, surgical treatment, and operative findings. PMID:26421218

  8. A rare localization of cerebral venous sinus thrombosis. Case report

    PubMed Central

    CARANGELO, B.; LAVALLE, L.; TIEZZI, G.; BRANCO, D.; LIPPA, L.; MILEO, E.; COSTANTINO, G.; MARIOTTINI, A.; MUSCAS, G.; MATURO, A.

    2015-01-01

    In this work the Authors report their experience on the treatment of a case of cavernous venous sinus thrombosis. The diagnosis is clinical and neuroradiological, CT, MRN, cerebral angiography and orbital venography have aided in establishing the diagnosis during life. Very interesting is the therapeutic approach. PMID:26017108

  9. [Traumatic arteriovenous pial fistula masquerading as a carotid-cavernous fistula: an uncommon disorder with an unusual presentation].

    PubMed

    Santos-Franco, Jorge Arturo; Lee, Angel; Nava-Salgado, Giovanna; Zenteno, Marco; Gómez-Villegas, Thamar; Dávila-Romero, Julio César

    2012-01-01

    Traumatic intracranial pial arteriovenous fistulae are infrequent lesions. Their cardinal signs have been related to mass effect and hemorrhage, but their clinical manifestations due to venous retrograde flow into ophthalmic veins has never been described. This phenomenon is usually seen in dural arteriovenous fistula draining to the cavernous sinus or carotid-cavernous sinus fistula.A traumatic intracranial pial arteriovenous fistula arising from the supraclinoid internal carotid artery in a young patient was revealed by aggressive behavior and ophthalmologic manifestations. The endovascular management included the use of coils, stent, and ethylene-vinyl alcohol with transient balloon occlusion of the parent vessel.

  10. Petrosal sinus sampling: technique and rationale.

    PubMed

    Miller, D L; Doppman, J L

    1991-01-01

    Bilateral simultaneous sampling of the inferior petrosal sinuses is an extremely sensitive, specific, and accurate test for diagnosing Cushing disease and distinguishing between that entity and the ectopic ACTH syndrome. It is also valuable for lateralizing small hormone-producing adenomas within the pituitary gland. The inferior petrosal sinuses connect the cavernous sinuses with the ipsilateral internal jugular veins. The anatomy of the anastomoses between the inferior petrosal sinus, the internal jugular vein, and the venous plexuses at the base of the skull varies, but it is almost always possible to catheterize the inferior petrosal sinus. In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Advance preparation is required for petrosal sinus sampling. Teamwork is a critical element, and each member of the staff should know what he or she will be doing during the procedure. The samples must be properly labeled, processed, and stored. Specific needles, guide wires, and catheters are recommended for this procedure. The procedure is performed with specific attention to the three areas of potential technical difficulty: catheterization of the common femoral veins, crossing the valve at the base of the left internal jugular vein, and selective catheterization of the inferior petrosal sinuses. There are specific methods for dealing with each of these areas. The sine qua non of correct catheter position in the inferior petrosal sinus is demonstration of reflux of contrast material into the ipsilateral cavernous sinus. Images must always be obtained to document correct catheter position. Special attention must be paid to two points to prevent potential complications: The patient must be given an adequate dose of heparin, and injection of contrast material into the inferior petrosal sinuses and surrounding veins must be done gently and carefully. When the procedure is performed as outlined, both inferior

  11. Cataract surgery in a case of carotid cavernous fistula.

    PubMed

    Nair, Akshay Gopinathan; Praveen, Smita Vittal; Noronha, Veena Olma

    2014-09-01

    A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF.

  12. Cataract surgery in a case of carotid cavernous fistula

    PubMed Central

    Nair, Akshay Gopinathan; Praveen, Smita Vittal; Noronha, Veena Olma

    2014-01-01

    A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF. PMID:25370401

  13. Segmental cavernous carotid ectasia in a patient with cluster-like headache.

    PubMed

    Semnic, Robert; Kozić, Duško; Semnic, Marija; Trifunović, Jasna; Simić, Svetlana; Radojičić, Aleksandra

    2015-01-01

    Cluster headache (CH) is a primary headache with severe, unilateral periorbital or temporal pain lasting 15-180 min, accompanied with various cranial autonomic features. A diagnosis of cluster-like headache can be made whenever underlying cause of CLH is present. We report a case where an ectatic cavernous segment of the internal carotid artery triggered CHL, most probably due to compression of the ophthalmic nerve within cavernous sinus. The pathological substrate of a vessel ectasia is degeneration of the tunica intima as a consequence of atherosclerosis and hypertension. On the other hand, cavernous sinus is unique space where parasympathetic, sympathetic and nociceptive fibers are in intimate relationship which is of great importance for understanding of CH pathophysiology. Magnetic resonance imaging and MR angiography are mandatory imaging tools used for precise localization of pathological changes in the cavernous sinus, especially in the group of secondary headaches attributed to vascular disorders. Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  14. Abducens nerve palsy due to inferior petrosal sinus thrombosis.

    PubMed

    Mittal, Shivam Om; Siddiqui, Junaid; Katirji, Bashar

    2017-02-24

    Isolated unilateral abducens nerve palsy is usually due to ischemia, trauma or neoplasm. Dorello's canal is the space between the petrous apex and superolateral portion of the clivus, bound superiorly by Gruber's ligament. The abducens nerve travels with inferior petrosal sinus (IPS) though the Dorello's canal before entering the cavernous sinus. A 31-year-old man presented with neck pain, and binocular horizontal diplopia, worse looking towards left and at distance. He had a history of intravenous drug abuse but no history of hypertension or diabetes. On examination, he had complete left 6th nerve palsy with normal fundi, pupils, and other cranial nerves. Methicillin-resistant Staphylococcus aureus bacteremia was detected with naïve tricuspid valve endocarditis and multiple septic emboli to lungs with infarcts. His cerebrospinal fluid was normal. MRI of the brain was normal. MRV of head and neck showed thrombosis of the left internal jugular vein, left sigmoid sinus and left inferior petrosal sinus with normal cavernous sinus and no evidence of mastoiditis. He was treated with broad spectrum antibiotics. He was not anticoagulated for fear of pulmonary hemorrhage from pulmonary infarcts. Although cerebral venous sinus thrombosis commonly presents with elevated intracranial pressure, isolated ipsilateral 6th nerve palsy from its compression in Dorello's canal due to thrombosis of the ipsilateral inferior petrosal sinus is extremely rare. To our knowledge, only two patients have been reported with isolated abducens palsy due to IPS thrombosis; one caused by septic emboli and the other developed it during IPS cortisol level sampling.

  15. Sinus Tumors

    MedlinePlus

    ... critical nerves and arteries in the area, 4) maintenance of the function of the nose, sinuses and any other involved structures, and 5) maintenance of separation between the intracranial (brain) and sinonasal ...

  16. Treatment of a traumatic carotid-cavernous fistula by the sole use of a flow diverting stent.

    PubMed

    Nadarajah, Mahendran; Power, Mark; Barry, Bryan; Wenderoth, Jason

    2012-05-01

    Direct caroticocavernous fistula (CCF) has traditionally been treated by detachable balloon placement within the affected cavernous sinus. We describe a case of a direct CCF treated solely with flow-diverting stents. These novel devices may offer a simpler and potentially safer vessel-sparing option in this rare condition.

  17. Sinus Anatomy

    MedlinePlus

    ... the nasal passage. The right and left nasal passages are separated in the middle by a vertical plate of cartilage and bone ... Most of the sinuses drain from underneath the middle turbinate, into a region ... through the nasal passage on each side, it streams through the crevices ...

  18. Sinusitis (acute)

    PubMed Central

    2008-01-01

    Introduction Acute sinusitis is defined pathologically, by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks. Clinically, it is characterised by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever. It affects 1−5% of the adult population each year in Europe. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people with clinically diagnosed acute sinusitis, and with radiologically or bacteriologically confirmed acute sinusitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides, different doses [amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides], long-course regimens), antihistamines, cephalosporins or macrolides, decongestants (xylometazoline, phenylephrine, pseudoephedrine), doxycycline, saline nasal washes, steam inhalation, and topical corticosteroids (intra-nasal). PMID:19450327

  19. Arteriovenous malformation in temporal lobe presenting as contralateral ocular symptoms mimicking carotid-cavernous fistula.

    PubMed

    Mohd-Tahir, Fadzillah; Siti-Raihan, Ishak; Wan Hazabbah, W H

    2013-01-01

    Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

  20. Cure of a direct carotid cavernous fistula by endovascular stent deployment.

    PubMed

    Weber, W; Henkes, H; Berg-Dammer, E; Esser, J; Kühne, D

    2001-01-01

    A 53-year-old woman underwent surgical thrombendarterectomy for treatment of artherosclerotic stenoses of her left internal carotid artery (ICA). A Fogarty catheter was used during this operation. The postoperative course was complicated by the development of a sixth cranial nerve palsy, protrusio, chemosis and ciliar injection of both eyes. Digital subtraction angiography showed a direct fistula between the cavernous segment of the left ICA and the cavernous sinus, with early and retrograde opacification of both superior ophthalmic veins. Endovascular occlusion of the fistula was achieved with preservation of the ICA by stent deployment over the rupture site of the ICA, as two detachable balloons could not obliterate the fistula while preserving the ICA patent. Follow-up angiography 7 months after the endovascular treatment confirmed persisting occlusion of the fistula with a patent ICA. Highly flexible porous coronary stents can easily be introduced into tortuous vessels, including the distal ICA. The haemodynamic effects achieved by stent deployment together with two balloons detached in the cavernous sinus may be sufficient to interrupt a direct carotid cavernous fistula.

  1. Cerebellar Hemorrhage due to a Direct Carotid–Cavernous Fistula after Surgery for Maxillary Cancer

    PubMed Central

    Kamio, Yoshinobu; Hiramatsu, Hisaya; Kamiya, Mika; Yamashita, Shuhei; Namba, Hiroki

    2017-01-01

    Infratentorial cerebral hemorrhage due to a direct carotid–cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus. PMID:28061497

  2. Bladder cavernous hemangioma. Case report.

    PubMed

    Rodriguez Collar, Tomás Lázaro; Casa de Valle Castro, Midalys; Báez Sarría, Felix; Trujillo Fernández, Reinerio

    2014-07-01

    To report a case of a bladder cavernous hemangioma, as well as the main features of its diagnosis and treatment. A 74 year old patient, regular smoker, presented with total macroscopic hematuria of moderate intensity with large rounded clots. On physical examination the patient's mucous membranes color was normal, and digital rectal examination showed a normal size prostate with fibroelastic consistency. An abdominal ultrasound was performed showing a slight bladder bottom thickening in addition to free clots and a homogeneous and normal prostate. Cystoscopy confirmed the presence of a sessile violet-colored rounded retrotrigonal tumor, 2 cm in diameter and 0.5 in height; it was immediately resected. The pathological study reported cavernous hemangioma. Patient's evolution has been satisfactory. Bladder cavernous hemangioma is a rare cause of hematuria, and transurethral resection of the small size lesions constitutes an effective option as a definitive surgical treatment.

  3. Chronic sinusitis (image)

    MedlinePlus

    ... and cartilage and lined with a mucous membrane. Sinusitis occurs when the membranes becomes inflamed and painful, ... a result of a blocked sinus opening. Chronic sinusitis is often caused by inflammation and blockage due ...

  4. Cavernous Hemangioma in the Breast.

    PubMed

    Aydın, Oğuz Uğur; Soylu, Lütfi; Ercan, Aydan İlkme; Bilezikçi, Banu; Özbaş, Serdar

    2015-10-01

    Although the observation of breast vascular tumors is rare, the most common tumor is hemangıoma in the benign group, and these tumors are observed incidentally in lumpectomy or mastectomy specimens during histological examinations. They are classified into capillary, cavernous, and venous hemangıomas. Cavernous hemangıoma is the most common subtype. Cavernous hemangıomas are benign vascular tumors, which malformatıon from mature blood vessels. Hemangıomas ın the benıgn group may show a suspicion of ductal carcinoma in situ (DCIS) in mammographic analysis. Ultrasonography (US) and magnetic resonance ımagıng (MRI) are the most useful imaging methods for analyzing the structure of breast vessels. In this case, a 54-year-old female who have any complaint. Scanning mammography (MG) detected the tumor, but physıcal examınatıon and US could not identify the mass. According to the MG analysis, the lesion was evaluated as BIRADS 4b, and the patient underwent excisional biopsy after wire localization. Pathological analysis revealed cavernous hemangıoma.

  5. Effects of cavern spacing on the performance and stability of gas-filled storage caverns

    SciTech Connect

    Hoffman, E.L.

    1993-04-01

    Three-dimensional finite element analyses of gas-filled storage caverns in domal salt were performed to investigate the effects of cavern spacing on surface subsidence, storage loss, and cavern stability. The finite element model used for this study models a seven cavern storage field with one center cavern and six hexagonally spaced surrounding caverns. Cavern spacing is described in terms of the P/D ratio which is the pillar thickness (the width between two caverns) divided by the cavern diameter. With the stratigraphy and cavern size held constant, simulations were performed for P/D ratios of 6.0, 3.0, 2.0, 1.0, and 0.5. Ten year simulations were performed modeling a constant 400 psi gas pressure applied to the cavern lining. The calculations were performed using JAC3D, a three dimensional finite element analysis code for nonlinear quasistatic solids. For the range of P/D ratios studied, cavern deformation and storage volume were relatively insensitive to P/D ratio, while subsidence volume increased with increasing P/D ratio. A stability criterion which describes stability in terms of a limiting creep strain was used to investigate cavern stability. The stability criterion indicated that through-pillar instability was possible for the cases of P/D = 0.5 and 1.0.

  6. New public information resources on salt caverns.

    SciTech Connect

    Tomasko, D.; Veil, J. A.

    1999-08-25

    For the past decade, interest has been growing in using underground salt caverns for disposing of wastes. The Railroad Commission of Texas has permitted a few caverns for disposal of nonhazardous oil field waste (NOW) and one cavern for disposal of naturally occurring radioactive materials (NORM) from oil field activities. Several salt caverns in Canada have also been permitted for disposal of NOW. In addition, oil and gas agencies in Louisiana and New Mexico are developing cavern disposal regulations. The US Department of Energy (DOE) has funded several studies to evaluate the technical feasibility, legality, economic viability, and risk of disposing of NOW and NORM in caverns. The results of these studies have been disseminated to the scientific and regulatory communities. However, as use of caverns for waste disposal increases, more government and industry representatives and members of the public will become aware of this practice and will need adequate information about how disposal caverns operate and the risks they pose. In anticipation of this need, DOE has fi.mded Argonne National Laboratory to develop a salt cavern public outreach program. Key components of this program are an informational brochure designed for nontechnical persons and a website that provides greater detail on cavern operations and allows downloadable access to the reports on the topic funded by DOE. This paper provides an overview of the public outreach program.

  7. New public information resources on salt caverns.

    SciTech Connect

    Tomasko, D.; Veil, J. A.

    1999-08-25

    For the past decade, interest has been growing in using underground salt caverns for disposing of wastes. The Railroad Commission of Texas has permitted a few caverns for disposal of nonhazardous oil field waste (NOW) and one cavern for disposal of naturally occurring radioactive materials (NORM) from oil field activities. Several salt caverns in Canada have also been permitted for disposal of NOW. In addition, oil and gas agencies in Louisiana and New Mexico are developing cavern disposal regulations. The US Department of Energy (DOE) has funded several studies to evaluate the technical feasibility, legality, economic viability, and risk of disposing of NOW and NORM in caverns. The results of these studies have been disseminated to the scientific and regulatory communities. However, as use of caverns for waste disposal increases, more government and industry representatives and members of the public will become aware of this practice and will need adequate information about how disposal caverns operate and the risks they pose. In anticipation of this need, DOE has funded Argonne National Laboratory to develop a salt cavern public outreach program. Key components of this program are an informational brochure designed for nontechnical persons and a website that provides greater detail on cavern operations and allows downloadable access to the reports on the topic funded by DOE. This paper provides an overview of the public outreach program.

  8. Plain Language Summary: Adult Sinusitis (Sinus Infection).

    PubMed

    Caspersen, Leslie A; Walter, Lindsey M; Walsh, Sandra A; Rosenfeld, Richard M; Piccirillo, Jay F

    2015-08-01

    This plain language summary serves as an overview in explaining sinusitis (pronounced sign-you-side-tis). The purpose of this plain language summary is to provide patients with standard language explaining their condition in an easy-to-read format. This summary applies to those 18 years of age or older with sinusitis. The summary is featured as an FAQ (frequently asked question) format. The summary addresses how to manage and treat sinusitis symptoms. Adult sinusitis is often called a sinus infection. A healthcare provider may refer to a sinus infection as rhinosinusitis (pronounced rhi-no-sign-you-side-tis). This includes the nose as well as the sinuses in the name. A sinus infection is the swelling of the sinuses and nasal cavity.The summary is based on the published 2015 "Clinical Practice Guideline: Adult Sinusitis." The evidence-based guideline includes research to support more effective diagnosis and treatment of adult sinus infections. The guideline was developed as a quality improvement opportunity for managing sinus infections by creating clear recommendations to use in medical practice. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  9. Unusual venous sinuses.

    PubMed

    Srijit, D; Shipra, P

    2007-01-01

    The dural venous sinuses lie in between the two layers of the dura mater. The dural venous sinuses are important, because they receive blood from the brain and the cranial bones. All sinuses are related to the inner surface of the skull, except for the inferior sagittal and the straight sinus. The sinuses related to the inner surface of the skull produce impressions on it. During routine ostelogical teaching for undergraduate medical students, we observed an unusual oblique sinus, which connected the right and the left transverse sinuses. This unusual oblique sinus measured 2 cm and had a course from the right to the left side. The superior sagittal sinus turned onto the right but at a much higher level than the left transverse sinus. Although these sinuses communicated with each other, the normal position of the confleunce of the sinus (meeting point of superior sagittal sinus, right and left transverse sinus and the occipital sinus) was not seen. The impression meant for the posterior lobe of the left cerebral hemisphere was distinctly greater than that of the right side. The presence of such an anomaly suggests a possible developmental defect or handedness of the individual. The knowledge of the anatomical variations of the dural venous sinuses may have great clinical implications during venography, shunt surgeries and also helpful for neurologists and radiologists in addition to academic interest (Fig. 2, Ref 10) Full Text (Free, PDF) www.bmj.sk.

  10. Natural gas cavern storage regulation

    SciTech Connect

    Heneman, H.

    1995-09-01

    Investigation of an incident at an LPG storage facility in Texas by U.S. Department of Transportation resulted in recommendation that state regulation of natural gas cavern storage might be improved. Interstate Oil & Gas Compact Commission has established a subcommittee to analyze the benefits and risks associated with natural gas cavern storage, and to draft a regulation model which will suggest engineering and performance specifications. The resulting analysis and regulatory language will be reviewed by I.O.G.C.C., and if approved, distributed to member states (including New York) for consideration. Should the states desire assistance in modifying the language to reflect local variables, such as policy and geology, I.O.G.C.C. may offer assistance. The proposed presentation will review the I.O.G.C.C. product (if published at that date), and discuss implications of its application in New York.

  11. Salt caverns for oil field waste disposal.

    SciTech Connect

    Veil, J.; Ford, J.; Rawn-Schatzinger, V.; Environmental Assessment; RMC, Consultants, Inc.

    2000-07-01

    Salt caverns used for oil field waste disposal are created in salt formations by solution mining. When created, caverns are filled with brine. Wastes are introduced into the cavern by pumping them under low pressure. Each barrel of waste injected to the cavern displaces a barrel of brine to the surface. The brine is either used for drilling mud or is disposed of in an injection well. Figure 8 shows an injection pump used at disposal cavern facilities in west Texas. Several types of oil field waste may be pumped into caverns for disposal. These include drilling muds, drill cuttings, produced sands, tank bottoms, contaminated soil, and completion and stimulation wastes. Waste blending facilities are constructed at the site of cavern disposal to mix the waste into a brine solution prior to injection. Overall advantages of salt cavern disposal include a medium price range for disposal cost, large capacity and availability of salt caverns, limited surface land requirement, increased safety, and ease of establishment of individual state regulations.

  12. Effects of cavern depth on surface subsidence and storage loss of oil-filled caverns

    SciTech Connect

    Hoffman, E L

    1992-01-01

    Finite element analyses of oil-filled caverns were performed to investigate the effects of cavern depth on surface subsidence and storage loss, a primary performance criteria of SPR caverns. The finite element model used for this study was axisymmetric, approximating an infinite array of caverns spaced at 750 ft. The stratigraphy and cavern size were held constant while the cavern depth was varied between 1500 ft and 3000 ft in 500 ft increments. Thirty year simulations, the design life of the typical SPR cavern, were performed with boundary conditions modeling the oil pressure head applied to the cavern lining. A depth dependent temperature gradient of 0.012{degrees}F/ft was also applied to the model. The calculations were performed using ABAQUS, a general purpose of finite element analysis code. The user-defined subroutine option in ABAQUS was used to enter an elastic secondary creep model which includes temperature dependence. The calculations demonstrated that surface subsidence and storage loss rates increase with increasing depth. At lower depths the difference between the lithostatic stress and the oil pressure is greater. Thus, the effective stresses are greater, resulting in higher creep rates. Furthermore, at greater depths the cavern temperatures are higher which also produce higher creep rates. Together, these factors result in faster closure of the cavern. At the end of the 30 year simulations, a 1500 ft-deep cavern exhibited 4 percent storage loss and 4 ft of subsidence while a 3000 ft-deep cavern exhibited 33 percent storage loss and 44 ft of subsidence. The calculations also demonstrated that surface subsidence is directly related to the amount of storage loss. Deeper caverns exhibit more subsidence because the caverns exhibit more storage loss. However, for a given amount of storage loss, nearly the same magnitude of surface subsidence was exhibited, independent of cavern depth.

  13. Extradural cavernous haemangioma simulating a disc protrusion.

    PubMed

    Slavotinek, J P; Fowler, S; Sage, M R; Brophy, B P

    1999-02-01

    Cavernous haemangiomas confined to the epidural space are rare and are therefore infrequently considered in the differential diagnosis of spinal epidural masses. In order to draw attention to this diagnosis, a case in which an epidural cavernous haemangioma simulates a lateral/foraminal disc protrusion is presented.

  14. Giant Cavernous Haemangioma of the Anterior Mediastinum

    PubMed Central

    Kaya, Seyda Ors; Samancılar, Ozgur; Usluer, Ozan; Acar, Tuba; Yener, Ali Galip

    2015-01-01

    Cavernous hemangiomas of the anterior mediastinum is rare. We present a case of a 56-year-old male patient with a giant cavernous hemangioma of the anterior mediastinum, 18 cm in diameters, approached by left posterolateral thoracotomy. To the best of our knowledge, such a unique case has not been previously presented in the literature. PMID:26644773

  15. Disposal of NORM waste in salt caverns

    SciTech Connect

    Veil, J.A.; Smith, K.P.; Tomasko, D.; Elcock, D.; Blunt, D.; Williams, G.P.

    1998-07-01

    Some types of oil and gas production and processing wastes contain naturally occurring radioactive materials (NORM). If NORM is present at concentrations above regulatory levels in oil field waste, the waste requires special disposal practices. The existing disposal options for wastes containing NORM are limited and costly. This paper evaluates the legality, technical feasibility, economics, and human health risk of disposing of NORM-contaminated oil field wastes in salt caverns. Cavern disposal of NORM waste is technically feasible and poses a very low human health risk. From a legal perspective, there are no fatal flaws that would prevent a state regulatory agency from approving cavern disposal of NORM. On the basis of the costs charged by caverns currently used for disposal of nonhazardous oil field waste (NOW), NORM waste disposal caverns could be cost competitive with existing NORM waste disposal methods when regulatory agencies approve the practice.

  16. Combined simultaneous transcranial and endoscopic endonasal resection of sphenoorbital meningioma extending into the sphenoid sinus, pterygopalatine fossa, and infratemporal fossa

    PubMed Central

    Matsuda, Masahide; Akutsu, Hiroyoshi; Tanaka, Shuho; Matsumura, Akira

    2017-01-01

    Background: Sphenoorbital meningiomas are surgically challenging because of their nature to extend to adjacent structures. Here, we describe a case of recurrent sphenoorbital meningioma extending into the sphenoid sinus, pterygopalatine fossa, and infratemporal fossa, which was resected using combined simultaneous transcranial and endoscopic endonasal approaches. Case Description: A 62-year-old man who had 15 years earlier undergone partial resection of a left sphenoorbital meningioma presented with a 1-year history of progressive proptosis of the left eye. Magnetic resonance imaging (MRI) showed a Gd-enhancing tumor occupying the left sphenoid wing and orbital lateral wall and extending into extracranial structures such as the sphenoid sinus, pterygopalatine fossa, and infratemporal fossa as well as adjacent structures such as the cavernous sinus and superior orbital fissure (SOF). Based on the MRI findings of tumor extension into the sphenoid sinus with broad continuity, the risk of postoperative cerebrospinal fluid (CSF) leakage through the large defect in the sphenoid sinus was considered high. Subtotal resection using combined simultaneous transzygomatic and endoscopic endonasal approaches was performed, leaving residual tumor in the cavernous sinus and SOF. The large skull base defect between the middle fossa and sphenoid sinus was covered with a free graft of fascia lata from the transcranial side and with a vascularized nasoseptal flap from the endonasal side. No CSF rhinorrhea and no neurological deficits developed postoperatively. Conclusion: Combined simultaneous transcranial and endoscopic endonasal approaches may become a safe and feasible alternative for sphenoorbital meningioma with a large skull base defect penetrating to the paranasal sinus.

  17. Sinusitis (For Parents)

    MedlinePlus

    ... and mucus can become trapped in the sinuses. Bacteria, viruses, and fungi can grow there and lead to ... cases of sinusitis thought to be caused by bacteria. Some doctors may recommend ... usually goes away without medical treatment. Acetaminophen, ibuprofen, ...

  18. Approaching chronic sinusitis.

    PubMed

    Sarber, Kathleen M; Dion, Gregory Robert; Weitzel, Erik K; McMains, Kevin C

    2013-11-01

    Chronic sinusitis is a common disease that encompasses a number of syndromes that are characterized by sinonasal mucosal inflammation. Chronic sinusitis can be defined as two or more of the following symptoms lasting for more than 12 consecutive weeks: discolored rhinorrhea, postnasal drip, nasal obstruction, facial pressure or pain, or decreased sense of smell. Chronic sinusitis is further classified as chronic sinusitis with polyposis, chronic sinusitis without polyposis, or allergic fungal sinusitis using physical examination, and histologic and radiographic findings. Treatment methods for chronic sinusitis are based upon categorization of the disease and include oral and inhaled corticosteroids, nasal saline irrigations, and antibiotics in selected patients. Understanding the various forms of chronic sinusitis and managing and ruling out comorbidities are key to successful management of this common disorder.

  19. Computed Tomography (CT) -- Sinuses

    MedlinePlus Videos and Cool Tools

    ... evaluate the paranasal sinus cavities – hollow, air-filled spaces within the bones of the face surrounding the ... cavities. The paranasal sinuses are hollow, air-filled spaces located within the bones of the face and ...

  20. [Maxillary sinus hypoplasia].

    PubMed

    Plaza, G; Ferrando, J; Martel, J; Toledano, A; de los Santos, G

    2001-03-01

    Maxillary sinus hypoplasia is rare, with an estimated prevalence of 1-5%. Out of the CT scans performed in sinusal patients between March 1998 and June 1999, we report on 4 isolated maxillary sinus hypoplasia, 4 maxillary sinus hypoplasia associated to concha bullosa, and 10 isolated conchae bullosas. All cases were evaluated by nasosinusal endoscopy and CT scan. Size, location and uni/bilateral presentation of concha bullosa is correlated to maxillary sinus hypoplasia presence, specially with regards to uncinate process presence, medial or lateral retraction. The pathogenesis of maxillary sinus hypoplasia is reviewed, and its relation to concha bullosa, evaluating how this could explain some cases of the so called chronic maxillary sinus atelectasia, as an acquired and progressive variant of maxillary sinus hypoplasia in adults.

  1. Complications of Sinusitis

    MedlinePlus

    ... Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste Upper Respiratory Infections Nasal Congestion & Snoring CSF ... Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste Upper Respiratory Infections Nasal Congestion & Snoring CSF ...

  2. Sinusitis in adults - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000563.htm Sinusitis in adults - aftercare To use the sharing features on this page, please enable JavaScript. Your sinuses are chambers in ... They are filled with air. Sinusitis is an infection of these chambers, which causes ...

  3. Sinus x-ray

    MedlinePlus

    Paranasal sinus radiography; X-ray - sinuses ... sinus x-ray is taken in a hospital radiology department. Or the x-ray may be taken ... Brown J, Rout J. ENT, neck, and dental radiology. In: Adam A, Dixon AK, Gillard JH Schaefer- ...

  4. Sinusitis (For Teens)

    MedlinePlus

    ... caused by infection. Our sinuses are the moist air spaces within the bones of the face around the nose. The frontal sinuses are located in the area near the eyebrows; the ... our sinuses are filled with air, making our facial bones less dense and much ...

  5. Computed Tomography (CT) -- Sinuses

    MedlinePlus

    ... More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Computed Tomography (CT) - Sinuses Computed tomography (CT) of the sinuses uses special x-ray equipment to evaluate the paranasal sinus cavities – hollow, air-filled spaces within the bones of the face surrounding the ...

  6. Multiple cavernous malformations with supravermian arachnoid cyst.

    PubMed

    Unalp, Aycan; Uran, Nedret

    2007-11-01

    Cerebral cavernous malformation are congenital vascular abnormalities that have been reported in 0.4% of the population; they represent 5-13% of all cerebrovascular malformations. Onset of cerebral cavernous malformations may be associated with seizures, intracranial hemorrhages, focal neurological deficit or migraine-type headaches. Some patients may require surgical intervention due to hemorrhage. Multiple cavernomas in childhood have been reported in the literature, but they are rare. This manuscript presents a 12-year-old girl with multiple cavernomas accompanied by supravermian arachnoid cyst detected by neuroimaging techniques. This is the first report that demonstrates a case of pediatric multiple cavernous malformation coexisting with arachnoid cyst of the supravermian cistern.

  7. Multiphase Flow and Cavern Abandonment in Salt

    SciTech Connect

    Ehgartner, Brian; Tidwell, Vince

    2001-02-13

    This report will explore the hypothesis that an underground cavity in gassy salt will eventually be gas filled as is observed on a small scale in some naturally occurring salt inclusions. First, a summary is presented on what is known about gas occurrences, flow mechanisms, and cavern behavior after abandonment. Then, background information is synthesized into theory on how gas can fill a cavern and simultaneously displace cavern fluids into the surrounding salt. Lastly, two-phase (gas and brine) flow visualization experiments are presented that demonstrate some of the associated flow mechanisms and support the theory and hypothesis that a cavity in salt can become gas filled after plugging and abandonment

  8. Allergic Fungal Sinusitis.

    PubMed

    Correll, Daniel P; Luzi, Scott A; Nelson, Brenda L

    2015-12-01

    A 42 year old male presents with worsening pain and an increase in thick chronic drainage of the left sinus. Image studies show complete opacification of the left frontal sinus, left sphenoid sinus, and the left maxillary sinus. The patient was taken to the operating room and tissue for microscopic evaluation was obtained. The microscopic findings were classic for allergic fungal sinusitis: areas of alternating mucinous material and inflammatory cell debris and abundant Charcot-Leyden crystals. Cultures were performed and the patient began steroid therapy and desensitization therapy.

  9. Bilateral Maxillary Sinus Hypoplasia

    PubMed Central

    Khanduri, Sachin; Agrawal, Sumit; Goyal, Swati

    2014-01-01

    Maxillary sinus hypoplasia (MSH) is an uncommon abnormality of paranasal sinuses noted in clinical practice. Computed tomography (CT) scan helps in diagnosing the anomaly along with any anatomical variation that may be associated with it. MSH is usually associated with other anomalies like uncinate process hypoplasia. Three types of MSH have been described. Type 1 MSH shows mild maxillary sinus hypoplasia, type 2 shows significant sinus hypoplasia with narrowed infundibular passage and hypoplastic or absent uncinate process, and type 3 is cleft like maxillary sinus hypoplasia with absent uncinate process. CT and endoscopic examination usually complement each other in diagnosing MSH. PMID:25548709

  10. Endovascular plug for internal carotid artery occlusion in the management of a cavernous pseudoaneurysm with bifrontal subdural empyema: technical note.

    PubMed

    Manjila, Sunil; Singh, Gagandeep; Ndubuizu, Obinna; Jones, Zoe; Hsu, Daniel P; Cohen, Alan R

    2017-09-01

    The authors demonstrate the use of an endovascular plug in securing a carotid artery pseudoaneurysm in an emergent setting requiring craniotomy for a concurrent subdural empyema. They describe the case of a 14-year-old boy with sinusitis and bifrontal subdural empyema who underwent transsphenoidal exploration at an outside hospital. An injury to the right cavernous segment of the ICA caused torrential epistaxis. Bleeding was successfully controlled by inflating a Foley balloon catheter within the sphenoid sinus, and the patient was transferred to the authors' institution. Emergent angiography showed a dissection of the right cavernous carotid artery, with a large pseudoaneurysm projecting into the sphenoid sinus at the site of arterial injury. The right internal carotid artery was obliterated using pushable coils distally and an endovascular plug proximally. The endovascular plug enabled the authors to successfully exclude the pseudoaneurysm from the circulation. The patient subsequently underwent an emergent bifrontal craniotomy for evacuation of a left frontotemporal subdural empyema and exenteration of both frontal sinuses. He made a complete neurological recovery. Endovascular large-vessel sacrifice, obviating the need for numerous coils and antiplatelet therapy, has a role in the setting of selected acute neurosurgical emergencies necessitating craniotomy. The endovascular plug is a useful adjunct in such circumstances as the device can be deployed rapidly, safely, and effectively.

  11. Site tests validate benefits of cavern probes

    SciTech Connect

    Crossley, N.G.

    1997-03-10

    More than 5 years` experience with downhole probes has allowed TransGas Ltd., Regina, to monitor and evaluate cavern integrity. The devices access natural-gas storage caverns` pressures and temperatures. Acquired data have helped determine gas-in-place inventory volumes, confirm spatial volumes, and assess changes in spatial volumes that may have resulted from cavern creep (shrinkage or closure) or downhole abnormality such as fluid infill or collapse of the side walls or roof areas. This conclusion of two articles presents details and results of a specific storage-site. The first article presented background and many of the details and lessons of TransGas` cavern gas-storage probe program.

  12. Management of a complex cavern storage facility for natural gas

    SciTech Connect

    1998-04-01

    The Epe cavern storage facility operated by Ruhrgas AG has developed into one of the largest gas cavern storage facilities in the world. Currently, there are 32 caverns and 18 more are planned in the future. Working gas volume will increase from approximately 1.5 {times} 10{sup 9} to 2 {times} 10{sup 9} m{sup 3}. The stratified salt deposit containing the caverns has a surface area of approximately 7 km{sup 2} and is 250 m thick at the edge and 400 m thick in the center. Caverns are leached by a company that uses the recovered brine in the chlorine industry. Cavern dimensions are determined before leaching. The behavior of each cavern, as well as the thermodynamic properties of natural gas must be considered in cavern management. The full-length paper presents the components of a complex management system covering the design, construction, and operation of the Epe gas-storage caverns.

  13. Bayou Choctaw Caverns 15 and 17 web analysis

    SciTech Connect

    Ehgartner, B.

    1993-01-01

    The relatively thin web of salt that separates Bayou Choctaw Caverns 15 and 17 was evaluated using the finite-element method. The stability calculations provided insight as to whether or not any operationrestrictions or recommendations are necessary. Because of the uncertainty in the exact dimensions of the salt web, various web thicknesses were examined under different operating scenarios that included individual cavern workovers and drawdowns. Cavern workovers were defined by a sudden drop in the oil side pressure at the wellhead to atmospheric. Workovers represent periods of low cavern pressure. Cavern drawdowns were simulated by enlargening the cavern diameters, thus decreasing the thickness of the web. The calculations predict that Cavern 15 dominates the behavior of the web because of its larger diameter. Thus, giventhe choice of caverns, Cavern 17 should be used for oil withdrawal in order to minimize the adverse impacts on web resulting from pressure drops or cavern enlargement. From a stability point of view, maintaining normal pressures in Cavern 15 was found to be more important than operating the caverns as a gallery where both caverns are maintained at the same pressure. However, during a workover, it may be prudent to operate the caverns under similar pressures to avoid the possibility of a sudden pressure surge at the wellhead should the web fail.

  14. Deformation behaviour of a large underground cavern

    NASA Astrophysics Data System (ADS)

    Mizukoshi, Tatsuo; Mimaki, Youichi

    1985-10-01

    The Imaichi underground power station, with a cross sectional area of 1420 m2, which is now under construction by Tokyo Electric Power Co., Inc., is one of the largest underground caverns in the world. Due to the considerable depth of the over-burden of 400 m, the horseshoe-shaped section was adopted for the first time in Japan to minimize excesive stress concentration on the surrounding bedrock and keep loosened zones to a minimum. The bedrock consists of sandstone, slate, siliceous sandstone and breccia. The rock is generally hard and compact, with few fractured zones which may have an adverse influence on the excavation of the cavern. The supporting system of the cavern consists of prestressed rock anchors, rock bolts and shotcrete. Approximately 800 instruments, mainly multiple stage extensometers, were used to monitor behaviour of the surrounding rock during excavation of the cavern. With the exception of some cracks which occurred in a portion of the shotcrete when about half the height of the cavern had been excavated, excavation work was completed without any major trouble. In spite of the symmetrical shape of the cavern, the deformation behaviour of the surrounding rock during excavation was remarkedly asymmetric. The reason for this was concluded to be the peculiar deformation behaviour exhibited by Breccia during stress relief, as shown by in-situ rock tests, etc., and analysis of deformation data after completion of the excavation work.

  15. Microbiology of sinusitis.

    PubMed

    Brook, Itzhak

    2011-03-01

    Most sinus infections are viral, and only a small proportion develops a secondary bacterial infection. Rhinoviruses, influenza viruses, and parainfluenza viruses are the most common causes of sinusitis. The most common bacteria isolated from pediatric and adult patients with community-acquired acute purulent sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. Staphylococcus aureus and anaerobic bacteria (Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus spp.) are the main isolates in chronic sinusitis. Pseudomonas aeruginosa and other aerobic and facultative gram-negative rods are commonly isolated from patients with nosocomial sinusitis, the immunocompromised host, those with HIV infection, and in cystic fibrosis. Fungi and Pseudomonas aeruginosa are the most common isolates in neutropenic patients. The microbiology of sinusitis is influenced by the previous antimicrobial therapy, vaccinations, and the presence of normal flora capable of interfering with the growth of pathogens.

  16. [Complications of bacterial rhino-sinusitis in children: a case report and a review of the literature].

    PubMed

    Amat, F

    2010-03-01

    Acute sinusitis in children is a controversial issue in terms of its diagnostic criteria, classification and therapeutic management. A therapeutic delay can lead to complications if the cause is bacterial. Guidelines have been set, but they are not consensual in pediatrics. Complications of acute bacterial sinusitis are uncommon in children, but they can be extremely severe and cause high morbidity and mortality. Because of their rarity, they often are not identified early, exposing the patient to an unfavorable outcome. We report on a case of acute bacterial pan-sinusitis complicated with thrombophlebitis of the cavernous sinuses and meningitis in a 9-year-old child, in spite of early and adapted antibiotic therapy. The bacterial agent was Staphylococcus aureus, which had no resistance or toxin profile. The progression was favorable under intravenous antibiotic therapy and after bilateral sphenoidectomy. This case raises the question of the best therapy for acute bacterial sinusitis in pediatrics and the management of complications.

  17. Analysis of cavern stability at the West Hackberry SPR site.

    SciTech Connect

    Ehgartner, Brian L.; Sobolik, Steven Ronald

    2009-05-01

    This report presents computational analyses that simulate the structural response of caverns at the Strategic Petroleum Reserve (SPR) West Hackberry site. The cavern field comprises 22 caverns. Five caverns (6, 7, 8, 9, 11) were acquired from industry and have unusual shapes and a history dating back to 1946. The other 17 caverns (101-117) were leached according to SPR standards in the mid-1980s and have tall cylindrical shapes. The history of the caverns and their shapes are simulated in a three-dimensional geomechanics model of the site that predicts deformations, strains, and stresses. Future leaching scenarios corresponding to oil drawdowns using fresh water are also simulated by increasing the volume of the caverns. Cavern pressures are varied in the model to capture operational practices in the field. The results of the finite element model are interpreted to provide information on the current and future status of subsidence, well integrity, and cavern stability. The most significant results in this report are relevant to Cavern 6. The cavern is shaped like a bowl with a large ceiling span and is in close proximity to Cavern 9. The analyses predict tensile stresses at the edge of the ceiling during repressuization of Cavern 6 following workover conditions. During a workover the cavern is at low pressure to service a well. The wellhead pressures are atmospheric. When the workover is complete, the cavern is repressurized. The resulting elastic stresses are sufficient to cause tension around the edge of the large ceiling span. With time, these stresses relax to a compressive state because of salt creep. However, the potential for salt fracture and propagation exists, particularly towards Cavern 9. With only 200 ft of salt between the caverns, the operational consequences must be examined if the two caverns become connected. A critical time may be during a workover of Cavern 9 in part because of the operational vulnerabilities, but also because dilatant damage is

  18. Dorsal spinal epidural cavernous hemangioma.

    PubMed

    Sanghvi, Darshana; Munshi, Mihir; Kulkarni, Bijal; Kumar, Abhaya

    2010-07-01

    A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas.

  19. Dorsal spinal epidural cavernous hemangioma

    PubMed Central

    Sanghvi, Darshana; Munshi, Mihir; Kulkarni, Bijal; Kumar, Abhaya

    2010-01-01

    A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas. PMID:21572634

  20. Experience in testing of a solution mined storage cavern

    SciTech Connect

    Goin, K.L.

    1982-01-01

    Recertification tests were made of the U.S. Department of Energy/Strategic Petroleum Reserve oil storage cavern No. 6 in the West Hackberry, LA, salt dome. The cavern has a volume of 8,600,000 bbl. Tests included hydrostatic tests of the brine filled cavern and nitrogen leak tests of the 3 wells entering the cavern. Test procedures are described and test results are discussed.

  1. Pineal Cavernous Malformations: Report of Two Cases

    PubMed Central

    Kim, Dong-Seok; Shim, Kyu-Won; Kim, Tae-Gon; Chang, Jong-Hee; Park, Yong-Gou

    2005-01-01

    Pineal hemorrhage only occurs in rare cases, and this known to have several different causes such as germ cell tumors, pineal cysts and vascular malformations, including the cavernous malformations. Pineal cavernous malformations are extremely rare: to date only fifteen cases have been reported worldwide. Although the diagnosis of pineal cavernous malformation is not easy because of the extreme rareness of this condition, the presence of this lesion can be suspected based on its typical radiological findings. Case 1. A 42-year- old man presented with a limitation in his upward gazing. Radiologic examinations showed acute hemorrhage in the pineal region. He underwent ventriculo-peritoneal (VP) shunting but the patient's condition deteriorated after the shunting surgery. We operated and totally removed the tumor and the hemorrhages via an occipital-transtentorial approach. Case 2. A 37-year-old man presented with diplopia. Radiologic examinations showed acute hemorrhage in the third ventricle. He underwent VP shunting, and after this procedure the diplopia was aggravated. We operated and totally removed the tumor and the hemorrhages via an occipital-transtentorial approach. If there is no doubt about the pineal cavernous malformation on MR imaging, we strongly recommend early surgical intervention without performing a risky biopsy. In this study, we describe our experiences for the diagnosis of cavernous malformations in the pineal region with special emphasis on the radiological aspects and the clinical course of this disease. PMID:16385664

  2. Convexity dural cavernous haemangioma mimicking meningioma: A case report.

    PubMed

    Wang, Xiang; Liu, Jian-Ping; You, Chao; Mao, Qing

    2016-06-01

    Dural cavernous haemangiomas are rare, and they do not display a classical ring of haemosiderin on MRI as parenchymal cavernous haemangiomas. Sometimes, they are misinterpreted as meningiomas with a dural tail sign. In this short report, a 37-year-old woman was diagnosed with a convexity cavernous haemangioma, and the tumour was totally resected.

  3. [Dental foreign body sinusitis].

    PubMed

    Thévoz, F; Arza, A; Jaques, B

    2000-01-01

    Unilateral chronic maxillary sinusitis is frequently attributed to dental origin. The goal of this retrospective study is to determine the frequency of maxillary sinusitis due to a foreign body of dental origin and its characteristics. Review of 197 sinusitis cases with maxillary sinus involvement operated in our department from 1991 to 1999. Selection of the 17 cases preoperatively suspect to be due to a foreign body of dental origin. 9% of the 197 maxillary sinusitis were classified "odontogenic". Intra-sinusal foreign bodies were identified in 5%: 2% of dental origin, 1% dental or radicular remnants, 2% of "pseudo" foreign bodies of mycotic origin. Chronic maxillary sinusitis attributable to a dental foreign body is rare and overestimated. There exists an important disproportion between the number of intra-sinusal dental foreign bodies and the number of patients who are symptomatic. Treatment is surgical by oral antrotomy and/or endonasal meatotomy. Only a prospective study could give a real estimation of the proportion of symptomatic cases and determine the predisposing factors.

  4. Analysis of cavern stability at the Bryan Mound SPR site.

    SciTech Connect

    Ehgartner, Brian L.; Sobolik, Steven Ronald

    2009-04-01

    This report presents computational analyses that simulate the structural response of caverns at the Strategic Petroleum Reserve Bryan Mound site. The cavern field comprises 20 caverns. Five caverns (1, 2, 4, and 5; 3 was later plugged and abandoned) were acquired from industry and have unusual shapes and a history dating back to 1946. The other 16 caverns (101-116) were leached according to SPR standards in the mid-1980s and have tall cylindrical shapes. The history of the caverns and their shapes are simulated in a 3-D geomechanics model of the site that predicts deformations, strains, and stresses. Future leaching scenarios due to oil drawdowns using fresh water are also simulated by increasing the volume of the caverns. Cavern pressures are varied in the model to capture operational practices in the field. The results of the finite element model are interpreted to provide information on the current and future status of subsidence, well integrity, and cavern stability. The most significant result in this report is relevant to caverns 1, 2, and 5. The caverns have non-cylindrical shapes and have potential regions where the surrounding salt may be damaged during workover procedures. During a workover the normal cavern operating pressure is lowered to service a well. At this point the wellhead pressures are atmospheric. When the workover is complete, the cavern is repressurized. The resulting elastic stresses are sufficient to cause tension and large deviatoric stresses at several locations. With time, these stresses relax to a compressive state due to salt creep. However, the potential for salt damage and fracturing exists. The analyses predict tensile stresses at locations with sharp-edges in the wall geometry, or in the case of cavern 5, in the neck region between the upper and lower lobes of the cavern. The effects do not appear to be large-scale, however, so the only major impact is the potential for stress-induced salt falls in cavern 5, potentially leading to

  5. Traumatic posterior communicating artery-cavernous fistula, angioarchitecture, and possible pathogenesis: a case report and literature review

    PubMed Central

    Du, Bin; Zhang, Meng; Liu, Qing-Lin; Shen, Jie; Wang, Yun-Yan

    2016-01-01

    Carotid-cavernous fistulas (CCFs) are an abnormal vascular shunt between the carotid artery and the cavernous sinus, and were traditionally classified into four subtypes based on the detailed fistulas anatomy and arterial supply. CCFs are frequently encountered in patients with traumatic skull base fractures. In this report, we present one such case caused by two head traumas. Computed tomography and digital subtraction angiography confirmed that this CCF arose from posterior communicating artery of the internal carotid artery, which is not included in the traditional Barrow et al’s categorization. The possible mechanisms include laceration of dural mater of posterior clinoid process and laceration or pseudoaneurysm formation of posterior communicating artery. This case was successfully treated with endovascular coil embolization. PMID:27099501

  6. Intraosseous Cavernous Hemangioma: A Rare Presentation in Maxilla

    PubMed Central

    Işılgan, Servet Elçin; Çerkez, Cem; Otrakçı, Volkan; Serel, Savaş

    2014-01-01

    Objective: Hemangiomas are benign vascular lesions mostly arising from soft tissues. However, intraosseous hemangioma is a rare entity, comprising only 1% of benign bone tumors. We describe here the presentation, diagnosis, and treatment of a 42-year-old woman with a painless hard swelling—diagnosed to be intraosseous hemangioma via orbital magnetic resonance imaging—localized on the left infraorbital margin. Methods: After en bloc excision of the mass with safety margins through a subciliary incision, the defect was reconstructed via Medpor, which was fixed to the drilled bones with polypropylene sutures. Results: Histopathological diagnosis of the specimen revealed intraosseous cavernous hemangioma. There seems to be no recurrence or any cosmetic deformity 3 months postoperatively. Conclusion: Total surgical excision is the preferred method of treatment for intraosseous hemangiomas with reconstruction. In this patient, we used Medpor for reconstruction of orbital floor, the infraorbital orbital rim and anterior wall of maxillary sinus. We think that Medpor is a good option since a natural smooth malar contour and adequate orbital rim can be achieved and there is no any other scar. PMID:25328568

  7. Cardiac Cavernous Hemangioma Coexisting With Pulmonary Cavernous Hemangiomas and Giant Hepatic Hemangioma.

    PubMed

    Wang, Chunping; Chen, Hao; Sun, Lin; Mei, Yunqing

    2017-02-01

    We describe a case of cardiac cavernous hemangioma with coexisting pulmonary cavernous hemangiomas and hepatic hemangioma. A 35-year-old woman who had previously received a living donor liver transplant to cure giant hepatic hemangioma was seen because of chest pain. A cardiac neoplasm and multiple pulmonary nodules were detected. The tumor was surgically removed, and biopsy specimens were taken from the lung nodules. Histopathologic examination confirmed that both lesions were cavernous hemangiomas. The patient was discharged without adverse events postoperatively. Cardiac hemangioma is an extremely rare entity; the present case is unique for its multiorgan involvement. Suspicion of this entity should be aroused if the imaging manifestation suggests a vascular nature.

  8. Overfilling of cavern blamed for LPG blasts

    SciTech Connect

    Not Available

    1992-07-06

    Three explosions and a fire Apr. 7 at an LPG salt dome storage cavern near Brenham, Tex., were triggered when the cavern was overfilled, the Texas Railroad Commission (TRC) has reported. This paper reports that a TRC investigation found that LPG escaped to the surface at the Brenham site through brine injection tubing after excessive fill from an LPG line forced the cavern's water level below the brine tubing's bottom. At the surface, LPG was released into a brine storage pit where it turned into a dense, explosive vapor. At 7:08 a.m., the vapor was ignited by an unknown source. The resulting blast killed three persons and injured 19 and brought operations at the site to a halt.

  9. Hospital cost of pediatric patients with complicated acute sinusitis.

    PubMed

    Padia, Reema; Thomas, Andrew; Alt, Jeremiah; Gale, Craig; Meier, Jeremy D

    2016-01-01

    Review costs for pediatric patients with complicated acute sinusitis. A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Analysis of cavern shapes for the strategic petroleum reserve.

    SciTech Connect

    Ehgartner, Brian L.; Sobolik, Steven Ronald

    2006-07-01

    This report presents computational analyses to determine the structural integrity of different salt cavern shapes. Three characteristic shapes for increasing cavern volumes are evaluated and compared to the baseline shape of a cylindrical cavern. Caverns with enlarged tops, bottoms, and mid-sections are modeled. The results address pillar to diameter ratios of some existing caverns in the system and will represent the final shape of other caverns if they are repeatedly drawn down. This deliverable is performed in support of the U.S. Strategic Petroleum Reserve. Several three-dimensional models using a close-packed arrangement of 19 caverns have been built and analyzed using a simplified symmetry involving a 30-degree wedge portion of the model. This approach has been used previously for West Hackberry (Ehgartner and Sobolik, 2002) and Big Hill (Park et al., 2005) analyses. A stratigraphy based on the Big Hill site has been incorporated into the model. The caverns are modeled without wells and casing to simplify the calculations. These calculations have been made using the power law creep model. The four cavern shapes were evaluated at several different cavern radii against four design factors. These factors included the dilatant damage safety factor in salt, the cavern volume closure, axial well strain in the caprock, and surface subsidence. The relative performance of each of the cavern shapes varies for the different design factors, although it is apparent that the enlarged bottom design provides the worst overall performance. The results of the calculations are put in the context of the history of cavern analyses assuming cylindrical caverns, and how these results affect previous understanding of cavern behavior in a salt dome.

  11. Transvenous approach to carotid-cavernous fistula via facial vein cut down.

    PubMed

    Thiex, Ruth; Gross, Bradley A; Gupta, Rishi; Wyers, Mark C; Frerichs, Kai U; Thomas, Ajith J

    2014-07-01

    Endovascular access to carotid-cavernous sinus fistulae (CCF) can be obtained through a transfemoral approach to the inferior petrosal sinus (IPS) or superior ophthalmic vein (SOV). If the transfemoral approach cannot be utilized, direct surgical exposure of the SOV can provide access to the CCF. The authors present an alternate approach to a CCF in a 66-year-old woman in whom the IPS was thrombosed and the facial vein so tortuous at its origin that it could not be passed with a wire. The facial vein was exposed surgically at the angle of the mandible after percutaneous attempts failed. After localization of the anterior facial vein with ultrasound, a 1 cm skin incision was made over the margin of the mandible. The dissected vein was cannulated using a micropuncture technique and a 0.018 inch wire. A four French short access sheath was inserted and sutured to the vein. Subsequent venogram allowed navigation of an SL-10 microcatheter over a Synchro soft microwire (both Boston Scientific, Natick, MA, USA) via the SOV into the cavernous sinus, and coil embolization was performed with angiographic cure of the fistula. No complications were encountered and the cosmetic result of the small incision of the mandibular region was excellent and less conspicuous than it would have been on the eyelid. This technical note illustrates that facial vein cut down is an attractive and safe alternate approach to endovascular management of CCF via a transvenous route in patients with a focally narrowed and tortuous IPS and common facial vein.

  12. 3-D Finite Element Analyses of the Egan Cavern Field

    SciTech Connect

    Klamerus, E.W.; Ehgartner, B.L.

    1999-02-01

    Three-dimensional finite element analyses were performed for the two gas-filled storage caverns at the Egan field, Jennings dome, Louisiana. The effects of cavern enlargement on surface subsidence, storage loss, and cavern stability were investigated. The finite element model simulated the leaching of caverns to 6 and 8 billion cubic feet (BCF) and examined their performance at various operating conditions. Operating pressures varied from 0.15 psi/ft to 0.9 psi/ft at the bottom of the lowest cemented casing. The analysis also examined the stability of the web or pillar of salt between the caverns under differential pressure loadings. The 50-year simulations were performed using JAC3D, a three dimensional finite element analysis code for nonlinear quasistatic solids. A damage criterion based on onset of dilatancy was used to evaluate cavern instability. Dilation results from the development of microfractures in salt and, hence, potential increases in permeability onset occurs well before large scale failure. The analyses predicted stable caverns throughout the 50-year period for the range of pressures investigated. Some localized salt damage was predicted near the bottom walls of the caverns if the caverns are operated at minimum pressure for long periods of time. Volumetric cavern closures over time due to creep were moderate to excessive depending on the salt creep properties and operating pressures. However, subsidence above the cavern field was small and should pose no problem, to surface facilities.

  13. Sonar surveys used in gas-storage cavern analysis

    SciTech Connect

    Crossley, N.G.

    1998-05-04

    Natural-gas storage cavern internal configuration, inspection information, and cavern integrity data can be obtained during high-pressure operations with specialized gas-sonar survey logging techniques. TransGas Ltd., Regina, Sask., has successfully performed these operations on several of its deepest and highest pressurized caverns. The data can determine gas-in-place inventory and assess changes in spatial volumes. These changes can result from cavern creep, shrinkage, or closure or from various downhole abnormalities such as fluid infill or collapse of the sidewall or roof. The paper discusses conventional surveys with sonar, running surveys in pressurized caverns, accuracy of the sonar survey, initial development of Cavern 5, a roof fall, Cavern 4 development, and a damaged string.

  14. Cavernous hemangioma of Meckel's cave. Case report.

    PubMed

    Fehlings, M G; Tucker, W S

    1988-04-01

    A case of a cavernous hemangioma located within Meckel's cave and involving the gasserian ganglion is described in a patient presenting with facial pain and a trigeminal nerve deficit. Although these lesions have been reported to occur in the middle fossa, this is believed to be the first case of such a vascular malformation arising solely from within Meckel's cave.

  15. Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note.

    PubMed

    Mori, Kentaro; Yamamoto, Takuji; Oyama, Kazutaka; Ueno, Hideaki; Nakao, Yasuaki; Honma, Keiichirou

    2008-12-01

    Experience with dissection of the cavernous sinus and the temporal bone is essential for training in skull base surgery, but the opportunities for cadaver dissection are very limited. A modification of a commercially available prototype three-dimensional (3D) skull base model, made by a selective laser sintering method and incorporating surface details and inner bony structures such as the inner ear structures and air cells, is proposed to include artificial dura mater, cranial nerves, venous sinuses, and the internal carotid artery for such surgical training. The transpetrosal approach and epidural cavernous sinus surgery (Dolenc's technique) were performed on this modified model using a high speed drill or ultrasonic bone curette under an operating microscope. The model could be dissected in almost the same way as a real cadaver. The modified 3D skull base model provides a good educational tool for training in skull base surgery.

  16. Endoscopic Sinus Surgery

    MedlinePlus

    ... information in the popular media may not reflect reality. Although useful, balloon sinuplasty is not for everyone. In many cases standard endoscopic sinus surgery or medical therapy may be the best treatment. However, in some ...

  17. Expectations of Sinus Surgery

    MedlinePlus

    ... your doctor at a clinic appointment after surgery. Irrigations – The most important thing you can do to ... regularly irrigate your nose and sinuses with saline irrigations after surgery. Your doctor will show you how ...

  18. Sinusitis Q and A

    MedlinePlus

    ... to find multiple bacteria present in a single culture sample. In addition, these organisms may demonstrate drug ... are often based on the results of sinus cultures and are prescribed for 3-4 weeks time. ...

  19. Complications of Sinus Surgery

    MedlinePlus

    ... further intracranial surgeries. Impaired sense of taste or smell : The sense of smell usually improves after the procedure because airflow is ... in their voice after sinus surgery. Impairment of smell or taste: (see above) Infection: The most common ...

  20. Sinus MRI scan

    MedlinePlus

    ... sinuses. The test is noninvasive. MRI uses powerful magnets and radio waves instead of radiation. Signals from ... in the eyes. Because the MRI contains a magnet, metal-containing objects such as pens, pocketknives, and ...

  1. Rhinitis and sinusitis.

    PubMed

    Dykewicz, Mark S; Hamilos, Daniel L

    2010-02-01

    Rhinitis and sinusitis are among the most common medical conditions and are frequently associated. In Western societies an estimated 10% to 25% of the population have allergic rhinitis, with 30 to 60 million persons being affected annually in the United States. It is estimated that sinusitis affects 31 million patients annually in the United States. Both rhinitis and sinusitis can significantly decrease quality of life, aggravate comorbid conditions, and require significant direct medical expenditures. Both conditions also create even greater indirect costs to society by causing lost work and school days and reduced workplace productivity and school learning. Management of allergic rhinitis involves avoidance, many pharmacologic options, and, in appropriately selected patients, allergen immunotherapy. Various types of nonallergic rhinitis are treated with avoidance measures and a more limited repertoire of medications. For purposes of this review, sinusitis and rhinosinusitis are synonymous terms. An acute upper respiratory illness of less than approximately 7 days' duration is most commonly caused by viral illness (viral rhinosinusitis), whereas acute bacterial sinusitis becomes more likely beyond 7 to 10 days. Although the mainstay of management of acute bacterial sinusitis is antibiotics, treatment of chronic sinusitis is less straightforward because only some chronic sinusitis cases have an infectious basis. Chronic rhinosinusitis (CRS) has been subdivided into 3 types, namely CRS without nasal polyps, CRS with nasal polyps, and allergic fungal rhinosinusitis. Depending on the type of CRS present, a variety of medical and surgical approaches might be required. Copyright 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  2. Chronic sinusitis in children.

    PubMed

    Calderon, E; O'Neal, M L; Fox, R W; Calderon-Moncloa, J

    1996-01-01

    Chronic sinusitis is now recognized as a common clinical syndrome in adults and children. An astute physician can diagnose chronic sinusitis during the physical exam, but fiber-optic rhinoscopy and x-rays (plain films and computerized tomography) are required to confirm this diagnosis, evaluate the severity of the sinusitis and determine follow-up treatment. Appropriate treatment plans are prescribed for an adequate duration to eliminate infection and inflammatory components of the pathologic process of the sinuses involved. Antibiotics, decongestants, and inhaled or systemic corticosteroids are required in the treatment of patients with chronic sinusitis. When combined with close clinical follow-up, successful resolution is expected. Surgical intervention is needed in the medically refractory and symptomatic cases, or when complications develop. The frequent diagnosis of chronic sinusitis in the past 1-2 decades is, in part, due to the enhanced awareness and clinical skills of the treating physicians, but other concerns about environmental influences such as frequent respiratory tract infections in childhood and air quality issues are considered potentially important.

  3. Crater Formation Above Salt Caverns: Piston vs Hour-glass

    NASA Astrophysics Data System (ADS)

    Berest, P.

    2016-12-01

    Conditions leading to crater formation above salt caverns are discussed. In most cases, at the end of leaching, the cavern roof had reached the top of the salt formation, allowing direct contact between brine and marl (or argillite) layers that compose the overburden of the salt formation. These layers are prone to weathering when in contact with saturated brine. Stoping takes place, and the cavern roof rises through the overburden. This process may be several years or dozens of years long. In Lorraine salt formations, stoping stops when the rising cavern top reaches a competent layer, the Beaumont Dolomite. Operators then lower cavern-brine pressure to trigger collapse. A rigid cylinder of rock (a "piston") drops into the cavern, and a crater whose initial edges are vertical is created. Cavern drop is more abrupt when the cavern top is filled partly with air. The contour of the piston is circular, as a circle is the shape such that the ratio between perimeter and area is minimal. In other cases, for instance in Kansas, the cavern rises until the uppermost keystone in the bedrock at shallow depth is breached, permitting loose materials to flow into the cavern through a relatively narrow hole at the bottom of the sink hole, as in an hour glass.

  4. Sinus preservation management for frontal sinus fractures in the endoscopic sinus surgery era: a systematic review.

    PubMed

    Carter, Kenny B; Poetker, David M; Rhee, John S

    2010-09-01

    We systematically reviewed the existing literature supporting the efficacy and safety of sinus preservation management for frontal sinus fractures in the modern era of endoscopic frontal sinus surgery. A systematic review of the English literature for the targeted objective was conducted using the PubMed database between January 1995 and August 2008. The PubMed database was queried using two major search terms of frontal sinus fracture or frontal sinus injury along with manual review of citations within bibliographies. Citations acquired from the primary search were filtered and relevant abstracts were identified that merited full review. Articles were identified that included any cohort of patients with frontal sinus fractures involving the frontal sinus outflow tract or posterior wall with sinus preservation management. A total of 231 citations were generated, and 56 abstracts were identified as potentially relevant articles. Sixteen articles merited full review, with seven articles meeting inclusion criteria for sinus preservation. There were 515 total patients in the studies with 350 patients managed with frontal sinus preservation. Similar short-term complications and effectiveness were found between fractures managed with sinus preservation and those with traditional management. Sinus preservation appears to be a safe and effective management strategy for select frontal sinus fractures. More transparent reporting of management strategies for individual cases or cohorts is needed. A standardized algorithm and categorization framework for future studies are proposed. Longer-term follow-up and larger prospective studies are necessary to assess the safety and efficacy of sinus preservation protocols.

  5. Get Smart: Know When Antibiotics Work - Sinus Infection (Sinusitis)

    MedlinePlus

    ... Glossary For Patients Common Illnesses Bronchitis (Chest Cold) Common Cold & Runny Nose Ear Infection Influenza (Flu) Sinus Infection ( ... A previous respiratory tract infection, such as the common cold Structural problems within the sinuses A weak immune ...

  6. Urgent treatment of severe symptomatic direct carotid cavernous fistula caused by ruptured cavernous internal carotid artery aneurysm using high-flow bypass, proximal ligation, and direct distal clipping: Technical case report

    PubMed Central

    Hasegawa, Hirotaka; Inoue, Tomohiro; Tamura, Akira; Saito, Isamu

    2014-01-01

    Background: Direct carotid cavernous fistula (CCF) secondary to ruptured carotid cavernous aneurysms (CCAs) is rare, but patients with this condition who develop acutely worsening and severe neuro-ophthalmic symptoms require urgent treatment. Endovascular methods are the first-line option, but this modality may not be available on an urgent basis. Case Description: In this article, we report a 45-year-old female with severe direct CCF due to rupture of the CCA. She presented with intractable headache and acute worsening of double vision and visual acuity. Emergent radiographic study revealed high-flow fistula tracked from the CCA toward the contralateral cavernous sinus and drained into the engorged left superior orbital vein. To prevent permanent devastating neuro-ophthalmic damages, urgent high-flow bypass with placement of a radial artery graft was performed followed by right cervical internal carotid artery (ICA) ligation and the clipping of the ICA at the C3 portion, proximal to the ophthalmic artery. In the immediate postoperative period, her symptoms resolved and angiography confirmed patency of the high-flow bypass and complete occlusion of the CCF. Conclusion: With due consideration of strategy and techniques to secure safety, open surgical intervention with trapping and bypass is a good treatment option for direct severe CCF when the endovascular method is not available, not possible, or is unsuccessful. PMID:24818056

  7. Cavernous hemangioma of the right atrium.

    PubMed

    Contrafouris, Constantinos; Kanakis, Meletios; Milonakis, Michael; Azariadis, Prodromos; Chatzis, Andrew

    2016-11-01

    A 42-year-old woman was diagnosed during the 3rd month of pregnancy with a large right atrial tumor. Three weeks after successful completion of a full-term pregnancy, she was admitted and underwent surgical removal of the tumor. Postoperative course was uneventful and pathology showed cavernous hemangioma. These neoplasms should be removed in order to prevent severe arrhythmias as also potential malignant transformation.

  8. Allowable pillar to diameter ratio for strategic petroleum reserve caverns.

    SciTech Connect

    Ehgartner, Brian L.; Park, Byoung Yoon

    2011-05-01

    This report compiles 3-D finite element analyses performed to evaluate the stability of Strategic Petroleum Reserve (SPR) caverns over multiple leach cycles. When oil is withdrawn from a cavern in salt using freshwater, the cavern enlarges. As a result, the pillar separating caverns in the SPR fields is reduced over time due to usage of the reserve. The enlarged cavern diameters and smaller pillars reduce underground stability. Advances in geomechanics modeling enable the allowable pillar to diameter ratio (P/D) to be defined. Prior to such modeling capabilities, the allowable P/D was established as 1.78 based on some very limited experience in other cavern fields. While appropriate for 1980, the ratio conservatively limits the allowable number of oil drawdowns and hence limits the overall utility and life of the SPR cavern field. Analyses from all four cavern fields are evaluated along with operating experience gained over the past 30 years to define a new P/D for the reserve. A new ratio of 1.0 is recommended. This ratio is applicable only to existing SPR caverns.

  9. Treatment of carotid-cavernous fistulas using intraarterial balloon assistance: case series and technical note.

    PubMed

    Gonzalez, L Fernando; Chalouhi, Nohra; Tjoumakaris, Stavropoula; Jabbour, Pascal; Dumont, Aaron S; Rosenwasser, Robert H

    2012-05-01

    Multiple approaches have been used to treat carotid-cavernous fistulas (CCFs). The transvenous approach has become a popular and effective route. Onyx is a valuable tool in today's endovascular armamentarium. The authors describe the use of a balloon-assisted technique in the treatment of CCFs with Onyx and assess its feasibility, utility, and safety. The authors searched their prospectively maintained database for CCFs embolized using Onyx with the assistance of a compliant balloon placed in the internal carotid artery (ICA). Five patients were treated between July 2009 and July 2011 at the authors' institution. A balloon helped to identify the fistulous point, served as a buttress for coils, protected from inadvertent arterial embolizations, and prevented Onyx and coils from obscuring the ICA during the course of embolization. No balloon-related complications were noted in any of the 5 cases. All 5 fistulas were completely obliterated at the end of the procedure. Four patients had available clinical follow-ups, and all 4 showed reversal of nerve palsies. Balloon-assisted Onyx embolization of CCFs offers a powerful combination that prevents inadvertent migration of the embolic material into the arterial system, facilitates visualization of the ICA, and serves as a buttress for coils deployed in the cavernous sinus through the fistulous point. Despite adding another layer of technical complexity, an intraarterial balloon can provide valuable assistance in the treatment of CCFs.

  10. Shunt for bypass graft of the cavernous carotid artery: an anatomical and technical study.

    PubMed

    al-Mefty, O; Khalil, N; Elwany, M N; Smith, R R

    1990-11-01

    During direct surgery of neoplastic and vascular lesions of the cavernous sinus, the intracavernous carotid artery may be injured beyond repair, or its total isolation may be necessary for surgical management of these lesions. The newly developed procedure of a saphenous vein graft bypass of the cavernous carotid artery allows re-establishment of carotid circulation. Patients with poor collateral circulation are at high risk for ischemic complications induced by the prolonged temporary occlusion required to perform the bypass graft. Optimal management of these patients is to perform the venous bypass graft for permanent vascularization while maintaining carotid cerebral circulation through an intraoperative shunt. We studied this procedure in cadavers, and three shunt types were evaluated: the external intrapetrous-supraclinoid shunt (Type A), the internal intrapetrous-supraclinoid shunt (Type B), and the neck internal carotid-supraclinoid shunt (Type C). Anatomical landmarks, techniques, distances, caliber, and materials used are presented. The rationale and candidates for such a procedure are discussed. The specifications of an optimal balloon shunt are presented, and the three procedures are compared.

  11. Subcutaneous Cavernous Hemangioma in the Nasal Dorsum: Report of Case Treated with Endoscopic Rhinoplasty

    PubMed Central

    Socher, Jan Alessandro; Marchi, Maurício F. de Sá; Rickli, Jeniffer C. Kozechen

    2013-01-01

    Introduction Hemangiomas are vascular malformations, with slow blood flow, that can occur in any part on the body. They are more common in women and, predominantly, are isolated lesions. The malformation does not spontaneously regress. Subcutaneous hemangioma is a rare variant with an aggressive growth pattern that sometimes recurs after excision. Objective Case report of a subcutaneous cavernous hemangioma in the nasal dorsum treated with endoscopic rhinoplasty. Case Report A 27-year-old woman had a fibroelastic tumor mass in the midline of the nasal dorsum, which was pulsatile; she had obstruction and nasal congestion with associated rhinorrhea, with evolution and worsening over the previous 2 years. Computed tomography showed a tumor demarcated in the nasal dorsum without evidence of intracranial communication. Endoscopic rhinoplasty with septoplasty and associated paranasal sinus sinusectomy was performed without arteriography embolization, sclerotherapy, or laser. Pathologic diagnosis showed cavernous hemangioma. Postoperative follow-up shows no recurrence at 3 years. Discussion This case presented with atypical features, thus making the diagnosis a challenge. Imaging studies were required to confirm the vascular nature of the tumor. Excisional biopsy is the procedure of choice for pathologic examination. Subcutaneous hemangiomas never involute and always need treatment. The surgical approach is exceptional because there was no preoperative diagnosis. In addition, the closed technique provided best aesthetic results in this case. Conclusion Endoscopic rhinoplasty is suitable for nasal dorsum tumor resection and has superior aesthetic result to open techniques. PMID:25992093

  12. Strategic petroleum reserve (SPR): oil-storage cavern, Sulphur Mines 6 certification tests and analysis. [Louisiana

    SciTech Connect

    Beasley, R.R.

    1982-04-01

    Well leak tests and a cavern pressure test were conducted in June and July 1981 and indicated that oil leakage from the cavern is unlikely to exceed the DOE criterion if oil is stored at near atmospheric wellhead brine pressures and higher pressures are only used for short periods of oil fill and withdrawal. The data indicate that cavern structural failure during oil storage is unlikely and that there was no leakage from cavern 6 to the adjacent cavern 7. Because of the proximity of cavern 6 to cavern 7, it is recommended that a similar type of oil be stored in these two caverns.

  13. Headaches and sinus disease.

    PubMed

    Blumenthal, H J

    2001-10-01

    Modern diagnostic tools like fiberoptic nasal endoscopy and CT imaging of the sinuses are very sensitive in helping clinicians diagnose sinus disease; we may now reevaluate the symptoms and signs most useful in making a clinical diagnosis of rhinosinusitis. Two major systems of classification and diagnostic criteria relating headaches and sinus disease have achieved currency-that of the International Headache Society (IHS) (1988) and the more recent task force recommendations of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) (1997). This report compares and contrasts the different starting points, certain assumptions, and conflicting conclusions of these two classification systems and recommends a cooperative alliance of the IHS and AAO-HNS when these diagnostic criteria are revised.

  14. Mucopyocele of the maxillary sinus

    PubMed Central

    Kshar, Avinash; Patil, Abhijeet; Umarji, Hemant; Kadam, Sonali

    2014-01-01

    Mucoceles are defined as chronic, cystic lesions in the paranasal sinuses. When the mucocele content becomes infected, the lesion is defined as mucopyocele. Most mucoceles are located in the frontal and anterior ethmoid sinuses and normally they involve the frontal-ethmoid complex, expanding to the superior-medial region of the orbit, leading to ocular disorders; maxillary sinus presentation is rare. In the present article, the authors described a rare case of mucopyocele in the maxillary sinus. PMID:24688571

  15. [Percussional auscultation of frontal sinuses].

    PubMed

    Akopian, R G

    2000-01-01

    Percussional auscultation of the frontal sinuses is used for diagnosis of frontal sinusitides. Phonendoscope placed by the sinus walls auscultates sounds forming as a result of comparative percussion of the anterior sinus walls. Three main percussional tones are singled out. This method was employed for diagnosis in 48 patients with frontal sinusitis. The technique is easy to perform, safe and precise (90%). The trend in frontal sinusitides development can be followed up.

  16. [Mucormycosis in paranasal sinuses].

    PubMed

    Volkenstein, S; Unkel, C; Neumann, A; Sudhoff, H; Dermoumi, H; Jahnke, K; Dazert, S

    2009-08-01

    Three patients with mucormycosis of the paranasal sinuses were treated in the University ENT departments in Bochum and Essen in recent years. All patients were immunocompromised for different reasons and had reduced resistance against microorganism infection. They presented with symptoms of orbital complications of sinusitis. The further progress of these life-threatening fungal infections with a mortality rate between 35 and 70% depends on early and definitive diagnosis and radical surgical therapy to reduce the amount of infectious agent. The difficulties of early diagnosis by imaging, histology, microbiology, or molecular biology and postoperative therapeutic options especially with amphotericin B, liposomal amphotericin B, and posaconazole are illustrated and discussed.

  17. Standing equine sinus surgery.

    PubMed

    Barakzai, Safia Z; Dixon, Padraic M

    2014-04-01

    Trephination of the equine sinuses is a common surgical procedure in sedated standing horses. Standing sinus flap surgery has become increasingly popular in equine referral hospitals and offers several advantages over sinusotomy performed under general anesthesia, including reduced patient-associated risks and costs; less intraoperative hemorrhage, allowing better visualization of the operative site; and allows surgeons to take their time. Other minimally invasive surgical procedures include sinoscopic surgery, balloon sinuplasty, and transnasal laser sinonasal fenestration. Despite the procedure used, appropriate indications for surgery, good patient selection, and familiarity with regional anatomy and surgical techniques are imperative for good results. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. [Histopathologic study of chronic sinusitis].

    PubMed

    Wayoff, M; Parache, R M; Bodelet, B; Gazel, P

    1983-01-01

    The conventional histopathology of the sinus is a criterium for the therapeutic indication, since it is possible to distinguish between granulomatous chronic sinusitis, chronic sinusitis with oedema and nasal polyposis. Each one of these clinical pictures has his own etiology and requires a specific therapeutic approach.

  19. Chronic odontogenic maxillary sinusitis.

    PubMed

    Ugincius, Paulius; Kubilius, Ricardas; Gervickas, Albinas; Vaitkus, Saulius

    2006-01-01

    The aim of the present study was to estimate average age of the patients in both sexes treated for MS, distribution by sex, amount of dexter and sinister MS with and without the fistulas into the maxillary sinus, with and without the foreign-bodies, length of stay in the Department of Maxillofacial Surgery at Kaunas Hospital of University of Medicine during the period from 1999 till 2004. The retrospective data analysis of the patients' treated from chronic MS was made. 346 patients (213 females and 133 males) were treated for chronic MS. 55 cases of chronic dexter MS with a fistula into maxillary sinus, 98 cases of chronic dexter MS without a fistula, 45 cases of chronic sinister MS with a fistula, 112 cases chronic sinister MS without a fistula, 16 cases of foreign-bodies in dexter maxillary sinus, 20 cases of foreign-bodies in sinister maxillary sinus have been detected. The main age of the female was 46.6+/-15.0, the main age of the men was 42.1+/-14.4. Statictically significant difference in the age difference of the women and the men was found (p=0.0024). It was determined, that females diagnosed and treated with chronic MS were 1.6 times more than males during the period from 1999 till 2004 in Kaunas Hospital of University of Medicine. Females treated for chronic MS were 4.5 years older than males.

  20. Nasal dermoid sinus cyst.

    PubMed

    Cauchois, R; Laccourreye, O; Bremond, D; Testud, R; Küffer, R; Monteil, J P

    1994-08-01

    Nasal dermoid sinus cyst is one of the diagnoses of midline nasal masses in children. This retrospective study analyzes the various theories regarding the origin of this congenital abnormality, the differential diagnosis, and the value of magnetic resonance imaging, as well as the various surgical options available.

  1. 36 CFR 7.47 - Carlsbad Caverns National Park.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Carlsbad Caverns National Park. 7.47 Section 7.47 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR SPECIAL REGULATIONS, AREAS OF THE NATIONAL PARK SYSTEM § 7.47 Carlsbad Caverns National Park. (a...

  2. 36 CFR 7.47 - Carlsbad Caverns National Park.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false Carlsbad Caverns National Park. 7.47 Section 7.47 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR SPECIAL REGULATIONS, AREAS OF THE NATIONAL PARK SYSTEM § 7.47 Carlsbad Caverns National Park. (a...

  3. 36 CFR 7.47 - Carlsbad Caverns National Park.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 1 2014-07-01 2014-07-01 false Carlsbad Caverns National Park. 7.47 Section 7.47 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR SPECIAL REGULATIONS, AREAS OF THE NATIONAL PARK SYSTEM § 7.47 Carlsbad Caverns National Park. (a...

  4. 36 CFR 7.47 - Carlsbad Caverns National Park.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Carlsbad Caverns National Park. 7.47 Section 7.47 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR SPECIAL REGULATIONS, AREAS OF THE NATIONAL PARK SYSTEM § 7.47 Carlsbad Caverns National Park. (a...

  5. 36 CFR 7.47 - Carlsbad Caverns National Park.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 1 2013-07-01 2013-07-01 false Carlsbad Caverns National Park. 7.47 Section 7.47 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR SPECIAL REGULATIONS, AREAS OF THE NATIONAL PARK SYSTEM § 7.47 Carlsbad Caverns National Park. (a...

  6. Cavernous hemangioma. Why is peripheral filling at scintigraphy so rare

    SciTech Connect

    Drane, W.E.; Weatherby, E. III

    1987-10-01

    Peripheral filling at dynamic CT occurs frequently with cavernous hemangiomas, yet this phenomenon is a rare finding on Tc-99m RBC imaging. A case of peripheral filling of a cavernous hemangioma with scintigraphy is reported and the rationale for its infrequent occurrence is discussed.

  7. Urgent treatment of severe subarachnoid hemorrhage caused by ruptured traumatic aneurysm of the cavernous internal carotid artery using coil embolization followed by superficial temporal artery-middle cerebral artery anastomosis: a case report.

    PubMed

    Inoue, Tomohiro; Tsutsumi, Kazuo; Iijima, Akira; Shinozaki, Munehisa; Ishida, Junro; Yako, Kyoko

    2005-11-01

    Traumatic aneurysm of the cavernous internal carotid artery (ICA) with extension into the subarachnoid space is associated with increased risk of fatality especially when it is accompanied by severe subarachnoid hemorrhage (SAH). Only cases of patients who survived the acute stage and who were treated in a delayed setting have been reported. There has been no successfully treated case immediately after an injury. We encountered a 48-year-old man who presented with dense SAH immediately after being involved in a motor vehicle accident. Emergent angiography revealed traumatic aneurysm of the left cavernous ICA with extension beyond the superior wall of the cavernous sinus into the subarachnoid space and concomitant direct high-flow carotid cavernous fistula. Detachable platinum coil occlusion of the cavernous ICA followed by superficial temporal artery-middle cerebral artery anastomosis on day 0 and aggressive therapy to SAH, including ventriculocisternal irrigation and drainage, was performed. The patient eventually made a good recovery. Considering the extremely poor prognosis and unstable nature of a ruptured traumatic aneurysm with extensive SAH in the acute stage, definitive and immediate prevention of rebleeding in conjunction with proper revascularization would be warranted, such as in the present case.

  8. Sinus pericranii, petrosquamosal sinus and extracranial sigmoid sinus: Anatomical variations to consider during a retroauricular approach.

    PubMed

    Cisneros, Juan Carlos; Lopes, Paula Tardim; Bento, Ricardo Ferreira; Tsuji, Robinson Koji

    2017-06-01

    Lateral and sigmoid sinus malformations are uncommon and dangerous anatomical variations that surgeons may encounter when performing a retroauricular approach. We report three cases of rare temporal bone venous sinus anomalies seen in patients who underwent cochlear implant surgery. The first patient had a diagnosis of CHARGE syndrome and presented a bilateral persistent petrosquamosal sinus with sigmoid sinus agenesis, which made mastoidectomy for cochlear implantation difficult. The second patient presented an anomalous venous lake in the occipital region, which communicated the left dural venous sinuses with a conglomerate of pericranial vessels in the left nuchal region, also consistent with left sinus pericranii. The third patient presented with an extracranial sigmoid sinus that produced a troublesome bleeding immediately after the muscular-periosteal flap incision was performed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Meningioma and cavernous angioma following childhood radiotherapy.

    PubMed

    Baheti, Akshay D; Mahore, Amit S; Zade, Bhooshan P; Jalali, Rakesh

    2010-01-01

    Prophylactic cranial irradiation has been a part of multimodality management of acute lymphoblastic leukemia (ALL). With optimum treatment and the resultant long-term cure rates, long-term side effects of radiation including radiation-induced neoplasms have been increasingly unearthed. We report a rare case of development of both a meningioma and a cavernous angioma following prophylactic cranial irradiation as a part of treatment of ALL. Regular follow-up and high index of suspicion for late radiation sequelae after treatment are therefore justifiable in leukemia survivors with history of prophylactic cranial irradiation.

  10. Primary Intraosseous Cavernous Hemangioma in the Skull

    PubMed Central

    Yang, Yi; Guan, Jian; Ma, Wenbin; Li, Yongning; Xing, Bing; Ren, Zuyuan; Su, Changbao; Wang, Renzhi

    2016-01-01

    Abstract Primary intraosseous cavernous hemangiomas (PICHs) are benign vascular tumors that may involve any part of the body. PICH occurs more frequently in the spine and less commonly in skull. The earliest description in the English literature was in 1845 by Toynbee, who reported a vascular tumor arising in the confines of the parietal bone. Skull PICHs do not always have typical radiologic features and should always be considered in the differential diagnosis of malignant skull lesions. We now reviewed and analyzed related literatures in detail with reporting a rare case of PICH in the left front bone that was surgically resected. PMID:26986133

  11. Primary cavernous hemangioma of the thyroid gland.

    PubMed

    Michalopoulos, Nikolaos V; Markogiannakis, Haridimos; Kekis, Panagiotis B; Papadima, Artemisia; Lagoudianakis, Emmanuel; Manouras, Andreas

    2010-07-01

    A 78-year-old euthyroid patient presented for evaluation of a symptomatic, slowly growing neck mass. Ultrasound scan revealed a multinodular goiter and a hypoechoic nodule of the right thyroid lobe. Total thyroidectomy was performed and the lesion was completely excised. Definite diagnosis was obtained after histological examination of the surgical specimen. Cavernous hemangiomas of the thyroid gland are infrequent lesions which may escape diagnosis preoperatively. An effort should be made not to rupture these lesions in order to ensure a bloodless procedure.

  12. Pathognomonic scintigraphic finding of hepatic cavernous hemangioma

    SciTech Connect

    Kim, S.M.; Park, C.H.; Yang, S.L.; Rosato, F.

    1987-01-01

    Hemangioma is the most common benign tumor of the liver. An accurate diagnosis of such tumor is essential for proper management of patients with hepatic cavernous hemangioma (HCH). Noninvasive diagnosis of HCH can be made using sequential Tc-99m RBC scintigraphy by demonstrating a perfusion-blood pool mismatch. In addition, a case of HCH was observed which demonstrated peripheral enhancement with subsequent central enhancement on a sequential Tc-99m RBC blood pool scintigraphy. It is felt that this scintigraphic finding is pathognomonic for HCH.

  13. Disposal of oil field wastes into salt caverns: Feasibility, legality, risk, and costs

    SciTech Connect

    Veil, J.A.

    1997-10-01

    Salt caverns can be formed through solution mining in the bedded or domal salt formations that are found in many states. Salt caverns have traditionally been used for hydrocarbon storage, but caverns have also been used to dispose of some types of wastes. This paper provides an overview of several years of research by Argonne National Laboratory on the feasibility and legality of using salt caverns for disposing of oil field wastes, the risks to human populations from this disposal method, and the cost of cavern disposal. Costs are compared between the four operating US disposal caverns and other commercial disposal options located in the same geographic area as the caverns. Argonne`s research indicates that disposal of oil field wastes into salt caverns is feasible and legal. The risk from cavern disposal of oil field wastes appears to be below accepted safe risk thresholds. Disposal caverns are economically competitive with other disposal options.

  14. Beta adrenergic receptors in human cavernous tissue

    SciTech Connect

    Dhabuwala, C.B.; Ramakrishna, C.V.; Anderson, G.F.

    1985-04-01

    Beta adrenergic receptor binding was performed with /sup 125/I iodocyanopindolol on human cavernous tissue membrane fractions from normal tissue and transsexual procedures obtained postoperatively, as well as from postmortem sources. Isotherm binding studies on normal fresh tissues indicated that the receptor density was 9.1 fmoles/mg. with a KD of 23 pM. Tissue stored at room temperature for 4 to 6 hours, then at 4C in saline solution for 19 to 20 hours before freezing showed no significant changes in receptor density or affinity, and provided evidence for the stability of postmortem tissue obtained within the same time period. Beta receptor density of 2 cavernous preparations from transsexual procedures was not significantly different from normal control tissues, and showed that high concentrations of estrogen received by these patients had no effect on beta adrenergic receptor density. Displacement of /sup 125/iodocyanopindolol by 5 beta adrenergic agents demonstrated that 1-propranolol had the greatest affinity followed by ICI 118,551, zinterol, metoprolol and practolol. When the results of these displacement studies were subjected to Scatfit, non- linear regression line analysis, a single binding site was described. Based on the relative potency of the selective beta adrenergic agents it appears that these receptors were of the beta 2 subtype.

  15. Giant cavernous hemangioma of the adrenal gland

    PubMed Central

    Quildrian, Sergio Damián; Silberman, Ezequiel Aníbal; Vigovich, Felix Alberto; Porto, Eduardo Agustín

    2012-01-01

    INTRODUCTION Cavernous hemangioma of the adrenal gland is a rare non-functioning benign neoplasm. PRESENTATION OF CASE A 62-year-old woman with chronic obstructive pulmonary disease was diagnosed as having an incidental non-functioning adrenal tumor. Because of the impossibility of ruling out the presence of malignancy, conventional surgical resection was carried out. The histopathology revealed a 12.5 cm × 11.5 cm × 8 cm adrenal mass with large and lacunae vascular spaces lined with mature endothelial cells. These findings were compatible with cavernous hemangioma. DISCUSSION The majority of patients in the literature underwent surgical resection due to the impossibility of excluding malignancy, because of related symptoms in patients with large masses, or because of the risk of spontaneous tumoral rupture. CONCLUSION These tumors are quite infrequent. Due to the low frequency and the lack of specific symptoms, most adrenal hemangiomas are diagnosed postoperatively. PMID:23287064

  16. Molecular diagnosis in cerebral cavernous malformations.

    PubMed

    Mondejar, R; Lucas, M

    2017-10-01

    Cerebral cavernous malformations (CCMs; OMIM 116860) are enlarged vascular cavities without intervening brain parenchyma whose estimated prevalence in the general population is between 0.1% and 0.5%. Familial CCM is an autosomal dominant disease with incomplete clinical and radiological penetrance. Three genes have been linked to development of the lesions: CCM1/KRIT1, CCM2/MGC4607, and CCM3/PDCD10. The aetiological mutation is not detected in a large percentage of cases and new approaches are therefore needed. The aim of this review is to analyse current molecular techniques and the possible mutations or variations which can be detected in a molecular genetics or molecular biology laboratory. Likewise, we will analyse other alternatives that may help detect mutations in those patients showing negative results. A molecular diagnosis of cerebral cavernous malformations should provide at least the copy number variation and sequencing of CCM genes. In addition, appropriate genetic counselling is a crucial source of information and support for patients and their relatives. Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Evaluating the effects of the number of caverns on the performance of underground oil storage facilities

    SciTech Connect

    Hoffman, E.L.; Ehgartner, B.L.

    1992-01-01

    Three dimensional finite element calculations were performed to investigate the effect field size, in terms of the number of caverns, on the performance of SPR oil storage caverns leached in domal salt (interms of surface subsidence, storage losses, and cavern integrity). The calculations were performed for cavern fields containing 1, 7, 19, and an infinite number of caverns. The magnitude and volume of subsidence was significantly affected by increasing the number of caverns (nearly an order of magnitude increase was predicted for each increase in field size), while the extent of subsidence (approximately 2000 m fromthe center of the field) and storage loss were not. Furthermore, the percentage of storage loss volume manifested as surface subsidence increased as the cavern field was enlarged. This was attributed to elasticvolumetric dilatation of overlying strata. The multiple cavern calculations demonstrate that storage losses are greater for caverns farther from the center of the caverns field. Based on an accumulated strain stability criteria, the larger cavern fields are predicted to have a shorter life. This criteria also indicates that caverns on the periphery of a field may show signs of instability before the inner caverns. The West Hackberry site (containing 22 caverns) subsidence data closely agrees with the 19 cavern model subsidence predictions, providing confidence in the calculations. Even a 19 cavern field, substantially large by SPR standards, does not approach the behavior predicted by infinite cavern models (which are frequently used because they are economical). This demonstrates that 3D modeling is required to accurately investigate the performance of a multi-cavern array. Although based on a typical SPR cavern design, the results of this study describe mechanics common to all multi-cavern fields and should, in general, be useful tocavern engineers and architects.

  18. CaveMan Version 3.0: A Software System for SPR Cavern Pressure Analysis

    SciTech Connect

    BALLARD,SANFORD; EHGARTNER,BRIAN L.

    2000-07-01

    The U. S. Department of Energy Strategic Petroleum Reserve currently has approximately 500 million barrels of crude oil stored in 62 caverns solution-mined in salt domes along the Gulf Coast of Louisiana and Texas. One of the challenges of operating these caverns is ensuring that none of the fluids in the caverns are leaking into the environment. The current approach is to test the mechanical integrity of all the wells entering each cavern approximately once every five years. An alternative approach to detecting cavern leaks is to monitor the cavern pressure, since leaking fluid would act to reduce cavern pressure. Leak detection by pressure monitoring is complicated by other factors that influence cavern pressure, the most important of which are thermal expansion and contraction of the fluids in the cavern as they come into thermal equilibrium with the host salt, and cavern volume reduction due to salt creep. Cavern pressure is also influenced by cavern enlargement resulting from salt dissolution following introduction of raw water or unsaturated brine into the cavern. However, this effect only lasts for a month or two following a fluid injection. In order to implement a cavern pressure monitoring program, a software program called CaveMan has been developed. It includes thermal, creep and salt dissolution models and is able to predict the cavern pressurization rate based on the operational history of the cavern. Many of the numerous thermal and mechanical parameters in the model have been optimized to produce the best match between the historical data and the model predictions. Future measurements of cavern pressure are compared to the model predictions, and significant differences in cavern pressure set program flags that notify cavern operators of a potential problem. Measured cavern pressures that are significantly less than those predicted by the model may indicate the existence of a leak.

  19. Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies

    PubMed Central

    Chi, Cuong Tran; Nguyen, Dang; Duc, Vo Tan; Chau, Huynh Hong; Son, Vo Tan

    2014-01-01

    Summary We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases

  20. CD105 expression in oral capillary hemangiomas and cavernous hemangiomas.

    PubMed

    Matsumoto, Naoyuki; Tsuchiya, Motomi; Nomoto, Shouta; Matsue, Yasuyoshi; Nishikawa, Yohichi; Takamura, Tsuyoshi; Oki, Hidero; Komiyama, Kazuo

    2015-03-01

    Capillary hemangioma (capillary lobular hemangioma) and cavernous hemangioma (venous malformation) are relatively common oral tumors/malformations and are characterized by increased numbers of normal and abnormal blood vessels. However, the causes of these lesions are not well understood. CD105 (endoglin) is predominantly expressed in proliferating blood endothelial cells (ECs). We analyzed expressions of CD105, CD34, von Willebrand factor, Ki-67, cyclooxygenase-2 (COX-2), and vascular endothelial growth factor (VEGF)-A in 31 capillary hemangiomas and 34 cavernous hemangiomas. Staining scores were calculated as the product of the proportion score and intensity score. Morphologically normal oral mucosa specimens (n = 10) were simultaneously evaluated as normal controls. As compared with cavernous hemangiomas and normal controls, capillary hemangiomas had higher staining scores for CD105, VEGF-A, and COX-2. The Ki-67 labeling index was significantly higher in capillary hemangiomas than in cavernous hemangiomas and normal controls (P < 0.01). These findings suggest that the biological characteristics of capillary and cavernous hemangiomas are quite different. The ECs of capillary hemangiomas actively proliferated and were generally regulated by VEGF-A. In contrast, the ECs of cavernous hemangiomas lacked proliferative activity. These results suggest that angiogenesis and vasodilatation of pre-existing blood vessels are important in the development of capillary hemangioma and cavernous hemangioma, respectively.

  1. [Orbital complications of sinusitis].

    PubMed

    Šuchaň, M; Horňák, M; Kaliarik, L; Krempaská, S; Koštialová, T; Kovaľ, J

    2014-12-01

    Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal

  2. Strategic petroleum reserve caverns casing damage update 1997

    SciTech Connect

    Munson, D.E.; Molecke, M.A.; Neal, J.T.

    1998-01-01

    Hanging casing strings are used for oil and brine transfer in the domal salt storage caverns of the Strategic Petroleum Reserve (SPR). Damage to these casings is of concern because hanging string replacement is costly and because of implications on cavern stability. Although the causes of casing damage are not always well defined, many events leading to damage are assumed to be the result of salt falls impacting the hanging strings. However, in some cases, operational aspects may be suspected. The history of damage to hanging strings is updated in this study to include the most recent events. Potential general domal and local operational and material factors that could influence the tendency for caverns to have salt falls are examined in detail. As a result of this examination, general factors, such as salt dome anomalies and crude type, and most of the operational factors, such as geometry, location and depressurizations, are not believed to be primary causes of casing damage. Further analysis is presented of the accumulation of insolubles during cavern solutioning and accumulation of salt fall material on the cavern floor. Inaccuracies in sump geometry probably make relative cavern insolubles contents uncertain. However, determination of the salt fall accumulations, which are more accurate, suggest that the caverns with the largest salt fall accumulations show the greatest number of hanging string events. There is good correlation between the accumulation rate and the number of events when the event numbers are corrected to an equivalent number for a single hanging string in a quiescent, operating cavern. The principal factor that determines the propensity for a cavern to exhibit this behavior is thought to be the effect of impurity content on the fracture behavior of salt.

  3. Odontogenic maxillary sinusitis: a review.

    PubMed

    Simuntis, Regimantas; Kubilius, Ričardas; Vaitkus, Saulius

    2014-01-01

    Maxillary sinusitis of odontogenic origin is a well-known condition in both the dental and otolaryngology communities. It occurs when the Schneiderian membrane is violated by conditions arising from dentoalveolar unit. This type of sinusitis differs in its pathophysiology, microbiology, diagnostics and management from sinusitis of other causes, therefore, failure to accurately identify a dental cause in these patients usually lead to persistent symptomatology and failure of medical and surgical therapies directed toward sinusitis. Unilateral recalcitrant disease associated with foul smelling drainage is a most common feature of odontogenic sinusitis. Also, high-resolution CT scans and cone-beam volumetric computed tomography can assist in identifying dental disease. Sometimes dental treatment alone is adequate to resolve the odontogenic sinusitis and sometimes concomitant or subsequent functional endoscopic sinus surgery or Caldwell-Luc operation is required. The aim of this article is to give a review of the most common causes, symptoms, diagnostic and treatment methods of odontogenic maxillary sinusitis. Search on Cochrane Library, PubMed and Science Direct data bases by key words resulted in 35 articles which met our criteria. It can be concluded that the incidence of odontogenic sinusitis is likely underreported in the available literature.

  4. Clinical significance of unilateral sinusitis.

    PubMed Central

    Shin, H. S.

    1986-01-01

    In general, the etiologic factors of chronic paranasal sinusitis are systemic conditions such as nutrition, predisposition, allergy, and local factors such as nasal anatomic conditions. Among these factors, the development of unilateral sinusitis is a model case verifying the influence of local factors. In my study of 640 cases over a certain period of time, a comparison was made between 161 cases of unilateral sinusitis and 479 cases of bilateral sinusitis in order to verify the effects of local factors in the development of this disease. Patients with a history of previous sinus surgery or tumors were eliminated from the cases. 1. The male-female incidence rate, and the age distribution of the patients at the initial visit showed no prominent differences between unilateral and bilateral cases. 2. It was found that a larger number of cases of unilateral sinusitis had a duration of less than one year as compared to bilateral sinusitis which were longer than and year. Therefore it can be said that the duration of unilateral sinusitis is usually shorter than that of bilateral sinusitis. 3. In unilateral cases the patients with moderate to severe nasal septal deviation, one number of patients with septal deviation towards the diseased side was twice as high as that on the non-affected side. 4. The incidence rate of polyps occurring in the middle meatus was shown to be about twice as high in bilateral cases as in unilateral cases.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2856589

  5. Understanding Biofilms in Chronic Sinusitis.

    PubMed

    Tajudeen, Bobby A; Schwartz, Joseph S; Palmer, James N

    2016-02-01

    Chronic sinusitis is a burdensome disease that has substantial individual and societal impact. Although great advances in medical and surgical therapies have been made, some patients continue to have recalcitrant infections. Microbial biofilms have been implicated as a cause of recalcitrant chronic sinusitis, and recent studies have tried to better understand the pathogenesis of chronic sinusitis as it relates to microbial biofilms. Here, we provide an overview of biofilms in chronic sinusitis with emphasis on pathogenesis, treatment, and future directions. In addition, recent evidence is presented, elucidating the role of bitter taste receptors as a possible key factor leading to biofilm formation.

  6. Diagnosis and management of cavernous hemangioma of the liver

    SciTech Connect

    Takagi, H.

    1985-01-01

    Cavernous hemangiomas are the most common benign tumors of the liver, which are now seen more often thanks to common use of newer imaging techniques. A review of the literature on cavernous hemangiomas of the liver, including the author's experience with 14 cases, provides data as a touchstone for discussion of the incidence, etiology, symptoms, pathology, diagnosis including ultrasound, radionuclide imaging, computed tomography and angiography, management including resection, hepatic artery ligation, radiation and corticosteroid, and the natural history of these lesions. The author concludes that surgical resection of cavernous hemangiomas should be undertaken with due concern for the relation between the severity of symptoms and the operative risks involved.

  7. Isolated pyocele of anterior clinoid process presenting as a cavernous sinus syndrome.

    PubMed

    O'Donnell, Thomas J; Michael, L Madison; Laster, Robert; Fleming, James C

    2013-05-01

    A 37-year-old man presented with fever, decreased vision in the left eye, a partial left cranial nerve III paresis, and a left cranial nerve VI paresis. Neuro-imaging showed an opacification of a left pneumatised anterior clinoid process. After failing a course of intravenous antibiotics, a craniotomy was performed with exenteration of the cavity and resolution of symptoms. Although rare, a pyocele of a pneumatised anterior clinoid process may cause ocular morbidity and require surgical intervention.

  8. Difference between Sinusitis and a Cold

    MedlinePlus

    ... Disabilities Obesity Orthopedic Prevention Sexually Transmitted ... is an inflammation of the lining of the nose and sinuses. It is a very common infection in children. Viral sinusitis usually accompanies a cold. Allergic sinusitis may ...

  9. Multiple cerebrospinal cavernous angiomas

    PubMed Central

    Kodeeswaran, M.; Udesh, Reshmi; Ramya, L.; Jothi Kumar, S.

    2016-01-01

    Cavernous angiomas represent 5–12% of all spinal vascular lesions and 1% of all intramedullary lesions in pediatric patients. Intramedullary spinal cavernomas are relatively rare with only 24 cases reported till date to the best of our knowledge. A 15 -year-old boy presented to the clinic with acute onset motor weakness in all four limbs. He was diagnosed with multiple cerebral cavernomas and an acutely bleeding spinal cavernoma. Complete surgical excision of the spinal cavernoma was done. Postoperatively the patient's weakness gradually improved to a power of 4/5 in all his limbs over a period of 10 days. Only 24 cases of pediatric spinal cavernomas have been reported in the current literature. Current consensus on management of these rare lesions is based on previously published case reports/series and surgery appears to be the only definitive treatment. Further studies regarding any non-surgical expectant management appears warranted. PMID:27651109

  10. Radiological evaluation of hepatic cavernous hemangioma

    SciTech Connect

    Brant, W.E.; Floyd, J.L.; Jackson, D.E.; Gilliland, J.D.

    1987-05-08

    Cavernous hemangiomas of the liver are sufficiently common that they will often be incidentally discovered during hepatic imaging by ultrasound, computed tomography, or radiocolloid scintigraphy. The differentiation of these benign tumors from primary or metastatic hepatic malignancy is mandatory, but often it is not possible on the study in which the lesion was originally detected. There are several routes by which to arrive at the correct diagnosis, but the optimum study or sequence of studies may elude the physician caring for the patient. Knowledge of the imaging options, and the strengths and weaknesses of each of these options, will facilitate a rapid diagnosis and ensure proper treatment, with maximum patient safety and minimum expenditure of resources. This article examines these radiological options.

  11. Cerebral cavernous malformation proteins at a glance.

    PubMed

    Draheim, Kyle M; Fisher, Oriana S; Boggon, Titus J; Calderwood, David A

    2014-02-15

    Loss-of-function mutations in genes encoding KRIT1 (also known as CCM1), CCM2 (also known as OSM and malcavernin) or PDCD10 (also known as CCM3) cause cerebral cavernous malformations (CCMs). These abnormalities are characterized by dilated leaky blood vessels, especially in the neurovasculature, that result in increased risk of stroke, focal neurological defects and seizures. The three CCM proteins can exist in a trimeric complex, and each of these essential multi-domain adaptor proteins also interacts with a range of signaling, cytoskeletal and adaptor proteins, presumably accounting for their roles in a range of basic cellular processes including cell adhesion, migration, polarity and apoptosis. In this Cell Science at a Glance article and the accompanying poster, we provide an overview of current models of CCM protein function focusing on how known protein-protein interactions might contribute to cellular phenotypes and highlighting gaps in our current understanding.

  12. Reference value developed for mechanical integrity of storage caverns

    SciTech Connect

    Crotogino, F.

    1996-10-28

    A reference value to verify the mechanical integrity of salt-cavern wells used in hydrocarbon storage has been developed. Salt caverns play important roles in large-scale storage of hydrocarbon gases and liquids. Required for safe and economical operation of these storage caverns is verification of the external mechanical integrity of the access (injection and withdrawal) wells. This study had the following goals: Provision of an overview of current practice; and Development of a reference for external well mechanical-integrity testing with respect to performance, data evaluation, and assessment. The storage cavern operators expected to gain the following: Comparability between method and assessments; Aid in influencing the movement towards standardization by regulators; and A firm technical base for use in litigation between the operator and other parties.

  13. Optic chiasmal cavernous angioma: A rare suprasellar vascular malformation

    PubMed Central

    Abou-Al-Shaar, Hussam; Bahatheq, Ayman; Takroni, Radwan; Al-Thubaiti, Ibrahim

    2016-01-01

    Background: Suprasellar cavernous malformation in the optic pathway is not commonly encountered. To date, there are only few reports present in the literature. Case Description: The authors report a rare case of suprasellar optic pathway cavernous malformation in a 33-year-old female who presented with progressive visual loss. Her imaging revealed a large heterogeneous, hyperintense, hemorrhagic right suprasellar extra-axial complex cystic structure, causing mass effect on the adjacent hypothalamus and third ventricle displacing these structures. Gross total resection of the lesion was achieved utilizing a right frontal craniotomy approach. Histopathological examination confirmed the diagnosis of suprasellar chiasmal cavernous malformation. Conclusion: Although visual pathway cavernous malformation is a rare event, it should be included in the differential diagnosis of lesions occurring suprasellarly in the visual pathway and hypothalamus. PMID:27583178

  14. [Giant cavernous hemangioma of the orbit (case report)].

    PubMed

    Grusha, Ia O; Ismailova, D S; Eksarenko, O V; Fedorov, A A; Kharlap, S I

    2014-01-01

    The following case demonstrates a successful en bloc removal of a massive cavernous hemangioma of the orbit via vertical transpalpebral approach with postoperative improvement of optic nerve condition and optimal cosmetic result.

  15. [Cavernous haemangiomas: hearing and vestibular inaugural symptoms].

    PubMed

    Dumas, G; Schmerber, S

    2004-11-01

    Cavernous haemangiomas (cavernomas)(CH) are relatively rare (2% of cranial tumoral pathology) vascular malformations mostly observed in the central nervous system. Their most common topographical site in brain stem is midline in the pons, for which clinical course may mimic symptoms of peripheral origin (sudden deafness, fluctuating hearing loss, Meniere-like vertigo). To establish the correlation between the clinical manifestations of hearing and balance disturbance and the anatomical site within the pons of cavernous haemangiomas, and to describe their clinical features, and the findings on auditory brainstem response (ABR) and magnetic resonance imaging (MRI). To propose a literature review about CH and its implications. We made a retrospective review of the histories of three patients aged 24, 44 and 45 years, diagnosed as having cavernomas of the brainstem in which audiometric evaluation, videonystagmography (VNG), ABR and imaging techniques lead to the diagnosis of intracranial cavernoma. The clinical and radiological files were reviewed and a direct relationship between symptoms and localization was found in all 3 patients, especially in relation to our understanding of the auditory and vestibular pathways within the brainstem. The literature regarding cavernomas of the pons is reviewed and the clinical, neuroimage, pathological, natural course and management aspects of the disease are discussed. We recommend the use of cerebral MRI for initial diagnosis which shows a typical rosette-like appearance with a heterogeneous signal on T2-weighted images, along with follow-up and investigation into similar profiles among family members. At present there is no consensus about the treatment to follow when cavernomas are located in the brain stem. There is no specific medical treatment for this condition, and surgery is indicated only exceptionally. Anticoagulant therapy, platelet-dispersing medication and violent sports activities are contraindicated.

  16. Acute bacterial sinusitis in children.

    PubMed

    DeMuri, Gregory; Wald, Ellen R

    2013-10-01

    On the basis of strong research evidence, the pathogenesis of sinusitis involves 3 key factors: sinusostia obstruction, ciliary dysfunction, and thickening of sinus secretions. On the basis of studies of the microbiology of otitis media, H influenzae is playing an increasingly important role in the etiology of sinusitis, exceeding that of S pneumoniae in some areas, and b-lactamase production by H influenzae is increasing in respiratory isolates in the United States. On the basis of some research evidence and consensus,the presentation of acute bacterial sinusitis conforms to 1 of 3 predicable patterns; persistent, severe, and worsening symptoms. On the basis of some research evidence and consensus,the diagnosis of sinusitis should be made by applying strict clinical criteria. This approach will select children with upper respiratory infection symptoms who are most likely to benefit from an antibiotic. On the basis of some research evidence and consensus,imaging is not indicated routinely in the diagnosis of sinusitis. Computed tomography or magnetic resonance imaging provides useful information when complications of sinusitis are suspected. On the basis of some research evidence and consensus,amoxicillin-clavulanate should be considered asa first-line agent for the treatment of sinusitis.

  17. Managing acute invasive fungal sinusitis.

    PubMed

    Dwyhalo, Kristina M; Donald, Carrlene; Mendez, Anthony; Hoxworth, Joseph

    2016-01-01

    Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis and can be fatal, especially in patients who are immunosuppressed. Early diagnosis and intervention are crucial and potentially lifesaving, so primary care providers must maintain a high index of suspicion for this disease. Patients may need to be admitted to the hospital for IV antifungal therapy and surgical debridement.

  18. Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

    PubMed Central

    Yang, B T; Chong, V F H; Wang, Z C; Xian, J F; Chen, Q H

    2010-01-01

    Ectopic pituitary adenomas (EPAs) are rare lesions. The purpose of this study was to describe the CT and MRI features of sphenoid sinus EPAs. Eight patients with histology-proven EPAs in the sphenoid sinus, all of whom underwent CT and MRI, were reviewed retrospectively. The following imaging features were analysed: (i) size, (ii) margin, (iii) CT attenuation characteristics and (iv) MRI signal intensity. In addition, the involvement of adjacent structures and the time–intensity curve (TIC) of dynamic contrast-enhanced (DCE) MRI were analysed. All EPAs had well-defined margins and showed no relationship to the intrasellar pituitary gland. The mean size was 28 mm (range, 20–46 mm). On non-enhanced CT, the lesions appeared isodense to grey matter in 7 (88%) patients and hypodense in 1 (12%) patient. Only two patients underwent post-contrast CT, and they showed moderate enhancement. On T1 weighted images, EPAs appeared isointense in 6 (75%) patients and hypointense in 2 (25%). On T2 weighted images, the lesions appeared hyperintense in 2 (25%) patients and isointense in 6 (75%). EPAs showed mild to moderate heterogeneous contrast enhancement and exhibited a cribriform-like appearance. Two patients underwent DCE MRI; the TIC showed a rapidly enhancing and slow washout pattern. The following features were also seen: an empty sella, bone changes and involvement of the cavernous sinus (5 patients; 62.5%). In conclusion, a high index of suspicion for EPA and a familiarity with the imaging findings may help to diagnose this rare entity accurately. PMID:19651706

  19. Oil field waste disposal in salt caverns: An information website

    SciTech Connect

    Tomasko, D.; Veil, J. A.

    1999-12-10

    Argonne National Laboratory has completed the construction of a Website for the US Department of Energy (DOE) that provides detailed information on salt caverns and their use for disposing of nonhazardous oil field wastes (NOW) and naturally occurring radioactive materials (NORM). Specific topics in the Website include the following: descriptions of salt deposits and salt caverns within the US, salt cavern construction methods, potential types of wastes, waste emplacement, regulatory issues, costs, carcinogenic and noncarcinogenic human health risks associated with postulated cavern release scenarios, new information on cavern disposal (e.g., upcoming meetings, regulatory issues, etc.), other studies supported by the National Petroleum Technology Office (NPTO) (e.g., considerations of site location, cavern stability, development issues, and bedded salt characterization in the Midland Basin), and links to other associated Web sites. In addition, the Website allows downloadable access to reports prepared on the topic that were funded by DOE. Because of the large quantities of NOW and NORM wastes generated annually by the oil industry, information presented on this Website is particularly interesting and valuable to project managers, regulators, and concerned citizens.

  20. A review of cavernous malformations with trigeminal neuralgia.

    PubMed

    Adachi, Kazuhide; Hasegawa, Mitsuhiro; Hayashi, Takuro; Nagahisa, Shinya; Hirose, Yuichi

    2014-10-01

    Cavernous malformation with trigeminal neuralgia is relatively rare; only 10 cases have been reported. In deciding treatment strategies, it is helpful to classify cavernous malformation according to its origin, as follows: in the Gasserian ganglion (Type G); between the cisternal and intra-axial portions of the trigeminal nerve root (Type C); in the intra-axial trigeminal nerve root in the pons (Type P); or in the spinal tract of the trigeminal nerve root (Type S). A 62-year-old male presented with left trigeminal neuralgia (V2 area) and left facial hypoesthesia. Imaging studies revealed a cerebellopontine angle mass lesion with characteristics of a cavernous malformation and evidence of hemorrhage. The lesion was completely removed via a left anterior transpetrosal approach. The mass was attached to the trigeminal nerve root; it was located between the cisternal and intra-axial portions of the nerve root, and feeding off microvessels from the trigeminal nerve vascular plexus. Histological examination confirmed a cavernous malformation. In this case, the cavernous malformation was Type C. We review cases of cavernous malformation with trigeminal neuralgia and discuss therapeutic strategies according to the area of origin. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature

    PubMed Central

    Chen, Ching-Jen; Caruso, James P; Ding, Dale; Schmitt, Paul J; Buell, Thomas J; Raper, Daniel M; Evans, Avery; Newman, Steven A; Jensen, Mary E

    2017-01-01

    Carotid-cavernous fistulas (CCFs) pose an anatomically and physiologically challenging problem for clinicians. The most common method of treatment for these lesions is transvenous endovascular embolization via the inferior petrosal sinus or the facial vein. When transvenous access is not possible, an alternate approach must be devised. We describe a case example with bilateral Barrow Type B CCFs, which were inaccessible using the traditional transvenous approach. Hence, a direct transorbital approach, performed under fluoroscopic guidance, was employed to successfully obliterate the CCF. At five months follow-up, the patient was recovering without complications. This case delineates the technical aspects of transorbital CCF embolization and demonstrates that this approach is a viable alternative to conventional transvenous methods for appropriately selected CCF cases. We supplement our case example and technical note with a literature review of this approach. PMID:28191380

  2. ADVANCED UNDERGROUND GAS STORAGE CONCEPTS REFRIGERATED-MINED CAVERN STORAGE

    SciTech Connect

    1998-09-01

    Limited demand and high cost has prevented the construction of hard rock caverns in this country for a number of years. The storage of natural gas in mined caverns may prove technically feasible if the geology of the targeted market area is suitable; and economically feasible if the cost and convenience of service is competitive with alternative available storage methods for peak supply requirements. It is believed that mined cavern storage can provide the advantages of high delivery rates and multiple fill-withdrawal cycles in areas where salt cavern storage is not possible. In this research project, PB-KBB merged advanced mining technologies and gas refrigeration techniques to develop conceptual designs and cost estimates to demonstrate the commercialization potential of the storage of refrigerated natural gas in hard rock caverns. Five regions of the U.S.A. were studied for underground storage development and PB-KBB reviewed the literature to determine if the geology of these regions was suitable for siting hard rock storage caverns. Area gas market conditions in these regions were also studied to determine the need for such storage. Based on an analysis of many factors, a possible site was determined to be in Howard and Montgomery Counties, Maryland. The area has compatible geology and a gas industry infrastructure for the nearby market populous of Baltimore and Washington D.C.. As Gas temperature is lowered, the compressibility of the gas reaches an optimum value. The compressibility of the gas, and the resultant gas density, is a function of temperature and pressure. This relationship can be used to commercial advantage by reducing the size of a storage cavern for a given working volume of natural gas. This study looks at this relationship and and the potential for commercialization of the process in a storage application. A conceptual process design, and cavern design were developed for various operating conditions. Potential site locations were considered

  3. Microstructure and innervation of the mystacial vibrissal follicle-sinus complex in bearded seals, Erignathus barbatus (Pinnipedia: Phocidae).

    PubMed

    Marshall, Christopher D; Amin, Heidi; Kovacs, Kit M; Lydersen, Christian

    2006-01-01

    Vibrissal follicle-sinus complexes (F-SCs) are sensory receptors of the mammalian integument system. They are best developed within Pinnipedia. The objective of this study was to investigate the F-SCs of bearded seals (Erignathus barbatus) for benthic foraging adaptations. Bearded seals possessed approximately 244 mystacial F-SCs. In this species, F-SCs consisted of an outer dermal capsule (DC) surrounding a blood sinus system [upper cavernous sinus (UCS), ring sinus (RS), and lower cavernous sinus (LCS)] and concentric rings of epidermal tissue. The UCS comprised up to 62% of the F-SC length and may function as thermal protection for mechanoreceptors. A large asymmetrical ringwulst was located in the RS. A deep vibrissal nerve penetrated the DC at its base and terminated on mechanoreceptors in the epidermal tissues of the LCS and RS. The mean number of myelinated axons per F-SC was 1,314 (range, 811-1,650) and was among the highest number of axons per F-SC reported to date. An estimated mean number of 320,616 myelinated axons innervate the entire mystacial vibrissal array. Merkel-Neurite complexes (MNCs) and small simple laminated corpuscles were found in the region of the LCS. Myelinated axons also terminated on MNCs and lanceolate endings apical to the ringwulst. The number of F-SCs, their geometry in the mystacial region, the number of myelinated axons per F-SC, and the distribution of mechanoreceptors support the premise that pinniped vibrissae are sensitive active-touch receptor systems, and that structural differences in bearded seals, relative to other phocids, may be adaptations for benthic foraging.

  4. Features of Bayou Choctaw SPR caverns and internal structure of the salt dome.

    SciTech Connect

    Munson, Darrell E.

    2007-07-01

    The intent of this study is to examine the internal structure of the Bayou Choctaw salt dome utilizing the information obtained from graphical representations of sonar survey data of the internal cavern surfaces. Many of the Bayou Choctaw caverns have been abandoned. Some existing caverns were purchased by the Strategic Petroleum Reserve (SPR) program and have rather convoluted histories and complex cavern geometries. In fact, these caverns are typically poorly documented and are not particularly constructive to this study. Only two Bayou Choctaw caverns, 101 and 102, which were constructed using well-controlled solutioning methods, are well documented. One of these was constructed by the SPR for their use while the other was constructed and traded for another existing cavern. Consequently, compared to the SPR caverns of the West Hackberry and Big Hill domes, it is more difficult to obtain a general impression of the stratigraphy of the dome. Indeed, caverns of Bayou Choctaw show features significantly different than those encountered in the other two SPR facilities. In the number of abandoned caverns, and some of those existing caverns purchased by the SPR, extremely irregular solutioning has occurred. The two SPR constructed caverns suggest that some sections of the caverns may have undergone very regular solutioning to form uniform cylindrical shapes. Although it is not usually productive to speculate, some suggestions that point to the behavior of the Bayou Choctaw dome are examined. Also the primary differences in the Bayou Choctaw dome and the other SPR domes are noted.

  5. Northern Sinus Meridiani Stereo

    NASA Technical Reports Server (NTRS)

    2003-01-01

    MGS MOC Release No. MOC2-341, 25 April 2003

    This is a stereo (3-d anaglyph) composite of Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) wide angle images of northern Sinus Meridiani near 2oN, 0oW. The light-toned materials at the south (bottom) end of the picture are considered to be thick (100-200 meters; 300-600 ft) exposures of sedimentary rock. Several ancient meteor impact craters are being exhumed from within these layered materials. To view in stereo, use '3-d' glasses with red over the left eye, and blue over the right. The picture covers an area approximately 113 km (70 mi) wide; north is up.

  6. Northern Sinus Meridiani Stereo

    NASA Technical Reports Server (NTRS)

    2003-01-01

    MGS MOC Release No. MOC2-341, 25 April 2003

    This is a stereo (3-d anaglyph) composite of Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) wide angle images of northern Sinus Meridiani near 2oN, 0oW. The light-toned materials at the south (bottom) end of the picture are considered to be thick (100-200 meters; 300-600 ft) exposures of sedimentary rock. Several ancient meteor impact craters are being exhumed from within these layered materials. To view in stereo, use '3-d' glasses with red over the left eye, and blue over the right. The picture covers an area approximately 113 km (70 mi) wide; north is up.

  7. Management of Frontal Sinus Tumors.

    PubMed

    Selleck, Anne Morgan; Desai, Dipan; Thorp, Brian D; Ebert, Charles S; Zanation, Adam M

    2016-08-01

    The most common primary tumors of the frontal sinus are osteomas and inverted papillomas, although a variety of other tumors involving this space have been reported. With the advent of new surgical techniques and instrumentation, an endoscopic approach to this region has become feasible. The preoperative assessment and decision making must take into account the complexity of frontal sinus anatomy, tumor type, tumor location, and associated attachments. These procedures allow adequate visualization, tumor removal, and postoperative monitoring, and preserve fairly normal sinus function. Open techniques may also be required and should be in the surgeon's armamentarium.

  8. [Ostium of maxillary sinus in endoscopic sinus surgery].

    PubMed

    Tan, G; Sun, H; Chen, J

    1998-06-01

    To determine the clinical significance and operative method of maxillary sinus ostium in the treatment of chronic sinusitis and nasal polyps. Fifty-six patients (112 sides) undergone endoscopic sinus surgery were studied. The patency rates of the maxillary ostia in patients with enlarged and unchanged maxillary ostia were 92.9% and 80.4% respectively. Fifty-one patients (64 sides) undergone Caldwell-Luc operations were retrospectively studied. The patency rate of inferior antrostomy was 40.6%. CT scans of the sinuses of 38 cases with unilateral sinisitis or nasal polyps were reviewed. The scaled values of the maxillary hiatus on CT images showed no difference between the normal group and the diseased group. Pneumatization and proliferation of middle turbinate and bent uncinate process were the most common anatomic variation in the diseased group. The results suggest that management of anatomic variations surrounding the ostia is very important in the treatment of maxillary ostium.

  9. Quantitative Susceptibility Mapping in Cerebral Cavernous Malformations: Clinical Correlations.

    PubMed

    Tan, H; Zhang, L; Mikati, A G; Girard, R; Khanna, O; Fam, M D; Liu, T; Wang, Y; Edelman, R R; Christoforidis, G; Awad, I A

    2016-07-01

    Quantitative susceptibility mapping has been shown to assess iron content in cerebral cavernous malformations. In this study, our aim was to correlate lesional iron deposition assessed by quantitative susceptibility mapping with clinical and disease features in patients with cerebral cavernous malformations. Patients underwent routine clinical scans in addition to quantitative susceptibility mapping on 3T systems. Data from 105 patients met the inclusion criteria. Cerebral cavernous malformation lesions identified on susceptibility maps were cross-verified by T2-weighted images and differentiated on the basis of prior overt hemorrhage. Mean susceptibility per cerebral cavernous malformation lesion (χ̄lesion) was measured to correlate with lesion volume, age at scanning, and hemorrhagic history. Temporal rates of change in χ̄lesion were evaluated in 33 patients. Average χ̄lesion per patient was positively correlated with patient age at scanning (P < .05, 4.1% change with each decade of life). Cerebral cavernous malformation lesions with prior overt hemorrhages exhibited higher χ̄lesion than those without (P < .05). Changes in χ̄lesion during 3- to 15-month follow-up were small in patients without new hemorrhage between the 2 scans (bias = -0.0003; 95% CI, -0.06-0.06). The study revealed a positive correlation between mean quantitative susceptibility mapping signal and patient age in cerebral cavernous malformation lesions, higher mean quantitative susceptibility mapping signal in hemorrhagic lesions, and minimum longitudinal quantitative susceptibility mapping signal change in clinically stable lesions. Quantitative susceptibility mapping has the potential to be a novel imaging biomarker supplementing conventional imaging in cerebral cavernous malformations. The clinical significance of such measures merits further study. © 2016 by American Journal of Neuroradiology.

  10. Paranasal sinus obliteration in Wegener granulomatosis

    SciTech Connect

    Paling, M.R.; Roberts, R.L.; Fauci, A.S.

    1982-08-01

    The authors report 14 cases of Wegener granulomatosis in which one or more paranasal sinuses were obliterated by bone. The maxillary antra were involved in all cases, with the other sinuses being affected less frequently. These changes are thought to result from chronic bacterial sinusitis superimposed on the granulomatous vasculitic process. Computed tomography dramatically demonstrated the bone changes, consisting of a combination of sinus wall thickening and trabeculated new bone formation within the sinuses.

  11. Lunar Holes and Their Associating Subsurface Caverns: From SELENE (Kaguya) to UZUME

    NASA Astrophysics Data System (ADS)

    Haruyama, J.; Kawano, I.; Nishibori, T.; Iwata, T.; Yamamoto, Y.; Shimada, K.; Yamamoto, K.; Hasenaka, T.; Morota, T.; Nishino, M. N.; Hashizume, K.; Shirao, M.; Komatsu, G.; Hasebe, N.; Shimizu, H.; Kobayashi, K.; Yokobori, S.; Miyake, Y.; Michikawa, Y.; Tsuji, T.; Shinoda, R.

    2016-05-01

    We present a summary of lunar holes and associated caverns. Furthermore, we also introduce the project Unprecedented Zipangu Underworld of the Moon/Mars Exploration (UZUME) to explore the holes and caverns.

  12. Vascular permeability in cerebral cavernous malformations

    PubMed Central

    Mikati, Abdul G; Khanna, Omaditya; Zhang, Lingjiao; Girard, Romuald; Shenkar, Robert; Guo, Xiaodong; Shah, Akash; Larsson, Henrik BW; Tan, Huan; Li, Luying; Wishnoff, Matthew S; Shi, Changbin; Christoforidis, Gregory A; Awad, Issam A

    2015-01-01

    Patients with the familial form of cerebral cavernous malformations (CCMs) are haploinsufficient for the CCM1, CCM2, or CCM3 gene. Loss of corresponding CCM proteins increases RhoA kinase-mediated endothelial permeability in vitro, and in mouse brains in vivo. A prospective case-controlled observational study investigated whether the brains of human subjects with familial CCM show vascular hyperpermeability by dynamic contrast-enhanced quantitative perfusion magnetic resonance imaging, in comparison with CCM cases without familial disease, and whether lesional or brain vascular permeability correlates with CCM disease activity. Permeability in white matter far (WMF) from lesions was significantly greater in familial than in sporadic cases, but was similar in CCM lesions. Permeability in WMF increased with age in sporadic patients, but not in familial cases. Patients with more aggressive familial CCM disease had greater WMF permeability compared to those with milder disease phenotype, but similar lesion permeability. Subjects receiving statin medications for routine cardiovascular indications had a trend of lower WMF, but not lesion, permeability. This is the first demonstration of brain vascular hyperpermeability in humans with an autosomal dominant disease, as predicted mechanistically. Brain permeability, more than lesion permeability, may serve as a biomarker of CCM disease activity, and help calibrate potential drug therapy. PMID:25966944

  13. Vascular permeability in cerebral cavernous malformations.

    PubMed

    Mikati, Abdul G; Khanna, Omaditya; Zhang, Lingjiao; Girard, Romuald; Shenkar, Robert; Guo, Xiaodong; Shah, Akash; Larsson, Henrik B W; Tan, Huan; Li, Luying; Wishnoff, Matthew S; Shi, Changbin; Christoforidis, Gregory A; Awad, Issam A

    2015-10-01

    Patients with the familial form of cerebral cavernous malformations (CCMs) are haploinsufficient for the CCM1, CCM2, or CCM3 gene. Loss of corresponding CCM proteins increases RhoA kinase-mediated endothelial permeability in vitro, and in mouse brains in vivo. A prospective case-controlled observational study investigated whether the brains of human subjects with familial CCM show vascular hyperpermeability by dynamic contrast-enhanced quantitative perfusion magnetic resonance imaging, in comparison with CCM cases without familial disease, and whether lesional or brain vascular permeability correlates with CCM disease activity. Permeability in white matter far (WMF) from lesions was significantly greater in familial than in sporadic cases, but was similar in CCM lesions. Permeability in WMF increased with age in sporadic patients, but not in familial cases. Patients with more aggressive familial CCM disease had greater WMF permeability compared to those with milder disease phenotype, but similar lesion permeability. Subjects receiving statin medications for routine cardiovascular indications had a trend of lower WMF, but not lesion, permeability. This is the first demonstration of brain vascular hyperpermeability in humans with an autosomal dominant disease, as predicted mechanistically. Brain permeability, more than lesion permeability, may serve as a biomarker of CCM disease activity, and help calibrate potential drug therapy.

  14. [Bacteriological study of maxillary sinusitis].

    PubMed

    Renon, P; Casanova, M; Verdier, M; Asperge, A; Le Mouel, C

    1984-01-01

    Suppurated maxillary sinusitis are frequent diseases. Diameatic puncture allows bacteriological investigations. Our results are positive in two thirds of cases. The bacterial flora is very varied, whose identification and antibiograms involve efficient treatment with daily washing and in situ antibiotherapy.

  15. [Sinusitis--judicious antibiotic treatment].

    PubMed

    Niedzielska, Grazyna

    2007-01-01

    The paper presents different forms of sinusitis in children and adults as well as the patomechanism of sinusitis of infective and non-infective origin. The role of bacterial infection has been discussed. Participation of major pathogens of URTI such as S. pneumoniae, H. influenzae and M. catarrhalis has been highlighted and the factors influencing growth of their antibiotic-resistant stains. Guidelines concerning antibiotic therapy in children and adults, depending on disease course, age and factors influencing growth of resistant stains have been presented. Causes of failure in treatment of sinusitis have been analysed eg. in case of bacterial biofilm growth or non-neutrophilic inflammation forms. Antimicrobial treatment concerns mainly acute and aggravated infections. In case of chronic sinusitis, antibiotic therapy is complementary to surgical treatment.

  16. Radiography of the Paranasal Sinuses

    MedlinePlus

    ... your back or over your lap. This head. Radiography of the paranasal sinuses apron will protect your ... face, especially when lowering his or her head. Radiography of sitting and others while you are standing. ...

  17. Evaluating Complications of Chronic Sinusitis

    PubMed Central

    Hong, Phillip; Pereyra, Charles A.; Breslin, Adam; Melville, Laura

    2017-01-01

    Chronic sinusitis is a relatively common diagnosis throughout the US. In patients with an otherwise unremarkable medical history the treatment is typically supportive, requiring only clinical evaluation. We present the case of a 25-year-old male with a history of chronic sinusitis that was brought to our emergency department with new-onset seizure. Three days before he had presented to his usual care facility with two days of headache and fever and was discharged stating headache, subjective fever, and neck stiffness. After further investigation he was diagnosed with a mixed anaerobic epidural abscess. The evaluation and management of chronic sinusitis are based on the presence of symptoms concerning for complication. Prompt investigation of complicated sinusitis is essential in preventing debilitating and fatal sequelae. Our case study underscores the importance of early diagnosis and appropriate management. PMID:28163938

  18. [Surgical dilemmas. Sinus floor elevation].

    PubMed

    ten Bruggenkate, C M; Schulten, E A J M; Zijderveld, S A

    2008-12-01

    Limited alveolar bone height prevents the placement of dental implants. Sinus floor elevation is an internal augmentation of the maxillary sinus that allows implants to be placed. The principle of this surgical procedure is the preparation of a 'top hinge door', that is raised together with the Schneiderian membrane in the cranial direction. The space which created under this lid is filled with a bone transplant. Autogenous bone is the standard transplant material, despite the fact that a second surgery site is necessary. Under certain circumstances bone substitutes can be used, with a longer healing phase. If sufficient alveolar bone height is available to secure implant stability, simultaneous implantation and sinus floor elevation are possible. Considering the significant anatomical variation in the region of the maxillary sinus, a sound knowledge of the anatomy is of great importance.

  19. Experience in testing of a solution mined storage cavern. [Strategic Petroleum Reserve

    SciTech Connect

    Goin, K.L.

    1982-01-01

    Recertification tests were made of the Department of Energy/Strategic Petroleum Reserve oil storage cavern number 6 in the West Hackberry, Louisiana Salt Dome. The cavern has a volume of 8,600,000 barrels. Tests included hydrostatic tests of the brine filled cavern and nitrogen leak tests of the three wells entering the cavern. Test procedures are described and test results are discussed.

  20. Propranolol Treatment of Cavernous Malformations with Symptomatic Hemorrhage.

    PubMed

    Zabramski, Joseph M; Kalani, M Yashar S; Filippidis, Aristotelis S; Spetzler, Robert F

    2016-04-01

    Cerebral cavernous malformations are more common than generally thought, affecting approximately 1 in every 250 adults. Most of these lesions are asymptomatic or have a relatively benign course, but a small minority behave aggressively and present with recurrent episodes of symptomatic hemorrhage. A safe and effective medical treatment option for the management of this latter group would be useful. Propranolol has recently been shown to be effective in the treatment of infantile hemangioma, a close pathologic counterpart of cavernous malformations. These results suggest a potential role for propranolol treatment in the management of patients with symptomatic cavernous malformations. Low-dose propranolol (20 mg, three times daily) was used to treat 2 adult female patients in their mid- to late fifties, both of whom had symptomatic cavernous malformations and a history of repeated hemorrhage. Serial magnetic resonance imaging studies after the initiation of propranolol demonstrated regression of the lesions and no evidence of recurrent hemorrhage. Propranolol may offer a safe and effective treatment for patients who have cavernous malformations with symptomatic hemorrhage. Additional studies are needed to confirm these findings. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. CAVERN ROOF STABILITY FOR NATURAL GAS STORAGE IN BEDDED SALT

    SciTech Connect

    DeVries, Kerry L; Mellegard, Kirby D; Callahan, Gary D; Goodman, William M

    2005-06-01

    This report documents research performed to develop a new stress-based criterion for predicting the onset of damage in salt formations surrounding natural gas storage caverns. Laboratory tests were conducted to investigate the effects of shear stress, mean stress, pore pressure, temperature, and Lode angle on the strength and creep characteristics of salt. The laboratory test data were used in the development of the new criterion. The laboratory results indicate that the strength of salt strongly depends on the mean stress and Lode angle. The strength of the salt does not appear to be sensitive to temperature. Pore pressure effects were not readily apparent until a significant level of damage was induced and the permeability was increased to allow penetration of the liquid permeant. Utilizing the new criterion, numerical simulations were used to estimate the minimum allowable gas pressure for hypothetical storage caverns located in a bedded salt formation. The simulations performed illustrate the influence that cavern roof span, depth, roof salt thickness, shale thickness, and shale stiffness have on the allowable operating pressure range. Interestingly, comparison of predictions using the new criterion with that of a commonly used criterion indicate that lower minimum gas pressures may be allowed for caverns at shallow depths. However, as cavern depth is increased, less conservative estimates for minimum gas pressure were determined by the new criterion.

  2. MC-19 Margaritifer Sinus Region

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Mars digital-image mosaic merged with color of the MC-19 quadrangle, Margaritifer Sinus region of Mars. Heavily cratered highlands, which dominate the Margaritifer Sinus quadrangle, are marked by large expanses of chaotic terrain. In the northwestern part, the major rift zone of Valles Marineris connects with a broad canyon filled with chaotic terrain. Latitude range -30 to 0, longitude range 0 to 45 degrees.

  3. MC-20 Sinus Sabeus Region

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Mars digital-image mosaic merged with color of the MC-20 quadrangle, Sinus Sabeus region of Mars. Heavily cratered highlands dominate the Sinus Sabeus quadrangle. The northern part is marked by a large impact crater, Schiaparelli. Schiaparelli is an ancient remnant of the many large impact events that occurred during the period of heavy bombardment. Latitude range -30 to 0 degrees, longitude range -45 to 0.

  4. Sinus Venosus Atrial Septal Defect

    DTIC Science & Technology

    2010-04-01

    chest CT was performed to evaluate for pulmonary embolism (figure 2). The chest radiograph (figure 1) demonstrates increased central pulmonary ...Fig. 5 Sinus venosus defect at birth . The shaded area in purple represents the sinus venosum. The anomalous right pulmonary venous anatomy...department (ED) with chest pain and an ankle fracture after being hit by a car while riding a horse. Chest imaging noted enlarged central pulmonary

  5. Frontal Sinus Fractures: Current Concepts

    PubMed Central

    Strong, E. Bradley

    2009-01-01

    Frontal sinus injuries may range from isolated anterior table fractures resulting in a simple aesthetic deformity to complex fractures involving the frontal recess, orbits, skull base, and intracranial contents. The risk of long-term morbidity can be significant. Optimal treatment strategies for the management of frontal sinus fractures remain controversial. However, it is critical to have a thorough understanding of frontal sinus anatomy as well as the current treatment strategies used to manage these injuries. A thorough physical exam and thin-cut, multiplanar (axial, coronal, and sagittal) computed tomography scan should be performed in all patients suspected of having a frontal sinus fracture. The most appropriate treatment strategy can be determined by assessing five anatomic parameters including the: frontal recess, anterior table integrity, posterior table integrity, dural integrity, and presence of a cerebrospinal fluid leak. A well thought out management strategy and meticulous surgical techniques are critical to success. The primary surgical goal is to provide a safe sinus while minimizing patient morbidity. This article offers an anatomically based treatment algorithm for the management of frontal sinus fractures and highlights the key steps to surgical repair. PMID:22110810

  6. Threat of a sinkhole: A reevaluation of Cavern 4, Bayou Choctaw salt dome, Louisiana

    SciTech Connect

    Neal, J.T.; Todd, J.L.; Linn, J.K.; Magorian, T.R.

    1993-09-01

    Cavern Lake at Bayou Choctaw salt dome resulted from the failure of Cavern 7 in 1954. Uncontrolled solutioning of this cavern through the thin caprock had set the stage for overburden to collapse into the cavern below. A similar situation developed with nearby Cavern 4, but with less dissolutioning of the caprock. Because pressure loss was already a problem and because another 800 ft diameter lake would have endangered surface operations, solutioning of Cavern 4 was stopped and the cavern abandoned in 1957 in order to protect the already-small site. In 1978 the Strategic Petroleum Reserve (SPR) acquired a number of caverns at Bayou Choctaw, including Cavern 4, and the possible repeat of the Cavern 7 failure and formation of another lake thus became an issue. The cavern dimensions were re-sonared in 1980 for comparison with 1963 and 1977 surveys. Annual surface leveling between 1982--1992 showed less subsidence occurring than the site average, and a cavern monitoring system, installed in 1984, has revealed no anomalous motion. Repeat sonar surveys in 1992 showed very little, if any, change occurred since 1980 although a small amount of uncertainty exists as a result of changing sonar techniques. We conclude that significant additional solutioning or erosion of the caprock has not occurred and that there is no increased threat to SPR operations.

  7. Cavernous hemangioma of the orbit: an unusual acute presentation

    PubMed Central

    Louisraj, Sophia; Ponnudurai, Thendral; Rodriguez, Dominic; Thomas, Philip A; Nelson Jesudasan, Christadoss Arul

    2017-01-01

    We report an unusual presentation of an orbital cavernous hemangioma in a 26-year-old female, who noted sudden redness and swelling of the left eye (LE) on waking up. At presentation, upper eyelid edema with periorbital ecchymosis and subconjunctival hemorrhage were noted in the LE. Although there was transient symptomatic relief with topical medications, blurring of vision developed in the LE. When seen 10 days later, the patient’s LE showed axial proptosis. Magnetic resonance imaging revealed an intraconal soft tissue mass in the superomedial quadrant of the left orbit. Superior orbitotomy with mass excision was done; histopathological examination of the excised mass revealed a cavernous hemangioma. The patient had complete visual recovery following surgery. To our knowledge, an acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage and periorbital ecchymosis has not previously been reported. PMID:28769595

  8. Brainstem cavernous malformations: Natural history versus surgical management.

    PubMed

    Walcott, Brian P; Choudhri, Omar; Lawton, Michael T

    2016-10-01

    While brainstem cavernous malformations were once considered inoperable, improvements in patient selection, surgical exposures, intraoperative MRI-guidance, MR tractography, and neurophysiologic monitoring have resulted in good outcomes in the majority of operated patients. In a consecutive series of 104 patients with brainstem cavernous malformations, only 14% of patients experienced cranial nerve or motor dysfunction that was worse at late follow-up, relative to their preoperative condition. Outcomes were predicted by several factors, including larger lesion size, lesions that crossed the midline, the presence of a developmental venous anomaly, older age, and greater time interval from lesion hemorrhage to surgery. The 14% of patients who experienced a persistent neurological deficit as a result of surgery, while substantial from any perspective, compares favorably with the risks of observation based on a recent meta-analysis. Curative resection is a safe and effective treatment for brainstem cavernous malformations that will prevent re-hemorrhage in symptomatic patients.

  9. Cerebral sinus venous thrombosis

    PubMed Central

    Alvis-Miranda, Hernando Raphael; Milena Castellar-Leones, Sandra; Alcala-Cerra, Gabriel; Rafael Moscote-Salazar, Luis

    2013-01-01

    Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment. PMID:24347950

  10. Seizure risk from cavernous or arteriovenous malformations

    PubMed Central

    Josephson, C.B.; Leach, J.-P.; Duncan, R.; Roberts, R.C.; Counsell, C.E.

    2011-01-01

    Objectives: To determine the risk of epileptic seizures due to a brain arteriovenous malformation (AVM) or cavernous malformation (CM). Methods: In a prospective population-based study of new diagnoses of AVMs (n = 229) or CMs (n = 139) in adults in Scotland in 1999–2003, we used annual medical records surveillance, general practitioner follow-up, and patient questionnaires to quantify the risk of seizures between clinical presentation and AVM/CM treatment, last follow-up, or death. Results: The 5-year risk of first-ever seizure after presentation was higher for AVMs presenting with intracranial hemorrhage or focal neurologic deficit (ICH/FND: n = 119; 23%, 95% confidence interval [CI] 9%–37%) than for incidental AVMs (n = 40; 8%, 95% CI 0%–20%), CMs presenting with ICH/FND (n = 38; 6%, 95% CI 0%–14%), or incidental CMs (n = 57; 4%, 95% CI 0%–10%). For adults who had never experienced ICH/FND, the 5-year risk of epilepsy after first-ever seizure was higher for CMs (n = 23; 94%, 95% CI 84%–100%) than AVMs (n = 37; 58%, 95% CI 40%–76%; p = 0.02). Among adults who never experienced ICH/FND and presented with or developed epilepsy, there was no difference in the proportions achieving 2-year seizure freedom over 5 years between AVMs (n = 43; 45%, 95% CI 20%–70%) and CMs (n = 35; 47%, 95% CI 27%–67%). Conclusions: AVM-related ICH confers a significantly higher risk of a first-ever seizure compared to CMs or incidental AVMs. Adults with a CM have a high risk of epilepsy after a first-ever seizure but achieve seizure freedom as frequently as those with epilepsy due to an AVM. PMID:21536634

  11. Giant cavernous haemangioma of the wandering spleen.

    PubMed

    Misra, Aditya P; Misra, Ritu; Kumar, Abhay

    2013-02-01

    Cavernous haemangioma is a rare disorder of the spleen with fewer than 100 cases reported [1]. Spleen may have an unusual degree of mobility and occupy an atypical location in less than 0.2 % of all the patients [2] Wandering spleen has been associated with incomplete fusion or even absence of gastrosplenic and lienorenal ligaments [3]. A 36-year-old woman presented with a six-month history of pain in the left hypochondrium and a massive splenomegaly. Ultrasonography, Doppler studies, and computed tomography were performed. Ultrasonography showed a large heterogeneous solid cystic mass, measuring 11.2 cm × 10.6 cm, located in the pelvis. Thin soft tissue connecting this mass to spleen noticed. Spleen was malrotated & in left lumbar fossa. Doppler studies shows prominent vessels at the periphery of the mass with high velocity external flow and scanty vascularity at the centre, probably suggesting haemangioma. Contrast-enhanced computed tomography (CECT) of the abdomen showed spleen in left lumbar region with a large heterogeneous, predominantly cystic mass lesion measuring 11.2 x 10.6 cm seen arising from diaphragmatic surface of lower pole of the spleen (Fig. 1), findings were suggestive of wandering spleen with a haemangioma or a hydatid cyst. The patient was explored by a left para-median incision under general anaesthesia. Peroperatively, there was a malrotated enlarged spleen with a large solid lesion confined to the lower half of the spleen (Fig. 2). Gastrosplenic ligament was not visualized. Total splenectomy was done after ligating the splenic artery as the main splenic artery was supplying the mass.

  12. Genetic Screening of Pediatric Cavernous Malformations.

    PubMed

    Merello, Elisa; Pavanello, Marco; Consales, Alessandro; Mascelli, Samantha; Raso, Alessandro; Accogli, Andrea; Cama, Armando; Valeria, Capra; De Marco, Patrizia

    2016-10-01

    Cerebral cavernous malformations (CCMs) are vascular malformations mostly located within the central nervous system. Heterozygous loss of function mutations in CCM1/KRIT1, CCM2/MGC4607, and CCM3/PDCD10 genes are identified in about 90 % of familial cases of CCMs and two thirds of sporadic cases with multiple lesions. In this study, we performed genetic screening of a cohort of 31 patients, mainly pediatric. We analyzed the CCM1, CCM2, and CCM3 genes by multiplex ligation-dependent probe amplification (MLPA) and direct sequencing of exons and intronic boundaries. A total of 9 typical pathogenic loss-of-function mutations were identified in 10 out 31 patients (32 %). The 75 % of familial cases were mutated and the percentage reached to 85 % when we consider only pediatric cases. Detection rate in sporadic cases with multiple lesions was considerably lower (16 %). We identified a novel variant of CCM3, the c.130-131insT (p.R45Efs*8), in 1 pediatric sporadic case with multiple lesions that introduced a premature termination codon into the messenger RNA (mRNA), most likely leading to mRNA decay. Similar to other CCM pediatric series, the main symptoms associated to clinical debut consisted of cerebral hemorrhage. In conclusion, the penetrance of CCM mutations in familial pediatric cases is high (85 %). The genetic workup could improve clinical and genetic counseling in CCM patients. Moreover, we confirmed the high risk of hemorrhage in children with CCMs.

  13. Immune Response in Human Cerebral Cavernous Malformations

    PubMed Central

    Shi, Changbin; Shenkar, Robert; Du, Hongyan; Duckworth, Edward; Raja, Harish; Batjer, H. Hunt; Awad, Issam A.

    2009-01-01

    Background and Purpose Preliminary observations suggesting the presence of B and plasma cells and oligoclonality of immunoglobulin (Ig) G in cerebral cavernous malformations (CCMs) have motivated a systematic study correlating the infiltration of the immune cells with clinical activity and antigen-triggered immune response in surgically excised lesions. Methods Infiltration of plasma, B, T and HLA-DR expressing cells and macrophages within 23 excised CCMs was related to clinical activity. Relative amounts of Ig isotypes were determined. IgG clonality of mRNA from CCMs was assessed by spectratyping, cloning and sequencing. Results Infiltration of the immune cells ranged widely within CCM lesions and cells were generally co-expressed with each other. Immune cell infiltration did not associate with recent bleeding and lesion growth. Significantly more B lymphocytes in CCM lesions were associated with venous anomaly. More T cells were present in solitary lesions. More T cells and less macrophages were present in CCMs from younger subjects. IgG isotype was present in all CCM lesions. Most lesions also expressed IgM and IgA, with IgM predominance over IgA correlating with recent CCM growth. Oligoclonality was shown in IgG mRNA from CCMs, but not from peripheral blood lymphocytes, with only eight CDR3 sequences observed among 134 clones from two CCM lesions. Conclusions An antigen-directed oligoclonal IgG immune response is present within CCM lesions regardless of recent clinical activity. Apparent differences in immune response in younger patients and in lesions with recent growth will need confirmation in other series. The pathogenicity of oligoclonal immune response will require systematic hypothesis testing in recently available CCM murine models. PMID:19286587

  14. Spontaneous Healing of Iatrogenic Direct Carotid Cavernous Fistula

    PubMed Central

    Kwon, H-J.; Jin, S-C.

    2012-01-01

    Summary Direct carotid-cavernous fistula (CCF) by selective navigation using a microcatheter or microwire is a rare complication, and its timing of treatment has not been elucidated. We report two cases of direct CCFs resulting from injury to the cavernous posterior segment of the internal carotid artery during selective navigation. We did not plan to perform emergent endovascular treatment for these direct CCFs because no symptoms related to direct CCFs developed. Follow-up angiography revealed spontaneous healing of both direct CCFs. Close observation rather than emergent treatment may represent another option for direct CCF by selective navigation during the endovascular procedure. PMID:22681734

  15. [Primary intraosseous cavernous hemangioma in anterior clinoid process].

    PubMed

    Yamashita, Taro; Mikami, Takeshi; Minamida, Yoshihiro; Baba, Takeo; Houkin, Kiyohiro

    2006-08-01

    Primary intraosseous cavernous hemangiomas (PICHs) are rare tumors, and there are no previous reports of cases with a tumor at the anterior clinoid process. We report a case of a PICH at the anterior clinoid process in a 66-year-old female presenting with headaches and visual impairment. CT and MR imaging showed a mass in the anterior clinoid process. The lesion showed hyperintensity on T1- and T2-weighted imaging, and gadolinium was homogenously enhanced. The lesion was removed surgically, and histologically confirmed as a cavernous hemangioma. Preoperative examinations could not provide a definitive diagnosis. A brief clinical and radiological review of the literature is presented.

  16. Multiple spinal cavernous malformations in Klippel-Trenaunay-Weber syndrome.

    PubMed

    Göksu, Ethem; Alpsoy, Erkan; Uçar, Tanju; Tuncer, Recai

    2012-01-01

    Klippel-Trenaunay-Weber syndrome (KTWS) is a rare, congenital vascular disorder characterized by cutaneous haemangiomas, venous varicosities, and hypertrophy of the osseous and soft tissue. Various vascular anomalies of the central nervous system have been described in this syndrome. Two previous associations between KTWS and spinal cord cavernous malformations have been reported in the English literature. In this report, we present a patient in whom multiple cavernous malformations located in the conus medullaris region and cauda equina were associated with KTWS. General physical examination as well as neuroradiological and operative findings are described.

  17. Massive Intracerebral Hemorrhage Caused by a Cavernous Malformation

    PubMed Central

    Kim, Young Soo; Lee, Jae Il; Choi, Chang Hwa

    2012-01-01

    We present a rare case of massive intracerebral hemorrhage resulting from a small, superficially-located supratentorial cavernous malformation, or cavernoma. These lesions rarely lead to massive, life-threatening intracerebral hemorrhages. A 17-year-old female presented with a 3-week history of declining mental status. Brain computed tomography and magnetic resonance imaging revealed a sizable intracranial hemorrhage, within the right occipital region, associated with a small nodule at the hematoma's posterior margin. An emergency operation removed the entire hematoma and nodule. Histological examination of the nodule was compatible with a diagnosis of cavernous malformation. The patient's post-operative course was uneventful. PMID:22396841

  18. Optical coherence tomography imaging of optic disc cavernous haemangioma.

    PubMed

    Katta, Mohamed; Mehta, Hemal; Ho, Ivan; Garrick, Ray; Chong, Robert

    2016-11-01

    Optic disc cavernous haemangiomas are either found incidentally or after presentation with vitreous haemorrhage. They are characterised by a cluster of grapes appearance to the multiple vascular saccules that make up the tumour. They are more often found in the retinal periphery but rarely occur at the optic disc. Optical coherence tomography (OCT) imaging may be a useful non-invasive imaging modality to follow-up these lesions. We present the case of an asymptomatic 60-year-old lady referred from her optometrist with a lesion overlying the optic disc and the ensuing diagnosis of cavernous haemangioma using fundus fluorescein angiography and OCT.

  19. A novel multipurpose mini-endoscope for frontal sinus endoscopy "sinus view".

    PubMed

    Al Kadah, Basel; Bozzato, Victoria; Bozzato, Alessandro; Papaspyrou, George; Schick, Bernhard

    2015-07-01

    Endoscopic frontal sinus surgery has been proven to enable the treatment of most frontal sinus pathologies but may be challenging for the surgeon in regard to the variable frontal sinus anatomy. Frontal sinus drainage identification and frontal sinus visualization are an essential part of successful frontal sinus surgery. We demonstrate a novel modular mini-endoscopic system for frontal sinus surgery. Fifty-two patients (37 male, 15 female) with a chronic rhino-sinusitis were enrolled. In this study, all patients were subjected to standard endonasal endoscopic sinus surgery with use of the fibre optic endoscope "Sinus View" (1.1 mm diameter, 10,000 pixels, irrigation channel and additional working channel) accessing the frontal sinus. A frontal sinus drainage type I in 38 cases, a frontal sinus drainage type IIa in 9 cases and a frontal sinus drainage type IIb in 5 cases according to Draf were performed. The modular mini-endoscopic system "Sinus view" was used to identify frontal sinus drainage in ten patients before ethmoidectomy and in the remaining patients (N = 42) after ethmoidectomy. Visualization of the frontal sinus drainage or the frontal sinus itself was easily carried out after irrigation. A clear identification of the frontal sinus by illumination was achieved in all cases. In addition the working channel of the endoscope was successfully used to perform visualized balloon dilatation at the frontal sinus drainage or for biopsy. The endonasal visualization of the frontal sinus drainage and frontal sinus itself is facilitated by also using a modular mini-endoscope with the option to use the working channel of the endoscope for biopsy or balloon dilatation.

  20. Disposal of oil field wastes and NORM wastes into salt caverns.

    SciTech Connect

    Veil, J. A.

    1999-01-27

    Salt caverns can be formed through solution mining in the bedded or domal salt formations that are found in many states. Salt caverns have traditionally been used for hydrocarbon storage, but caverns have also been used to dispose of some types of wastes. This paper provides an overview of several years of research by Argonne National Laboratory on the feasibility and legality of using salt caverns for disposing of nonhazardous oil field wastes (NOW) and naturally occurring radioactive materials (NORM), the risk to human populations from this disposal method, and the cost of cavern disposal. Costs are compared between the four operating US disposal caverns and other commercial disposal options located in the same geographic area as the caverns. Argonne's research indicates that disposal of NOW into salt caverns is feasible and, in most cases, would not be prohibited by state agencies (although those agencies may need to revise their wastes management regulations). A risk analysis of several cavern leakage scenarios suggests that the risk from cavern disposal of NOW and NORM wastes is below accepted safe risk thresholds. Disposal caverns are economically competitive with other disposal options.

  1. Sex determination using maxillary sinus

    PubMed Central

    Kanthem, Ranjith Kumar; Guttikonda, Venkateswara Rao; Yeluri, Sivaranjani; Kumari, Geetha

    2015-01-01

    Background: Individual identification is a subtle concept and often one of the most important priorities in mass disasters, road accidents, air crashes, fires, and even in the investigation of criminal cases. Matching specific features detected on the cadaver with data recorded during the life of an individual is an important aspect in forensics, and can be performed by fingerprint analysis, deoxyribonucleic acid matching, anthropological methods, radiological methods and other techniques which can facilitate age and sex identification. Sinus radiography is one such method that has been used for determination of the sex of an individual. Hence, an attempt is being made to use the different dimensions of the maxillary sinus in the determination of sex using coronal and axial sections of plain computed tomography (CT) scan. Materials and Methods: A total of 30 patients including 17 male and 13 female, visiting the Outpatient Department of the Mamata General Hospital were included as the study subjects. The dimensions of right and left maxillary sinuses of 30 subjects from plain CT were measured using SYNGO software and statistical analysis was done. Results: Sex determination using height, length, width, and volume of the maxillary sinus on both sides showed statistically significant results with a higher percentage of sexual dimorphism in the case of volume. Conclusion: Volume of the right maxillary sinus can be used as accurate diagnostic parameter for sex determination. PMID:26005308

  2. Converting LPG caverns to natural-gas storage permits fast response to market

    SciTech Connect

    Crossley, N.G.

    1996-02-19

    Deregulation of Canada`s natural-gas industry in the late 1980s led to a very competitive North American natural-gas storage market. TransGas Ltd., Regina, Sask., began looking for method for developing cost-effective storage while at the same time responding to new market-development opportunities and incentives. Conversion of existing LPG-storage salt caverns to natural-gas storage is one method of providing new storage. To supply SaskEnergy Inc., the province`s local distribution company, and Saskatchewan customers, TransGas previously had developed solution-mined salt storage caverns from start to finish. Two Regina North case histories illustrate TransGas` experiences with conversion of LPG salt caverns to gas storage. This paper provides the testing procedures for the various caverns, cross-sectional diagrams of each cavern, and outlines for cavern conversion. It also lists storage capacities of these caverns.

  3. Evaluation of hard-rock-cavern construction methods for compressed-air energy storage: Final report

    SciTech Connect

    Thrasher, J.E.; Lange, R.B.

    1988-04-01

    This report presents the results of construction cost and schedule estimates for caverns mined in hard rock for 100-MW and 220-MW compressed air energy storage (CAES) plants with 10 hours storage capacity and using either water-compensated cavern operation with constant turbine-inlet pressure operation on uncompensated cavern operation with sliding turbine-inlet pressure operation. The estimates are made for caverns mined by large-parallel-tunnel methods and by room-and-pillar methods. The results indicate that, for the cavern sizes involved, the room-and-pillar method is cost-competitive with the large-parallel-tunnel methods, but the method requires marginally more construction time. The largest cavern size in the estimates may, however, be approaching the size where the room-and-pillar method may no longer be competitive. The technical feasibility of water curtains for preventing or minimizing leakage of air from CAES hard-rock caverns is evaluated, and construction cost and schedule estimates are made for uncompensated caverns. It is concluded that the performance of water curtains is dependent upon the accuracy of the values of site specific variables and assumptions utilized in the design. A method is presented for assessing if a water curtain may be economical for a compensated CAES cavern. Such an assessment for a water curtain for an uncompensated CAES cavern is more complex and beyond the scope of this study. Also, a program for testing the operation of a water curtain in conjunction with an air-storage cavern operation is proposed. For the specific cavern sizes considered in this report, the estimated water-curtain construction costs and times for the uncompensated room-and-pillar caverns are found to be greater than for the uncompensated large-parallel-tunnel caverns. 11 refs., 18 figs., 19 tabs.

  4. Unexpected location of pilonidal sinuses.

    PubMed

    Sion-Vardy, N; Osyntsov, L; Cagnano, E; Osyntsov, A; Vardy, D; Benharroch, D

    2009-12-01

    Pilonidal sinuses usually occur in the sacrococcygeal area in young men, and occasionally can be found in other ectopic sites. We present a retrospective case review on unusual locations of pilonidal sinuses in the past 4 years. The lesion sites were as follows: one on the penis, two on the scalp, two on the abdomen, one on the neck, two in the groin and two in the axilla. Abdominal and penile lesions are uncommon, but the other locations reported are unusually rare. To our knowledge, the groin has not been reported previously as a site of a pilonidal sinus, although the histological appearance of hidradenitis suppurativa may well resemble it. When trying to clarify the pathogenesis of these occurrences, we found that recurrent hair removal was a common characteristic of the patients we contacted, and this may have been the initiating trauma.

  5. Modeling the Carotid Sinus Baroreceptor

    PubMed Central

    Srinivasan, Ramachandra; Nudelman, Harvey B.

    1972-01-01

    A mathematical model that describes the relationship between sinus pressure and nerve discharge frequency of the carotid sinus baroreceptor is presented. It is partly based upon the single-fiber data obtained by Clarke from the sinus nerve of a dog. The model takes into account what is currently known about the physiology of the baroreceptor. It consists of two nonlinear ordinary differential equations and eight free parameters. With one set of values for these eight parameters, the model reproduces well the experimental results reported by Clarke for positive ramp pressure inputs. Only three parameters needed to be adjusted in order to fit the dynamic data. The remaining five were obtained from static and steady-state data. PMID:5056961

  6. Analysis of SPR salt cavern remedial leach program 2013.

    SciTech Connect

    Weber, Paula D.; Gutierrez, Karen A.; Lord, David L.; Rudeen, David Keith

    2013-09-01

    The storage caverns of the US Strategic Petroleum Reserve (SPR) exhibit creep behavior resulting in reduction of storage capacity over time. Maintenance of oil storage capacity requires periodic controlled leaching named remedial leach. The 30 MMB sale in summer 2011 provided space available to facilitate leaching operations. The objective of this report is to present the results and analyses of remedial leach activity at the SPR following the 2011 sale until mid-January 2013. This report focuses on caverns BH101, BH104, WH105 and WH106. Three of the four hanging strings were damaged resulting in deviations from normal leach patterns; however, the deviations did not affect the immediate geomechanical stability of the caverns. Significant leaching occurred in the toes of the caverns likely decreasing the number of available drawdowns until P/D ratio criteria are met. SANSMIC shows good agreement with sonar data and reasonably predicted the location and size of the enhanced leaching region resulting from string breakage.

  7. Intracranial Pseudoaneurysms, Fusiform Aneurysms and Carotid-Cavernous Fistulas

    PubMed Central

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Lv, Ming; Zhang, Jingbo; Wu, Zhongxue

    2008-01-01

    Summary The study assessed the effectiveness and safety of endovascular covered stents in the management of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Fourteen endovascular covered stents were used to repair three pseudoaneurysms, six fu-siform aneurysms and six direct carotid-cavernous fistulas. Aneurysms were in the carotid artery in seven cases, in the vertebral artery two cases. It was not possible to treat two additional cases transcutaneously for technical reasons
2/15. Percutaneous closure of the lesions with an endovascular covered stent was successful in 13 of 15 cases. Initial follow-up showed good stent patency. No complications were observed after stent implantation. During follow-up, stent thromboses were detected in two of nine patients with follow-up digital subtracted angiography. One carotid-cavernous fistula of Barrow Type A transformed into Barrow Type D at nine month follow-up study was cured with a procudure of Onyx-18 injection. Endovascular covered stents may be an option for percutaneous closure of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Endoluminal vascular repair with covered stents offers an alternative therapeutic approach to conventional modalities. PMID:20557743

  8. Horizontal natural gas storage caverns and methods for producing same

    DOEpatents

    Russo, Anthony

    1995-01-01

    The invention provides caverns and methods for producing caverns in bedded salt deposits for the storage of materials that are not solvents for salt. The contemplated salt deposits are of the bedded, non-domed variety, more particularly salt found in layered formations that are sufficiently thick to enable the production of commercially usefully sized caverns completely encompassed by walls of salt of the formation. In a preferred method, a first bore hole is drilled into the salt formation and a cavity for receiving insolubles is leached from the salt formation. Thereafter, at a predetermined distance away from the first bore hole, a second bore hole is drilled towards the salt formation. As this drill approaches the salt, the drill assumes a slant approach and enters the salt and drills through it in a horizontal direction until it intersects the cavity for receiving insolubles. This produces a substantially horizontal conduit from which solvent is controlledly supplied to the surrounding salt formation, leaching the salt and producing a concentrated brine which is removed through the first bore hole. Insolubles are collected in the cavity for receiving insolubles. By controlledly supplying solvent, a horizontal cavern is produced with two bore holes extending therefrom.

  9. Simulation of Cavern Formation and Karst Development Using Salt

    ERIC Educational Resources Information Center

    Kent, Douglas C.; Ross, Alex R.

    1975-01-01

    A salt model was developed as a teaching tool to demonstrate the development of caverns and karst topography. Salt slabs are placed in a watertight box to represent fractured limestone. Erosion resulting from water flow can be photographed in time-lapse sequence or demonstrated in the laboratory. (Author/CP)

  10. [Intramedullary spinal cord cavernous hemangiomas: clinical features and surgical treatment].

    PubMed

    Ishii, Ken; Nakamura, Masaya

    2011-01-01

    Intramedullary spinal cord cavernous hemangiomas (angiomas) are occult vascular malformations characterized by rare lesions consisting of closely packed capillary-like vessels. In general, patients with this disease become symptomatic because of hemorrhage leads to progressive neurological deficits. Therefore, surgical tumor resection should be considered for symptomatic patients should be considered a surgical tumor resection.

  11. Simulation of Cavern Formation and Karst Development Using Salt

    ERIC Educational Resources Information Center

    Kent, Douglas C.; Ross, Alex R.

    1975-01-01

    A salt model was developed as a teaching tool to demonstrate the development of caverns and karst topography. Salt slabs are placed in a watertight box to represent fractured limestone. Erosion resulting from water flow can be photographed in time-lapse sequence or demonstrated in the laboratory. (Author/CP)

  12. Fracture and Healing of Rock Salt Related to Salt Caverns

    SciTech Connect

    Chan, K.S.; Fossum, A.F.; Munson, D.E.

    1999-03-01

    In recent years, serious investigations of potential extension of the useful life of older caverns or of the use of abandoned caverns for waste disposal have been of interest to the technical community. All of the potential applications depend upon understanding the reamer in which older caverns and sealing systems can fail. Such an understanding will require a more detailed knowledge of the fracture of salt than has been necessary to date. Fortunately, the knowledge of the fracture and healing of salt has made significant advances in the last decade, and is in a position to yield meaningful insights to older cavern behavior. In particular, micromechanical mechanisms of fracture and the concept of a fracture mechanism map have been essential guides, as has the utilization of continuum damage mechanics. The Multimechanism Deformation Coupled Fracture (MDCF) model, which is summarized extensively in this work was developed specifically to treat both the creep and fracture of salt, and was later extended to incorporate the fracture healing process known to occur in rock salt. Fracture in salt is based on the formation and evolution of microfractures, which may take the form of wing tip cracks, either in the body or the boundary of the grain. This type of crack deforms under shear to produce a strain, and furthermore, the opening of the wing cracks produce volume strain or dilatancy. In the presence of a confining pressure, microcrack formation may be suppressed, as is often the case for triaxial compression tests or natural underground stress situations. However, if the confining pressure is insufficient to suppress fracture, then the fractures will evolve with time to give the characteristic tertiary creep response. Two first order kinetics processes, closure of cracks and healing of cracks, control the healing process. Significantly, volume strain produced by microfractures may lead to changes in the permeability of the salt, which can become a major concern in

  13. Analogue of Caldera Dynamics: the Controlled Salt Cavern Collapse

    NASA Astrophysics Data System (ADS)

    Jousset, P. G.; Rohmer, J.

    2012-12-01

    Caldera collapse (or pit-crater) dynamics are inferred from geological observations and laboratory experiments. Here, we present an analogue of caldera collapse at field scale and possible analogy with large scale caldera dynamics. Through an original exploitation technique in sedimentary environment, a salt layer is emptied, leaving a brine-filled cavern, which eventually collapses after overburden falls into the cavern. Such a collapse was monitored in East France by many instruments (including GPS, extensometers, geophones, broadband seismological sensors, tiltmeter, gravity meter, … ), which allowed us to describe mechanisms of the collapse. Micro-seismicity is a good indicator of spatio-temporal evolution of physical properties of rocks prior to catastrophic events like volcanic eruptions or landslides and may be triggered by a number of causes including dynamic characteristics of processes in play or/and external forces. We show evidence of triggered micro-seismicity observed in the vicinity of this underground salt cavern prone to collapse by a remote M~7.2 earthquake, which occurred ~12000 kilometres away. High-dynamic broadband records reveal the strong time-correlation between a dramatic change in the rate of local high-frequency micro-seismicity and the passage of low-frequency seismic waves, including body, Love and Rayleigh surface waves. Pressure was lowered in the cavern by pumping operations of brine out of the cavern. We demonstrate the near critical state of the cavern before the collapse by means of 2D axisymmetric elastic finite-element simulations. Stress oscillations due to the seismic waves may have exceeded the strength required for the rupture of the complex media made of brine and rock triggering micro-earthquakes and leading to damage of the overburden and eventually collapse of the salt cavern. The increment of stress necessary for the failure of a Dolomite layer is of the same order or magnitude as the maximum dynamic stress magnitude

  14. Numerical Simulations of Leakage from Underground LPG Storage Caverns

    SciTech Connect

    Yamamoto, Hajime; Pruess, Karsten

    2004-09-01

    To secure a stable supply of petroleum gas, underground storage caverns for liquified petroleum gas (LPG) are commonly used in many countries worldwide. Storing LPG in underground caverns requires that the surrounding rock mass remain saturated with groundwater and that the water pressure be higher than the liquid pressure inside the cavern. In previous studies, gas containment criteria for underground gas storage based on hydraulic gradient and pressure have been discussed, but these studies do not consider the physicochemical characteristics and behavior of LPG such as vaporization and dissolution in groundwater. Therefore, while these studies are very useful for designing storage caverns, they do not provide better understanding of the either the environmental effects of gas contamination or the behavior of vaporized LPG. In this study, we have performed three-phase fluid flow simulations of gas leakage from underground LPG storage caverns, using the multiphase multicomponent nonisothermal simulator TMVOC (Pruess and Battistelli, 2002), which is capable of solving the three-phase nonisothermal flow of water, gas, and a multicomponent mixture of volatile organic chemicals (VOCs) in multidimensional heterogeneous porous media. A two-dimensional cross-sectional model resembling an actual underground LPG facility in Japan was developed, and gas leakage phenomena were simulated for three different permeability models: (1) a homogeneous model, (2) a single-fault model, and (3) a heterogeneous model. In addition, the behavior of stored LPG was studied for the special case of a water curtain suddenly losing its function because of operational problems, or because of long-term effects such as clogging of boreholes. The results of the study indicate the following: (1) The water curtain system is a very powerful means for preventing gas leakage from underground storage facilities. By operating with appropriate pressure and layout, gas containment can be ensured. (2

  15. Treatment for Inappropriate Sinus Tachycardia.

    PubMed

    Salazar Adum, Juan Pablo; Arora, Rohit

    Inappropriate Sinus Tachycardia (IST) is a chronic medical condition with a wide variety of clinical presentations making it, sometimes, very insidious at the time of the diagnosis. Several therapeutic options, including, pharmacotherapy, cardiac rehabilitation, and modification or ablation of the sinus node, have been proposed for the management of IST, but because of the complexity and lack of understanding of pathophysiology, it can be difficult to manage, despite the numerous treatment options currently available. The purpose of this review is to analyze the treatment for IST, focusing on the role of newer therapy and the potential benefits in the management of this cardiac rhythm disturbance.

  16. Cerebral Cavernous Malformations: Somatic Mutations in Vascular Endothelial Cells

    PubMed Central

    Gault, Judith; Awad, Issam A.; Recksiek, Peter; Shenkar, Robert; Breeze, Robert; Handler, Michael; Kleinschmidt-DeMasters, Bette Kay

    2009-01-01

    OBJECTIVE Germline mutations in three genes have been found in familial cases of cerebral cavernous malformations (CCM). We previously discovered somatic and germline truncating mutations in the KRIT1 gene supporting the “two-hit” mechanism of CCM lesion formation in a single lesion. The purpose of this study was to screen for somatic, nonheritable, mutations in three more lesions from different patients and identify the cell type(s) in which somatic mutations occur. METHODS Somatic mutations were sought in DNA from three surgically excised, fresh-frozen CCM lesions by cloning and screening PCR products generated from KRIT1 or PDCD10 coding regions. Laser capture microdissection (LCM) was used to isolated endothelial and nonendothelial cells in order to determine if somatic mutations were found in endothelial cells. RESULTS A CCM lesion harbored somatic and germline KRIT1 mutations on different chromosomes and are therefore biallelic. Both mutations are predicted to truncate the protein. The KRIT1 somatic mutations (novel c.1800delG mutation and previously identified 34 nucleotide deletion) in CCMs from two different patients were only found in the vascular endothelial cells lining caverns. No obvious somatic mutations were identified in the two other lesions; however, the results were inconclusive possibly due to the technical limitations or the fact that these specimens had a small proportion of vascular endothelial cells lining pristine caverns. CONCLUSION The “two-hit” mechanism occurs in vascular endothelial cells lining CCM caverns from two patients with somatic and Hispanic-American KRIT1 germline mutations. Methods for somatic mutation detection should focus on vascular endothelial cells lining pristine caverns. PMID:19574835

  17. Bacterial colonization or infection in chronic sinusitis.

    PubMed

    Pandak, Nenad; Pajić-Penavić, Ivana; Sekelj, Alen; Tomić-Paradžik, Maja; Cabraja, Ivica; Miklaušić, Božana

    2011-12-01

    The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Streptococcus viridans and Streptococcus pneumoniae. Maxillary or ethmoidal sinus swabs yielded bacterial growth in 47 (72.31%) patients. The most frequently found bacteria in sinuses were Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella spp. and Streptococci (pneumoniae, viridans and spp.). The insignificant number of leukocytes was present in each sinus and nasopharyngeal swab. Every published microbiology study of chronic sinusitis proved that sinus mucosa were colonized with bacteria and not infected, yet antibiotic therapy was discussed making no difference between infection and colonization. Chronic sinusitis should be considered a chronic inflammatory condition rather than bacterial infection, so routine antibiotic therapy should be avoided. Empiric antibiotic therapy should be prescribed only in cases when the acute exacerbation of chronic sinusitis occurs and the antibiotics prescribed should aim the usual bacteria causing acute sinusitis. In case of therapy failure, antibiotics should be changed having in mind that under certain circumstances any bacteria colonizing sinus mucosa can cause acute exacerbation of chronic sinusitis.

  18. Long-term sealing analyses for US Strategic Petroleum Reserve (SPR) caverns

    SciTech Connect

    Ehgartner, B.

    1994-02-01

    It is inevitable that sealing and abandonment will someday occur in a SPR cavern or caverns. To gain insight into the long-term behavior of a typical SPR cavern following sealing and abandonment, a suite of mechanical finite-element calculations was performed. The initial analyses predict how quickly and to what extent a cavern pressurizes after it is plugged. The analyses also examine the stability of the cavern as it changes shape due to the excessive pressures generated as the salt creeps and the brine in the cavern thermally expands. These large-scale analyses do not include the details of the plug but assume a good seal is established in the cavern wells. In another series of analyses, the potential for forming a leak at the plug is evaluated. A cement plug, emplaced in the casing seat of a cavern well, is loaded using the predicted brine pressures from the cavern analyses. The plugged casing analyses examine the potential for forming a leak path in and along the interfaces of salt, casing, and cement plug. In the last set of analysis, the dimensional scale of the problem is further reduced to examine a preexisting crack along a casing/salt interface. The cracked interface is assumed to be fluid filled and fully pressurized by the cavern fluids. The analyses address the potential for the fluid path to extend upwards along a plugged casing should an open microannulus surround the casing after it is plugged.

  19. Preliminary technical and legal evaluation of disposing of nonhazardous oil field waste into salt caverns

    SciTech Connect

    Veil, J.; Elcock, D.; Raivel, M.; Caudle, D.; Ayers, R.C. Jr.; Grunewald, B.

    1996-06-01

    Caverns can be readily formed in salt formations through solution mining. The caverns may be formed incidentally, as a result of salt recovery, or intentionally to create an underground chamber that can be used for storing hydrocarbon products or compressed air or disposing of wastes. The purpose of this report is to evaluate the feasibility, suitability, and legality of disposing of nonhazardous oil and gas exploration, development, and production wastes (hereafter referred to as oil field wastes, unless otherwise noted) in salt caverns. Chapter 2 provides background information on: types and locations of US subsurface salt deposits; basic solution mining techniques used to create caverns; and ways in which salt caverns are used. Later chapters provide discussion of: federal and state regulatory requirements concerning disposal of oil field waste, including which wastes are considered eligible for cavern disposal; waste streams that are considered to be oil field waste; and an evaluation of technical issues concerning the suitability of using salt caverns for disposing of oil field waste. Separate chapters present: types of oil field wastes suitable for cavern disposal; cavern design and location; disposal operations; and closure and remediation. This report does not suggest specific numerical limits for such factors or variables as distance to neighboring activities, depths for casings, pressure testing, or size and shape of cavern. The intent is to raise issues and general approaches that will contribute to the growing body of information on this subject.

  20. Oncocytic Schneiderian papilloma of frontal sinus.

    PubMed

    Kalfert, David; Laco, Jan; Celakovský, Petr; Smatanová, Katarína; Ludvíková, Marie

    2013-01-01

    Oncocytic Schneiderian papilloma (OSP) is one of the three morphologically distinct tumors that arise from Schneiderian membrane (the others include exophytic papilloma and inverted papilloma). OSP almost always occurs unilaterally in the paranasal sinuses, usually in the maxillary sinus, ethmoid cells or sphenoid sinus. We report a case of a 64-year-old woman with OSP arising from the left frontal sinus. In the report herein, we describe an OSP originating in the region of frontal sinus, which, to the best of our knowledge, represents the first documented example in English literature of OSP developing in this anatomical site.

  1. Overview of Frontal Sinus Pathology and Management.

    PubMed

    Vázquez, Alejandro; Baredes, Soly; Setzen, Michael; Eloy, Jean Anderson

    2016-08-01

    The frontal sinus is the most complex of all paranasal sinuses. Given its proximity to the cranial vault and orbit, frontal sinus pathology can progress to involve these structures and lead to significant morbidity, or even mortality. Surgical management of the frontal sinus is technically challenging. Various open and endoscopic surgical techniques are available to the otolaryngologist. This article presents an overview of the major disease entities that affect the frontal sinus, with a special emphasis on treatment principles and surgical management. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. When Sinuses Attack! (For Kids)

    MedlinePlus

    ... you have a cold? continue When Good Sinuses Go Bad What about that cold that won't go away? A cold virus can: damage the delicate ... if you are feeling well enough, you can go to school or go outside and play. In ...

  3. Pneumatization of the sphenoid sinus.

    PubMed

    Terra, E R; Guedes, F R; Manzi, F R; Bóscolo, F N

    2006-01-01

    This paper describes a case of pneumatization of the sphenoid sinus in the pterygoid process and greater wing of the sphenoid bone, observed on a panoramic radiograph. Conventional radiographs and computerized tomography in axial and coronal sections confirmed the presence of the pneumatization of these structures.

  4. Adaptations in the structure and innervation of follicle-sinus complexes to an aquatic environment as seen in the Florida manatee (Trichechus manatus latirostris).

    PubMed

    Sarko, Diana K; Reep, Roger L; Mazurkiewicz, Joseph E; Rice, Frank L

    2007-09-20

    Florida manatees are large-bodied aquatic herbivores that use large tactile vibrissae for several purposes. Facial vibrissae are used to forage in a turbid water environment, and the largest perioral vibrissae can also grasp and manipulate objects. Other vibrissae distributed over the entire postfacial body appear to function as a lateral line system. All manatee vibrissae emanate from densely innervated follicle-sinus complexes (FSCs) like those in other mammals, although proportionately larger commensurate with the caliber of the vibrissae. As revealed by immunofluorescence, all manatee FSCs have many types of C, Adelta and Abeta innervation including Merkel, club, and longitudinal lanceolate endings at the level of the ring sinus, but they lack other types such as reticular and spiny endings at the level of the cavernous sinus. As in non-whisking terrestrial species, the inner conical bodies of facial FSCs are well innervated but lack Abeta-fiber terminals. Importantly, manatee FSCs have two unique types of Abeta-fiber endings. First, all of the FSCs have exceptionally large-caliber axons that branch to terminate as novel, gigantic spindle-like endings located at the upper ring sinus. Second, facial FSCs have smaller caliber Abeta fibers that terminate in the trabeculae of the cavernous sinus as an ending that resembles a Golgi tendon organ. In addition, the largest perioral vibrissae, which are used for grasping, have exceptionally well-developed medullary cores that have a structure and dense small-fiber innervation resembling that of tooth pulp. Other features of the epidermis and upper dermis structure and innervation differ from that seen in terrestrial mammals.

  5. Allergic fungal sinusitis causing nasolacrimal duct obstruction.

    PubMed

    Kim, Charles; Kacker, Ashutosh; Chee, Ru-Ik; Lelli, Gary J

    2013-04-01

    Allergic fungal sinusitis is thought to represent a chronic autoimmune reaction directed against fungal elements within the sinuses, and is commonly seen in individuals with a history of chronic sinusitis that is refractory to medical therapy. The authors present a case of allergic fungal sinusitis involving the lacrimal drainage system. A 54-year-old woman initially presented with recurrent erythema and induration of the left nasolacrimal sac due to dacryocystitis, which was unresponsive to treatment with topical and systemic antibiotics. Radiological evaluation demonstrated the presence of multiple soft tissue masses along the medial canthi. During subsequent endoscopic dacryocystorhinostomy, significant amounts of allergic mucin were found within the sinuses and marked eosinophilia was present within tissue obtained from the lacrimal sac, findings highly suggestive of allergic fungal sinusitis. A diagnosis of allergic fungal sinusitis should be considered in patients presenting with epiphora in the appropriate clinical context. However, involvement of the lacrimal drainage system is an exceedingly unusual presentation.

  6. Differentiation of transverse sinus thrombosis from congenitally atretic cerebral transverse sinus with CT.

    PubMed

    Chik, Yolanda; Gottesman, Rebecca F; Zeiler, Steven R; Rosenberg, Jason; Llinas, Rafael H

    2012-07-01

    Transverse sinus thrombosis can have nonspecific clinical and radiographic signs. We hypothesized that the novel "sigmoid notch sign" (on head CT) can help differentiate transverse sinus thrombosis from a congenitally atretic sinus among individuals with absent signal in 1 transverse sinus by MR venography. We retrospectively evaluated 53 subjects with a unilaterally absent transverse sinus signal on MR venography. Eleven had true transverse sinus thrombosis and 42 had an atretic transverse sinus. Reviewers were trained in the sigmoid notch sign: "positive" if 1 of the sigmoid notches was asymmetrically smaller than the other, consistent with a congenitally absent transverse sinus on that side. This sign was scored on CT scans by 2 blinded reviewers to determine if signal dropout was clot or atretic sinus. A consensus rating was reached when the reviewers disagreed. Characteristics of the sigmoid notch sign as a diagnostic test were compared with a gold standard of full chart review by an independent reviewer. Each reviewer had a sensitivity of 91% (detecting 10 of 11 clots based on a negative sigmoid notch sign) and specificity of 71% to 81%; consensus specificity increased to 86% (36 of 42 individuals with an atretic sinus had a positive notch sign, detecting atretic sinuses based on presence of the sign). Asymmetries of the sigmoid notches on noncontrast brain CT is a very sensitive and specific measure of differentiating transverse sinus thrombosis from an atretic transverse sinus when absence of transverse sinus flow is visualized on MR venography.

  7. Ex vivo comparative study on three sinus lift tools for transcrestal detaching maxillary sinus mucosa.

    PubMed

    Li, Yanfeng; Hu, Pin; Han, Yishi; Fan, Jiadong; Dong, Xinming; Ren, Huan; Yang, Chunhao; Shi, Tingting; Xia, Dong

    2017-07-04

    The objective of this study was to comparatively evaluate 3 different sinus lift tools, namely umbrella-shaped sinus lift curette YSL-04, our recently designed probe-improved sinus lift curettes, and our newly invented elevator 014, using our previous developed goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time. Goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time were generated according to our previously developed protocol. The effectiveness for each tool was evaluated through the length of sinus mucosa detached in mesial and distal directions or buccal and palatal directions, and the space volume created by detaching maxillary sinus mucosa in mesial, distal, buccal and palatal directions. The results showed that all 3 sinus lift tools could transcrestally detach the maxillary sinus mucosa and create extra space under the elevated sinus floor on the goat ex vivo sinus models. Moreover, our newly invented elevator 014 had advantages over the other 2 in term of the capability to detach the sinus mucosa. Our newly invented elevator 014 might be a promising tool for detaching maxillary sinus mucosa in transcrestal maxillary sinus floor elevation.

  8. Relationship between prognosis of dental implants and maxillary sinusitis associated with the sinus elevation procedure.

    PubMed

    Kim, Young-Kyun; Hwang, Jin-Young; Yun, Pil-Young

    2013-01-01

    The aims of this study were to evaluate the incidence of maxillary sinusitis associated with the sinus elevation procedure and to analyze the influence of maxillary sinusitis on the prognosis of dental implants. Data were collected from medical records and dental radiographic findings of patients who received dental implant therapy along with a sinus elevation procedure at Seoul National University Bundang Hospital from June 2003 to December 2008. A total of 338 sinus elevation cases (643 implants) were included in this study, out of which maxillary sinusitis was reported in 33 cases (9.8%). The type of surgical approach used and the occurrence of sinus membrane perforation could be considered factors affecting maxillary sinusitis associated with the sinus elevation procedure. The implants at the site of the maxillary sinusitis associated with the sinus elevation procedure showed lower survival rates in male patients. Better clinical outcomes were achieved in the group receiving combined medical and surgical therapy for sinusitis associated with the sinus elevation procedure. Postoperative maxillary sinusitis decreased the survival rates of implants, whereas early diagnosis and combined medical and surgical therapy had the opposite effect.

  9. The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx.

    PubMed

    Chalouhi, Nohra; Dumont, Aaron S; Tjoumakaris, Stavropoula; Gonzalez, L Fernando; Bilyk, Jurij R; Randazzo, Ciro; Hasan, David; Dalyai, Richard T; Rosenwasser, Robert; Jabbour, Pascal

    2012-05-01

    Endovascular therapy is the primary treatment option for carotid-cavernous fistulas (CCFs). Operative cannulation of the superior ophthalmic vein (SOV) provides a reasonable alternative route to the cavernous sinus when all transvenous and transarterial approaches have been unsuccessful. The role of the liquid embolic agent Onyx in the management of CCFs has not been well documented, especially when using an SOV approach. The purpose of this study is to assess the safety and efficacy of Onyx embolization of CCFs through a surgical cannulation of the SOV. The authors retrospectively reviewed all patients with CCFs who were treated with Onyx through an SOV approach between April 2009 and April 2011. Traditional endovascular approaches had failed in all patients. A total of 10 patients were identified, 1 with a Type A CCF, 5 with a Type B CCF, and 4 with a Type D CCF. All fistulas were embolized in 1 session. Onyx was the sole embolic agent used in 7 cases and was combined with coils in 3 other cases. Complete obliteration was achieved in 8 patients and a significant reduction in fistulous flow was achieved in 2 patients, which later progressed to near-complete occlusion on angiographic follow-up. All patients experienced a complete clinical recovery with excellent cosmetic results and were free from recurrence at their latest clinical follow-up evaluations. Onyx embolization is an excellent therapy for CCFs in general, and through an SOV approach in particular. Direct operative cannulation of the SOV followed by Onyx embolization may be the best treatment option in patients with CCFs when all other endovascular approaches have been exhausted.

  10. Evaluating the safety of frontal sinus trephination.

    PubMed

    Lee, Annie S; Schaitkin, Barry M; Gillman, Grant S

    2010-03-01

    The depth of the frontal sinus was measured using axial computed tomography (CT) images to examine the safety of frontal sinus trephination at selected distances from the midline. Review of 200 sinus CT scans. Two hundred sinus CT scans (400 frontal sinuses) were reviewed to measure the frontal sinus depth at 5 mm, 10 mm, and 15 mm from midline. Males had a significantly deeper frontal sinus than females at all measurements points (P < .001). The measurements revealed a considerable number of small but nonhypoplastic frontal sinuses, which were shallower than the length of standard frontal trephine instruments (7 mm) and would risk penetration of the posterior table of the sinus. Of all frontal sinuses studied, 9.54% were <7 mm deep at 5 mm from the midline, 10.12% at 10 mm, and 8.96% at 15 mm from the midline. Overall, 15.3% of all frontal sinuses studied had at least one point where the measured depth was <7 mm. Although the majority of patients have frontal sinuses deep enough to accommodate standard trephine instruments, surgeons should recognize that up to 15% of nonhypoplastic frontal sinuses may not be sufficiently deep at a given point to allow safe trephination without risking unintentional transgression of the posterior table. This study suggests that trephination routinely carried out at a given predetermined distance from the midline may be an unsafe practice. Careful evaluation of the imaging is essential in every case to avoid inadvertent injury and to help select the safest distance from the midline for frontal sinus trephination.

  11. Anatomical aspects of sinus floor elevations.

    PubMed

    van den Bergh, J P; ten Bruggenkate, C M; Disch, F J; Tuinzing, D B

    2000-06-01

    Inadequate bone height in the lateral part of the maxilla forms a contra-indication for implant surgery. This condition can be treated with an internal augmentation of the maxillary sinus floor. This sinus floor elevation, formerly called sinus lifting, consists of a surgical procedure in which a top hinge door in the lateral maxillary sinus wall is prepared and internally rotated to a horizontal position. The new elevated sinus floor, together with the inner maxillary mucosa, will create a space that can be filled with graft material. Sinus lift procedures depend greatly on fragile structures and anatomical variations. The variety of anatomical modalities in shape of the inner aspect of the maxillary sinus defines the surgical approach. Conditions such as sinus floor convolutions, sinus septum, transient mucosa swelling and narrow sinus may form a (usually relative) contra-indication for sinus floor elevation. Absolute contra-indications are maxillary sinus diseases (tumors) and destructive former sinus surgery (like the Caldwell-Luc operation). The lateral sinus wall is usually a thin bone plate, which is easily penetrated with rotating or sharp instruments. The fragile Schneiderian membrane plays an important role for the containment of the bonegraft. The surgical procedure of preparing the trap door and luxating it, together with the preparation of the sinus mucosa, may cause a mucosa tear. Usually, when these perforations are not too large, they will fold together when turning the trap door inward and upward, or they can be glued with a fibrin sealant, or they can be covered with a resorbable membrane. If the perforation is too large, a cortico-spongious block graft can be considered. However, in most cases the sinus floor elevation will be deleted. Perforations may also occur due to irregularities in the sinus floor or even due to immediate contact of sinus mucosa with oral mucosa. Obstruction of the antro-nasal foramen is, due to its high location, not a

  12. Virtual reality surgical anatomy of the sphenoid sinus and adjacent structures by the transnasal approach.

    PubMed

    Wang, Shou-Sen; Xue, Liang; Jing, Jun-Jie; Wang, Ru-Mi

    2012-09-01

    To examine the three-dimensional virtual anatomical features of the sphenoid sinus and adjacent structures during virtual surgery and explore their relevance to actual transsphenoidal surgery. CT images of the sphenoid sinus and surrounding structures from 28 Chinese adult patients were measured using a 16-slice helical CT scanner. Image analysis was performed using the volume-rendering method. Two experienced neurosurgeons wearing stereoscopic glasses performed virtual transsphenoidal surgery by the transnasal approach. The virtual anatomical features of the sphenoid sinus and the adjacent structures during virtual surgery were described. The distance from the sphenopalatine foramen to the left and right sphenoid ostium was 10.1 ± 2.7 mm and 10.5 ± 3.2 mm, respectively, to the left and right sphenoidal crest 12.9 ± 2.0 mm and 12.8 ± 2.2 mm, respectively, and to the left and right uncinate process 24.0 ± 1.9 mm and 23.9 ± 2.0 mm, respectively. The distance from the uncinate process to the medial and lateral edge of the most prominent part of the anterior bend of the cavernous internal carotid artery (ICA) was 33.7 ± 3.7 mm and 34.8 ± 3.7 mm, respectively, and the angle between the two lines was 9.7 ± 1.9°. The study provides virtual anatomical information about the sphenoid sinus and important surrounding structures that is essential for successful real life transsphenoidal surgery. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  13. Sensitivity of storage field performance to geologic and cavern design parameters in salt domes.

    SciTech Connect

    Ehgartner, Brian L.; Park, Byoung Yoon

    2009-03-01

    A sensitivity study was performed utilizing a three dimensional finite element model to assess allowable cavern field sizes for strategic petroleum reserve salt domes. A potential exists for tensile fracturing and dilatancy damage to salt that can compromise the integrity of a cavern field in situations where high extraction ratios exist. The effects of salt creep rate, depth of salt dome top, dome size, caprock thickness, elastic moduli of caprock and surrounding rock, lateral stress ratio of surrounding rock, cavern size, depth of cavern, and number of caverns are examined numerically. As a result, a correlation table between the parameters and the impact on the performance of storage field was established. In general, slower salt creep rates, deeper depth of salt dome top, larger elastic moduli of caprock and surrounding rock, and a smaller radius of cavern are better for structural performance of the salt dome.

  14. Regulatory, technical pressures prompt more U. S. salt-cavern gas storage

    SciTech Connect

    Barron, T.F. )

    1994-09-12

    Natural-gas storage in US salt caverns is meeting the need for flexible, high delivery and injection storage following implementation Nov. 1, 1993, of the Federal Energy Regulatory Commission's Order 636. This ruling has opened the US underground natural-gas storage market to more participants and created a demand for a variety of storage previously provided by pipelines as part of their bundled sales services. Many of these new services such as no-notice and supply balancing center on use of high-delivery natural gas storage from salt caverns. Unlike reservoir storage, nothing restricts flow in a cavern. The paper discusses the unique properties of salt that make it ideal for gas storage, choosing a location for the storage facility, cavern depth and shape, cavern size, spacing, pressures, construction, conversion or brine or LPG storage caverns to natural gas, and operation.

  15. Sensitivity of storage field performance to geologic and cavern design parameters in salt domes.

    SciTech Connect

    Ehgartner, Brian L.; Park, Byoung Yoon; Herrick, Courtney Grant

    2010-06-01

    A sensitivity study was performed utilizing a three dimensional finite element model to assess allowable cavern field sizes in strategic petroleum reserve salt domes. A potential exists for tensile fracturing and dilatancy damage to salt that can compromise the integrity of a cavern field in situations where high extraction ratios exist. The effects of salt creep rate, depth of salt dome top, dome size, caprock thickness, elastic moduli of caprock and surrounding rock, lateral stress ratio of surrounding rock, cavern size, depth of cavern, and number of caverns are examined numerically. As a result, a correlation table between the parameters and the impact on the performance of a storage field was established. In general, slower salt creep rates, deeper depth of salt dome top, larger elastic moduli of caprock and surrounding rock, and a smaller radius of cavern are better for structural performance of the salt dome.

  16. Beta electron fluxes inside a magnetic plasma cavern: Calculation and comparison with experiment

    NASA Astrophysics Data System (ADS)

    Stupitskii, E. L.; Smirnov, E. V.; Kulikova, N. A.

    2010-12-01

    We study the possibility of electrostatic blanking of beta electrons in the expanding spherical blob of a radioactive plasma in a rarefied ionosphere. From numerical studies on the dynamics of beta electrons departing a cavern, we obtain the form of a function that determines the portion of departing electrons and calculate the flux density of beta electrons inside the cavern in relation to the Starfish Prime nuclear blast. We show that the flux density of electrons in geomagnetic flux tubes and inside the cavern depend on a correct allowance for the quantity of beta electrons returning to the cavern. On the basis of a physical analysis, we determine the approximate criterion for the return of electrons from a geomagnetic flux tube to the cavern. We compare calculation results in terms of the flux density of beta electrons inside the cavern with the recently published experimental results from operation Starfish Prime.

  17. Frontal sinus mini-trephination for acute sinusitis complicated by intracranial infection.

    PubMed

    McIntosh, D L; Mahadevan, M

    2007-10-01

    Acute bacterial sinusitis is common in the pediatric population. Intracranial spread of infection is a rare but life-threatening complication of acute sinusitis. Due to the infrequent presentation of this complication, there are no well-defined management protocols for the acute sinusitis. We present three pediatric cases where children presented with intracranial sepsis, and the underlying source of infection was from the paranasal sinuses. In all cases, endoscopic sinus surgery was performed in the acute setting, with the use of frontal sinus mini-trephines playing a significant role. We describe our experience and review the available literature.

  18. Silent sinus syndrome and maxillary sinus atelectasis in children.

    PubMed

    Farneti, Paolo; Sciarretta, Vittorio; Macrì, Giovanni; Piccin, Ottavio; Pasquini, Ernesto

    2017-07-01

    Silent sinus syndrome (SSS) and chronic maxillary atelectasis (CMA) are unusual conditions having subtle symptoms with a possible progressive evolution. They are particularly infrequent in the pediatric population. Our objective was to review our experience with pediatric patients having SSS or CMA, and to review all cases involving patients under 14 years of age reported in the literature. A retrospective review of 6 patients diagnosed with SSS or CMA surgically treated from 2001 to 2014 was carried out. All cases reported in literature were reviewed. All patients underwent functional endoscopic sinus surgery with an improvement in symptoms after surgery. Diplopia disappeared in two patients who presented with it and enophthalmos improved in all five patients presenting with it. Only one patient out of four presenting with headache had a persistence of the symptoms which were, however, milder than they had been preoperatively. Endoscopic examination demonstrated a reventilated maxillary sinus in all cases. A radiological examination at follow-up was performed in 5 cases and demonstrated a reexpansion of the maxillary sinus as compared to the contralateral side in all patients except one. None of the patients required an orbital floor reconstruction. Eleven similar cases reported in the literature were analyzed and compared. Endoscopic uncinectomy and middle meatal antrostomy should be the treatment of choice for these conditions in patients presenting with enophthalmos and/or hypoglobus and symptoms related to it. Orbital floor reconstruction should be performed as a delayed procedure only in selected cases. Chronic maxillary atelectasis or SSS should be considered as a possible cause of persistent headache of unknown origin in pediatric patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Intranasal steroids for acute sinusitis.

    PubMed

    Zalmanovici Trestioreanu, Anca; Yaphe, John

    2013-12-02

    Acute sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school. We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of acute sinusitis in adults and children. We searched CENTRAL 2013, Issue 4, MEDLINE (January 1966 to May week 2, 2013), EMBASE (1990 to May 2013) and bibliographies of included studies. Randomised controlled trials (RCTs) comparing INCS treatment to placebo or no intervention in adults and children with acute sinusitis. Acute sinusitis was defined by clinical diagnosis and confirmed by radiological evidence or by nasal endoscopy. The primary outcome was the proportion of participants with either resolution or improvement of symptoms. Secondary outcomes were any adverse events that required discontinuation of treatment, drop-outs before the end of the study, rates of relapse, complications and return to school or work. Two review authors independently extracted data, assessed trial quality and resolved discrepancies by consensus. No new trials were found for inclusion in this update. Four studies involving 1943 participants with acute sinusitis met our inclusion criteria. The trials were well-designed and double-blind and studied INCS versus placebo or no intervention for 15 or 21 days. The rates of loss to follow-up were 7%, 11%, 41% and 10%. When we combined the results from the three trials included in the meta-analysis, participants receiving INCS were more likely to experience resolution or improvement in symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11; 95% confidence interval (CI) 1.04 to 1.18). Higher doses of INCS had a stronger effect on improvement of symptoms or complete relief: for mometasone furoate 400 µg versus 200 µg (RR 1.10; 95% CI 1.02 to 1.18 versus RR 1.04; 95% CI 0.98 to 1.11). No significant adverse events were reported and there was no significant difference in the drop-out and

  20. Controlateral cavernous syndrome, brainstem congestion and posterior fossa venous thrombosis with cerebellar hematoma related to a ruptured intracavernous carotid artery aneurysm.

    PubMed

    Aldea, Sorin; Guedin, Pierre; Roccatagliata, Luca; Boulin, Anne; Auliac, Stéphanie; Dupuy, Michel; Cerf, Charles; Gaillard, Stéphan; Rodesch, Georges

    2011-06-01

    Intracavernous carotid artery aneurysms (ICCAs) are rarely associated with life-threatening complications. We describe a 55-year-old woman who, after the rupture of an intracavernous carotid artery aneurysm, presented with a contralateral cavernous sinus syndrome and severe posterior fossa and spinal cord symptoms. Following parent artery occlusion, thrombosis of the posterior fossa and spinal cord veins caused a progressive worsening of the neurological status to a "locked-in" state. The patient fully recovered with anticoagulation therapy. Comprehension of the pathophysiological mechanism associated with the rupture of ICCA and early diagnosis of the related symptoms are essential in order to plan a correct treatment that includes the management of the aneurysm rupture and of possible complications related to venous thrombosis.

  1. Genetic Analysis of Multiple Endocrine Neoplasia Type 1 (MEN1) Leads to Misdiagnosis of an Extremely Rare Presentation of Intrasellar Cavernous Hemangioma as MEN1

    PubMed Central

    Lee, Dong Min; Yu, Seung Hee; Yoon, Hyun Hwa; Lee, Kang Lock; Eom, Young Sil; Lee, Kiyoung; Kim, Byung-Joon; Kim, Yeun Sun; Park, Ie Byung; Kim, Kwang-Won

    2014-01-01

    Background Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder characterized by the simultaneous occurrence of endocrine tumors in target tissues (mainly the pituitary, endocrine pancreas, and parathyroid glands). MEN1 is caused by mutations in the MEN1 gene, which functions as a tumor suppressor and consists of one untranslated exon and nine exons encoding the menin protein. This condition is usually suspected when we encounter patients diagnosed with tumors in multiple endocrine organs, as mentioned above. Methods A 65-year-old woman who underwent surgery for a pancreatic tumor (serous cystadenoma) 5 years previously was referred to our hospital due to neurologic symptoms of diplopia and left ptosis. Brain magnetic resonance imaging revealed a 3.4-cm lesion originating from the cavernous sinus wall and extending into the sellar region. It was thought to be a nonfunctioning tumor from the results of the combined pituitary function test. Incidentally, we found that she also had a pancreatic tumor, indicating the necessity of genetic analysis for MEN1. Results Genomic analysis using peripheral leukocytes revealed a heterozygous c.1621G>A mutation in the MEN1 gene that was previously reported to be either a pathogenic mutation or a simple polymorphism. We pursued a stereotactic approach to the pituitary lesion, and microscopic findings of the tumor revealed it to be an intrasellar cavernous hemangioma, a rare finding in the sellar region and even rarer in relation to oculomotor palsy. The patient recovered well from surgery, but refused further evaluation for the pancreatic lesion. Conclusion There is great emphasis placed on genetic testing in the diagnosis of MEN1, but herein we report a case where it did not assist in diagnosis, hence, further discussion on the role of genetic testing in this disease is needed. Also, in cases of pituitary tumor with cranial nerve palsy, despite its low prevalence, intrasellar cavernous hemangioma could be

  2. STORAGE OF CHILLED NATURAL GAS IN BEDDED SALT STORAGE CAVERNS

    SciTech Connect

    JOel D. Dieland; Kirby D. Mellegard

    2001-11-01

    This report provides the results of a two-phase study that examines the economic and technical feasibility of converting a conventional natural gas storage facility in bedded salt into a refrigerated natural gas storage facility for the purpose of increasing the working gas capacity of the facility. The conceptual design used to evaluate this conversion is based on the design that was developed for the planned Avoca facility in Steuben County, New York. By decreasing the cavern storage temperature from 43 C to -29 C (110 F to -20 F), the working gas capacity of the facility can be increased by about 70 percent (from 1.2 x 10{sup 8} Nm{sup 3} or 4.4 billion cubic feet (Bcf) to 2.0 x 10{sup 8} Nm{sup 3} or 7.5 Bcf) while maintaining the original design minimum and maximum cavern pressures. In Phase I of the study, laboratory tests were conducted to determine the thermal conductivity of salt at low temperatures. Finite element heat transfer calculations were then made to determine the refrigeration loads required to maintain the caverns at a temperature of -29 C (-20 F). This was followed by a preliminary equipment design and a cost analysis for the converted facility. The capital cost of additional equipment and its installation required for refrigerated storage is estimated to be about $13,310,000 or $160 per thousand Nm{sup 3} ($4.29 per thousand cubic feet (Mcf)) of additional working gas capacity. The additional operating costs include maintenance refrigeration costs to maintain the cavern at -29 C (-20 F) and processing costs to condition the gas during injection and withdrawal. The maintenance refrigeration cost, based on the current energy cost of about $13.65 per megawatt-hour (MW-hr) ($4 per million British thermal units (MMBtu)), is expected to be about $316,000 after the first year and to decrease as the rock surrounding the cavern is cooled. After 10 years, the cost of maintenance refrigeration based on the $13.65 per MW-hr ($4 per MMBtu) energy cost is

  3. Orthostatic hypotension associated with dorsal medullary cavernous angioma.

    PubMed

    Idiaquez, J; Araya, P; Benarroch, E

    2009-01-01

    Orthostatic hypotension (OH) is a rare manifestation of medulla oblongata lesions that may be because of interruption of descending sympathoexcitatory axons. To illustrate the location of a medullary lesion that produced OH following resection in relationship to the location of putative sympathoexcitatory pathways. A case with dorsal medullary cavernous angioma presenting with OH is described. The possible localization of lesion was compared with distribution of tyrosine hydroxylase (TH)-immunoreactive axons in a comparable section of the medulla of a control brain. The patient had marked OH after partial removal of the cavernous angioma. Biopsy confirmed the diagnosis. The magnetic resonance imaging location of the lesion overlapped that of TH-immunoreactive axons of the medullary transtegmental tract. A restricted lesion of medullary lesion interrupting the catecholaminergic transtegmental tract arising from the sympathoexcitatory C1 neurons of the rostral ventrolateral medulla could result in severe OH.

  4. [Recurrent neurosensory macular detachment in carotid-cavernous fistula].

    PubMed

    de Dompablo, E; Díez-Álvarez, L; Ruiz-Casas, D; Sánchez-Gutiérrez, V; Ciancas, E; González-López, J J

    2015-07-01

    A 46 year-old man was seen in the emergency department complaining of vision loss and exophthalmos in his right eye. He also complained of headache, diplopia of 4 months onset, and neurosensory detachment that resolved spontaneously the month before. The study revealed tortuous conjunctival and episcleral vessels and neurosensory macular detachment in his right eye. A carotid-cavernous fistula was confirmed by computed tomography angiography. The fistula closed spontaneously during the hospitalization. One month later, the neurosensory detachment disappeared again. Carotid-cavernous fistula should be included in the differential diagnosis of neurosensory macular detachments. These neurosensory detachments can resolve spontaneously 11 the fistula is closed. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Red blood cell scan in cavernous hemangioma of the larynx

    SciTech Connect

    Finkelstein, D.M.; Noyek, A.M.; Kirsh, J.C. )

    1989-09-01

    Cavernous hemangioma of the larynx is an uncommon, difficult-to-diagnose vascular tumor for which there is no significant imaging literature to date. The possibility of improved diagnosis through RBC scanning might obviate injudicious biopsy and potential hemorrhage within the airway. Utilizing the radionuclide RBC scan, which labels the patient's own RBCs initially with cold pyrophosphate, and subsequently with technetium 99m as pertechnetate, we have identified successfully four patients with cavernous hemangioma of the larynx. All presented with a supraglottic mass involving at least the aryepiglottic fold and arytenoid region unilaterally. This report describes our satisfactory diagnostic imaging experience with the radionuclide RBC scan and suggests both its imaging specificity and its role in the management of this lesion.

  6. Supratentorial high convexity intradural extramedullary cavernous angioma: case report.

    PubMed

    Sakakibara, Yohtaro; Matsumori, Takashi; Taguchi, Yoshio; Koizumi, Hirotaka

    2010-01-01

    A 59-year-old man presented with a 2-month history of numbness in the lower left side of the face and upper left extremity. Axial T(1)-weighted magnetic resonance imaging showed a wedge-shaped mass measuring 3 x 2.5 cm in the right frontoparietal high convexity area that was heterogeneously enhanced after administration of gadolinium-diethylenetriaminepenta-acetic acid. Right frontoparietal craniotomy was performed and a bluish soft mass was found under the arachnoid membrane. The mass could be dissected free from the arachnoid membrane and the brain surface. Histological examination revealed the typical findings of cavernous angioma. Cavernous angioma should be considered in the differential diagnosis of supratentorial high convexity intradural extramedullary tumor, especially appearing as a heterogeneously enhanced mass adjacent to the brain parenchyma causing mass effect.

  7. Challenges associated with reentry maxillary sinus augmentation.

    PubMed

    Mardinger, Ofer; Moses, Ofer; Chaushu, Gavriel; Manor, Yifat; Tulchinsky, Ze'ev; Nissan, Joseph

    2010-09-01

    This study was a retrospective assessment of reentry sinus augmentation compared with sinus augmentation performed for the first time. There were 38 subjects who required sinus augmentation. The study group (17 patients, 21 sinuses) included subjects following failure of a previous sinus augmentation procedure that required reentry augmentation. The control group (21 patients, 21 sinuses) included subjects in which sinus augmentation was performed for the first time. Patients' medical files were reviewed. A preformed questionnaire was used to collect data regarding demographic parameters, medical and dental health history, habits, and intra- and postoperative data. Operative challenges in the study group included adhesions of the buccal flap to the Schneiderian membrane (62%, 13/21, P<.001), bony fenestration of the lateral wall with adhesions (71%, 15/21, P<.001), limited mobility of a clinical fibrotic Schneiderian membrane (71%, 15/21, P<.001), and increased incidence of membrane perforations (47%, 10/21, versus 9.5%, 2/21, P=.03). In the control group the Schneiderian membrane was thin and flexible. Sinus augmentation succeeded in all cases of both groups. Implant failure was significantly higher in the study group (11% versus 0%, P<.001). Clinical success of reentry sinus augmentation is predictable despite its complexity. Clinicians should be aware of anatomical changes caused by previous failure of this procedure. Patients should be informed about the lower success rate of implants when reentry sinus augmentation is required. Copyright (c) 2010 Mosby, Inc. All rights reserved.

  8. Beyond the sniffer: frontal sinuses in Carnivora.

    PubMed

    Curtis, Abigail A; Van Valkenburgh, Blaire

    2014-11-01

    Paranasal sinuses are some of the most poorly understood features of mammalian cranial anatomy. They are highly variable in presence and form among species, but their function is not well understood. The best-supported explanations for the function of sinuses is that they opportunistically fill mechanically unnecessary space, but that in some cases, sinuses in combination with the configuration of the frontal bone may improve skull performance by increasing skull strength and dissipating stresses more evenly. We used CT technology to investigate patterns in frontal sinus size and shape disparity among three families of carnivores: Canidae, Felidae, and Hyaenidae. We provide some of the first quantitative data on sinus morphology for these three families, and employ a novel method to quantify the relationship between three-dimensional sinus shape and skull shape. As expected, frontal sinus size and shape were more strongly correlated with frontal bone size and shape than with the morphology of the skull as a whole. However, sinus morphology was also related to allometric differences among families that are linked to biomechanical function. Our results support the hypothesis that frontal sinuses most often opportunistically fill space that is mechanically unnecessary, and they can facilitate cranial shape changes that reduce stress during feeding. Moreover, we suggest that the ability to form frontal sinuses allows species to modify skull function without compromising the performance of more functionally constrained regions such as the nasal chamber (heat/water conservation, olfaction), and braincase (housing the brain and sensory structures).

  9. Cavernous Hemangioma of Tongue: Management of Two Cases

    PubMed Central

    Puppala, Niharika; Deshmukh, Sudhanwa N; B, Jagadesh; S, Anuradha

    2014-01-01

    Hemangiomas are benign tumours of infancy and childhood, most commonly located in the head and neck region and occur more frequently in the lips, tongue and palate. The treatment depends upon lesion location, size and evolution stage and the patient’s age. This paper describes the management of cavernous hemangioma in a 2 -year -old child and 14 -year -old child using different approaches. PMID:25478463

  10. Asymptotic solution of the problem for a thin axisymmetric cavern

    NASA Technical Reports Server (NTRS)

    Serebriakov, V. V.

    1973-01-01

    The boundary value problem which describes the axisymmetric separation of the flow around a body by a stationary infinite stream is considered. It is understood that the cavitation number varies over the length of the cavern. Using the asymptotic expansions for the potential of a thin body, the orders of magnitude of terms in the equations of the problem are estimated. Neglecting small quantities, a simplified boundary value problem is obtained.

  11. Relative Evaluation of the Independent Volume Measures of Caverns

    SciTech Connect

    MUNSON,DARRELL E.

    2000-08-01

    Throughout the construction and operation of the caverns of the Strategic Petroleum Reserve (SPR), three types of cavern volume measurements have been maintained. These are: (1) the calculated solution volume determined during initial construction by solution mining and any subsequent solutioning during oil transfers, (2) the calculated sonar volume determined through sonar surveys of the cavern dimensions, and (3) the direct metering of oil to determine the volume of the cavern occupied by the oil. The objective of this study is to compare these measurements to each other and determine, if possible, the uncertainties associated with a given type of measurement. Over time, each type of measurement has acquired a customary, or an industry accepted, stated uncertainty. This uncertainty is not necessarily the result of a technical analysis. Ultimately there is one definitive quantity, the oil volume measure by the oil custody transfer meters, taken by all parties to the transfer as the correct ledger amount and for which the SPR Project is accountable. However, subsequent transfers within a site may not be with meters of the same accuracy. In this study, a very simple theory of the perfect relationship is used to evaluate the correlation (deviation) of the various measures. This theory permits separation of uncertainty and bias. Each of the four SPR sites are examined, first with comparisons between the calculated solution volumes and the sonar volumes determined during construction, then with comparisons of the oil inventories and the sonar volumes obtained either by surveying through brine prior to oil filling or through the oil directly.

  12. Long term storage of finished gasolines in large salt caverns

    SciTech Connect

    Koenig, J.W.J.

    1995-05-01

    Strategic oil stocking requires large low cost storage facilities. Crude oil has been held in very large salt mines and/or artificially made salt caverns for many years, notably in Europe and the USA. Following crude oil, gasoils and refinery light feed stocks have been tried also. Military organisations tried jet fuel and early cases of underground aviation gasoline storage in steel tanks have been reported.

  13. Geotechnical issues and guidelines for storage of compressed air in excavated hard rock caverns

    SciTech Connect

    Allen, R.D.; Doherty, T.J.; Fossum, A.F.

    1982-04-01

    The results of a literature survey on the stability of excavated hard rock caverns are presented. The objective of the study was to develop geotechnical criteria for the design of compressed air energy storage (CAES) caverns in hard rock formations. These criteria involve geologic, hydrological, geochemical, geothermal, and in situ stress state characteristics of generic rock masses. Their relevance to CAES caverns, and the identification of required research areas, are identified throughout the text. This literature survey and analysis strongly suggests that the chief geotechnical issues for the development and operation of CAES caverns in hard rock are impermeability for containment, stability for sound openings, and hydrostatic balance.

  14. [Condition of cavernous tissue of the penis after unilateral incomplete proximal intracavernous falloprosthesis].

    PubMed

    Taurashvili, G I; Medvedev, V L; Chilov, S A; Kochov, V N; Taruashvili, I G

    2011-01-01

    Unilateral incomplete proximal intracavernous falloprosthesis (UIPIF) was followed by US-dopplerography of the intact penis and penis in medical erection induced by E1 prostoglandin introduction into the intact cavernous body. UIPIF preserves 89-90% of functionally active cavernous tissue with effective blood flow. Investigation 2 months and more after operation demonstrated that systolic blood flow rate in the cavernous artery of the cavernous tissue around the endoprosthersis can reach values registered in normal erection. The conclusion is made that after UIPIF quality of sexual life of the patient improves due to creation of additional density and axial stability of the trunk of the penis.

  15. Role of Endoscopic Ultrasound for the Diagnosis of Isolated Gastric Cavernous Haemangioma

    PubMed Central

    Hu, Jinlong; Sao, Hua

    2016-01-01

    Isolated gastric cavernous haemangioma is extremely rare in the stomach. Historically, endoscopy, computed tomography and MRI had been used to diagnose gastric cavernous haemangioma. Biopsy, is not an option due to its vascular nature and submucosal location. We report an isolated gastric cavernous haemangioma that was diagnosed by end-oscopic ultrasound in a 25-year-old male and treated by laparotomy. The final diagnosis of cavernous haemagioma was confirmed by post-operative pathology. There was no recurrence during 3-month follow-up period. PMID:27790564

  16. Transcatheter Arterial Embolization of Two Symptomatic Giant Cavernous Hemangiomas of the Liver

    SciTech Connect

    Althaus, Sandra; Ashdown, Boyd; Coldwell, Douglas; Helton, W. Scott; Freeny, Patrick C.

    1996-09-15

    Cavernous hemangiomas are usually asymptomatic; however, a small percentage may cause symptoms. This case report discusses palliation by transcatheter arterial embolization with polyvinyl alcohol particles.

  17. Structural analysis of the West Hackbery No. 6 SPR storage cavern

    SciTech Connect

    Benzley, S.E.

    1980-08-01

    Four separate structural analyses of the West Hackberry No. 6 SPR storage cavern are presented. One analysis covers the creep response of the cavern beginning shortly before the time when an accidental fire occurred and proceeding through the cavern recertification pressure test. The second analysis models the surface uplife that is expected during the same pressure test. The third and fourth numerical studies investigate the structural response of West Hackberry No. 6 to slabbing and a rapid pressure drop. All analyses indicate that this cavern should be structurally stable for the conditions assumed.

  18. New information on disposal of oil field wastes in salt caverns

    SciTech Connect

    Veil, J.A.

    1996-10-01

    Solution-mined salt caverns have been used for many years for storing hydrocarbon products. This paper summarizes an Argonne National Laboratory report that reviews the legality, technical suitability, and feasibility of disposing of nonhazardous oil and gas exploration and production wastes in salt caverns. An analysis of regulations indicated that there are no outright regulatory prohibitions on cavern disposal of oil field wastes at either the federal level or in the 11 oil-producing states that were studied. There is no actual field experience on the long-term impacts that might arise following closure of waste disposal caverns. Although research has found that pressures will build-up in a closed cavern, none has specifically addressed caverns filled with oil field wastes. More field research on pressure build-up in closed caverns is needed. On the basis of preliminary investigations, we believe that disposal of oil field wastes in salt caverns is legal and feasible. The technical suitability of the practice depends on whether the caverns are well-sited and well-designed, carefully operated, properly closed, and routinely monitored.

  19. Can nonhazardous oil field wastes be disposed of in salt caverns?

    SciTech Connect

    Veil, J.A.

    1996-10-01

    Solution-mined salt caverns have been used for many years for storing hydrocarbon products. This paper summarizes an Argonne National Laboratory report that reviews the legality, technical suitability, and feasibility of disposing of nonhazardous oil and gas exploration and production wastes in salt caverns. An analysis of regulations indicated that there are no outright regulatory prohibitions on cavern disposal -of oil field wastes at either the federal level or in the 11 oil-producing states that were studied. There is no actual field experience on the long-term impacts that might arise following closure of waste disposal caverns. Although research has found that pressures will build up in a closed cavern, none has specifically addressed caverns filled with oil field wastes. More field research on pressure build up in closed caverns is needed. On the basis of preliminary investigations, we believe that disposal of oil field wastes in salt caverns is legal and feasible. The technical suitability of the practice depends on whether the caverns are well-sited and well-designed, carefully operated, properly closed, and routinely monitored.

  20. Update on cavern disposal of NORM-contaminated oil field wastes.

    SciTech Connect

    Veil, J. A.

    1998-09-22

    Some types of oil and gas production and processing wastes contain naturally occurring radioactive material (NORM). If NORM is present at concentrations above regulatory levels in oil field waste, the waste requires special disposal practices. The existing disposal options for wastes containing NORM are limited and costly. Argonne National Laboratory has previously evaluated the feasibility, legality, risk and economics of disposing of nonhazardous oil field wastes, other than NORM waste, in salt caverns. Cavern disposal of nonhazardous oil field waste, other than NORM waste, is occurring at four Texas facilities, in several Canadian facilities, and reportedly in Europe. This paper evaluates the legality, technical feasibility, economics, and human health risk of disposing of NORM-contaminated oil field wastes in salt caverns as well. Cavern disposal of NORM waste is technically feasible and poses a very low human health risk. From a legal perspective, a review of federal regulations and regulations from several states indicated that there are no outright prohibitions against NORM disposal in salt caverns or other Class II wells, except for Louisiana which prohibits disposal of radioactive wastes or other radioactive materials in salt domes. Currently, however, only Texas and New Mexico are working on disposal cavern regulations, and no states have issued permits to allow cavern disposal of NORM waste. On the basis of the costs currently charged for cavern disposal of nonhazardous oil field waste (NOW), NORM waste disposal in caverns is likely to be cost competitive with existing NORM waste disposal methods when regulatory agencies approve the practice.

  1. Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case.

    PubMed

    Martinez Santos, Jaime; Kaderali, Zul; Spears, Julian; Rubin, Laurence A; Marotta, Thomas R

    2016-07-01

    Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis.

  2. Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case.

    PubMed

    Santos, Jaime Martinez; Kaderali, Zul; Spears, Julian; Rubin, Laurence A; Marotta, Thomas R

    2015-05-29

    Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis.

  3. Operative surgical nuances of modified extradural temporopolar approach with mini-peeling of dura propria based on cadaveric anatomical study of lateral cavernous structures

    PubMed Central

    Otani, Naoki; Wada, Kojiro; Toyooka, Terushige; Fujii, Kazuya; Kobayashi, Yasushi; Mori, Kentaro

    2016-01-01

    Background: Extradural temporopolar approach (ETA) has been modified as less invasive manner and named as trans-superior orbital fissure (SOF) approach with mini-peeling technique. The present study discusses the operative nuances of this modified technique on the basis of cadaveric study of lateral cavernous structures. Methods: In five consecutive cadaveric specimens, we performed an extradural anterior clinoidectomy with mini-peeling of the dura propria to expose the anterior clinoid process entirely. We also investigated the histological characteristics of the lateral cavernous sinus (CS) between the dura propria and periosteal dura at the SOF, foramen rotundum (FR), and foramen ovale (FO) levels, and of each trigeminal nerve division. Results: Coronal histological examination of the lateral wall of the CS showed invagination of the dura propria and periosteal dura into the SOF. In contrast, no such invagination was observed at the levels of the FR and FO. This finding supports the technical rationale of the only skeletonization of the SOF for peeling of the dura propria but not FR. In addition, our modified ETA method needs only minimal dural incision between the SOF and FR where no cranial nerves are present. Conclusion: Our technical modification of ETA may be recommended for surgical treatment of paraclinoid lesions to reduce the risk of intraoperative neurovascular injury. PMID:27500005

  4. VIIIth nerve cavernous hemangioma mimicking a stage 1 acoustic schwannoma.

    PubMed

    Bonfort, G; Veillon, F; Debry, C; Kehrli, P; Chibbaro, S

    2015-10-01

    To report a case of VIIIth nerve cavernous hemangioma, a very rare differential diagnosis among the various pathologies presenting as small enhancing entities into the internal auditory canal. It is one of the most challenging when imaging is not able to differentiate it from an intrameatal vestibular schwannoma. We report a cavernous hemangioma extruding from the internal auditory canal, diagnosed after a left translabyrinthine resection in a 45-year-old man complaining of profound sensorineural hearing loss, with no facial paresis or dizziness. The preoperative differential diagnosis of a vestibular schwannoma was impossible, due to the absence of calcifications that usually characterize temporal bone hemangiomas. Clinical presentation, radiological features and treatment considerations are discussed along with up-to-date review of pertinent literature. When considering an apparent small intra-auditory canal schwannoma, otoneurologists should be aware of the rare possibility of a cavernous hemangioma. Early diagnosis and surgical treatment may improve the functional outcome, possibly preserving neural integrity. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Avoca, New York Salt Cavern Gas Storage Facility

    SciTech Connect

    Morrill, D.C.

    1995-09-01

    The first salt cavern natural gas storage facility in the northeastern United States designed to serve the interstate gas market is being developed by J Makowski Associates and partners at Avoca in Steuben County, New York. Multiple caverns will be leached at a depth of about 3800 ft from an approximately 100 ft interval of salt within the F unit of the Syracuse Formation of the Upper Silurian Salina Group. The facility is designed to provide 5 Bcf of working gas capacity and 500 MMcfd of deliverability within an operating cavern pressure range between 760 psi and 2850 psi. Fresh water for leaching will be obtained from the Cohocton River aquifer at a maximum rate of 3 million gallons per day and produced brine will be injected into deep permeable Cambrian age sandstones and dolostones. Gas storage service is anticipated to commence in the Fall of 1997 with 2 Bcf of working gas capacity and the full 5 Bcf or storage service is scheduled to be available in the Fall of 1999.

  6. Bryan Mound SPR cavern 113 remedial leach stage 1 analysis.

    SciTech Connect

    Rudeen, David Keith; Weber, Paula D.; Lord, David L.

    2013-08-01

    The U.S. Strategic Petroleum Reserve implemented the first stage of a leach plan in 2011-2012 to expand storage volume in the existing Bryan Mound 113 cavern from a starting volume of 7.4 million barrels (MMB) to its design volume of 11.2 MMB. The first stage was terminated several months earlier than expected in August, 2012, as the upper section of the leach zone expanded outward more quickly than design. The oil-brine interface was then re-positioned with the intent to resume leaching in the second stage configuration. This report evaluates the as-built configuration of the cavern at the end of the first stage, and recommends changes to the second stage plan in order to accommodate for the variance between the first stage plan and the as-built cavern. SANSMIC leach code simulations are presented and compared with sonar surveys in order to aid in the analysis and offer projections of likely outcomes from the revised plan for the second stage leach.

  7. Intraosseous Cavernous Hemangioma in the Mandible: A Case Report.

    PubMed

    Elif, Bilgir; Derya, Yildirim; Gulperi, Kocer; Sevgi, Bozova

    2017-01-01

    Intraosseous vascular lesions are rare conditions. They are most commonly seen in the vertebral column and skull; nevertheless, the mandible is a quite rare location. In this report, we present a case of intraosseous cavernous hemangioma in the mandible and discuss the clinical and radiological features. A 28-year-old male patient attended to our clinic with a complaint of painless swelling of mandible. Clinical evaluation revealed a bone-hard, smooth-surfaced, immobile mass in the left mandibular lingual area. The patient was evaluated with panoramic and occlusal radiography and computed tomography. The lesion surgically excised and pathological examination revealed an intraosseous cavernous hemangioma. Follow-up imaging 1 year later with cone beam computed tomography revealed recurrence of the lesion. The conclusion of this paper; when a bone hard, well-shaped mass was seen in the mandible, the possibility of intraosseous hemangioma must be remembered and before surgical procedure detailed radiographic evaluation should be performed. Key words:Hemangioma, intraosseous, mandible, cavernous, cbct.

  8. Intraosseous Cavernous Hemangioma in the Mandible: A Case Report

    PubMed Central

    Derya, Yildirim; Gulperi, Kocer; Sevgi, Bozova

    2017-01-01

    Intraosseous vascular lesions are rare conditions. They are most commonly seen in the vertebral column and skull; nevertheless, the mandible is a quite rare location. In this report, we present a case of intraosseous cavernous hemangioma in the mandible and discuss the clinical and radiological features. A 28-year-old male patient attended to our clinic with a complaint of painless swelling of mandible. Clinical evaluation revealed a bone-hard, smooth-surfaced, immobile mass in the left mandibular lingual area. The patient was evaluated with panoramic and occlusal radiography and computed tomography. The lesion surgically excised and pathological examination revealed an intraosseous cavernous hemangioma. Follow-up imaging 1 year later with cone beam computed tomography revealed recurrence of the lesion. The conclusion of this paper; when a bone hard, well-shaped mass was seen in the mandible, the possibility of intraosseous hemangioma must be remembered and before surgical procedure detailed radiographic evaluation should be performed. Key words:Hemangioma, intraosseous, mandible, cavernous, cbct. PMID:28149481

  9. Critical analysis of anatomical landmarks within the sphenoid sinus for transsphenoidal surgery.

    PubMed

    Ahmadipour, Yahya; Lemonas, Elias; Maslehaty, Homajoun; Goericke, Sophia; Stuck, Boris A; El Hindy, Nicolai; Sure, Ulrich; Mueller, Oliver

    2016-11-01

    The transsphenoidal approach to the sellar region has been introduced more than a 100 years ago. It is the accepted standard operative corridor to pathologies of the pituitary gland and surrounding structures. There are anatomical landmarks within the sphenoid sinus that are used for orientation directing to the sella floor or the cavernous sinus. Yet, little data can be found on the consistency of these landmarks. It is the aim of this study to evaluate the reliability of these anatomical landmarks for the surgeon's orientation. A total of 245 computed tomography (CT) volume data sets of the cranium performed according to a standardized protocol were analyzed for study purposes. CT scans of the cranium of 125 patients admitted to the emergency room of our hospital receiving a trauma spiral according to the local protocol were employed as a control group when no pathology in the sellar region was observed. In addition, preoperative CT scans of a group of 120 patients diagnosed with pituitary adenomas between 2009 and 2013 were analyzed. Image analysis of the anatomical landmarks included the minimal intercarotid distance (ICD), diameter of the sphenoid sinus (DSS), direction of the septum sinuum sphenoidalium (SSS), and the distance between vomer and clivus (VCD). The overall mean ICD was 16.2 mm, with patients suffering from adenomas showing a mean ICD of 15.8 mm compared with an average 16.5 mm in the control group. DSS was equal for both groups (adenoma group: mean 31.5 mm; controls: mean 31.3 mm). Mean VCD was 27.9 mm in patients with pituitary adenomas compared with 26.7 mm in controls. A septum of the sphenoid sinus located in the midline was found in overall 23 % only. SSS was directed into the bony shield of the internal carotid artery in 28 % of underlying tumors and in 37 % of the control group. This is the first detailed description of landmarks of the sphenoid sinus based on a large radiologic-anatomical analysis of CT scans yielding a wide

  10. [Measures for prevention of maxillary sinus mucosa perforation by sinus-lifting procedure].

    PubMed

    Arkhipov, A V

    2012-01-01

    The paper describes the sinus-lifting technique useful in patients with alveolar bone deficiency. The technique allows significantly lowering the risk of maxillary sinus mucosa perforation and improves bone tissue regeneration.

  11. Late recovery from foreign body sinusitis after maxillary sinus floor augmentation

    PubMed Central

    Felisati, Giovanni; Saibene, Alberto Maria; Lenzi, Riccardo; Pipolo, Carlotta

    2012-01-01

    A 55-year-old male patient was referred to our clinic with signs and symptoms of recurring sinusitis after a right maxillary sinus floor augmentation for implantological purposes. Investigations showed an antibiotic-resistant ethmoidomaxillary sinusitis resulting from bone graft infection and displacement of previously inserted xenograft material into the maxillary sinus. The patient thus underwent a surgical procedure combining nasal endoscopy and oral surgery in order to remove the infected graft and restore sinusal drainage. The procedure was apparently successful but sinusitis relapsed after surgery and persisted despite 2 weeks of antibiotic therapy and local medications. A CT scan showed persistence of grafting fragments in the maxillary sinus. A new surgical procedure was scheduled while a more accurate endoscopic local medication was performed. Six hours after the treatment, the patient spontaneously expelled the fragments and promptly recovered. The patient successfully underwent another maxillary sinus floor augmentation procedure 6 months later. PMID:23234824

  12. Comprehensive review on endonasal endoscopic sinus surgery

    PubMed Central

    Weber, Rainer K.; Hosemann, Werner

    2015-01-01

    Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

  13. The bovine paranasal sinuses: Bacterial flora, epithelial expression of nitric oxide and potential role in the in-herd persistence of respiratory disease pathogens.

    PubMed

    Murray, Gerard M; O'Neill, Rónan G; Lee, Alison M; McElroy, Máire C; More, Simon J; Monagle, Aisling; Earley, Bernadette; Cassidy, Joseph P

    2017-01-01

    The bovine paranasal sinuses are a group of complex cavernous air-filled spaces, lined by respiratory epithelium, the exact function of which is unclear. While lesions affecting these sinuses are occasionally reported in cattle, their microbial flora has not been defined. Furthermore, given that the various bacterial and viral pathogens causing bovine respiratory disease (BRD) persist within herds, we speculated that the paranasal sinuses may serve as a refuge for such infectious agents. The paranasal sinuses of clinically normal cattle (n = 99) and of cattle submitted for post-mortem examination (PME: n = 34) were examined by microbial culture, PCR and serology to include bacterial and viral pathogens typically associated with BRD: Mycoplasma bovis, Histophilus somni, Mannheimia haemolytica and Pasteurella multocida, bovine respiratory syncytial virus (BRSV) and bovine parainfluenza-3 virus (BPIV-3). Overall, the paranasal sinuses were either predominantly sterile or did not contain detectable microbes (83.5%: 94.9% of clinically normal and 50.0% of cattle submitted for PME). Bacteria, including BRD causing pathogens, were identified in relatively small numbers of cattle (<10%). While serology indicated widespread exposure of both clinically normal and cattle submitted for PME to BPIV-3 and BRSV (seroprevalences of 91.6% and 84.7%, respectively), PCR identified BPIV-3 in only one animal. To further explore these findings we investigated the potential role of the antimicrobial molecule nitric oxide (NO) within paranasal sinus epithelium using immunohistochemistry. Expression of the enzyme responsible for NO synthesis, inducible nitric oxide synthase (iNOS), was detected to varying degrees in 76.5% of a sub-sample of animals suggesting production of this compound plays a similar protective role in the bovine sinus as it does in humans.

  14. The bovine paranasal sinuses: Bacterial flora, epithelial expression of nitric oxide and potential role in the in-herd persistence of respiratory disease pathogens

    PubMed Central

    O’Neill, Rónan G.; Lee, Alison M.; McElroy, Máire C.; More, Simon J.; Monagle, Aisling; Earley, Bernadette; Cassidy, Joseph P.

    2017-01-01

    The bovine paranasal sinuses are a group of complex cavernous air-filled spaces, lined by respiratory epithelium, the exact function of which is unclear. While lesions affecting these sinuses are occasionally reported in cattle, their microbial flora has not been defined. Furthermore, given that the various bacterial and viral pathogens causing bovine respiratory disease (BRD) persist within herds, we speculated that the paranasal sinuses may serve as a refuge for such infectious agents. The paranasal sinuses of clinically normal cattle (n = 99) and of cattle submitted for post-mortem examination (PME: n = 34) were examined by microbial culture, PCR and serology to include bacterial and viral pathogens typically associated with BRD: Mycoplasma bovis, Histophilus somni, Mannheimia haemolytica and Pasteurella multocida, bovine respiratory syncytial virus (BRSV) and bovine parainfluenza-3 virus (BPIV-3). Overall, the paranasal sinuses were either predominantly sterile or did not contain detectable microbes (83.5%: 94.9% of clinically normal and 50.0% of cattle submitted for PME). Bacteria, including BRD causing pathogens, were identified in relatively small numbers of cattle (<10%). While serology indicated widespread exposure of both clinically normal and cattle submitted for PME to BPIV-3 and BRSV (seroprevalences of 91.6% and 84.7%, respectively), PCR identified BPIV-3 in only one animal. To further explore these findings we investigated the potential role of the antimicrobial molecule nitric oxide (NO) within paranasal sinus epithelium using immunohistochemistry. Expression of the enzyme responsible for NO synthesis, inducible nitric oxide synthase (iNOS), was detected to varying degrees in 76.5% of a sub-sample of animals suggesting production of this compound plays a similar protective role in the bovine sinus as it does in humans. PMID:28282443

  15. Investigation of Lunar Spinels at Sinus Aestuum

    NASA Astrophysics Data System (ADS)

    Weitz, C. M.; Staid, M. I.; Gaddis, L. R.; Besse, S.; Sunshine, J. M.

    2017-05-01

    We have analyzed Moon Mineralogy Mapper (M3) data of spinels at Sinus Aestuum. Our results indicate that Fe- or Cr-spinels with 0.7 μm absorptions are mixed into most of the DMD across the Sinus Aestuum highlands. Cr-spinels with 0.7 μm absorptions are mixed into most of the dark mantle deposit (DMD) across the Sinus Aestuum highlands.

  16. Sphenoid sinus barotrauma after scuba diving.

    PubMed

    Jeong, Jin Hyeok; Kim, Kuk; Cho, Seok Hyun; Kim, Kyung Rae

    2012-01-01

    We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after scuba diving. The patient attended our emergency department because of intractable headache but did not improve with conservative treatment. After computed tomography and magnetic resonance imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum. He therefore underwent surgery for sinus ventilation and abscess drainage.

  17. Geomechanical Analysis and Design Considerations for Thin-Bedded Salt Caverns

    SciTech Connect

    Michael S. Bruno

    2005-06-15

    The bedded salt formations located throughout the United States are layered and interspersed with non-salt materials such as anhydrite, shale, dolomite and limestone. The salt layers often contain significant impurities. GRI and DOE have initialized this research proposal in order to increase the gas storage capabilities by providing operators with improved geotechnical design and operating guidelines for thin bedded salt caverns. Terralog has summarized the geologic conditions, pressure conditions, and critical design factors that may lead to: (1) Fracture in heterogeneous materials; (2) Differential deformation and bedding plane slip; (3) Propagation of damage around single and multiple cavern; and (4) Improved design recommendations for single and multiple cavern configurations in various bedded salt environments. The existing caverns within both the Permian Basin Complex and the Michigan and Appalachian Basins are normally found between 300 m to 1,000 m (1,000 ft to 3,300 ft) depth depending on local geology and salt dissolution depth. Currently, active cavern operations are found in the Midland and Anadarko Basins within the Permian Basin Complex and in the Appalachian and Michigan Basins. The Palo Duro and Delaware Basins within the Permian Basin Complex also offer salt cavern development potential. Terralog developed a number of numerical models for caverns located in thin bedded salt. A modified creep viscoplastic model has been developed and implemented in Flac3D to simulate the response of salt at the Permian, Michigan and Appalachian Basins. The formulation of the viscoplastic salt model, which is based on an empirical creep law developed for Waste Isolation Pilot Plant (WIPP) Program, is combined with the Drucker-Prager model to include the formation of damage and failure. The Permian salt lab test data provided by Pfeifle et al. 1983, are used to validate the assumptions made in the material model development. For the actual cavern simulations two

  18. Risk assessment of nonhazardous oil-field waste disposal in salt caverns.

    SciTech Connect

    Elcock, D.

    1998-03-05

    In 1996, Argonne National Laboratory (ANL) conducted a preliminary technical and legal evaluation of disposing of nonhazardous oil-field wastes (NOW) into salt caverns. Argonne determined that if caverns are sited and designed well, operated carefully, closed properly, and monitored routinely, they could be suitable for disposing of oil-field wastes. On the basis of these findings, Argonne subsequently conducted a preliminary evaluation of the possibility that adverse human health effects (carcinogenic and noncarcinogenic) could result from exposure to contaminants released from the NOW disposed of in domal salt caverns. Steps used in this evaluation included the following: identifying potential contaminants of concern, determining how humans could be exposed to these contaminants, assessing contaminant toxicities, estimating contaminant intakes, and calculating human cancer and noncancer risk estimates. Five postclosure cavern release scenarios were assessed. These were inadvertent cavern intrusion, failure of the cavern seal, failure of the cavern through cracks, failure of the cavern through leaky interbeds, and a partial collapse of the cavern roof. Assuming a single, generic, salt cavern and generic oil-field wastes, potential human health effects associated with constituent hazardous substances (arsenic, benzene, cadmium, and chromium) were assessed under each of these scenarios. Preliminary results provided excess cancer risk and hazard index (referring to noncancer health effects) estimates that were well within the US Environmental Protection Agency (EPA) target range for acceptable exposure risk levels. These results led to the preliminary conclusion that from a human health perspective, salt caverns can provide an acceptable disposal method for nonhazardous oil-field wastes.

  19. Systemic corticosteroids for acute sinusitis.

    PubMed

    Venekamp, Roderick P; Thompson, Matthew J; Hayward, Gail; Heneghan, Carl J; Del Mar, Chris B; Perera, Rafael; Glasziou, Paul P; Rovers, Maroeska M

    2014-03-25

    Acute sinusitis is the inflammation and swelling of the nasal and paranasal mucous membranes and is a common reason for patients to seek primary care consultations. The related impairment of daily functioning and quality of life is attributable to symptoms such as facial pain and nasal congestion. To assess the effects of systemic corticosteroids on clinical response rates and to determine adverse effects and relapse rates of systemic corticosteroids compared to placebo or standard clinical care in children and adults with acute sinusitis. We searched CENTRAL (2014, Issue 1), MEDLINE (1966 to February week 1, 2014) and EMBASE (January 2009 to February 2014). Randomised controlled trials (RCTs) comparing systemic corticosteroids to placebo or standard clinical care for patients with acute sinusitis. Two review authors independently assessed the methodological quality of the trials and extracted data. Five RCTs with a total of 1193 adult participants met our inclusion criteria. We judged methodological quality to be moderate in four trials and high in one trial. Acute sinusitis was defined clinically in all trials. However, the three trials performed in ear, nose and throat (ENT) outpatient clinics also used radiological assessment as part of their inclusion criteria. All participants were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control treatment (placebo in four trials and non-steroidal anti-inflammatory drugs (NSAIDs) in one trial). In four trials antibiotics were prescribed in addition to oral corticosteroids or control treatment, while one trial investigated the effects of oral corticosteroids as a monotherapy.When combining data from the five trials, participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than those receiving the control treatment: at days three to seven (risk ratio (RR) 1.3, 95% confidence interval (CI) 1.1 to 1

  20. Catheter ablation of inappropriate sinus tachycardia.

    PubMed

    Gianni, Carola; Di Biase, Luigi; Mohanty, Sanghamitra; Gökoğlan, Yalçın; Güneş, Mahmut F; Horton, Rodney; Hranitzky, Patrick M; Burkhardt, J David; Natale, Andrea

    2016-06-01

    Catheter ablation for inappropriate sinus tachycardia (IST) is recommended for patients symptomatic for palpitations and refractory to other treatments. The current approach consists in sinus node modification (SNM), achieved by ablation of the cranial part of the sinus node to eliminate faster sinus rates while trying to preserve chronotropic competence. This approach has a limited efficacy, with a very modest long-term clinical success. To overcome this, proper patient selection is crucial and an epicardial approach should always be considered. This brief review will discuss the current role and limitations of catheter ablation in the management of patients with IST.

  1. Odontogenic maxillary sinusitis obscured by midfacial trauma.

    PubMed

    Simuntis, Regimantas; Kubilius, Ričardas; Ryškienė, Silvija; Vaitkus, Saulius

    2015-01-01

    We present a case of odontogenic maxillary sinusitis whose sinonasal symptomatology was thought to be the consequence of a previous midfacial trauma. The patient was admitted to the Clinic of Oral and Maxillofacial Surgery after more than 10 years of exacerbations of sinonasal symptoms, which began to plague soon after a facial contusion. We decided to perform CT of paranasal sinuses, and despite the absence dental symptomatology, the dental origin of sinusitis was discovered. The majority of sinonasal symptoms resolved after appropriate dental treatment, and there was no need for nasal or sinus surgery.

  2. Bone suture and lateral sinus lift surgery.

    PubMed

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2015-01-01

    Bone suture in lateral sinus lift has four indications. Three of them depend on creating a hole in the lateral maxillary sinus wall above the antrostomy window for securing the elevated medial maxillary sinus membrane to manage perforated Schneiderian membrane. Covering the buccal antrostomy window with the buccal fat pad (BFP) for better nourishment of the inserted graft and as an alternative for bone tags in fixation of collagen membrane has been reported previously. A new indication for firmly anchoring the BFP to the medial maxillary sinus wall as the last resort for the management of perforated Schneiderian membrane is explained in this article.

  3. [Cytokine pattern in various forms of sinusitis].

    PubMed

    Rudack, C; Hauser, U; Wagenmann, M; Bachert, C; Ganzer, U

    1998-01-01

    Inflammatory sinus diseases include acute sinusitis, chronic purulent sinusitis, and chronic polypoid rhinosinusitis. We investigated the cytokine profile of different types of rhinosinusitis in order to evaluate whether a distinct form of rhinosinusitis is associated with the expression of a specific cytokine profile. Fresh sinus mucosa obtained during routine surgery from patients with acute sinusitis (n = 10), chronic sinusitis (n = 7), antrochoanal polyp (n = 10), nasal polyps (n = 8), and controls of turbinate mucosa (n = 7) were homogenized. The cytokine protein content (IL-1 beta,IL-3,IL-5,IL-6,IL-8,GM-CSF) of tissue homogenates was measured using ELISA technique. In the group of proinflammatory cytokines, the protein levels measured for interleukin IL-8, a proinflammatory cytokine, IL-1 beta, and IL-6 were elevated in acute sinusitis. In the group of eosinophil-activating cytokines interleukin-3, -5 and granulocyte an makrophage-colony stimulating factor, we measured a significantly elevated protein level of IL-5 in nasal polyp tissue in contrast to significantly elevated IL-3 protein level in chronic sinusitis. These findings suggest that IL-8 plays a pivotal role in neutrophil-dominated and IL-5 in eosinophil-dominated sinusitis. IL-3 seems to sustain chronic inflammation.

  4. Sinusitis: A Rare Cause for Galactorrhoea

    PubMed Central

    Bennett, W. O.; Kennedy, J. R.; Reddy, V. M.; Dyer, R.; Hickey, S. A.

    2012-01-01

    A 32-year-old woman presented to the endocrinology clinic with recent onset galactorrhoea. Investigations revealed raised prolactin levels. An MRI scan demonstrated a normal pituitary gland, and an incidental finding of sphenoid sinusitis with expansion of the sphenoid sinus was thought to be due to a mucocele. It is postulated that either the direct local pressure by the mucocele or localised inflammation secondary to sinusitis might cause hyperprolactinaemia. The patient underwent endoscopic surgery to drain the mucocele, after which her galactorrhoea resolved. A review of the literature reveals only one previously documented case of sinusitis causing hyperprolactinaemia and galactorrhoea. PMID:23198229

  5. Sinusitis: a rare cause for galactorrhoea.

    PubMed

    Bennett, W O; Kennedy, J R; Reddy, V M; Dyer, R; Hickey, S A

    2012-01-01

    A 32-year-old woman presented to the endocrinology clinic with recent onset galactorrhoea. Investigations revealed raised prolactin levels. An MRI scan demonstrated a normal pituitary gland, and an incidental finding of sphenoid sinusitis with expansion of the sphenoid sinus was thought to be due to a mucocele. It is postulated that either the direct local pressure by the mucocele or localised inflammation secondary to sinusitis might cause hyperprolactinaemia. The patient underwent endoscopic surgery to drain the mucocele, after which her galactorrhoea resolved. A review of the literature reveals only one previously documented case of sinusitis causing hyperprolactinaemia and galactorrhoea.

  6. Treatment of chronic sinusitis in a horse with systemic and intra-sinus antimicrobials.

    PubMed

    Gordon, Danielle L; Radtke, Catherine L

    2017-03-01

    A 12-year-old Norwegian Fjord gelding was diagnosed with paranasal sinusitis as a post-operative complication of tooth repulsion surgery. The infection with inspissated purulent material persisted despite sinus trephination and lavage, and systemic antimicrobial therapy. Resolution occurred following infusion of a gelatin/penicillin mixture into the right rostral and caudal maxillary sinus.

  7. Analysis of cavern and well stability at the West Hackberry SPR site using a full-dome model.

    SciTech Connect

    Sobolik, Steven R.

    2015-08-01

    This report presents computational analyses that simulate the structural response of caverns at the Strategic Petroleum Reserve (SPR) West Hackberry site. The cavern field comprises 22 caverns. Five caverns (6, 7, 8, 9, 11) were acquired from industry and have unusual shapes and a history dating back to 1946. The other 17 caverns (101-117) were leached according to SPR standards in the mid-1980s and have tall cylindrical shapes. The history of the caverns and their shapes are simulated in a three-dimensional geomechanics model of the site that predicts deformations, strains, and stresses. Future leaching scenarios corresponding to oil drawdowns using fresh water are also simulated by increasing the volume of the caverns. Cavern pressures are varied in the model to capture operational practices in the field. The results of the finite element model are interpreted to provide information on the current and future status of subsidence, well integrity, and cavern stability. The most significant results in this report are relevant to Cavern 6. The cavern is shaped like a bowl with a large ceiling span and is in close proximity to Cavern 9. The analyses predict tensile stresses at the edge of the ceiling during repressurization of Cavern 6 following workover conditions. During a workover the cavern is at low pressure to service a well. The wellhead pressures are atmospheric. When the workover is complete, the cavern is repressurized. The resulting elastic stresses are sufficient to cause tension around the edge of the large ceiling span. With time, these stresses relax to a compressive state because of salt creep. However, the potential for salt fracture and propagation exists, particularly towards Cavern 9. With only 200 feet of salt between the caverns, the operational consequences must be examined if the two caverns become connected. A critical time may be during a workover of Cavern 9 in part because of the operational vulnerabilities, but also because dilatant damage

  8. Treating Sinusitis: Don't Rush to Antibiotics

    MedlinePlus

    ... AAAAI) Treating Sinusitis (AAAAI) Don’t rush to antibiotics DOWNLOAD PDF The sinuses are small, hollow spaces ... or teeth. Each year, millions of people use antibiotic drugs to treat sinus problems. However, they usually ...

  9. Features of West Hackberry SPR Caverns and Internal Structure Of the Salt Dome

    SciTech Connect

    Munson, Darrell Eugene

    2006-09-01

    The intent of this report is to examine the internal structure of the West Hackberry salt dome utilizing the information from the geometric configuration of the internal cavern surfaces obtained from graphical representations of sonar survey data. In a general sense, the caverns of West Hackberry are remarkable in the symmetry of their shapes. There are only rather moderate deviations from what would be considered an ideal cylindrical solution mining geometry in these caverns. This finding is in marked contrast to the directional solutioning found in the elliptical cross sectioned, sometimes winged, caverns of Big Hill. None of the persistent lineaments prevalent in Big Hill caverns are evident in West Hackberry caverns. Irregularities of the West Hackberry caverns are restricted to preferential solution formed pits and protuberances with moderate dimensions. In fact, the principal characteristic of West Hackberry caverns is the often large sections of smooth and cylindrical cavern wall. Differences in the cavern characteristics between West Hackberry and Big Hill suggest that the former dome is quite homogeneous, while the latter still retains strong remnants of the interbeds of the original bedded Louann salt. One possible explanation is that the source of the two domes, while both from the Louann mother salt, differs. While the source of the Big Hill dome is directly from the mother salt bed, it appears that the West Hackberry arises from a laterally extruded sill of the mother salt. Consequently, the amount of deformation, and hence, mixing of the salt and interbed material in the extruded sill is significantly greater than would be the case for the directly formed diapir. In West Hackberry, remnants of interbeds apparently no longer exist. An important aspect of the construction of the West Hackberry caverns is the evidence of an attempt to use a uniform solutioning construction practice. This uniformity involved the utilization of single well solutioning and

  10. Costs for Off-Site Disposal of Nonhazardous Oil Field Wastes: Salt Caverns Versus other Disposal Methods.

    DTIC Science & Technology

    1997-04-01

    May. IOGCC, 1995, Natural Gas Storage in Salt Caverns - A Guide for State Regulators, Interstate Oil and Gas Compact Commission, Oklahoma City...Idealized Cavern in a Salt Dome Formation -- Incoming wastem I Displaced brine Fia aigSurface casing Top of salt formation Overlying formations...Major U.S. Rock Salt Deposits ................................... 15 2 Idealized Cavern in a Salt Dome Formation

  11. Large cavernous hemangioma in the cecum treated by laparoscopic ileocecal resection

    PubMed Central

    Huh, Jung Wook; Cho, Sang Hyuk; Lee, Jae Hyuk; Kim, Hyeong Rok

    2009-01-01

    A cavernous hemangioma of the cecum is a rare vascular malformation but is clinically important because of the possibility of massive bleeding. We report a case of a large cavernous hemangioma with pericolic infiltration in the cecum which was removed successfully using minimally invasive surgery. PMID:19598312

  12. Sinus augmentation by orthodontic movement as an alternative to a surgical sinus lift: a clinical report.

    PubMed

    Savi de Carvalho, Renato; Consolaro, Alberto; Francischone, Carlos Eduardo; de Macedo Carvalho, Ana Paula Rabello

    2014-10-01

    Maxillary sinus pneumatization may significantly reduce the alveolar bone height. As a result, the sinus membrane may need to be apically repositioned, with or without grafts, before or at the time of implant placement. The sinus lift, however, is a relatively invasive surgical procedure that can lead to complications and sometimes unsuccessful results. This clinical report presents an orthodontic movement to enlarge the amount of bone at the sinus region for implant placement. The approach avoided surgery in a patient who used tobacco and exhibited recurrent sinusitis. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  13. Increased number of white matter lesions in patients with familial cerebral cavernous malformations.

    PubMed

    Golden, M J; Morrison, L A; Kim, H; Hart, B L

    2015-05-01

    Familial cerebral cavernous malformations, an autosomal dominant disorder, result in excess morbidity and mortality in affected patients. The disorder is most prevalent in the Southwest United States, where the affected families are most often carriers of the CCM1-KRIT1 Common Hispanic Mutation. The brain and spinal cord parenchyma in these individuals is usually affected by multiple cavernous malformations. Previous studies have shown abnormalities of endothelial cell junctions and the blood-brain barrier in cerebral cavernous malformations. Endothelial cell abnormalities have also been described in pathologic studies of white matter hyperintensities. We compared the prevalence of white matter hyperintensities in a population with known familial cerebral cavernous malformations. We examined 191 subjects with familial cerebral cavernous malformations who were enrolled into an institutional review board-approved study. All carry the same Common Hispanic Mutation in the CCM1 gene. Each subject underwent 3T MR imaging, including gradient recalled-echo, SWI, and FLAIR sequences. The number of cavernous malformations and the number of nonhemorrhagic white matter hyperintensities were counted. Subjects older than 60 years of age were excluded due to the high prevalence of white matter lesions in this population, and children younger than 6 were excluded due to potential sedation requirements. Logistic regression analysis was performed to determine the prevalence of abnormal white matter hyperintensities in those with familial cerebral cavernous malformations compared with healthy controls or those with sporadic cerebral cavernous malformation within the familial cerebral cavernous malformations group; it was also performed to evaluate the associations between abnormal white matter hyperintensities and age, sex, headaches, thyroid disease, diabetes, hypertension, hyperlipidemia, seizure history, or modified Rankin Scale score. Familial CCM1 carriers have a higher

  14. Flow Diverters as Useful Adjunct to Traditional Endovascular Techniques in Treatment of Direct Carotid-Cavernous Fistulas.

    PubMed

    Ogilvy, Christopher S; Motiei-Langroudi, Rouzbeh; Ghorbani, Mohammad; Griessenauer, Christoph J; Alturki, Abdulrahman Y; Thomas, Ajith J

    2017-09-01

    Direct carotid-cavernous sinus fistulas (CCFs) are high-flow arteriovenous shunts that are typically the result of a severe head injury. The endovascular treatment of these lesions includes the use of detachable balloons, coils, liquid embolic agents, and covered stents. To minimize the chance of treatment failure and subsequent complications, endoluminal reconstruction using a flow-diverting stent may be added to the treatment construct. We present 3 cases and review the existing literature. Three patients with direct traumatic CCFs were treated with either coils, coils and Onyx, or a detachable balloon, followed by placement of a flow-diverting stent for endoluminal reconstruction. All 3 cases had complete angiographic occlusion of the CCFs and recovered clinically. No complications were observed. We believe that endovascular coil or balloon occlusion of the fistula from either a transvenous or transarterial approach followed by flow diversion may be an appropriate treatment for direct CCFs. This addition of a flow diverter may facilitate endothelialization of the injury to the internal carotid artery. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Risk assessment of nonhazardous oil-field waste disposal in salt caverns.

    SciTech Connect

    Elcock, D.

    1998-03-10

    Salt caverns can be formed in underground salt formations incidentally as a result of mining or intentionally to create underground chambers for product storage or waste disposal. For more than 50 years, salt caverns have been used to store hydrocarbon products. Recently, concerns over the costs and environmental effects of land disposal and incineration have sparked interest in using salt caverns for waste disposal. Countries using or considering using salt caverns for waste disposal include Canada (oil-production wastes), Mexico (purged sulfates from salt evaporators), Germany (contaminated soils and ashes), the United Kingdom (organic residues), and the Netherlands (brine purification wastes). In the US, industry and the regulatory community are pursuing the use of salt caverns for disposal of oil-field wastes. In 1988, the US Environmental Protection Agency (EPA) issued a regulatory determination exempting wastes generated during oil and gas exploration and production (oil-field wastes) from federal hazardous waste regulations--even though such wastes may contain hazardous constituents. At the same time, EPA urged states to tighten their oil-field waste management regulations. The resulting restrictions have generated industry interest in the use of salt caverns for potentially economical and environmentally safe oil-field waste disposal. Before the practice can be implemented commercially, however, regulators need assurance that disposing of oil-field wastes in salt caverns is technically and legally feasible and that potential health effects associated with the practice are acceptable. In 1996, Argonne National Laboratory (ANL) conducted a preliminary technical and legal evaluation of disposing of nonhazardous oil-field wastes (NOW) into salt caverns. It investigated regulatory issues; the types of oil-field wastes suitable for cavern disposal; cavern design and location considerations; and disposal operations, closure and remediation issues. It determined

  16. Radar logging of storage cavern walls at the Strategic Petroleum Reserve: A feasibility estimate

    SciTech Connect

    Castle, J.G.

    1989-07-01

    The feasibility of using a radar logging tool to map the salt walls in the caverns storing crude oil at the Strategic Petroleum Reserve (SPR) is examined. The tool design has dimensions small enough to permit entry into every SPR cavern at Big Hill, Bayou Choctaw, West Hackberry, and Bryan Mound, is able to resolve wall features as small as five feet, and can measure the range to the cavern wall with an uncertainty less than one foot. Usable radar echoes are predicted if the walls are very rough in 37 of the 45 storage caverns during operation at 1 GHz. Dependence on frequency and wall roughness is presented. Very strong echoes are to be expected in most caverns at 1 GHz. 11 refs., 5 figs., 5 tabs.

  17. The petrosquamosal sinus in humans

    PubMed Central

    San Millán Ruíz, Diego; Gailloud, Philippe; Yilmaz, Hasan; Perren, Fabienne; Rathgeb, Jean-Paul; Rüfenacht, Daniel A; Fasel, Jean H D

    2006-01-01

    This article provides a comprehensive description of the morphology of the human petrosquamosal sinus (PSS) derived from original observations made on 13 corrosion casts of the cranial venous system combined with routine clinical imaging studies in two patients. The PSS is not a rare finding in the adult human. In particular, continuous developments in imaging techniques have made radiologists become increasingly aware of this anatomical entity in recent years. The role of the PSS as a major encephalic drainage pathway and its potential implication in pathological conditions such as intracranial venous hypertension are discussed. PMID:17118059

  18. Allergic fungal sinusitis in children.

    PubMed

    Thorp, Brian D; McKinney, Kibwei A; Rose, Austin S; Ebert, Charles S

    2012-06-01

    Allergic fungal sinusitis (AFS) is a subtype of eosinophilic chronic rhinosinusitis (CRS) characterized by type I hypersensitivity, nasal polyposis, characteristic computed tomography scan findings, eosinophilic mucus, and the presence of fungus on surgical specimens without evidence of tissue invasion. This refractory subtype of CRS is of the great interest in the pediatric population, given the relatively early age of onset and the difficulty in managing AFS through commercially available medical regimens. Almost universally, a diagnosis of AFS requires operative intervention. Postoperative adjuvant medical therapy is a mainstay in the treatment paradigm of pediatric AFS.

  19. [Dural sinus thrombosis: case report].

    PubMed

    Falavigna, Asdrubal; Pontalti, João Luis; Teles, Alisson Roberto

    2006-06-01

    We report the case of a 24 year-old pregnant woman, seen at the neurology service by presenting agitation, hallucinations, mental confusion, headache, vision loss, aphasia and seizures. The neuroradiologic exam was compatible with thrombosis in dural sinus and cortical veins. Treatment with abciximab was accomplished and the mechanical lysis of the thrombus was made obtaining restoration of cerebral vein flow. After the procedure, she presented frontal hematoma which was withdrawn surgically. We discuss this infrequent pathology in clinical picture, pathogenesis, image exams and therapeutics.

  20. The role of the uncinate process in sinusitis aetiology: isolated agenesis versus maxillary sinus hypoplasia.

    PubMed

    Uluyol, S; Arslan, İ B; Demir, A; Mercan, G C; Dogan, O; Çukurova, İ

    2015-05-01

    This study aimed to evaluate the clinical significance of maxillary sinus hypoplasia and isolated agenesis of the uncinate process in sinusitis aetiology. Three patients with isolated agenesis of the uncinate process and 27 patients with 43 maxillary sinus hypoplasia variations were recruited. The frequencies of sinusitis episodes and radiological findings were compared between patient subgroups. In all, 23 type I maxillary sinus hypoplasia, 13 type II maxillary sinus hypoplasia and 7 type III maxillary sinus hypoplasia variations were detected. Patients with isolated agenesis of the uncinate process underwent antibiotic treatment an average of 7 times per year, whereas those with types I, II and III maxillary sinus hypoplasia were treated 1.57, 3.22, and 5.75 times per year, respectively, over a 5-year period. The antibiotic treatment frequency for patients with isolated agenesis of the uncinate process was significantly higher than for those with types I and II maxillary sinus hypoplasia. Isolated agenesis of the uncinate process seems to play a stronger role than types I and II maxillary sinus hypoplasia in the pathophysiology of chronic sinusitis.

  1. Treatment of severe sinus infection after sinus lift procedure: a case report.

    PubMed

    Almaghrabi, Bandar Abdulrahman; Hatton, Michael N; Andreana, Sebastiano; Hoeplinger, Mark A C

    2011-12-01

    Maxillary sinus floor augmentation may have a variety of postoperative complications including infection, sequestration of bone, and maxillary sinusitis. Complications can also occur due to a preexisting sinus condition called ostium stenosis. This case report presents a complication after sinus lift and grafting procedure due to an unrecognized ostium stenosis. A 50-year-old male patient had sinus augmentation on his right side. However, postoperatively, his symptoms were protracted. A CT scan showed thickening of the Schneiderian membrane and scattered graft material. Management included endoscopic nasal examination and ostium enlargement, antibiotic coverage, and full enucleation of the graft and diseased tissue. Patency of the sinus ostium should be carefully evaluated before sinus lift/grafting procedure using CT technology. Radiology and otolaryngology consultations may be necessary to rule out ostium stenosis before surgery.

  2. Paranasal sinus mucoceles: our clinical experiments

    PubMed Central

    Topdag, Murat; Iseri, Mete; Sari, Fatih; Erdogan, Selvet; Keskin, I Gurkan

    2015-01-01

    Objectives: We present the clinical and radiological features, treatment protocols, and medium-long-term results of our patients following surgery for paranasal sinus mucocele, along with a review of the relevant literature. Materials and methods: A total of 18 patients (11 women and 7 men) who underwent surgery for paranasal sinus mucocele at Kocaeli University Faculty of Medicine, Department of Otolaryngology, between 2006 and 2013 were examined retrospectively. The mean patient age was 41 (range 4-73). Demographic and radiological features, symptoms, treatment protocols, and postoperative outcomes were recorded. Results: The most frequently affected sinus was the maxillary sinus (n=9, 50%) followed by the frontal sinus (n=6, 33%) and sphenoidal sinus (n=3, 16%). The main symptom was headache. Endoscopic marsupialization of the mucocele was applied in all 18 patients, while frontal sinus exploration with the osteoplastic flap procedure was performed in one patient and the Caldwell-Luc operation was performed in another patient. The Caldwell-Luc procedure was subsequently required in one patient (6%) and endoscopic revision surgery was required in another patient (6%). Conclusion: Sinus mucocele that enlarges, eroding the surrounding bone tissue, and induces various clinical symptoms due to the impression of the expansile mass, is treated surgically, and must be planned carefully to prevent serious complications. PMID:26770462

  3. Maxillary sinus hemangioma: MR and CT studies.

    PubMed

    Kulkarni, M V; Bonner, F M; Abdo, G J

    1989-01-01

    A maxillary sinus hemangioma was detected as an incidental finding during magnetic resonance imaging of the head. The CT findings are more characteristic for the diagnosis of this lesion. Preoperative diagnosis of maxillary sinus hemangioma is important since these lesions can frequently cause a large amount of hemorrhage during surgery.

  4. Cholesterol granuloma of the maxillary sinus.

    PubMed

    Chao, Ting-Kuang

    2006-06-01

    Cholesterol granuloma (CG) of the maxillary sinus is very rare. In this study, the searching of the literature was performed with the keywords of cholesterol granuloma and maxillary sinus. All retrieved literature were reviewed throughout to identify and analyze all individual characteristics. Two additional cases in our hospital were also included. The result showed that, in the overall 37 cases, the ratio of male to female was about 3:1. Caucasian (14/37) and Turkish (10/37) were reported more frequently. CG of maxillary sinus had an opposite sex predilection compared with the fungus balls of the maxillary sinus. In addition, the comorbidity of these two diseases was found only in one patient in the literature. These results suggested that the different mechanisms other than poor aeration of the maxillary sinus played a role in the formation of CG of maxillary sinus. The diagnosis for CG of the maxillary sinus before operation is difficult, but the clear golden yellow rhinorrhea and hemorrhagic signs may provide a good diagnostic evidence. The symptoms were vague and about half of the patients presented with non-specific symptoms. Therefore, it seemed reasonable that CG of the maxillary sinus was under diagnosed in the clinical practice. Treatment consists of complete excision via Caldwell-Luc or endoscopic approach and provides a good prognosis. Bilateral involvements are rare but possible in this disease entity.

  5. Frequency of the odontogenic maxillary sinusitis extended to the anterior ethmoid sinus and response to surgical treatment

    PubMed Central

    Crovetto-Martínez, Rafael; Martin-Arregui, Francisco J.; Zabala-López-de-Maturana, Aitor; Tudela-Cabello, Kiara

    2014-01-01

    Objectives: Odontogenic sinusitis usually affects the maxillary sinus but may extend to the anterior ethmoid sinuses. The purpose of this study is to determine the percentage of odontogenic maxillary sinusitis extended to the anterior ethmoid sinuses and determine also the surgical resolution differences between odontogenic maxillary sinusitis and odontogenic maxillary associated to anterior ethmoidal sinusitis. Study Design: This is a retrospective cohort study performed on 55 patients diagnosed of odontogenic sinusitis and treated surgically by functional endoscopic sinus surgery. Results: This study showed that 52.7% of odontogenic maxillary sinusitis spreads to anterior ethmoid, causing added anterior ethmoid sinusitis. We found that 92.3% of the odontogenic maxillary sinusitis (who underwent middle meatal antrostomy) and 96.5% of the odontogenic maxillary sinusitis extended to the anterior ethmoid (treated with middle meatal antrostomy and anterior ethmoidectomy) were cured. Conclusions: Ethmoid involvement is frequent in maxillary odontogenic sinusitis. The ethmoid involvement does not worsen the results of “functional endoscopic sinus surgery” applied to the odontogenic sinusitis. Key words:Odontogenic maxillary sinusitis, ethmoiditis, functional endoscopic sinus surgery. PMID:24608208

  6. A coculture system of cavernous endothelial and smooth muscle cells.

    PubMed

    Ning, H; Lin, G; Lue, T F; Lin, C-S

    2013-01-01

    In erectile dysfunction (ED) research, monocultures of cavernous endothelial cells (CECs) and smooth muscle cells (CSMCs) have been reported, but a CEC-CSMC coculture system is still lacking. In the present study, we wished to investigate the feasibility of setting up such a system and test whether it can be used for diabetic ED research. Cavernous tissues were obtained from patients undergoing surgery for penile prosthesis. CSMCs were isolated by explant culture and verified by calponin staining. CECs were isolated by binding to CD31 antibody, followed by magnetic capture. These CECs were nearly 100% pure endothelial cells as determined by flow cytometric analysis for endothelial markers CD31, vWF and eNOS. Functional analyses, that is, low-density lipoprotein (LDL) uptake and capillary tube formation, also confirmed their endothelial phenotype. When cocultured with CSMCs, CECs formed capillary-like structures, and based on the extent of this capillary-like network, it was determined that a ratio of 1:4 in cell number between CECs and CSMCs was better than ratios of 1:1 and 1:9. It was also found that direct contact between CECs and CSMCs was necessary and a coculture period of 3 weeks was optimal. Autologous CSMCs were better than allogeneic CSMCs, and fibroblasts were completely incompetent. When treated with high glucose (25 mM), the CEC-CSMC coculture expressed significantly lower level of CD31 but significantly higher level of collagen-IV (Col-IV), and the diameter of the capillaries increased significantly, when compared with normal glucose (5 mM)-treated cocultures. These data are consistent with previously observed changes in the cavernous tissues of diabetic patients and thus suggest that the coculture system could be utilized for diabetic ED research.

  7. Advanced Underground Gas Storage Concepts: Refrigerated-Mined Cavern Storage, Final Report

    SciTech Connect

    1998-09-30

    Over the past 40 years, cavern storage of LPG's, petrochemicals, such as ethylene and propylene, and other petroleum products has increased dramatically. In 1991, the Gas Processors Association (GPA) lists the total U.S. underground storage capacity for LPG's and related products of approximately 519 million barrels (82.5 million cubic meters) in 1,122 separate caverns. Of this total, 70 are hard rock caverns and the remaining 1,052 are caverns in salt deposits. However, along the eastern seaboard of the U.S. and the Pacific northwest, salt deposits are not available and therefore, storage in hard rocks is required. Limited demand and high cost has prevented the construction of hard rock caverns in this country for a number of years. The storage of natural gas in mined caverns may prove technically feasible if the geology of the targeted market area is suitable; and economically feasible if the cost and convenience of service is competitive with alternative available storage methods for peak supply requirements. Competing methods include LNG facilities and remote underground storage combined with pipeline transportation to the area. It is believed that mined cavern storage can provide the advantages of high delivery rates and multiple fill withdrawal cycles in areas where salt cavern storage is not possible. In this research project, PB-KBB merged advanced mining technologies and gas refrigeration techniques to develop conceptual designs and cost estimates to demonstrate the commercialization potential of the storage of refrigerated natural gas in hard rock caverns. DOE has identified five regions, that have not had favorable geological conditions for underground storage development: New England, Mid-Atlantic (NY/NJ), South Atlantic (DL/MD/VA), South Atlantic (NC/SC/GA), and the Pacific Northwest (WA/OR). PB-KBB reviewed published literature and in-house databases of the geology of these regions to determine suitability of hard rock formations for siting storage

  8. Mechanical Behavior of Salt Caverns: Closed-Form Solutions vs Numerical Computations

    NASA Astrophysics Data System (ADS)

    Wang, Linlin; Bérest, Pierre; Brouard, Benoît

    2015-11-01

    Creep closure and structural stability of a cylindrical elongated cavern leached out from a salt formation are discussed. The Norton-Hoff creep law, or "power law", is used to capture the main features of salt rheological behavior. Two failure criteria are considered: (1) shear stresses must not be larger than a certain fraction of the mean stress (dilation criterion); and (2) the effective stress at the cavern wall (actual stress plus cavern fluid pressure) must not be tensile. The case of a brine-filled cavern whose pressure is kept constant is discussed first. It is proved that creep closure reaches a steady state such that stresses in the rock mass remain constant. However, decades are needed to reach such a state. During the transient phase that results from the slow redistribution of stresses in the rock mass, deviatoric stresses decrease at the vicinity of the cavern wall, and onset of dilation is less and less likely. At this point, the case of a rapid brine pressure increase, typical of a tightness test, is considered. It is proved that during such a swift pressure increase, cavern behavior is almost perfectly elastic; there is no risk of dilation onset. However, even when cavern pressure remains significantly smaller than geostatic, the effective stress at cavern wall can become tensile. These results, obtained through numerical computations, are confirmed by closed-form solutions obtained in the case of an idealized perfectly cylindrical cavern; these solutions provide a better insight into the main structural features of the behavior of the cavern.

  9. Differentiation of Transverse Sinus Thrombosis from Congenitally Atretic Cerebral Transverse Sinus with Computed Tomography

    PubMed Central

    Chik, Yolanda; Gottesman, Rebecca F.; Zeiler, Steven; Rosenberg, Jason; Llinas, Rafael H.

    2015-01-01

    Background Transverse sinus thrombosis can have nonspecific clinical and radiographic signs. We hypothesized that the novel “sigmoid notch sign” (on head CT) can help differentiate transverse sinus thrombosis from a congenitally atretic sinus among individuals with absent signal in one transverse sinus by magnetic resonance venography (MRV). Methods We retrospectively evaluated 53 subjects with a unilaterally absent transverse sinus signal on MRV. 11 had true transverse sinus thrombosis and 42 had an atretic transverse sinus. Reviewers were trained in the sigmoid notch sign: “positive” if one of the sigmoid notches was asymmetrically smaller than the other, consistent with a congenitally absent transverse sinus on that side. This sign was scored on CT scans by, two blinded reviewers to determine if signal dropout was clot or atretic sinus. A consensus rating was reached when the reviewers disagreed. Characteristics of the sigmoid notch sign as a diagnostic test were compared to a gold standard of full chart review by an independent reviewer. Results Each reviewer had a sensitivity of 91% (detecting 10/11 clots based on a negative sigmoid notch sign) and specificity of 71-81%; consensus specificity increased to 86% (36 of 42 individuals with an atretic sinus had a positive notch sign, detecting atretic sinuses based on presence of the sign). Conclusion Asymmetries of the sigmoid notches on non-contrast brain CT is a very sensitive and specific measure of differentiating transverse sinus thrombosis from an atretic transverse sinus when absence of transverse sinus flow is visualized on MRV. PMID:22588265

  10. Sinus floor bone failures in maxillary sinus floor augmentation: a case-control study.

    PubMed

    Cortes, Arthur Rodriguez Gonzalez; Pinheiro, Lucas Rodrigues; Cavalcanti, Marcelo Gusmão Paraíso; Arita, Emiko Saito; Tamimi, Faleh

    2015-04-01

    Extreme bone resorption in posterior maxilla may lead to absence of part of the sinus floor. This phenomenon has been termed sinus floor bone failure, and may compromise sinus floor augmentation. The present article aims to evaluate risk factors related to sinus floor bone failures and to evaluate the influence of these failures in sinus floor augmentation outcomes in patients with severely atrophic posterior maxilla. In this case-control study, patients were selected among those referred for sinus floor augmentation. Only patients presenting a ridge bone height of less than 3 mm were included. Cases were defined as presenting sinus floor bone failure, whereas controls did not present any interruption in the sinus floor bone. Information collected included clinical dental records and computed tomographic assessment of sinus width, septa, and schneiderian membrane. Risk estimates for sinus floor bone failures were calculated as adjusted odds ratios (AORs) with 95% confidence intervals (CIs) using conditional logistic regression analyses. A p value under 0.05 was considered statistically significant. In addition, sinus floor augmentation outcomes of both groups were also assessed. In all, 23 cases and 58 controls were included in the study. Sinus floor bone failures were significantly associated with the number of missing posterior teeth (AOR 3.67; 95% CI 0.86 to 15.63; p = .046) and a history of periodontitis (AOR 6.39; 95% CI 1.86 to 21.95; p = .002). Of the total, 15 cases and 27 controls underwent sinus floor augmentation. Schneiderian membrane perforation occurred during the surgery of two cases and of one control. No implants were lost during a mean postsurgical follow-up of 20 months. The number of missing posterior teeth and a history of periodontitis may be considered as risk factors for sinus floor bone failures. © 2013 Wiley Periodicals, Inc.

  11. An interesting case of angiogenesis in cavernous hemangioma

    PubMed Central

    Das, Dipankar; Bhattacharjee, Kasturi; Deka, Panna; Bhattacharjee, Harsha; Misra, Diva Kant; Koul, Akanksha; Kapoor, Deepika; Deka, Apurba

    2016-01-01

    Cavernous hemangioma is the most common orbital tumor in adult. There is lot of literatures for clinicopathological features of this tumor. These tumors had been studied for the model of angiogenesis in many of the experimental setups. We present a case of 34-year-old male with this tumor in the left eye with computerized tomography evidence. Postsurgical laboratory findings gave interesting evidence of tumor angiogenesis with tumor endothelial cells and sprouting of the small vessels endothelial cells. Podosome rosette could be conceptualized from the characteristic patterns seen in the tumor. PMID:27905347

  12. Cavernous angioma of the corpus callosum presenting with acute psychosis.

    PubMed

    Pavesi, Giacomo; Causin, Francesco; Feletti, Alberto

    2014-01-01

    Psychiatric symptoms may occasionally be related to anatomic alterations of brain structures. Particularly, corpus callosum lesions seem to play a role in the change of patients' behavior. We present a case of a sudden psychotic attack presumably due to a hemorrhagic cavernous angioma of the corpus callosum, which was surgically removed with complete resolution of symptoms. Although a developmental defect like agenesis or lipoma is present in the majority of these cases, a growing lesion of the corpus callosum can rarely be the primary cause. Since it is potentially possible to cure these patients, clinicians should be aware of this association.

  13. [Pontine cavernous angioma (cavernoma) with initial ENT manifestations].

    PubMed

    Pino Rivero, V; González Palomino, A; Pantoja Hernández, C G; Trinidad Ruíz, G; Marqués Rebollo, L; Blasco Huelva, A

    2006-01-01

    We report the case of a 22 years old female who consulted us for facial parestesias, hearing loss in right ear and sudden tinnitus. Her audiometry showed an unilateral discreet sensorineural hipoacusia and the cranial IRM, a mass of 20 mm diameter in right pontine region and bulbus informed as cavernous angioma with signs of recent bleeding. The patient was sent to Neurosurgery but she refused the intervention. The risk of hemorrhage in the cavernomas is estimated at 0.25% to 1.6% per year and represents the main reason to advise a surgical treatment.

  14. A Giant Cavernous Hemangioma of the Left Atrioventricular Groove

    PubMed Central

    Fan, Chengming; Tan, Changming; Kong, Demiao; Yuan, Shuwen; Wu, Sijie

    2017-01-01

    A 10-year-old Chinese female diagnosed with an asymptomatic giant cardiac cavernous hemangioma was reported. The patient originally tended to observation because this unusual cardiac tumoral mass was discovered incidentally during routine health examination of transthoracic echocardiography. Over 5 years of follow-up, the mass had enlarged obviously, and the patient visited our outpatient clinic and was prone to excision. Subsequently, a total resection surgery of the tumor was performed, and the tumor was found to be located on the left atrioventricular groove with complete packing membrane. The patient was discharged on postoperative day 4 and remains asymptomatic on last follow-up. PMID:28409047

  15. Electrical properties of air in the Carlsbad Caverns

    SciTech Connect

    Wilkening, M.; Romero, V.

    1980-01-01

    Radon 222 and its daughter product concentrations in the Carlsbad Caverns are higher than in outdoor air by a factor of several hundred. The effects of the radiation from these substances on the electrical properties of air in the cave have been studied. The rate of ion-pair production, the ion density, and the electrical conductivity are much higher in the Cave than in outdoor air. The mobility of the ions is less than outdoors due to the high humidity and low condensation nuclei concentration. A small net space charge produces a barely detectable electric field of the order of one percent of the earth's fair weather field.

  16. Concomitant orbital cavernous haemangioma and schwannoma in a patient.

    PubMed

    Gupta, Shweta; Kaliki, Swathi; Gowrishankar, Swarnalata

    2017-01-12

    A woman aged 39 years presented with right eye painless proptosis and decreased vision since 5 months. Right fundus examination revealed optic disc oedema. CT of the orbit revealed a well-defined homogeneous mass in the intraconal space in both orbits. Surgical excisional biopsy of the orbital lesions was performed. Histopathological examination of the right orbital lesion was suggestive of cavernous haemangioma and the left orbital lesion revealed schwannoma. The patient had an unremarkable postoperative course with improved visual acuity. This case illustrates benign orbital masses of 2 different tissues of origin in a single patient, which has not been described in the literature.

  17. Neodymium YAG laser for treatment of oral cavernous hemangiomas

    NASA Astrophysics Data System (ADS)

    Bradley, Paul F.

    1999-02-01

    Oral cavernous haemangiomas are common lesions which may require treatment due to episodes of bleeding when bitten or deformity particularly when involving the lips and/or cheeks. Surgery can be hazardous due to haemorrhage while cryosurgery tends to be tedious for large lesions and be accompanied by major oedema. Sclerosants produce hard bulky masses. Embolization is seldom helpful due to lack of arterial feeders. The Nd:YAG laser is proving a useful modality in the oro-facial region and appeared worth investigating for these lesions in a laboratory animal model, by thermography and in the clinical situation.

  18. Cerebral cavernous malformations: from CCM genes to endothelial cell homeostasis.

    PubMed

    Fischer, Andreas; Zalvide, Juan; Faurobert, Eva; Albiges-Rizo, Corinne; Tournier-Lasserve, Elisabeth

    2013-05-01

    Cerebral cavernous malformations (CCMs) are vascular lesions that can occur sporadically or as a consequence of inherited loss-of-function mutations, predominantly in the genes CCM1 (KRIT1), CCM2 (MGC4607, OSM, Malcavernin), or CCM3 (PDCD10, TFAR15). Inherited, familial CCM is characterized by the development of multiple lesions throughout a patient's life leading to recurrent cerebral hemorrhages. Recently, roles for the CCM proteins in maintaining vascular barrier functions and quiescence have been elucidated, and in this review we summarize the genetics and pathophysiology of this disease and discuss the molecular mechanisms through which CCM proteins may act within blood vessels.

  19. Congenital midline sinus of the upper lip.

    PubMed

    Fok, Denise; Kua, Ee Hsiang Jonah; Por, Yong Chen

    2015-06-01

    A congenital lip sinus is a rare condition that has been reported to occur in both the upper and lower lips, either in isolation or in association with congenital deformities such as a cleft lip and palate in Van der Woude syndrome. The prevalence of lower lip sinuses has been estimated to be about 0.00001% of the white population. Upper lip sinuses are even more uncommon. To date, there have been several case reports of upper lip sinuses and fistulas, but no similar cases have been described in Singapore. We herein report a case of congenital upper lip sinus presenting as a recurring upper lip abscess and review the current literature on this condition.

  20. Removal of a chopstick out of the cavernous sinus, pons, and cerebellar vermis through the superior orbital fissure.

    PubMed

    Mitilian, Delphine; Charon, Brigitte; Brunelle, Francis; Di Rocco, Federico

    2009-10-01

    Penetrating non-missile orbito cranial injuries are rare in a civilian pediatric setting. We describe a case of a trans-orbital penetration by a wooden chopstick deep down into the cerebellar vermis detected at neuroradiological examination in a child presenting for head injury. The foreign body was successfully pulled out in one piece surgically.

  1. [Clinical analysis of fungal rhino-sinusitis in 189 cases].

    PubMed

    Lin, Lin; Zhou, Ni; Chen, Zisong

    2015-12-01

    To investigate the clinical features of fungal rhino-sinusitis. Clinical data of 189 patients suffering from fungal rhino-sinusitis treated by functional endoscopic sinus surgery was analyzed retrospectively. The analyzed data included clinical type, age of onset, predilectionsite, reason, and surgical outcome. Among the 189 patients with fungal rhino-sinusitis,181 cases were fungal ball,6 cases were allergic fungal rhino-sinusitis, 1 case was acute invasive fungnal rhino-sinusitis, 1 case was chronic invasive fungnal rhino-sinusitis. One hundred and twenty-eight cases were in the maxillary sinus (123 cases were unilateral, 5 cases were bilateral). Nineteen cases were in the ethmoid sinus. 31 cases were in the sphenoid sinus. Two cases were both in the maxillary sinus and ethmoid sinus, 1 case was both in the maxillary sinus and sphenoid sinus. Two cases invasive fungnal rhino-sinusitis had diabetes history. All the patients treated by functional endoscopic sinus surgery, 184 cases without recurrence, 5 cases suffered re-operation. The incidence of fungal rhinosinusitis is showing a rising trend, fungal ball is the highest. The sinusitis patients whom we highly doubt for fungal infection should be confirmed by using sinonasal secretion smear, cultivation and histopathological examination. Surgical treatment should completely remove the fungal masses, to avoid reoperation.

  2. Bilateral inferior petrosal sinus sampling

    PubMed Central

    Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo

    2016-01-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  3. Bilateral inferior petrosal sinus sampling.

    PubMed

    Zampetti, Benedetta; Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo; Loli, Paola

    2016-07-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50-70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

  4. Nitric oxide and the paranasal sinuses.

    PubMed

    Lundberg, Jon O

    2008-11-01

    The discovery within the paranasal sinuses for the production of nitric oxide (NO) has altered the traditional explanations of sinus physiology. This review article reports the ongoing investigation of sinus physiology beginning with the discovery of NO gas production in the paranasal sinuses that occurred in 1995, and the impact that finding has had both in the basic science and clinical arenas. It was shown that healthy paranasal sinus epithelium expresses an inducible NO synthase that continuously generates large amounts of NO, a pluripotent gaseous messenger with potent vasodilating, and antimicrobial activity. This NO can be measured noninvasively in nasally exhaled breath. The role of NO in the sinuses is likely to enhance local host defense mechanisms via direct inhibition of pathogen growth and stimulation of mucociliary activity. The NO concentration in a healthy sinus exceeds those that are needed for antibacterial effects in vitro. In patients with primary ciliary dyskinesia (PCD) and in cystic fibrosis, nasal NO is extremely low. This defect NO generation likely contributes to the great susceptibility to chronic sinusitis in these patients. In addition, the low-nasal NO is of diagnostic value especially in PCD, where nasal NO is very low or absent. Intriguingly, NO gas from the nose and sinuses is inhaled with every breath and reaches the lungs in a more diluted form to enhance pulmonary oxygen uptake via local vasodilation. In this sense NO may be regarded as an "aerocrine" hormone that is produced in the nose and sinuses and transported to a distal site of action with every inhalation. Copyright 2008 Wiley-Liss, Inc.

  5. Clinical Features and Treatments of Odontogenic Sinusitis

    PubMed Central

    Lee, Sung Jin

    2010-01-01

    Purpose The aim of this study was to investigate how clinical features such as sex, age, etiologic factors, and presenting symptoms of odontogenic sinusitis are differentiated from other types of sinusitis. Also, this study was designed to find methods for reducing the incidence of odontogenic sinusitis. Materials and Methods A retrospective chart analysis was completed on twenty-seven patients with odontogenic sinusitis. They were all treated at Kangbuk Samsung Hospital between February 2006 and August 2008. The study protocol and informed consent forms were approved by the institutional review boards for human beings at Kangbuk Samsung Hospital. Results Ten patients (37.0%) had dental implant related complications and 8 (29.6%) had dental extraction related complications. Unilateral purulent nasal discharge was the most common symptom (66.7%). The therapeutic modality included transnasal endoscopic sinus surgery in 19 (70.4%) patients, and a Caldwell-Luc operation in two (7.4%) patients. Conclusion In our study, there was no significant difference in the incidence between genders. The average age of the patients was 42.9 years. The incidence was highest in the fourth decade. There were no significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis. However, almost all of the patients with odontogenic sinusitis had unilateral symptoms. Iatrogenic causes, which include dental implants and dental extractions, were the most common etiologic factors related to the development of odontogenic sinusitis. Therefore, a preoperative consultation between a rhinologist and a dentist prior to the dental procedure should be able to reduce the incidence of odontogenic sinusitis. PMID:20879062

  6. Clinical features and treatments of odontogenic sinusitis.

    PubMed

    Lee, Kyung Chul; Lee, Sung Jin

    2010-11-01

    The aim of this study was to investigate how clinical features such as sex, age, etiologic factors, and presenting symptoms of odontogenic sinusitis are differentiated from other types of sinusitis. Also, this study was designed to find methods for reducing the incidence of odontogenic sinusitis. A retrospective chart analysis was completed on twenty-seven patients with odontogenic sinusitis. They were all treated at Kangbuk Samsung Hospital between February 2006 and August 2008. The study protocol and informed consent forms were approved by the institutional review boards for human beings at Kangbuk Samsung Hospital. Ten patients (37.0%) had dental implant related complications and 8 (29.6%) had dental extraction related complications. Unilateral purulent nasal discharge was the most common symptom (66.7%). The therapeutic modality included transnasal endoscopic sinus surgery in 19 (70.4%) patients, and a Caldwell-Luc operation in two (7.4%) patients. In our study, there was no significant difference in the incidence between genders. The average age of the patients was 42.9 years. The incidence was highest in the fourth decade. There were no significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis. However, almost all of the patients with odontogenic sinusitis had unilateral symptoms. Iatrogenic causes, which include dental implants and dental extractions, were the most common etiologic factors related to the development of odontogenic sinusitis. Therefore, a preoperative consultation between a rhinologist and a dentist prior to the dental procedure should be able to reduce the incidence of odontogenic sinusitis.

  7. Sinusitis

    MedlinePlus

    ... and face. You may also need imaging tests. Treatments include antibiotics, decongestants, and pain relievers. Using heat pads on the inflamed area, saline nasal sprays, and vaporizers can also help. NIH: National Institute of Allergy and Infectious Diseases

  8. Presentation of Preauricular Sinus and Preauricular Sinus Abscess in Southwest Nigeria

    PubMed Central

    Adegbiji, W. A.; Alabi, B. S.; Olajuyin, O. A.; Nwawolo, C. C.

    2013-01-01

    BACKGROUND AND AIM: Preauricular sinus abscess is a common congenital external ear disease. This abscess is usually misdiagnosed because it is commonly overlooked during physical examination. In Nigeria, the prevalence was 9.3% in Ilorin, north central Nigeria This study is to determine the distribution and clinical presentation of the preauricular sinus abscess in Ekiti, south west Nigeria. MATERIALS AND METHODS: This is a prospective hospital based study of all patients with diagnosis of preauricular sinus abscess seen in our clinic carried out between April 2008 to March 2010. Detailed clinical history, administered interviewer’s assisted questionnaires full examination and. Data obtained were collated and analysed. RESULTS: Preauricular sinus were noticed in 184 (4.4%) out of 4170 patients seen during the study period. Preauricular sinus abscess were noticed in 21 (11.4%) of the preauricular sinuses especially in children. Unilateral preauricular sinus abscess accounted for 90.5%. Common presenting complaints were preauricular swelling (81.0%), 90.5% with recurrent earaches, 76.2% with ear discharges. All patients had antibiotic / analgesic while 17 out of 21 (81.0%) had surgical excisions. CONCLUSION: Preauricular sinus abscess were noticed among 11.4% of the preauricular sinuses especially in children, unilateral preauricular sinus abscess accounted for 90.5%. Common complaints were otorrhoea, earaches, and swelling and they were mostly managed surgically. PMID:24711764

  9. Correlations between anatomic variations of maxillary sinus ostium and postoperative complication after sinus lifting.

    PubMed

    Lee, Jang Won; Yoo, Ji Yong; Paek, Seung Jae; Park, Won-Jong; Choi, Eun Joo; Choi, Moon-Gi; Kwon, Kyung-Hwan

    2016-10-01

    The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis.

  10. Correlations between anatomic variations of maxillary sinus ostium and postoperative complication after sinus lifting

    PubMed Central

    2016-01-01

    Objectives The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. Materials and Methods The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. Results Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. Conclusion Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis. PMID:27847736

  11. Effects of cavern spacing and pressure on subsidence and storage losses for the US Strategic Petroleum Reserve

    SciTech Connect

    Ehgartner, B.

    1992-03-01

    The effects of cavern spacing and operating pressure on surface subsidence and cavern storage losses were evaluated using the finite- element method. The base case for the two sensitivity studies was a typical SPR cavern. The predicted responses of the base case and those from the pressurization study compared quite closely to measured surface subsidence and oil pressurization rates. This provided credibility for the analyses and constitutive models used. Subsidence and cavern storage losses were found to be strongly influenced by cavern spacing and pressurization. The relationship between subsidence volume and losses in storage volume varied as cavern spacing and operating pressure deviated from the base case. However, for a typical SPR cavern subsidence volume is proportional to storage loss and when expressed in ft., subsidence is equal to the percentage of storage loss.

  12. Transcrestal sinus lift and implant placement using the sinus balloon technique

    PubMed Central

    Galán-Gil, Sónnica; Carrillo-García, Celia; Peñarrocha-Diago, David; Peñarrocha-Diago, Miguel

    2012-01-01

    Objective: A description is made of transcrestal sinus lift using the sinus balloon technique, evaluating the bone height achieved and implant success one year after prosthetic loading. Material and method: Between January and July 2007, transcrestal sinus lift using the sinus balloon technique for dental implant placement was carried out in 6 patients. A panoramic X-ray study and maxillary computed tomography scan were carried out before the operation, in order to discard possible sinus pathology. During the intervention, the integrity of the sinus membrane was evaluated using a Medi Pack Pal endoscope (Farol Store and Co., Tuttlingen, Germany), and the intraoperative complications were analyzed. The dental implants were placed in the same surgical step in the presence of 3 mm or more of residual bone. Following the operation, panoramic X-rays were used to assess the bone height gained. One year after prosthetic loading, the implant success rate was determined based on the criteria of Buser. Results: One patient was excluded due to Schneider’s membrane perforation as confirmed by endoscopy. Trans-crestal sinus lift was carried out in 5 males with a mean age of 41.6 years (range 27-51), without antecedents of sinus disease. There were no intraoperative complications. In four patients the implants were placed simultaneous to sinus lift, while in another case implant placement was postponed due to insufficient remaining bone height. The mean gain in height after the operation was 8.7 mm. One year after prosthetic loading, the implant success rate was 100%. Conclusions: Transcrestal sinus lift using the sinus balloon technique is a minimally invasive procedure. In 5 patients the bone height gained proved sufficient to allow implant placement even in the presence of 3 mm of residual bone. Key words: Sinus lift, balloon, sinus complications. PMID:22157670

  13. Cavernous malformation of the optic chiasm: Neuro-endoscopic removal.

    PubMed

    Venkataramana, N K; Rao, Shailesh A V; Arun, L N; Krishna, C

    2016-01-01

    Cavernous malformations (CMs) arising from the optic nerve and chiasm are extremely rare. In large autopsy series, CMs were estimated to range from 0.02 to 0.13% in the general population. However, with introduction of MRI, these lesions were found more often than previously thought, ranging from 0.2% to 0.4%. Only 29 cases have been reported according to our knowledge. Most patients present with drop in visual acuity and visual field. Although MRI findings of cavernous malformations have been reported, they may not be diagnostic enough. Among the 29 reported, 16 underwent total resection with good results. In some, resection was complicated by damage to the surrounding neural tissue. Surgical removal is the recommended treatment to restore or preserve vision and to eliminate the risk of future hemorrhage. However, the anatomical location and eloquence of nearby neural structures can make these lesions difficult to access and remove. CMs appear to occur in every age group (range 4 months to 84 years mean-34.6 years) ith an approximately equal male to female ratio. They typically present with chiasmal apoplexy, characterized by sudden visual loss, acute headaches, retro orbital pain, and nausea.

  14. Cavernous hemangioma of the parotid gland in adults

    PubMed Central

    Peral-Cagigal, Beatriz; Madrigal-Rubiales, Beatriz; Verrier-Hernández, Alberto

    2014-01-01

    Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland and most of them occur in children, nevertheless in adults hemangiomas are very rare. We report the case of a 62 year old woman with a mass in the parotid right tail associated with fluctuating swelling episodes unrelated to meals and with a slowly progressive growth. The provisional diagnosis was a pleomorphic adenoma, so a right superficial parotidectomy was performed. During surgery, the macroscopic appearance makes suspect a vascular lesion. The histopathological result was a cavernous hemangioma. The classic clinical presentation of a parotid hemangioma is an intraglandular mass associated or not with skin lesions characterized by reddish macules and/or papules, and a vibration or pulsation when palpating the parotid region. In imaging tests, phleboliths could be observed which are very suggestive of a hemangioma or a vascular malformation. In the absence of these signs, the diagnosis could be difficult, particularly in an adult due to its low prevalence, with about 50 cases reported worldwide. However a hemangioma should be considered in the differential diagnosis of parotid tumors in adults. Key words:Cavernous hemangioma, parotid gland, superficial parotidectomy, pleomorphic adenoma. PMID:25674332

  15. Nitrogen Monitoring of West Hackberry 117 Cavern Wells

    SciTech Connect

    Bettin, Giorgia; Lord, David L.

    2015-02-01

    U.S. Strategic Petroleum Reserve (SPR) oil storage cavern West Hackberry 117 was tested under extended nitrogen monitoring following a successful mechanical integrity test in order to validate a newly developed hydrostatic column model to be used to differentiate between normal "tight" well behavior and small-leak behavior under nitrogen. High resolution wireline pressure and temperature data were collected during the test period and used in conjunction with the hydrostatic column model to predict the nitrogen/oil interface and the pressure along the entire fluid column from the bradenhead flange nominally at ground surface to bottom of brine pool. Results here and for other SPR caverns have shown that wells under long term nitrogen monitoring do not necessarily pressurize with a relative rate (P N2 /P brine) of 1. The theoretical relative pressure rate depends on the well configuration, pressure and the location of the nitrogen-oil interface and varies from well to well. For the case of WH117 the predicted rates were 0.73 for well A and 0.92 for well B. The measured relative pressurization rate for well B was consistent with the model prediction, while well A rate was found to be between 0.58-0.68. A number of possible reasons for the discrepancy between the model and measured rates of well A are possible. These include modeling inaccuracy, measurement inaccuracy or the possibility of the presence of a very small leak (below the latest calculated minimum detectable leak rate).

  16. PDCD10 gene mutations in multiple cerebral cavernous malformations.

    PubMed

    Cigoli, Maria Sole; Avemaria, Francesca; De Benedetti, Stefano; Gesu, Giovanni P; Accorsi, Lucio Giordano; Parmigiani, Stefano; Corona, Maria Franca; Capra, Valeria; Mosca, Andrea; Giovannini, Simona; Notturno, Francesca; Ciccocioppo, Fausta; Volpi, Lilia; Estienne, Margherita; De Michele, Giuseppe; Antenora, Antonella; Bilo, Leda; Tavoni, Antonietta; Zamponi, Nelia; Alfei, Enrico; Baranello, Giovanni; Riva, Daria; Penco, Silvana

    2014-01-01

    Cerebral cavernous malformations (CCMs) are vascular abnormalities that may cause seizures, intracerebral haemorrhages, and focal neurological deficits. Familial form shows an autosomal dominant pattern of inheritance with incomplete penetrance and variable clinical expression. Three genes have been identified causing familial CCM: KRIT1/CCM1, MGC4607/CCM2, and PDCD10/CCM3. Aim of this study is to report additional PDCD10/CCM3 families poorly described so far which account for 10-15% of hereditary cerebral cavernous malformations. Our group investigated 87 consecutive Italian affected individuals (i.e. positive Magnetic Resonance Imaging) with multiple/familial CCM through direct sequencing and Multiplex Ligation-Dependent Probe Amplification (MLPA) analysis. We identified mutations in over 97.7% of cases, and PDCD10/CCM3 accounts for 13.1%. PDCD10/CCM3 molecular screening revealed four already known mutations and four novel ones. The mutated patients show an earlier onset of clinical manifestations as compared to CCM1/CCM2 mutated patients. The study of further families carrying mutations in PDCD10/CCM3 may help define a possible correlation between genotype and phenotype; an accurate clinical follow up of the subjects would help define more precisely whether mutations in PDCD10/CCM3 lead to a characteristic phenotype.

  17. Cavernous malformation of the optic chiasm: Neuro-endoscopic removal

    PubMed Central

    Venkataramana, N. K.; Rao, Shailesh A. V.; Arun, L. N.; Krishna, C.

    2016-01-01

    Cavernous malformations (CMs) arising from the optic nerve and chiasm are extremely rare. In large autopsy series, CMs were estimated to range from 0.02 to 0.13% in the general population. However, with introduction of MRI, these lesions were found more often than previously thought, ranging from 0.2% to 0.4%. Only 29 cases have been reported according to our knowledge. Most patients present with drop in visual acuity and visual field. Although MRI findings of cavernous malformations have been reported, they may not be diagnostic enough. Among the 29 reported, 16 underwent total resection with good results. In some, resection was complicated by damage to the surrounding neural tissue. Surgical removal is the recommended treatment to restore or preserve vision and to eliminate the risk of future hemorrhage. However, the anatomical location and eloquence of nearby neural structures can make these lesions difficult to access and remove. CMs appear to occur in every age group (range 4 months to 84 years mean-34.6 years) ith an approximately equal male to female ratio. They typically present with chiasmal apoplexy, characterized by sudden visual loss, acute headaches, retro orbital pain, and nausea PMID:26889286

  18. Role of Delta-Notch signaling in cerebral cavernous malformations.

    PubMed

    Kar, Souvik; Baisantry, Arpita; Nabavi, Arya; Bertalanffy, Helmut

    2016-10-01

    Cerebral cavernous malformations (CCM) commonly known as cavernous hemangioma are associated with abnormally enlarged thin-walled blood vessels. As a result, these dilated capillaries are prone to leakage and result in hemorrhages. Clinically, such hemorrhages lead to severe headaches, focal neurological deficits, and epileptic seizures. CCM is caused by loss of function mutations in one of the three well-known CCM genes: Krev interaction trapped 1 (KRIT1), OSM, and programmed cell death 10 (PDCD10). Loss of CCM genes have been shown to be synergistically related to decreased Notch signaling and excessive angiogenesis. Despite recent evidences indicating that Notch signaling plays a pivotal role in regulating angiogenesis, the role of Notch in CCM development and progression is still not clear. Here, we provide an update literature review on the current knowledge of the structure of Notch receptor and its ligands, its relevance to angiogenesis and more precisely to CCM pathogenesis. In addition to reviewing the current literatures, this review will also focus on the cross talk between Delta-Notch and vascular endothelial growth factor (VEGF) signaling in angiogenesis and in CCM pathogenesis. Understanding the role of Notch signaling in CCM development and progression might help provide a better insight for novel anti-angiogenic therapies.

  19. Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases.

    PubMed

    Chi, Cuong Tran; Nguyen, Dang; Duc, Vo Tan; Chau, Huynh Hong; Son, Vo Tan

    2014-01-01

    We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced

  20. Risk analyses for disposing of nonhazardous oil field wastes in salt caverns

    SciTech Connect

    Tomasko, D.; Elcock, D.; Veil, J.

    1997-09-01

    Argonne National Laboratory (ANL) has completed an evaluation of the possibility that adverse human health effects (carcinogenic and noncarcinogenic) could result from exposure to contaminants released from nonhazardous oil field wastes (NOW) disposed of in domal salt caverns. In this assessment, several steps were used to evaluate potential human health risks: identifying potential contaminants of concern; determining how humans could be exposed to these contaminants; assessing the contaminants` toxicities; estimating contaminant intakes; and, finally, calculating human cancer and noncancer risks. Potential human health risks associated with hazardous substances (arsenic, benzene, cadmium, and chromium) in NOW were assessed under four postclosure cavern release scenarios: inadvertent cavern intrusion, failure of the cavern seal, failure of the cavern through cracks or leaky interbeds, and a partial collapse of the cavern roof. To estimate potential human health risks for these scenarios, contaminant concentrations at the receptor were calculated using a one-dimensional solution to an advection/dispersion equation that included first order degradation. Even under worst-case conditions, the risks have been found to be within the US EPA target range for acceptable exposure levels. From a human health risk perspective, salt caverns can provide an acceptable disposal method for NOW.

  1. Literature Survey Concerning the Feasibility of Remedial Leach for Select Phase I Caverns

    SciTech Connect

    Weber, Paula D.; Flores, Karen A.; Lord, David L.

    2015-09-01

    Bryan Mound 5 ( BM5 ) and West Hackberry 9 ( WH9 ) have the potential to create a significant amount of new storage space should the caverns be deemed "leach - ready". This study discusses the original drilling history of the caverns, surrounding geology, current stability, and, based on this culmination of data, makes a preliminary assessment of the leach potential for the cavern. The risks associated with leaching BM5 present substantial problems for the SPR . The odd shape and large amount of insoluble material make it difficult to de termine whether a targeted leach would have the desired effect and create useable ullage or further distort the shape with preferential leaching . T he likelihood of salt falls and damaged or severed casing string is significant . In addition, a targeted le ach would require the relocation of approximately 27 MMB of oil . Due to the abundance of unknown factors associated with this cavern, a targeted leach of BM5 is not recommended. A targeted leaching of the neck of WH 9 could potentially eliminate or diminis h the mid - cavern ledge result ing in a more stable cavern with a more favorable shape. A better understanding of the composition of the surrounding salt and a less complicated leaching history yields more confidence in the ability to successfully leach this region. A targeted leach of WH9 can be recommended upon the completion of a full leach plan with consideration of the impacts upon nearby caverns .

  2. Simulation of production and injection performance of gas storage caverns in salt formations

    SciTech Connect

    Hagoort, J. )

    1994-11-01

    This paper presents a simple yet comprehensive mathematical model for simulation of injection and production performance of gas storage caverns in salt formations. The model predicts the pressure and temperature of the gas in the cavern and at the wellhead for an arbitrary sequence of production and injection cycles. The model incorporates nonideal gas properties, thermodynamic heat effects associated with gas expansion and compression in the cavern and tubing, heat exchange with the surrounding salt formation, and non-uniform initial temperatures but does not include rock-mechanical effects. The model is based on a mass and energy balance for the gas-filled cavern and on the Bernoulli equation and energy balance for flow in the wellbore. Cavern equations are solved iteratively at successive timesteps, and wellbore equations are solved within an iteration cycle of the cavern equations. Gas properties are calculated internally with generally accepted correlations and basic thermodynamic relations. Example calculations show that the initial temperature distribution has a strong effect on production performance of a typical gas storage cavern. The primary application of the model is in the design, planning, and operation of gas storage projects.

  3. [Compound odontoma as a cause of chronic maxillary sinusitis].

    PubMed

    Crespo Del Hierro, Jorge; Ruiz González, Manuel; Delgado Portela, Margarita; García Del Castillo, Eduardo; Crespo Serrano, Juan

    2008-01-01

    Sinusitis of dental origin is a relatively frequent entity, but the presence of an odontoma in the sinus as a source of this pathology is exceptional. Here we present a case of a young patient who presented chronic maxillary sinusitis over 2 years, originating in an odontoma located in the sinus drainage area.

  4. Estimate of the risks of disposing nonhazardous oil field wastes into salt caverns

    SciTech Connect

    Tomasko, D.; Elcock, D.; Veil, J.

    1997-12-31

    Argonne National Laboratory (ANL) has completed an evaluation of the possibility that adverse human health effects (carcinogenic and noncarcinogenic) could result from exposure to contaminants released from nonhazardous oil field wastes (NOW) disposed in domal salt caverns. Potential human health risks associated with hazardous substances (arsenic, benzene, cadmium, and chromium) in NOW were assessed under four postclosure cavern release scenarios: inadvertent cavern intrusion, failure of the cavern seal, failure of the cavern through cracks or leaky interbeds, and a partial collapse of the cavern roof. To estimate potential human health risks for these scenarios, contaminant concentrations at the receptor were calculated using a one-dimensional solution to an advection/dispersion equation that included first order degradation. Assuming a single, generic salt cavern and generic oil-field wastes, the best-estimate excess cancer risks ranged from 1.7 {times} 10{sup {minus}12} to 1.1 {times} 10{sup {minus}8} and hazard indices (referring to noncancer health effects) ranged from 7 {times} 10{sup {minus}9} to 7 {times} 10{sup {minus}4}. Under worse-case conditions in which the probability of cavern failure is 1.0, excess cancer risks ranged from 4.9 {times} 10{sup {minus}9} to 1.7 {times} 10{sup {minus}5} and hazard indices ranged from 7.0 {times} 10{sup {minus}4} to 0.07. Even under worst-case conditions, the risks are within the US Environmental Protection Agency (EPA) target range for acceptable exposure levels. From a human health risk perspective, salt caverns can, therefore, provide an acceptable disposal method for NOW.

  5. Hydrogeologic factors affecting cavern morphology within rocks of Mississippian age in northwestern Arkansas

    SciTech Connect

    Fanning, B.J. . Dept. of Geology); Brahana, J.V. . Geological Survey)

    1993-02-01

    Cavern development within rocks of Mississippian age in northwestern Arkansas is associated with two Pleistocene erosional features, the Boston Mountains Plateau and the Springfield Plateau. Each plateau is characterized by a distinct stratigraphic sequence with unique lithologies. Cavern morphology (both cross-sectional and planimetric) in each plateau is the result of the complex interaction of numerous hydrogeologic factors. Four of the most dominant factors which affect cavern morphology appear to be: (1) composition and continuity of the confining units; (2) percentage of noncarbonate components in rocks of the cavern-forming interval; (3) nature and distribution of ground-water recharge to the cavern-forming interval; and (4) nature and distribution of fractures within the cavern-forming interval. Network maze patterns typically develop in the Pitkin Limestone, the formation in which most caverns form beneath the Boston Mountains Plateau. The Pitkin, a bioclastic limestone, is confined above by siltstones of the Cane Hill member of the Hale Formation and below by shales of the Fayetteville Formation. The maze pattern indicates that these caverns probably were formed by dissolution of the rock matrix by diffuse recharge moving vertically through leaky confining units. Single rooms are the dominant cavern morphology in the chert-dominated Boone Formation of the Springfield Plateau. Where the concentration of chert is greater than 50 percent, the Boone lacks structural integrity and fails to develop well-integrated conduit networks. Point recharge features in outcrop areas of the Boone Formation are not visible in most of the Springfield Plateau because the insoluble residuum masks the upper bedrock surface. Where the Boone Formation is less than 7 meters thick, surface karst features are more prevalent.

  6. Chronic Cutaneous Draining Sinus of Dental Origin

    PubMed Central

    Sisodia, N; Manjunath, MK

    2014-01-01

    Extra oral sinus of odontogenic origin occurs when the purulent by-products of dental pulp necrosis spread along the path of least resistance from the root apex to the skin on the face. Patients presenting with cutaneous sinus usually visit a general physician or dermatologist first, as the lesion can mimic various dermatologic pathologies, ranging from an infected sebaceous cysts to a basal cell carcinoma. Despite systemic antibiotics, symptoms often persist causing further confusion, and at times leading to unnecessary surgical interventions. The location of this sinus in the head and neck region should lead the physician to seek a dental opinion in order to avoid misdiagnosis. PMID:25506495

  7. A Rational Approach to Sinus Augmentation: The Low Window Sinus Lift

    PubMed Central

    Zaniol, Alex

    2017-01-01

    Sinus augmentation is a well-known approach to treating alveolar bone ridge atrophy in the posterior maxilla. The preparation of the lateral window is crucial. Its size, design, and position in the vestibular sinus wall may affect the intra- and postsurgical complication rates and affect the intrasurgical activity of both surgeons and assistants. The present paper describes a rational technique that also exploits the guided surgery approach for design and preparation of a lateral window for sinus augmentation, the Low Window Sinus Lift. To illustrate the use of this approach, a case is presented in which the 50-year-old patient had the left maxillary first molar extracted, followed two months later by sinus augmentation and placement of three implants. One year after delivery of the definitive prosthesis, all three implants were successful, and the prosthesis was fully functional. Controlled studies should be undertaken to assess whether this technique provides significant advantages compared to other sinus augmentation approaches. PMID:28337349

  8. A Rational Approach to Sinus Augmentation: The Low Window Sinus Lift.

    PubMed

    Zaniol, Terry; Zaniol, Alex

    2017-01-01

    Sinus augmentation is a well-known approach to treating alveolar bone ridge atrophy in the posterior maxilla. The preparation of the lateral window is crucial. Its size, design, and position in the vestibular sinus wall may affect the intra- and postsurgical complication rates and affect the intrasurgical activity of both surgeons and assistants. The present paper describes a rational technique that also exploits the guided surgery approach for design and preparation of a lateral window for sinus augmentation, the Low Window Sinus Lift. To illustrate the use of this approach, a case is presented in which the 50-year-old patient had the left maxillary first molar extracted, followed two months later by sinus augmentation and placement of three implants. One year after delivery of the definitive prosthesis, all three implants were successful, and the prosthesis was fully functional. Controlled studies should be undertaken to assess whether this technique provides significant advantages compared to other sinus augmentation approaches.

  9. [Improved methods for researching isolated carotid sinus baroreceptors automatically controlling for sinus pressure].

    PubMed

    Wei, Hua; Zhao, Hai-Yan; Liu, Ping; Huang, Hai-Xia; Wang, Wei; Fu, Xiao-Suo; Niu, Wei-Zhen

    2013-01-01

    To develop a system for automatically controlling carotid sinus pressure in the study on baroreceptors. The preparation containing carotid sinus with parts of the connected vessels and carotid sinus nerve (CS-CSN) were isolated and perfused. A critical pressure controlling component (PRE-U, Hoerbiger, Deutschland) dictated by a computer was integrated into the system to clamp the intrasinus pressure. The pressure command and the relevant intrasinus pressure were compared to evaluate the validity of the pressure controlling system. A variety of sinus pressure-controlling patterns, including pulsation, ramp and step pressures, could be achieved accurately by using the system, and the pressure-dependent discharge activities of sinus nerve were confirmed. This system for clamping carotid sinus pressure could realize multiple pressure-controlling patterns and is a useful and flexible pressure controlling method that could applied in the study on mechano-electric transduction of baroreceptors.

  10. Microsurgical thromboendarterectomy of the cavernous carotid artery--case report and surgical technique.

    PubMed

    Fujitsu, K; Fujii, S; Tanaka, N; Kuwabara, T

    1990-10-01

    A 53-year-old male suffered a transient right hemiparesis and left monocular blindness. Angiography revealed 80% stenosis of the cavernous carotid artery. Microsurgical thromboendarterectomy was performed by a direct approach through Parkinson's triangle. During surgery, the carotid circulation was transiently trapped between the cervical and the supraclinoid segment and the trapped arterial lumen was irrigated with heparinized saline. Soft elastic lesion was easily removed. Cavernous carotid thromboendarterectomy through a direct approach is considered as a suitable operation for the solitary and localized stenotic lesions of the cavernous carotid artery, although this operation has not yet been reported to date.

  11. Retroperitoneal tumor: giant cavernous hemangioma – case presentation and literature review

    PubMed Central

    Haponiuk, Ireneusz; Jaworski, Radoslaw; Peksa, Rafal; Irga-Jaworska, Ninela; Jaskiewicz, Janusz

    2016-01-01

    Retroperitoneal hemangiomas are very rare. This paper presents the case of a 71-year-old female patient with giant cavernous hemangioma of the retroperitoneum who underwent surgical treatment for abdominal pain and left lower limb edema. Interventional staged treatment with percutaneous transcatheter arterial embolization prior to surgery was considered. Radical resection of the tumor was performed, which caused the symptoms to abate. Additionally a literature review of cases involving cavernous hemangioma in the retroperitoneal space is presented. No description of retroperitoneal cavernous hemangioma originating from the bowel was found in the analyzed reports. PMID:28096841

  12. "SAFE" SINUS LIFT - USE OF ACRYLIC STONE TRIMMER TO AVOID SINUS LINING PERFORATION.

    PubMed

    Konatham Haribabu, Prashanth; Raja, Krishna Kumar V B; Iyer, Shankar S

    2012-04-02

    Abstract Abstract Iatrogenic injury to the maxillary sinus membrane is a common complication during direct sinus lift procedures. The most common cause being the perforation of the Schneiderian membrane using a tungsten-carbide round bur no.6. We propose a safe technique by using an acrylic stone trimmer to create a window in the maxillary antrum thereby minimizing the risk of injury to the delicate sinus membrane.

  13. Safe sinus lift: use of acrylic stone trimmer to avoid sinus lining perforation.

    PubMed

    Haribabu, Prashanth Konatham; Raja, Krishna Kumar; Iyer, Shankar

    2014-06-01

    Iatrogenic injury to the maxillary sinus membrane is a common complication during direct sinus lift procedures. The most common cause is perforation of the Schneiderian membrane using a tungsten-carbide round bur no.6. We propose a safe technique in which an acrylic stone trimmer is used to create a window in the maxillary antrum thereby minimizing the risk of injury to the delicate sinus membrane.

  14. Experimental study on histological changes in the sinus membrane following sinus lift.

    PubMed

    Onişor-Gligor, Fl; Lucaciu, Ondine; Câmpian, R; Oană, L; Gheban, D; Florea, A

    2011-01-01

    The aim of this study is to assess the histological changes in the sinus mucosa adjacent to the alloplastic material used for subantral augmentation. The study included ten sheep and a dog. The first group of five sheep underwent a sinus lift procedure, using PerioGlas as an augmentation material; the second similar group of sheep was the control group. The dog underwent a sinus lift procedure, with PerioGlas augmentation, after the sinus membrane was intentionally perforated and two implants were placed in the same operative step. Scanning electron microscopy (SEM) of the sinus mucosa in the control group revealed cells without cilia between goblet cells. The cilia were uniformly arranged in sections in the same direction. Changes occurred in the sinus mucosa after grafting, such as drastic reduction of ciliated cells, which seemed to be replaced by goblet cells. In all sheep undergoing grafting, generalized fibrosis was found in the mucosal area that came into contact with PerioGlas. In two of the sheep in which grafting was performed, mucoid cysts with pseudo stratified ciliated epithelium were present. Even when the sinus mucosa was perforated (in the dog), the inflammatory process developed in the mucosa did not prevent the integration of the graft and implants. In conclusion, following the sinus lift procedure, changes occur in the sinus membrane to adapt to the new situation, without the appearance of chronic or acute suppurative processes.

  15. The forensic importance of frontal sinus radiographs.

    PubMed

    da Silva, Rhonan Ferreira; Prado, Felippe Bevilacqua; Caputo, Isamara Geandra Cavalcanti; Devito, Karina Lopes; Botelho, Tessa de Luscena; Daruge Júnior, Eduardo

    2009-01-01

    The identification of unidentified human remains through the comparison of antemortem and postmortem radiographs has found wide acceptance in recent years. Reported here is the forensic case of an unidentified adult male who had died as the result of a traffic accident, after which the body was identified by matching images of ante- and postmortem radiographs of the frontal sinus. A general discussion on identification using frontal sinus radiographs is presented, highlighting the reliability of this method, in reference to the uniqueness of the frontal sinus in humans. However, it also notes a few difficulties, especially in reference to the X-ray technique in cases where antemortem radiographs are available and a potentially larger number of anatomical, pathological or traumatic features are present. The comparison of frontal sinus outlines is recommended when it may become necessary to provide quantitative substantiation for forensic identification based on these structures.

  16. Frontal sinus recognition for human identification

    NASA Astrophysics Data System (ADS)

    Falguera, Juan Rogelio; Falguera, Fernanda Pereira Sartori; Marana, Aparecido Nilceu

    2008-03-01

    Many methods based on biometrics such as fingerprint, face, iris, and retina have been proposed for person identification. However, for deceased individuals, such biometric measurements are not available. In such cases, parts of the human skeleton can be used for identification, such as dental records, thorax, vertebrae, shoulder, and frontal sinus. It has been established in prior investigations that the radiographic pattern of frontal sinus is highly variable and unique for every individual. This has stimulated the proposition of measurements of the frontal sinus pattern, obtained from x-ray films, for skeletal identification. This paper presents a frontal sinus recognition method for human identification based on Image Foresting Transform and shape context. Experimental results (ERR = 5,82%) have shown the effectiveness of the proposed method.

  17. Palatal sinus elevation revisited: a technical note.

    PubMed

    Seemann, Rudolf; Wagner, Florian; Ewers, Rolf; Ulm, Christian

    2013-08-01

    The palatal sinus lift is a good choice for patients with scarred buccal soft tissue and those with poor wound healing such as smokers or diabetics or when visual side effects such as swelling must be concealed. We provide a surgical protocol for palatal sinus lifting without a vertical release incision. The incision is started in a slightly palatal aspect, at the distal end of the dental arch, and describes a curve laterally on the alveolar crest while running in a mesial direction. As a marginal incision, it can continue to the central incisor. Submucosal exposure will lift the gum and the greater palatine artery. After insertion of a tongue depressor, the sinus is opened on the palatal side, opposite the zygomaticoalveolar crest, using a rose bur or a piezotome. After sinus augmentation, the incision is easy to close, and the wound will heal smoothly.

  18. Acute venous sinus thrombosis after chickenpox infection.

    PubMed

    Sardana, Vijay; Mittal, Lal Chand; Meena, S R; Sharma, Deepti; Khandelwal, Girish

    2014-08-01

    Chickenpox is one of the classic childhood diseases. Recently chicken pox has been reported in adults with more severe systemic and neurological complications. Cerebral venous thrombosis (CVT) is a life threatening disorder if not treated in time. We report a patient with post varicella CVT as a rare complication of primary Varicella zoster virus. Vasculitic arterial infarction is known while venous stroke has rarely been reported with Varicella-zoster virus infection. Here, we report an immunocompetent 30 yr old male who developed chickenpox after contact with his daughter two month back. He presented with acute neurological deficit, one week after onset of skin lesion. MR venography revealed non-visualisation of left transverse sinus and left sigmoid sinus suggestive of venous sinus thrombosis. Varicella infection is rarely associated with venous sinus thrombosis. Possibly hypercoagulable state produced by the infection or direct invasion of virus in venous endothelial wall with subsequent damage to endothelium leading to thrombosis could be the cause.

  19. A new approach to sinus relief.

    PubMed

    Peroff, R P

    1990-10-01

    You suffer from "sinus". Medical treatment isn't getting you better, and now you need surgery. It is better that you be treated surgically today rather than as in the past. Five years ago, surgery meant an incision through the eyebrow, with probable numbing of the forehead, in order to relieve the pain of acute frontal sinusitis; or a long eyebrow incision, or shaving the front part of the scalp and pulling down the forehead skin from the skull was the procedure of choice for chronic disease in these sinuses. If the cheek sinuses were chronically diseased, an incision was made through the gums above the upper teeth, often resulting in numbing of the teeth and marked swelling of the cheek.

  20. Karst Landforms in Northern Sinus Meridiani, Mars

    NASA Astrophysics Data System (ADS)

    Baioni, D.; Sgavetti, M.; Wezel, F. C.

    2012-03-01

    The abstract shows the results of geomorphologic study in great detail of the northern part of Sinus Meridiani. Here karst-like landforms are observed. Based on the kind and degree, three morpho-units are identified.

  1. Maxillary sinus manifestations of methamphetamine abuse.

    PubMed

    Faucett, Erynne A; Marsh, Katherine M; Farshad, Kayven; Erman, Audrey B; Chiu, Alexander G

    2015-01-01

    Methamphetamines are the second most commonly used illicit drug worldwide and cost the United States health-care system ∼$23.4 billion annually. Use of this drug affects multiple organ systems and causes a variety of clinical manifestations. Although there are commonly known sequelae of methamphetamine abuse such as "meth mouth," there is limited evidence regarding maxillary sinus manifestations. The following cases highlight the initial evaluation and management of two methamphetamine abusers with loculated purulent collections within the maxillary sinus as a result of methamphetamine abuse. Our aim was to delineate the otolaryngologic symptoms associated with the patients' methamphetamine abuse. Computed tomography and magnetic resonance imaging studies revealed loculated purulent collections within the maxillary sinus of probable odontogenic origin in both patients. Methamphetamine abuse leading to rampant caries and poor oral hygiene may predispose individuals for craniofacial infections and fluid collections. These cases illustrate the development of maxillary sinusitis and maxilla mucoceles that have been associated with methamphetamine use.

  2. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    NASA Technical Reports Server (NTRS)

    Smith, M. L.; Ellenbogen, K. A.; Eckberg, D. L.

    1992-01-01

    Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position.

  3. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    NASA Technical Reports Server (NTRS)

    Smith, M. L.; Ellenbogen, K. A.; Eckberg, D. L.

    1992-01-01

    Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position.

  4. Major orbital complications of endoscopic sinus surgery

    PubMed Central

    Rene, C; Rose, G; Lenthall, R; Moseley, I

    2001-01-01

    BACKGROUND—The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss.
METHODS—A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery.
RESULTS—All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply.
CONCLUSION—Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed. 

 PMID:11316724

  5. Ophthalmic manifestations of paranasal sinus mucocoeles.

    PubMed

    Sadiq, S Ahmed; Lim, M Kim; Jones, Nicholas S

    2009-04-01

    To investigate the ophthalmic manifestations of paranasal sinus mucocoeles. A retrospective study of all patients (1992-1998) diagnosed with paranasal sinus mucocoeles. All patients had a CT scan. Of the 45 patients, only 3 (6.7%) did not have ophthalmic symptoms or signs. The most common (64.4%) presenting feature was peri-orbital swelling, often associated with pain and tenderness. Other presenting features included diplopia, proptosis, hypoglobus, diplopia, decreased colour vision, epiphora, facial swelling and nasal polyps. The frontal sinus was the most commonly (70%) involved site. Paranasal sinus mucocoeles present most commonly with ophthalmic symptoms and signs. Patients with this condition are therefore highly likely to present initially to the ophthalmology department. Awareness of the aetiology of this condition is important so that appropriate and timely referral is made to the otolaryngologists to ensure appropriate management of this condition.

  6. Cavernous antioxidant effect of green tea, epigallocatechin-3-gallate with/without sildenafil citrate intake in aged diabetic rats.

    PubMed

    Mostafa, T; Sabry, D; Abdelaal, A M; Mostafa, I; Taymour, M

    2013-08-01

    This study aimed to assess the cavernous antioxidant effect of green tea (GT), epigallocatechin-3-gallate (EGCG) with/without sildenafil citrate intake in aged diabetic rats. One hundred and four aged male white albino rat were divided into controls that received ordinary chow, streptozotocin (STZ)-induced aged diabetic rats, STZ-induced diabetic rats on infused green tea, induced diabetic rats on epigallocatechin-3-gallate and STZ-induced diabetic rats on sildenafil citrate added to EGCG. After 8 weeks, dissected cavernous tissues were assessed for gene expression of eNOS, cavernous malondialdehyde (MDA), glutathione peroxidase (GPx), cyclic guanosine monophosphate (cGMP), and serum testosterone (T). STZ-induced diabetic rats on GT demonstrated significant increase in cavernous eNOS, cGMP, GPx and significant decrease in cavernous MDA compared with diabetic rats. Diabetic rats on EGCG demonstrated significant increase in cavernous eNOS, cGMP, GPx and significant decrease in cavernous MDA compared with diabetic rats or diabetic rats on GT. Diabetic rats on EGCG added to sildenafil showed significant increase in cavernous eNOS, cGMP and significant decrease in cavernous MDA compared with other groups. Serum T demonstrated nonsignificant difference between the investigated groups. It is concluded that GT and EGCG have significant cavernous antioxidant effects that are increased if sildenafil is added.

  7. Subpubic sinus: a remnant of cloaca.

    PubMed

    Chou, T D; Chu, C C; Diau, G Y; Chiang, J H

    1995-05-01

    A 14-month-old girl had purulent discharge from a sinus over the subpubic region for 2 weeks. Radiography and voiding cystourethrography revealed a 4.5 cm. long fistula extending to the retropubic region without any connection to the lower urinary tract. The fistula was excised. Histological findings revealed that the fistula had 3 different types of epithelium: stratified squamous, transitional and columnar. Clinical and pathological findings indicated that the sinus was most likely a remnant of the cloaca.

  8. Massive Intradural Dermoid Cyst Without Sinus Tract.

    PubMed

    Abouhassan, William; Chao, John Kuang; Lehman, James A

    2017-10-01

    Dermoid cysts can present as a rare, benign, congenital intracranial tumor of neuroectoderm origin trapped during embryogenesis. Past clinical reports have reported lesions in the posterior fossa, at the midline, and in the intradural region all in conjunction with a superficial sinus tract. The authors present a unique patient of a completely intracranial, intradural, dermoid tumor of the midline cerebellum devoid of any evidence of sinus tract. The histological characteristics, radiological features, and management of this unusual patient are described.

  9. Giant arachnoid granulation mimicking dural sinus thrombosis

    PubMed Central

    Ayaz, Ercan; Atalay, Basak; Baysal, Begumhan; Senturk, Senem; Aslan, Ahmet

    2017-01-01

    Arachnoid granulations (AG) are composed of dense, collagenous connective tissue that includes clusters of arachnoid cells. They tend to invaginate into the dural sinuses, through which cerebrospinal fluid enters the venous system. AG are most commonly seen at the junction between the middle and lateral thirds of the transverse sinuses near the entry sites of the superficial veins. Presently described is the case of a 21-year-old female who presented at the clinic with recurrent headaches. Magnetic resonance (MR) imaging revealed a 3.5-cm lesion, which extended from confluens sinuum through the superior sagittal sinus. The lesion had created a scallop-shaped area of erosion in the neighboring occipital bone. To exclude sinus thrombosis, MR venography was performed, which displayed a maintained venous flow around the lesion. Headaches were treated symptomatically with medical therapy. Giant AG can be misdiagnosed as dural sinus thrombosis. MR imaging combined with MR venography is the most useful diagnostic tool to differentiate giant AG from dural sinus thrombosis. PMID:28971178

  10. Giant arachnoid granulation mimicking dural sinus thrombosis.

    PubMed

    Ayaz, Ercan; Atalay, Basak; Baysal, Begumhan; Senturk, Senem; Aslan, Ahmet

    2017-01-01

    Arachnoid granulations (AG) are composed of dense, collagenous connective tissue that includes clusters of arachnoid cells. They tend to invaginate into the dural sinuses, through which cerebrospinal fluid enters the venous system. AG are most commonly seen at the junction between the middle and lateral thirds of the transverse sinuses near the entry sites of the superficial veins. Presently described is the case of a 21-year-old female who presented at the clinic with recurrent headaches. Magnetic resonance (MR) imaging revealed a 3.5-cm lesion, which extended from confluens sinuum through the superior sagittal sinus. The lesion had created a scallop-shaped area of erosion in the neighboring occipital bone. To exclude sinus thrombosis, MR venography was performed, which displayed a maintained venous flow around the lesion. Headaches were treated symptomatically with medical therapy. Giant AG can be misdiagnosed as dural sinus thrombosis. MR imaging combined with MR venography is the most useful diagnostic tool to differentiate giant AG from dural sinus thrombosis.

  11. Configuration of frontal sinuses: A forensic perspective

    PubMed Central

    Suman, Jhansi Lakshmi; Jaisanghar, Nallusamy; Elangovan, Somasundaram; Mahaboob, Nazargi; Senthilkumar, Balasubramaniyan; Yoithapprabhunath, Thukanayakanpalayam Ragunathan; Srichinthu, Kenniyan Kumar

    2016-01-01

    Background: Identification of an individual whether living or deceased is of paramount importance in maintaining the integrity of the society. A simple, reliable, and efficacious method always finds a way for easier acceptance and inclusion in any discipline. Likewise, identification of an individual using the radiographic frontal sinus patterns is a simple technique which emphasized to conduct the study with a proven result. Objective: The objective of the study is to evaluate the radiographic configurations of frontal sinuses for their uniqueness based on different parameters. Study Group and Methods: Study group consisted of thirty individuals (15 males and 15 females) of age between 20 and 30. Individuals with the history of sinusitis, surgery, or any trauma were not included in the study. Paranasal sinus views were taken using standard exposure parameters, and the radiographs were assessed for their uniqueness. Results: The radiographs were assessed for area size, area asymmetry, superiority of the upper border, outline of the upper border, presence or absence of partial septa and supraorbital cells, and based on these results, a unique code number was assigned to each individual to prove the uniqueness. Conclusion: A frontal sinus comparison is particularly useful when no other means of an individual identification are available. Caution must be taken regarding the physiological and pathological changes (trauma, infection, old age, surgery, etc.) and postmortem changes and about the technical issues while taking a radiograph (distance, angle, orientation of the skull). In spite of all these issues, the configuration of frontal sinus is an excellent individualizing feature. PMID:27829755

  12. Silent sinus syndrome: A traumatic case.

    PubMed

    Février, E; Vandersteen, C; Castillo, L; Savoldelli, C

    2017-06-01

    Silent sinus syndrome is an unusual cause of progressive enophthalmos and hypoglobus due to atelectasia of the maxillary sinus associated with osteolysis of the orbital floor. This syndrome is classically idiopathic, but the term is also used to describe traumatic or iatrogenic (surgical orbital decompression) cases. We report the case of a 33-year-old man who presented with a left orbital trauma without functional disorder. Computed tomography (CT) scan revealed a nondisplaced fracture of the left orbital floor. No surgical indication was made. Three months later, the patient presented with progressive enophthalmos. CT revealed a complete lysis of the left orbital floor and a left maxillary sinus atelectasia. The original nondisplaced fracture of the orbital floor was not responsible for enophthalmos but the associated fracture of the left uncinate process that induced the closure of the left maxillary sinus infundibulum. This induced in turn hypoventilation of the sinus and a left orbital floor lysis. Treatment consisted in surgical opening of the maxillary sinus ostium and reconstruction of the orbital floor. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Cavernous Hemangioma of the Rib: A Case Report.

    PubMed

    Young Park, Joon; Gyoon Park, Jin; Jin Lee, Seung

    2016-07-01

    Hemangioma of the rib is a rare benign vascular tumor. Herein, we report a 63-year-old man presenting with hemangioma of the left sixth rib. An osteolytic eccentric expansive mass with calcification and focal cortical disruption was detected on chest computed tomography (CT). The mass showed low 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) avidity on positron emission tomography. The patient underwent resection of the left sixth rib. Based on the histopathology findings, a diagnosis of cavernous hemangioma was made. Rib hemangiomas and malignant lesions appear similar on CT scans; therefore, most cases of rib hemangiomas reported in the literature were treated with rib resection. However, rib hemangiomas should be included in the differential diagnosis of an asymptomatic patient if an osteolytic expansive lesion containing sunburst calcifications with low 18F-FDG avidity is observed on a CT scan.

  14. Epileptic Seizures Induced by a Spontaneous Carotid Cavernous Fistula

    PubMed Central

    Yildirim, Erkan

    2016-01-01

    A 79-year-old woman was admitted to our emergency department with complaints of fainting and loss of consciousness three times during the past month. She was diagnosed with epilepsy and started to be treated with antiepileptic drug. Physical examination showed, in the left eye, chemosis, limited eye movements in all directions, and minimal exophthalmos as unexisting symptoms on admission developed on the sixth day. Orbital magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) imaging revealed a carotid cavernous fistula (CCF). Epileptic attacks and ophthalmic findings previously present but diagnosed during our examinations were determined to ameliorate completely after performing the coil embolization. Based on literature, we present the first case with nontraumatic CCF manifesting with epileptic seizures and intermittent eye symptoms in the present report. PMID:28077946

  15. Observations on vapor pressure in SPR caverns : sources.

    SciTech Connect

    Munson, Darrell Eugene

    2010-05-01

    The oil of the Strategic Petroleum Reserve (SPR) represents a national response to any potential emergency or intentional restriction of crude oil supply to this country, and conforms to International Agreements to maintain such a reserve. As assurance this reserve oil will be available in a timely manner should a restriction in supply occur, the oil of the reserve must meet certain transportation criteria. The transportation criteria require that the oil does not evolve dangerous gas, either explosive or toxic, while in the process of transport to, or storage at, the destination facility. This requirement can be a challenge because the stored oil can acquire dissolved gases while in the SPR. There have been a series of reports analyzing in exceptional detail the reasons for the increases, or regains, in gas content; however, there remains some uncertainty in these explanations and an inability to predict why the regains occur. Where the regains are prohibitive and exceed the criteria, the oil must undergo degasification, where excess portions of the volatile gas are removed. There are only two known sources of gas regain, one is the salt dome formation itself which may contain gas inclusions from which gas can be released during oil processing or storage, and the second is increases of the gases release by the volatile components of the crude oil itself during storage, especially if the stored oil undergoes heating or is subject to biological generation processes. In this work, the earlier analyses are reexamined and significant alterations in conclusions are proposed. The alterations are based on how the fluid exchanges of brine and oil uptake gas released from domal salt during solutioning, and thereafter, during further exchanges of fluids. Transparency of the brine/oil interface and the transfer of gas across this interface remains an important unanswered question. The contribution from creep induced damage releasing gas from the salt surrounding the cavern is

  16. Brainstem Hemorrhage Caused by Direct Carotid-Cavernous Fistula

    PubMed Central

    Chan, Fook-How; Shen, Chao-Yu; Liu, Jung-Tung; Li, Cho-Shun

    2014-01-01

    Summary A 34-year-old woman presented with a history of persisting headache for years, and a newly developed dizziness, left facial palsy and right hemiparesis two days prior to this admission. Initial computed tomographic angiography of the head demonstrated an area of increased density in the left middle and posterior fossae. Multiple aneurysmally dilated venous ectasias with contrast enhancement at the left pre-pontine cistern causing a massive mass effect to the brainstem were also noted, suggesting a huge vascular abnormality. Digital subtraction angiography revealed an abnormal vascular lesion surrounding the brainstem, which indicated a left direct carotid-cavernous fistula with posterior drainage. As her consciousness deteriorated the next day, a follow-up computed tomography scan was done which revealed a pontine hemorrhage. Subsequently, endovascular closure of the fistula with sacrifice of the left ICA was performed, which successfully eliminated the imaging abnormalities. PMID:25207913

  17. An Unusual Differential Diagnosis of Orbital Cavernous Hemangioma: Ancient Schwannoma

    PubMed Central

    Ribeiro, Sara Filipa Teixeira; Queirós, Tatiana; Amorim, José M.; Ferreira, Ana M.; Sales-Sanz, Marco

    2017-01-01

    Schwannomas are rare lesions of the orbit that can be confused with cavernous hemangioma on imaging studies. We report the case of an 84-year-old woman with a 9-year history of a tumoral lesion in the inferolateral left orbit. The imaging studies did not reveal specific characteristics, only bone remodeling due to the long evolution of the tumor. The patient underwent complete excision of the tumor by anterior orbitotomy via the inferior conjunctival fornix. The histopathological examination revealed an ancient schwannoma, a variant of schwannoma with uncommon histological features. The follow-up was uneventful. The present case emphasizes the importance of considering neural tumors in the differential diagnosis of orbital masses with bone changes and degenerative alterations such as hemorrhagic areas, cysts, and/or calcifications. PMID:28626414

  18. CNS cavernous haemangioma: "popcorn" in the brain and spinal cord.

    PubMed

    Hegde, A N; Mohan, S; Lim, C C T

    2012-04-01

    Cavernous haemangiomas (CH) are relatively uncommon non-shunting vascular malformations of the central nervous system and can present with seizures or with neurological deficits due to haemorrhage. Radiologists can often suggest the diagnosis of CH based on characteristic magnetic resonance imaging (MRI) features, thus avoiding further invasive procedures such as digital subtraction angiography or surgical biopsy. Although typical MRI appearance combined with the presence of multiple focal low signal lesions on T2*-weighted images or the presence of one or more developmental venous anomaly within the brain can improve the diagnostic confidence, serial imaging studies are often required if a solitary CH presents at a time when the imaging appearances had not yet matured to the typical "popcorn" appearance. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  19. Computed tomography and sonography of cavernous hemangioma of the liver

    SciTech Connect

    Itai, Y.; Ohtomo, K.; Araki, T.; Furui, S.; Iio, M.; Atomi, Y.

    1983-08-01

    Accuracy and limitations of computed tomography (CT) and sonography in the detection and diagnosis of cavernous hemangioma of the liver were analyzed in 39 cases. In 35 of 38 lesions examined by CT before and after bolus contrast enhancement, findings were dense contrast enhancement spreading in all directions on subsequent scans and/or density (other than capsule or septa) higher than normal hepatic parenchyma after 2 min. Lesions smaller than 1 cm were not detected. Misregistration in sequential scane prevented diagnosis of three of nine lesions smaller than 2 cm. Sonography revealed various patterns of mass, but in the smaller lesions, an extremely hyperechoic pattern was dominant. The contributions of CT and sonography depend on the size of the lesions.

  20. Varied appearances of hepatic cavernous hemangiomas with sonography, computed tomography, magnetic resonance imaging and scintigraphy

    SciTech Connect

    Bree, R.L.; Schwab, R.E.; Glazer, G.M.; Fink-Bennett, D.

    1987-11-01

    The incidental detection of an hepatic cavernous hemangioma may create a problem in differential diagnosis. The authors here review the characteristics of hemangiomas as recorded by various types of imaging.