[Clinical significance of nuclear medicine in the presurgical diagnosis of epilepsy].
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Brain↗
Biomedical subjects
C Menzel
Publications and source records attributed to C Menzel.
[Incidence of lesions described by magnetic resonance imaging in the clarification of focal epilepsy of frontal and temporal origin].
AIM: Today, MRI is an integral part of the presurgical evaluation of patients suffering from partial epilepsy. These patients frequently show focal morphological abnormalities with potential epileptogenic character and surgical resection of these lesions is associated with superior postsurgical outcome as to seizure frequency. Apart from easily detectable defects, such as post-traumatic lesions or cerebral infarction, as wide variety of mainly small abnormalities can be detected using MRI. METHODS: In this study, 484 patients suffering from partial epilepsy of temporal or frontal onset were evaluated for the incidence of different lesions in this population. RESULTS: All lesions found were included without evaluating their potential epileptogenicity, which remains to be proven using other procedures (EEG, SPECT, PET, etc.). Involvement of the hippocampal formation was a major finding in temporal lobe epilepsy, which could be detected as sclerosis (T2w-images), atrophy (T2w-TSE or T1w-IR-images) or both (15%). In addition and in declining frequency various tumors (14%), post-traumatic lesion (-5%), and focal cortical dysplasia or other disturbances of cortical integrity (-4%) were found. These lesions are detectable with best contrast on different sequences. As a consequence it is suggested to acquire sequences in 3 dimensions including a T1w-SE, two (coronal and axial) double-echo-SE sequences and similarly two T1w-IR-sequences. The application of contrast media can be restricted to special questions, derived either from the first imaging results or from the patients history. CONCLUSION: Using qualitative data for interpretation, the sensitivity as to the detection of any focal pathology of a recent-generation MRI in this population was 75%, with 79% for temporal lobe epilepsies and 67% for frontal lobe epilepsies. Quantitative measurements of hippocampal volume or signal seem to be able to increase the sensitivity of the method.
Atrophy↗
Pregnancy after ovarian stimulation and intrauterine insemination in a woman with cavernous macrohemangioma of the liver. A case report.
BACKGROUND: There are only a few reports on cavernous hepatic hemangiomas after hormonal substitution or during pregnancy. So far, there have been no publications on ovulation stimulation in such patients. CASE: We report on a 31-year-old, asymptomatic, healthy woman with an incidental ultrasound finding of a cavernous macrohemangioma (diameter, 14 cm) of the liver. For treatment of primary infertility, clomiphene citrate therapy had been administered repeatedly in the past. Because these treatments were not successful and andrologic subfertility existed, homologous intrauterine insemination was recommended. The first treatment cycle with clomiphene citrate, human chorionic gonadotropin and subsequent intrauterine insemination was successful. During pregnancy, 2.5-cm growth of the liver hemangioma and a smaller, second lesion occurred but remained asymptomatic. Primary cesarean section was performed at 37 weeks' gestation to prevent rupture or hemorrhage of the hepatic hemangioma. Macrohemangiomas of the liver are associated with the risk of rupture and severe hemorrhage due to pressure during pregnancy and delivery. CONCLUSION: During ovulation stimulation, pregnancy and the immediately postpartum period, there was no change in this benign tumor.
Adult↗
Quality assurance in breast cancer brachytherapy: geographic miss in the interstitial boost treatment of the tumor bed.
PURPOSE: To assess the role of geographic misses in the interstitial boost treatment of breast cancer patients and to evaluate methods of optimizing breast implants in design, performance, and dosimetry. METHODS AND MATERIALS: During lumpectomy, the tumor excision sites of 89 patients were marked by five hemoclips. Postoperative radiographs demonstrated the clips' positions with respect to the extension of the surgical cavity, which was demarcated by air and hematoseroma. Twenty-seven selected patients received interstitial boosts to the tumor bed. The implant was first designed according to the clinical assumptions of the tumor bed's topography and then compared with the radiological findings. Prior to brachytherapy, the planning of the implant's dimension and the needle guidance was performed under simulator control. Dose distributions were first calculated following the Paris System and then electively optimized for the target volume by changing source positions and dwell times. RESULTS: Compared to clinical estimations, the radiological determination of the tumor bed's location revealed an overall potential of topographic errors of 51.8% (14 out of 27 patients), rising up to 78.5% in patients with large adipose breasts (11 out of 13 patients). This observation was due to a high mobility of the tissue, leading to varying tumor site projections at the time of mammography, surgery, and brachytherapy. In all patients, the presimulation of the implant resulted in an adequate coverage of the target volume. In 17 of the 27 treated patients, dose distributions were modified to achieve a higher dose delivery in zones where a higher residual tumor load was expected (boost-in-boost). CONCLUSION: Breast implants have a high potential of geographic misses that can be avoided by intraoperative clip demarcation. The delineation of the tumor bed allows for dose reports actually referring to the target volume and not to the implant system to be obtained. In addition, modern afterloading techniques offer possibilities of individual dose planning with regard to high risk subvolumes within the implanted tissue.
Brachytherapy↗
Fluorine-18 fluorodeoxyglucose positron emission tomography in the follow-up of differentiated thyroid cancer.
Whole-body fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging was performed during the follow-up of 33 patients suffering from differentiated thyroid cancer. Among them there were 26 patients with papillary and seven with follicular tumours. Primary tumour stage (pT) was pT1 in six cases, pT2 in eight cases, pT3 in three cases and pT4 in 14 cases. FDG PET was normal in 18 patients. In three patients a slightly increased metabolism was observed in the thyroid bed, assumed to be related to remnant tissue. In one case local recurrence, in ten cases lymph node metastases (one false-positive, caused by sarcoidosis) and in three cases distant metastases were found with FDG PET. In comparison with whole-body scintigraphy using iodine-131 (WBS) there were a lot of discrepancies in imaging results. Whereas three patients had distant metastases (proven with 131I) and a negative FDG PET, in four cases 131I-negative lymph node metastases were detectable with PET. Even in the patients with concordant "staging", differences between 131I and FDG were observed as to the exact lesion localization. Therefore, a coexistence of 131I-positive/FDG-negative, 131I-negative/FDG-positive and 131I-positive/FDG-positive malignant tissue can be assumed in these patients. A higher correlation of FDG PET was observed with hexakis (2-methoxyisobutylisonitrile) technetium-99m (I) (MIBI) scintigraphy (performed in 20 cases) than with WBS. In highly differentiated tumours 131I scintigraphy had a high sensitivity, whereas in poorly differentiated carcinomas FDG PET was superior. The clinical use of FDG PET can be recommended in all cases of suspected or proven recurrence and/or metastases of differentiated thyroid cancer and is particularly useful in cases with elevated serum thyroglobulin levels and negative WBS.
Adult↗
Interventional brain SPECT--a review.
Brain SPECT with HMPAO or ECD has-due to its short accumulation period--a rather high time resolution of approx 60 sec. Compared to isopropyl amphetamine (I-123) and FDG-PET, shortlasting interventions may be evaluated by SPECT. Usually, a two-step approach is used, injecting one third of the dose under baseline conditions and two thirds during intervention. The first study is then subtracted from the second study, resulting in a "difference" image which allows to calculate the effect of the intervention. These interventional procedures may include drug, mechanical, and mental intervention as well as ictal, blood pressure and receptor intervention. Moreover, the difference of pCO2 after hyperventilation or hypoventilation may also be used as a stimulus. The above mentioned procedures are described in detail.
Brain↗
18F-fluorodeoxyglucose-PET and 99mTc-bicisate-SPECT in Creutzfeldt-Jakob disease.
In a patient with the occipitoparietal form of Creutzfeldt-Jakob disease (CJD) (Heidenhain type) positron emission tomography (PET) demonstrated decreased glucose utilization in the occipital lobes and adjacent cortical regions. Single photon emission computed tomography (SPECT) with 99mTc-bicisate showed a "coupled" decrease in blood flow in identical cortical areas in this patient. In contrast, magnetic resonance imaging (MRI) was normal. In the early stage of CJD, when still no major morphological abnormalities can be observed, functional imaging is useful for differential diagnosis, particularly to exclude other causes of dementia or pathological EEG patterns.
Aged↗
[123I]IBZM SPECT for imaging of striatal D2 dopamine receptors in 56 schizophrenic patients taking various neuroleptics.
OBJECTIVE: The purpose of this study was to compare the binding of various typical and atypical neuroleptics to striatal D2 dopamine receptors in schizophrenic patients. METHOD: Fifty-six inpatients with schizophrenia, including 14 with schizoaffective disorder and one with schizophreniform disorder, were evaluated. Fourteen patients were neuroleptic free. Single photon emission computed tomography (SPECT) was performed 90 minutes after intravenous injection of [123I]benzamide ([123I]IBZM). Subsequent semiquantitative analysis of D2 receptor binding was done with the use of the basal ganglia (striatum)/frontal cortex (BG/FC) ratio of activity. Clinical symptoms were rated with the Positive and Negative Syndrome Scale and the Hamilton Depression Rating Scale. RESULTS: The BG/FC ratios in patients taking typical neuroleptics were significantly lower than those in the neuroleptic-free subjects but not lower than those in the patients taking atypical neuroleptics (clozapine, remoxipride). For atypical antipsychotics, a dose-dependent relationship with striatal D2 receptor binding could not be demonstrated. BG/FC ratios were not significantly correlated with clinical symptoms or with duration of illness. CONCLUSIONS: The results indicate that [123I]IBZM SPECT is useful for semiquantitative imaging of striatal D2 dopamine receptors and for estimating their blockade by neuroleptics. Thus, it may improve drug monitoring in psychiatric patients. Furthermore, the findings suggest a complex relationship between the antipsychotic effect of atypical neuroleptics and D2 receptor blockade.
Adult↗
"High-dose" radioiodine therapy in advanced differentiated thyroid carcinoma.
UNLABELLED: There is yet no consensus concerning the appropriate regimen of the application of [131I]sodium iodine (Nal) activities to patients suffering from advanced differentiated thyroid carcinoma. We report on a total of 167 applications of [131I]Nal, including 78 applications of 11.1 GBq. Response to high-activity radioiodine therapy (RIT) is correlated to the course of the disease as well as to the reaction of thyreoglobulin and acute/subacute side effects of radiation. METHODS: Following radioablation of thyroid remnants using 1.85 to 3.7 GBq[131I]Nal, 26 patients with advanced differentiated thyroid carcinoma (follicular, 11; papillary, 4;mixed-cell thyroid carcinoma, 11) were treated with repeated activities of 11.1 GBq[131I]Nal. Initial tumor staging according to UICC showed T4 in 54%, T3 in 19%, T2 in 19% and was not obtained in 8%. Differentiated thyroid carcinoma was multifocal in 23% of patients. Applied accumulated activities ranged from 14.8 to 99.9 GBq with a mean of 55.5 GBq per patient. RESULTS: Mean post-diagnostical follow-up was 73 mo, mean follow-up after diagnosis of metastatic spread was 48 mo. Follicular thyroid carcinoma remained as stable disease in 7 of 11 patients, 6 of whom showed metastatic disease after a mean of 20 mo, and only 1 complete remission was achieved using high-dose therapies, with progressive disease in the remaining patients. Overall, 73% of follicular thyroid carcinoma had progressive disease without major response to high-activity RIT. In contrast, only 20% of papillary thyroid carcinoma/mixed-cell thyroid carcinoma showed progressive disease, and complete remission was achieved in 47% of patients. Pulmonary and lymph node metastases in the majority of patients showed good response to therapy, whereas local recurrences and bone metastases showed minor reactions to RIT. After low-activity therapies 8% of patients showed WHO grade I hematotoxic reactions. After high-activity therapies, 38% of patients had WHO I, 8% WHO II and one patient had WHO III toxicity (4%). CONCLUSION: Use repetitive high-activity RIT with a maximum of 44.4 GBq applied during 1 yr and a maximum of 99.9 GBq accumulated activity resulted in a significant increase of hematotoxicity. However, during the follow-up period (mean, 4 yr), no clinical symptoms possibly related to low blood counts were seen in patients with advanced differentiated thyroid carcinoma. Initiation of high-activity RIT in reaction to metastatic tumor outspread to achieve complete remission was found to be useful in treating papillary thyroid carcinoma and mixed-cell thyroid carcinoma, but only in a minority of follicular thyroid carcinoma patients.
Adenocarcinoma, Follicular↗
Evaluation of technetium-99m-ECD in childhood epilepsy.
UNLABELLED: In childhood epilepsy, it is difficult, but of critical importance, to determine whether surgical intervention might be beneficial for an individual patient. Because both established procedures-MRI and electroencephalography (EEG)-have limitations, interictal and ictal regional cerebral blood flow (rCBF) SPECT has proven to be a valuable adjunctive method in the presurgical evaluation of children. METHODS: We evaluated the usefulness of the new rCBF tracer 99mTc-ECD in 14 children with focal epilepsy (mean age 9.7 yr). Eleven interictal and 8 ictal studies were performed. Results were correlated with ictal and interictal surface EEG, MRI and histological findings and the postsurgical outcome. RESULTS: On the basis of the presurgical evaluation, nine patients underwent surgery. MRI studies demonstrated pathological features with possible relation to epilepsy in 50%. Overall, interictal 99mTc-ECD SPECT showed areas of hypoperfusion in 80% of patients. Ictal rCBF SPECT was informative in all patients, including one who showed bifrontal hyperperfusion in accordance with EEG results. CONCLUSION: Technetium-99m-ECD has proven to be of value for interictal and ictal rCBF SPECT in childhood epilepsy. No side effects during or after tracer administration were noticed. Ictal and interictal rCBF SPECT showed good correlation with MRI and EEG results in patients in whom correlation with the postoperative situation was possible and presented additional significant information in those patients with normal MRI and uninterpretable EEG results. No false lateralizations occurred. In children with focal epilepsy, interictal rCBF SPECT may accelerate the application of long-term electrocorticography (ECoG) in patients with normal MRI results. Ictal rCBF SPECT may also help to avoid ECoG, if a focal hyperperfusion correlates with a focal MRI abnormality, and the surface EEG gives no contradictory information.
Brain↗
Prognostic value of thyroglobulin after thyroidectomy before ablative radioiodine therapy in thyroid cancer.
UNLABELLED: Serum thyroglobulin (Tg) is a suitable marker for differentiated thyroid carcinoma after total thyroid ablation by surgery and 131I therapy. Before the first 131I treatment, Tg is not a reliable tumor marker since it can also originate from remnant tissue. It was hypothesized that the ratio of serum Tg to 131I uptake in the thyroid bed could be used to correct Tg values for variations in remnant tissue. METHODS: The hypothesis was evaluated in 111 patients with differentiated thyroid cancer (38 follicular/73 papillary). Tg and 131I uptake in the thyroid bed were measured before the first 131I therapy. The ratio of Tg to 131I uptake was determined in four groups: Group A, tumor free (n = 81); Group B, lymph node metastases (n = 11); Group C, distant metastases (n = 11); Group D, later recurrence [during a mean follow-up of 56 mo; (n = 8)]. Wilcoxon two-sample test was performed to determine statistical significance between Group A and Groups B-D. RESULTS: Significant differences in the Tg/131I uptake ratios (median) between Group A (1.0 ng/ml/%) and Groups B (3.3 ng/ml/%) and D (3.3 ng/ml/%) were observed (p < 0.01). In tumor-free patients (Group A), there was no value higher than 5.7 ng/ml/%. Therefore, a higher ratio, observed in 14 of the 30 remaining patients, was indicative of metastases or later recurrence. CONCLUSION: The ratio of serum Tg to 131I uptake in the thyroid bed might be used as a prognostic marker for thyroid cancer before implementing ablation with 131I.
Adenocarcinoma, Follicular↗
[Scintigraphy of the parathyroid glands with 99mTc-MIBI].
AIM: Since about 3 years 99mTc-MIBI is used instead of 201Tl/99mTc subtraction scintigraphy for the localization of parathyroid involvement in hyperparathyroidism (HPT). The sensitivity of the new method was evaluated. PATIENTS AND METHODS: 24 patients aged between 28 and 83 years with surgically confirmed primary HPT were studied. Planar images were acquired 15 minutes and 3 hours after tracer injection. Additionally, in 9 patients dynamic images were obtained for 2 hours to study tracer kinetics. RESULTS: 19 out of 24 adenomas (79%) were identified correctly with 99mTc-MIBI. CONCLUSION: The sensitivity of the scintigraphy using 99mTc-MIBI is in the range of the 201Tl/99mTc subtraction scintigraphy. Because of the superior logistic and the lower radiation exposure, 99mTc-MIBI can replace the 201Tl/99mTc scintigraphy in the preoperative diagnostic assessment.
Adenoma↗
The relevance of interictal rCBF brain SPECT in temporal lobe epilepsy: diagnostical value and effects of spatial resolution.
Interictal rCBF-SPECT is frequently being used as an adjunctive method for localization of an epileptogenic area during presurgical evaluation of patients suffering from medically refractory temporal lobe epilepsy. This study retrospectively evaluates interictal rCBF-SPECT using Tc-99m-HMPAO in comparison to the results of MRI. The final results of surface EEG and ECoG and the postsurgical clinical results as to seizure frequency were used a a 'gold-standard' for the evaluation of both imaging procedures. As spatial resolution is discussed to be the major reason for higher sensitivity of F-18-DG-PET compared to rCBF-SPECT, special attention has been paid to the spatial resolution of the different SPECT systems being used in this study. In 55 patients the complete data set could be obtained retrospectively, 36 of them being evaluated using SPECT systems with relatively low spatial resolution (Picker Dyna 2000, Elscint Helix) and 19 pt. being evaluated using moderate- to high-resolution SPECT systems (ADAC Genesys, DSI Ceraspect). Overall sensitivity of the interictal rCBF-SPECT was 75%, with 69% for low-resolution systems and 84% for high-resolution systems. Approximately at the same time when our institution installed the ADAC Genesys, the MRI equipment was changed form the 1.5 T Philips Gyroscan S15 to the 1.5 T Philips Gyroscan ACS II, the latter allowing superior imaging opportunities. Overall sensitivity of MRI was 60%, with 56%, for the Gyroscan S15 and 68% for the Gyroscan ACS II. The overall positive predictive value (PPV) was 87% for the interictal rCBF-SPECT and 87% for the MRI. Due to the lack of true negative studies in this population specificity was not calculated. False lateralization using rCBF-SPECT occurred in 5 pts. (9%), however, in 3 pts. the area of hypoperfusion correlated with a detectable MRI pathology, yet EEG/ECoG revealed the epileptogenic focus to be elsewhere. In conclusion, the interictal rCBF-SPECT revealed reasonable sensitivity and PPV in pt. suffering from focal temporal lobe epilepsy and modern SPECT systems showed significantly improved results. Since there is a variety of possible reasons for regional cortical hypoperfusion, the interictal SPECT could add significant information prior to the application of ECoG. This specially appeared to be useful in patients with abnormal MRI scan. Furthermore, in patients presenting with a clear pathology on MRI and a corresponding EEG focus, ECoG could be avoided if the interictal rCBF-SPECT additionally showed localized and singular involvement of the affected temporal lobe. ECoG was mainly applied in those patients with relatively wide-spread hypoperfusion additionally involving frontal or parietal cortical areas.
Adolescent↗
Increased technetium-99m-HMPAO uptake in grade II astrocytoma.
Most brain tumors show decreased uptake of blood flow tracers in brain SPECT imaging and in some cases meningiomas show increased uptake, mainly associated with high regional blood flow values. A reason for regionally increased tracer uptake is partial epilepsy when a tracer is injected during the ictal phase. We present a case of a histologically proven Grade II astrocytoma in the mesial part of the left temporal lobe that caused complex partial seizures. After tracer injection during a phase without signs of clinical seizure, markedly increased uptake of 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) occurred, although the tumor was partially calcified.
Adult↗
[Changes in the blood picture after radioiodine therapy of thyroid cancer].
AIM: In this study the effect of radioiodine which was administered because of thyroid carcinoma on blood count and various other parameters was examined. PATIENTS AND METHODS: In 567 patients who had been treated because of a thyroid carcinoma between 1980 and 1990 with radioiodine, changes of hemoglobin, RBC, WBC, platelets, potassium, uric acid, gamma GT, GOT, GPT and AP were measured in correlation with the totally administered dose. RESULT: In low doses (< 18.5 GBq [500 mCi]), which are sufficient in most cases with clinical course without complications, relevant changes of blood count (hemoglobin: < or = 9.0/10.5 g/dl, RBC: < or = 3.1/3.5 10(12)/l (female/male), WBC: < or = 2.5 10(9)/l, platelets: < or = 0.5 10(11)/l) were observed in only 5 out of 469 cases. After moderate doses (> or = 18.5 GBq [500 mCi] and < 37 GBq [1000 mCi]) we found in only 1 out of 77 cases relevant changes. After very high doses (> or = 37 GBq [1000 mCi]), which are used to treat metastases and/or recurrences, thrombopoesis is most sensitive to the radiation exposure of the bone marrow. Relevant decrease of RBC and WBC were observed in 2 out of 21 patients. Pancytopenia (hemoglobin: < or = 12.0/13.5 g/dl, RBC: < or = 3.9/4.3 10(12)/l [female/male], WBC: < or = 3.5 10(9)/l, platelets: < or = 1.4 10(11)/l) occurred in 4 cases. CONCLUSION: In high-dose therapy with radioiodine frequent (monthly, but in any cases before each therapy) controls of blood count are necessary. In patients without metastases or recurrence no relevant changes can be expected in most cases.
Adolescent↗
Brain single-photon emission tomography using technetium-99m bicisate (ECD) in a case of complex partial seizure.
The clinical application of technetium-99m bicisate (ethyl cysteinate dimer, ECD) for ictal and interictal studies of regional cerebral blood flow (rCBF) in a patient suffering from medically intractable simple and complex partial seizures is reported. The interictal study was performed 60 min p.i. and the ictal studies were performed at 60 min p.i. using an annular crystal single photon emission tomography (SPET) system dedicated for high-resolution brain SPET imaging. Visual evaluation of the studies was carried out, as well as semiquantitative measurement of regional tracer uptake. Magnetic resonance imaging (MRI) scans revealed atrophy of almost the complete left frontal lobe and the ventral parts of the left temporal lobe, including in part the temporomesial structures. The left parietal and occipital structures and the right hemisphere were normal. The interictal study showed a large perfusion defect involving the whole left frontal lobe as well as the left temporal lobe with remaining small areas of normal cortical tracer uptake. The ictal studies detected circumscribed hyperperfusion within the left mesial temporal lobe (ventral part of the hippocampus). Additionally an increase in perfusion could be seen within the entire remaining left temporal lobe. Semiquantitative evaluation of tracer uptake comparing both studies detected markedly increased uptake within the focus compared to the remaining left temporal lobe. On this basis the newly available tracer for studies of rCBF, 99mTc-bicisate, seems to be of value for the detection of epileptogenic foci. Additionally, the value of ictal rCBF studies in the presurgical evaluation of those patients presenting severe morphological alterations on MRI is clearly underlined by this case.
Adult↗
Vascularisation of ocular coralline hydroxyapatite implants.
Vascularisation of coralline hydroxyapatite used to replace the enucleated bulb is of critical importance for the uncomplicated implantation of a motility peg connecting the implant with the cosmetic prosthesis. Technetium-99m diphosphopropanedicarboxylic acid (DPD) single-photon emission tomography (SPET) was used to evaluate the rate of vascularisation as well as the time required for completion of vascularisation. Twenty-four patients were enrolled in the study, which was designed to evaluate vascularisation 10 days, 2 months and 4 months after implantation of a coralline implant. Nineteen patients completed the study and the visual impression of the completion of the vascularisation was scored from 0 (no vascularisation) to + (complete vascularisation) for each patient. No tracer accumulation was detected in any patient at the 10-day examination. Increasing vascularisation was demonstrated with time, and full vascularisation of the coralline implant was seen in all but one case by 4 months after implantation. We conclude that vascularisation of ocular coralline hydroxyapatite implants occurs early and is completed by 4 months after implantation in most cases, but should be confirmed at this time by 99mTc-DPD SPET.
Adult↗
[Orbital implants of coralline hydroxyapatite as eye replacement after enucleation].
BACKGROUND During the last two decades, hydroxyapatite has become popular as alloplastic material for bone replacement in orthopedic and dental surgery. We investigated prospectively the feasibility of hydroxyapatite spheres as replacement of enucleated eyes. PATIENTS AND METHODS Thirty-three consecutive patients entered a prospective study designed to evaluate the results obtained after either primary (n = 26) or secondary (n = 7) implantation of a hydroxyapatite sphere as replacement of the enucleated eyeball. Each patient was examined preoperatively, 1, 2, and 4 months after surgery, as well as every 6 months thereafter. At each examination time the motility of both coralline sphere and overlying cosmetic prosthesis was evaluated and the conjunctival sac was carefully examined at the slit-lamp. RESULTS The postoperative follow-up averaged 10.5 months for the primary implantations and 7.2 months for the secondary implantations. Two implants had to be removed because of infection unresponsive to antibiotic treatment. Defects in the conjunctiva overlying the implant necessitated wound revision in two cases. A buccal mucosal graft was performed in two additional ones. A temporary cosmetic prosthesis could be fitted in all but two of the remaining patients as early as 3 weeks after surgery. Motility of at least 3 mm in all directions could be obtained in 31 cases. CONCLUSION Our study demonstrated that satisfactory motility and good biocompatibility can be achieved, at least in the medium term, with implantation of coralline hydroxyapatite spheres.
Adolescent↗