Conventionally, cranionasal cerebrospinal fluid (CSF) fistulas have been closed by repair of the dural defect via an open craniotomy. These techniques may be cumbersome, not without complications, and far from successful. In recent years, endoscopic techniques have been developed in the field of nasal surgery and neurosurgery. Furthermore, by means of computer-aided surgery or neuronavigation, it is possible to identify the surgical track with a high degree of accuracy and, by the same token, identify the defect in the cranium.By combining the endoscopic technique with computer-aided surgery, we have operated on six patients with cranionasal CSF fistulas endonasally. The fistula was confirmed before surgery by subaracnoidal injection of fluorescein.The surgery was successful and without any complications in all six cases.The method is recommended as the operation of first choice for cranionasal CFS fistulas, as compared to transcranial surgery. It is probably more efficient and with fewer complications than conventional surgery. A collaboration between neurosurgeons and ENT surgeons, like ours, can be recommended.
We have used a packing technique for surgical treatment of carotico-cavernous fistulas, which allows preservation of the flow in the internal carotid artery. We have treated six patients for carotico-cavernous fistulas with this technique, and in all patients the preoperative symptoms and signs disappeared completely. One patient still had a slight paresis of the left abducent nerve due to the operation three months after the operation. Surgical treatment of carotico-cavernous fistulas is effective and probably preserves the flow in the internal carotid artery.
Cytogenetic analyses of 11 consecutive cases of meningiomas from 7 female and 4 male patients are reported. Chromosomal abnormalities were found in all cases. Only two of the cases showed cells with normal karyotype in addition to the abnormal stemline. Two of the cases displayed a more aggressive growth pattern than is usually seen in meningiomas. The first case was characterized by tumor invasion into the bone, a stemline with monosomy 22 and a hyperhaploid sideline. The second case was characterized by recurrency and a hypodiploid stemline. Extended clonal evolution was observed in one case.
A meningioma of the meningotheliomatous type showed frequent relapses after surgery. Cytogenetic analysis of a tumor biopsy after the last relapse showed a highly aberrant hyperhaploid stemline.
