Post-traumatic bilateral epidural hygroma of posterior cranial fossa: case report and brief review of literature.

Post-traumatic bilateral epidural hygroma of posterior cranial fossa: case report and brief review of literature.

World Neurosurg. 2015 Dec 23;

Authors: Kumar J, Harsh V, Strickland BA, Sahay CB, Kumar A

Abstract
BACKGROUND: Post-traumatic posterior fossa epidural hygroma is a rare entity without a clear management established in the medical literature. We present one such case and review the literature relevant to this unusual entity. An attempt to outline the mechanism of formation and management of posterior cranial fossa epidural hygroma is also made.
CASE DESCRIPTION: Two-year old child presents after a rooftop fall injury with symptoms of headache, drowsiness, vomiting, and brief loss of consciousness. The left occipital region demonstrated swelling, found to have epidural hygroma via CT scan. After failing conservative management, surgical repair of the dura was performed. The child was discharged post-operative day eleven in stable condition with marked improvement in occipital swelling.
CONCLUSIONS: It is imperative to consider epidural hygroma in very small children presenting with occipital injury. Owing to loose adhesion of dura and internal cranial lamina layers in younger pediatric population, potential epidural space may be easily created due to injury and small breaches in meningeal integrity near the cisterna magna may favor CSF leak. During operation if water-tight repair of visible dural tear is performed, duro-periosteal hitching or vacuum drain placement may not be required.

PMID: 26723294 [PubMed - as supplied by publisher]

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Influence of the paraflocculus on normal and abnormal spontaneous firing rates in the inferior colliculus.

Influence of the paraflocculus on normal and abnormal spontaneous firing rates in the inferior colliculus.

Hear Res. 2015 Dec 24;

Authors: Vogler DP, Robertson D, Mulders WH

Abstract
Spontaneous firing rates of neurons in the central auditory pathway, such as in the inferior colliculus, are known to be increased after cochlear trauma. This so-called hyperactivity is thought to be involved in the generation of tinnitus, a phantom auditory perception. Recent research in an animal model suggests behavioural signs of tinnitus can be significantly reduced by silencing or removal of the paraflocculus (PF) of the cerebellum. The current study investigated the effects of acute PF removal on spontaneous firing rates recorded from single neurons in the right inferior colliculus of guinea pigs with normal hearing (which did not receive acoustic trauma) or with hearing loss caused by acoustic trauma. Spontaneous firing rates were obtained at either 2 or 13 weeks after initial surgery on the left side. In half of the animals in each group the left PF was removed immediately prior to the spontaneous firing rates recordings. In the acoustic trauma groups, spontaneous firing rates in the inferior colliculus were higher when the PF was removed compared to animals with an intact PF. This effect of PF removal was not observed in animals that did not receive acoustic trauma. These results suggest that the PF has a tonic inhibitory effect on hyperactivity in the inferior colliculus in animals with hearing loss, but not on normal spontaneous firing rates in normal hearing animals.

PMID: 26724754 [PubMed - as supplied by publisher]

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Changes in cochlear function related to acoustic stimulation of cervical vestibular evoked myogenic potential stimulation.

Changes in cochlear function related to acoustic stimulation of cervical vestibular evoked myogenic potential stimulation.

Hear Res. 2015 Dec 24;

Authors: Strömberg AK, Olofsson Å, Westin M, Duan M, Stenfelt S

Abstract
Evaluation of cervical evoked myogenic potentials (c-VEMP) is commonly applied in clinical investigations of patients with suspected neurotological symptoms. Short intense acoustic stimulation of peak levels close to 130 dB SPL is required to elicit the responses. A recent publication on bilateral significant sensorineural hearing loss related to extensive VEMP stimulation motivates evaluations of immediate effects on hearing acuity related to the intense acoustic stimulation required to elicit c-VEMP responses. The aim of the current study was to investigate changes in DPOAE-levels and hearing thresholds in relation to c-VEMP testing in humans. More specifically, the current focus is on immediate changes in hearing thresholds and changes in DPOAE-levels at frequencies 0.5 octaves above the acoustic stimulation when applying shorter tone bursts than previously used. Hearing acuity before and immediately after exposure to c-VEMP stimulation was examined in 24 patients with normal hearing and referred for neurotologic testing. The stimulation consisted of 192 tonebursts of 6 milliseconds and was presented at 500 Hz and 130 dB peSPL. Békésy thresholds at 0.125 to 8 kHz and DPOAE I/O growth functions with stimulation at 0.75 and 3 kHz were used to assess c-VEMP related changes in hearing status. No significant deterioration in Békésy thresholds was detected. Significant reduction in DPOAE levels at 0.75 (0.5-1.35 dB) and 3 kHz (1.6-2.1 dB) was observed after c-VEMP stimulation without concomitant changes in cochlear compression. The results indicated that there was no immediate audiometric loss related to c-VEMP stimulation in the current group of patients. The significant reduction of DPOAE levels at a wider frequency range than previously described after the c-VEMP test could be related to the stimulation with shorter tone bursts. The results show that c-VEMP stimulation causes reduction in DPOAE-levels at several frequencies that corresponds to half the reductions in DPOAE levels reported after exposure to the maximally allowed occupational noise for an eight hours working day. Consequently, extended stimuli intensity or stimulation repetition with c-VEMP testing should be avoided to reduce the risk for noise-induced cochlear injury.

PMID: 26724755 [PubMed - as supplied by publisher]

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Intentional severing of the internal carotid artery in the surgical treatment.

Intentional severing of the internal carotid artery in the surgical treatment.

World Neurosurg. 2015 Dec 24;

Authors: Katsuno M, Tanikawa R, Hashimoto M, Matsuno A

Abstract
BACKGROUND: Thrombosed brain aneurysm is usually treated by cerebrovascular surgery rather than endovascular surgery. The basilar-superior cerebellar artery (BA-SCA) aneurysm can be accessed via the transsylvian, temporopolar, or anterior temporal approaches. However, a disadvantage of these approaches is that the surgical route is obstructed by the internal carotid artery (ICA). Therefore, we propose that after establishing a high-flow bypass, severing the ICA will enable safe clipping of a BA-SCA aneurysm.
CLINICAL PRESENTATION: In this case, we sought to clip a large thrombosed BA-SCA aneurysm; however, the operative field was limited by the ICA after utilizing a zygomatic anterior temporal approach with anterior clinoidectomy, including severing of the distal dural ring. Therefore, after establishment of a high-flow bypass, the operative field was widened by intentional severing the ICA between the ophthalmic artery and posterior communicating artery. Using this procedure, we achieved complete obliteration of the thrombosed BA-SCA aneurysm without additional arterial ischemic complications.
DISCUSSION AND CONCLUSIONS: Intentional severing of the ICA after establishing a high-flow bypass will not become the standard technique for treatment of upper basilar artery aneurysms. However, this technique can extend the operative field to allow clipping of an upper basilar artery aneurysm after several skull base techniques.

PMID: 26724639 [PubMed - as supplied by publisher]

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The role of ultrasound-guided transcutaneous tru-cut biopsy in diagnosing untreated and recurrent laryngo-hypopharyngeal masses.

The role of ultrasound-guided transcutaneous tru-cut biopsy in diagnosing untreated and recurrent laryngo-hypopharyngeal masses.

Eur J Radiol. 2016 Jan;85(1):158-163

Authors: De Fiori E, Conte G, Ansarin M, De Benedetto L, Bonello L, Alterio D, Maffini F, Bellomi M, Preda L

Abstract
OBJECTIVE: To evaluate the diagnostic performance of Ultrasound-guided Transcutaneous Tru-Cut biopsy (USGTCB) of laryngo-hypopharyngeal masses suspicious for malignancy. Furthermore we investigated whether USGTCB is accurate for both untreated masses and suspected recurrences.
MATERIALS AND METHODS: From August 2004 to July 2014 we prospectively enrolled 66 patients for a total of 68 USGTCBs: 38 USGTCB were performed for a suspicious untreated mass and in 30 for a suspected recurrence. We calculated the sensitivity, specificity, positive predictive value and negative predictive value for all procedures and separately for untreated masses and suspected recurrences.
RESULTS: USGTCB diagnosed 57 malignancies (51 squamous cell carcinomas, 6 other tumors) and 11 benign lesions. There were no false positives reported, whereas five false negatives were observed: two in patients with an untreated mass, three in patients with a suspected recurrence. Overall, the sensitivity of the technique was 91.9% (95% confidence interval [CI]: 82.2-97.3%); the specificity was 100% (95% CI: 54.1-100%); positive and negative predictive values were 100% (95% CI: 93.7-100%) and 54.5% (95% CI: 23.5-83.1%) respectively, with similar performances in untreated masses and suspected recurrences of SCC.
CONCLUSION: USGTCB is an effective procedure for the histological diagnosis of laryngo-hypopharyngeal masses suspicious for malignancy in patients showing contraindications to biopsy via microlaryngoscopy under general, with similar performances for untreated masses and suspected recurrences.

PMID: 26724661 [PubMed - as supplied by publisher]

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