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1.
World Neurosurg ; 103: 951.e5-951.e12, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28433840

ABSTRACT

BACKGROUND: We describe a rare case of a sphenoid sinus myxoma that was resected via an endoscopic endonasal skull base approach. We review the literature regarding these rare tumors of the paranasal sinuses. CASE DESCRIPTION: A 72-year-old woman was diagnosed with an incidental sphenoid sinus tumor and left sphenoid wing meningioma during a workup for left-sided proptosis and diplopia. Biopsies of the sphenoid wing and sphenoid sinus tumors were obtained. After undergoing surgical resection of the meningioma, the patient then underwent definitive resection of the sphenoid sinus myxoma via endoscopic endonasal skull base approach. Postoperative imaging demonstrated a gross total resection. The patient suffered postoperative thromboembolic complications due to underlying hypercoagulable state but made a complete recovery and returned to her neurologic baseline. There has been no evidence of recurrent myxoma in the sphenoid sinus 24 months after surgery. DISCUSSION: Myxomas are benign tumors derived from primitive mesenchyme. Myxomas very rarely present in the paranasal or skull base location. Complete surgical resection is the primary treatment for these tumors. The endoscopic endonasal approach is an effective technique for resecting various benign and more aggressive extradural skull base tumors. CONCLUSIONS: Myxomas of the sphenoid sinus are rare. The endoscopic endonasal skull base approach is an effective and minimal access technique for resection of this rare tumor of the sphenoid sinus.


Subject(s)
Meningeal Neoplasms/diagnostic imaging , Meningioma/diagnostic imaging , Myxoma/diagnostic imaging , Neoplasms, Multiple Primary/diagnostic imaging , Paranasal Sinus Neoplasms/diagnostic imaging , Sphenoid Bone/diagnostic imaging , Sphenoid Sinus/diagnostic imaging , Aged , Female , Humans , Magnetic Resonance Imaging , Meningeal Neoplasms/surgery , Meningioma/surgery , Myxoma/surgery , Neoplasms, Multiple Primary/surgery , Paranasal Sinus Neoplasms/surgery , Sphenoid Bone/surgery , Sphenoid Sinus/surgery
2.
Dysphagia ; 20(1): 19-22, 2005.
Article in English | MEDLINE | ID: mdl-15886963

ABSTRACT

Chronic aspiration is a difficult and potentially lethal problem. Patients who have persistent soilage of the upper respiratory tract despite discontinuing oral intake may be offered surgical intervention to avoid life-threatening pulmonary infections. The Lindeman procedures (tracheoesophageal diversion and laryngotracheal separation) have gained popularity as surgical treatments for intractable aspiration because of their efficacy in preventing aspiration and their technical simplicity. A major downside of these procedures is the necessity for a tracheostoma and the loss of speech following surgery. Rarely, patients recover from the neurologic deficits which led to their intractable aspiration and desire reversal of their Lindeman procedure. While few "successful" reversals have been reported, detailed accounts of the long-term results of such patients are lacking. We describe a patient who underwent a laryngotracheal separation for intractable aspiration following a brainstem stroke. In the following six months he experienced significant neurologic recovery and, after careful evaluation, underwent surgical restoration of laryngotracheal continuity. Five years later he speaks fluently and has no dietary restrictions. Videofluooroscopic examination and quantitative voice analysis reveal near-normal laryngeal function.


Subject(s)
Larynx/surgery , Pneumonia, Aspiration/surgery , Trachea/surgery , Tracheostomy/methods , Aged , Chronic Disease , Deglutition Disorders/etiology , Gastroesophageal Reflux/surgery , Humans , Male , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/prevention & control , Stroke/complications
3.
Otolaryngol Clin North Am ; 36(4): 569-76, 2003 Aug.
Article in English | MEDLINE | ID: mdl-14567053

ABSTRACT

Mycobacterial infections are grouped into infections caused by M. tuberculosis and those caused by the atypical mycobacterial organisms. Tuberculosis is a systemic disease, with cervical lymphadenitis of the head and neck being the most common extrapulmonary manifestation of the disease. It is important to use imaging, histopathologic examination, and culture to differentiate tuberculosis from atypical mycobacterial infections, because treatments differ. Tuberculosis is best treated as a systemic disease, with anti-tuberculosis medication. The atypical infections can be addressed as local infections and are amendable to surgical therapy.


Subject(s)
Mycobacterium Infections/diagnosis , Humans , Lymphadenitis/microbiology , Mycobacterium Infections, Nontuberculous/diagnosis , Tuberculosis/diagnosis , Tuberculosis, Laryngeal/diagnosis
4.
Arch Otolaryngol Head Neck Surg ; 129(7): 786-92, 2003 Jul.
Article in English | MEDLINE | ID: mdl-12874083

ABSTRACT

OBJECTIVE: To develop a murine model of effective treatment with immunotherapy for established head and neck squamous cell carcinoma. DESIGN: Prospective animal study. Subjects Female C3H mice, 8 to 12 weeks old. INTERVENTIONS: A subcutaneous inoculation of 2 x 10(5) SCC VII cells in C3H mice was established for 7 to 12 days. Tests for concomitant immunity were performed, with and without interleukin 12 modification. Tumors were also tested for responsiveness to interleukin 12 (5 mice) and to cyclophosphamide followed by interleukin 12 (5 mice). SCC VII tumors in 24 mice were treated with interleukin 12 followed by cyclophosphamide and interleukin 12. Five mice with tumors treated with isotonic sodium chloride solution served as controls. Tumors were measured 3 to 4 times weekly, and cure was defined as complete regression of the tumor for at least 60 days. Cured mice were rechallenged with 2 x 10(5) SCC VII cells to verify antitumor immunity. Immunohistochemistry of regressing tumors was performed for CD4+ and CD8+ T cells. RESULTS: Tumor-bearing mice easily developed second tumors when challenged with 2 x 10(5) tumor cells in the opposite flank. However, interleukin 12 treatment provided immunity to second tumors in 8 (100%) of 8 mice when started at day 4 and in 2 (40%) of 5 when treated from day 7. SCC VII did not respond to standard interleukin 12 or cyclophosphamide plus interleukin 12 therapy. Seventy-five percent of animals (18/24) treated with interleukin 12 followed by cyclophosphamide plus interleukin 12 were successfully cured, and all cured mice resisted subsequent challenge with SCC VII. Immunohistochemistry of regressed tumors showed an intense CD4+ and CD8+ infiltrate that was absent in the untreated and nonresponding tumors. CONCLUSIONS: Nonimmunogenic SCC VII is a nonimmunogenic tumor that can be converted into an immunogenic tumor with interleukin 12 treatment. Additional treatment with cyclophosphamide plus interleukin 12 leads to complete regression in 75% of mice.


Subject(s)
Adjuvants, Immunologic/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Interleukin-12/therapeutic use , Animals , CD4 Antigens/metabolism , CD8 Antigens/metabolism , Carcinoma, Squamous Cell/immunology , Carcinoma, Squamous Cell/metabolism , Female , Immunohistochemistry , Immunotherapy , Mice , Mice, Inbred C3H , Models, Animal , Prospective Studies
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