3D ultrasound coronal C-scan imaging for optic nerve sheath meningioma.
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Aged↗
Biomedical subjects
R A Holliday
Publications and source records attributed to R A Holliday.
Imaging the neonatal mandible for accurate distraction osteogenesis.
The position of mandibular teeth is difficult to document in the neonatal patient. Panorex images are difficult to obtain in an uncooperative pediatric patient. The new technique presented by the authors uses computed tomographic data to create a curved, reformatted image of the mandible, and generates an image similar to a panorex image. This curved, reformatted mandibular image provides accurate visualization of the mandible and mandibular teeth. This technique allows for precise pin placement and osteotomy in distraction osteogenesis.
Humans↗
Asymmetry of the ethmoid roof: analysis using coronal computed tomography.
OBJECTIVES/HYPOTHESIS: To determine the incidence and degree of asymmetry in the height and contour of the ethmoid roof. STUDY DESIGN: Retrospective review of direct coronal paranasal sinus computed tomography (CT) scans. METHODS: Retrospective review of 200 consecutive direct coronal sinus CT scans done at New York University Medical Center from July 25, 2000 to October 11, 2000. The height and contour of the fovea ethmoidalis were examined for symmetry between the right and left sides. When an asymmetry in the height of the fovea ethmoidalis existed, this difference was quantified. RESULTS: In 19 scans (9.5%), there was an asymmetry between the height of the fovea ethmoidalis on the right and left sides. Of these 19, 12 (63.2%) were lower on the right side, whereas 7 (36.8%) were lower on the left. Ninety-six patients (48.0%) demonstrated a contour asymmetry with "flattening" of the ethmoid roof on one side, 46 on the right and 50 on the left. One patient demonstrated both height and contour asymmetry. The fovea ethmoidalis on the remaining 86 scans (43.0%) was symmetric. CONCLUSIONS: In a patient population with sinus and nasal symptoms, the height and contour of the right and left fovea ethmoidalis were symmetric in less than 50% of individuals. The asymmetry was most often the result of a difference in contour with flattening of the fovea on one side. This underscores the importance of careful preoperative and intraoperative review of paranasal sinus CT scans in patients undergoing endoscopic sinus surgery.
Cephalometry↗
Recurrence of clival chordoma along the surgical pathway.
Chordomas are locally aggressive malignant tumors of notochordal origin whose metastatic potential is increasingly recognized. Surgical pathway recurrence has been noted only rarely in the literature. We present three patients with clival chordomas whose sole or initial recurrence was along the pathway of prior surgical access. A characteristic mass found along the pathway of prior surgical access for resection of a chordoma should suggest recurrent chordoma.
Adult↗
Role of the agger nasi cell in chronic frontal sinusitis.
Agger nasi cells contribute to nasofrontal duct (NFD) obstruction and chronic frontal sinus disease. To investigate this relationship, we conducted a review of the surgical outcome and computed tomographic imaging in 26 patients with chronic frontal sinusitis. Coronal and sagittal images were used to delineate the anatomic variability and mucosal disease in the NFD and frontal sinus region. Data from coronal and sagittal images were compared. The results were also correlated with the outcome of frontal sinus surgery in patients with a clinical history of chronic frontal sinus disease. Our data suggest that agger nasi cell pneumatization with narrowing of the frontal sinus outflow tract is a significant cause of persistent frontoethmoid pain and chronic frontal sinusitis. Sagittal reformatted images are more capable than coronal images of demonstrating agger nasi cell encroachment on the NFD, as well as NFD mucosal disease. Endoscopic frontal sinusotomy is an effective treatment for chronic frontal sinus disease.
Adult↗
Evaluation and management of spontaneous temporal bone cerebrospinal fluid leaks.
Spontaneous temporal bone cerebrospinal fluid leak may be defined as a leak without an apparent precipitating cause. These transdural fistulas occur rarely, and diagnosis is predicated upon a high index of suspicion. Leaks have been reported through both middle and posterior fossa defects, although the vast majority involve the middle fossa plate. In a previous study we reported 7 cases of spontaneous temporal bone cerebrospinal fluid leaks, all involving the middle fossa tegmen. Upon further review of these cases and 5 previously unreported cases, the defect was localized to the tegmen tympani in 9 of the total 12 cases. Diagnostic methods are discussed, with the importance of high-resolution computed tomography stressed. The role of contrast cisternography is also evaluated. An outline for surgical management is presented based upon residual hearing and defect location and accessibility. A transmastoid procedure offers the advantage of visualization of both the middle and posterior fossa plates, and this approach can be supplemented with an obliterative procedure when indicated. The middle fossa approach provides optimal exposure of the tegmen plate with less likelihood of ossicular injury when dealing with tegmen tympani defects. Adjuncts to surgical therapy include intrathecal fluorescein dye and continuous postoperative lumbar cerebrospinal fluid drainage.
Journal Article↗
Postoperative imaging of the multichannel cochlear implant.
PURPOSE: To present the postoperative radiographic appearance of the multichannel cochlear implant and to suggest criteria for the radiographic evaluation of postimplant patients. METHODS: One hundred forty-one patients, 73 female and 68 male, had multichannel cochlear implants inserted. One hundred thirty-five intraoperative radiographs, 31 postoperative radiographic examinations, and 10 postoperative CT examinations were retrospectively reviewed. RESULTS: In 135 patients, a Stenver's or anteroposterior projection confirmed the normal placement of the implant by demonstrating the electrodes to be regularly spaced and gently curved within the first turn of the cochlea. The insertion depth was determined by counting the number of electrodes that projected medial to the cochlear promontory. In 5 patients in whom intracochlear placement of the electrode array could not be confirmed on plain radiographs, CT demonstrated the location of the electrode array. In 3 patients with postoperative infections, CT either correctly identified or excluded the presence of a collection beneath the implant. CONCLUSION: Plain radiographs of the temporal bone are sufficient for the postoperative treatment of the majority of postimplant patients. CT should be performed when plain radiographs cannot adequately show the location of the electrode array or if postoperative infection is suspected.
Adolescent↗
Clinically unsuspected venous malformations limited to the submandibular triangle: CT findings.
PURPOSE: To present the CT characteristics of histologically confirmed venous vascular malformations limited to the submandibular triangle in patients without clinical stigmata of venous vascular malformations. METHODS: The clinical records and CT scans of five women with venous vascular malformations limited to the submandibular triangle were reviewed. Patients ranged from 39 to 70 years of age. None of the patients had a history of malignant tumors. All patients presented with a solitary suprahyoid neck mass. None of the patients demonstrated cutaneous manifestations of venous vascular malformation. RESULTS: Contrast-enhanced CT scans in all five patients demonstrated a lobulated, heterogeneously enhancing, well-circumscribed solid mass, separable from the submandibular gland. Areas of contrast enhancement within each mass were isodense to the internal jugular vein in four of five cases. Only two of five lesions demonstrated focal calcifications. Excisional biopsy (two patients) demonstrated pathologic features compatible with venous vascular malformation. Fine needle aspirations (three patients) yielded venous blood or blood-tinged fluid. CONCLUSIONS: Venous vascular malformations may present as isolated neck masses in adults without typical clinical stigmata. Clues to the CT diagnosis include a lobulated appearance to the mass with intense but heterogeneous contrast enhancement. This appearance, in combination with results of fine needle aspiration, may be sufficiently diagnostic to preclude excisional biopsy.
Adult↗
Advanced imaging techniques of the brachial plexus.
The brachial plexus is a complex structure that arises from nerve roots in the neck and terminates by dividing into peripheral nerves in the axilla. Imaging the brachial plexus can be difficult because of this anatomy. MRI now is the imaging modality of choice in the evaluation of brachial plexopathy. T1-weighted axial and oblique coronal images supplemented by T-2 weighted or STIR images are a standard protocol. MRI can be used to diagnose nerve root avulsion, neuromas, tumor, and radiation fibrosis.
Brachial Plexus↗
Multidimensional distraction osteogenesis: the canine zygoma.
The principle of distraction osteogenesis, well-established in the enchondral bones of the axial skeleton, has recently been applied to the membranous bones (mandible, cranium) of the craniofacial skeleton in the experimental animal and in the human. In the craniofacial skeleton, however, the technique has been used only to lengthen bone in a direction along its major axis, i.e., unidimensional distraction. A canine model is presented to demonstrate the feasibility of distracting membranous bone away from its dominant axis, i.e., multidimensional distraction. Four mongrel dogs, 5 months of age, were the subjects of this study. Two osteotomies were made in the zygomatic arch, and the bone-lengthening device was fixed to the zygoma. After 7 days of external fixation, the osteotomized segment was lengthened 1 mm/day away from the long axis of the bone for 15 days. External fixation was then maintained for a minimum of 4 weeks, after which the dogs were sacrificed. Craniofacial CT with three-dimensional reconstruction documented multidimensional bone lengthening, and histologic analysis of the specimen confirmed the presence of new cortical bone in the expanded areas. Refinement in technique and miniaturization and internalization of the bone-lengthening device may allow for more precise changes in the amount and direction of lengthening, thus making distraction osteogenesis more widely applicable for use in the human craniofacial skeleton.
Animals↗
Petrous jugular malposition (diverticulum).
Jugular bulb anatomy is variable. A "high-riding" bulb extending into the tympanic cavity is a well-described anomaly. Petrous jugular malposition (diverticulum) (PJMD), however, is rare. The relationship between PJMD and clinical symptoms is questionable because the differentiation between PJMD as an anatomic variant and pathologic process is unproved. A literature review reveals 14 previously documented cases. We report an additional four cases. Diagnostic and management dilemmas are discussed, with the importance of high-resolution CT stressed.
Adult↗
Manifestations of AIDS in the oromaxillofacial region. The role of imaging.
The primary role of sectional imaging of the oromaxillofacial region in patients who have AIDS is to assess the extent of disease already identified by the clinician. In patients in whom the clinical presentation is complex or confusing, radiographic detection of otherwise occult manifestations of HIV infection plays a key role in the management of the patient with AIDS. The varied manifestations of HIV infection in the oromaxillofacial region and the indications for imaging have been reviewed.
AIDS-Related Opportunistic Infections↗
Cholesterol cysts of the temporal bone: diagnosis and treatment.
Cholesterol cyst (or granuloma) of the temporal bone, a recognized clinical entity distinct from cholesteatoma, is more common than previously thought. Apparently it is caused by obstruction of previously pneumatized temporal bone air cells. Surgical cure is achieved by drainage and reestablishment of normal pneumatization. This paper reviews 14 cholesterol cysts of the temporal bone, emphasizing the importance of preoperative imaging and surgical approach. Use of magnetic resonance imaging differentiates cholesterol cysts from cholesteatoma or other neoplasms. Computed tomography delineates the location of the lesion and defines temporal bone anatomy essential to surgical approach. The two studies together allow the surgeon to properly plan drainage, as in the case of a cholesterol cyst, versus excision or exteriorization, as in the case of cholesteatoma. The infralabyrinthine approach to a petrous apex cholesterol cyst is the procedure of choice when hearing preservation is desired.
Adolescent↗
Otologic disease in AIDS patients: CT correlation.
The contrast-enhanced computed tomographic (CT) scans of the temporal bone and brain in 18 patients with otologic disease and acquired immunodeficiency syndrome (AIDS) were retrospectively reviewed. Seven scans revealed middle ear and mastoid disease; three scans were consistent with central nervous system (CNS) pathology; and eight scans demonstrated no abnormalities. CT scanning was found useful in localizing otopathology and diagnosing CNS toxoplasmosis, aural polyps, osteomyelitis, mastoiditis, and middle ear effusion due to hypertrophic lymphoid tissue. The authors conclude that AIDS patients with sensorineural hearing loss should undergo contrast-enhanced brain CT scans to rule out CNS pathology; AIDS status does not alter criteria for CT scanning in patients with conductive hearing loss; and that images of the nasopharynx should be included on temporal bone CT scans of patients with conductive hearing loss in order to exclude eustachian tube obstruction by hypertrophic lymphoid tissue.
Acquired Immunodeficiency Syndrome↗
Diagnosis of surgical sinusitis using nasal endoscopy and computerized tomography.
The ability to identify surgical sinus disease using diagnostic nasal endoscopy and coronal CT scanning of the paranasal sinuses is studied prospectively. Fifty consecutive patients with symptoms of chronic sinusitis lacking surgical indications by traditional work-up comprise the patient population. Sixty percent had endoscopic or CT indications for surgery. There was a 90% correlation between endoscopy and CT examination with the combined work-up being more accurate than either modality alone. Functional endoscopic sinus surgery was performed in 18 cases. There were no major complications. Approximately 89% of the postoperative group report significant improvement, with 55.6% reporting total relief of symptoms. A complete endoscopic sinus work-up can often identify surgically correctable sinusitis despite normal routine rhinoscopic and plain-film examination. It is therefore, warranted in those patients with a suggestive history.
Adult↗
MRI of mastoid and middle ear disease.
MR and CT are complementary studies in evaluating inflammatory disease or neoplasms of the mastoid and middle ear cavities. CT should be performed prior to MR in the evaluation of patients with primary temporal bone pathology because of its ability to detect and delineate both soft tissue and bony abnormalities. CT should be performed whenever intratympanic or facial nerve pathology is suspected, even if the MR examination is normal. MR can be used to further characterize tympanic cavity masses as effusion, glomus tumor, hemorrhage or cholesterol granuloma. The prospect of Gd-DTPA-enhanced MR promises increased sophistication in the detection of glomus tumors and facial nerve neuromas. Noncontrast MR cannot differentiate between cholesteatoma and granulation tissue. The efficacy of Gd-DTPA in inflammatory disease of the temporal bone awaits further investigation.
Ear Diseases↗