Skull Base

Skull base osteomyelitis originating in the middle ear or mastoid: A review of 3 cases

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.

Skull base presentation of multiple myeloma

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.

Role of irrigation with hypertonic saline for a recurrent skull base hydatid cyst: Case report and review of the literature

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.

Radiologic findings after successful chemoradiation for nasopharyngeal cancer with skull base erosion

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.

Correlation between otitis media and craniofacial morphology in adults

December 1, 2007     Renata C. Di Francesco, MD, PhD, Perboyre Lacerda Sampaio, MD, PhD, and Ricardo Ferreira Bento, MD, PhD
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Abstract

We conducted a comparison study to determine if the development of otitis media in adults is correlated with craniofacial morphology. Our study population was made up of 66 adults, aged 18 to 40 years; 32 of these patients had otitis media and 34 did not. All subjects underwent a complete otolaryngologic examination, video-otoscopy, fiberoptic nasal endoscopy, and lateral cephalometry. Statistical analysis of the cephalometric measurements in the otitis media group and the control group revealed significant differences in the angle between the anterior skull base and medial skull base, upper facial height, and anterior facial height. Also, some significant differences were seen between the measurements in the otitis media group and the normal dimensions of the harmonic face as reported in the literature; these differences were seen in the length of the anterior skull base, the angle of cranial deflection, the depth of the maxilla, the angle of the mandibular plane, the angle of facial depth, the angle of the facial cone, and lower facial height. Not all of these significant differences, however, were predictive of the evolution of otitis media. Based on our analysis, we conclude that four cephalometric measurements are predictive of the evolution of otitis media: (1) the length of the anterior skull base, (2) the angle between the anterior skull base and medial skull base, (3) maxillary depth, and (4) upper facial height. No correlations were found between otitis media and nasal blockage or between otitis media and facial type.

Recurrence of isolated multiple myeloma in the skull base: A case report and review of the literature

August 31, 2007     Omar F. Husein, MD; Abraham Jacob, MD; Douglas D. Massick, MD; D. Bradley Welling, MD, PhD
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Abstract
Extramedullary plasmacytoma involving the skull base is rare. We describe what we believe is the first reported case of recurrent multiple myeloma presenting as an isolated lesion in the central skull base in a patient with no evidence of systemic involvement. We discuss the patient's presentation, clinical course, and treatment, and we review the relevant scientific literature.

Long-term follow-up of a multiloculated arachnoid cyst of the middle cranial fossa

May 31, 2007     Marc A. Cohen, MD; Noam A. Cohen, MD, PhD; Gul Moonis, MD; David W. Kennedy, MD
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Abstract
Arachnoid cysts are benign intracranial lesions that are typically diagnosed incidentally. We describe the case of a 56-year-old man who presented with a multiloculated arachnoid cyst of the middle cranial fossa that extended into the sphenoid sinus. The lesion was identified on computed tomography of the head, which had been obtained for an unrelated investigation. However, establishing a definitive diagnosis proved to be difficult. Because the cyst had caused extensive skull base erosion, the patient was managed conservatively with close observation. We report the radiographic progression of this lesion during more than a decade of follow-up, and we review the literature pertaining to the presentation, pathophysiology, and treatment of arachnoid cysts.

Skull base thrombotic mycosis

March 1, 2007     Eric P. Wilkinson, MD; Robert A. Robinson, MD, PhD; Douglas K. Trask, MD, PhD
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Synovial chondromatosis of the temporomandibular joint space

May 31, 2005     Jason S. Hamilton, MD; Sean Jones-Quaidoo, MD; Ryan F. Osborne, MD
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The carotid-vertebral space: An 'extended' lateral window to the ventromedial cranial base and lower craniocervical junction

April 30, 2005     Amin B. Kassam, MD; Atul Patel, MD; William Welch, MD; Jeffrey Balzer, PhD; Carl Snyderman, MD; Barry Hirsch, MD; Ricardo Carrau, MD
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Abstract
We describe a unique method of accessing the ventromedial skull base and lower craniocervical junction. Our method employs a trajectory between that of the more anterior transoral or retropharyngeal approaches and the various posterior or posterolateral skull base approaches. This "extended" lateral approach allows surgeons to resect very large tumors of the skull base through a single incision. The operative field is more extensive than that achieved with other approaches; it extends from the cerebellar hemisphere to the extradural ventral upper cervical spine, and it provides access to tissue outside the spinal canal, such as the ventral strap muscles. We describe our use of this approach during a single-stage resection of a large hemangiopericytoma in a 37-year-old man.

Endoscopic view of a clival skull base tumor invading the sphenoid space

January 1, 2005     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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