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Calcifying pseudoneoplasm of the neuraxis (CAPNON) is an extremely rare entity with fewer than 150 cases reported in the literature and mostly with a supratentorial or spinal location. Posterior fossa CAPNON has been reported scarcely, and association with perilesional edema is a topic not yet approached which might play a significant role in treatment decision and clinical progression. Our objective is to report, to our knowledge, the first series of 3 posterior fossa CAPNON surgically treated in a single institution and assess features that help provide a systematic approach to diagnosis and timely treatment. This was a monocentric, retrospective study of surgical patients diagnosed with a posterior fossa CAPNON in the last 5 years. A thorough bibliographic research was conducted. Three patients were included. Locations involved IV ventricle, right cerebellopontine angle with extension to foramen magnum, and cerebellar vermis. Two of them presented with symptoms linked to acute hydrocephalus, and the other one presented with progressive cranial nerve palsy and brainstem compression signs. The 3 of them showed radiological signs of perilesional edema on their preoperative magnetic resonance imaging. Gross total resection was accomplished in one case, with near and subtotal resections in the others. There were no complications. The outcome was favorable in all cases. It is essential to contemplate this infrequent diagnosis in cases of calcified lesions involving the posterior fossa. When symptoms manifest, surgery should be considered. Perilesional edema could be associated with symptomatic progression and hence a sign suggesting the need for surgical treatment. [ABSTRACT FROM AUTHOR]

A 9-year-old male patient presented with recurrent episodes of corneal ulcers in both eyes since the age of 2 years. The patient had profound bilateral hearing loss and multiple left-sided preauricular skin tags. He was diagnosed with neurotropic keratitis with bilateral corneal anesthesia in both eyes and on further work-up was diagnosed to have Goldenhar Syndrome with features of left-sided facial skeletal hypoplasia and bilateral auditory nerve atresia. The patient was managed by multiple specialities with standard of care medications, therapies, and procedures and is presently thriving. Goldenhar syndrome is a rare congenital disorder which involves ocular, auricular, and cranial nerves along with facial and vertebral anomalies. The insufficient knowledge of its pathogenesis and variable clinical presentations present a challenge in timely diagnosis and management of these cases. The involvement is generally unilateral and unilateral skeletal asymmetry with bilateral cranial nerve involvement is a rare event. The wide variation in clinical presentation and under diagnosis of these cases in India mandates a better understanding of this entity among medical professionals to facilitate early diagnosis and favorable clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: Skull baseosteomyelitis (SBO) is a rare phenomenon that typically occurs in diabetic or immunocompromised patients, causing significant morbidity and mortality. This study aimed to analyze a single institution's treatment results in SBO patients and propose anew integrated clinicoradiological classification system.Methods: The medical records of 32 SBO patients that were treated at a tertiary care center between 2006 and 2017 were retrospectively reviewed. A scoring system based on anatomical involvement according to MRI was created. Subsequently, the scoring system was integrated with cranial nerve dysfunction status and a clinical grading system (CGS) was proposed.Results: Among the 32 patients, 78.1% were diabetic and 63% had cranial nerve dysfunction at presentation. Bone erosion based on CT was greater in the patients without regression (P = 0.046). The regression rate decreased from clinical grade (CG)1 to CG3 (P = 0.029). Duration of hospitalization increased as CG increased (P = 0.047). Surgery had no effect on regression status at the time of discharge (P = 0.41). The 1-year, 2-year, and 5-year overall survival rates were 82.2%, 70.8%, and 45.8%, respectively. CG was significantly correlated with overall survival but not with disease-specific survival (log-rank; P = 0.017, P = 0.362, respectively).Conclusion: SBO continues to pose a challenge to clinicians, and causes significant morbidity and mortality. The proposed new classification system can be an option for grouping SBO patients according to clinical and radiological findings, helping clinicians estimate prognosis. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article offers information on the diagnosis of facial pain is challenging because of interdisciplinary differences in defining both anatomical boundaries and the diagnoses themselves, including provides a comprehensive systematic approach for clinicians to diagnose head pain.

Trigeminal neuralgia (TN) is a common cranial nerve disease. Meanwhile, it is suggested in some studies that orofacial pain can also lead to some psychological diseases. Therefore, the current study was carried out aiming to explore the relationship between depression as well as anxiety and TN; at the same time, the effect on the postoperative outcome of microvascular decompression (MVD) would also be explored. The Hamilton Depression Rating Scale (HDRS) scores, as well as the Hamilton Anxiety Rating Scale (HARS) scores in TN cases were compared with those among patients without TN. Multiple logistic regression models were also used to assess the associations of HDRS and HARS scores with TN. Patients were divided into 2 groups according to the MVD outcome in TN patients, and the HDRS and HARS scores were between pain-free patients and those who still suffered from pain. The HDRS and HARS scores in TN patients were evidently increased relative to those observed in normal individuals. HDRS and HARS scores were found to be positively associated with the Visual Analog Scale pain score and onset duration in TN patients. Additionally, remarkably higher HDRS and HARS scores were observed in the persistent pain group than in pain-free group. The findings of this study reveal that depression and anxiety are closely associated with the incidence of TN, which may also affect the outcome of patients undergoing MVD. [ABSTRACT FROM AUTHOR]

Abstract The aim of this systematic review was to describe the anatomical and surgical factors related to cranial nerve injuries in Le Fort I osteotomy. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Two independent reviewers performed an unrestricted electronic database search in the MEDLINE/PubMed, LILACS, Scopus, Web of Science, and Cochrane databases up to and including August 2018. Thirty-two articles were selected for data extraction and synthesis: 30 studies were identified in the main search and two by a manual search. The level of agreement between the reviewers was considered excellent (κ = 0.779 for study selection and κ = 0.767 for study eligibility). This study revealed that the main nerve affected was the trigeminal nerve, followed by the oculomotor, abducens, optic, facial, and vagus and accessory nerves. Cleft lip and palate patients presented the highest incidence of cranial nerve damage. Cranial nerve damage after Le Fort I osteotomy is not rare. Anatomical and structural knowledge of the patient are necessary in order to minimize the risks of cranial nerve injury in Le Fort I osteotomy. [ABSTRACT FROM AUTHOR]

The signs of lower cranial nerve palsies are rare and are often caused by tumors. A 49-year-old woman was admitted to our hospital with progressive right-sided atrophy of the tongue, sternocleidomastoid and trapezius, dysarthria, and dysphagia for 3 years. Brain magnetic resonance imaging revealed a circular lesion adjacent to the lower cranial nerves. Cerebral angiography confirmed that the lesion was an unruptured aneurysm in the C1 segment of the right internal carotid artery. After endovascular treatment, the symptoms of this patient had partially improved. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the potential for reducing surgical invasiveness in parotid cystadenolymphomas by means of capsular dissection based on the experience made in our department and on various aspects of these lesions gained from the relevant literature.Methods: All patients treated for cystadenolymphomas with extracapsular or capsular dissection at a tertiary referral center between 2000 and 2017 were examined retrospectively. A literature review of various aspects and of different treatment strategies for this lesion was also performed.Results: 629 patients were included in the study. 499 had solitary tumors (79.3%) and 130 had unilateral multicentric lesions (20.7%). 595 patients were managed by means of ED, while 34 patients underwent a CD. Our analysis detected an overall occurrence rate of ipsilateral metachronous tumors of 2.06% (13/629), all after extracapsular dissection, with a mean follow-up of 104.1 months. No statistical difference could be found between ED and CD in the overall occurrence rate of ipsilateral metachronous tumors or in the complication rate. No cases of a malignancy arising from a preexisting Warthin tumor could be detected in our study sample.Conclusion: A clear potential for reducing surgical invasiveness could be shown. A reliable imaging diagnosis, appropriate patient counseling and high compliance with close follow-up are the basic prerequisites for an acceptable outcome. [ABSTRACT FROM AUTHOR]

Background In cranial surgery, different foreign body (FB) materials are used and may be left intentionally or unintentionally in the surgical field after closure, inducing a foreign body granuloma (FBG). This is a rare complication in neurosurgery, but it may be a diagnostic dilemma, with sometimes medicolegal implications. Methods We performed a systematic review of the English literature between 1965 and 2018 and found a total of 77 articles concerning 100 cases of FBG caused by retained material located within the cranium or surrounding soft tissues. Results There were 60 females and 40 males, with ages ranging from 1 to 77 years. Most initial diagnoses were cranial/intracranial tumors, trigeminal neuralgia, hemifacial spasm, intracranial aneurysm, hydrocephalus, head injury, infectious disease, and nontraumatic intracerebral hematoma. The interval from the causative surgical operation to presentation of the FBG ranged from 2 weeks to 20 years. Various radiologic modalities were used and histologic study confirmed the presence of FBG in all patients. Intentional FB was used and left in 77 patients, and unintentional FB was found postoperatively in 23 patients. Associated infection was found in 13 patients. Complete recovery was seen in 47.6% of patients with sufficient data. Conclusions Despite being unusual, a retained FBG should be considered in the differential diagnosis of any patient after cranial surgery. A history of surgery, clinical symptoms, physical examination findings, laboratory results, and the use of appropriate neuroimaging explorations may provide a correct preoperative diagnosis. In addition, unintentionally retained FBs are preventable errors in the operating room. Highlights • Different neurosurgical materials may induce a cranial foreign body granuloma (FBG). • FBG is a rare complication in cranial surgery, but it may be a diagnostic dilemma. • In a systematic review, 77 articles concerning 100 cases of cranial FBG were found. • An FBG should be considered in any patient with new symptoms after cranial surgery. • Retained FBGs are sometimes preventable errors in the operating room. [ABSTRACT FROM AUTHOR]

Background Surgical treatment of brainstem cavernous malformations (CMs) remains a great challenge for neurosurgeons. Several cases published in the literature have addressed surgical approaches. However, no surgical approach has been reported to provide better exposure for CMs located in the superior midbrain. Methods We presented 10 cases of superior midbrain CMs in children treated in Beijing Tiantan Hospital from 2002 to 2016. The most common presenting signs and symptoms were hydrocephalus and cranial nerve deficit. We used the transcallosal anterior interforniceal approach in all patients to remove the CM lesion. Results Total resection was achieved in all patients. During the follow-up period, temporary short-term memory impairment was present in 5 patients, unilateral ptosis occurred in 1 patient, and upward gaze dysfunction occurred in 2 patients. There was complete neurologic functional improvement for cranial nerves. Exacerbation of hydrocephalus occurred in 4 patients requiring additional ventriculoperitoneal shunt postoperatively. Conclusions The transcallosal anterior interforniceal approach can provide good exposure and direct visualization to superior midbrain CMs. Complications are short-term and reversible. Highlights • Brainstem CMs are associated with high morbidity and mortality. • A suitable surgical approach is important to preserve intact neurologic functions. • Despite complications, the TAIF approach provides advantages for resection of superior midbrain CMs. • TAIF approach can provide better exposure of the third ventricle and direct visualization of the midbrain. • Complications of TAIF approach are short term and reversible. [ABSTRACT FROM AUTHOR]

Background Varicella-zoster virus (VZV) is a common herpesvirus infection that can result in acute varicella/chickenpox, as well as delayed activation in herpes zoster/shingles. Ramsay-Hunt syndrome is a rare presentation of VZV reactivation, involving 1% of cases and resulting in lesion formation along the seventh cranial nerve distribution. We report the first case of a patient who presented with acute calvarial osteomyelitis after VZV reactivation and Propionibacterium acnes suprainfection. Clinical Presentation A 41-year-old man with a history of VZV presented with a 6-month history of chest pain, flulike symptoms, and left-sided headaches. Several concomitant external calvarial lesions were identified, and imaging was concerning for an infectious or neoplastic etiology. The patient underwent surgical debridement, and pathologic samples identified coinfection with P. acnes and VZV. Antibacterial and antiviral therapy resulted in a good outcome. Conclusion Osteomyelitis resulting as a complication of VZV infection is rare, particularly in the calvaria. This is the first reported case of Ramsay-Hunt syndrome−type VZV infection being complicated by osteomyelitis of the calvaria. Our case also demonstrates the diagnosis of VZV osteomyelitis through the use of current pathologic methods. [ABSTRACT FROM AUTHOR]

CANVAS is a recently defined progressive ataxic syndrome with impairment of vestibular, somatosensory and cerebellar function due to atrophic degeneration of dorsal root ganglia and dorsal columns, of cranial nerve somatosensory ganglia, of vestibular ganglia and vestibular nerves and of cerebellar Purkinje cells. While all patients eventually develop sensory impairment in a non-length dependent pattern and lose sensory nerve action potentials, some retain their tendon reflexes. Here we study 5 CANVAS patients with absent sensory nerve action potentials but intact, even brisk Achilles tendon reflexes and, in 4, preserved H reflexes in the upper and lower limbs. These findings imply that dorsal root ganglion neurons subserving cutaneous afferents more vulnerable than those subserving muscle afferents. Our findings have a clinical message: preservation of the Achilles tendon jerk does not exclude a large fibre peripheral neuronopathy. [ABSTRACT FROM AUTHOR]

This study evaluated the volume of thickened dura mater lesions and their impact on clinical findings in immune-mediated hypertrophic pachymeningitis (HP). The volume of contrast-enhanced dura mater on magnetic resonance imaging was evaluated using the imaging feature quantification system in 19 patients with immune-mediated HP, including 12 with antineutrophil cytoplasmic antibody-related, 4 with IgG4-related, and 3 with idiopathic HP, as well as 10 with multiple sclerosis (MS) as controls. The implications of HP volume on neurological manifestations and cerebrospinal fluid (CSF) laboratory markers were statistically analyzed in patients with immune-mediated HP. The volumes of the contrast-enhanced dura mater in the convexity, cranial fossa, and tentorium cerebelli were significantly higher in patients with immune-mediated HP than in those with MS. Among patients with immune-mediated HP, those with cranial nerve (CN) VIII neuropathy had a significantly higher volume of the contrast-enhanced dura mater in the cranial fossa than those without CN VIII neuropathy. The volume of the contrast-enhanced dura mater in the tentorium cerebelli was positively correlated with CSF protein levels. Quantification of the thickened dura mater is useful for elucidating the relationship with the clinical findings in immune-mediated HP. Thickened dura mater lesions in the cranial fossa may be implicated in the development of CN VIII neuropathy. The enlargement of HP lesions in the tentorium cerebelli can increase CSF protein levels. • HP lesion quantification clarifies their relationship with clinical findings. • HP lesions in the cranial fossa are implicated in cranial nerve VIII disorders. • HP lesion enlargement in the tentorium cerebelli increases CSF protein levels. [ABSTRACT FROM AUTHOR]

Lipoblastoma is a rare and benign tumor arising from embryonal fat cells. It develops primarily in infancy and early childhood. We present a case study of a 10-month-old child treated for an extensive tumor of the infratemporal fossa and parapharyngeal space. The systematic review of 60 reports in 80 children with lipoblastoma of the head and neck is also reported. Systematic review of all articles included lipoblastomas of the head and neck area in children published from 1964 to 2022 in the PubMed database was conducted. Clinical presentation of extensive lipoblastoma of the head and neck in a child. On the basis of all inclusion criteria 83 articles were identified concerning pediatric lipoblastoma. There were 36 F (45%) and 39 M (48%), in 6 patients, (7%) gender was not specified. Ages ranged from 0mth (6h) to 15 yo (180mth). The tumor was located in the head in 22 (27%) cases, while the neck area accounted for 53 (65%) cases. General description without precise location was shown in 6 (7%) cases. All patients underwent complete surgical excision. Post surgical recurrence was noted in 6% clinical cases in the analyzed articles. Lipoblastoma is characterized by a rapidly growing predominantly adipose mass. The treatment of choice is complete surgical excision. In selected cases when the pathology is hard to reach, as a consequence of the extensive penetration of the mass, we recommend performing the procedure with an interdisciplinary team. Endoscopy assistance and microdebrider significantly facilitated the removal of pathology in the described advanced case of lipoblastoma. This is the only case reported in the pediatric literature of a head and neck lipoblastoma, where due to extensive involvement and location of the disease the cranial nerves V2 and inferior alveolar branch of V3 could not be spared. Long-term follow-up even to 10 years is required because there is a reported tendency for these tumors to recur. • Timely and invasive biopsies are warranted if the clinical picture indicates. • In hard-to-reach cases the procedure should be performed by a multidisciplinary team. • Endoscopic assistance significantly facilitated the removal of this reported tumor. [ABSTRACT FROM AUTHOR]

Background: Congenital Zika infection can result in a spectrum of neurological abnormalities in the newborn. Newborns exposed to Zika virus in utero often have neuroimaging as part of their clinical evaluation.Methods: Through the Congenital Zika Program at Children's National Health System in Washington DC, we performed fetal or neonatal neuroimaging, including magnetic resonance imaging and ultrasound, on over 70 fetuses or neonates with intrauterine Zika exposure. Novel findings on neonatal brain magnetic resonance imaging were observed in two instances.Results: Gadolinium-contrast magnetic resonance imaging showed enhancement of multiple cranial nerves at three days of age on one infant. Another infant underwent magnetic resonance imaging at 16 days of age and was shown to have a chronic ischemic cerebral infarction. This infant had previously normal fetal magnetic resonance imaging.Conclusion: Cranial nerve enhancement and cerebral infarction may be among the expanding list of neurological findings in congenital Zika infection. Postnatal brain magnetic resonance imaging should be considered for newborns exposed to Zika virus in utero. [ABSTRACT FROM AUTHOR]

Purpose: To compare efficancy of three-dimentional SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolutions) and CISS (constructive interference in steady state) sequences in the imaging of the cisternal segments of cranial nerves V-XII.Methods: Temporal MRI scans from 50 patients (F:M ratio, 27:23; mean age, 44.5±15.9 years) admitted to our hospital with vertigo, tinnitus, and hearing loss were retrospectively analyzed. All patients had both CISS and SPACE sequences. Quantitative analysis of SPACE and CISS sequences was performed by measuring the ventricle-to-parenchyma contrast-to-noise ratio (CNR). Qualitative analysis of differences in visualization capability, image quality, and severity of artifacts was also conducted. A score ranging 'no artefact' to 'severe artefacts and unreadable' was used for the assessment of artifacts and from 'not visualized' to 'completely visualized' for the assesment of image quality, respectively. The distribution of variables was controlled by the Kolmogorov-Smirnov test. Samples t-test and McNemar's test were used to determine statistical significance.Results: Rates of visualization of posterior fossa cranial nerves in cases of complete visualization were as follows: nerve V (100% for both sequences), nerve VI (94% in SPACE, 86% in CISS sequences), nerves VII-VIII (100% for both sequences), IX-XI nerve complex (96%, 88%); nerve XII (58%, 46%) (p<0.05). SPACE sequences showed fewer artifacts than CISS sequences (p<0.002). [ABSTRACT FROM AUTHOR]

Introduction Neurosarcoidosis occurs in about 5% to 15% of patients with sarcoidosis. The purpose of this study was to identify and characterize a cohort of neurosarcoidosis patients and to review the largest previously reported neurosarcoidosis case series. Methods This retrospective study enrolled all patients with the diagnosis of probable or definitive neurosarcoidosis according to Zajicek and Scolding criteria, followed at the neurology department of a tertiary center in Portugal from January 1989 to December 2015. Results A total of 15 patients presented a diagnosis of probable or definitive neurosarcoidosis, with a mean age at time of diagnosis of 38.5 years. The presenting neurologic syndrome was isolated cranial neuropathy, aseptic meningitis, myelitis, brain parenchymal lesion, myelorradiculitis and meningomyelorradiculitis. MRI study most often presented different enhancing lesions and the CSF analysis commonly revealed a lymphocytic pleocytosis and raised proteins. Thirteen patients had histopathology confirmation of systemic sarcoidosis and one preformed a spinal cord biopsy. Corticosteroids was the most often used treatment alone or in combination with immunosuppressive drugs. After a mean follow-up of 86.1 months, the majority of patients fully recovered to a mRankin 0. Discussion Fully comprehension of neurosarcoidosis is still a challenge due to its rarity and limited number of large published series, which renders the epidemiological study of this disease very difficult. In this study, the thoroughly medical records review and the summarize of previous published cohorts allow to add some information in the epidemiological and clinical knowledge of this entity. [ABSTRACT FROM AUTHOR]

Background Cranial neuropathies are a spectrum of disorders associated with dysfunction of one or more of the twelve cranial nerves and the subsequent anatomic structures they innervate. Objective The purpose of this article is to review radiographic imaging findings of end-organ aberrations secondary to cranial neuropathies. Method All articles related to cranial neuropathies were retrieved through the PubMed MEDLINE NCBI database from January 1, 1991 to August 31, 2014. These manuscripts were analyzed for their relation to cranial nerve end-organ disease pathogenesis and radiographic imaging. Results The present review reveals detectable end-organ changes on CT and/or MRI for the following cranial nerves: olfactory nerve, optic nerve, oculomotor nerve, trochlear nerve, trigeminal nerve, abducens nerve, facial nerve, vestibulocochlear nerve, glossopharyngeal nerve, vagus nerve, accessory nerve, and hypoglossal nerve. Conclusion Radiographic imaging can assist in the detailed evaluation of end-organ involvement, often revealing a corresponding cranial nerve injury with high sensitivity and diagnostic accuracy. A thorough understanding of the distal manifestations of cranial nerve disease can optimize early pathologic detection as well as dictate further clinical management. [ABSTRACT FROM AUTHOR]

Background: Results from a previous phase 3 study suggested that prophylactic cranial irradiation reduces the incidence of symptomatic brain metastases and prolongs overall survival compared with no prophylactic cranial irradiation in patients with extensive-disease small-cell lung cancer. However, because of the absence of brain imaging before enrolment and variations in chemotherapeutic regimens and irradiation doses, concerns have been raised about these findings. We did a phase 3 trial to reassess the efficacy of prophylactic cranial irradiation in the treatment of extensive-disease small-cell lung cancer.Methods: We did this randomised, open-label, phase 3 study at 47 institutions in Japan. Patients with extensive-disease small-cell lung cancer who had any response to platinum-based doublet chemotherapy and no brain metastases on MRI were randomly assigned (1:1) to receive prophylactic cranial irradiation (25 Gy in ten daily fractions of 2·5 Gy) or observation. All patients were required to have brain MRI at 3-month intervals up to 12 months and at 18 and 24 months after enrolment. Randomisation was done by computer-generated allocation sequence, with age as a stratification factor and minimisation by institution, Eastern Cooperative Oncology Group performance status, and response to initial chemotherapy. The primary endpoint was overall survival, analysed in the intention-to-treat population. This trial is registered with the UMIN Clinical Trials Registry, number UMIN000001755, and is closed to new participants.Findings: Between April 3, 2009, and July 17, 2013, 224 patients were enrolled and randomly assigned (113 to prophylactic cranial irradiation and 111 to observation). In the planned interim analysis on June 18, 2013, of the first 163 enrolled patients, Bayesian predictive probability of prophylactic cranial irradiation being superior to observation was 0·011%, resulting in early termination of the study because of futility. In the final analysis, median overall survival was 11·6 months (95% CI 9·5-13·3) in the prophylactic cranial irradiation group and 13·7 months (10·2-16·4) in the observation group (hazard ratio 1·27, 95% CI 0·96-1·68; p=0·094). The most frequent grade 3 or worse adverse events at 3 months were anorexia (six [6%] of 106 in the prophylactic cranial irradiation group vs two [2%] of 111 in the observation group), malaise (three [3%] vs one [<1%]), and muscle weakness in a lower limb (one [<1%] vs six [5%]). No treatment-related deaths occurred in either group.Interpretation: In this Japanese trial, prophylactic cranial irradiation did not result in longer overall survival compared with observation in patients with extensive-disease small-cell lung cancer. Prophylactic cranial irradiation is therefore not essential for patients with extensive-disease small-cell lung cancer with any response to initial chemotherapy and a confirmed absence of brain metastases when patients receive periodic MRI examination during follow-up.Funding: The Ministry of Health, Labour and Welfare of Japan. [ABSTRACT FROM AUTHOR]

Purpose Moebius Syndrome is a rare congenital neurological condition often characterized by multiple cranial nerve involvement. This case study presents an eight-year old girl with Moebius Syndrome (MC) who received 30 sessions of speech therapy. This occurred after presenting to clinic 11 months after left facial reanimation with gracilis thigh muscle transfer surgery. On examination, only flickers of left facial movement were observed. There was no movement on the right side of the face. As a consequence of the minimal movement, MC presented with drooling and unintelligible speech. The purpose of speech therapy was three fold: minimise the pooling of saliva, improve the placement of the articulators so that articulation of speech sounds would be more accurate, and gain advances in overall intelligibility. Methods Therapy focussed on speech, facial movement and saliva management using a combination of speech drills, evidence-based articulation therapies, facial exercises with surface electromyography biofeedback, self-awareness training and compensatory saliva management strategies. Results After a course of 30 one-hour speech therapy sessions, substantial improvements were seen in speech sound accuracy, overall intelligibility, facial movement and saliva control. Conclusions The combination of surgery and speech therapy led to functional gains that surgery alone did not achieve. The impact of speech therapy on surgical outcomes in individuals with Moebius syndrome deserves further investigation. [ABSTRACT FROM AUTHOR]

Objective To investigate the necessity of drilling the occipital condyle in a tailored far lateral approach for resection of ventrolateral foramen magnum meningiomas (FMMs). Methods Clinical data of 15 patients with ventrolateral FMMs who underwent surgery during a 6-year period were reviewed retrospectively. Results A retrocondylar approach was performed in 8 cases (6 above the vertebral artery [VA] and 2 below the VA) in which the dural attachment was surgically accessible with no restriction of the initial part of the V4 segment of the VA, and a partial transcondylar approach was performed in 7 cases on both sides of the VA where the dural attachment associated with the VA auxiliary space was reached by superolateral displacement of the VA by drilling of the condyle. Exposure of the V3 segment of the VA was performed in all patients, but no circumcision of the dural ring along with transposition of the VA was needed. Simpson grade II resection was achieved in all patients. Postoperative complications were encountered in 20% of patients, predominantly associated with cranial nerve impairment. No tumor recurrence was demonstrated during follow-up lasting 7–68 months (mean 29.2 months). Conclusions The surgical approach for ventrolateral FMMs varies depending on the location of dural attachment with reference to VA dural entry. Bone removal is warranted in FMMs arising from both sides of the VA to allow superolateral displacement of the VA to some extent, improving surgical accessibility to the hidden VA auxiliary space and achieving a more radical tumor resection. It should be a reasonable alternative to the conventional aggressive VA transposition in cases of ventrolateral FMMs. [ABSTRACT FROM AUTHOR]

Background: Temporal bone fractures (TBFs) are harbingers of high energy head trauma that can result in a variety of significant complications of the auditory, vestibular, nervous, and vascular systems. Multiple cohort studies have identified the incidence and proper evaluation of these fractures. We hypothesize that these have changed with the advent of modern high resolution computer tomography (CT) imaging.Methods: We performed a retrospective review of all TBFs admitted to an urban level one trauma center between June 1, 2011 and May 31, 2015. A database was compiled including demographics, physical exam findings, imaging performed and results, morphology and directionality of fracture as well as outcomes and follow-up.Results: One hundred thirteen patients were identified, representing 4.7% of skull fractures and 35.9% of skull base fractures. Most were subsequent to falls (41.6%) followed by pedestrian vehicular trauma (19.5%). The majority of TBF patients (67.3%) had additional fractures of the skull and 77.9% of TBF patients also had some kind of intracranial hemorrhage. The morphology of TBF and the overall mortality (7.9%) was consistent with previous reports. The incidence of facial nerve paralysis (1.6%), CSF leak (1.7%), and hearing loss (18.6%) were all lower than previously reported. Trauma imaging was able to identify 98.6% of TBF, calling the utility of routine temporal bone CT imaging into question.Conclusion: TBFs are less common than they once were and though they still carry a mortality rate similar to previously reported cohorts, the incidence of complications among survivors has dramatically improved. Additionally, modern CT imaging is very capable of identifying these injuries and dedicated temporal bone CT may only be of utility in cases where facial nerve injury or vascular injury is suspected.Level Of Evidence: Epidemiologic study, Level III. [ABSTRACT FROM AUTHOR]

Tissue engineering of bone has combined bespoke scaffolds and osteoinductive factors to maintain functional osteoprogenitor cells, and the periosteum has been confirmed as a satisfactory source of osteoblasts. Suitable matrices have been identified that support cell proliferation and differentiation, including demineralised bone matrix (both compatible and osteoinductive) and acellular human dermis. We have evaluated the osteogenic potential of an osteogenic unit, developed by combining periosteum, demineralised bone matrix, and acellular human dermis, in rodents with critical-size cranial defects. Briefly, remnants from the superior maxillary periosteum were used to harvest cells, which were characterised by flow cytometry and reverse retrotranscriptase-polymerase chain reaction (RT-PCR). Cells were cultured into the osteogenic unit and assessed for viability before being implanted into 3 rodents, These were compared with the control group (n = 3 ) after three months. Histological analyses were made after staining with haematoxylin and eosin and Von Kossa, and immunostaining, and confirmed viable cells that stained for CD90, CD73, CD166, runt-related transcription factor, osteopontin, and collagen type I in the experimental group, while in the control group there was only connective tissue on the edges of the bone in the injury zone. We conclude that osteogenic unit constructs have the osteogenic and regenerative potential for use in engineering bone tissue. [ABSTRACT FROM AUTHOR]

Background: Microvascular decompression (MVD) is a surgical treatment for cranial nerve disorders via a small craniotomy. The postoperative pain of this procedure can be classified as surgical site somatic pain and postcraniotomy headache similar in nature to a migraine, including its association with photophobia, nausea, and vomiting. This headache can be difficult to treat and can impact on postoperative recovery. Sumatriptan is used to treat migraine-like headaches in various settings. This single-centre randomized controlled trial investigated whether postoperative administration of sumatriptan after MVD surgery impacts the quality of postoperative recovery.Methods: Fifty patients who complained of postoperative headache after MVD were randomized to receive an s.c. injection of sumatriptan (6 mg) or saline. The primary outcome was quality of recovery as measured by the Quality of Recovery-40 (QoR-40) score at 24 h.Results: The QoR-40 scores were significantly higher in the sumatriptan group (median 184; interquartile range 169-196) than in the placebo group (133; 119-155; P<0.01), suggesting higher quality of recovery. The sumatriptan group also had significantly lower headache scores at 4, 12, and 24 h. There were no significant differences in other secondary outcomes.Conclusions: Use of sumatriptan improved the quality of recovery as measured by the QoR-40 and reduction of headache at 24 h after surgery. Sumatriptan is a useful alternative treatment for postcraniotomy headache. The mechanism remains unknown but could be related to reduction in headache, mood modulation, or both, mediated by a serotonin effect.Clinical Trial Registration: NCT01632657. [ABSTRACT FROM AUTHOR]

Background: In 2014-2015, several regions of the United States experienced an outbreak of acute flaccid myelitis in pediatric patients. A common, unique feature was disease localization to the gray matter of the spinal cord.Methods: We report 11 children, ages 13 months to 14 years (median 9 years), in the Intermountain West who presented with extremity weakness (n = 10) or cranial neuropathy (n = 1) of varying severity without an apparent etiology.Results: All children experienced acute paralysis, and 10 had symptoms or signs that localized to the spinal cord. Maximum paralysis occurred within 4 days of onset in all patients. All had spinal gray matter lesions consistent with acute myelitis detected by magnetic resonance imaging; no single infectious cause was identified. Despite therapy with intravenous immunoglobulin, corticosteroids, or plasma exchange, nine of 10 (90%) children had motor deficits at follow-up.Conclusions: Recognition of this disorder enables clinicians to obtain appropriate imaging and laboratory testing, initiate treatment, and provide families with accurate prognostic information. In contrast to other causes of acute flaccid paralysis in childhood, most children with acute flaccid myelitis have residual neurological deficits. [ABSTRACT FROM AUTHOR]

PHACES syndrome is a neurocutaneous disorder characterized by the presence of segmental hemangiomas with associated anomalies of the posterior fossa, cerebral vasculature, cardiovascular system, eyes, and ventral or midline structures. We present the first case of propranolol-responsive congenital trigeminal and facial nerve palsies secondary to an intracranial hemangioma in a patient with PHACES syndrome. [ABSTRACT FROM AUTHOR]

Summary The aim of this study was to evaluate the in vivo biocompatibility of a biphasic calcium phosphate (BCP) bone graft substitute consisting of 60% hydroxyapatite and 40% β-tricalcium phosphate (β-TCP) in comparison to a pure β-TCP of identical shape and porosity. The materials were evaluated using an established rat cranial defect model in 24 animals. One bone defect with a diameter of 5 mm was created per animal. The defects were filled with either BCP or β-TCP and left to heal for 4 weeks. Twelve samples (6 per material) were processed for histological evaluation and immunohistochemistry. The remaining 12 samples were processed for mRNA expression analysis. No signs of inflammation or adverse material reactions were detected. New bone formation in the former defect site did not differ between the two groups (BCP: 49.2%; β-TCP: 52.4%). Osteoblast-like and TRAP-positive osteoclast-like cells were found at the surface of the bone graft substitute granules. The β-TCP group showed significantly higher mRNA levels for the bone resorption marker Acp5 and osteogenic differentiation marker Runx2. The expression of IGF1, IGF2, VEGF, Phex, Alpl, Col1, Col2, Bglap and MMP8 did not differ between the groups. The in vivo biocompatibility of BCP is to a large part identical to those of TCP. Within the limitation of the animal model, the implantation study shows that BCP can be used as bone graft substitute, due to the fact that the material integrates into tissue, remains stable in the implantation bed and serves as an osteoconductive scaffold. [ABSTRACT FROM AUTHOR]

Background: Cranial nerve deficits during CEA are a known complication. The purpose of this study is to evaluate if significant changes in somatosensory evoked potentials and electroencephalography increase cranial nerve deficits during CEA. Procedures: This is an observational retrospective case-control study analyzed with data collected from patients who underwent CEA at the University of Pittsburgh Medical Center. Five hundred and eightyseven patients were included in the final analysis. Due to the small number of cranial nerve deficits and the comparatively large number of potential covariates, we used a regression analysis with Bayesian shrinkage. Findings: Analysis was performed on 587 patients, of which a total of 11 (1.8%) cases of cranial nerve deficits were recorded. The marginal mandibular branch of the facial nerve was injured in nine (81%) patients and hypoglossal nerve was injured in two (19%) patients. Of the 11 patients, 9 cases resolved by the time of discharge, the 2 cases that persisted both were injuries to the facial nerve. Multivariate analysis using Bayesian shrinkage showed that after adjusting for all risk factors only IOM changes increased the risk of cranial nerve deficits (OR 38.47, 95% CI 7.73, 191.42). Conclusions: Cranial nerve injury is 38 times more likely in patients who experienced a change in IOM during CEA shunt. Future studies examining the effect of stretch and the degree of retraction on the CN might be more helpful in reducing cranial nerve deficits. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to investigate the influence of platelet-rich fibrin (PRF) on angiogenesis and osteogenesis in guided bone regeneration (GBR) using xenogenic bone in rabbit cranial defects. Materials and methods In each rabbit, 2 circular bone defects, one on either side of the midline, were prepared using a reamer drill. Each of the experimental sites received bovine bone with PRF, and each of the control sites received bovine bone alone. The animals were sacrificed at 1 week ( n = 4), 2 weeks ( n = 3) and 4 weeks ( n = 3). Biopsy samples were examined histomorphometrically by light microscopy, and expression of vascular endothelial growth factor (VEGF) was determined by immunohistochemical staining. Results At all experimental time points, immunostaining intensity for VEGF was consistently higher in the experimental group than in the control group. However, the differences between the control group and the experimental group were not statistically significant in the histomorphometrical and immunohistochemical examinations. Conclusions The results of this study suggest that PRF may increase the number of marrow cells. However, PRF along with xenogenic bone substitutes does not show a significant effect on bony regeneration. Further large-scale studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

The purpose of this study is to: a) assess transport distraction to reconstruct cranial defects in radiated and non-radiated fields b) examine adipose grafting's effect on the bony regenerate and overlying wound, and c) elucidate sources of bone formation during transport distraction osteogenesis. Twenty-three male New Zealand white rabbits (3 months; 3.5 kg) were used, 10 non-irradiated and 13 irradiated (17 treatment, 6 control) with a one-time fraction of 35 Gy. A 16 × 16 mm defect was abutted by a 10 × 16 mm transport disc 5 weeks after irradiation, and 11 animals were fat grafted at the distraction site. Latency (1 day), distraction (1.5 mm/day), and consolidation (4 weeks) followed. Fluorochromes were injected subcutaneously and microCT, fluorescence, and histology assessed. In distracted animals without fat grafting, bone density measured 701.87 mgHA/ccm and 2271.95 mgHA/ccm in irradiated and non-irradiated animals. In distracted animals with fat grafting, bone density measured 703.23 mgHA/ccm and 2254.27 mgHA/ccm in irradiated and non-irradiated animals. Fluorescence revealed ossification emanating from the dura, periosteum, and transport segment with decreased formation in irradiated animals. Transport distraction is possible for cranial reconstruction in irradiated fields but short-term osseous fill is significantly diminished. Adipose grafting enhances wound healing in previously irradiated fields but does not enhance ossification. [ABSTRACT FROM AUTHOR]

Human embryonic stem cells (hESCs) are an exciting cell source as they offer an unlimited supply of cells that can differentiate into all cell types for regenerative medicine applications. To date, there has been no report on hESCs with calcium phosphate cement (CPC) scaffolds for bone regeneration in vivo. The objectives of this study were to: (i) investigate hESCs for bone regeneration in vivo in critical-sized cranial defects in rats; and (ii) determine the effects of cell seeding and platelets in macroporous CPC on new bone and blood vessel formation. hESCs were cultured to yield mesenchymal stem cells (MSCs), which underwent osteogenic differentiation. Four groups were tested in rats: (i) CPC control without cells; (ii) CPC with hESC-derived MSCs (CPC + hESC-MSC); (iii) CPC with hESC-MSCs and 30% human platelet concentrate (hPC) (CPC + hESC-MSC + 30% hPC); and (iv) CPC + hESC-MSC + 50% hPC. In vitro, MSCs were derived from embryoid bodies of hESCs. Cells on CPC were differentiated into the osteogenic lineage, with highly elevated alkaline phosphatase and osteocalcin expressions, as well as mineralization. At 12 weeks in vivo, the groups with hESC-MSCs and hPC had three times as much new bone as, and twice the blood vessel density of, the CPC control. The new bone in the defects contained osteocytes and blood vessels, and the new bone front was lined with osteoblasts. The group with 30% hPC and hESC-MSCs had a blood vessel density that was 49% greater than the hESC-MSC group without hPC, likely due to the various growth factors in the platelets enhancing both new bone and blood vessel formation. In conclusion, hESCs are promising for bone tissue engineering, and hPC can enhance new bone and blood vessel formation. Macroporous CPC with hESC-MSCs and hPC may be useful for bone regeneration in craniofacial and orthopedic applications. [ABSTRACT FROM AUTHOR]

Abstract: Some but not all patients with Tolosa–Hunt syndrome (THS) have dramatic responses to steroid treatment. A systematic study about the factors that may influence the steroid response of THS patients has not been published. We retrospectively identified 40 patients diagnosed with THS and treated with steroids with respect to patient age at onset, gender, the cranial nerve(s) involved, as well as imaging findings and laboratory tests. Within the context of these data we evaluated the therapeutic efficacy of steroid treatment and recurrence of attacks. We did not note a significant relationship between genders, whether THS was benign or inflammatory, the distribution of cranial nerve palsies, the initial dose of steroids and the effectiveness of steroid treatment for relief of orbital pain or cranial nerve palsies at 72h or 1week after treatment. Our study reveals that a rapid alleviation of pain by steroid treatment is a characteristic feature of THS patients. The alleviation of cranial nerve palsy is somewhat slower and more variable, and may involve additional mechanisms. There is an effect of patient age and whether attacks will recur (recurrence was more likely in patients who were young at the time of first attack), whether THS will be benign or inflammatory (more likely to be inflammatory in young patients) and the short-term response of cranial nerve palsy to steroid treatment, which was more effective in young patients. These relationships may be of value in counseling patients presenting with THS. [Copyright &y& Elsevier]

Abstract: Since the widespread availability and use of antibiotics the prevalence of Lemierre syndrome (L.S.) has decreased. It is a well-described entity, consisting of postanginal septicaemia with thrombophlebitis of the internal jugular vein with metastatic infection, most commonly in the lungs. The most common causative agent is a gram-negative, non-spore-forming obligate anaerobic bacterium, Fusobacterium necrophorum (F.n.). We describe the unusual clinical features of a 12-year-old boy with Lemierre syndrome with isolated hypoglossal nerve palsy – the latter symptom is an extremely rare manifestation of this disease. [Copyright &y& Elsevier]

We present the case of a 51-year-old woman with a history of several years of non-organ specific Systemic Lupus Erythematosus, who presented a toxic syndrome and adenopathy and cranial nerve affection. We carried out the differential diagnosis. We then described the case resolution and progression. [ABSTRACT FROM AUTHOR]

Abstract: Functional carotid body tumours are rare, but linked to malignant hypertension, postoperative persistent hypotension, cranial nerve injury and stroke. The aim of this study is to analyze the treatment options for functional carotid body tumours. Six patients with functional carotid body tumours who underwent surgical procedures were studied retrospectively. They all had abnormal levels of preoperative catecholamine (norepinephrine, 721±452.2ng/l). One patient presented preoperative hypertension. Preoperative alpha- and beta-adrenergic blockade was carried out. Surgical methods included complete resection (6), saphenous vein interposition (3) and carotid shunt (1). With thorough supervision and treatment, the 6 patients underwent tumour resection. They all experienced intraoperative hypertension while the tumours were being resected. Postoperative problems included endurance hypotension (3/6, 50%), coughing when drinking (3/6, 50%) and deviation of the tongue on protrusion (3/6, 50%). The clinical highlights of functional carotid body tumour include preoperative abnormal catecholamine, peroperative fluctuations of blood pressure level, and regime issues. Operative resection could be the best option for functional carotid body tumours. Careful preoperative evaluation, measurement of serum catecholamine, treatment for alpha- and beta-adrenergic blockade, and gentle intraoperative manipulation are essential to avoid life-threatening complications. [Copyright &y& Elsevier]

Abstract: The anuran brainstem is segmentally organized into rhombomeres (r) and this segmental organization is uniquely preserved throughout development. We hypothesized that rhombomeres associated with cranial nerves (CN) also contain oscillators that are capable of producing rhythmic motor output (bursts) in isolation. We used in vitro brainstem preparations from pre- and post-metamorphic bullfrogs (Lithobates catesbeianus) to determine if rhombomeric organization of oscillators is present throughout development. Brainstems were transected into segments containing one or more rhombomeres and motor output was measured with suction electrodes attached to CN V, X and XII. Rhythmic motor output was observed in 85% of tadpoles and 91% of frogs in an anterior segment (r0–r5), 27% of tadpoles and 18% of frogs in the middle segment (r6–r7), and 77% of tadpoles and 55% of frogs in the caudal segment (r8). There were significant reductions in burst frequency and whole nerve amplitude following transections. These data support the hypothesis that brainstem oscillators associated with specific groups of rhombomeres are present throughout development in anurans. [Copyright &y& Elsevier]

Summary: Objectives: To identify the key predictive factors of radiation-induced cranial nerve palsy in patients with nasopharyngeal carcinoma (NPC). Method and materials: From November 1998 to December 2007, all consecutive patients with newly diagnosed NPC who were curatively treated with radiotherapy and subsequently developed radiation-induced cranial nerve palsy (RICNP) were included in our study. Patients with cranial nerve palsy due to disease recurrence were excluded. Their records were retrospectively reviewed. Results: Amongst 965 patients with NPC treated with radical radiotherapy, 41 developed new cranial nerve palsy. After exclusion of 5 patients with cranial nerve palsy due to recurrence, 36 (3.7%) developed RICNP. The median follow-up was 8.9years (range, 3.2–11.3years). Ten of the 36 patients had cranial nerve palsy at presentation. Twenty-seven patients had single cranial nerve palsy and 9 patients had multiple cranial nerve palsy. The most commonly involved cranial nerve was cranial nerve XII, with 30 patients having palsy of cranial nerve XII and 6 of them having bilateral cranial nerve XII palsies. Magnetic resonance imaging features of radiation-induced hypoglossal nerve palsy were demonstrated in our study. Multivariate analysis revealed that cranial nerve palsy at presentation was an independent prognostic factor for the development of RICNP. Other factors including T staging, N staging, gender, age, radiotherapy technique and the use of chemotherapy have no significant relationship with the risk of developing RICNP. Conclusion: RICNP in patients with NPC is not a rare complication, and cranial nerve palsy at presentation is an important prognostic factor. [ABSTRACT FROM AUTHOR]

Surgical excision is the preferred definitive treatment for carotid body tumors, although postoperative morbidity rate as quoted in the literature is rather high. Morbidity includes cranial nerve dysfunction, stroke, and the majority severe blood loss. Embolization of the feeding branches of the external carotid artery can be performed a few days prior to surgery with the intention to decrease blood loss during operation, facilitate surgical resection, and reduce operating time and morbidity. The special risk of embolization is migration into the intracranial circulation. Poloxamer 407, a reverse-thermal polymer, is a nontoxic compound that is a viscous liquid at room temperatures but instantly changes to a firm water-soluble gel when warmed to body temperature. It dissolves spontaneously or can be dissolved at will by cooling. We describe an intraoperative technique for complete devascularization of carotid body tumor by using an intraarterial temporary occlusion technique with a poloxamer 407. [Copyright &y& Elsevier]

Purpose: To subclassify patients with the T4 classification nasopharyngeal carcinoma (NPC), according to the seventh edition of the American Joint Committee on Cancer staging system, using magnetic resonance imaging (MRI), and to evaluate the prognostic value of subclassification after intensity-modulated radiotherapy (IMRT). Methods and Materials: A total of 140 patients who underwent MRI and were subsequently histologically diagnosed with nondisseminated classification T4 NPC received IMRT as their primary treatment and were included in this retrospective study. T4 patients were subclassified into two grades: T4a was defined as a primary nasopharyngeal tumor with involvement of the masticator space only; and T4b was defined as involvement of the intracranial region, cranial nerves, and/or orbit. Results: The 5-year overall survival (OS) rate and distant metastasis-free survival (DMFS) rate for T4a patients (82.5% and 87.0%, respectively), were significantly higher than for T4b patients (62.6% and 66.8%; p = 0.033 and p = 0.036, respectively). The T4a/b subclassification was an independent prognostic factor for OS (hazard ratio = 2.331, p = 0.032) and DMFS (hazard ratio = 2.602, p = 0.034), and had no significant effect on local relapse-free survival. Conclusions: Subclassification of T4 patients, as T4a or T4b, using MRI according to the site of invasion, has prognostic value for the outcomes of IMRT treatment in NPC. [ABSTRACT FROM AUTHOR]

Abstract: Nonpharmacologic and nonsurgical transcranial modulation of the nerve function may provide new opportunities in evaluation and treatment of cranial nerve diseases. This study investigates the possibility of using low-intensity transcranial focused ultrasound (FUS) to selectively stimulate the rat abducens nerve located above the base of the skull. FUS (frequencies of 350 kHz and 650 kHz) operating in a pulsed mode was applied to the abducens nerve of Sprague-Dawley rats under stereotactic guidance. The abductive eyeball movement ipsilateral to the side of sonication was observed at 350 kHz, using the 0.36-msec tone burst duration (TBD), 1.5-kHz pulse repetition frequency (PRF), and the overall sonication duration of 200 msec. Histologic and behavioral monitoring showed no signs of disruption in the blood brain barrier (BBB), as well as no damage to the nerves and adjacent brain tissue resulting from the sonication. As a novel functional neuro-modulatory modality, the pulsed application of FUS has potential for diagnostic and therapeutic applications in diseases of the peripheral nervous system. [Copyright &y& Elsevier]

Background: Painful scapular winging due to chronic long thoracic nerve (LTN) palsy is a relatively rare disorder that can be difficult to treat. Pectoralis major tendon (PMT) transfer has been shown to be effective in relieving pain, improving cosmesis, and restoring function. However, the available body of literature consists of few, small-cohort studies, and more outcomes data are needed. Materials and methods: Outcomes of 26 consecutive patients with electromyelogram-confirmed LTN palsy who underwent direct (n = 4) or indirect transfer (n = 22) of the PMT for dynamic stabilization of the scapula were reviewed. All patients were followed up clinically for an average of 21.8 months (range, 3-62 months) with evaluations of active forward flexion, active external rotation, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and observation of scapular winging. Results: Preoperative to postoperative results included increases in the mean active forward flexion from 112° to 149° (P < .001) an in mean active external rotation from 53.8° to 62.8° (P = .045), an improvement in the mean ASES score from 28 to 67.0 (P < .001), and an improvement in the mean VAS pain score from 7.7 to 3.0 (P < .001). Recurrent scapular winging occurred in 5 patients. There was no difference in outcome by length of follow-up. Conclusions: PMT transfer is an effective treatment for painful scapular winging resulting from LTN palsy. This is the largest reported series of consecutive patients treated with PMT transfer for the correction of scapular winging. [ABSTRACT FROM AUTHOR]

Abstract: This study investigates the bone grinding temperature in skull base neurosurgery and develops a skull thermal model to visualize the thermal injury to cranial nerves. Patients suffering from brain cancer in the skull base often require radical surgical resection of the tumor using the miniature ball-end diamond wheel to grind the bone for identifying and preserving the nerve. An inverse heat transfer method is developed and quantifies the grinding thermal power of 0.4–0.5W, which can raise the bone temperature by over 20°C. A thermal analysis on a skull model is also demonstrated based on this heat generation. [Copyright &y& Elsevier]

Abstract: Ewing’s sarcoma (ES) is a part of a larger family of round blue cell tumors, which occasionally manifest as osseous or extraosseous lesions adjacent to or within the central nervous system (CNS). While a large body of literature exists on ES of bone, data are lacking on tumors with cranial or spinal components that affect the CNS. Here, we perform a systematic review of the literature and summarize the best available evidence on diagnosis, treatment and outcomes of ES affecting the CNS with emphasis on the breadth of clinical presentations, diagnostic tools and emerging management options for these rare and challenging lesions. We include a review of known prognostic factors and propose several new considerations for prognostication of ES affecting the CNS. [Copyright &y& Elsevier]

Abstract: We report a rare case of orbital apex syndrome following epidural steroid injections of the lumbar spine in an immunocompetent individual with osteomyelitis and discitis caused by Aspergillus fumigatus. We suspect that the craniospinal venous system, also known as the Batson''s plexus, was the main route for steroid-facilitated disease propagation from the spine to intracranial structures. [Copyright &y& Elsevier]

Abstract: Bone fillers have emerged as an alternative to the invasive surgery often required to repair skeletal defects. Achieving controlled release from these materials is desired for accelerating healing. Here, oppositely-charged Poly (d,l-lactic-co-glycolic acid) (PLGA) nanoparticles were used to create a cohesive colloidal gel as an injectable drug-loaded filler to promote healing in bone defects. The colloid self-assembled through electrostatic forces resulting in a stable 3-D network that may be extruded or molded to the desired shape. The colloidal gel demonstrated shear-thinning behavior due to the disruption of interparticle interactions as the applied shear force was increased. Once the external force was removed, the cohesive property of the colloidal gel was recovered. Similar reversibility and shear-thinning behavior were also observed in colloidal gels loaded with dexamethasone. Near zero-order dexamethasone release was observed over two months when the drug was encapsulated in PLGA nanoparticles and simply blending the drug with the colloidal gel showed similar kinetics for one month. Surgical placement was facilitated by the pseudoplastic material properties and in vivo observations demonstrated that the PLGA colloidal gels stimulated osteoconductive bone formation in rat cranial bone defects. [Copyright &y& Elsevier]