The use of sialendoscopy for the treatment of multiple salivary gland stones.

OBJECTIVE: The purpose of this study is to document our experience with sialendoscopy for the treatment of multiple calculi of the salivary ducts, as well as to discuss the technique and indications for the procedure. PATIENTS AND METHODS: In this retrospective non-interventional study, 530 consecutive cases of sialolithiasis were investigated, and the cases with multiple calculi were selected for further analysis. These selected cases were analyzed from clinical and surgical aspects. RESULTS: Multiple calculi were detected in 37 of 530 consecutive investigated sialolithiasis cases. The gender distribution was 15 men and 22 women, with a mean age of 40.4 years. Among these patients, the submandibular gland was affected in 33 cases (right in 13 and left in 20) and the parotid gland was affected in 4 cases (right in 3 and left in 1). As for complications, 1 patient had a postoperative infection and 2 other patients had postoperative ranulas that were considered minor complications. Among all 37 cases, we had 3 cases in which preoperative imaging (sonography in 1 and radiography in 2) showed a single sialolith in the duct, but failed to show further sialoliths that were discovered later by sialendoscopy. CONCLUSIONS: The use of sialendoscopy allows a better diagnosis and minimally invasive treatment for multiple calculi. Interventional sialendoscopy allows the extraction of sialoliths in most patients, preventing open gland excision or surgical removal of the gland even in cases with multiple calculi. Sialendoscopy allows exploration of the ductal system in detail. This technique helps to discover additional stones in the ductal system that could not have been identified with the conventional imaging modalities available.

[Vermian epidermoid cyst revealed by head injury]. / Kyste epidermoide vermien revele par un traumatisme cranien.

Vermian epidermoid cyst developing in the fourth ventricle is very rare. We report a case observed in a 24-year-old man, who presented severe headache, dizziness and a blurred vision following head injury. Examination revealed a discrete gait disturbance. Cerebral CT-scan showed a large hypodense lesion of the posterior fossa without contrast enhancement. MRI demonstrated the vermian location of this lesion which displaced the roof of the fourth ventricle upward and the brainstem forward. A suboccipital approach allowed total removal of a well-encapsulated epidermoid cyst, non adherent to the floor of the fourth ventricle. The postoperative course was uneventful.

[Lipoma of the skull base. A case report]. / Lipome de la base du crâne. A propose d'un cas.

OBJECTIVES: Intra osseous lipomas are rare benign tumours that occur most frequently within the metaphysis of long bones. Involvement of the skull base is exceptional. We report a case of a lipoma of the skull base discovered incidentally. METHODS: A 45 year-old female patient consulted for galactorrhea with Hyperprolactinemia. RESULTS: MRI showed, in addition to the microadenoma, a high signal intensity T1 and T2 and fat saturated expansive lesion of the body and the right greater wing of the sphenoid. CT-scan of the skull base showed that this lesion was a well circumscribed fat containing and trabeculated lytic lesion leading to the diagnosis of a lipoma of the sphenoid. CONCLUSIONS: Lipomas of the skull base are exceptional. They are well recognized on CT-scan and MRI and in typical cases biopsies are not necessary. No treatment is necessary for asymptomatic lesions.