RESUMO
Se presenta un caso de una paciente con pérdida de peso, congestión nasal epistaxis, aumento de volumen en cuello con disfagia a sólidos y líquidos de 1 mes de evolución. La tomografía de cuello muestra una masa de tejidos blandos en la base de cuello con erosión del esfenoides con extensión a la fosa craneal media, con erosión del clivus, el esfenoides y la silla turca. El diagnostico histopatológico es un estesioneuroblastoma.
We present a case of a patient with weight loss, nasal congestion, epistaxis, increase neck volu me with dysphagia to solids and liquids of 1 month of evolution. The neck tomography shows a soft tissue mass at the base of the neck with erosion of the sphe noid with extension to the middle cranial fossa, with erosion of the clivus, the sphenoid and the sella turcica. The histopathological diagnosis is an esthesioneuroblastoma.
Assuntos
Humanos , Feminino , Adulto , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Epistaxe/patologia , Cavidade Nasal/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico , Neoplasias da Base do Crânio/diagnóstico por imagem , Osso Etmoide/patologia , Meningioma/diagnóstico por imagemRESUMO
AIM: During the paranasal sinuses surgery different complications may occur, both vascular and bony. The objective of the present study was to evaluate the ethmoidal roof configuration through the Keros and Yenigun classifications, analyzing results stratified by gender and side. MATERIALS AND METHODS: We retrospectively analyzed 120 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in a coronal view and the anterior-posterior length in a cross section. RESULTS: The Keros Type II was the most frequent and no statistically significant difference was found when comparing by gender. Yenigun type I was more prevalent, and a statistically significant difference was found between men and women in types I and II (p = 0.010 and p = 0.049, respectively). Statistical difference was observed in anterior-posterior means in the comparison between both classifications. In both, right and left side for men (p = 0.003 and p = 0.05) and women (p = 0.029 and p = 0.039). CONCLUSION: We demonstrate the morphological variability that exists in this region. Gender differences that must be considered by the surgeon to avoid complications. Further studies are needed to evaluate the value of these findings when predicting surgical complications. A CT before PNS surgery is already widely accepted.
Assuntos
Osso Etmoide/patologia , Doenças dos Seios Paranasais/patologia , Adulto , Estudos Transversais , Osso Etmoide/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/cirurgia , Estudos Retrospectivos , Fatores Sexuais , Tomografia Computadorizada por Raios XRESUMO
Los osteomas fronto-etmoidales son los tumores benignos más frecuentes de los senos paranasales, pudiendo evolucionar con complicaciones por compresión de estructuras adyacentes. Se presenta el caso de una paciente de 63 años de edad, que consultó por aumento de volumen nasofrontal, cefalea y diplopía. Tras el examen clínico, se evidenció una asimetría facial con lateralización del bulbo ocular derecho y exoftalmo. La tomografía de los senos paranasales mostró una lesión que ocupa parcialmente el seno frontal, etmoidal y parte de la cavidad nasal. Los cuidados anatómicos y planificación quirúrgica se desarrollaron en un modelo estereolitográfico mientras que la cirugía de exéresis total se realizó con ayuda del sistema piezoeléctrico. El examen histológico confirmó el diagnostico de osteoma. Se obtuvo una reconstrucción exitosa, recuperando totalmente simetría y función ocular.
Fronto-ethmoidal osteomas are the most frequent benign tumors of the paranasal sinuses, and may evolve with complications by compression of adjacent structures. The case is a 63-year-old female patient, who consulted about increased nasofrontal volume, headache and diplopia. After the clinical exam, she presented a facial asymmetry with lateralization of the right eyeball and exophthalmus. Computed tomography of the sinuses showed a lesion that partially occupies the frontal sinus, ethmoidal sinus and part of the nasal cavity. The anatomical care and surgical planning was developed in a stereolithographic model while the total excision surgery was performed with the help of the piezoelectric system. Histological examination confirmed the diagnosis of osteoma. A successful reconstruction is obtained, fully recovering symmetry and ocular function.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Osso Etmoide/cirurgia , Seio Frontal/cirurgia , Osteoma/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Piezocirurgia/métodos , Cirurgia Assistida por Computador , Osso Etmoide/patologia , Seio Frontal/patologia , Modelos Anatômicos , Osteoma/patologia , Neoplasias dos Seios Paranasais/patologia , Planejamento de Assistência ao PacienteRESUMO
BACKGROUND: The surgical management of anterior skull base cerebrospinal fluid (CSF) fistulas has evolved throughout the last decade. Endonasal endoscopic surgery of the anterior skull base has become the standard procedure for the repair of most these fistulas. OBJECTIVES: To describe the presenting symptoms, etiology, treatment, and long-term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. MATERIAL/ METHODS: Retrospective analysis of 25 patients with CSF fistulas treated endoscopically at the University of Puerto Rico Hospital from November 2004 to August 2008. RESULT: The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in one patient, and trauma in one patient. The most common location of leak was the cribiform plate, followed by the ethmoid roof. An overlay technique was used for repair in 61% of the procedures versus 39% for the underlay technique. The mean follow up was 23 months. Our overall initial rate of closure was 94% with 100% after a second procedure. CONCLUSIONS: Endoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia , Procedimentos Cirúrgicos Otorrinolaringológicos , Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/etiologia , Síndrome da Sela Vazia/etiologia , Encefalocele/complicações , Osso Etmoide/patologia , Osso Etmoide/cirurgia , Seio Etmoidal/patologia , Seio Etmoidal/cirurgia , Feminino , Cefaleia/etiologia , Humanos , Masculino , Meningite/etiologia , Meningocele/complicações , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Base do Crânio/patologia , Seio Esfenoidal/patologia , Seio Esfenoidal/cirurgia , Transplante Autólogo , Resultado do TratamentoRESUMO
OBJECTIVE: To describe the anatomy of the sphenopalatine foramen (SPF) region and possible anatomical variations. STUDY DESIGN: Prospective study accomplished from September, 2006, to January, 2007. METHODS: The sphenopalatine foramen (SPF) of 61 cadavers were carefully dissected. Presence of the ethmoidal crest, location of sphenopalatine and accessory foramens, and the number of arterial branches emerging through foramens were observed. Data were analyzed in relation to gender, racial group, and symmetry of the cadaver. Prediction of the presence of accessory foramen was evaluated. RESULTS: Mixed race cadavers prevailed in 122 nasal fossae dissected (75% males). Ethmoidal crest was present in 100% of the cadavers, being anterior to the SPF in 98.4% of the cases. The most frequent SPF location was the transition of the middle and superior meatus (86.9%). Mean distance from the SPF and accessory foramen to anterior nasal spine was 6.6 cm and 6.7 cm, respectively. Accessory foramen was present in 9.83% of the cases. A single arterial stem emerged through the SPF in 67.2% of the cases, and 100% through accessory foramens. The prevalence analyses showed no differences that were statistically significant (P > 0.05) between gender and racial group. The symmetry analyses showed a strong conformity (P < 0.01) between nasal fossae in relation to the SPF location. There was no statistically significant conformity between nasal fossae and accessory foramen (P = 0.53). None of the variables of interest presents any statistically significant (P > 0.05) association with the presence of the accessory foramen. CONCLUSIONS: There are anatomical variations in the lateral nose wall that should be considered for successful endoscopic surgical treatment of severe epistaxis.
Assuntos
Endoscopia/métodos , Epistaxe/cirurgia , Palato/patologia , Osso Esfenoide/patologia , Artérias/patologia , Cadáver , Dissecação , Osso Etmoide/patologia , Feminino , Humanos , Masculino , Osso Nasal/patologia , Palato/irrigação sanguínea , Palato/cirurgia , Estudos Prospectivos , Grupos Raciais , Fatores Sexuais , Osso Esfenoide/irrigação sanguínea , Osso Esfenoide/cirurgiaRESUMO
Os autores relatam o caso de um meningioma gigante de rima olfatória num paciente masculino, preto, de 42 anos submetido à cirurgia de exerese do tumor. Os meningiomas säo tumores originários da proliferaçäo de células meningoteliais da aracnóide näo marcadamente anaplásicas, sendo considerados tumores benignos do ponto de vista histológico. Ocorrem mais comumente da quarta à sexta década de vida, com pico aos 45 anos. Aproximadamente 65 por cento säo mais freqüentes no sexo feminino, porém, a partir dos 65 anos, essa predominância é perdida. Constituem 35 por cento dos tumores cerebrais, sendo a maioria intracranianos e supratentoriais. A sobrevida dos pacientes com meningioma gigante da rima olfatória é alta quando feita a ressecçäo completa do tumor, apesar de o procedimento cirúrgico ser muito delicado.