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Central nervous system
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
Are the following statements regarding cerebral anatomy true or false? The foramen rotundum transmits the mandibular nerve.The foramen spinosum is anteromedial to the foramen ovale.The foramen ovale transmits the middle meningeal artery.The foramen ovale is posterolateral to the foramen rotundum.The foramen lacerum is located at the base of the lateral pterygoid plate.
Imaging of the Neck
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
An understanding of the pathology of nasopharyngeal cancer is essential in order to correctly interpret imaging at the time of staging and subsequent follow-up.40 Most nasopharyngeal tumours originate in the fossa of Rosenmuller and tend to spread submucosally with early infiltration of the palatal muscles and obstruction of the Eustachian tube (Figure 37.5). The most common spread is laterally with infiltration of the parapharyngeal and masticator spaces with potential involvement of the mandibular nerve and intracranial spread. Anterior spread of tumour into the nasal fossa can result in erosion of the maxillary sinus and infiltration of the pterygopalatine fossa and thence along the maxillary nerve onto the foramen rotundum (Figure 37.6). NPC can spread superiorly to erode the clivus (Figure 36.7), petrous apex, sphenoid sinus and foramen lacerum. Inferiorly it can extend along the pharyngeal wall to the oropharynx while posteriorly it infiltrates the retropharyngeal space and prevertebral muscles. Nodal metastases (Figure 37.8) to all cervical levels including the retropharyngeal group are extremely common and may be the presenting feature but level 2B nodes rather than retropharyngeal nodes appear to be the first echelon nodes in NPC.41, 42 Tomita et al. showed that primary tumour existence beyond the midline of the nasopharynx was associated with a higher incidence of bilateral lymph node metastases than primary tumour presence within the midline, with incidences of 66% and 18% respectively.43 Distant metastases to the lung and liver are common.
Evaluating the perioperative analgesic effect of ultrasound-guided trigeminal nerve block in adult patients undergoing maxillofacial surgery under general anesthesia: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2023
Maha Misk, Abdelrhman Alshawadfy, Medhat Lamei, Fatma Khames, Mohamed Abd Elgawad, Hamdy A. Hendawy
Following intubation, the blocks were performed in an aseptic setting with the patients being observed with a fitted oxygen face mask. The block was performed on the same side of the surgery. The side of the patient’s face that needed to be blocked was on the upper side while they lay supine. The high-frequency, linear array transducer (Sonosite M-Turbo ® US machine, 7–12 MHz) was positioned longitudinally on the side of the face slightly below the zygomatic bone, above the mandibular notch, and in front of the mandibular condyle. The probe’s angle was cephalad, pointing in the direction of the pterygopalatine fossa. To reach the foramen rotundum, the local anesthetic could be injected deeply into the superior head of the lateral pterygoid muscle along the pterygomaxillary fissure. The zygomatic bone, lateral pterygoid muscle, lateral pterygoid plate, maxillary bone, and maxillary artery were identified in the pterygopalatine fossa using US and color power Doppler US. A 22-G, 5 cm insulated echogenic needle was inserted out of plane above the zygomatic bone (suprazygomatic approach) and introduced in a lateral to medial and posterior to anterior direction in the pterygopalatine fossa. The patient’s mouth was kept open with an oral airway to prevent the coronoid process from creating an auditory shadow. The probe was slightly elevated in a superior direction. A negative aspiration was followed by the administration of 5 mL of 0.25% bupivacaine.
Internal maxillary artery to middle cerebral artery bypass for a complex recurrent middle cerebral artery aneurysm: case report and technical considerations
Published in British Journal of Neurosurgery, 2022
Ronan J. Doherty, Daragh Moneley, Paul Brennan, Mohsen Javadpour
Preoperatively the patient underwent computed tomographic angiography (CTA) of the head which was used for intraoperative navigation and localisation of the IMAX (Figure 2). Under general anaesthesia, the patient was positioned supine, with the head in the Mayfield head holder and rotated approximately 45 degrees towards the contralateral side. The previous left frontotemporal incision and pterional craniotomy were reopened. The temporalis muscle was reflected inferiorly and a zygomatic arch osteotomy was performed. Under the operating microscope, a temporal fossa craniectomy was performed consisting of removal of bone of the lateral part of middle cranial fossa floor extending medially as far as a line connecting the foramen rotundum and foramen ovale (Figures 3 and 4). The left IMAX was localised in the infratemporal fossa using a combination of CTA-based neuronavigation and micro-Doppler probe (Mizuho Inc. Tokyo, Japan) (Figure 5). In addition, the deep temporal arteries in the deep aspect of the temporalis muscle were followed proximally to lead to the location of the IMAX.
Radiotherapy for Melanoma with Perineural Invasion: University of Florida Experience
Published in Cancer Investigation, 2018
Simeng Zhu, William M. Mendenhall
All seven patients were white and included five males and two females. The median age at the time of treatment was 60 years (range, 35–81 years). Five patients (patients 1 through 5) presented with cutaneous lesions which were found to have PNI after excision. Of note, none of them displayed any neurologic symptoms at presentation. In contrast, patients 6 and 7, both had a history of skin cancer resection and presented with neurologic symptoms due to a local recurrence with perineural tumor spread to the skull base and were deemed to be incompletely resectable. Patient 6 presented with a 7-month history of right-sided facial pain, which was initially misdiagnosed as trigeminal neuralgia until imaging revealed enlargement of the second division of the right trigeminal nerve. Biopsy of the nerve revealed melanoma. The patient recalled that he had over 50 resections of “skin cancers,” but he could not remember whether any one of them was thought to be melanoma. Patient 7 presented with a 2.5-year history of left facial numbness, hyperesthesia, dysesthesia, and sharp pain in the left hemi-face. He also had a history of stinging and tearing of the left eye as well as trismus and difficulty chewing and eating. Imaging showed a mass in the left pterygopalatine fossa that also involved the inferior orbital fissure, foramen rotundum, and trigeminal ganglion. An endoscopic biopsy of the mass revealed melanoma. This patient also reported a history of multiple “skin cancer” resections without knowledge of a prior diagnosis of melanoma.