Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases.

BACKGROUND: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author. MATERIAL AND METHODS: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented. RESULTS: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods. CONCLUSIONS: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure.

Symptomatic macroglossia and tongue myositis in polymyositis: treatment with corticosteroids and intravenous immunoglobulin.

Symptomatic macroglossia occurs in some rare congenital muscle diseases, such as Becker's and Duchenne's dystrophies or Pompe's disease. Herein we describe a case of symptomatic macroglossia with myositis of the tongue occurring in a patient with polymyositis. Tongue myositis was evidenced by dysarthria, frequent biting during mastication, swallowing difficulties without aspiration, and noisy breathing. Magnetic resonance imaging showed homogeneous hypertrophy of the tongue, especially the mouth's floor muscles. The diagnosis of tongue myositis was established by electromyography and biopsy. No other cause for the macroglossia was found. Symptoms resolved quickly with corticosteroid and intravenous immunoglobulin treatment. To our knowledge, this is the first reported case of symptomatic tongue myositis occurring in the course of polymyositis.

Suprasellar seeding of a benign choroid plexus papilloma of the fourth ventricle with local recurrence.

A suprasellar location of a benign choroid plexus papilloma is reported. Local recurrence within the fourth ventricle was also present, 8 years after apparently complete removal. Imaging and histological findings were similar to those of the initial lesion. At surgery, the suprasellar lesion had no connection with the ventricular system. Seeding of choroid plexus papillomas is discussed, and the pertinent literature reviewed.

Intracranial dural arteriovenous fistulae with perimedullary venous drainage. Anatomical, clinical and therapeutic considerations.

We report five cases of intracranial dural arteriovenous fistula (DAVF) with perimedullary venous drainage. All the patients presented with rapidly progressive myelopathy and three had autonomic disorders. The DAVF were on the tentorium cerebelli (two cases), sigmoid (one), superior petrosal (one), and cavernous sinus (one). Slow venous drainage was directed through dilated perimedullary cervical veins. The transverse sinus was occluded in two cases. MRI, performed in four cases, demonstrated high signal on T2-weighted spin-echo sequences in the medulla oblongata and upper cervical spinal cord consistent with oedema, which signal resolved after complete cure of the DAVF in three cases. Embolisation was performed in all cases. It was followed by clinical deterioration in two cases and in the dramatic improvement in the other three, with complete clinical cure in two. Extensive venous thrombosis may explain the deterioration observed in one case.

[The place of imaging in the investigation of the parotid and parapharyngeal space]. / Place de l'imagerie dans l'exploration de la parotide et de l'espace parapharyngé.

What strategy should be adopted and what results should be expected from imaging techniques in the various pathological process affecting the parotid and parapharyngeal space? When the pathological process is associated with morphological changes in the parotid, it is sometimes necessary to have recourse to imaging. MRI is the method of choice. Pathology in the parapharyngeal space (PPS) always requires an MRI and/or CT scan. It is necessary to have a very thorough understanding of the anatomy of the PPS and associated spaces to obtain a precise preoperative assessment and, where possible, an indication of the nature of the lesion.

Cavernous hemangiomas of the orbit: MR imaging.

PURPOSE: To describe the MR imaging findings in eight patients with cavernous hemangioma of the orbit. METHODS: CT, MR imaging and echographic studies of eight patients with cavernous hemangioma localized in the orbit were reviewed. All patients presented with a progressive symptomatology: in seven cases with a painless proptosis, in one case with a failing of visual acuity of the concerned eye. The patients were examined with T2- and T1-weighted spin echo sequences, before and after intravenous administration of Gadolinium*, in axial, coronal and sagittal planes. In seven patients, a fat saturation prepulse was given after the Gd-enhanced study. Two patients were also examined with CT scan, with and without intravenous contrast administration. Three patients underwent a Doppler color-coded transorbital sonography. The analyzed criteria were: location, form, margins, size, signal or density. Seven patients underwent surgery with pathologically proved cavernous hemangioma. In one patient, therapy was conservative, because of the absence of significant clinical complaints. RESULTS: In all cases, MRI showed a well-defined intraconal mass. The lesions were homogeneous, isointense to muscle on the T1-weighted sequence and hyperintense to muscle on the T2-weighted sequences. In five cases, a peripheral rim, hypointense to the mass on the T1- and T2-weighted sequences could be observed. After Gadolinium*, six lesions showed initial central patchy enhancement. On the three following T1-Gadolinium* sequences, these lesions showed total and homogeneous filling. In two patients, the lesions showed immediate homogeneous enhancement. On CT, the orbital masses were spontaneously hyperdense, with associated focus of microcalcifications. On echography, the lesions appeared hyperechogenic, heterogeneous, with individualization of small areas of very slow flow. CONCLUSION: From the analysis of the MR appearance of an intraconal, well-defined mass, associating homogeneous signal, isointense to muscle on T1-weighted sequence, hyperintense on T2-weighted sequence, and especially progressive filling on Gd-enhanced sequences, the diagnosis of cavernous hemangioma may be highly suggestive, in a patient presenting a painless progressive proptosis.

Cavernous hemangioma of the intracranial optic pathways: CT and MRI.

PURPOSE: The purpose of this work was to describe the CT and MR findings in three patients with cavernous hemangioma (CH) of the intracranial optic pathways. METHOD: CT and MR studies of three patients with CH of the optic chiasm were reviewed. All patients underwent MRI of the chiasmal area, with coronal T2- and T1-weighted studies as well as gadolinium-enhanced coronal and sagittal T1-weighted studies. RESULTS: The patients (mean age, 40 years) presented with chiasmal apoplexy (two cases) and progressive decrease of visual acuity (one case). In all cases, MRI showed regular enlargement of the optic chiasm, with extension to the optic nerve in one case and to the left optic tract in one case. The chiasmatic dimension was 2.5-3 cm in two cases and 1-1.5 cm in the other case. In all cases, MRI revealed an acute (isointense signal on T1-weighted and hypointense signal on T2-weighted sequences) or subacute (hyperintense signal on T1 - and T2-weighted sequences) hemorrhage with, adjacent to it, an area with signals of blood of different ages, highly suggestive of CH. CT showed, in chiasmatic CHs, a suprasellar mass spontaneously denser than adjacent brain parenchyma. In two cases, microcalcifications were associated. In two cases, CT and MRI revealed slight heterogeneous enhancement after contrast agent administration. In one case, no enhancement was observed. Two patients underwent surgery by frontopterional craniotomy. The optic chiasms were swollen with an intrinsic bluish mass. The cerebrospinal fluid was not xanthochromic. Microscope examination confirmed the diagnosis of CH. After 12 months, the operated patients had improved visual acuity and visual field but did not completely recover. The nonoperated patient (because of spontaneous rapid recovery of visual acuity) was followed clinically and on MRI over 18 months. CONCLUSION: CH in the optic chiasm must be suspected in the presence of an acute chiasmatic syndrome. MRI is the best imaging modality, showing either an acute or a subacute chiasmatic hemorrhage or the typical pattern of CH with heterogeneous alternation of foci of blood of different ages, with a central focus of methemoglobin, a peripheral rim of hemosiderin, adjacent foci of acute or subacute hemorrhage, and slight or no enhancement after gadolinium administration.

[Central neurocytoma. Immunohistochemical study: MIB1, p53 and bcl-2. Report of 5 cases]. / Neurocytome central. Etude immunocytochimique: MIB1, p53 et bcl-2. A propos de 5 observations.

To further characterize central neurocytoma, a rare intraventricular tumour described in 1982, we analyzed six tumours by immunohistochemistry for MIB1, p53 and bcl-2. bcl-2, an inhibitor of p53-mediated apoptosis is frequently expressed in gliomas, especially in tumors with wild-type p53. Its expression in peripheral neuroblastomas suggests a down-regulation during final terminal differentiation. Six tumors from five patients (one female/four males, age ranged from 18 to 63 years) were examined. All patients were alive from 2 to 88 months after initial surgical resection. On histological sections, tumours demonstrated a typical pattern. Synaptophysin staining was seen in all cases. Proliferation index was low (< 4.5%). bcl-2 was never expressed. p53 expression varied but within low values (< 10% of cells). These latter antibodies were rarely analyzed until now in this usually benign neoplasm which represents a well differentiated variant of neuron derived tumors.

Nasopharyngeal tuberculosis.

Rhinopharyngeal tuberculosis is a rare pathological condition. It is most often associated with lymph node and pulmonary lesions, but it may be an isolated finding. The authors report a recent case of an isolated rhinopharyngeal tuberculosis in a 64-year-old female. A review of the literature is presented. They emphasize the clinical presentation, that, in all aspects, may resemble a malignant tumour of the nasopharynx, as well as the difficulty of obtaining a pathological and bacteriological diagnosis.

[Cervical spine infection with Streptococcus anginosus. Case report]. / Infection du rachis cervical A streptococcus anginosus.

A case of cervical spine infection due to Streptococcus anginosus is reported. Streptococcus milleri is encountered in the mouth, gastro-intestinal tract, vagina and nasopharynx. It is an uncommon pathogen responsible of suppurative infections such as brain liver or spleen abscesses, intra-abdominal or soft tissue abscesses and pleural empyema. In rare cases it can cause spondylodiscitis and osteomyelitis. Based on the review of eight cases of spondylodiscitis or osteomyelitis, diagnosis and treatment are discussed.

[Etiological investigations in cerebral ischemic accidents]. / Exploration étiologique des accidents ischémiques cérébraux.

First-line investigations for all patients include full blood count, erythrocyte sedimentation rate, plasma glucose, plasma cholesterol, plasma electrolytes, creatinine. ECG, chest X-ray and colour Doppler sonography of the neck. Carotid selective arteriography is performed when colour Doppler of the symptomatic carotid artery shows a stenosis of about 70% or more, provided the patient is fit for carotid endarterectomy. The search for paroxysmal atrial fibrillation is worthwhile in patients with palpitations. Transesophageal echocardiography is indicated if a cardiac source of embolism is suspected on the basis of clinical examination, ECG or chest X-ray and in patients without any apparent cause of stroke, if an embolic mechanism is likely. Finally, in the young patient atherosclerosis is so rare that special etiological investigations are justified.

Imaging in neurenteric cysts of the posterior cranial fossa.

Neurenteric cysts are cystic masses lined by a columnar epithelium of endodermal origin. They are rare in the central nervous system. We report two neurenteric cysts in the posterior cranial fossa and describe their neuroradiological features. The lesions were of low density on CT and more accurately delineated on MRI. They gave the same signal as cerebrospinal fluid on all sequences. There was no contrast enhancement.

Mucoceles of the paranasal sinuses: uncommon location.

Mucoceles are the most common lesions causing expansion of the paranasal sinuses. The sinuses most commonly involved are, in decreasing order of frequency, frontal sinus, ethmoid sinuses, maxillary sinus and sphenoid sinus. We reviewed 46 cases of surgically proven mucoceles and the purpose of this study was to report five cases of mucoceles in an uncommon location.

[Dissection of the intracranial arteries. Apropos of 10 cases]. / Dissections des artères intracrâniennes. A propos de 10 observations.

Ten cases of spontaneous dissection of the cerebral arteries are reported. 3 males and 7 females aged 6 to 60 years (mean age 30 years) were investigated in the Department of Neuroradiology of Toulouse between 1989 and 1994 with CT, angiography and MRI. In 5 cases the dissection involved the carotid artery, in 5 cases the vertebro-basilar system. The clinical presentation was of two types: ischaemic stroke (7 cases) or subarachnoid haemorrhage (3 cases). Their evolution is never lethal, contrary to the classical descriptions of the literature. In all cases an initial angiography then follow up has been performed showing an irregular located arterial stenosis. The diagnosis of intracranial dissection is sometimes made in front of a dissequant aneurysm. In case of doubt, magnetic resonance (MR) imaging is helpful showing a linear hypersignal parallel to an arterial segmental stenosis, and angiography MR an irregular aspect and stenosis of the endoluminal artery.

Asymptomatic cerebral embolic signals in patients with carotid stenosis. Correlation with appearance of plaque ulceration on angiography.

BACKGROUND AND PURPOSE: Asymptomatic cerebral emboli may be detected in patients with carotid stenosis by transcranial Doppler ultrasonography of the middle cerebral artery (MCA). The aim of this study was to determine the angiographic correlates of such embolic signals. METHODS: Doppler signals from 48 MCAs in 26 patients with carotid stenosis that was either symptomatic (n = 20) or asymptomatic (n = 6) were recorded for 40 minutes. The grade of carotid stenosis and the ulcerated or nonulcerated appearance of the plaque were assessed using the criteria of the North American Symptomatic Carotid Endarterectomy Trial. RESULTS: Embolic signals were detected in 8 MCAs from 7 patients; 4 (50%) of these MCAs were clinically symptomatic compared with 16 (40%) without embolic signal. Although there was a trend toward more severe stenosis in the cases with embolic signals, this was not significant (mean +/- SD, 67 +/- 29% versus 55 +/- 36%). In contrast, an image of ulceration was found on ipsilateral carotid angiography in 5 cases (63%) with embolic signals and in only 9 cases (23%) without embolic signals (odds ratio, 5.74; 95% confidence interval, 1.15 to 28.79, by multivariate regression analysis). CONCLUSIONS: This study demonstrates that the occurrence of embolic signals in patients with carotid stenosis is associated with the appearance of plaque ulceration on angiography.