Petrous bone extension of middle-ear acquired cholesteatoma.

PURPOSE: To describe CT and MR features of extension to the petrous bone, which is a rare complication of acquired cholesteatoma (AC). MATERIAL AND METHODS: Postcontrast CT was performed in 4 patients, in axial (n=4) and coronal planes (n=2). The section thickness was 1.2 or 2.5 mm. MR was performed in 3 cases, using T1- and T2-weighted images (n=3) and postcontrast T1-weighted images (n=2). RESULTS: CT demonstrated a well-outlined lesion involving the petrous bone (n=4). Density could be assessed in 3 cases, showing a hypodense unenhanced mass. Lateral (n=1), superior (n=2), and posterior (n=2) semicircular canals were affected in 3 patients. AC extended to the vestibula, cochlea, and internal acoustic meatus (IAM) in 3 patients. Two ACs extended to the level of IAM, whereas 2 extended further, to the petrous apex. In one case the sphenoid sinus was affected. On MR imaging the lesion was hypointense relative to brain on T1-weighted images and hyperintense on T2-weighted images. MR imaging helped to delineate the lesion and to distinguish it from other cystic lesions of the petrous bone. CONCLUSION: CT and MR offer accurate preoperative assessment of the extension of cholesteatoma, which helps to choose the surgical approach.

[Neurinoma of the intracranial and intraspinal spinal nerve]. / Les neurinomes du nerf spinal intracrânien et intrarachidien.

Two personal cases and a review of the literature permit to distinguish by anatomical, clinical and paraclinical aspects : neurilemmoma of the jugular foramen (type III), neurilemmoma of the bulbar spinal (type I), and of the medullary spinal (type II). This classification permits to choice surgical approach.

[Total right hemispherectomy: neurophysiological study after twenty-six years]. / Hémisphérectomie droite totale. Etude neurophysiologique après vingt-six ans.

Twenty-six years after a total right hemispherectomy for tumor when thirteen years old, a right-handed patient presented with disturbances of equilibrium, urinary incontinence, and a marked reduction in motor impulses, in spite of a subnormal intelligence quotient (0.85). Computed tomography examinations suggested the presence of a normal pressure hydrocephalus. However intracranial pressure monitoring and isotopic and cerebrospinal fluid perfusion tests showed the absence of any cerebral obstruction, and free communication between the cerebral and spinal spaces, though intracranial volume capacity accommodation was greatly reduced. Clinical examination demonstrated good quality sensory appreciation by the left half of the body, the possibility of detecting an object in the visual hemifield supposedly blind, and perfect location of a sound source. Somesthetic evoked potentials were studied by stimulating the median nerve in the left and right wrist regions. Left hemisphere evoked potentials from a contralateral stimulus, were of normal latency, amplitude and morphology, the response to an ipsilateral stimulus also presenting an early potential component (N 26 starting at N 21). This exceptional finding in a hemispherectomized patient could be related to activity of the spinoreticulothalamic tracts in the lemniscal or extralemniscal systems. Auditory function tests demonstrated perfect stereoaudiometry and the quality of perception during dichotic listening tests. Auditory evoked potentials in the brain stem included only minor functional-type anomalies, with slightly increased latencies in the pons on the left, and the mesencephalon and pons on the right. The presence of a bilateral wave VI was related to activity of the median geniculate pathway. Visual function tests showed good quality left photomotor reflexes and positive object detection in the anopsic hemifield. Results of these tests were reproducible during the same examination and after an interval of several months. The relevant literature is reviewed.

[Use of radiology in the diagnosis of posttraumatic otoliquorrhea. A report on 33 operated cases (author's transl)]. / Apport de la radiologie dans le diagnostic des otoliquorrhées d'origine post-traumatique. A propos de 33 cas opérés.

The association of standard radiography and tomography can enable the origin of the fistula to be established with reasonable precision : complementary contrast cisternography should permit direct localization. Treatment is essentially the concern of the E.N.T. surgeon, but the problem cannot be resolved without a perfect understanding between the neurosurgeon, surgeon, E.N.T. specialist, and the radiologist.