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Kaan Yağmurlu, Michael A Mooney, Kaith K Almefty, Baran Bozkurt, Necmettin Tanriover, Andrew S Little, Mark C Preul
OBJECTIVE: To describe an endoscopic anterolateral surgical route to the lateral portion of Meckel's cave. METHODS: A sublabial transmaxillary transpterygoid approach was performed in 6 cadaveric heads (12 sides). A craniectomy was drilled between the foramen rotundum (FR) and foramen ovale (FO) with defined borders. Extradural dissection was performed up to the V2-V3 junction of the trigeminal ganglion. The working space was analyzed using anatomical measurements...
March 3, 2018: World Neurosurgery
Denys Fontaine, Serena Santucci, Michel Lanteri-Minet
Cluster headache (CH) is a primary headache and considered as one of the worst pains known to man. The sphenopalatine ganglion (SPG) plays a pivotal role in cranial autonomic symptoms associated with pain. Lesioning procedures involving the SPG and experimental acute SPG stimulation have shown some degree of efficacy with regard to CH. A neuromodulation device, chronically implanted in the pterygopalatine fossa, has been specifically designed for acute on-demand SPG stimulation. In a pilot placebo-controlled study in 28 patients suffering from refractory chronic CH, alleviation of pain was achieved in 67...
2018: Journal of Pain Research
Alexander P Marston, Glenn Merritt, Jonathan M Morris, Shelagh A Cofer
OBJECTIVES: The suprazygomatic maxillary nerve block is associated with improved post-operative pain management after select craniofacial surgical procedures. This study's objective is to better define the impact of pediatric facial skeletal growth on techniques for accessing the pterygopalatine fossa (PPF). METHODS: Pediatric patients with prior thin-slice maxillofacial computed tomography imaging were identified in an institutional radiology database. Aquarius image-processing software (Ver...
February 2018: International Journal of Pediatric Otorhinolaryngology
Nishkarsh Gupta, Rohini Dattatri, Sachidanand Jee Bharati, Sushma Bhatnagar
Oral cancers are one of the most common cancers in India. These patients have pain during the course of the disease. Various drugs including opioid and nonsteroidal anti-inflammatory drug have been used to manage pain. However, these are associated with side effects such as constipation and vomiting. An early interventional block may decrease the requirement for analgesics and improve the overall quality of life. We describe a case of oral carcinoma successfully managed with ultrasound-guided pterygopalatine block...
January 2018: Indian Journal of Palliative Care
Olivier Mauvais, Cécile Badet, Laetitia Lestrade, Laurent Tavernier
Primitive tumors of pterygopalatine fossa (PPF) are often benign tumors or extension of a malignant sinonasal tract. Primitive tumors may rarely occur in PPF.The authors present a 71-year-old woman with a 6-month history of left cranial nerve palsy. Magnetic resonance imaging and positron emission tomography-computed tomography showed an enhancing isolated lesion at the PPF. A transmaxillary biopsy was performed, leading to diagnosis of primitive squamous cell carcinoma. The patient underwent radiotherapy treatment...
February 7, 2018: Journal of Craniofacial Surgery
Ahmad Safadi, Alberto Schreiber, Dan M Fliss, Piero Nicolai
Juvenile angiofibroma (JA) is a benign, highly vascular tumor which is diagnosed on the basis of clinical and imaging features. It has a characteristic pattern of spread commonly involving the pterygopalatine fossa and pterygoid base. The mainstay of treatment is surgery, while radiotherapy is rarely used for the treatment of recurrent lesion. Endoscopic endonasal surgery is currently the treatment of choice for small to intermediate size JAs, and is feasible even for advanced lesions; however, this should only be practiced in well-experienced centers...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Huy Q Truong, Xicai Sun, Emrah Celtikci, Hamid Borghei-Razavi, Eric W Wang, Carl H Snyderman, Paul A Gardner, Juan C Fernandez-Miranda
OBJECTIVE Multiple approaches have been designed to reach the medial middle fossa (for lesions in Meckel's cave, in particular), but an anterior approach through the greater wing of the sphenoid (transalisphenoid) has not been explored. In this study, the authors sought to assess the feasibility of and define the anatomical landmarks for an endoscopic anterior transmaxillary transalisphenoid (EATT) approach to Meckel's cave and the middle cranial fossa. METHODS Endoscopic dissection was performed on 5 cadaver heads injected intravascularly with colored silicone bilaterally to develop the approach and define surgical landmarks...
February 2, 2018: Journal of Neurosurgery
Xinjie Bao, Xiangyi Kong, Chengxian Yang, Huanwen Wu, Wenbin Ma, Renzhi Wang
Malignant peripheral nerve sheath tumor (MPNST) is an uncommon neoplasm that rarely involves the head and neck region. Intracranial MPNSTs unrelated to cranial nerves are highly malignant tumors with poor overall survival, probably because of infiltrating growth into surrounding brain tissue. The pathogenesis of MPNST remains unclear. There are no conclusive explanations for the mechanisms underlying the initiation, progression, and metastasis of MPNST. In this paper, we describe a case of MPNST in the pterygopalatine fossa with intracranial metastatic recurrence and review related literatures...
January 2018: Medicine (Baltimore)
Lu Yang, Li Hu, Weidong Zhao, Huankang Zhang, Quan Liu, Dehui Wang
BACKGROUND: The anatomical locations involved in trigeminal schwannomas (TSs) are quite complex. The endoscopic endonasal approach provides a minimal damage access corridor to both anterior and middle skull base for surgery. Given the nerve function recovery and postoperative neurological deterioration varied in different reports, the author demonstrates his surgery tips and the functional outcomes under endoscopic surgery in one single institution. METHODS: A retrospective review of patients with TSs was undertaken to assess the outcome of endoscopic surgery from 2006 to 2016...
March 2018: European Archives of Oto-rhino-laryngology
Masahiro Shin, Masaaki Shojima, Kenji Kondo, Hirotaka Hasegawa, Shunya Hanakita, Akihiro Ito, Taichi Kin, Nobuhito Saito
OBJECTIVE: Skull base meningiomas carry a nonnegligible risk of recurrence. In particular, those arising from the sphenoid wings or middle cranial fossa penetrate into extracranial regions, uncommonly showing massive expansion into the craniofacial regions on recurrence. The role of endoscopic endonasal surgery for those intractable lesions remains unclear. METHODS: We performed endoscopic endonasal craniofacial surgery for 8 recurrent meningiomas invading into the pterygopalatine fossa, infratemporal fossa, nasopharynx, paranasal sinus, or orbit, comprising 2 meningothelial and 1 fibrous meningiomas (World Health Organization [WHO] grade I), 3 atypical and 1 clear cell meningiomas (grade II), and 1 anaplastic meningioma (grade III)...
January 12, 2018: World Neurosurgery
Daniel Fossum Bratbak, Mari Folvik, Ståle Nordgård, Lars Jacob Stovner, David W Dodick, Manjit Matharu, Erling Tronvik
PURPOSE: The pterygopalatine ganglion has yet not been identified on medical images in living humans. The primary aim of this study was to evaluate whether the pterygopalatine ganglion could be identified on 3 T MR imaging. METHODS: This study was performed on medical images of 20 Caucasian subjects on both sides (n = 40 ganglia) with an exploratory design. 3 T MR images were assessed by two physicians for the presence and size of the pterygopalatine ganglion...
December 22, 2017: Surgical and Radiologic Anatomy: SRA
Héctor Fernández-Susavila, Ramón Iglesias-Rey, Antonio Dopico-López, María Pérez-Mato, Tomás Sobrino, José Castillo, Francisco Campos
Proper occlusion of the medial cerebral artery, as determined by laser Doppler monitoring, during cerebral ischaemia in rat models is an important inclusion criterion in experimental studies. However, successful occlusion of the artery does not always guarantee a reproducible infarct volume, which is crucial for validating the efficacy of new protective drugs. In a rat intraluminal ischaemic model, laser Doppler monitoring alone was compared with laser Doppler monitoring in combination with magnetic resonance angiography (MRA) and diffusion-weighted imaging (DWI)...
December 19, 2017: Disease Models & Mechanisms
Vijendra S Shenoy, Nidhin Prakash, Panduranga M Kamath, Raghavendra A Rao, D Deviprasad, Vishnu Prasad, Vikranth Kamboj, Lavan Kumar Borra
Functional endoscopic sinus surgery (FESS) is one of most common surgeries in otorhinolaryngology practice. It is done in the narrow confines of the nasal cavity. Bleeding into the surgical field is a major problem faced by endoscopic surgeons. To assess the effectiveness of pterygopalatine fossa infiltration with lignocaine and adrenaline in controlling surgical field bleeding during endoscopic sinus surgery. A randomized blinded study was done among 68 patients who underwent FESS. Infiltration with 2% lignocaine with 1:80,000 adrenaline was given only on one side and the surgeon was blinded as to which side was infiltrated and he was asked to assess the surgical field using a standard scale...
December 2017: Indian Journal of Otolaryngology and Head and Neck Surgery
Mitchell R Gore
Background: Lateral sphenoid encephaloceles present a surgical challenge. These encephaloceles may be difficult to access given their lateral location and proximity to the neural and vascular structures of the sphenoid floor, pterygopalatine fossa, and lateral and superior sphenoid walls. Additionally, many patients have idiopathic intracranial hypertension, increasing the risk of recurrence. When untreated or undiscovered, these encephaloceles increase the risk of meningitis. Methods: All consecutive endoscopic repairs of lateral sphenoid encephaloceles by a single surgeon from 2012 to 2017 were analyzed for method of repair, complications, and recurrence rate...
2017: BMC Ear, Nose, and Throat Disorders
Alireza P Shabanzadeh, Philippe M D'Onofrio, Philippe P Monnier, Paulo D Koeberle
BACKGROUND: A reliable model of ischemia-reperfusion is required to evaluate the efficacy and safety of neuroprotective therapies for stroke. We present a novel reproducible pterygopalatine-ophthalmic artery ligation model of ischemia-reperfusion injury in the retina. METHODS: Rats were subjected to ophthalmic artery/meningeal sheath ligation (OAML-standard method) or clamping of the pterygopalatine-ophthalmic artery (OAC-new method) for 30 minutes. Retinal ganglion cell (RGC) survival was assessed by prelabeling with FluoroGold (FG) (Santa Cruz Biotechnology, CA, USA) and RNA-binding protein with multiple splicing (RBPMS) at 14 days after ischemia, and all results were compared with a sham group (n = 7 in each group)...
November 29, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Usama Hagag, Mohamed G Tawfiek
OBJECTIVES: To describe the 'blind' and ultrasound-guided approaches to block the maxillary nerve in donkeys. To compare the success and complication rates between the 'blind' and ultrasound-guided techniques based on staining of nerves and other structures in cadavers and assessing level of analgesia in live animals. STUDY DESIGN: Prospective anatomical and experimental study. ANIMALS: Eighteen cadaver heads and nine adult live donkeys. METHODS: Phase 1: the anatomical characteristics of the maxillary nerve and its related structures were investigated within the pterygopalatine fossa in five cadavers...
January 2018: Veterinary Anaesthesia and Analgesia
M Eordogh, A Grimm, I Gawish, L Patonay, R Reisch, H R Briner, G Baksa
BACKGROUND: The knowledge of sinonasal vasculature is inevitable in transnasal neurosurgery. We performed an anatomical study on the sphenopalatine artery from the perspective of skull base procedures. METHODOLOGY: To analyse the anatomical landmarks of the sphenopalatine artery, arterial skull corrosion casts (26 head halves) underwent endoscopic transnasal phantom surgery. Furthermore, we performed microsurgical dissection on formaldehyde-fixated cadavers with arterial perfusion (14 head halves) as well as studied Cone Beam CT-scans of anonymised patients and cadavers (115 head sides)...
November 22, 2017: Rhinology
Daniele Cantarella, Ramon Dominguez-Mompell, Sanjay M Mallya, Christoph Moschik, Hsin Chuan Pan, Joseph Miller, Won Moon
BACKGROUND: Mini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT...
November 1, 2017: Progress in Orthodontics
Jan Plzák, Vít Kratochvil, Adam Kešner, Pavol Šurda, Aleš Vlasák, Eduard Zvěřina
OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations...
October 2017: Clinics
Peter Raab, Ludwig Sedlacek, Stefanie Buchholz, Stefan Stolle, H Lanfermann
PURPOSE: The aim of this study was to describe radiological imaging findings of a complicated sinusitis, which should raise the suspicion of rhino-orbital-cerebral mucormycosis as being the underlying cause. METHODS: In this retrospective analysis, we describe the cases and imaging findings of 8 patients with proven mucormycosis. These patients presented mostly with new facial or orbital swelling and were referred for imaging to our institution. Magnetic resonance imaging and computed tomography images were classified as abnormal or normal with respect to orbital, paranasal and cerebral signal results...
December 2017: Clinical Neuroradiology
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