Metastases to Meckel's cave: Report of two cases and comparative analysis of malignant tumors with meningioma and schwannoma of Meckel's cave

Objective

To investigate clinical characteristics of patients with malignant tumors of Meckel's cave with two illustrative cases. A comparative analysis of clinical features of malignant tumors of Meckel's cave with meningioma and schwannoma of Meckel's cave is discussed.

Methods

We report two cases of malignant tumors involving Meckel's cave. We identified 19 additional cases of malignant tumors of Meckel's cave in the literature. We analyzed the symptoms, results of neurological and radiographic examination, pre-operative diagnosis and final diagnosis of these tumors. Our findings were then compared with well described case series of meningioma and schwannoma involving Meckel's cave.

Results

Of the 21 patients with malignant tumor involving Meckel's cave, 76% (16/21) had pain, 67% (14/21) had paraesthesia, 89% (17/21) had objective evidence of trigeminal sensory involvement and 42% (8/21) had objective evidence of trigeminal motor involvement. In contrast, of patients with trigeminal schwannomas [1], only 23% presented with pain, 36% with paraesthesia, 74% with objective evidence of trigeminal involvement and 42% with trigeminal motor involvement. Pain and paraesthesia were seen more often in malignant tumors. In Delfini et al.’s [2] series of meningiomas involving Meckel's cave, 81% of patients presented with pain, 25% with paraesthesia, 63% with trigeminal sensory deficits and only 13% with trigeminal motor involvement. Patients with malignant tumors were more likely to be older, and have paraesthesia in comparison with patients with meningioma.

Conclusion

Subtle clinical clues may help differentiate malignant from benign involvement of Meckel's cave. We emphasize the need to thoroughly investigate patients early for a possible primary as well as metastases, in those found to have a lesion in the Meckel's cave.     

Quantification and characterization of aortic cholesterol in rabbits fed a high-cholesterol diet

Determination of fat percentage of aortic intimal area stained by Sudan III is useful as an index of atherosclerosis in the rabbit animal model. However, the determination of sudanophilic area of the thoracic aorta is two-dimensional and does not measure the third dimension of depth. The objective of the present study was to quantify and characterize aortic lipids using the gas–liquid chromatographic (GLC) technique and to determine whether elevated measurements of total cholesterol and cholesteryl esters was correlated with increased measurements of sudanophilic area staining of the thoracic aorta in rabbits given either a normal chow or a 1% cholesterol diet. The GLC results showed that there was a mean accumulation of 10.9 mg of cholesterol per gram of aortic tissue in the rabbits given a cholesterol diet (mean sudanophilic area of 23.8%). In contrast, rabbits on a normal chow diet had only a deposition of 0.58 mg of cholesterol per gram of the aortic tissue diet (mean sudanophilic area of 1.4%). The present study suggests that quantification of the aortic lipids can be performed by using GLC techniques and that it could be used as an alternative to the measurement of sudanophilic area when assessing the severity of atherosclerosis.     

First trimester combined screening for Trisomy 21 in Hong Kong: outcome of the first 10,000 cases

Objective.?To examine the effectiveness of first trimester fetal Trisomy 21 (T21) screening using a combination of maternal age, nuchal translucency, maternal serum levels of free β-hCG and PAPP-A in a predominantly Chinese population in Hong Kong.

Methods.?Consecutive women who underwent the combined screening for T21 between 11 and 13 + 6 weeks of gestation between 2003 and 2007 were recruited. Risk of T21 was calculated using Fetal Medicine Foundation algorithm and karyotyping was advised when the risk was 1:300 or above. All women were followed up for pregnancy and fetal outcome.

Results.?10,363 fetuses underwent screening. 99% of the women were Chinese and 27.4% were at or above 35 years old. 618 fetuses were screened positive (5.9%), which included 31 cases of T21, 14 cases of T18, 7 cases of T13, 10 cases of 45XO and 7 cases of other chromosomal abnormalities. Among the 9745 screened negative fetuses all but 50 (0.5%) had a known outcome, which included three T21 and four other chromosomal abnormalities. All were subsequently identified at the morphology scan except for one case of T21. The detection rate and false positive rates for T21 were 91.2% and 5.4%, respectively and the positive predictive value for all chromosomal abnormalities was 1 in 9.

Conclusions.?Combined screening for T21 is highly effective among Chinese women. Training, quality control, regular auditing and follow up are essential to maintain screening standards.     

Infant feeding fractices within white and Asian Communities in inner-city Leeds

A structured questionnaire was devised in order to ascertain infant feeding practices. Multi-lingual interviewers visited the homes of 127 Caucasian and 184 Asian families with infants aged 6–24 months, in inner-city Leeds. The Asian families interviewed were from four-defined communities; Bangladeshis, Pakistanis, Punjabis and Gujaratis.
When compared with asian mothers, Caucasian mothers were more likely to breast-feed, and demonstrated a more positive approach to their chosen feeding pattern whether breast or bottle. Few differences in feeding practices were noted between the distinct Asian groups despite inter-group variations in English language ability, family size and duration of residence in Britain. Most of the Asian infants were still drinking from a feeding bottle at the age of 2 years, and two-thirds of the milk feeds were sweetened. In contrast, the majority of white Caucasian infants were no longer using a feeding bottle at 12 months of age, although one-third drank milk swetened, The mothers interviewed claimed that health professionals had advised them to add items to the milk, and to use vitamin fruit juices.
The feeding practices reported have clear implications for dental health, particularly among the Asain children. There is an urgent need for effective health education initiatives by health advisers based on a thorough evaluation of cultural differences in attitudes and practices     

Surgical treament of lateral skull base tumours

Tumours of retrolabyrinthine and base of skull are perhaps dealt best by using the Fisch’s technique with minimal marbidity. The classical Fisch technique may be modified depending upon the type and extent of the tumour as seen in our case no 4. This technique has definite advantage over the others in adequate visualization and management of these tumours which often encroaches upon the internal carotid artery and the great venous sinuses. Review of the available literature fails to show any similar experience an this technique in management of lateral skull base tumours in this part of our country.