Transpetrosal access to meningiomas juxtaposing the temporal bone

Meningiomas arising from the petroclival dura have presented a challenge to both otolaryngologists and neurosurgeons. Access by means of subtemporal, suboccipital, translabyrinthine, or transcochlear routes have inherent limitations both surgically as well as from resultant morbidity. Since 1988, the authors have used a transpetrosal transtentorial (combined subtemporal suboccipital presigmoid) approach to these lesions in selected cases. The goals of this technique have been to preserve function of the cranial nerves, to avoid excessive retraction of the temporal lobe and cerebellum, and to eliminate damage to the venous sinus and Labbé's vein. Exposure of the base of the tumor for ablation of the blood supply and access for tumor removal is an important advantage of this approach.     

Hydroxychloroquine retinopathy: A review of imaging

Hydroxychloroquine (HCQ) retinopathy can result in permanent vision loss. In early stages of HCQ retinopathy, patients are usually asymptomatic with preservation of visual acuity. We aspire that our review, in conjunction with the American Academy of Ophthalmology screening guidelines, shall shed light on effective screening measures utilizing multimodal imaging techniques to detect early signs of HCQ retinopathy before advanced changes manifest clinically.     

Pituitary surgery: current status, including transsphenoidal surgery

Advances in CT scanning and digital subtraction angiography have improved the accuracy of preoperative diagnosis of pituitary disease. Modern radioimmunoassay techniques are able to evaluate "subdivisions" and "relatives" of the classic pituitary hormones, including monomeric and oligomeric growth hormones, somatomedin C, beta-lipotropin, and beta-endorphin, as well as the alpha subunit of follicle-stimulating hormone. Pituitary pathologic states can now be identified immunologically in patients in whom results of radiologic studies are normal. Bromocriptine, a centrally active dopamine antagonist and ergot derivative, is effective in the treatment of prolactinomas, but it is not effective in the treatment of acromegaly. Transsphenoidal surgery remains the treatment of choice in adults with pituitary-dependent Cushing's disease. The surgical advantages of the sublabial, transseptal, transsphenoidal approach include wide-field pituitary accessibility via a midline exposure.     

Sensitizing the teachers towards school mental health issues: an Indian experience

The School Mental Health (SMH) services play critical roles fostering positive mental health and helping children with psychological problems. Despite its proven value, SMH services remain less developed in India. In this context, sensitizing teachers about child mental health issues could be considered as an important step in SMH promotion. Towards this goal, a large scale sensitization program for school teachers on SMH issues was carried out in an Indian city. This paper reports the process and the outcome of this sensitization program.     

Trigeminal schwannomas: the role of the neurotologist in multidisciplinary management.

Trigeminal neuromas are slow-growing benign tumors representing approximately 10% of all intracranial neuromas and less than 0.5% of all intracranial tumors. Historically, excision of these tumors through traditional neurosurgical routes--including the frontotemporal transsylvian, subtemporal-intradural, subtemporal-transtentorial, or suboccipital approaches--has resulted in an unsatisfactorily high rate of recurrence. In this study we compare contemporary skull base/neurotologic approaches with conventional procedures for trigeminal neuroma extirpation.