Biomedical subjects

Madjid Samii

Publications and source records attributed to Madjid Samii.

At least 55 records · Page 3Linked to original sources

PubMed2003

Intraventricular meningiomas: a review of 16 cases with reference to the literature.

BACKGROUND: Primary intraventricular meningiomas are notably rare with an incidence of 0.5 to 3% among all intracranial meningiomas. We present a series of 16 patients with histologically verified intraventricular meningiomas, the clinical and neuroradiological findings, and surgical results. METHODS: The charts of the patients including surgical records, discharge letters, histologic records, follow up records and imaging studies were analyzed retrospectively from 1978 to 2001. RESULTS: Collectively, 110 primary intraventricular tumors were surgically resected in our neurosurgical department from 1983 through 2001. There were 16 patients with primary intraventricular meningiomas. Thirteen (81.3%) of these tumors were located in the lateral ventricles, one (6.2%) in the third and two (12.5%) in the forth ventricle. Mean age was 47.1 years and there was no difference in incidence between the sexes. The most common presenting symptoms and signs were headache, mental change, and hemianopia. Other symptoms included gait ataxia, vertigo, hemiparesis, double vision, aphasia, and alexia/agraphia. On CT and MR studies most of the lateral ventricular meningiomas were located in the trigone (11 cases), two tumors originated at the level of foramen of Monro or in the frontal horn. The tumors were approached via a transcortical parieto-occipital (11 cases), transcallosal (3 cases), or median suboccipital (2 cases) route. Total removal was achieved in 15 out of 16 cases. There was no operative mortality. Clinical improvement was seen in symptoms like headaches, paresis, cerebellar signs and visual disturbances, whereas mental change showed less improvement. CONCLUSIONS: Although intraventricular meningiomas are quite rare, they represent an important differential diagnosis of intraventricular neoplasms. They can reach a substantial size by the time of diagnosis, yet total removal can be achieved in most cases.

Adult↗

PubMed2003

C-Fos immunoreactivity mapping of the auditory system after electrical stimulation of the cochlear nerve in rats.

The aim of this study was to establish the use of c-Fos immunoreactivity as a marker for functional mapping in the auditory system in response to direct electrical stimulation of the cochlear nerve in the cerebellopontine angle. In rats the cochlear nerve was electrically stimulated with a biphasic current (120-250 microA, 5 Hz) for 30 min using a bipolar concentric Tungsten electrode. Bilateral cochlectomy was performed in a control group in order to investigate basal expression of c-Fos in the auditory brainstem nuclei. The response of auditory brainstem nuclei to electrical stimulation and the completeness of cochlear ablations were electrophysiologically verified. After the experiments, the animals were prepared for cryotomy and c-Fos immunohistochemistry. The results were morphologically analyzed and statistically compared among groups. In anesthetized animals with unilateral electrical stimulation of the cochlear nerve increased expression of c-Fos was detected in the ipsilateral ventral (VCN) and bilateral dorsal cochlear nucleus (DCN), whereas the VCN of the contralateral side revealed only few immunoreactive cells. In animals with bilateral cochlear ablation the number of c-Fos reactive cell nuclei representing basal expression was generally low in the VCN and DCN of both sides. Our data show that electrical stimulation of the cochlear nerve leads to increased expression of c-Fos in the cochlear nucleus. It also confirms bilateral connections between the cochlear nuclei. These experimental results suggest that c-Fos immunoreactivity mapping provides a powerful tool for functional investigations on the cellular level after direct electrical stimulation of the cochlear nerve. Future functional studies analyzing the effect of electrical stimulation of the central auditory system as performed by auditory brainstem implants could be investigated in detail by mapping c-Fos expression on cellular level.

Animals↗

PubMed2003

Metabolic changes in the vicinity of brain contusions: a proton magnetic resonance spectroscopy and histology study.

Proton MR spectroscopy (1H-MRS) has been previously used to monitor metabolic changes in areas of diffuse brain injury. We studied metabolism in the close vicinity of experimental traumatic brain contusions and remote on the contralateral side from 1h to 28d post-injury. Changes of creatine and phosphocreatine (Cr&PCr), N-acetylaspartate (NAA), choline (Cho), inositol (Ino), taurine (Tau), glutamate (Glu), and lactate (Lac) were assessed and compared to neuronal, glial and inflammatory changes in histology. In the pericontusional zone Cr&PCr, NAA, and Glu decreased immediately after trauma by -35%, -60%, and -37%, respectively, related to primary cell disintegration and secondary perturbations as reflected in histology. These metabolites partially recovered at 7d (-15%, -37%, and -21% respectively), in parallel to indicators of repair in immunhistochemistry. Control levels were not regained at 28d, in correlation to a decrease of viable neurons. Cho and Ino, initially lowered by -26% and -31% respectively, increased at 7d by +74% and 31%, reflecting glial activation and proliferation. The signal including the lactate resonance increased by >1000% with a maximum at 7d, possibly related to energy failure, inflammation and glial activation. A partial contribution of lipids to this signal cannot be fully excluded. The contralateral side showed mild astroglial activation in histology, but no changes in 1H-MRS. The study demonstrates the feasibility of volume selective 1H-MRS using the LCModel (Linear Combination of Model in vitro spectra of metabolites solutions) to monitor metabolic changes close to focal traumatic lesions and suggests how metabolic alterations can be differentiated in cause.

Animals↗

PubMed2003

Natural history of petroclival meningiomas.

OBJECTIVE: For evaluation of the natural history of petroclival meningiomas, a cooperative retrospective study of 21 conservatively treated patients is reported. METHODS: All patients had petroclival meningiomas that were observed for at least 4 years, with regular clinical and radiological control examinations. The follow-up periods ranged from 48 to 120 months (mean, 82 mo; median, 85 mo). Functional evaluations were performed by using the Karnofsky index. Individual growth curves and rates were defined. RESULTS: Age and sex distributions and presenting symptoms were comparable to those of other studies. During follow-up monitoring, radiological tumor growth was observed in 76% of the cases. With 63% of the growing tumors, there was functional deterioration. We performed statistical analyses of demographic features, radiological findings, and functional deterioration. Severe functional deterioration was observed to be statistically significantly associated with infratentorial growth and increased growth rates. A change in the growth pattern often preceded functional deterioration. CONCLUSION: This study provides a better understanding of the natural course of petroclival meningiomas. The growth patterns of these tumors are unpredictable and variable. The exact factors influencing growth remain unclear. This study can contribute to the optimization of individual management of these tumors.

Adult↗

PubMed2003

Temporal profiles of cerebrospinal fluid leukotrienes, brain edema and inflammatory response following experimental brain injury.

The post-traumatic changes of leukotrienes LTC4, LTD4, LTE4, and LTB4 in cerebrospinal fluid of rats from 10 min to 7 days were investigated after controlled cortical impact in relation to brain edema and cellular inflammatory response. LTC4 increased five-fold at 4 h, normalized at 24 h, and showed another four-fold increase at 7 days. The same pattern was observed for LTD4 and LTE4. LTB4 however, behaved differently: concentrations were lower and levels peaked two-fold at 24 h. Edema in the injured hemisphere increased continuously up to 24 h without change contralaterally. Leukocyte infiltration, macrophage presence and microglia activation were most prominent at 24 h, 7 days and 24 h respectively. Leukotriene changes in CSF seem to reflect those in the affected tissue, with a time delay and in lower concentrations, and were not linearly correlated to brain edema. The initially high leukotriene levels are rather likely to contribute to the cytotoxic edema than to enhance a vasogenic edema component. The profile of LTB4 was parallel to the time course of leukocyte infiltration, indicating initiation of infiltration as well as prolonged production by leukocytes themselves. The second leukotriene peak at 7 days is likely to follow a different pathway and might be related to a production in macrophages or activated glia.

Animals↗

PubMed2003

Hamartomas of the internal auditory canal: report of two cases.

OBJECTIVE AND IMPORTANCE: To highlight the clinical, radiological, and surgical findings and therapeutic options for this rare entity, which may mimic a purely intrameatal vestibular schwannoma, and to define the particular aspects of preoperative differential diagnosis and surgical management. CLINICAL PRESENTATION: Two patients presented with clinical findings typical of vestibular schwannomas, i.e., tinnitus, hearing loss of 30 dB, and an intrameatal contrast-enhancing lesion on magnetic resonance imaging studies. TECHNIQUE: The lesions were exposed via a suboccipital transmeatal approach, and tumor infiltration of the cochlear and/or facial cranial nerves was identified. In view of the unclear intraoperative histology, surgical management was based on criteria of cranial nerve function. In Patient 1, after nerve decompression by subtotal tumor removal, preserved auditory brainstem responses and facial nerve electromyography indicated functional nerve preservation and facilitated the decision for partial resection. In Patient 2, minimal tumor dissection resulted in complete loss of auditory brainstem response without reversibility. Therefore, a radical tumor removal was performed that sacrificed the cochlear but preserved the facial nerve. CONCLUSION: Symptoms and signs of internal auditory canal hamartomas are congruent with other typical pathological lesions of the internal auditory canal and cerebellopontine angle. Accurate preoperative diagnosis by radiological means is not possible, but careful evaluation of the different signal intensities on magnetic resonance imaging studies may indicate this rare pathological condition. Intraoperative surgical findings of tumor infiltration of the faciocochlear cranial nerve complex may support simple observation. In view of the nonneoplastic characteristic of these lesions, a more conservative approach is justified. The decision should be based on the functional status of the cranial nerves, for which reliable electrophysiological monitoring is indispensable.

Adult↗

PubMed2003

The natural history of incidental meningiomas.

OBJECTIVE: Little information about the natural history of incidental meningiomas exists in the literature. The aim of this study was to determine the natural history of asymptomatic meningiomas by comparing different methods of growth rate calculation to establish a strategy for dealing with these tumors. METHODS: In 47 asymptomatic patients, hospital charts, follow-up records, and imaging studies were reviewed. Of these patients, 6 underwent surgery. Tumor growth rates were determined by calculating the absolute and relative growth rates and the tumor volume doubling times. RESULTS: In 41 patients with conservative management, the average tumor size was 9 cm(3), and the majority (66%) of growth rates were less than 1 cm(3)/yr. The absolute growth rate ranged from 0.03 to 2.62 cm(3)/yr (mean, 0.796 cm(3)/yr). Relative annual growth rates ranged from 0.48 to 72.8% (mean, 14.6%). The tumor doubling time ranged from 1.27 to 143.5 years (mean, 21.6 yr). A moderate correlation between the age and growth rates was found. In young patients, annual growth rates tended to be higher and tumor doubling times shorter. There was no clear correlation between the initial tumor size and tumor doubling time. The mean annual growth rate of meningiomas with calcification was lower than in tumors without calcification. Also, tumors with hypointense or isointense T2 signals on magnetic resonance imaging had a lower growth rate. In the group of six patients with surgical excision, tumor growth rates were higher and tumor doubling times shorter than in the nonsurgical group. CONCLUSION: The majority of incidental meningiomas show minimal growth; thus, they may be observed without surgical intervention unless specific symptoms appear. Tumor growth is associated with patient age. The initial tumor size is not considered a predictive factor for tumor growth. Radiological features, such as calcification or T2 signal intensity, may provide useful information to predict the growth potential of meningiomas.

Adult↗

PubMed2003

"Nihil nocere" and beyond: the issue of leadership in healthcare.

The quality of leadership is usually assessed in terms of business performance, which is reflected in expenditure and revenue figures. Although cost efficiency becomes an ever more important factor in healthcare, financial revenue is not the only defining factor for quality of leadership in a business where the consequence of failure may be deadly in the true sense of the word. Moreover, since "health" and "well-being" are both complex issues involving a variety of psychological variables, customer satisfaction in this field is not always strictly related to the quality of the delivered care. This difficulty in the definition of an accomplished leader in healthcare may have added to the negligence in developing leadership in this field.

Administrative Personnel↗

PubMed2003

Brachial plexus injury: factors affecting functional outcome in spinal accessory nerve transfer for the restoration of elbow flexion.

OBJECT: Between 1994 and 1998, 44 nerve transfers were performed using a graft between a branch of the accessory nerve and musculocutaneous nerve to restore the flexion of the arm in patients with traumatic brachial plexus injuries. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 39 patients: 1) time interval between injury and surgery; and 2) length of the nerve graft used to connect the accessory and musculocutaneous nerves. METHODS: The postoperative follow-up interval ranged from 23 to 84 months, with a mean +/- standard deviation of 36 +/- 13 months. Reinnervation of the biceps muscle was achieved in 72% of the patients. Reinnervation of the musculocutaneous nerve was demonstrated in 86% of the patients who had undergone surgery within the first 6 months after injury, in 65% of the patients who had undergone surgery between 7 and 12 months after injury, and in only 50% of the patients who had undergone surgery 12 months after injury. A statistical comparison of the different preoperative time intervals (0-6 months compared with 7-12 months) showed a significantly better outcome in patients treated with early surgery (p < 0.05). An analysis of the impact of the length of the interposed nerve grafts revealed a statistically significant better outcome in patients with grafts 12 cm or shorter compared with that in patients with grafts longer than 12 cm (p < 0.005). CONCLUSIONS: Together, these results demonstrated that outcome in patients who undergo accessory to musculocutaneous nerve neurotization for restoration of elbow flexion following brachial plexus injury is greatly dependent on the time interval between trauma and surgery and on the length of the nerve graft used.

Accessory Nerve↗

PubMed2003

The sphenopetroclival venous gulf: a microanatomical study.

OBJECT: The sphenopetroclival area is the border zone between the middle and posterior cranial fossa. Several authors have studied the microsurgical anatomy of this region and have furnished sometimes contradictory descriptions of this area, which still represents a great challenge for the neurosurgeon. On the basis of previous anatomical data reported in the literature, the authors undertook a new microanatomical analysis of the sphenopetroclival region and report their findings. METHODS: Twenty human cadaveric heads were used to reproduce, in the laboratory, different skull base approaches to expose the petroclival area. Measurements were taken in 40 specimens. From this study has emerged the finding that the sphenopetroclival area is a venous space, which the authors have named the "sphenopetroclival venous gulf" (SPCVG). The SPCVG is filled anteriorly by blood from the cavernous sinus (lateral sellar compartment [LSC], medially by blood from the basilar plexus, and laterally by blood from the superior petrosal sinus; this venous gulf is drained by the inferior petrosal sinus. The SPCVG is comparable in shape to an irregular hedron figure. It contains the Dorello canal, the venous segment of the abducent nerve, and the superior sphenopetrosal (Gruber) ligament, the fibers of which are in anatomical continuity with those of the inferior sphenopetrosal (petrolingual) ligament, forming a "falciform ligament." CONCLUSIONS: The structures defining the posterior surface of the SPCVG may represent a helpful surgical corridor through which it is possible to approach the LSC via the posterior fossa. This conceptualization of the SPCVG is an attempt to define univocally the microanatomy of the sphenopetroclival region in its entirety.

Abducens Nerve↗

PubMed2002

Abducens nerve schwannoma: a case report and review of the literature.

BACKGROUND: Schwannomas of the abducens nerve are extremely rare tumors; only 10 cases have been reported so far. The tumor may be located within the cavernous sinus (CS) or more commonly at the prepontine region. Patients usually present with VIth cranial nerve paresis. CASE DESCRIPTION: We report a case of a 42-year-old male patient who presented with headache, vertigo, and hearing deficit, but no symptoms or signs related to a VIth cranial nerve impairment. Computed tomography and magnetic resonance imaging showed a large mass with a ring-like contrast enhancement in the prepontine area. Surgical treatment, via a simple retrosigmoid suboccipital approach, revealed a schwannoma originating from the VIth cranial nerve at its prepontine portion. Postoperative histological examination confirmed the diagnosis of schwannoma, and the patient had only a VIth cranial nerve palsy, which resolved during long-term follow-up. CONCLUSIONS: Abducens schwannomas are rare tumors, representing less than 1% of all intracranial schwannomas in our clinic and about 13% of oculomotor nerve schwannomas reported in the literature. These lesions can be mainly divided into tumors originating from the intracavernous portion of the VIth cranial nerve or more commonly from the cisternal part of the nerve, leading to a lesion in the prepontine region. In such cases, with no invasion of the cavernous sinus, radical tumor resection with preservation of the abducens nerve can be performed via a simple suboccipital retrosigmoid approach.

Abducens Nerve Diseases↗

PubMed2002

Skin markers for surgical planning for intradural lesions of the thoracic spine. Technical note.

BACKGROUND: Preparation for surgery for thoracic intraspinal lesions commonly involves rather difficult X-ray procedures in the operating room. The object of this report is to inform neurosurgeons about a modified technique for preoperative surface localization of intraspinal thoracic pathology. METHODS: Adhesive, disposable radiographic skin markers placed at the presumed level of an intraspinal lesion are visualized along with the lesion on sagittal magnetic resonance scans of the thoracic spine. RESULTS: The lesion and the skin markers were clearly identified within the same field of view. The lesion itself rather than the vertebral body becomes the reference point for localization. CONCLUSION: Preoperative imaging with adhesive skin markers facilitates positioning and draping for surgery for thoracic intraspinal lesions. It may even replace intra-operative X-ray procedures in selected cases.

Adhesives↗

PubMed2002

Falsely low serum prolactin in two cases of invasive macroprolactinoma.

The differential diagnosis of tumors at the base of the skull comprises meningiomas, neurinomas, gliomas, metastatic carcinomas, chordomas, epidermoids, and pituitary adenomas. About half of the pituitary adenomas are prolactinomas which are unique in a sense that medical therapy causes rapid tumor shrinkage and symptomatic improvement. We report on two patients in which the diagnosis of an invasive macroprolactinoma was masked by apparently low prolactin levels caused by a high-dose hook effect in the chemiluminometric assay. The first case a 49 year old male with impairment of hearing on the left side was presented in the Department of Otorhinolaryngology. A massive invasively growing tumor was demonstrated on a cranial MRI. Endocrine tests revealed normal pituitary function and normoprolactinemia. The patient underwent debulking surgery, occipitocervical fusion because of destruction of the first cervical vertebra and subsequent irradiation. The histopathological diagnosis was invasive prolactinoma. A repeat prolactin (PRL) sample, which was assayed using serial dilutions, revealed a real PRL level of 89,700 ng/ml. Dopamine agonist therapy was initiated under which PRL levels declined in parallel with tumor size. The second case a 40 year old male was presented with acute visual loss. Cranial MRI showed a large tumor at the base of the skull. Based on a transnasal biopsy, the preliminary diagnosis was a poorly differentiated carcinoma for which emergency irradiation was performed. Endocrine tests demonstrated partial hypopituitarism and moderate hyperprolactinemia. Hydrocortisone was substituted and dopamine agonist therapy was started because of moderate hyperprolactinemia. The final histopathological diagnosis was invasive prolactinoma. A repeat PRL sample assayed in serial dilution demonstrated an apparent rise in PRL with a maximum value of 6,460 ng/ml. Under dopamine agonist therapy, PRL declined to normal values, tumor size decreased and cranial nerve palsies disappeared. The apparently falsely low prolactin levels in the initial work-up of both patients were caused by a high-dose hook effect in the PRL assay. Serial dilutions of serum PRL samples is, therefore, mandatory in the diagnostic work-up of patients with large invasive tumors at the base of the skull. This avoids unnecessary aggressive and dangerous treatment like surgery or radiotherapy in cases where pharmacological treatment may be the choice.

Adult↗

PubMed2002

Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 143 patients.

OBJECTIVE: The concept of neurovascular decompression for the treatment of hemifacial spasm is now widely accepted. In this study, we report our long-term results for 145 cases treated with this procedure. METHODS: The results of 145 microvascular decompressions to treat hemifacial spasm (performed between 1980 and 1998) among 143 patients (62.2% female patients and 37.8% male patients; mean age, 54.5 yr) are presented. The onset of symptoms was typical in 95.9% of cases and atypical in 4.1%. Platysma muscle involvement was observed for 24.5% of patients, with a higher incidence among female patients (74.3%). Patients were monitored with annual questionnaires. Twenty-six patients were lost to follow-up monitoring, and 117 are still undergoing follow-up monitoring, with an average period of 9.6 years (range, 1-17.6 yr). RESULTS: At discharge, 69 patients (59%) were spasm-free and 48 patients (41%) experienced further spasm. At 6 months, the number of spasm-free patients had increased to 108 (92.3%), whereas only 9 patients (7.7%) complained of hemifacial spasm; 44 patients were spasm-free at an average time of 15 weeks. In follow-up examinations (average period, 9.4 yr), 106 patients were spasm-free. Seven patients experienced only temporary relief, with recurrence after 4.5 years. Two patients were spasm-free after 4 or 6 weeks, and the recurrence of spasm was observed 1 year later. Two patients were never completely spasm-free. Among the patients who did not undergo previous surgery elsewhere, only two experienced recurrence. CONCLUSION: Deafness was the main postoperative complication (8.3%); most of those cases (66%) occurred before the routine use of intraoperative evoked potential monitoring. Analysis of our series demonstrates that this surgical procedure involves very low risk, is well tolerated by elderly patients, is associated with very low recurrence rates, and is a definitive treatment for more than 90% of cases.

Adult↗

PubMed2002

Neurosurgical emergencies and missing neurosurgical intensive care unit capacity: is "operate-and-return" a sound policy?

Available neurosurgical intensive care beds are rare and are often regarded as a precondition for accepting remote neurosurgical emergencies for operative treatment. From a medical and ethical point of view, the practice of rejecting acute patients as a result of a shortage of intensive care unit beds is questionable, because the primary need is fast treatment, and postoperative intensive care is secondary. We performed a retrospective analysis of outcome of 36 patients, who returned straight from our operating room to the intensive care unit of the referring hospital because no domestic neurosurgical intensive care unit beds were available (group 1). For the two largest cohorts, acute subdural haematoma ( =12) and primary intracerebral haemorrhage ( =15), outcome was compared by matched pair analysis with control patients kept in-house postoperatively (group 2). The mortality rate was higher in group 1 compared with group 2 (acute subdural haematoma 67 versus 58%; intracerebral haemorrhage 47 versus 40%). Despite this tendency, we regard "operate-and-return" treatment as a sound and practicable alternative to offer to hospitals trying to refer patients with neurosurgical emergencies. It is to be preferred to denying treatment, because this results in a delay or cancellation of treatment, with the associated negative effects on outcome. However, postoperative neurosurgical intensive care unit treatment has to be considered the optimum goal, and there needs to be a continuous demand to authorities to increase the number of neurosurgical intensive care unit beds.

Aged↗

PubMed2002

Auditory brainstem implant part II: subjective assessment of functional outcome.

UNLABELLED: OBJECTIVE The purpose of this study was to present the patients' recommendations and judgments about their hearing and communication abilities with the help of the auditory brainstem implant. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS AND METHODS: This evaluation was based on the data obtained by the self-administered questionnaires designed for the European Auditory Brainstem Implant Multicenter Clinical Trial. Eleven patients who had used their auditory brainstem implant for a minimum of 6 months to a maximum of 41 months were evaluated with the help of these questionnaires. RESULTS: All the patients had used their implant on a regular daily basis for an average of 13 hours per day. None of them experienced any side effects during the daily use of the device. Nine patients (82%) used their auditory brainstem implant in both quiet and noisy surroundings. The most common cause of disturbance was a noisy surrounding. All the patients were able to distinguish speech from environmental sounds. The role of the auditory brainstem implant in differentiating various environmental sounds was considered to be very useful by 9 patients (82%). As an adjuvant to lip-reading, the auditory brainstem implant was considered most useful for understanding speech in quiet surroundings. DISCUSSION AND CONCLUSION: It was concluded that the auditory brainstem implant is an effective support for receiving and, to some degree, differentiating environmental sounds, and that as an adjuvant to lip-reading, it enhances speech perception, especially in quiet surroundings. A comparison between the results of this study and the results of the audiologic tests presented in Part I of this study (published earlier) revealed that patient satisfaction was not directly correlated with the results of the objective auditory tests. In general, patients' judgments of their individual hearing and communication abilities usually rated higher than could have been predicted by the objective audiometric data.

Auditory Brain Stem Implants↗

PubMed2002

Skull base trauma: diagnosis and management.

The singular anatomical relationship of the base of the skull is responsible for the particular problems that may arise after injury. Extensive dural laceration and severe neurovascular damage may accompany skull base injuries. Trauma to the anterior skull base is frequently related to the paranasal sinuses, and trauma to the middle and the posterior skull base usually affects the petrous bone. Injury to the anterior fossa including the paranasal sinuses may produce CSF leakage, damage the olfactory nerves, optic nerves, and orbita contents. Fractures may affect the carotid canal, injure the internal carotid artery and result in carotid-cavernous fistula. Trauma to the petrous bone may cause facial palsy and deafness, and CSF leakage with otorrhoea or paradoxal rhinoliquorrhoea. Trauma to the posterior fossa may lacerate the major venous sinuses, and affect the cranio-cervical stability. Each one of these injuries will need a particular strategy. Decision making for management as a whole must consider all aspects, including the fact that these injuries frequently involve polytraumatized patients. Decisions regarding the timing of surgery and the sequence of the surgical procedures must be made with great care. Modern surgical techniques and recent technologies including functional preservation of the olfactory nerves in frontobasal trauma, visual evoked potentials, assisted optic nerve decompression, facial nerve reconstruction, interventional technique for intravascular repair of vascular injuries, and recent developments in cochlea implants and brain stem implants, all contributed significantly to improve outcome and enhance the quality of life of patients. This article reviews basic principles of management of skull base trauma stressing the role of these advanced techniques.

Cerebrospinal Fluid Otorrhea↗

PubMed2002

Late metastasis of breast adenocarcinoma into internal auditory canal and cerebellopontine angle: case report.

A case of metastasis of breast adenocarcinoma into the internal auditory canal (IAC) and cerebellopontine angle (CPA) is presented, which appeared 16 years after primary tumor had been treated by surgery and radiation therapy. The 66-year old patient was considered cured from the primary disease, when she started with a rapidly developing hearing loss and intermittent facial palsy. Magnetic resonance image (MRI) displayed an intra- and extracanalicular tumor mass, which radiologically resembled a vestibular schwannoma. Surgery was performed and histopathological studies showed an adenocarcinoma compatible with breast origin. Metastasis is a rare occurrence within the IAC and CPA. Clinical history of severe facial palsy will rise suspicion of malignant tumor in spite of the radiological findings.

Adenocarcinoma↗