Transoccipital power-based color-coded duplex sonography of cerebral sinuses and veins. (65/71)

BACKGROUND AND PURPOSE: Power-based transcranial color-coded duplex sonography is a new development for cerebrovascular imaging that is suited for detection of slow velocities. The purpose of this study was to evaluate the ability of this technique to detect cerebral sinuses and veins by means of the occipital window and to provide reference data. METHODS: The straight and inferior sagittal sinuses, great and internal cerebral veins, and basal veins were insonated in 120 normal subjects. The number of identified vessels, peak systolic (PSV) and end-diastolic (PDV) velocities, and resistance indices were determined. RESULTS: In subjects aged 20 to 59 years, straight sinuses were identified in 81% and great and internal cerebral veins in 34%. In subjects aged 60 to 79 years, straight sinuses were detected in 50%, great cerebral veins in 20%, and internal cerebral veins in 13%. All insonated inferior sagittal sinuses and basal veins were missed. Velocities were highest in straight sinuses (PSV, 35 [7 to 64] cm/s; PDV, 23 [2 to 43] cm/s), slower in great cerebral veins (PSV, 23 [12 to 34] cm/s; PDV, 16 [7 to 26] cm/s), and slowest in internal cerebral veins (PSV, 14 [10 to 18] cm/s; PDV, 10 [5 to 15] cm/s) (mean with 95% confidence intervals [CIs]). Straight sinus velocities decreased with age for PSV (20 to 39 years, 40 [7 to 73] cm/s; 60 to 79 years, 28 [9 to 46] cm/s; P < .01) and PDV values (20 to 39 years, 28 [4 to 52] cm/s; 60 to 79 years, 16 [5 to 26] cm/s; P < .001) (mean with 95% CIs) and were higher in women than men in the group aged 20 to 39 years. (P < .05). Resistance indices increased with age in the straight sinus (20 to 39 years, 0.30 [0.18 to 0.42]; 60 to 79 years, 0.42 [0.31 to 0.53]; P < .001) (mean with 95% CIs). CONCLUSIONS: Transoccipital power-based color-coded duplex sonography enabled imaging and velocity measurements in the straight sinus of subjects aged 20 to 59 years. In elder subjects detection rate of the straight sinus decreased, and it was low for deep cerebral veins in all age groups.  (+info)

Approaches and reconstruction in skull base operation. (66/71)

OBJECTIVE: To design convenient lateronasal and infrafrontal approaches or lateronasal subvolution approach to radically resect skull base tumors involving cranial cavity. METHODS: From 1987 through 1994, 22 patients with malignant tumors, 6 with benign tumors, one with a giant sphenoid sinus cyst and one with intranasal meningoencephalocele underwent the operation. Twenty-three cases had anterocranial fossa involved; 4, midcranial fossa; 2, anteromedial cranial fossa; and 1 case, posteromedial cranial fossa. Among the patients with malignant tumors, 11 underwent expansive maxillectomy and 10 had orbital contents resected. The intracranial approaches through lateronasal and infrafront (21 cases), nasal columella lateral subvolution (3 cases) and other approaches were used. RESULTS: The reconstruction of bony skull base defect in excess of 3.00 cm x 3.00 cm with total front musculocutaneous flap (8 cases), galeal and pericranial flap (5 cases) or other tissues (3 cases) has effectively prevented meningoencephalocele. Twelve cases had the dura resected in a range of 2.00 cm x 2.00 cm to 7.00 cm x 6.00 cm. Reconstruction of the dura defect with autofascia lata in 9 cases and other tissues in 3 cases effectively prevented the cerebrospinal fluid leak. Eight of 22 (36.4%) patients with malignant tumors have been alive and free of disease for 3-7 years after the operation. Six patients with benign tumors, one patient with giant sphenoid sinus cyst and one with meningoencephalocele were cured with this reconstructing method. CONCLUSIONS: Frontal musculocutaneous and pericranial flaps have advantages over free bone because of easy surviving and easy operating without occurrence of osteonecrosis and exclusive reaction.  (+info)

Morphogenic mechanisms in the development of ethmoidal sinuses. (67/71)

BACKGROUND: The current teaching in regard to the development of paranasal sinuses is that they are evaginations of the nasal cavity; this seems to totally ignore earlier observations. METHODS: Serial coronal sections of the heads of 23 human fetuses from 18-mm CR length to 282-mm CR length were stained by various methods and studied. RESULTS: The ethmoidal sinuses develop by the formation of 'turbinal cushions' at the 33-mm CR stage. By the 45-mm CR stage, the cushions have grown toward each other and made contact. The epithelium covering the cushions also proliferates to fill up the enclosed space, and it proliferates dorsoventrally as well. The cushions fuse at the 50-mm CR stage. The fusion part of the process should be described as a 'constriction' of the nasal cavity. Next, the epithelium disintegrates and results in the formation of the sinus. This part of the process only can be described as an 'evagination' of the nasal cavity. As the advancing epithelium of the sinus encounters cartilage, it causes disintegration of the developing nasal cartilage. This area of disintegration appears as a spot stained pink with H & E, black with mucicarmine, and yellow with van Gieson's stains, respectively. These spots are seen between the 89-mm and the 225-mm CR stages (both inclusive). CONCLUSIONS: Two mechanisms operate in the development of ethmoidal sinuses: constriction of the nasal cavity by a pair of turbinal cushions, and evagination from the nasal cavity by proliferation and subsequent disintegration of the nasal epithelium.  (+info)

Self-induced ethmoidectomy from rhinotillexomania. (68/71)

A 53-year-old woman with a long history of compulsive nose picking (rhinotillexomania) presented with a large, self-inflicted nasal septal perforation and right-sided penetration of the ethmoidal sinus, or "ethmoidectomy."  (+info)

Sphenoethmoidal mucoceles with intracranial extension--three case reports. (69/71)

Three unusual cases of sphenoethmoidal mucoceles with rare intracranial extension are reported. A 64-year-old female presented with a 7-month history of right visual disturbance. Computed tomography (CT) and magnetic resonance (MR) imaging demonstrated a huge mass in the right middle fossa. She underwent right frontotemporal craniotomy. Postoperatively, her proptosis and cranial nerve dysfunction had improved markedly. A 53-year-old female complained of headache, nausea, and dizziness. CT and MR imaging revealed a cystic mass filling the right sphenoid sinus. The cystic lesion was evacuated through the transnasal approach. She was doing well postoperatively and has been asymptomatic. A 39-year-old male complained of headache, vomiting, and right visual disturbance. CT and MR imaging demonstrated a homogeneous mass occupying the sphenoid sinus. Sphenoidotomy exposed the cyst extending superiorly into the anterior cranial fossa. He recovered from the visual disturbances and has been asymptomatic since. MR imaging provides confirmation of the diagnosis of sphenoethmoidal mucocele and is important for preoperative evaluation.  (+info)

Antral-ethmoidal decompression in Graves' disease. Five-year experience. (70/71)

The orbital manifestations of Graves' disease frequently constitute the major and distressing portion of the morbidity in this poorly understood process. Patients with optic neuropathy, exposure keratopathy or disfiguring proptosis may be aided considerably by decompression to permit swollen orbital contents to move into the maxillary and ethmoid sinus cavities. Experience with 38 patients treated over a five-year period indicates that antral-ethmoidal decompression is a logical, successful form of therapy and generally free of serious complications. it may provide benefit earlier in the course of Graves' exophthalmopathy than has been accepted in the past.  (+info)

Subperiosteal hematoma of the orbit associated with sinusitis. (71/71)

Subperiosteal hematoma of the orbit is a rare but well-recognized entity, usually caused by trauma. Two cases of subperiosteal hematoma associated with sinusitis are presented. A 44-year-old woman experienced the sudden onset of proptosis, and decreased visual acuity. Computed tomographic scanning and magnetic resonance imaging revealed a frontoethmoidal mucocele and a biconvex mass in the upper part of the left orbit. The mucocele was drained during nasal endoscopic surgery and the subperiosteal hematoma was evacuated during superior orbitotomy. A 42-year-old man had a headache and proptosis. Computed tomographic scan revealed sinusitis and subperiosteal orbital hematoma of the left orbit. Subperiosteal orbital hematoma associated with sinusitis is extremely rare but should be suspected in a patient with acute onset of proptosis in whom computed tomographic scanning reveals paranasal sinusitis.  (+info)