Pterygopalatine Fossa: Microsurgical Anatomy and its Relevance for Skull Base Surgery

Introduction The purpose of this study was to define the anatomical relationships of the pterygopalatine fossa (PPF) and its operative implications in skull base surgical approaches. Methods Ten cadaveric heads were dissected at the Dianne and M Gazi Yasargil Educational Center MicrosurgicaLaboratory, in Little Rock, AK, USA. The PPF was exposed through an extended dissection with mandible and pterygoid plate removal. Results The PPF has the shape of an inverted cone. Its boundaries are the pterygomaxillary fissure; themaxilla, anteriorly; themedial plate of the pterygoid process, and greater wing of the sphenoid process, posteriorly; the palatine bone,medially; and the body of the sphenoid process, superiorly. Its contents are the maxillary division of the trigeminal nerve and its branches; the pterygopalatine ganglion; the pterygopalatine portion of the maxillary artery (MA) and its branches; and the venous network. Differential diagnosis of PPF masses includes perineural tumoral extension along the maxillary nerve, schwannomas, neurofibromas, angiofibromas, hemangiomas, and ectopic salivary gland tissue. Transmaxillary and transpalatal approaches require extensive resection of bony structures and are narrow in the deeper part of the approach, impairing the surgical vision and maneuverability. Endoscopic surgery solves this problem, bringing the light source to the center of the surgical field, allowing proper visualization of the surgical field, extreme close-ups, and different view angles. Conclusion We provide detailed information on the fossa's boundaries, intercommunications with adjacent structures, anatomy of the maxillary artery, and its variations. It is discussed in the context of clinical affections and surgical approaches of this specific region, including pterygomaxillary disjunction and skull base tumors.

Tumor de células de la granulosa: neoplasia estromal de los cordones sexuales: revisión de la literatura, a propósito de dos casos clínicos / Granulosa cell tumor: stromal neoplasm of the sexual cords: review of the literature and clinical cases

Los tumores de las células de la granulosa, hacen referencia a un conjunto de neoplasias derivadas del tejido estromal de los cordones sexuales, secretores de estrógenos, que corresponden al 1-5% de todos los tumores malignos del ovario, aunque pueden presentar localizaciones extraováricas. Son tumores raros e infrecuentes, cuya incidencia general varía de 0,4 a 1,7 casos por cada 100.000 mujeres al año. Se clasifican en dos grupos diferenciados en función de la edad de las pacientes, su historia natural y sus características patogénicas: tumores de células de la granulosa tipo adulto (TCGA) o tipo juvenil (TCGJ). El diagnóstico de esta rara patología se basa en cuatro pilares fundamentales, por un lado, las manifestaciones clínicas y la confirmación mediante pruebas de imagen, y, por otro lado, los marcadores tumorales y el estudio inmunohistoquímico de las muestras biológicas. En el manejo terapéutico de los estadios iniciales de la enfermedad (supervivencia a los 5 años superior al 90% en los estadios I), se recomienda el tratamiento quirúrgico mediante histerectomía con anexectomía bilateral en pacientes con TCGA y deseos genésicos cumplidos, reservando la anexectomía unilateral para los casos de TCGJ o para aquellas pacientes sin descendencia (aunque con posterioridad se recomienda completar el tratamiento). La quimioterapia sistémica postoperatoria se incluye cuando existe extensión extraovárica o recurrencia de la enfermedad. La tasa de recidiva (considerado uno de los principales factores de mal pronóstico), es alta en estadios avanzados, aunque la probabilidad de desarrollar metástasis a distancia es baja.

Tumors of the granulosa cells refer to a set of neoplasms derived from the stromal tissue of the sex cords, secretory of estrogens. They correspond to 1-5% of all malignancies of the ovary, though they may have extraovarian locations. These tumors are rare and uncommon, whose general incidence may vary from 0.4 to 1.7 cases per 100,000 women per year. They are classified into two groups depending on the age of the patients, their natural history and their pathogenic characteristics: adult type tumors of the granulosa cell (AGCT) or juvenile type (JGCT). The diagnosis of this rare pathology is based on the study of clinical manifestations and confirmation through image tests, and also on tumor markers tests and the immunohistochemical study of biological samples. In the therapeutic handling of the early stages of the disease (5-year survival greater than 90% in stage I), surgical treatment via hysterectomy with bilateral adnexectomy in patients with AGCT and met genesic perspectives is recommended; for the cases of JGCT or for those patients without progeny, preserving the unilateral adnexectomy is justified (although completion of the treatment is recommended at later stages). Postoperative systemic chemotherapy is practiced when there is extraovarian extension or recurrence of the disease. The rate of relapse (considered one of the main factors of poor prognosis), is high in advanced stages, although the probability of developing distant metastasis is low.

The Val66Met polymorphism at the BDNF gene does not influence Wisconsin Card Sorting Test results in children and adolescents with bipolar disorder

OBJECTIVES: To assess the role of the Val66Met polymorphism at the brain-derived neurotrophic factor (BDNF) gene on the performance of children and adolescents with bipolar disorder [juvenile bipolar disorder (JBD)] on the Wisconsin Card Sorting Test (WCST). METHODS: Children and adolescents were assessed by the K-SADS-PL and a clinical evaluation for BD and comorbid conditions. Manic and depressive symptoms were assessed with the Young Mania Rating Scale and the Children Depression Rating Scale - Reviewed. The Val66Met polymorphism at the BDNF was genotyped from a blood sample. Patients' IQ and executive functions were assessed by a standard cognitive flexibility test (WCST). RESULTS: Fifty-three subjects were included in the study. No significant difference was observed between the Val/Val and Val/Met+Met/Met groups on any WCST scores in the MANCOVA (F48,5 = .76; p = .59; Perseverative Errors, p = .66; Nonperseverative Errors, p = .58; Categories Completed, p = .34; Attempts to Reach First Category, p=.64; and Percentage of Conceptual Level Responses, p = .99). CONCLUSIONS: Our findings from this sample of children and adolescents with BD do not replicate results from studies of adults and suggest the existence of differences in the neurobiology of this disorder across the life cycle. Investigations of larger samples are necessary to confirm these data.