ABSTRACT
A 28-year-old man presented with monostotic fronto-orbital fibrous dysplasia associated with convulsions. Signs of meningeal irritation were observed. Computed tomography (CT) showed right frontal sinusitis, and destruction from the inner to outer table with expansion of the diploic space. T1- and T2-weighted magnetic resonance imaging showed an abnormal low-intensity mass, with heterogeneous gadolinium enhancement. Although the meningitis resolved, signs of infection continued for 2 months due to sinusitis. Treatment of the right frontal sinusitis was undertaken, accompanied by open biopsy. The histological diagnosis was fibrous dysplasia. Once the infection had completely resolved, orbitofrontal reconstruction was undertaken. Cranioplasty was carried out using cranial bone cement. Three-dimensional CT was valuable to show the likely postoperative result.
Subject(s)
Fibrous Dysplasia, Monostotic/complications , Frontal Bone/pathology , Orbit/pathology , Seizures/etiology , Adult , Bone Cements , Craniotomy , Ethmoid Sinusitis/complications , Fibrous Dysplasia, Monostotic/diagnosis , Fibrous Dysplasia, Monostotic/diagnostic imaging , Fibrous Dysplasia, Monostotic/surgery , Frontal Bone/diagnostic imaging , Frontal Bone/surgery , Frontal Sinusitis/complications , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Meningitis/complications , Orbit/diagnostic imaging , Orbit/surgery , Tomography, X-Ray ComputedABSTRACT
We presented a case of neurofibromatosis type I (NF-1) associated with an extracranial arteriovenous fistula (AVF) fed by the occipital and vertebral artery. A 20-year-old man was referred to our hospital because of an occipital subcutaneous pulsatile mass. A CT scan showed a huge subcutaneous enhanced mass. Angiography revealed that the occipital AVF was fed by bilateral occipital arteries, the left ascending pharyngeal artery, the left middle cerebral artery, and the left vertebral artery with-abundant communication with the subcutaneous veins. Endovascular treatment by using both coil and glue (Eudragid) embolization via the occipital artery successfully obliterated the AVF. Subsequently surgical operation was performed. Postoperative angiography showed the disappearance of the AVF. Combination of intravascular surgery and surgical operation should be considered as an effective treatment for NF-1 associated with AVF.