The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

ObjectivesNecrotizing external otitis (NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns.MethodsRetrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns (group A) or complex spreading patterns (group B) as diagnosed by CT. Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records.Results41 NEO patients were included, of which 27 patients belonged to group A (66%). The disease-related mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII (42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A (28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0 (IQR 6.0–19.5) months.ConclusionNEO is a severe disease, with significant mortality and morbidity (cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies (N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies.Level of evidenceLevel IV.     

Primary cranial vault lymphoma mimicking meningioma

Primary lymphomas of the cranial vault are rare; only six patients have been described in the literature. We report a 75-year-old woman who was admitted to our hospital after a focal seizure. CT showed a homogeneous mass which, on contrast enhancement, was similar to a meningioma. The tumour was excised and found to be a centroblastic, centrocytic non-Hodgkin's lymphoma. Treatment was completed with radiotherapy and chemotherapy.     

Radiographic findings in tuberculosis of the calvarium

We reviewed the pattern of involvement of the calvarium by tuberculosis (TB) in five patients and the role of imaging in its management. Four patients presented with localised scalp swelling and one with generalized seizures. Radiographs revealed lucent lesions with minimal surrounding sclerosis in the frontal (2), parietal (2) and occipital (1) bones. CT showed lesions involving the entire thickness of the calvarium and accompanying contrast-enhancing soft tissue. The patient presenting with seizures had a ring-enhancing lesion in the parietal lobe in addition to the extra-axial lesions. Although radiographs in all cases demonstrated calvarial TB, CT showed the extent of the defect, involvement of adjacent soft tissues, and in one case an intra-axial lesion. Radiographs suffice for follow-up of these patients. Received: 23 July 1999 Accepted: 20 September 1999     

经去颧弓扩大颞下入路切除海绵窦,岩尖,上斜坡肿瘤

本文介绍采用改进的去颧弓扩大颞下入路手术治疗８例位于或累及海绵窦、岩骨尖部、上斜坡、天幕游离前外缘肿瘤患者。该方法的要点是断去颧弓，扇形形成颞肌瓣，翻向颧弓断段以下，咬除蝶骨嵴外侧部分，形成低位颞额骨窗，仅轻度上抬颞叶，则可充分暴露病变范围。由于手术空间扩大，更利于肿瘤切除。本组８例均达到全部或大部分切除，患者术后均得以康复，原有体征不同程度改善。     

孕酮对离体胎鼠头盖骨成骨细胞增殖与分化的影响

目的：从细胞、基因水平探讨孕酮对成骨细胞增殖及分化的影响。方法：胎鼠头盖骨成骨细胞在体外经不同浓度（１０－９ｍｏｌ／Ｌ～１０－６ｍｏｌ／Ｌ）的孕酮作用后，对其细胞增殖、碱性磷酸酶（ＡＬＰ）活性、骨钙素ｍＲＮＡ表达、骨钙素分泌及骨小结形成进行检测分析。结果：（１）孕酮对成骨细胞增殖无明显促进作用；（２）孕酮增加细胞ＡＬＰ活性；（３）孕酮提高骨钙素ｍＲＮＡ表达及骨钙素的分泌，孕酮对骨钙素基因表达的刺激作用呈剂量依赖性；（４）孕酮增加骨小结形成的数量及面积。结论：孕酮对离体胎鼠头盖骨成骨细胞的分化具有多重促进效果，但对细胞的增殖无影响。     

颅底恶性肿瘤切除术后组织缺损一期修复的探讨──附18例报告

目的：为解决颅底恶性肿瘤的广泛切除或根治性切除术后所致的颅底骨与软组织缺损，预防此缺损所致的颅内感染，脑脊液漏等并发症。方法：在术中应用了斜方肌下部岛状肌皮瓣，胸大肌下部岛状肌皮瓣，颞肌复合组织瓣等各种修复方法分别对18例患者进行了一期修复。结果：修复成功率73．2％（13例），术后并发症27．8％（5例）.结论：根据组织缺损的不同大小、范围、程度、部位和不同的手术入路来选择不同的修复方法，关系到手术成败。     

Intraosseous lipoma of the frontal bone. A case report

Intraosseous lipomas are among the most uncommon bone tumors. They arise most often in the appendicular skeleton. There are very few reported cases of intraosseous lipomas within the skull bones. We report a case of intraosseous lipoma of the frontal bone with conventional radiography and CT findings.     

儿童颅骨生长性骨折

目的 探讨儿童颅骨生长性骨折(Growing skull fractwre，GSF)的发病机制、诊治方法。方法 对我院1992年1月2002年4月10年间收治的6例GSF患儿的临床资料进行回顾行分析。结果 6例均有明确颅脑损伤病史，平均发病年龄2．99岁，头部包块、颅骨缺损及神经功能障碍等症状常见，颅骨平片见以骨折线为长轴的梭形颅骨缺损，CT检查显示包块为蛛网膜囊肿或脑膨出，术中见硬脑膜缺损大于颅骨缺损；Goldstein分型：Ⅰ型2例，Ⅱ型2例，Ⅲ型2例；GOS5分者3例(2例Ⅰ型和1例Ⅱ型)，4分者2例(Ⅱ型和Ⅲ型各1例)，3分者1例(Ⅲ型)。结论 ①颅骨骨折致硬脑膜破损为GSF发病的病理基础，婴幼儿期颅脑发育、外伤后局部颅内压力增高、骨折缘缺血为发病的重要因素；②GSF患儿颅骨缺损范围与病程不呈正相关，颅脑CT在GSF的诊断方面优于颅骨平片；③GSF一经确诊即应手术治疗，扩大开颅术能显露硬脑膜残缘，严密修补硬脑膜是手术成功的关键，Medepor材料适用于GSF患儿。Goldstein分型对指导预后有一定意义。     

Intraoperative lateral rectus electromyographic recordings optimized by deep intraorbital needle electrodes

ObjectiveWe demonstrate the advantages and safety of long, intraorbitally-placed needle electrodes, compared to standard-length subdermal electrodes, when recording lateral rectus electromyography (EMG) during intracranial surgeries.MethodsInsulated 25 mm and uninsulated 13 mm needle electrodes, aimed at the lateral rectus muscle, were placed in parallel during 10 intracranial surgeries, examining spontaneous and stimulation-induced EMG activities. Postoperative complications in these patients were reviewed, alongside additional patients who underwent long electrode placement in the lateral rectus.ResultsIn 40 stimulation-induced recordings from 10 patients, the 25 mm electrodes recorded 6- to 26-fold greater amplitude EMG waveforms than the 13 mm electrodes. The 13 mm electrodes detected greater unwanted volume conduction upon facial nerve stimulation, typically exceeding the amplitude of abducens nerve stimulation. Except for one case with lateral canthus ecchymosis, no clinical or radiographic complications occurred in 36 patients (41 lateral rectus muscles) following needle placement.ConclusionsIntramuscular recordings from long electrode in the lateral rectus offers more reliable EMG monitoring than 13 mm needles, with excellent discrimination between abducens and facial nerve stimulations, and without significant complications from needle placement.SignificanceLong intramuscular electrode within the orbit for lateral rectus EMG recording is practical and reliable for abducens nerve monitoring.     

Propionibacterium skull base osteomyelitis complicated by internal carotid artery pseudoaneurysm

The microbiology of skull base osteomyelitis (SBO) is evolving. We present here the first case of SBO caused by Propionibacterium acnes leading to the development of a pseudoaneurysm of the internal carotid artery. Otolaryngologists should recognize this pathogen as a potential cause of invasive temporal bone infection to optimize prompt diagnosis and treatment. Laryngoscope , 127:2337–2339, 2017