Search

Spontaneous herniation of brain parenchyma through a dural and osseous defect in the temporal bone is a rare entity and a bilateral form is even more infrequent. It usually presents as an intermittent but persistent otorrhea. Manifestation as nose cerebrospinal fluid (CSF) leak is very uncommon. Our objective is presenting this unusual case report of a spontaneous bilateral encephalocele with a bilateral tegmen tympani defect., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

The facial nerve palsy due to extrinsic tumoral compression of the facial nerve at the geniculate ganglium is very rare. We present the case of a patient with a temporal bone cavernoma and symptoms of a torpid peripheral facial House-Brackmann grade IV nerve palsy with dry eye and loss of stapedial reflex. The routine computed tomographic and magnetic resonance imaging studies showed no abnormalities, but the same imaging techniques done after the clinical suspiction identified a less that 1cm lesion that was compatible with an osseous cavernous angioma. The lesion was approached and removed through a microsurgical middle fossa extradural approach with a good postoperative recovery (House-Brackmann grade II).

Introduction: Petrous and petroclival lesions may be surgically treated with combinations of suprainfratentorial presigmoideo approach and microsurgical techniques., Objective: To demonstrate the utility and to present our surgical experiences with this approach., Patients and Methods: Thirteen patients with lesions of the clival, petrous region and of the cerebellopontine angle with extension toward the anterior portion of brainstem were taken to the operative room. There were nine women and four men. Eleven were adults and two children. The main clinical manifestations were headache (100%), dysfunction of cranial nerves (90%), ataxia (90%) hemiparesis (75%). There was papiledema in 45%. Petroclival meningiomas and schwannomas were the more frequent lesions. There were three patients with intraxial brainstem tumors and two arteriovenous malformations. There were not aneurysms. We performed nine retrolaberintic, three translaberintic and one transcochlear approach., Results: There was not severe incapacity, vegetative or dead patients. The surgical complications were facial nerve paresis (31%), cerebrospinal fluid leak (23%), decreased gag reflex (15%), abducens nerve paresis, hemiparesis and Claude Bernard Horner syndrome (8%). 50% of these complications disappeared three months later., Conclusions: The suprainfratentorial presigmoidal approach and their surgical variations could be utilized to obtaining a low morbimortality, in the treatment of different neoplasm and vascular diseases of the petrous and petroclival region.

We report the case of a 67-year-old woman with paralysis of the right recurrent nerve. Imaging studies showed a mass in the right petrous apex and jugular foramen. Surgery was performed using a lateral approach to the skull base. The tumor excised from the petrous apex was a chondroid chordoma. Chordomas are rare dysontogenic neoplasms that arise from notochord remnants, generally on the midline. It should be included in the differential diagnosis of tumors of the skull base.

Endocranial complications of otitis show new etiopathogenic possibilities. We have accomplished an analysis of this issue after one of these cases. A female patient with a nasopharyngeal carcinoma developed an otogenous meningitis. Radiotherapeutic management was followed by osteoradionecrosis of cranial basis, local hypoimmunity favorized the reported course: middle otitis, labyrinthitis, petrositis and meningitis. Comments on pathogenetic, clinic and therapeutical peculiarities of this case.

Four patients, 3 woman and 1 man, with giant petroclival meningiomata are presented. In all cases the tumor size exceed 44 mm in its greater diametre. Main clinical symptoms were endocranial hypertension and cranial nerves deficit. A modified transcochlear approach in two stages was used. A total petrosectomy was performed, using the petrosygmoidal via for opening the dura. Transversus and sygmoid sinus were spared. Total removal was achieved in 2 cases, subtotal and partly in each of the other 2. No operative mortality occurred (hospital exitus) and neurologic morbility related to V-VI-VII and VIII cranial nerves and 1 hemyparesia was recorded. The AA. explain and comment the fundamentals of the followed procedure and compare, as well, the own outcomes with those reported by more classic alternatives. Finally, the conclusion is drawn out that retroclival meningiomata are conditions treatable, although always are difficulty approached and demand meticulous microsurgical techniques.

Cholesterol granuloma of the petrous apex is a relatively rare tumor, and usually is not associated with middle ear pathology. Precise assessment of the diagnosis and extension allows the surgeon to plan the most appropriate and functional strategy. The advent of magnetic resonance imaging has helped, showing a high signal in T1 and T2 without enhancement after the administration of intravenous paramagnetic contrast. The occipito-temporal approach provides direct access to the anterior and posterior petrous apex without opening the dura, which preserves the facial and the cochlear-vestibular functions.

Congenital cholesteatoma are unusual. They may arise in different sites of the temporal bone: petrous process, middle ear and mastoid. Primary cholesteatomas originate from embryonary ectodermal inclusions but the pathogenesis is not clear and many different hypotheses regarding its origin have been suggested. The clinical diagnosis is not easy if the tympanic membrane is normal, and computerized tomography and magnetic resonance imaging are useful. We report two cases of congenital cholesteatoma: One located in the petrous process and the other in the mastoid without affection of the tympanic cavity.

This paper presents the modification made for a transcochlear approach which would permit reaching the pertoclivis area and proeponten cistern. The disadvantage, inconvenience of the approach used on 5 patient is discussed here.

Cholesterol granuloma of the petrous apex is an inflammatory granulation tissue response to the presence of cholesterol crystals. It is not generally associated with middle-ear pathology. CT and MRI are fundamental for diagnosis. MRI is more specific and shows a well-circunscribed mass with high signal intensity on both T1 and T2 weighted images. We present a case of cholesterol granuloma of the petrous apex that was previously diagnosed as cholesteatoma. We emphasize the importance of preoperatory differentiation of the lesion from cholesteatoma. Cholesterol granuloma does not require full excision of the lesion. Drainage and permanent aeration is usually sufficient.