Efficacy and Advantages of Spinal Anesthesia in Lumbar Disk Surgery.

BACKGROUND: Quality of life (QoL) may be affected due to various reasons such as low back or leg pains with accompanying neurologic problems. Lumbar disk surgery is one of the most common performed surgeries to relieve those symptoms. Various anesthetic techniques can be used safely to perform lumbar disk surgeries. Properties that make an anesthetic technique good are mainly the quick onset and returning of the effects. This large retrospective study with patients who have undergone lumbar disk surgery under spinal anesthesia aims to evaluate the perioperative and postoperative parameters of the spinal anesthesia and review the literature. METHODS: Cases operated under spinal anesthesia between January 2017 and December 2020 were investigated, and 617 patients who underwent simple lumbar disk surgery were included in the study. Demographic characteristics and American Society of Anesthesiologists (ASA) physical status of the patients were recorded. Visual analog scale (VAS) and QoLscores were obtained before and after the operation. RESULTS: There were 282 (45.7%) male and 335 (54.3%) female patients with a mean age of 39.48 ± 16.71 years (range: 18-58 years) at symptom onset. The mean operating time was 46.3 minutes (range: 22-68 minutes). Average blood loss was 85 mL (range: 55-125 mL). All the patients were mobilized 6 to 12 hours after surgery. In our patient group, there were both high- and normal-risk groups in terms of the ASA physical status. During the clinical follow-up, a statistically significant improvement was found for the VAS and QoL scores (p < 0.05). CONCLUSIONS: In this large retrospective study, our results have confirmed that spinal anesthesia is at least comparable to general anesthesia and even superior to it in some aspects.

Spinal anesthesia efficiency in thoracolumbar stabilizations.

Background and purpose:

Spinal surgery has an important place in neurosurgery practice. Surgical procedures on the lumbar spine include stabilization, discectomy, foraminotomy and decompression. Lumbar and lower thoracic spinal surgery can be safely performed under spinal anesthesia (SA). However, there are not many studies on the safety and efficacy of spinal anesthesia in patients who have undergone long segment stabilization surgery.

Patients who underwent lumbar and lower thoracic spinal instrumentation operations with general anesthesia (GA) or spinal anesthesia were included in the study. Demographic characteristics and American Society of Anesthesiologists (ASA) physical status of the patients were all recorded. Visual analog scale and quality of life scores were obtained before and after the operation.

572 patients with SA and 598 patients with GA were included in the study, 352 / 347 had only-lumbar region and 220 / 251 had thoracolumbar region operations, respectively. All patients underwent short/long segment stabilization. Mean operating time was 106.1 / 156.7 minutes. Average blood loss was 375 / 390 mL. All patients were mobilized 16-24 / 24-36 hours after surgery. In our patient group, there were both high-risk and normal-risk subgroups in terms of ASA physical status. During the clinical follow-up, a statistically significant improvement was found for VAS and quality of life scores for both groups (p<0.05).

Spinal anesthesia appears to be a very effective method in lumbar and thoracolumbar surgery. Along with careful patient selection, using this highly effective method provides a comfortable space for the surgeon.

Effect of radiofrequency denervation on pain severity among patients with cervical, thoracic or lumbar spinal pain: A clinical retrospective study.

Background: Low back pain is the leading cause of job-related disabilities. The zygapophyseal (facet) joint has been identified as a cause of spinal pain in 15%-45% of individuals. Radiofrequency ablation (RFA) to the facet joints of the lumbar, cervical and thoracic regions and discussion of the 2-year follow-up results will provide additional data and contribute to understanding the long-term effectiveness of RFA. Methods: Patients with cervical, thoracic or low back pain, not accompanied by radicular pain and without primary and/or metastatic disease in the spinal region during radiological evaluation were retrospectively analysed. A total of 1274 patients aged >18 years who had clinical follow-up for at least 1 year and had back pain for >6 months were included in the study. The RFA groups were compared within themselves before and after the application. Moreover, patients who received RFA were compared with those who did not receive RFA (controls). The visual analogue scale and quality-of-life scores of the patients were evaluated. Periodic clinical follow-ups revealed changes in neurological status. Results: Of the 774 patients who underwent RFA, 156, 184 and 434 patients had pain in the cervical, thoracic and lumbar and lumbosacral regions, respectively. The control groups consisted of 108, 122 and 270 patients, respectively. No significant difference in any of the baseline demographic variables was observed between the groups (p > 0.05). A significant improvement was found in both visual analogue scale and quality-of-life scores when compared before and after RFA application within the groups. In addition, a significant improvement was found in the RFA group compared with the control group. Conclusions: As far as we know, this is the first comparative study of RFA involving the cervical, thoracic and lumbar spinal regions. RFA made it possible to obtain satisfactory results in all three regions. With its increasing popularity and frequency of use, new indications for RFA may emerge.

Diagnostic value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in adnexal torsion cases.

AIM: To evaluate if the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) could be used to diagnose adnexal torsion. METHODS: A retrospective study reviewed medical records of women who underwent surgery due to an adnexal mass between January 2012 and December 2017 at a tertiary referral center in Turkey. According to the surgical findings, the women were divided into a torsion group and a control group. NLR and PLR were compared between women who had adnexal torsion and those who did not. RESULTS: A total of 201 women were included in the study: 67 in the torsion group and 134 in the control group. Mean WBC count (9584.0 ± 3080.8 vs. 6678.2 ± 1886.1 h/mm3 ), mean NLR (5.9 ± 4.3 vs. 2.1 ± 0.8), and mean PLR (210.5 ± 132.7 vs. 147.9 ± 48.7) were higher in the torsion group than in the control group (p < 0.001). According to the ROC curve analyses, the optimal cut-off value for NLR and PLR were 2.51 (sensitivity, 72%; specificity, 78%) and 154.4 (sensitivity, 61%; specificity, 64%) in the diagnosis of adnexal torsion, respectively. CONCLUSION: NLR and PLR have been found useful hematological markers for the diagnosis of adnexal torsion. NLR and PLR could be helpful in cases, which is difficult to make a definitive diagnosis with patients' symptom and the ultrasonographic examination.

Brachial artery thrombosis following bee sting, case report.

INTRODUCTION: Bee stings are the most common among insect emergencies. PRESENTATION OF CASE: We present a 47-year-old male patient who was admitted to the emergency department with complaints of pallor, chills, numbness and bruising on the left palm one hour after a bee sting on his left leg, and a very rare case of brachial artery stenosis in Dopler ultrasonography. DISCUSSION: Often bee stings occur only with local allergic reactions; sometimes it can also cause myocardial infarction, pulmonary edema, bleeding, hemolytic anemia, and kidney disease and neurological manifestations. Side effects are generally thought to be related to the dose of this venom in these patients who are admitted to the emergency room with a bruise extending from the left hand to the arm after bee bites. CONCLUSION: With this case presented, we wanted to emphasize that thrombosis may occur due to bee stings, albeit rarely, and doctors in emergency departments should recognize these very rare cases.

Important landmarks and distances for posterior fossa surgery measured by temporal MDCT.

In this retrospective study, we aimed to present important anatomical structures and distances for posterior fossa surgery by temporal multidetector computed tomography (MDCT). The temporal MDCT images of 317 adult patients (158 males and 159 females) were retrieved from the hospital's picture archiving and communication system (PACS). In the coronal temporal MDCT views, the cochlea-carotid canal and jugular bulb-mastoid bone outer surface were measured. In the axial MDCT views, the carotid canal-jugular bulb and carotid canal-posterior fossa distances were measured; the carotid canal and jugular bulb anterior-posterior (AP) and transverse dimensions were also measured. The bilateral cochlea-carotid canal, jugular bulb-mastoid bone outer surface, and right carotid canal-jugular bulb distances were significantly greater in the males than those in the females (p < 0.05). The carotid canal-posterior fossa distance was not different in both genders (p > 0.05). The carotid canal-jugular bulb and the carotid canal-posterior fossa distances were greater on the left side than those on the right side in both genders (p < 0.05). In males, the outer surface distance was greater on the left jugular bulb-mastoid bone than that on the right side of that bone (p < 0.05). The difference between the carotid canal AP dimensions was not significant between males and females (p > 0.05). However, the carotid canal transverse dimension, jugular bulb AP, and transverse dimensions were significantly greater in the males than those in the females, bilaterally (p < 0.05). In each gender separately, the carotid canal AP and transverse dimensions were greater on the left side and the jugular bulb AP and transverse dimensions were greater on the right side than those on the left side (p < 0.05). Positive correlations were found between the cochlea-carotid canal, the jugular bulb-mastoid bone outer surface, and the carotid canal-jugular bulb distances as well as between the jugular bulb-mastoid bone outer surface and the carotid canal-posterior fossa distances (p < 0.05). In older patients, the carotid canal-posterior fossa distances were shorter on the left side (p < 0.05). Vascular and neural localizations should be well understood in the operative area before applying the surgical approach in the posterior fossa. Computed tomography (CT) has a greater role in the evaluation of bone structures and vascular canals in this area.

Pneumorrachis and pneumocephalus associated with neck injury after stabbing.

BACKGROUND: Trauma-related pneumocephalus and subcutaneous emphysema are relatively common, but pneumocephalus and pneumorrachis that occur without surgery are very rare. We present a case of pneumorrachis and pnemocephalus developing in the literature for the first time after stabbing from the anterior cervical region and providing improvement with conservative treatment. CASE PRESENTATION: A 42-year-old male patient was brought to the emergency department after stabbed in the neck. Anteromedial injury of the sternocloid muscle was followed by two lacerations with active bleeding from the same site. The patient was unconscious (Glasgow coma score 8(E2, M4, V2). The patient was intubated. Bleeding foci and lacerations were repaired in the emergency. Cranial, cervical, thoracic and lumbar non-contrast computed tomography scans were performed. Moderate pneumocephalus was seen in the subarachnoid space in the anterior of the bilateral frontal lobe and in the suprasellar cistern region. Pneumorrachis was seen in C2-C7 levels of cervical spinal canal. The patient was pentotalized. 100% oxygen treatment for 6 h was given from the ventilator in intensive unit. After 72 h, cranial, cervical, thoracic and lumbar CT were performed. Pneumorrachis and pneumocephalus were fully recovered. CONCLUSION: Pneumorrachis is usually asymptomatic and is self-limiting. It is a radiological diagnosis and is not a clinical diagnosis. CT scan is considered the preferred diagnostic method for reliable and rapid detection of pneumorrachis. In case of coexistence, The physician should be alert to diagnose and treat the underlying cause for related injuries.In such cases, successful results can be obtained with hyper-oxy therapy (100% oxygen inhalation) and antibiotic prophylaxis without the need for surgical treatment.

Cation Disorder and Local Structural Distortions in AgxBi1-xS2 Nanoparticles.

By combining X-ray absorption fine structure and X-ray diffraction measurements with density functional and molecular dynamics simulations, we study the structure of a set of AgxBi1-xS2 nanoparticles, a materials system of considerable current interest for photovoltaics. An apparent contradiction between the evidence provided by X-ray absorption and diffraction measurements is solved by means of the simulations. We find that disorder in the cation sublattice induces strong local distortions, leading to the appearance of short Ag-S bonds, the overall lattice symmetry remaining close to hexagonal.

Is there a relationship between basilar artery tortuosity and vertigo?

OBJECTIVE: The aim of this study was to investigate the relationship between basilar artery (BA) tortuosity, hypogenesis/agenesis of the vertebral artery (VA), and vertigo, with the use of magnetic resonance imaging (MRI). PATIENTS AND METHODS: This case-control study included patients admitted to the outpatient clinics, who were aged 18-80 years, without any known systemic diseases. All patients were evaluated with a 1.5-tesla MRI system. BA Tortuosity, VA agenesis, and VA asymmetry were noted. BA diameter (central) and length (longitudinal) were measured. RESULTS: A total of 154 vertigo patients (46 M, 108 F; mean age of 48.95 ± 17.3 years) and 346 control subjects (112 M, 234 F; mean age of 45.12 ± 17.0 years) were included. The mean age of the vertigo patients was significantly higher than that of the control group (48.95 vs 45.12 years) (p = 0.021). The rate of BA tortuosity was higher in patients with vertigo (p = 0.030). When the participants were divided into two groups according to median age (<45 vs. ≥45 years) there was no statistically significant difference between the groups in terms of VA asymmetry (p = 0.070) and hypogenesis/agenesis (p = 0.577). There was a statistically significant difference between the groups in respect of BA tortuosity (p = 0.033), BA diameter (p < 0.001), and BA length (p < 0.001). When the study populations were divided into two groups according to the presence of vascular tortuosity, the mean age, BA diameter, and BA length values were higher in the tortuosity (+) group (all p < 0.001). CONCLUSION: These results demonstrated that vertigo and BA tortuosity rates seem to increase with age. Likewise, BA diameter and length increased with age, although there was no significant relationship with vertigo. Patients with tortuosity were significantly older, and had higher rates of VA asymmetry/agenesis, and increased BA diameter compared to subjects without tortuosity.

Sonoelastographic evaluation of the sciatic nerve in patients with unilateral lumbar disc herniation.

OBJECTIVE: The aim of this study was to compare strain elastography (SE) and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects. MATERIALS AND METHODS: The study group included patients with complaints of unilateral sciatica for 3-12 months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age- and gender-matched control group was formed of healthy subjects. Evaluations were performed on both the axial and longitudinal planes from the bilateral gluteal region using a 5-9 MHz multifrequency convex probe. RESULTS: There were 40 patients (20 male, 20 female) with a mean age of 43.1 ± 12.7 years in the study group, and 40 healthy subjects (22 male, 18 female) with a mean age of 42.9 ± 10.7 years in the control group (p > 0.05). The sciatic nerve stiffness assessed on both the axial (12.3 ± 3.7 kPA) and longitudinal (14.3 ± 3.8 kPA) planes of the involved side was significantly higher than non-involved side (axial: 6.8 ± 2.1 and longitudinal: 8.3 ± 2.3 kPA) in the patient group (p < 0.001). CONCLUSIONS: Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. Although the findings in this preliminary study show that shear wave elastography can detect a change in sciatic nerve stiffness in patients with unilateral LDH, larger studies are required to determine the clinical utility of this technique.

RF Channel-Select Micromechanical Disk Filters-Part II: Demonstration.

This Part II of a two-paper sequence presents fabrication and measurement results for a micromechanical disk-based RF channel-select filter designed using the theory and procedure of Part I. Successful demonstration of an actual filter required several practical additions to an ideal design, including the introduction of a 39-nm-gap capacitive transducer, voltage-controlled frequency tuning electrodes, and a stress relieving coupled array design, all of which combine to enable a 0.1% bandwidth 223.4-MHz channel-select filter with only 2.7 dB of in-band insertion loss and 50-dB rejection of out-of-band interferers. This amount of rejection is more than 23 dB better than a previous capacitive-gap transduced filter design that did not benefit from sub-50-nm gaps. It also comes in tandem with a 20-dB shape factor of 2.7 realized by a hierarchical mechanical circuit design utilizing 206 micromechanical circuit elements, all contained in an area footprint of only [Formula: see text]. The key to such low insertion loss for this tiny percent bandwidth is Q 's >8800 supplied by polysilicon disk resonators employing for the first time capacitive transducer gaps small enough to generate coupling strengths of Cx/Co  âˆ¼  0.1 %, which is a 6.1× improvement over previous efforts. The filter structure utilizes electrical tuning to correct frequency mismatches due to process variations, where a dc tuning voltage of 12.1 V improves the filter insertion loss by 1.8 dB and yields the desired equiripple passband shape. Measured filter performance, both in- and out-of-channel, compares well with predictions of an electrical equivalent circuit that captures not only the ideal filter response, but also parasitic nonidealities that distort somewhat the filter response.

RF Channel-Select Micromechanical Disk Filters-Part I: Design.

This Part I of two papers introduces a design flow for micromechanical RF channel-select filters with tiny fractional bandwidths capable of eliminating strong adjacent channel blockers directly after the antenna, hence reducing the dynamic range requirement of subsequent stages in an RF front-end. Much like VLSI transistor circuit design, the mechanical circuit design flow described herein is hierarchical with a design stack built upon vibrating micromechanical disk building blocks capable of Q 's exceeding 10 000 that enable low-filter passband loss for tiny fractional bandwidths. Array composites of half-wavelength coupled identical vibrating disks constitute a second level of hierarchy that reduces the filter termination impedance. A next level of hierarchy couples array composites with full-wavelength beams to affect fully balanced differential operation. Finally, identical differential blocks coupled with quarter-wavelength beams generate the desired passband. Part II of this study corroborates the efficacy of this design hierarchy via experimental results that introduce a 39-nm-gap capacitive transducer, voltage-controlled frequency tuning, and differential operation toward demonstration of a 0.1% bandwidth, 223.4-MHz channel-select filter with only 2.7 dB of in-band insertion loss and 50 dB of stopband rejection.

Solution processed infrared- and thermo-photovoltaics based on 0.7 eV bandgap PbS colloidal quantum dots.

Harnessing low energy photons is of paramount importance for multi-junction high efficiency solar cells as well as for thermo-photovoltaic applications. However, semiconductor absorbers with the bandgap lower than 0.8 eV have been limited to III-V (InGaAs) or IV (Ge) semiconductors that are characterized by high manufacturing costs and complicated lattice matching requirements in their growth and integration with higher bandgap cells. Here, we have developed solution processed low bandgap photovoltaic devices based on PbS colloidal quantum dots (CQDs) with a bandgap of 0.7 eV suited for both thermo-photovoltaics and low energy solar photon harvesting. By matching the spectral response of those cells to that of the infrared solar spectrum, we report a record high short circuit current (JSC) of 37 mA cm-2 under the full solar spectrum and 5.5 mA cm-2 when placed at the back of a silicon wafer resulting in power conversion efficiencies (PCEs) of 6.4% and 0.7%, respectively. Moreover, the device reached an above bandgap PCE of ∼6% as a thermo-photovoltaic cell recorded under a 1000 °C blackbody radiator.

An Evaluation of the Quality of Sleep Before and After Surgical Treatment of Patients with Cervical Disc Herniation.

OBJECTIVE: It has been reported in recent studies that 50-80% of patients with cervical disc hernia have concomitant sleep disorders. The aim of this study was to evaluate the quality of sleep before and after surgical treatment in patients with cervical disc hernia and to assess the effects on treatment. METHODS: The study included 32 patients performed discectomy and fusion with an intervertebral cage through the right anterior cervical approach. Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) were applied to all patients preoperatively and at one month postoperatively. RESULTS: The postoperative PSQI total points and all the PSQI subscale points, the ODI and VAS scores were significantly reduced compared to the preoperative values. A positive correlation was determined between the preoperative ODI points and the PSQI total points and sleep duration, sleep latency and daytime functional loss subscale points. A positive correlation was also found between preoperative ODI points and VAS points. A positive correlation was determined between the preoperative VAS points and and the PSQI total points and sleep duration, and sleep latency subscale points. A negative correlation was determined between the postoperative ODI and the daytime functional loss subscale points. CONCLUSION: The results of the study showed that in patients with cervical disc hernia, sleep quality and daytime functionality were negatively affected by severity of pain that limited daily activities. Bringing the pain under control with surgical treatment was observed to increase sleep quality. It can be concluded that when planning treatment for these patients, it should be taken into consideration that there could be a sleep disorder in addition to the complaints and symptoms such as pain, hypoestesia and loss of strength.

Infrared Solution-Processed Quantum Dot Solar Cells Reaching External Quantum Efficiency of 80% at 1.35 µm and Jsc in Excess of 34 mA cm-2.

Developing low-cost photovoltaic absorbers that can harvest the short-wave infrared (SWIR) part of the solar spectrum, which remains unharnessed by current Si-based and perovskite photovoltaic technologies, is a prerequisite for making high-efficiency, low-cost tandem solar cells. Here, infrared PbS colloidal quantum dot (CQD) solar cells employing a hybrid inorganic-organic ligand exchange process that results in an external quantum efficiency of 80% at 1.35 µm are reported, leading to a short-circuit current density of 34 mA cm-2 and a power conversion efficiency (PCE) up to 7.9%, which is a current record for SWIR CQD solar cells. When this cell is placed at the back of an MAPbI3 perovskite film, it delivers an extra 3.3% PCE by harnessing light beyond 750 nm.

Plasmon-Enhanced Energy Transfer in Photosensitive Nanocrystal Device.

Förster resonance energy transfer (FRET) interacted with localized surface plasmon (LSP) gives us the ability to overcome inadequate transfer of energy between donor and acceptor nanocrystals (NCs). In this paper, we show LSP-enhanced FRET in colloidal photosensors of NCs in operation, resulting in substantially enhanced photosensitivity. The proposed photosensitive device is a layered self-assembled colloidal platform consisting of separated monolayers of the donor and the acceptor colloidal NCs with an intermediate metal nanoparticle (MNP) layer made of gold interspaced by polyelectrolyte layers. Using LBL assembly, we fabricated and comparatively studied seven types of such NC-monolayer devices (containing only donor, only acceptor, Au MNP-donor, Au MNP-acceptor, donor-acceptor bilayer, donor-Au MNP-acceptor trilayer, and acceptor-Au MNP-donor reverse trilayer). In these structures, we revealed the effect of LSP-enhanced FRET and exciton interactions from the donor NCs layer to the acceptor NCs layer. Compared to a single acceptor NC device, we observed a significant extension in operating wavelength range and a substantial photosensitivity enhancement (2.91-fold) around the LSP resonance peak of Au MNPs in the LSP-enhanced FRET trilayer structure. Moreover, we present a theoretical model for the intercoupled donor-Au MNP-acceptor structure subject to the plasmon-mediated nonradiative energy transfer. The obtained numerical results are in excellent agreement with the systematic experimental studies done in our work. The potential to modify the energy transfer through mastering the exciton-plasmon interactions and its implication in devices make them attractive for applications in nanophotonic devices and sensors.

The importance of medial-lateral styloid process angulation/coronal plane angle in symptomatic eagle syndrome.

We used three-dimensional computerized tomography (3DCT) to obtain images of Eagle Syndrome (ES) cases and measurements of relevant variables. Twenty-five subjects with ES and 25 controls were included in this retrospective study. Styloid process length, anterior-posterior styloid process angulation (Sagittal plane angle) (APA), medial-lateral styloid process angulation (Coronal plane angle) (MLA), tonsil-stiloid distance and carotid-stiloid distance were measured on CT and 3DCT images, and cranial and neck angiography was obtained, from a total of 580 images. The styloid process lengths were 40.3 and 40.5 mm on the right and left sides in the ES group. The left MLA was lower in symptomatic (Median: 67.0°) than asymptomatic (Median: 72.6°) ES patients. In ES patients with styloid process length above 3 cm, MLA (coronal plane angle) is important, and the symptoms are more intense when this angle is smaller. Clin. Anat. 30:487-491, 2017. © 2017 Wiley Periodicals, Inc.

Evaluation of posterior clinoid process pneumatization by multidetector computed tomography.

In the present study, we investigated the types and ratio of posterior clinoid process (PCP) pneumatization in paranasal sinus multidetector computed tomography (MDCT). Paranasal MDCT images of 541 subjects (227 males, 314 females), between 15 and 65 years old, were included into the study. Pneumatization of anterior clinoid process and pneumatization types (I, II, or III) were evaluated in the males and females. PCP pneumatization was detected in 20.7 % of the males and 11.5 % of the females. Right, left, and bilateral PCP pneumatizations were detected in 7.9, 5.7, and 7.0 % of the males and 2.9, 3.2, and 4.5 % of the females, respectively. PCP pneumatization of the males is significantly higher than the females. The most detected type of pneumatization was type I (61.2 %) for all groups. In right, left, and bilateral pneumatizations separately, type I pneumatization was the most detected pneumatization type with the ratio of the 70.4, 65.2, and 50.0 %, respectively. In males, type I (61.7 %), and similarly in females, type I (60.6 %) pneumatization were detected more. Type II and type III pneumatizations were detected in decreasing order in both groups. In younger subjects, pneumatization of posterior clinoid process was found as higher, and in older subjects, PCP pneumatization was found as lower. Sclerosis process related to the aging may be responsible for the lower pneumatization ratios in older subjects. Structure of the surrounding regions of PCP is important for surgical procedures related to cavernous sinus, basilar apex aneurysms, and mass lesions. Preoperative radiological examinations are useful for operative planning. Any anomalies to PCP can cause unnecessary injury to the neurovascular complex structure around the cavernous sinus or postclinoidectomy CSF fistulas. Posterior clinoidectomies should be avoided in patients with type III PCP pneumatization to prevent CSF fistulas.

Esthesioneuroblastoma located in the thoracic extradural space: Case report.

OBJECTIVE: Esthesioneuroblastoma accounted for only 6% of the malignant nasal cavity neoplasms (ENB) is a rare tumor which originates from the olfactory epithelium. ENB's are locally agresive and can metastasize by lymphatic and hematogenous routes. A patient with the mass on the nasal dorsum was reported in this article. CASE HISTORY: A 52-year-old-man admitted to the hospital with a 3 months history of progressive nasal obstruction, epistaxis and mass on the nasal dorsum. On rhinoscopy, a polypoid mass was seen in the both nasal cavity and intranasal biopsy with local anesthesia was performed. Histopathologic diagnosis of the tumor was Kadish stage B esthesioneuroblastoma. Tumor was excised by using bilateral endoscopic endonasal resection and lateral rhinotomy approach and paranasal radiotherapy performed postoperatively. Ten months after surgery, neck metastasis was occured and patient was underwent neck dissection. Twenteeth months after initial treatment, distant metastasis was identified on the T 10 vertebra and following the cranial and spinal radiotherapy to the neck he was free of local recurrence at follow up 13 months after surgery. CONCLUSION: It has been known that the metastasis of the ENB to the spinal cord is an uncommon event, and it occurs often years after initial diagnosis. MRI scan is helpful for making the diagnosis, and surgery is the treatment of choice for obtaining diagnostic tissue and debulking the tumor. Radiotherapy is also a mainstay of postoperative treatment.