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 685,946 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the case of a young woman who presented with cerebrospinal fluid (CSF) rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed.
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PMID:Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up. 1140 39

Non-traumatic cerebrospinal fluid rhinorrhea indirectly caused by a remote brain tumor has rarely been reported. Here we describe a case of non-traumatic cerebrospinal fluid rhinorrhea that occurred as the initial symptom of a posterior falx meningioma. In addition, based on the period of occurrence of cerebrospinal fluid rhinorrhea before or after the tumor operation, we introduced a novel classification for these cases into pre-treatment and post-treatment types. The findings of the present case and the results of our literature research suggest that different treatments should be used for patients with these two types of non-traumatic cerebrospinal fluid rhinorrhea resulting from remote brain tumor. After tumor excision, patients of the pre-treatment type may receive conservative management or cerebrospinal fluid shunting, while patients of the post-treatment type need direct repair of the fistula.
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PMID:Non-traumatic cerebrospinal fluid rhinorrhea indirectly caused by remote brain tumor: a case report and review of the literature. 1151 49

Two children (ages 12 and 13 years) with transfusion-acquired human immunodeficiency virus (HIV) infection presented with facial pain and rhinorrhea. Radiographic imaging showed extensive paranasal sinus disease, presumed to be bacterial sinusitis, and the patients were treated with broad-spectrum oral antibiotics. Both patients were unresponsive to oral agents and were switched to intravenous antibiotics. Despite aggressive antimicrobial therapy, one patient (case 1) developed increased periorbital swelling and proptosis, and the other patient (case 2) developed symptoms of nasopharyngeal obstruction. Repeat imaging showed progression of the infiltrative process extending from the paranasal sinuses into the orbit (case 1), and nasopharynx (case 2). Surgical exploration and tissue biopsies were performed on both patients and the histopathology was consistent with Burkitt's/Burkitt's-like lymphoma. Combination systemic and intrathecal chemotherapy resulted in a complete remission in both patients. These reports illustrate the fact that Burkitt's/Burkitt's-like lymphoma in the paranasal sinuses may initially masquerade as an acute bacterial sinusitis. The ability of the tumor to extend rapidly from the sinuses into the orbit and nasopharynx reinforces the importance of early diagnosis and treatment. Burkitt's/Burkitt's-like lymphoma in the paranasal sinuses has not been previously described in HIV-infected children.
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PMID:Burkitt's/Burkitt's-like lymphoma presenting as bacterial sinusitis in two HIV-infected children. 1158 30

A unique case of carcinosarcoma in the maxillary sinus is reported. A 47-year-old man visited our hospital with complaints of right nasal obstruction and bloody rhinorrhea. Examination revealed a hemorrhagic mass with necrosis in the maxillary sinus that infiltrated the right nasal cavity. Histologically, the tumor was composed of both carcinomatous and sarcomatous elements. Nests of squamous cell carcinoma and adenocarcinoma were scattered in the sarcomatous element with osteosarcomatous differentiation. No distinct demarcation between the two elements was observed and some spindle-shaped cells in the sarcomatous component were immunoreactive to epithelial markers by immunohistochemical staining. Although the histogenesis of carcinosarcoma remains unclear, the histologic pattern of the present case indicates the possibility that a multipotential cell, capable of both epithelial and mesenchymal differentiation, was the origin of the rare tumor.
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PMID:A rare case of carcinosarcoma of the maxillary sinus with osteosarcomatous differentiation. 1168 31

According to the literature, half of the schwannoma cases occur in the head and neck areas and only less than 4% occur in the sinonasal tract. In this case, a 39-year-old male patient, with a-year-long progressive left side nasal obstruction and purulent rhinorrhea, is presented. The CT reveals a mass filling the left nasal cavity and nasopharyngeal space, with bony erosion of the inferior turbinate and medial maxillary bone. During surgical intervention, the mass is found to originate from the medial side of the left middle turbinate with maxillary sinusitis and inferior turbinate atrophy. The pathological examination reveals a noncapsulated tumor with palisading cellular arrangement and high cellular density. The pathological findings and nervous origin of the tumor are discussed after an extensive review of the literature.
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PMID:Nasal schwannoma: a case report and clinicopathologic analysis. 1172 10

The following article describes a diagnostic concept of paranasal sinus imaging, based on more than 10 years close collaboration of the authors. CT and MR are the primary imaging modalities for investigating paranasal sinus lesions. Conventional X-ray images add little information due to insufficient sensitivity. Angiography is restricted to those patients who require preoperative tumor embolization or emergency treatment of intractable epistaxis. After thorough medical treatment of inflammatory paranasal sinus disease, CT becomes the method of choice to clearly depict preoperative osseous anatomy and to distinguish between benign and malignant intraosseous lesions. In cases where trauma is involved, CT easily identifies anterior skull base fractures. Moreover, CT will be the first step to localize early or late CSF rhinorrhea. MR, with its ability to distinguish between different soft tissues, compliments CT. This holds particularly true for inflammatory or neoplastic disease close to the skull base, orbital apex and cavernous sinus. The signal intensity in T(1) and T(2) weighted images provides additional information with respect to cellularity and vascularization of lesions, which has important diagnostic and therapeutic implications.
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PMID:[State of the Art. Diagnostic imaging of paranasal sinus diseases]. 1191 51

During the transsphenoidal approach (TSA), the proper sellar floor reconstruction plays an important role in the surgical results. The authors have evaluated the usefulness of a silicone as a substitute for bone splint in sellar floor reconstruction. Silicone plates were used in 10 patients who had 7 pituitary adenomas, 2 Rathke's cleft cysts, and 1 metastatic tumor. Among the ten cases, seven underwent standard TSAs and three received extended TSAs. The silicone plate was cut to a size slightly larger than that of bone window, inserted with a three-pronged fork, and then adjusted precisely. In nine patients, complications that related to surgical repair did not occur. A postoperative cerebrospinal fluid (CSF) rhinorrhea occurred in one pituitary macroadenoma, and no infection was observed in any case. From the authors' experience, advantages of the silicone plate are its simplicity to shape for any size of defects, and the easy detectability of the previous bone window at reoperation.
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PMID:Usefulness of silicone plate for sellar floor reconstruction. 1208 14

The endoscopic endonasal transsphenoidal approach has been proposed in the past decade as a minimally invasive surgical technique for the removal of pituitary tumors. From January 1997 to November 1999, 100 consecutive patients with pituitary tumors underwent endoscopic endonasal surgery, according to Jho's technique. We employed 0 degrees, 30 degrees, 45 degrees, and 70 degrees rigid endoscopes, 18 - 30 cm in length, 4 mm in diameter with an outer sleeve for irrigation and secured to a holder. Among the 87 pituitary adenomas, tumor removal was total in 51, subtotal (> 80 %) in 20 and partial in 16 cases. Four craniopharyngiomas were totally removed and an intra-suprasellar arachnoid cyst was emptied; a biopsy was performed in the two patients with a clivus chordoma. The two cases of sphenoid sinusitis were cured by surgery, the three patients with spontaneous CSF rhinorrhea were successfully treated and the residual nasal meningocele was removed. The endoscopic endonasal transsphenoidal approach appeared to be less traumatic than the traditional microsurgical approach, was very effective, and was characterized by a reduced number of complications. However, the relatively small series together with the short follow-up do not allow us to draw definitive conclusions. The post-operative reduction in hospital stay (two days in 40 of 100), significantly reduced the cost of patient's management.
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PMID:Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. 1249 53

Esthesioneuroblastoma, also known as olfactory neuroblastoma, is a rare neuroendocrine tumor originating from the olfactory epithelium of the upper nasal cavity and representing < 3% of all tumors of the nasal cavities. This malignant tumor is characterized by a slow growth and local recurrencies and has a more favorable prognosis as compared with other more frequent forms of neuroblastomas originating from the suprarenal medulla and the sympathetic nervous system. Affected patients usually present with a history of progressive nasal obstruction, rhinorrhea, and severe epistaxis--sign of the conspicuous vascularity of this type of tumor. The combined use of CT and MR techniques allows the diagnostic suspicion of esthesioneuroblastoma and is of vital importance in the accurate staging of the disease and in the treatment planning.
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PMID:[Esthesioneuroblastoma. Description of a case investigated with CT and MR]. 1251 Apr 21

To assess the feasibility of passive marker computer-aided surgery in a single institution, we performed 22 procedures in 21 patients with disorders including sinonasal tumors (n = 9), fungal sinusitis (n = 4), recurrent polyps (n = 3), chronic sinusitis (n = 3), and cerebrospinal fluid rhinorrhea (n = 2). Passive marker computer-aided surgery was successful in 19 of the 21 patients. The accuracy was on the order of 1.35 mm. Probe conversion, rotation, and cordlessness were helpful in all 19 cases. The system helped with landmarks (n = 14), margins (n = 7), skull base (n = 6), orbit (n = 5), and approach (n = 4). Computer-aided surgery accurately confirmed the location of an instrument and demonstrated tumor-normal tissue interfaces. It aided the surgeon in procedures on the sinonasal area and cranial base. The potential advantages of a passive marker system as compared with other available technologies center around the ability to convert and/or rotate virtually any instrument to a cordless imaging probe on demand during the operation.
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PMID:Passive marker computer-aided sinonasal and cranial base surgery: observations from a learning curve. 1253 58


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