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ABSTRACT: Computer-assisted navigation systems can now potentially guide the surgeon to the cochlea with a trajectory avoiding the facial nerve through a keyhole approach. Five temporal bone specimens, with 4 titanium screws placed in the mastoid cortex, were studied. Preoperative computed tomographic scan images were loaded on an electromagnetic computer-assisted surgery (CAS) system (Digipointeur, Collin, Bagneux, France). A drill was connected to the CAS to monitor its progression continuously. A conical approach passing through the facial recess and ending in the scala tympani was performed. A 0.5-mm wire was inserted into the cochlea. The keyhole approach was technically feasible in all cases. No facial nerve injury was observed on imaging and dissection control. The wire was positioned in the scala tympani and the position accuracy of the CAS was <0.76 mm on the target in all cases. The CAS system with fiducial markers yielded sufficient precision to allow a minimally invasive approach to the cochlea.
Surgical Innovation 04/2011; 18(3):259-67. · 2.13 Impact Factor
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ABSTRACT: Acute posterior lingual abscess is rare, but may potentially compromise the airway acutely.
Lingual abscesses call for prompt and aggressive management because they are potentially life-threatening infections. Anterior lingual abscess (the most common) and posterior third lingual abscess must be differentiated.
A young man who experienced the beginnings of dyspnea and total aphagia presented to the Emergency Department. A posterior lingual abscess was identified on computed tomography scan.
Multi-antimicrobial therapy is the cornerstone of treatment. Surgical drainage is also of critical importance for preventing deeper spread of the infection.
We present this case to increase awareness among emergency physicians and head and neck surgeons of the clinical findings of acute abscess of the base of the tongue, which can be difficult to diagnose clinically. Imaging of the oral cavity and pharynx is the key to the diagnosis, and the key to choosing the best surgical strategy.
Journal of Emergency Medicine 12/2008; 41(5):e107-10. · 1.31 Impact Factor
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ABSTRACT: Leptomeningeal carcinomatosis is rare in evolution of head and neck cancers. Prognosis is poor and treatment is through supportive care. We report an atypical rapid post-operative leptomeningeal carcinomatosis after skull base resection for an ethmoidal adenocarcinoma. The anterior skull base resection was near-total and we suspect a seeding of subarachnoid space either before surgery, either during surgical extirpation or from the residual intracranial nodule. It is the first description of rapid LMC after surgery (less than 1 month). Post-operative MRI diagnosed the LMC through the detection of contrast enhancing leptomeningeal nodules at bilateral second and eighth cranial nerves and at bilateral interpedoncular area. A strong index of suspicion along with clinical and radiological correlation is essential to arrive at a correct diagnosis. Otolaryngologists should be aware of the possibility of leptomeningeal carcinomatosis, before or after surgery, in a patient presents with an appropriate constellation of neurologic symptoms and a history of cancer.
Auris Nasus Larynx 01/2008; 34(4):565-7. · 0.76 Impact Factor
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ABSTRACT: Lymphadenopathy in a patient taking TNFalpha antagonist therapy may indicate lymph node tuberculosis or a hematological malignancy. Although histological evidence of granuloma suggests tuberculosis, many other infections responsible for granulomatous reactions have been reported in patients on TNFalpha antagonist therapy. We report a case of granulomatous lymphadenopathy due to Bartonella henselae in a patient taking etanercept to treat ankylosing spondylitis.
Joint, bone, spine: revue du rhumatisme 04/2007; 74(2):184-6. · 2.25 Impact Factor
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ABSTRACT: To report the first case of spontaneous intratumoral and brainstem hemorrhage in a patient with a vestibular schwannoma.
Case report and review of the literature.
University-based, tertiary referral center.
A 73-year-old woman with a vestibular schwannoma, anti-vitamin K overdose, and arterial hypertension experienced a rapid onset of headache, facial palsy, diplopia, and hoarseness.
The patient was admitted to the intensive care unit and treated with vitamin K and corticoids.
Clinical and radiologic findings.
At admission, the magnetic resonance imaging and computed tomographic scans showed an intratumoral hemorrhage. The patient entered a coma 24 hours after the onset of the symptoms. At that time, the computed tomographic scan demonstrated a massive intratumoral and brainstem hemorrhage. The patient died 3 days later.
Intratumoral, subarachnoid, and brainstem hemorrhages can occur in patients with vestibular schwannoma. Oral anticoagulant therapy is a risk factor for tumor-related hemorrhage.
Ontology & Neurotology 03/2006; 27(2):209-12. · 1.90 Impact Factor
