ABSTRACT
BACKGROUND: Propofol and remifentanil intravenous combination is one popular form of total intravenous anesthesia (TIVA) in mainstream clinical practice, but it has rarely been applied to a rat model for laryngoscopy and laryngeal electromyography (LEMG). Our objective was to establish a safe and reproducible general anesthetic protocol for laryngoscopy and endoscopic LEMG in a rat model. Our hypothesis is that TIVA allows a minimally morbid, and feasible laryngoscopy and LEMG. METHODS: Sprague Dawley rats were subjected to either inhalational anesthesia (IA) (isoflurane) or TIVA (propofol and remifentanil) and underwent laryngoscopy and LEMG. The primary outcome was a complete minimally interrupted rigid laryngoscopy and obtaining reproducible motor unit potentials from the posterior cricoarytenoid muscles. The secondary outcome was morbidity and mortality. RESULTS: Seventeen out of twenty-two rats underwent both TIVA and IA. Only two underwent IA only. All nineteen rats that underwent IA had a successful experiment. Seventeen rats underwent TIVA, however, only nine completed a successful experiment due to difficulty achieving a surgical plane, and respiratory events. Upon comparing the success of the two anaesthetic regimens, IA was superior to TIVA (P = 0.0008). There was no statistical difference between the amplitudes (p = 0.1985) or motor units burst duration (p = 0.82605) of both methods. Three mortalities were encountered, one of which was due to lidocaine toxicity and two were during anesthetic induction. Respiratory related morbidity was encountered in two rats, all seen with TIVA. CONCLUSIONS: TIVA is not an ideal anesthetic regimen for laryngeal endoscopy and LEMG in rat models. Contrary to our hypothesis, IA did not affect the quality of the LEMG and allowed a seamless rigid endoscopy.
Subject(s)
Anesthetics, Inhalation/adverse effects , Electromyography/methods , Isoflurane/administration & dosage , Laryngoscopy/methods , Propofol/administration & dosage , Anesthesia, Intravenous/methods , Animals , Disease Models, Animal , Male , Random Allocation , Rats , Rats, Sprague-Dawley , Remifentanil , Sensitivity and SpecificityABSTRACT
BACKGROUND: Drug induced sleep endoscopy (DISE) is hoped to identify reasons of failure of adenotonsillectomy (AT) in treating pediatric sleep disordered breathing (SDB). Maxillomandibular disproportion has been studied as another association which may explain alternative pathogenesis of SDB. We aimed to explore the relation between the size of the gonial angle and inclination of the epiglottis measured from cone beam CT (CBCT) and tongue base collapse based on DISE in children with SDB. METHOD: A retrospective chart review was conducted at a tertiary pediatric center. Children (6-17 years old) assessed at a multi-disciplinary Upper Airway Clinic, diagnosed with SDB and maxillo-mandibular disproportion (MMD), and who underwent DISE were eligible. Variables obtained from the electronic medical records of the clinic and prospective database included demographics, comorbidities, surgeries performed, investigations, DISE findings and CBCT findings. The gonial angle of subjects with and without tongue base collapse (TBC) on SNP were compared. RESULTS: In total 29 patients (13 male, 8 female) age 6-17 (median= 9) were eligible for the study from January 2009 - July 2016. We included 11 subjects, and 10 comparators. The mean gonial angle of the TBC group was 139.3°± 7.6°, while that of the comparison group was 129.4°±3.5 (mean difference -9.937, 95% CI of -15.454 to - 4.421, P = 0.001, power of test 0.95). Additionally, the mean inclination of the epiglottis had a mild positive correlation (r=0.32, p<0.05) with the gonial angle, in the whole cohort. CONCLUSIONS: This pilot study suggests that TBC may be mediated by a wider gonial angle in children with SDB patients. The posterior tilt of the epiglottis on CBCT may be a surrogate sign of TBC.
Subject(s)
Mandible/diagnostic imaging , Sleep Apnea Syndromes/etiology , Snoring/etiology , Tongue/diagnostic imaging , Adenoidectomy , Adolescent , Body Weights and Measures , Child , Child, Preschool , Cone-Beam Computed Tomography , Female , Humans , Male , Pilot Projects , Retrospective Studies , Sleep Apnea Syndromes/diagnostic imaging , Sleep Apnea Syndromes/surgery , Snoring/diagnostic imaging , Tonsillectomy , Treatment FailureSubject(s)
Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Non-Hodgkin/diagnosis , Skull Neoplasms/diagnosis , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Female , Humans , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/radiotherapy , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/radiotherapy , Magnetic Resonance Imaging , Remission Induction , Rituximab/administration & dosage , Skull Neoplasms/drug therapy , Skull Neoplasms/radiotherapy , Vincristine/administration & dosageABSTRACT
The fungus Cryptococcus neoformans can cause common opportunistic infection in acquired immune deficiency syndrome (AIDS) patients. But other conditions can be associated with sarcoidosis. Meningoencephalitis is the most common manifestation of this disease. One of the most important neurological complications is the development of intracranial hypertension (ICH), which may result in high morbidity and mortality. We report the case of a patient harboring a ventriculoperitoneal shunt, and having contracted a cryptococcal meningitis as a risk factor for pulmonary sarcoidosis. Brain MRI showed arachnoiditis, with a mass in contact with the right frontal horn. Indian ink staining of the cerebrospinal fluid (CSF) showed positivity that was confirmed by the identification of Cryptococcus neoformans after culture. The evolution was favorable under medical treatment with removal of material. The relationship between sarcoidosis and cryptococcosis, described in the literature is not coincidental but is a rare complication of sarcoidosis of potential severity (40% of mortality). Sarcoidosis is a common systemic disease that may increase host susceptibility to CNS cryptococcal infection without any other signs or symptoms of host immunosuppression. The diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.
Subject(s)
Arachnoiditis/etiology , Meningitis, Cryptococcal/etiology , Prosthesis-Related Infections/etiology , Sarcoidosis, Pulmonary/complications , Ventriculoperitoneal Shunt/adverse effects , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Arachnoiditis/cerebrospinal fluid , Arachnoiditis/diagnosis , Arachnoiditis/drug therapy , Arachnoiditis/microbiology , Carbon , Cerebrospinal Fluid/microbiology , Coloring Agents , Confusion/etiology , Cryptococcus neoformans/isolation & purification , Disease Susceptibility , Drug Therapy, Combination , Flucytosine/administration & dosage , Flucytosine/therapeutic use , Humans , Magnetic Resonance Imaging , Male , Meningitis, Cryptococcal/cerebrospinal fluid , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/drug therapy , Middle Aged , Prosthesis-Related Infections/cerebrospinal fluid , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/drug therapy , Psychomotor Agitation/etiology , Staining and LabelingABSTRACT
Tuberous sclerosis is a phacomatosis resulting from an autosomal dominant inheritance. It is characterized by the presence of multiple hamartomas in various organs, especially the brain, the skin, the kidneys and the heart. The diagnosis of tuberous sclerosis is based on imaging and clinical examination, where magnetic resonance imaging constitutes the key investigation showing characteristic brain lesions. Neuro-encephalic manifestations may be particularly severe, and may even be life threatening. The authors report personal cases series and review the literature highlighting epidemiology, clinical features and imaging of neuro-encephalic tuberous sclerosis.
Subject(s)
Brain/pathology , Neurons/pathology , Tuberous Sclerosis/pathology , Tuberous Sclerosis/physiopathology , Brain/diagnostic imaging , Brain/physiopathology , Diagnosis, Differential , Humans , Mental Disorders/diagnosis , Mental Disorders/etiology , Mental Disorders/pathology , Nervous System Diseases/diagnosis , Nervous System Diseases/etiology , Nervous System Diseases/pathology , Neuroimaging/methods , Neurons/diagnostic imaging , Neurons/physiology , Radiography , Tuberous Sclerosis/complications , Tuberous Sclerosis/diagnosisABSTRACT
Thalamo-mesencephalic neuroepithelial cysts are rare lesions of the central nervous system. They are thought to arise from neuroectoderm and are also referred to as ependymal cysts due to their origin. It can remain asymptomatic throughout life or rarely can cause symptoms. We describe a 42-year-old woman who presented with thalamic syndrome due to a neuroepithelial cyst of the thalamo-midbrain. Differential diagnosis is made with other cystic lesions in the brain. However a good analysis of imaging feature led to diagnosis. When the lesion is symptomatic, mini-invasive procedure is indicated.
Subject(s)
Central Nervous System Cysts/diagnosis , Central Nervous System Cysts/pathology , Neoplasms, Neuroepithelial/diagnosis , Neoplasms, Neuroepithelial/pathology , Thalamic Diseases/diagnosis , Adult , Central Nervous System Cysts/surgery , Diagnosis, Differential , Female , Humans , Mesencephalon/pathology , Neoplasms, Neuroepithelial/surgery , Neurosurgical ProceduresABSTRACT
Paranasal sinus injuries by foreign bodies have a lower incidence compared with facial injuries. Among them, penetrating maxillofacial injuries to the sphenoid sinus and skull base remain rare. We report the case of a 41-year-old man who presented with, after a missile-related maxillofacial injury, a metallic foreign body enclosed within the sphenoid sinus with carotid-canal fracture. Angiographic evaluation showed a mass in the right internal carotid artery. The foreign object was successfully extracted through a transmaxillary sublabial approach with a good outcome. We discuss the extensive preoperative evaluation and interdisciplinary management of this unusual injury.
Subject(s)
Blast Injuries/diagnostic imaging , Blast Injuries/surgery , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Skull Fractures/diagnostic imaging , Skull Fractures/surgery , Sphenoid Sinus/injuries , Adult , Humans , Male , Metals , Skull Fractures/etiology , Tomography, X-Ray ComputedABSTRACT
STUDY DESIGN: Case report of a rare form of idiopathic spinal epidural lipomatosis (SEL) manifesting with relapsing and remitting course. OBJECTIVE: To describe this very rare clinical and pathological condition and the results of surgical intervention. SETTING: A department of neurosurgery in Morocco. METHODS: A 24-year-old man presented with a 2-year history of mid-thoracic back pain and progressive neurogenic claudication with two episodes of remitting and relapsing course. Spinal magnetic resonance imaging revealed a fatty epidural mass extending from T4 to T9. Posterior decompression was performed, and he was followed for 3 years after the operation. RESULTS: Pathological examination of the surgical specimen revealed nodules of mature fat cells without neoplasm. The patient's symptoms completely resolved after surgical decompression. CONCLUSION: Fluctuating clinical course has not been reported previously in SEL. Such pathology should be considered in the differential diagnosis of demyelinating diseases.
Subject(s)
Lipomatosis/diagnosis , Lipomatosis/pathology , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/pathology , Adult , Decompression, Surgical , Demyelinating Diseases/diagnosis , Demyelinating Diseases/pathology , Diagnosis, Differential , Epidural Space , Humans , Lipomatosis/surgery , Magnetic Resonance Imaging , Male , Recurrence , Remission, Spontaneous , Spinal Cord Diseases/surgery , Thoracic Vertebrae/pathologyABSTRACT
Mesenchymal chondrosarcoma is a highly malignant and extremely rare tumor of the orbit: only 18 cases have been reported to date. We report a case of spheno-orbital mesenchymal chondrosarcoma in a 36-year-old woman presented with a 4-month history of progressive left exophthalmia and temporal mass. A CT-scan of the orbit and MRI showed a spheno-orbital mass, with temporal fossa extension, fed by the internal maxillary artery visible on cerebral angiography. Surgery via a transcranial, left frontotemporozygomatic approach after selective embolization enabled subtotal removal. Definitive histologic examination revealed mesenchymal chondrosarcoma. Postoperatively, exophthalmia spectacularly regressed. We report our clinical findings and present a review of the literature.
Subject(s)
Bone Neoplasms/surgery , Chondrosarcoma/surgery , Skull/surgery , Adult , Bone Neoplasms/diagnostic imaging , Chondrosarcoma/diagnostic imaging , Chondrosarcoma/radiotherapy , Combined Modality Therapy , Exophthalmos/etiology , Female , Humans , Magnetic Resonance Imaging , Radiotherapy/methods , Skull/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Intraosseous cavernous hemangiomas are a rare finding in the calvarium. It is a benign tumors arising from the intrinsic vasculature of the bone. We report one case observed in a 31 year-old female, presented with a progressive left parietal mass. A plain X-ray of the skull and cranial CT-scan showed a osteolytic lesion in the left parietal bone. Surgery consisted of total resection of the lesion and cranioplasty. The postoperative course was uneventful. Histological study revealed a cavernous hemangioma of the diploe. In view of this observation and the literature review, clinical; radiological and therapeutic aspect of this rare entity are discussed.
Subject(s)
Hemangioma, Cavernous/pathology , Parietal Bone/pathology , Skull Neoplasms/pathology , Adult , Female , Hemangioma, Cavernous/surgery , Humans , Skull Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
The authors report the case of a 35-years-women with a thoracic disc herniation, who presented with seven years history of episodic acute ureteric colic. An early diagnosis of a spinal disc herniation was made difficult by the absence of neurological findings. Imaging studies showed no lesion in the genito-urinary tract. Magnetic resonance imaging demonstrated a postero-lateral disc herniation at T10-T11 level. The pain disappeared immediately after surgery decompression. A literature search showed that acute ureteric colic associated with a lower thoracic disc herniation has not been previously reported.
Subject(s)
Back Pain/etiology , Colic/diagnosis , Diagnostic Errors , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/diagnosis , Kidney Diseases/diagnosis , Thoracic Vertebrae/pathology , Adult , Decompression, Surgical , Diagnosis, Differential , Female , Humans , Intervertebral Disc Displacement/pathology , Lumbosacral Region , Magnetic Resonance Imaging , Time FactorsABSTRACT
Liponeurocytoma (lipomatous medulloblastoma) is an uncommon clinicopathologic entity. We report a case of cerebellar liponeurocytoma in an adult and attempt to better characterize this uncommon lesion. A 43-year-old woman presented with symptoms and signs of increased intracranial pressure and cerebellar dysfunction. CT and MRI showed a heterogeneous well-circumscribed mass in the left cerebellar hemisphere with hydrocephalus. Complete surgical excision of the tumor was accomplished through a suboccipital craniotomy. Pathological examination with immunohistochemical study revealed a medulloblastoma with neuronal, astrocytic and lipomatous differentiation. Postoperative radiation therapy was given. After surgery, the patient was followed up for a 16 month-period; symptoms improved dramatically and no evidence of tumor recurrence was found. Careful analysis of the histopathological and immunohistochemical studies correctly identifies liponeurocytoma (lipomatous medulloblastoma). To our knowledge, only 16 cases have been reported. Although this lesion appears to have a better prognosis than the conventional form of adult medulloblastoma, complete surgical removal with postoperative radiation therapy is recommended.
Subject(s)
Cerebellar Neoplasms/diagnosis , Magnetic Resonance Imaging , Medulloblastoma/diagnosis , Neurologic Examination , Tomography, X-Ray Computed , Adult , Cerebellar Neoplasms/pathology , Cerebellar Neoplasms/radiotherapy , Cerebellar Neoplasms/surgery , Cerebellum/pathology , Cerebellum/surgery , Combined Modality Therapy , Female , Humans , Hydrocephalus/diagnosis , Hydrocephalus/pathology , Hydrocephalus/surgery , Medulloblastoma/pathology , Medulloblastoma/radiotherapy , Medulloblastoma/surgery , Prognosis , Radiotherapy, AdjuvantABSTRACT
Non-dysraphic spinal cord lipomas are rare benign lesions, accounting for approximately 1% of all spinal cord tumors. Patients usually present with long histories of disability followed by rapid progression of their symptoms. Presenting symptoms include spinal pain, dysesthesic sensory changes, gait difficulties, weakness, and incontinence. Magnetic resonance imaging is the examination of choice. The T1- and T2-weighted images show increased and decreased signal intensity, respectively. The goal of intervention is decompression and generous debulking following by duraplasty. Early diagnosis of spinal cord lipomas and early surgery is advanced prior to irreversible disease progression. One new case of true non-dysraphic cervicodorsal spinal cord lipoma is reported.
Subject(s)
Lipoma/pathology , Spinal Cord Neoplasms/pathology , Spinal Dysraphism/pathology , Adult , Humans , Lipoma/surgery , Magnetic Resonance Imaging , Male , Spinal Cord/pathology , Spinal Cord Neoplasms/surgery , Treatment OutcomeABSTRACT
Intradiploic epidermoid cyst of the skull is a rare clinical entity that can exceptionally grow to a large size with intracranial extension. The authors report the case of a 38-year-old man with a giant epidermoid cyst of the parietal bone with extra and intracranial extension, presenting with focal neurological symptoms. The diagnosis was suggested at imaging (skull radiographs, CT and MRI), and confirmed at histology. Complete removal of the cyst and its capsule was performed followed by cranioplasty. Postoperatively, the patient was discharged free of symptoms. CT scan provides good evaluation of the bony lesion and may suggest intracranial extension. MRI is superior for evaluation of cerebral compression. The pathogenesis, clinical presentation, diagnostic evaluation and therapeutic management of these rare lesions are reviewed.
Subject(s)
Bone Diseases/diagnosis , Epidermal Cyst/diagnosis , Skull , Adult , Biopsy , Bone Diseases/complications , Bone Diseases/epidemiology , Bone Diseases/surgery , Diagnosis, Differential , Epidermal Cyst/complications , Epidermal Cyst/epidemiology , Epidermal Cyst/surgery , Headache/etiology , Humans , Magnetic Resonance Imaging , Male , Methylmethacrylate/therapeutic use , Prognosis , Tomography, X-Ray ComputedSubject(s)
Brain Abscess/microbiology , Cerebellar Diseases/microbiology , Gram-Positive Bacterial Infections/microbiology , Lactococcus lactis/pathogenicity , Anti-Bacterial Agents , Brain Abscess/diagnosis , Brain Abscess/surgery , Cerebellar Diseases/diagnosis , Cerebellar Diseases/surgery , Combined Modality Therapy , Drug Therapy, Combination/therapeutic use , Female , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/surgery , Humans , Microbial Sensitivity Tests , Middle Aged , Mouth/microbiology , Postoperative Complications/diagnosis , Postoperative Complications/microbiology , Postoperative Complications/surgery , Suction , Surgery, Oral , Tomography, X-Ray Computed , VirulenceABSTRACT
The authors report an unusual case of spinal tuberculosis involving the posterior arch of T12 without disk lesion in a 20-year-old woman presenting with posterior compression of the spinal cord. The diagnosis was suggested at CT and MR imaging and confirmed by histological study after surgical resection. CT provides good evaluation of the bony lesion and may suggest intraspinal extension. MRI is superior for evaluation of cord compression. The patient improved after surgical and medical treatment. The imaging features of this entity are reviewed.