James C. Hoffman

The use of transarterial microembolization in the management of hemangiomas of the perioral region

The management of oral and perioral hemangiomas depends on several clinical factors. Surgery of these benign lesions can at times be disfiguring, especially when the lips, muscles, or the maxilla and mandible are involved. In addition, by the very nature of these lesions, surgical treatment may be associated with excessive intra- and perioperative blood loss. A series of five patients who had hemangiomas in the perioral region and who were initially treated with transarterial microembolization, preoperatively in two cases and as the only treatment in three cases, is presented. The technique of microembolization is described and recommendations for its use are given.

Intraventricular neuroblastoma in a patient with Von Hippel-Lindau's disease

SummaryCerebral neuroblastoma is a rare neoplasm that has not previously been associated with a phakomatosis. We report a case of an intraventricular neuroblastoma in a patient with Von Hippel-Lindaus disease. The neoplasm consisted of process-forming cells containing clear vesicles, dense-cored granules and microtubules. An unusual finding was the presence of intertwining cytoplasmic processes, apparently representing aberrant process formation. We suggest that this case represents a cerebral neuroblastoma occurring as an unusual manifestation of a phakomatosis.

Benign Hemangioendothelioma Involving the Central Nervous System“Strawberry Nevus” of the Neuraxis

Benign hemangioendothelioma is rarely included in discussions of vascular neoplasms involving the central nervous system, whereas it is a well-defined entity outside the neuraxis. We present four cases of benign hemangioendothelioma, including an infantile hemangioendothelioma with venous drainage into the transverse dural sinus, an intracranial hemangioendothelioma adherent to the falx cerebri, a spinal epidural hemangioendothelioma causing spinal cord compression, and a parasellar hemangioendothelioma. Although hemangioendothelioma resembles hemangioblastoma in some ways, it is a distinct entity differing from the other vascular lesions involving the central nervous system.

Lockjaw secondary to skull base osteochondroma: CT findings.

Osteochondromas arising from the long bones, pelvis, or scapulae are common. However, osteochondromas originating from the base of the skull are extremely unusual. Although these tumors are histologically benign, intracranial extension and their close proximity to the cranial nerves may require complex surgery. We present a case in which CT clearly delineated an osteochondroma arising from the base of the skull. The tumor had created a fusion with the ipsilateral coronoid process of the mandible, thus causing lockjaw.

Computed tomography of benign masseteric hypertrophy

Surgicalenign masseteric hypertrophy (BMH), although an uncommon condition, is important in the differential diagnosis of parotid region masses. We believe CT is the idal imaging modality for investigating patients with parotid region masses and that it has proved to be most useful in the diagnosis of masseteric hypertrophy. We present three cases of BMH and describe and discuss the CT findings and differential diagnosis of parotid region masses.

Actinomycosis masquerading as depression headache: Case report — management review of sinus actinomycosis†‡

Differentiating an organic from a functional headache can be difficult; recognizing the unusual organic cause even more so. A unique case of actinomycosis centering on the clivus and sphenoid sinus is presented. This report reviews the history, diagnosis, and treatment of actinomycosis especially as they pertain to otolaryngology.

Clinical indications for computer-assisted myelography.

Computer-assisted myelography (CAM) is a technique in which computed tomography (CT) is combined with the intrathecal administration of metrizamide to demonstrate the spinal cord and surrounding structures. This retrospective study of 139 CAMs performed at Emory University Hospital included 125 CAMs that were preceded by routine metrizamide myelography (secondary CAM). The remaining 14 CAMs were primary studies without concomitant myelography. These CAMs and conventional myelograms were reviewed to provide indications for the use of CAM as a replacement for other radiodiagnostic studies or as an adjunct to radiological diagnosis. Eighty-one CAMs (58%) were positive for some pathological process. Of the 69 secondary CAMs demonstrating a pathological condition, 46 (67%) revealed some aspect of the lesion not apparent on routine metrizamide myelography. In no case with positive myelography was CAM negative. However, conventional myelography often added valuable diagnostic information. Although high resolution CT has allowed limited visualization of the spinal cord, CAM is often indicated for cases in which diagnosis requires more definition of cervicomedullary, extradural, intradural, extramedullary, and intramedullary lesions. Our clinical review found CAM to be extremely useful in the diagnostic evaluation of pathological conditions involving the spine and spinal cord and suggests clinical indications for the use of CAM based upon selected illustrative cases. Furthermore, CAM seemed to be superior to other radiological procedures in certain instances, such as in cases of spinal dysraphism and in the evaluation of lesions at the foramen magnum. Until more experience is obtained using spinal CT and CAM, CAM should not replace myelography altogether. The present study indicates that, rather than replacing conventional CT and myelography, CAM should be used as a primary study in situations where it has been shown to be superior and as a complementary study when other neurodiagnostic examinations are equivocal or nondiagnostic.

The Efficacy of Angiography in the Evaluation of Glomus Tympanicum Tumors

Two cases of glomus tympanicum tumors are presented and the salient anatomical, clinical, and radiographic features of such lesions discussed. Accurate and early delineation is implemented by selective carotid angiography. Subtraction studies are essential to the delineati on of small glomus tum ors which may be obscured by the osseous density of the petrous ridge.

Intracranial cystic malignant fibrous histiocytoma in a child: sonographic and CT findings

Primary intracranial cystic malignant fibrous histiocytoma (MFH) is an extremely rare tumor with only 15 cases reported [1]. Only three cases of cystic intracranial MFH are found in the literature. We present the sonographic and CT findings in a child with such a lesion.

Supratentorial subarachnoid epithelial cyst: case report and ultrastructural study.

Supratentorial epithelial cysts are rare entities that have evoked controversy regarding their pathogenesis. Recent ultrastructural studies have failed to resolve this controversy. We present a case report and an ultrastructural study of such a cyst. The cyst wall was lined by columnar epithelial cells with prominent cilia and microvilli at their apical surface. They were joined by well-developed junctional complexes and contained abundant intracytoplasmic, electron-dense, granular material, some of which was membrane-bound. These ultrastructural findings suggest that epithelial cysts are derived from elements of the embryological tela choroidea.