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1.
Primary Ewing's sarcoma of the base of the skull   总被引:3,自引:0,他引:3  
The authors report a case of primary Ewing's sarcoma of the petrous bone. The radiological features, including the computed tomographic scan and angiographic findings, are described in detail.  相似文献   

2.
Villavicencio AT  Leveque JC  Bulsara KR  Friedman AH  Gray L 《Neurosurgery》2001,49(2):342-52; discussion 352-3
OBJECTIVE: The bony and vascular anatomic features in the region of the petrous apex can vary significantly. These variations affect the operative view obtained via extended subtemporal or anterior transpetrosal approaches to cranial base lesions for individual patients. The goal of this study was to evaluate three-dimensional computed tomography as a means of obtaining detailed preoperative anatomic information regarding bony and vascular landmarks and spatial relationships in the region of the petrous carotid artery and petrous apex. METHODS: We radiographically studied 15 patients (30 sides), using 0.8- to 1-mm-thick, reconstructed, computed tomographic images. Special attention was given to the course of the petrous carotid artery. RESULTS: The petrous carotid artery was located lateral to the trigeminal impression. The size of the petrous apex medial to the horizontal petrous carotid artery was observed to be variable. The width of bone from the trigeminal impression to the wall of the internal auditory canal averaged 9.6 mm (range, 5.2-16.1 mm). A variable amount of bone overlying the internal auditory canal (4.5 mm) was also present. Multiple other relationships among key landmarks were quantified. CONCLUSION: There is significant variability in the anatomic features of the petrous apex among patients. For each patient, detailed preoperative information regarding the amount of bone to be removed during a cranial base procedure can be obtained using three-dimensional computed tomography. This information may be critical for determination of the amount of extra exposure that can be achieved via an anterior petrosectomy for each patient.  相似文献   

3.
The authors present a rare case of malignant fibrous histiocytoma originating in the cranial bone. A 72-year-old male was admitted with a diffuse painless swelling in the left occipital region but no neurological abnormality. Plain skull x-ray films and computed tomographic scans showed a large tumor in the left temporo-occipital bone. The tumor invading subcutaneous tissue was totally excised and histologically diagnosed as malignant fibrous histiocytoma. Postoperatively, 40-Gy irradiation was given to the left temporo-occipital region. Several months later, however, the tumor recurred in the posterior fossa. Neuroradiological examination showed tumor extension into the occipital bone and muscle and the subdural space of the posterior fossa. A second operation extirpated all tumors except in the cerebellum. He died of pneumonia on the 14th postoperative day. Autopsy revealed malignant fibrous histiocytoma invading into the bilateral cerebellar hemispheres. Radiation and chemotherapy should be given as soon as possible following extensive surgery for malignant fibrous histiocytoma of the cranial bone.  相似文献   

4.
G Wilms  C Plets  L Goossens  J Goffin  K Vanwambeke 《Neurosurgery》1992,30(3):443-5; discussion 445-6
A patient with right hearing loss, in whom computed tomographic scanning demonstrated a mass in the right cerebellopontine angle with widening of and extension into the internal auditory canal, but with important posterior extension and broad implantation on the surface of the petrous bone, is reported. On both T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance images, there were clearly two separate tumoral lesions: an acoustic neurinoma extending into the internal auditory canal and a meningioma with broad implantation on the petrous apex. These findings were confirmed at surgery.  相似文献   

5.
BACKGROUND: A rare case of intradiploic epidermoid cyst of the occipital bone is described and recent literature, which emphasizes the radiological evaluation and surgical treatment of this lesion is reviewed. CASE DESCRIPTION: A 56-year-old female patient complained of headache and occasional episodes of vertigo for one year. Computed tomographic scan and magnetic resonance imaging were performed. The patient underwent occipital right craniotomy followed by total removal of the cyst and its capsule. RESULT: The postoperative course was uneventful and the patient was discharged 4 days later. CONCLUSION: A review of the literature shows that intradiploic epidermoid cyst of the occipital bone is rare. Correct radiological assessment and complete excision of this lesion and its capsule provides complete recovery.  相似文献   

6.
Giant intradiploic epidermoid tumor of the occipital bone: case report   总被引:1,自引:0,他引:1  
J Guridi  J Ollier  F Aguilera 《Neurosurgery》1990,27(6):978-80; discussion 980-1
The authors describe a case of a giant intradiploic epidermoid cyst of the occipital bone with an intracranial extension in the posterior fossa and no signs of neurological involvement. The lesion started as a painless lump under the scalp. Roentgenographic and computed tomographic findings led to a correct diagnosis, and the complete removal of the cyst was accomplished, despite its large size. The total removal of these cysts is associated with a good prognosis.  相似文献   

7.
Itshayek E  Spector S  Gomori M  Segal R 《Neurosurgery》2002,51(3):815-7; discussion 817-8
OBJECTIVE AND IMPORTANCE: Fibrous dysplasia of the cranium is a relatively uncommon disorder that affects primarily the anterior cranial region; its occurrence in the cranial base in combination with aneurysmal bone cyst (ABC) constitutes an extremely rare condition, only two cases of which have been reported previously in the literature. It is important to recognize and treat these cases properly because of the special location in the cranial base and the possibility of neural structure impingement. CLINICAL PRESENTATION: We report the case of a 19-year-old man with a slowly enlarging mass of the occiput, with computed tomographic and magnetic resonance imaging revealing involvement of petrous and basisphenoid bone and growing ABC. INTERVENTION: Open biopsy confirmed the diagnosis of fibrous dysplasia. Partial excision of the lesion and removal of the ABC were performed in a second stage after embolization. CONCLUSION: ABC associated with fibrous dysplasia of the cranial base may enlarge rapidly after puberty and require excision. This is facilitated by preoperative embolization.  相似文献   

8.
Primary myxoma of the temporal bone in a 17-year-old boy: case report   总被引:4,自引:0,他引:4  
Osterdock RJ  Greene S  Mascott CR  Amedee R  Crawford BE 《Neurosurgery》2001,48(4):945-7; discussion 947-8
OBJECTIVE AND IMPORTANCE: Only two cases of primary intracranial myxomas have been described previously in the literature: one patient had a primary intracranial myxoma in the pituitary fossa, and the other patient's myxoma was located in the posterior fossa. CLINICAL PRESENTATION: A rare case of primary myxoma of the temporal bone in a 17-year-old boy is described. The patient presented with a history of progressive left-sided hearing loss and increasing headaches of a few months' duration. INTERVENTION: An initial draining procedure in the left ear revealed extant mucous material, and further investigation showed a large calcified lesion involving the petrous and temporal bones and filling the middle fossa. At surgery, a large mucoid-appearing tumor was removed. The tumor pathology revealed a primary myxoma with bone and meningeal involvement. No clinical or histopathological evidence that it was a metastatic lesion was found. CONCLUSION: The features of myxomas on computed tomographic and magnetic resonance imaging, the histopathology, and surgical considerations are discussed.  相似文献   

9.
High-resolution computed tomography (CT) was performed on 31 patients clinically suspected of having petrous bone fracture. The location of the fracture was demonstrated accurately in 28 patients (90.3%), whereas it could be diagnosed by plain skull film in only 17 patients (54.8%). The anatomic location of fractures demonstrated by high-resolution CT clearly corresponded to the clinical symptoms and signs. We have classified petrous bone fracture into five types according to the anatomic levels demonstrated on CT images. The findings indicate that highresolution CT is extremely useful for diagnosing petrous bone fracture.  相似文献   

10.
A 25-year-old male presented with off-and-on vertigo of 10-year duration. He had left-sided cerebellar signs, left vocal cord paresis, and minimal left-sided hearing impairment. Computed tomography of the head revealed significant hyperostosis of squamous occipital, mastoid, and petrous temporal bone with no adjacent soft tissue mass. On excision, it turned out to be paraganglioma. Paraganglioma as a pure bony mass is not reported in the literature. The site of origin of such a tumor could not be ascertained, even on generous screening. The tumor remained nonsecretory on clinical and biochemical investigations.  相似文献   

11.
Epidermoids known as cholesteatomas, are congenital benign tumors and originate in the embryonic ectoderm. They account for 1.3% of all intracranial tumors. They are often found in the cerebellopontine angle and the paraseller region, but rarely in the petrous portion of the temporal bone. Epidermoids of the petrous bone tend to slowly present progressive facial palsy and hearing disturbance. In this article, two cases of epidermoids involving the petrous bone are reported. A 55-year-old male presented left facial palsy, left hearing disturbance and decreased gustation in the left side of the tongue. MRI revealed a non-enhanced mass on the petrous portion of the left temporal bone, and bone-window CT showed bone destruction in the same region (Case 1). A 71-year-old female was aware of left facial palsy and left hearing loss for 15 years. MRI showed a non-enhanced mass on the petrous bone, and bone-window CT demonstrated extensive bone erosion of the petrous bone and the middle cranial fossa (Case 2). In both cases, total removal was performed via the middle cranial fossa approach. Both tumors existed extradurally and had pressed against the genicurate ganglion of the facial nerve. The facial palsy of the former case recovered 12 months after surgery. We discuss the problems of diagnosis and treatment of epidermoids of the petrous bone.  相似文献   

12.
Osteolytic lesions can be seen in various diseases. We present a rare case of symptomatic hypertrophic pacchionian granulation mimicking bone tumor in the calvaria. A 50-year-old woman suffered from a previous VII cranial nerve peripheral paresis accompanied by headache. A plain radiograph revealed a punched-out paramedial occipital lesion. Precontrast-enhanced computed tomographic scans demonstrated a hypodense mass, with a defect of both tables of the left occipital bone. Magnetic resonance imaging (MRI) demonstrated a hypointense mass on the T1-weighted image and isointense to cerebrospinal fluid on the T2-weighted image, with capsule-like contrast enhancement by gadolinium. A biopsy was performed. Histologically, hypertrophic pacchionian granulation was diagnosed. The patient has had no growth for 2 years. This case suggests the need to include hypertrophic pacchionian granulation in the differential diagnosis of punched-out lesions.  相似文献   

13.
Two cases of pneumocephalus after ventriculoperitoneal shunt placement in patients with posterior fossa tumors were reported. In each instance, air entered the ventricles through a porencephalic cavity in the temporal lobe that communicated with the mastoid air cells. Thinning of the petrous bone may occur secondary to chronic hydrocephalus or congenital factors. The decrease of intracranial pressure after a shunt might play a role in causing pneumocephalus. The early discovery of the site of air entrance by computed tomographic scan and the direct repair of the bone and dural defect should be mandatory.  相似文献   

14.
Skull metastases occur in patients with various malignancies; however, those resulting from intrahepatic cholangiocarcinoma (ICC) have been rarely reported. In our hospital, 324 patients were diagnosed with metastatic brain or skull tumors from June 1969 to June 2011, but only 3 of them (0.9%) developed skull metastases from ICC. We report the case of 3 patients with skull metastases from ICC. A combination of computed tomography (CT), contrast-enhanced magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and methionine-PET were used for imaging. Sites of tumors were the lateral left orbit and right parietal bone in case 1, the left parietal bone, left temporal bone, and lateral left orbit in case 2, the right petrous bone, right occipital bone, and upper cervical vertebra in case 3. The metastases were confirmed to have originated from ICC by biopsy in two of the cases and diagnosed by MRI and FDG-PET in case 2. Radiosurgery and radiotherapy had positive effects on symptom improvement and cosmetic problems.  相似文献   

15.
The commonest skull manifestations in neurofibromatosis involve the orbit, with very few reports about occipital defects. We report a rare case of a 54-year-old lady with a massive plexiform neurofibroma extending from the auricular region down her left neck and into her shoulder, with an associated large left occipital and left petrous bone defect and extensive cerebellar meningo-encephalocoele, which presented with a relatively asymptomatic cervical mass and was treated with resection of the neurofibroma and advancement and rotational skin flaps.  相似文献   

16.
Morphologic and radiologic anatomy of the occipital bone.   总被引:2,自引:0,他引:2  
Several diseases may cause craniovertebral instability warranting occiput-cervical fusion. As occipital screw and rod constructs are becoming more popular, requiring that screws be placed either medially or laterally in the occipital bone, the need for clearer anatomical and computed tomography (CT)-confirmed data regarding the relative thickness of the occiput in its various localities has become more critical. In 18 cadaveric specimens, the occipital bone was divided into 35 measurable segments. Transversely, the occipital bone was divided into five lines starting at the level of the inion; horizontal lines then proceeded inferiorly in 1-cm segments, 1, 2, 3, and 4 cm below the level of inion. In a comparable fashion, the occipital bone was divided vertically, starting at the midline, and proceeding laterally also in 1-, 2-, and 3-cm segments. Anatomical measurements of thickness were directly performed using a Vernier caliper. Results were directly correlated with axial CT measurements of bony thickness. Anatomical and CT measurements closely correlated within the same specimen, but there was significant interspecimen variability. The marked differences in the occipital bone anatomy noted between specimens indicates that patients undergoing occipital screw placement for cranial-cervical instability would benefit from preoperative occipital CT evaluations.  相似文献   

17.
Vilela MD  Rostomily RC 《Neurosurgery》2004,55(1):143-53; discussion 153-4
OBJECTIVE: The preauricular subtemporal-infratemporal (PSI) approach is commonly used to resect clival tumors and other lesions anterior to the brainstem. One of the surgical steps in this approach is a condylar osteotomy or a condylectomy, which often leads to temporomandibular joint dysfunction. We describe a modification of the PSI approach that preserves the temporomandibular joint without sacrificing the ability to mobilize the petrous internal carotid artery or gain surgical access to the clivus and anterior brainstem. METHODS: Anatomic studies in cadaveric specimens were performed, and the extent of exposure of critical skull base and intradural structures was documented with postdissection fine-cut computed tomographic scans. This modification of the PSI approach was subsequently used in three consecutive patients with a clival chondrosarcoma, and the completeness of tumor resection was documented with postoperative magnetic resonance imaging and computed tomographic scans. RESULTS: This approach allowed complete mobilization of the petrous internal carotid artery and surgical access to the mid-lower clivus, jugular tubercle, hypoglossal canal, occipital condyle, anterior brainstem, and the origin of the trigeminal through hypoglossal nerves. It also proved to be safe and feasible in the three patients who underwent surgical resection of a clival chondrosarcoma, allowing a complete tumor removal. CONCLUSION: This variation of the PSI approach is practical, has no additional morbidity, and provides complete access to critical cranial base regions and tumor margins. It can certainly be used as an alternative to the standard PSI approach when dealing with clival tumors and other lesions anterior to the brainstem.  相似文献   

18.
19.
Osteoclastomas of the petrous bone   总被引:1,自引:0,他引:1  
Two cases of osteoclastoma of the petrous bone are presented that were clinically taken for tumors of the glomus jugulare. The petrous bone is a very uncommon location for such tumors, and only six cases have been reported in the English literature. The histopathological features as well as the clinical course are described, and the literature is critically reviewed.  相似文献   

20.
《The spine journal》2020,20(6):866-873
BACKGROUND CONTEXTThe occipital bone is often involved in the surgical treatment of basilar invagination (BI). However, the anatomy of the occipital bone associated with BI patients has yet to be investigated.PURPOSETo present a morphological map of the occipital bone in BI patients and help guide screw placement for occipitocervical fusion.Study DesignA retrospective case-control study.METHODSRadiological measurements of the occipital bone were performed on computed tomography images based on a matrix of 99 points centered around the external occipital protuberance (EOP) in a cohort of 50 BI patients and 50 cases with no head and cervical disease. The comparison between the BI group and the control group was assessed using Student t analysis and p<.05 was considered statistically significant.RESULTSAll thicknesses measured from points of the matrix in the BI group were thinner than those in the control group (p<.05). The maximum thicknesses in both groups were located at the center of the EOP, which were 15.11±2.84 mm in the BI group and 17.56±3.03 mm in the control group, respectively. Additionally, thickness decreased with the distance away from the center of EOP.CONCLUSIONSThe occipital bone in BI patients is thinner than that in the general population. A limited safe zone in BI patients is available for surgeons to place screws, which may need to be fully evaluated before operation.  相似文献   

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