Computed tomography of the carotid space and related cervical spaces. Part II: Neurogenic tumors.

Fourteen neurogenic tumors of the neck were examined with computed tomography (CT) and, in ten cases, angiography. Schwannomas and paragangliomas occurred in the carotid space. These tumors could be distinguished on CT from those occurring more anteriorly, in relation to the parapharyngeal space, and more posteriorly, in relation to the paraspinal space. Schwannomas alone occurred in the paraspinal space. Schwannomas were heterogeneously hypodense before contrast enhancement and at least partially hyperdense after contrast enhancement, with displacement of adjacent vessels on CT, and, if they were of vagal origin, anteromedial displacement of the internal carotid artery on angiography. Paragangliomas usually were homogeneously hyperdense after contrast enhancement, with incorporation of adjacent vessels on CT, and, if they were of carotid body origin, lateral displacement of the internal carotid artery on angiography.

Craniosynostosis: computed tomographic evaluation of skull base and calvarial deformities and associated intracranial changes.

Computed tomography has proven useful in children with craniosynostosis for the evaluation of deformity of the skull base, calvarium, and parenchymal brain structures. A retrospective analysis of 24 children seen during a 4-year period who had adequate preoperative, postoperative, and follow-up scans was carried out. Bone windows were used, and both bone thinning adjacent to fused sutures and thickening of affected sutures were demonstrated. Changes in calvarial contour were easily followed. Current trends in craniofacial reconstructive surgery have placed emphasis on skull base abnormalities; these are readily measured on axial computed tomographic (CT) sections, and postoperative progress may be monitored by serial scanning. In addition, new data revealing distortion of brain structures and cerebrospinal fluid pathways in these children have been obtained with CT scans. These soft tissue abnormalities had not been appreciated before the CT era, and they add a new dimension to the evaluation of these disorders. We think that these abnormalities indicate a local pressure increase on the brain at the fusion site. The restoration of parenchymal changes toward normal during the postoperative period correlated well with cosmetic improvement.

Cerebellar metastasis from ovarian carcinoma.

The most common sources of metastatic disease of the brain are lung and breast carcinoma. Considerably less common are metastases from malignant melanoma, hypernephroma, and carcinomas of the alimentary tract. All other sources are rare. This report presents a unusual case of a single cerebellar metastatic lesion from ovarian carcinoma.

Computed tomography of disseminated meningeal and ependymal malignant neoplasms.

We studied computed tomography (CT) scans of 50 patients with clinical signs and symptoms compatible with disseminated meningeal tumor, all documented by cerebrospinal fluid cytology, surgical biopsy or autopsy. Twenty-three patients also had nuclear scans, and 13 had cerebral angiograms. Represented in the series were patients with metastatic carcinoma, gliomas, and lymphomas. The characteristic CT findings included gyral enhancement without edema; sulcal and basilar cisternal obliteration and enhancement, and ependymal-subependymal enhancement. The correct diagnosis was made by CT in 28 of the 50 cases (56%).

Variations of the ophthalmic and middle meningeal arteries: relation to the embryonic stapedial artery.

Recognition of the anatomic variations of the ophthalmic and middle meningeal arteries may be pertinent in tailoring the angiographic study to resolve a given clinical problem. An understanding of these anomalies is based on knowledge of the normal embryology. Unfortunately some early aspects of vascular development remain obscure. Fragmentary observations gleaned from the embryologic literature were correlated with selective and/or subselective angiography performed in 42 patients with such anomalies. This analysis has provided the basis for a tenable scheme for development of the ophthalmic and middle meningeal arteries as they relate to the embryonic stapedial artery. A classification for anomalies of these arteries is proposed based on deviation from this normal embryologic mechanism.

Cerebral cysticercosis: occurrence in the immigrant population.

Six cases of cerebral cysticercosis have been diagnosed at the Neurological Institute of New York during the past 18 years. Three recent cases are discussed, with emphasis on the variability of signs and symptoms and the best available diagnostic techniques. One must have a high index of suspicion when evaluating patients who have immigrated to the United States from endemic areas, although the disease may be acquired through food contaminated by carriers in nonendemic areas. Conventional radiography (e.g., plain films and pneumography) and, more recently, computerized tomography are the most effective tests to confirm this diagnosis. Cerebrospinal fluid and serum eosinophilia and indirect hemagglutination titers are nonspecific but occasionally helpful. Therapy is currently confined to surgical excision of lesions where possible and symptomatic treatment otherwise.