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Objectives/Hypothesis: Interstitial laser therapy (ILT) has become useful for tumor palliation in patients with advanced head and neck cancer. Cisplatinum chemotherapy also is a frequent adjuvant treatment for recurrent tumors, but systemic toxicity limits application. Intratumor cisplatinum injection combined with ILT may improve therapy of these recurrent tumors with reduced toxicity. Study Design: Prospective. Tumor transplants were injected with cisplatinum in a gel implant before ILT to evaluate treatment response and toxicity in a preclinical study. Methods: UCLA-P3 human squamous cell carcinoma tumors were grown as subcutaneous transplants in nude mice and treated by intratumor injection of 2 mg/mL cisplatinum in a slow-release, collagen-based gel carrier 4 hours before interstitial implantation of Nd:YAG laser fiberoptics to induce local tumor hyperthermia. Treatment efficacy and toxicity were followed for 12 weeks after combined drug and laser therapy compared with ILT alone. Results: Combined cisplatinum gel and ILT was a significant improvement (P < .01 by chi-square test) and induced 57% complete responses without regrowth in 21 transplanted tumors compared with only 24% in 21 tumors after ILT alone during 12-week follow-up. Recurrences in both cases appeared to result from nonuniform laser energy delivery within tumors via the implanted fiberoptic tip. Conclusions: The results of this experimental combined cisplatinum and ILT study suggest it may be possible to improve treatment of advanced head and neck cancer by intratumor injection of gel implants containing the drug followed by interstitial Nd:YAG laser hyperthermia.

A new treatment for cancer has been tested in vitro using light-sensitive anthracyclines followed by laser photoactivation, as described by several investigators. We previously reported 10-fold enhanced laser killing after 2 hours of incubation with daunomycin by cultured human carcinoma cells. This short-term uptake leads to drug localization in cytoplasmic and membrane sites prior to nuclear accumulation and topoisomerase inhibition. In the present study, daunomycin was incubated for 2 or 24 hours with P3 squamous carcinoma cells to directly compare cytoplasmic vs. nuclear drug targeting before and after KTP-532 laser activation. Monolayer cultures of the P3 cells sensitized with daunomycin for 2 hours, then chilled (4 degree C), and exposed to the KTP laser (532 nm, 94.2 J/cm2) had a 2- to 10-fold increased therapeutic response compared with drug or laser alone when measured by MTT tetrazolium assays. After 24 hours of incubation with daunomycin, the chemotherapeutic response of P3 tumor cells was amplified 2-fold by laser exposure. The results suggest that daunomycin and laser treatment can be combined for improved therapy of human cancer.

The search for simpler techniques for skin resurfacing has led many groups to investigate the usefulness of lasers as precision tools for photodermabrasion. A new modality for superficial ...

Photodynamic therapy (PDT) with lasers and new dyes has gained popularity in recent years as a minimally invasive technique with high tumoricidal effects in vitro and in some cancer patients. However, because new laser dyes are not FDA approved at present, the clinical evaluation of PDT may be years away. During the past 6 years we have used laser alone for photothermal ablation in both preclinical studies and in a large number of patients with an observed 60% tumor response rate. The 40% treatment failure led us to explore the possibility of combined therapy with lasers and standard chemotherapeutic drugs. We have recently tested a promising preclinical alternative using implantation of a bare 600-microns KTP 532 laser fiberoptic in multiple tumor sites 30 min after intratumor injection of the anthrapyrazole DUP-941. As a control, this drug was injected in 3 sites of P3 human squamous cell tumor transplants in nude mice, which led to tumor stasis without regression. Similar 400-600 mm3 tumors exposed to laser illumination alone (0.8 W for 5 sec) at multiple sites resulted in tumor regrowth after 10 weeks in 80% of the animals. However, combining interstitial laser illumination with intratumor DUP-941 injections led to complete tumor regression in 85% of the mice. We propose that intratumor drug injection followed by interstitial laser fiberoptic treatment represents a potentially useful new method for tumor ablation in advanced cancer patients.

Vestibular function of a population including labyrinthine-defective patients and a control group of age-matched normal healthy volunteers was evaluated using videonystagmoscopy. This device is made of one or two CCD infra-red cameras mounted on diving glasses and allows observation of ocular movements on a video monitor and/or recording on a videotape. Eye movements are observed after rotations in a Bárány chair and during passive head tilts. With this simple and non-invasive test, a screening of vestibular function at bedside or during ENT clinical investigations can be performed. A further study with videonystagmography to quantify these results being prepared.

In 6 patients who had undergone a hypoglossal-facial anastomosis, showing clinical signs of recovery, a new short-latency trigemino-hypoglossal reflex of the R1 blink reflex type was demonstrated, implying a heterotopical sprouting of trigeminal neurones towards hypoglossal motoneurones. We therefore studied the motoneuronal excitability for this R1 reflex response in order to compare the convergent properties of facial motoneurones (normal side) with those of the hypoglossal motoneurones (operated side) with the use of the classical double-shock and variable interstimulus delay (conditioning-test stimulus) technique. On normal side, conditioning stimuli (ipsi- or contralateral infraliminar supraorbital nerve) produced a clear-cut facilitation of the R1 blink reflex response within a 30–80 ms interstimulus time interval. By contrast a similar procedure remained without any effect on the R1 blink reflex response mediated via the trigeminal-hypoglossal reflex arc. These data indicate that despite the heterotopical sprouting of some axons of neurones from the principal trigeminal nucleus towards the XIIth nucleus, those hypoglossal motoneurones involved in the neoformated trigemino-hypoglossal reflex arc remain totally inexcitable by other trigeminal afferents and thus appear unable to ensure the physiological function of the normal blink reflex.

Hypoglossal-facial anastomosis (HFA) is a cross-over between the proximal stump of the hypoglossal nerve (XII) and the distal one of the facial nerve (VII). The hypoglossal axons regrow within the sheaths of facial fibres, allowing the progressive reinnervation of the facial muscles. This model is interesting to study some mechanisms of plasticity of the nervous system for several reasons: 1) It is a quite simple and reproducible model of pathophysiological state. It allows the study of 2) the modifications of the nervous system induced by the HFA, both upwards and downwards to the lesion and 3) the modifications of reflex activities involving intrapontine connections such as the blink reflex. The electrophysiological features of the trigemino-facial (TF) and trigemino-hypoglossal (TG) connections demonstrated that a central reorganisation of the blink reflex (BR) was induced by HFA: the afferent volleys of the TF and TH reflexes elicited by cutaneous and mucosal trigeminal afferents respectively have been shown to project onto common interneurones located within the trigeminal principal sensory nucleus. A long-term prospective study showed: 1) a reinnervation of the facial muscles by the hypoglossal axons is a necessary perequisite for the central reorganisation of BR, 2) a hyperinnervation of the facial muscles by the hypoglossal axons, 3) a transient and regressive cross-innervation of paralyzed face by the healthy contralateral facial nerve.

Speech disorders were often allotted to hypoglossal-facial anastomosis (HFA) without being clearly shown. We have compared patients with a peripheral facial paralysis at those with HFA.Retrospective study comparing verbal communication (articulation) and non-verbal within two groups of patients: patients with patient FP versus with HFA.10 patients with idiopathic FP versus 7 patients with HFA took part in this study. The series of tests includes an evaluation of the motor possibilities, bilabial pressure measurement (for the patients with FP), speech capacities and finally an evaluation of the verbal and non-verbal communication from a scale of satisfaction.The results highlight: the presence of real speech disorders (permanent) among patients with FP and their absence among patients having profited from HFA; a real satisfaction of the HFA versus FP on the quality of life compared to daily tasks, more specifically concerning verbal and food skills.The HFA is not responsible for speech disorders, and makes undeniable improvements confirmed subsequently by the patients.

The authors investigated the evolution of the dynamic features of the cross-innervation process in patients with complete facial palsy due to facial nerve transection during surgery for acoustic neuroma removal followed by a hypoglossal-facial nerve anastomosis (HFA). Clinical and electrophysiologic investigations were carried out before and over a 3-year period after HFA. Cross-innervation had started by the 10th day, progressed to the seventh to eighth month, then decreased and finally disappeared by the 12th month after HFA. Ipsilateral reinnervation was observed by the fourth month, progressed to the 12th to 18th month, and remained stable for the remainder of the follow-up period.

Ollier's disease is a constitutional pathology of unknown etiology. It is characterized by bone dysplasia generating numerous enchondromas. The malignant degeneration of this dysplasia is well known. The aim of this article is to study the diagnostic, therapeutic and prognostic characteristics of these lesions.We report a case of parapharyngeal chondrosarcoma extended to the base of the skull in a patient with Ollier's disease. The treatment was a surgical removal by a cervicotransoral incision combined with a preauricular incision and with a mastoidectomy. It was therefore possible to control the skull base, the parapharyngeal space, the infratemporal fossa and the major neurovascular structures. The removal of the lesion was completed at the level of the clivus and sphenoid with optics (30 and 70 degrees ). We discuss this treatment and the follow up on the bases of literature data.The neoplastic degeneration of enchondromas is estimated between 25 to 50% of cases. The most frequent location is the pelvic bones. Chondrosarcomas are slow growing tumors and their metastatic potential is less significant as we note it in our case report. Their diagnostic is essentially based on histological criteria's and their treatment is surgical.Chondrosarcomas of the ENT area occurring with Ollier's disease is rare. Their prognostic is good if the surgical treatment is well done.

An open therapeutic trial was conducted in patients with Bell's palsy. Results were compared with data in the literature.Between 1997 and 2000, 76 patients with Bell's palsy were treated with intravenous methylprednisolone (2 mg/kg/day) and acyclovir (5-10 mg/kg/8 hours) for 7 days. Treatment was initiated in all patients before the 14th day of illness. Severity of the palsy was scored on the first day of treatment and again one year later using the House and Brackman scale.Grade II or III palsy were observed in 38% of the patients at initial presentation, grades IV to VI in 62%. After treatment, 92% of the patients had reverted to grades I and II (good outcome) and only 8% had sequelae at 1-year follow-up. All patients with initial grade I or II recovered completely. For patients with grade IV, V, or VI complete recovery at 1 year was observed in 94, 86 and 50% respectively.Data in the literature suggest that corticosteroids should improve recovery in Bell's plasy. In our study, adjunction of acyclovir did not demonstrate any clear improvement in the cure rate. Benefit could depend on early prescription.

OBJECTIVE:To define the management of internal acoustic meatus and cerebellopontine angle (CPA) lipomas according to their clinical, histological, and surgical characteristics.METHODS:We report four new cases of CPA lipomas diagnosed in the Department of Otorhinolaryngology–Head and Neck Surgery of Hôpital Pitié-Salpêtrière and review 94 cases reported previously in the literature.RESULTS:Lipomas represented 0.14% of CPA and internal acoustic meatus tumors. Localization was on the left side in 59.9%, on the right side in 37%, and bilateral in 3.1% of the patients. The diagnosis was confirmed radiologically in 33 of 98 patients, surgically in 60 patients, and by autopsy in 5 patients. The most frequent associated symptoms were of cochleovestibular origin, such as hearing loss (62.2%), dizziness (43.3%), and unilateral tinnitus (42.2%). Other associated symptoms involved the facial nerve (9%) or the trigeminal nerve (14.4%). Complete resection was performed in only 32.8% of the patients with frequent cranial nerve involvement. Frequent cranial nerve involvement was seen in 95.4% of all patients. After surgery, patient symptomatology was unchanged in 9.2% of the patients, and 50% were improved; however, new postoperative deficits occurred in two-thirds of the patients. Overall, 72.2% of the patients experienced new postoperative deficits such as hearing loss (64.8%). Preservation of hearing was possible in only 26% of the patients. Only 18% of patients were improved after surgery without any new postoperative deficits.CONCLUSION:Preoperative diagnosis of internal acoustic meatus/CPA lipomas is based on magnetic resonance imaging. The aim of surgery in these cases is not tumor removal but cranial nerve decompression or vestibular transection, and surgery is performed only in patients with disabling and uncontrolled symptoms.

The authors report two cases of patients with word deafness. The word deafness occurred after a head injury for the first patient and after an arterio venous malformation embolization for the second patient. MRI demonstrated bilateral lesions of the inferior colliculi but brainstem auditory-evoked potentials (BAEP) were within normal limits. These cases demonstrated that lesions involving the two inferior colliculi induced pure word deafness but do not affect BAEP.

In normal subjects, electrical stimulation of trigeminal mucosal afferents (lingual nerve - V3) can elicit a short latency (12.5+/-0. 3 ms; mean+/-S.D.) reflex response in the ipsilateral genioglossus muscle (Maisonobe et al., Reflexes elicited from cutaneous and mucosal trigeminal afferents in normal human subjects. Brain Res. 1998;810:220-228). In the present study on patients with hypoglossal-facial (XII-VII) nerve anastomoses, we were able to record similar R1-type blink reflex responses in the orbicularis oculi muscles, following stimulation of either supraorbital nerve (V1) or lingual nerve (V3) afferents. However, these responses were not present in normal control subjects. Voluntary swallowing movements produced clear-cut facilitations of the R1 blink reflex response elicited by stimulation of V1 afferents. In a conditioning-test procedure with a variable inter-stimulus interval, the R1 blink reflex response elicited by supraorbital nerve stimulation was facilitated by an ipsilateral mucosal conditioning stimulus in the V3 region. This facilitatory effect was maximal when the two stimuli (conditioning and test) were applied simultaneously. This effect was not observed on the R1 component of the blink reflex in the normal control subjects. These data strongly suggest that in patients with XII-VII anastomoses, but not in normal subjects, both cutaneous (V1) and mucosal (V3) trigeminal afferents project onto the same interneurones in the trigeminal principal sensory nucleus. This clearly supports the idea that peripheral manipulation of the VIIth and the XIIth nerves induces a plastic change within this nucleus.

It has been shown that in patients in whom the central stump of the hypoglossal nerve has been anastomosed to the peripheral stump of a lesioned facial nerve, supraorbital nerve stimulation can elicit a short-latency reflex (12.5±0.6 ms; mean±S.D.) in facial muscles similar to the R1 disynaptic blink reflex response, but not followed by an R2 blink reflex component46. Thus in addition to replacing the facial neurons at peripheral synapses, these hypoglossal nerves contribute to a trigemino-hypoglossal reflex. The aim of this work was to study the type of reflex activities which can be elicited in both facial and tongue muscles by electrical stimulation of cutaneous (supraorbital nerve) or mucosal (lingual nerve) trigeminal (V) afferents in normal subjects. The results show that although stimulation of cutaneous V1 afferents elicits the well-known double component (R1–R2) blink reflex response in the orbicularis oculi muscles, it does not produce any detectable reflex response in the genioglossus muscle, even during experimental paradigms designed to facilitate the reflex activity. Conversely, stimulation of mucosal V3 afferents can elicit a single reflex response of the R1 type in the genioglossus muscle but not in the orbicularis oculi muscles, even during experimental paradigms designed to facilitate the reflex activity. These data are discussed in terms of two similar but separate circuits for the R1 responses of cutaneous (blink reflex) and mucosal (tongue reflex) origins. They suggest that in patients with hypoglossal-facial (XII–VII) nerve anastomosis, the short-latency trigemino-`hypoglossal-facial' reflex of the R1 blink reflex type observed in facial muscles following supraorbital nerve stimulation could be due to changes in synaptic effectiveness of the central connectivity within the principal trigeminal nucleus where both cutaneous and mucosal trigeminal afferents project.

In patients with hemifacial spasm (HFS), abnormal muscle responses due to abnormal cross-transmission are observed in facial muscles. However, the site in the facial nerve responsible for the cross-transmission remains a matter of controversy. We have developed a model in which by considering the electrophysiological parameters involved in producing the abnormal muscle response, we can determine the site of the abnormal cross-transmission within the facial nerve. This model was applied to HFS patients with three different etiologies: idiopathic, post-Bell's palsy, and post-XII-VII anastomosis. Our data show that: in idiopathic HFS, the cross-transmission may occur in the facial nerve at the level of the pontocerebellar angle; in post-Bell's palsy, it is inside the petrous bone; and in XII-VII anastomosis, it must be in the extracranial part of the facial nerve. The possible mechanisms for this cross talk are discussed in terms of ephaptic transmission or of a central hyperexcitability in the facial motor nucleus.

A short review of the literature and of some personal data that deals with the electrophysiological observations that can be made in patients with hemifacial spasm and that allow one to discuss the two hypotheses that are proposed as possible mechanisms for the pathophysiology of hemifacial spasm is presented. The first part of the paper summarizes the technological and methodological aspects used for investigations. The second part presents data that support the peripheral nerve hypothesis. Although the peripheral nerve hypothesis has been prominent for a long time, recent data in the literature as well as the authors personal findings, as reported in the third section, favour the central or ‘nucleus’ hypothesis, which seems actually the most probable to explain as a whole the clinical and electrophysiological characteristics of HFS.

Laser phototherapy and diagnosis are emerging as new tools for cancer detection and treatment. Tumor uptake of laser dyes and chemotherapy drugs followed by laser fiberoptic insertion provides a less invasive and more effective treatment option for many cancer patients. Further development will be needed to identify optimal drug and laser combinations before this new approach becomes clinically useful.

Laser activation of anthracycline-related drugs combines chemotherapy with photoablation for improved treatment. Hypericin, a structurally related anthraquinone, was tested for laser activation and cytotoxicity in human cancer cells. Viability of P3 squamous cell carcinoma cells incubated with 1 to 20 microgram/mL hypericin was reduced by more than 95% after 1 minute exposure at 4 degrees C to an argon laser (514 nm, 5 W), a KTP-532 laser (532 nm, 5 W), or a 20-A xenon lamp. Viability was reduced over 90% in six human carcinoma, sarcoma, and melanoma cell lines by this combined treatment, but only trace toxicity was seen after separate exposure to hypericin or light alone. These results show that hypericin is a sensitive agent for phototherapy of human cancer cells in vitro and indicate that this drug may be useful for tumor targeting via minimally invasive imaging-guided laser fiber optics.

Interstitial laser therapy (ILT) is a promising therapeutic technique in which laser energy is delivered percutaneously to various depths in tissue. In this study, the authors compared high-speed magnetic resonance imaging (MRI) of ILT in tissues during treatment with post-treatment histopathologic specimens. The use of 5-second MRI scans allowed detection of thermal damage by the 1064-nm neodymium:yttrium-aluminum-garnet laser in ex vivo liver and brain tissues. These tissues were treated by ILT with 20 W of laser output for 5 to 30 seconds via a 600-microns fiberoptic inserted 1 cm into the specimens at a power density of 7 kW/cm2 at the tip of the bare fiber. Sequential MRI measurements of lesion areas made during and after treatment were compared to measurements of laser-induced tissue damage in histopathologic sections. Fast MRI scans and tissue histology both demonstrated increased lesion size with time of ILT. Serial images obtained during ILT detected thermal changes as areas of low signal intensity that exceeded the size of the post-treatment lesions as measured on either final MRI or histology. The thermal effects detectable by these high-speed MRI sequences can be used to monitor laser-induced tissue changes during therapy, thereby providing a valuable noninvasive method for the intraoperative assessment of heat distribution during ILT.

Functional motor control requires perfect matching of the central connections of motoneurons with their peripheral inputs. It is not known, however, to what extent these central circuits are influenced by target muscles, either during development or after a lesion. Surgical interventions aimed at restoring function after peripheral nerve lesions provide an opportunity for studying this interaction in the mature human nervous system. A patient was studied in whom the spinal accessory nerve was anastomosed into a lesioned facial nerve, allowing voluntary contractions of the previously paralysed muscles. This procedure, in addition to replacing the facial neurons at peripheral synapses, allowed a new short latency trigeminospinal accessory reflex of the R1 blink reflex type to be demonstrated, implying that trigeminal neurons had sprouted towards spinal accessory motoneurons over a distance of at least 1 cm. These results show an unexpected influence of the periphery in remodelling central connectivity in humans. The motoneuronal excitability for this R1 reflex response was therefore studied to compare the convergent properties of facial motoneurons (normal side) with those of the spinal accessory motoneurons (operated side) using a classic double shock technique with variable interstimulus intervals (conditioning test stimulus). On the normal side, conditioning stimuli (to the ipsilateral or contralateral infraliminar supraorbital nerve) produced a clearcut facilitation of the R1 blink reflex when the interstimulus interval was 30-80 ms. By contrast, a similar procedure had no effect on the R1 blink reflex mediated via the trigeminal-spinal accessory reflex arc. These data indicate that despite the heterotopic sprouting of some axons from neurons in the XIth nucleus, motoneurons involved in the newly formed reflex arc remain totally inexcitable by other trigeminal afferents and seem unable to ensure a physiological functioning of the normal blink reflex. Thus the functional relevance of the recovered R1 blink response remains unclear.

Tissue uptake and biodistribution of hypericin was measured in rabbits and in nu/nu mice xenografted with P3 human squamous cell carcinoma to assess the value of this dye as an in vivo sensitizer for laser photoinactivation of solid tumors. Hypericin has absorption maxima at 545 and 590 nm with a fluorescence emission peak at 640 nm in ethanol. Dye uptake after intravenous injection was tested at 4 and 24 hours in rabbit tissues by ethanol extraction and quantitative fluorescence spectrophotometry. Maximum dye levels were seen at 4 hours in most vascular organs with lung having fivefold higher uptake than spleen followed by liver, blood, and kidney. Mice were examined after 2, 4, 6, 8, and 24 hours and after 3 and 7 days for dye uptake. The peak concentration of hypericin in murine organs was reached at 4 hours with uptake per gram of tissue as follows: lung > spleen > liver > blood > kidney > heart > gut > tumor > stomach > skin > muscle > brain. Elimination of hypericin was rapid in most murine organs with residual dye under 10% of maximum by 7 days compared to 25% to 30% retention for the squamous cell tumors and several normal tissues. These results suggest that hypericin may be a useful photosensitizer for KTP/532 laser interstitial therapy of human cancer.

Imaging-guided palliative therapy of recurrent and/or inaccessible head and neck tumors may soon become clinically practical since sensitive and noninvasive monitoring techniques of energy deposition in tissues are now available. Interstitial tumor therapy (ITT) is a technique whereby a source of energy (laser, radiofrequency, ultrasonic, cryoenergy, etc.) is directly applied into tumors at various depths. Recent studies have demonstrated the efficiency of ultrasound (UTZ) and magnetic resonance imaging (MRI) for real and/or "near" real time tumor and vessel identification as well as monitoring and quantifying energy-induced tissue damage. We now report our initial clinical experience with patients in which UTZ and/or MRI-guided ITT techniques were successfully applied for the treatment of recurrent, nonresectable, local, and/or metastatic head and neck carcinomas. Patients were treated on an outpatient basis either in the operating room or in an upgraded specially equipped SIGNA 1.5T MR suite. Most patients tolerated these procedures well and were successfully palliated for periods ranging from 3 months to 5 years posttreatment. The upgrades introduced in a standard MRI suite, the clinical experience, and future perspectives will be reviewed.

In a previous study it was shown that a central and widespread hyperexcitability of the facial motor nucleus was a common feature of the affected side of patients with hemifacial spasm (HFS). It was thus concluded that the patients’ abnormal reactions would depend on the existence or not of a background activity in the facial motoneurons. This background activity would be increased in HFS by a permanent neuronal antidromic excitation originating from the ectopic focus and ephaptic transmission on the facial nerve itself. These data raise the following question: what happens to the facial motoneuron hyperexcitability when the ectopic ephaptic excitation of the facial nerve has been removed?

An unusual case of clear cell sarcoma (CCS) found in the parotid region of a 75-year-old man with a long history of chronic lymphoid leukemia is reported. Treatment of the patient included a total parotidectomy with preservation of the facial nerve. The tumor was pathologically consistent with a clear cell sarcoma. Since CCS originates from the neural crest and is melanin producing, we suggest that this particular tumor originated from the superficial musculo-aponeurotic system (SMAS). To our knowledge, this is the first case of CCS that has been reported in the parotid region.

Hypoglossal facial crossover is the most common procedure performed to rehabilitate a paralysed face, when the trunk of the facial nerve is not available for end-to-end anastomosis. This technique always gives at least a symmetrical face at rest. Independent movements allowing smiling and closing of the eye could be the best end result. This present work was performed to study the central and peripheral arrangements, following a hypoglossal-facial crossover. The peripheral changes were studied with classical electromyography. The central changes were studied with the Blink reflex. In this way we demonstrated the presence of central connections between the trigeminal and hypoglossal nuclei.

With the use of qualitative and quantitative electrophysiological methods, the aim of the present study was to substantiate the idea that a central hyperexcitability exists in the facial motoneurons in hemifacial spasm (HFS). The study was carried out on eight patients (six men, two women, 40–65 years) affected with HFS from both idiopathic (n = 6) and postparalytic (n = 2) origin. In a first set of experiments, we studied trigeminofacial reflexes elicited by electrical stimulation of supraorbital nerves on both the normal and affected side of HFS patients and in four control subjects using classical conventional techniques as described previously [1, 3, 5]

Interstitial tumor therapy guided by imaging techniques is minimally invasive and a promising surgical approach which will become clinically practical only when effective, simple, and safe modalities for tumor excision and control of tumor vascular supply are available. In a novel experiment utilizing a 1.5 T magnetic resonance (MR) scanner, the carotid artery of a New Zealand white rabbit was identified and then clamped using the Premium Surgicliptm 9.0' disposable automatic clip applier. The magnetic resonance imager equipped with an angiography package was used to locate vasculature in the carotid triangle of the rabbit via fast scan techniques. The artery was then clamped with titanium clips, and repeat magnetic resonance angiography (MRA) clearly demonstrated the cessation of blood flow within the chosen vessel. The experimental results are promising, since the angiography package not only provided the visualization of the arterial vessel, but was also used to guide an MR compatible surgical instrument to the vessel, with no artifact seen.© (1993) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Many new photosensitizers and laser wavelengths are being tested to improve photodynamic therapy by enhancing specific tumor uptake and/or retention, lowering systemic toxicity, and increasing laser tissue penetration. In this study the potential synergistic effects of rhodamine-123 (Rh-123) and merocyanine-540 (MC-540) sensitization of human tumor cell lines after laser exposure were explored. In a first series of experiments, the kinetics of uptake of Rh-123 and M-540 were tested on three human leukemia cell lines (K562, RAJI, 729HF2), P3 squamous carcinoma, and M26 melanoma. Our results demonstrate a clear difference in the rate and amount of uptake of MC-540 (K562P3RAJI729HF2M26) and Rh-123 (P3RAJI729HF2K562M26) by these cell lines. In a second series of experiments, M26 tumor cells were sensitized with either Rh-123 (1 microgram/ml) or with MC-540 (20 micrograms/ml) alone or with a combination of the two dyes for 60 minutes, then exposed to the argon (514.5 nm) laser at nonthermal energy levels. Our results demonstrate a significant enhancement of the tumoricidal effects of the laser on M26 carcinoma cells after sensitization with both dyes together (MC-540 and Rh-123) when compared to each dye alone. As with combination antibiotherapy, the synergistic effects of two laser dyes that have different intracellular targeting sites appear to enhance tumoricidal effects significantly after exposure to a matching laser wavelength. The data provide evidence for effective laser phototherapy by dye synergy.

Syringomas are benign tumors of eccrine origin that occur primarily in the lower eyelid region of females. Since they do not involute and are typically refractory to conventional forms of therapy, they may grow to become considerable, chronic cosmetic and functional deficits. The current study reports on a patient with familial syringomas, previously refractory to two different standard therapies, who was successfully treated with the superpulsed CO 2 laser. A simple, accurate, and reproducible method of dosimetry of laser energy was used to treat these lesions with the Sharplan 700 CO 2 laser connected to the operating microscope. Each lesion was irradiated separately with single pulses at a calculated energy density of 1 J/cm 2. Superficial scabbing was observed 1 week postoperatively, with no edema or pain. Mild erythema persisted for 1 month, with complete healing thereafter. No recurrences were noted after a 2 year follow-up. There was no evidence of scarring, ectropion, or changes in pigmentation. The disease and methods of treatment are reviewed.

The authors have developed an animal model for the electrophysiological investigation of the blink reflex. The justification for such investigations and the experimental protocol were presented. The authors studied the blick reflex with electromyographic recordings obtained after the stimulation of the supra orbital nerve (V1) in the awake rat and in the anaesthesized rat. Two components of the reflex, R1 and R2 were observed. The early component, R1 was ipsilateral to the stimulus. It was observed whatever the degree of anaesthesia. The R2 component came later and was only observed in awake or weakly anaesthesized rats. It appeared to be isolated and unprecedented by an R1 component when the contralateral supra orbital nerve was stimulated. The R1 responses were facilitated by prior ipsilateral or contralateral stimulation of V1.

Hemifacial spasm is characterized by intermittent involuntary contractions of one or several groups of muscles innervated by the facial nerve. The possible causal mechanisms have been the subject of numerous publications. The pre-eminent work of Moller and Jannetta implicates the compression of the facial nerve at its point of entry into the central nervous system, the Root Entry Zone, while the physiopathology is poorly understood, two principle hypotheses emerge: 1) ephaptic transmission between injured fibers; 2) hyper excitability of the facial motor nucleus. Using standard electromyographic techniques and blink reflex studies, we were able to demonstrate hyperexcitability of the facial nucleus. The cause of this hyperexcitability remains unexplained. It could be the result of a permanent antidromic stimulation from a peripheral ectopic center of excitation.

The ophthalmological signs are stressed in the management of frontal mucoceles. The authors report good results of their surgical technique with bicoronal approach, exenteration of the pathology and complete obliteration of the frontal sinus by bone chips.

Functional motor control requires perfect matching of central connectivity of motoneurones with their peripheral connections. However, it is not known to what extent central circuitry is influenced by target muscles, either during development or following a lesion. Surgical interventions aimed at restoring function following peripheral nerve lesions provide an opportunity for studying this interaction in the mature human nervous system. We have followed 8 patients in whom the hypoglossal nerve was anastomosed into a lesioned facial nerve, allowing voluntary contractions of the previously paralyzed muscles. We show that, in addition to replacing the facial neurons at peripheral synapses, a new short-latency trigemino-hypoglossal reflex, of the R1 blink reflex type, can be demonstrated in patients showing recovery, implying a sprouting of trigeminal neurons towards hypoglossal motoneurones, over a distance of at least 0.5 cm. These surprising results show an unexpected influence of the periphery in remodelling central connectivity in man.

Transethmoid-sphenoid decompression has been performed on 11 patients with indirect optic nerve injury. Visual improvement occurred in 8 patients, including 4 patients with initial total blindness. Optic neuropathy improved even when there was a long interval, up to 92 days, between trauma and decompression. There is still controversy about the treatment of traumatic optic neuropathy. Our results suggest that surgery can be helpful in the management of this condition. Transethmoid-sphenoid optic nerve decompression is a minimally invasive procedure that gave, in this series, satisfactory results with low morbidity.

The failure rate of cancer treatment remains unacceptably high, still being a leading cause of mortality in adults and children despite major advances over the past 50 years in the fields of surgery, radiation therapy and, more recently, chemo and immunotherapy. Surgical access to some deep tumors of the head and neck and other areas often require extensive dissections with residual functional and cosmetic deformities. Repeated treatment is not possible after maximum dose radiotherapy and chemotherapy is still limited by its systemic toxicity. An attractive solution to these problems would be the development of a new adjunctive method combining the best features of interstitial laser therapy for selective tumor destruction via minimally invasive techniques for access and 3-D magnetic resonance imaging (MRI) as a monitoring system for laser-tissue interactions. Interstitial laser therapy (ILT) via fiberoptics allow laser energy to be delivered directly into deeper tissues. However, this concept will become clinically useful only when noninvasive, accurate, and reproducible monitoring methods are developed to measure energy delivery to tissues. MRI has numerous advantages in evaluating the irreversible effects of laser treatment in tissues, since laser energy includes changes not only in the thermal motions of hydrogen protons within the tissue, but also in the distribution and mobility of water and lipids. These techniques should greatly improve the use of ILT in combination with MRI to allow treatment of deeper, more difficult to reach tumors of head and neck and other anatomical areas with a single needle stick.© (1992) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The mitochondrial dye Rhodamine 123 (Rh-123) has been shown to be an effective photosensitizer for argon-laser irradiation of some types of human cancer cells in vitro. We reported that 514.5-nm laser illumination of Rh-123 sensitized human melanoma, and squamous carcinoma cells strongly inhibited tumor-cell proliferation as measured by decreased 3H-thymidine (3H-T) uptake in vitro and may eradicate some tumors when grown as transplants in nude mice. However, several other human tumors were resistant to Rh-123 laser therapy in vitro and in vivo. In the current study, it was possible to obtain 100- to 1000-fold increased sensitivity to 514.5-nm laser illumination by replacement of Rh-123 with the cationic rhodamine dyes Rh-3G and Rh-6G. Cell viability was decreased over 95% and 3H-T incorporation reduced at least 80% by laser phototherapy after sensitizing tumor cells with 1 micrograms/mL Rh-123, 0.01 microgram/mL Rh-3G, or 0.001 microgram/mL Rh-6G. However, Rh-123 alone did not decrease 3H-T uptake significantly unless present at over 10- to 100-fold higher levels than Rh-3G, respectively. The tumor cell dye uptake level was measured by N-butanol extraction and absorption scans at 400 to 600 nm. The results revealed that dye uptake was more rapid, and retention of Rh-3G and Rh-6G was 5- to 10-fold higher than for Rh-123 in the human tumor cells. The data suggest that Rh-3G and Rh-6G may be highly sensitive chromophores for laser phototherapy of human cancer cells.

About a series of 33 patients operated in the ENT Depart. Prof. Soudant-La Pitié-Salpêtrière Hospital-Paris. Any emphasis was put on 11 cases of aspergillosis sinusitis. Most of the time, clinical signs are non specific. But X rays studies are of great help for the diagnosis. Treatment of chronic sinusitis of dental origin, particularly aspergillosis, remains surgical: caldwell-luc operation or endonasal approach. As a conclusion, the authors suggest systematic removal of all intrasinusal foreign body.

We have been studying 17 cases for operated mucoceles over a period of 4 years. Usual predisposing factors are often present, however we found no underlying malignant tumor revealed by a mucocele. Surgical treatment always included exclusion and filling with bone grafts in case of frontal involvement. Small ethmoidal lesions without symptom found on the CT scan are worrying because of their potential deterioration; in such cases, our attitude has been surgical.

The temporomandibular joint (TM joint) is a synovial joint with two condylar surfaces and an intra-articular cartilaginous disc. Its development has two origins. Its physiology is complex and intimately related to dental occlusion, which is why we talk about the temporomandibular and dental joint. Recent neurophysiological data allow a better approach to TM joint dysfunction. The lateral pterygoid muscle plays decisive role in the pathogenesis of TM joint dysfunction.

Post traumatic optic nerve compression gives a Clinic picture of physiological section. CT Scan is consistent with optic canal lesion when considering direct signs (bony fragments compressing the nerve) or indirect (fractures and hematoma of posterior orbital wall, of posterior ethmoid, and sphenoid). 23 patients had a surgical decompression through transethmoidosphenoidal approach. A lesion of optic canal was found in 22 out of 23 cases. Improvement of vision was noted in 12 cases.

There are two types of neurofibromatosis, i.e. peripheral neurofibromatosis (type 1) and central neurofibromatosis (type 2). Neurinomas of the acoustic nerve are basically seen in central neurofibromatosis, in which case they are generally bilateral. Surgical indications for neurinoma are rare and 5 patients will be discussed: 2 of these underwent an operation on the neurinoma by the posterior route on several occasions, while 1 patient was operated by the trans-labyrinth route. Nuclear magnetic resonance remains the best means of monitoring.