Aneurysmal cyst of the petrosal bone.

An aneurysmal cyst of the petrosal bone presenting as hearing loss and recurrent bacterial meningitis is reported. None of the clinical or radiographic signs described previously were present. Because other diagnostic methods are not reliable, it is recommended that coronal thin section computed tomography be performed in every case of suspected malformation of the skull base and in the diagnosis of recurrent bacterial meningitis.

[Severe lesions of the petrous bone caused by pseudomonas aeruginosa].

Pseudomonas aeruginosa is often isolated in infections of the ear cleft. In some circumstances, this organism can cause serious petrous or peri-petrous lesions. Two pictures are seen: Malignant external otitis with severe headaches, signs of external otitis, and usually pseudomonas aeruginosa is isolated.

Atypical osteomyelitis of the skull base.

Most cases of osteomyelitis of the skull base occur as a result of inadequately treated localized malignant otitis externa. We present four patients with osteomyelitis of the skull base who did not present initially as malignant otitis externa. Increased morbidity may occur when these atypical cases are not promptly recognized and treated.

Late posttraumatic meningitis with concealed CSF otorrhea.

An 11-year-old girl with repeated pneumococcal meningitis after head injury is reported. High resolution CT scan with metrizamide cisternogram disclosed a fracture in petrous bone with collection of contrast medium in middle ear. Operative repair of the dura defect successfully stopped further intracranial infection.

Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms.

A subtemporal-preauricular infratemporal fossa approach to remove 22 large neoplasms involving the lateral and posterior cranial base is detailed. The areas from which a neoplasm could be removed by this approach included the sphenoid and clival bone; the medial half of the petrous temporal bone; the infratemporal fossa; the nasopharynx; the retro- and parapharyngeal area; the ethmoid, sphenoid, and maxillary sinuses; and the intradural clivus-foramen magnum area. The pathology of the neoplasms included benign tumors such as meningioma, malignant cartilaginous neoplasms such as chordoma, and other malignant lesions such as nasopharyngeal carcinoma.

Obliteration of the middle ear and mastoid cleft in subtotal petrosectomy: indications, technique, and results.

Lateral surgical approaches to the base of the skull through the temporal bone often result in a large cavity with exposed dura and vascular structures and no possibility of reconstruction of the middle ear conductive hearing mechanism. Subtotal petrosectomy with tympanomastoid obliteration provides a relatively safe and secure closure of the surgical defect in the temporal bone and eliminates the problems associated with an open mastoid cavity. Eradication of all accessible air cell tracts and mucosa in the petrous pyramid, obliteration of the eustachian tubal orifice, closure of the external auditory canal, and fat obliteration of the middle ear and mastoid clefts are essential in the procedure.

[Peroperative echography in pediatric neurosurgery. Experience in a series of 40 procedures].

Forty neurosurgical operations (supra-tentorial: 27; infra-tentorial: 10; intra-spinal: 3) have been performed under real time ultrasonography control. The supra-tentorial anatomical Landmarks visualized on the screen were the base of the skull, the cranial vault, the falx cerebri and the ventricles. The infra-tentorial landmarks were the petrous bone, the tentorium and the brainstem.

Tuberculous petrous apicitis.

Tuberculous osteomyelitis of the temporal bone is a rare and dangerous entity that should be included in the differential diagnoses of infectious processes of the base of skull. A 21-year-old man presented with petrous apicitis, extradural and retromandibular abscesses, and paresis of the facial nerve. Immediate middle fossa craniotomy and drainage of the extradural abscess, in combination with a mastoidectomy, incision and drainage of the facial abscess, and antimicrobial therapy for gram-positive cocci, failed to check the destructive nature of the infection.

Treatment of invasive external otitis with cefsulodin.

Thirteen patients with invasive infections of the external ear were treated with cefsulodin sodium. Eleven were elderly diabetic patients with malignant external otitis, and two were nondiabetic adults with cellulitis or chondritis of the external ear. Four of 11 patients with malignant external otitis had extensive disease, with progression of infection to the petrous apex, medial base of the skull, or parapharyngeal soft tissue.

Malignant external otitis: CT evaluation.

Malignant external otitis is an aggressive infection caused by Pseudomonas aeruginosa that most often occurs in elderly diabetics. Malignant external otitis often spreads inferiorly from the external canal to involve the subtemporal area and progresses medically towards the petrous apex leading to multiple cranial nerve palsies. The computed tomographic (CT) findings in malignant external otitis include obliteration of the normal fat planes in the subtemporal area as well as patchy destruction of the bony cortex of the mastoid.

Histopathology of Pseudomonas osteomyelitis of the temporal bone starting as malignant external otitis.

Although the natural history and treatment of "malignant external otitis" have been well described, available histopathologic data are limited to three case reports. The histopathology in two additional cases, in which the disease process was advanced and uncontrolled, is presented to illustrate the unique progression of temporal bone osteomyelitis due to the Pseudomonas organism. In both cases the bony labyrinthine capsule demonstrated remarkable resistance to the osteomyelitic process even though the infection seemed to pass around the inner ear from all sides.

Surgical therapy of internal carotid artery lesions of the skull base and temporal bone.

Five cases of carotid artery lesions at the skull base or temporal bone, treated surgically, are presented. These lesions include mycotic aneurysms and carotid stenosis secondary to angiofibroma and a glomus caroticum. One case demonstrated an anomalous carotid anatomic pattern with a persistent stapedial artery.

Lower cranial nerve palsies due to Pseudomonas osteomyelitis of the skull base.

A patient with pseudomonas osteomyelitis of the base of the left posterior fossa is reported. His clinical course was one of progressive paresis of the left 8th, 10th, and 11th cranial nerves. There have been three prior reports of osteomyelitis of the base of the skull not in contiguity with an infected paranasal sinus.

[Surgery of extensive tumors of the petrosal bone and the lateral skull base region (author's transl)].

Report on the problems in total removal of extensive tumors of the petrosal bone and the skull base in this region. These problems are: 1. Freeing of the tumor involved internal carotid artery from the carotid foramen to the cavernous sinus.

Combined craniofacial resection for malignant disease.

A combined craniofacial approach has been employed in nineteen patients with tumors involving the base of the skull. Monoblock resection of the temporal bone, anterior fossa, or anterior and middle fossa can be achieved with acceptable mortality, even in cases of advanced cancer that recurs after radiation. Immediate reconstruction with a full thickness flap was routinely employed to provide improved cosmesis and to minimize the risk of intracranial infection.