Hanifi Bayarogullari

Our experience with the surgical management of paranasal sinus osteomas

The aim of this work is to describe our experience with the management of osteomas of the fronto-ethmoidal region, and to evaluate the limits and possibilities of different approaches: endonasal endoscopic versus external surgical resection of symptomatic osteomas. A review of 26 patients with detected osteomas in tertiary health care center was accomplished. We analysed the 26 adult patients, which detected paranasal sinus (PNS) osteomas—patients who underwent paranasal sinus CT examinations almost exclusively for other reasons. We analysed the patient’s symptoms, localization and size of osteomas, clinical and imaging signs, in relation to adjacent structures. Of the 26 cases, 16 located in the etmoid sinus, eight in the frontal sinus, of which two with orbital one with an ethmoid extension, and one isolated maxillary and sphenoid sinus were involved. We treated 11 patients with endoscopic (eight cases) and external surgical approaches (three cases). Besides this surgical excision; 15 cases were kept in follow up, because of asymptomatic nature of the PNS osteomas or patients lack of consent. While the extranasal approach is still a part of the treatment concept for removing osteomas; over the last years, in suitable cases, the endoscopically controlled endonasal approach has greatly gained importance due to the improved surgical equipment and experience.

Evaluation of the postnatal development of the sternum and sternal variations using multidetector CT.

PURPOSE We aimed to evaluate the postnatal development and the maturation of the sternum and sternal variations using multidetector computed tomography (MDCT). Additionally, we aimed to examine the roles of gender and age in sternal development. MATERIALS AND METHODS Two hundred and fifty patients who underwent thorax MDCT examinations were evaluated for sternal development and variations. Coronal curved planar reconstruction and maximum intensity projection images were used to better assess the ossification centers in the manubrium and the body of the sternum. Multiplanar images were used to accurately measure the thickness and the sagittal dimension of the manubrium, the sagittal dimension of the body, and the total sagittal dimension of the sternum in the sagittal plane. RESULTS No significant differences in the manubrium measurements were observed between the genders. The thickness and sagittal dimension of the manubrium, sagittal dimension of the body, and total sagittal dimension of the sternum in the sagittal plane were significantly different between the age groups. We evaluated the ossification centers; shape and developmental variations in the manubrium and body; direction, calcification, and termination of the xiphoid process; developmental variations in the xiphoid process; and manubriosternal and sternoxiphoidal fusion. Significant variations were observed from person to person. CONCLUSION The anatomy and the developmental properties of the sternum should be well understood in cases of potential chest and sternum injuries and in several surgical procedures. Therefore, knowledge of the development and the maturation of the sternum, and sternal variations and anomalies is important. We suggest that the postnatal development and the morphogenesis of the sternum can be adequately assessed using MDCT.

Magnetic resonance imaging findings of the abducens nerves in type 1 Duane's retraction syndrome.

Abstract Purpose: To investigate nervus abducens and extraocular mucles in patients with Type 1 Duane’s retraction syndrome using high-definition magnetic resonance imaging. Methods: The study included 10 patients with Type I Duane’s retraction syndrome who underwent magnetic resonance imaging (MRI) of the brain and orbits. Results: Overall, 10 cases were included in the study. There were seven women and three men. The mean age was 5.2 years (1–15 years). MRI of the abducens nerve was performed in all cases. Of the cases, the left eye was involved in eight cases, whereas the right eye was involved in two cases. There was no bilateral eye involvement. Among the 10 patients clinically diagnosed as Type 1 Duane’s retraction syndrome, the abducens nerve could not be visualized in eight cases, whereas the nerve was hypoplastic in one case and bilateral abducens nerves were present in one case by MRI. The extraocular muscles were normal in all cases on T2 weighted coronal MRI of the orbits. Conclusion: Absence of abducens nerve and normal extraocular muscles was detected in patients with Type 1 Duane’s retraction syndrome at the affected side.

Pseudoaneurysm of the carotid arterial system.

Abstract Pseudoaneurysms of internal, external, and common carotid arteries are seen rarely. Blunt traumas caused by automobile accidents are the prior reasons to this. Central venous catheterization, ballistic trauma, cystic medial necrosis, fibromuscular dysplasia, atherosclerosis, and other inflammatory processes are some other potential reasons for pseudoaneurysm. In contrast to true aneurysms, it does not contain 3-layer structure with adventitia, media, and intima sublayers in its wall. The wall contains coagulum and fibrous capsules. Clinically, after trauma, it presents itself as swelling after days to weeks of damage to vascular walls. Because it causes morbidity and mortality when it is ruptured, It should be treated via surgical or vascular intervention.

Liver hydatid cyst leading to bilateral pulmonary artery embolism and bilateral multiple pulmonar echinococcosis via inferior vena cava: report of a case

Hydatid disease (HD) is a worldwide parasitic disease. Echinococcosis may involve many organs but affect most commonly liver and lungs. The location of echinococcal cysts inside pulmonary artery is extremely rare. Radiologic findings range from purely cystic lesions to a completely solid appearance. Hydatid cysts (HC) can be solitary or multiple and varies size. Pulmonary artery embolism of HC can be symptomatic or asymptomatic. When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.

Two cases with giant pseudo-aneurysm of vertebral artery secondary to shrapnel injury

IntroductionDue to their locations, vertebral arteries (VA) are structures that are rarely injured after traumas. Formation of vertebral pseudo-aneurysm (PA) because of pieces of shrapnel is also rare. It causes clinical findings like cervical mass after the injuryCases presentationTwo Syrian 12- and 17-year-old male patients were admitted to the Department of Ear, Nose and Throat with the complaint of swelling in the left lower cervical region. In their USG examination which was ordered to investigate the cervical lesion, a lesion consistent with PA which shows a prominently thick wall structure due to circumferential thrombus formation and fibrotic tissue, chaotic flow, and ying-yang appearance in the centrally located cavity of the lesion in a color Doppler examination was detected. Later, multi-detector computed tomography angiography (MDCTA) was planned to demonstrate pseudo-aneurysms (PAs).ConclusionBecause there was no report on the development of giant pseudo-aneurysms secondary to shrapnel injury to date and because we thought these cases are demonstrative, we found the cases suitable for presenting as case reports.

Intrathoracic Rib Associated with Pulmonary Collapse in a Pediatric Patient

The ribs are essential structures of the osseous thorax that provide certain significant information and aid interpretation of radiologic images in daily routine practice. Intrathoracic rib is a rare congenital anomaly that is usually discovered incidentally, but may cause in vain interventions in case of being unaware. We herein report an intrathoracic rib in a girl whose chest X-ray was strange enough to obtain a spiral computed tomography (CT) scanning for a definitive diagnosis afterwards.

Retrograde filling carotid–cavernous fistula: MSCT angiography findings

Carotid–cavernous fistulas (CCF) are a specific type of dural arteriovenous fistula and have abnormal communications between the arterial system and the venous cavernous sinus at the wall of the cavernous sinus. The cavernous sinus (CS) is different from other venous sinuses according to its location and structure. It is situated outside of the dura, but other dural sinuses are located between two dural walls. It is where an artery is completely surrounded by a venous structure. There are various cranial nerves in the CS. It has rich communications with the other sinuses and veins, with the transverse and sigmoid sinuses through the superior and inferior petrosal sinuses, with the cerebral cortical veins through the sphenoparietal sinus and with pterygoid plexus, and with the facial veins through the superior and inferior ophthalmic veins. CCF can demonstrate wide-range clinical presentations according to these communications, like ophthalmic signs and symptoms (proptosis, chemosis, and visual loss); cranial nerve pareses; bleeding from the mouth, nose, or ears; and intracranial hemorrhage. High-pressure arterial blood moves directly into the cavernous sinus and ophthalmic veins, leads to venous hypertensions after CCF, and causes the sign and symptoms above. CCFs are classified as direct and indirect based on etiology and pathophysiology. Direct CCFs may occur following a traumatic tear in the cavernous segment of the internal carotid artery (ICA) or aneurysmic rupture within this segment. Direct CCFs account for 70–80% of all cases. Indirect CCFs occur spontaneously and are abnormal communications between the smaller meningeal arterial branches of the internal or external carotid system and cavernous sinus. Indirect CCFs account for 20% of all cases.

Evaluation of dural venous sinuses and confluence of sinuses via MRI venography: anatomy, anatomic variations, and the classification of variations

PurposeWe aimed to determine the anatomical variations more comprehensively particularly at the level of superior sagittal sinus (SSS), confluence of sinuses (CS), transverse sinuses (TS), straight sinuses (SS) and occipital sinuses (OS) with the help of the images obtained via MRI venography, and to contribute to the classification efforts.MethodsIn our retrospective study, we evaluated 211 patients who admitted to our hospital with various complaints and cerebral MRI venography has been performed. All investigations were performed by using 1.5-T MRIscanner (Achiva, Philips) with a VEN-3D –PCA MR venous angiography technique. Section thickness was 0.8 mm and axial plane was used. Other parameters were as follows: 17/7.1 (TR/TE), flip angle, 10.00, FOV, 220-mm, and matrix 244x140.ResultsWe divided our cases into 3 types but we increased the number of subgroups. Type I was divided into 4 subgroups (Type IA, IB, IC, ID), Type II into 9 (Type IIA1, IIA2, IIB1, IIB2, IIC, IID1, IID2, IIE1, IIE2) and Type III into 2 (Type IIIA, IIIB). Type I constitutes a 26.06% of whole cases, and Type II 59.71%, Type III 14.21%. In our cases R-TS wasn’t revealed in 10 cases (4.73%) whereas in 37 cases (17.53%) it was hypoplastic. L-TSwasn’t shown in 26 cases (12.32%) and in 85 cases (49.09%) it was hypoplastic. R-Sig S wasn’t revealed in 7 (3,31%) and was hypoplastic in 34 (16.11%) whereas L-Sig S wasn’t present in 2 (0.94%) and hypoplastic in 72 (34.12%). Among these cases 14 had bilateral hypoplastic TS (6.63%). In cases with hypoplastic TS or Sig S, as an alternative pathway 30 patients had OS (14.21%). Two of these patients had double OS.ConclusionOur wish is to contribute to the efforts of clarifying and classifying the intracranial venous structures and their anatomical variations. We hope our study enlightens a path in this field for future studies.

Antronasal Polyp Extending to Orbital Fossa.

Sinonasal infections and nasal polyps can be taken as 2 components of a disease. Polyps due to chronic inflammations of nasal cavity and sinuses are not rare. They may present with various clinical signs and symptoms, while the secondary complications may cause serious problems. They are most commonly treated medically, although surgery is the therapy of choice in some conditions. The complications can be listed as mucocele formation, orbital inflammation, intracranial extension by erosion of the boney structures.