April 17, 2013 John P. Leonetti, MD
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Abstract
The goal of this article is to review a series of patients with persistent unilateral middle ear effusion (MEE) and to suggest a more contemporary diagnostic algorithm. The author conducted a retrospective chart review of adults with persistent unilateral MEE and normal findings on physical and nasopharyngoscopic examinations whose MEE was eventually found to be caused by a variety of occult skull base lesions. The study population was made up of 79 patients-52 women and 27 men, aged 21 to 83 (mean: 54.8) at presentation-who had been referred to an academic tertiary care medical center between July 1, 1988, and June 30, 2008. Follow-up ranged from 9 months to 19.5 years (mean: 8.7 yr). Of this group, 50 patients (63.3%) had a malignant tumor, 26 (32.9%) had a benign tumor, and 3 (3.8%) had an internal carotid artery aneurysm. Eustachian tube occlusion had been caused by diffuse invasion in 33 patients (41.8%), by intracranial pathology in 24 (30.4%), and by extracranial-infratemporal lesions in 22 (27.8%). Nasopharyngoscopy cannot identify a variety of rare skull base lesions that cause eustachian tube compression or tissue invasion that ultimately leads to MEE. Therefore, patients with unexplained persistent unilateral MEE should undergo coronal magnetic resonance imaging or computed tomography to look for any intra- or extracranial lesions before undergoing ventilation tube placement.
July 5, 2012 Andrew I. Ahn, MD; Mary K. Wren, MD; Ted A. Meyer, MD, PhD
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Abstract
Skull base plasmacytomas are rare and difficult to differentiate clinically and radiologically from other tumors of the head and neck. Because of the risk of progression to multiple myeloma, early diagnosis is essential. We report the case of a 65-year-old woman who presented with left-sided conductive hearing loss and an external auditory canal mass. The tumor was removed along with much of the tympanic membrane, and it was found to be a plasmacytoma. The patient was subsequently diagnosed with multiple myeloma and treated with chemoradiation before being lost to follow-up.
April 30, 2012 Arun Goyal, MS; Shalabh Rastogi, MS; P.P. Singh, MS; Sonal Sharma, MD
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Abstract
Aneurysmal bone cysts have been described as pseudocysts in view of their lack of an epithelial lining. These cysts are uncommon, but when they do occur they typically involve the long bones of the extremities, the membranous bones of the thorax and pelvis, and the vertebrae. Skull involvement is uncommon. We present the case of a 14-year-old girl who presented with nasal obstruction and a swelling of the right cheek. Contrast-enhanced computed tomography detected a heterogeneous cystic mass involving the sphenoid and ethmoid bones. The mass was excised via a lateral rhinotomy approach, and it was identified as an aneurysmal bone cyst on histologic examination. The patient experienced a recurrence in the right sphenoid sinus within 3 months, and the lesion was removed via transnasal endoscopy.
March 31, 2012 Stephen M. Wold, MD and John T. Sinacori, MD
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Abstract
Sarcoidosis is a chronic, multisystem, granulomatous disease of unknown etiology. It manifests with a wide range of symptoms and clinical findings, including some that occur in the head and neck. Sinonasal sarcoidosis, in particular, frequently demonstrates a rather recalcitrant course and a potential for severe complications if left untreated. We present the case of a 46-year-old woman with extensive sinonasal sarcoidosis that progressed to involve the skull base and olfactory tract and ultimately led to the formation of a granuloma within the frontal lobe that required craniotomy and excision. Although surgery is not considered the primary treatment modality for sarcoidosis, it may have a role in managing this highly variable disease in certain patients.
January 25, 2012 Alireza Karimi Yazdi, MD, Amir A. Sazgar, MD, and Ali Kouhi, MD
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Abstract
Giant cell tumors are rare in the head and neck region. The most frequently involved sites of giant cell lesions in the head and neck are the maxilla and mandible, whereas the sphenoid and temporal bones are rarely involved. This tumor is usually located in the long bones of limbs. Reparative granuloma and brown tumor of hyperparathyroidism must be included in the differential diagnosis. Here we report the clinical and radiologic findings of a multicentric giant cell tumor with skull base involvement in a female patient. This case report demonstrates the similar pathophysiology of peripheral and central giant cell tumors.
December 15, 2011 Douglas Leventhal, MD, Thomas O. Willcox, MD, James J. Evans, MD, and Steven G. Finden, MD
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Abstract
A 75-year-old immunocompetent man presented to our office with right otalgia. After a comprehensive workup, he was found to have right temporal bone osteomyelitis and was treated with intravenous antibiotics. He then began to experience left-sided otalgia and was diagnosed with and treated for left temporal bone osteomyelitis. Subsequently, he began to exhibit myelopathic symptoms, and imaging revealed a C2 inflammatory process. The patient underwent endoscopic transoral odontoidectomy with resection of a large C1 to C2 pannus and recovered with no neurologic deficit. Skull base osteomyelitis is an uncommon condition that usually occurs in immunocompromised patients. Prompt diagnosis and appropriate treatment are of utmost importance in managing this condition.
November 22, 2011 Derek J. Rogers, MD, Mark E. Boseley, MD, Mark J. Stephan, MD, Samuel Browd, MD, PhD, and David C. Semerad, MD
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Abstract
Generalized enchondromatosis, of which Ollier disease is the most common type, is a rare bone dysplasia characterized by multiple intraosseous tumors near growth-plate cartilage. These cartilaginous tumors have a propensity to transform into chondrosarcomas. Enchondromas of the skull base are exceedingly rare. We present the case of a patient with generalized enchondromatosis who developed a large enchondroma of the clivus, and we discuss the clinical presentation and potential treatments for this entity.
October 26, 2011 Gretchen M. Oakley, BA, Dary J. Costa, MD, Ron B. Mitchell, MD, and Cirilo Sotelo, MD
March 1, 2011 Aaron Pang, MBBS, MRCS(Edin) and Kevin Chong, MBBS, FRCS(Edin)
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Abstract
Skull base osteomyelitis is a life-threatening condition that sometimes arises as a sequela of otitis media and mastoiditis. We present a retrospective analysis of the clinical course of 3 patients with skull base osteomyelitis that originated in the middle ear or mastoid. All 3 patients were elderly diabetic men who presented with headache. We review the clinical features, radiologic findings, and culture results in all 3 cases, and we describe the treatment regimens that led to a successful response in all 3 patients.
January 1, 2011 Anil Joshi, MRCS, MS, Dan Jiang, FRCS, Pranay Singh, MRCS, and David Moffat, BSc, MA, FRCS
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Abstract
Pathologic proliferation of the plasma cell population can produce a wide spectrum of disorders, ranging from benign solitary plasmacytoma to malignant multiple myeloma. The presentation of the resulting disease can be either localized or systemic, depending on the affected area. Multiple myeloma typically presents with systemic symptoms secondary to skeletal lytic lesions, anemia, renal failure, infection, and hyperviscosity syndrome; a diagnosis of multiple myeloma is not suspected in the absence of these features. Multiple myeloma of the skull base is very rare. We present the case of a 66-year-old man who came to us with a 2-year history of disequilibrium and who was found to have multiple myeloma with extensive involvement of the skull base.
August 31, 2010 Sadaf Zia, FCPS, Ather Enam, MD, Iftikhar Salahuddin, MD, and Aslam Khan, MD
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Abstract
Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. This disease is a rare finding in the head and neck region, and its presentation varies according to the area involved. We report the case of a 25-year-old woman who presented with bilateral neck swelling, which was found on histopathologic examination to be caused by a hydatid cyst. The patient underwent surgical drainage of the cyst and a modified radical mastoidectomy, followed by a 3-month course of treatment with albendazole. However, she experienced a recurrence in the left neck region 1 year later. At that time, reexploration of the left mastoid cavity was performed, with debridement of diseased occipital bone and foramen magnum. Intraoperatively, we used a novel method of saline irrigation with 3% hypertonic saline, previously not tested on exposed nerves, in an attempt to prevent further recurrence. Four years after the second surgery, no disease recurrence was found, and no neurologic sequelae were noted. We conclude that hypertonic saline irrigation can be considered as an option for preventing recurrence in cases that are difficult to clear surgically, especially around cranial nerves, although more studies are needed to document the safety of this approach.
January 1, 2010 Federico Ampil, MD, Guillermo Sangster, MD, Glenn Mills, MD, Cherie Ann Nathan, MD, Timothy Lian, MD, and Andrew Hall, BS
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Abstract
Nonoperative management is generally accepted as a treatment strategy for nasopharyngeal cancer characterized by destruction of the skull base. Chemoradiotherapy is considered the standard of care in these cases. We report a case in which imaging studies documented the successful treatment of the patient's locally extensive nasopharyngeal carcinoma with this nonsurgical approach.
