HIV Presenting as Inflammatory Pseudotumor of the Skull Base: Case Report and Review of the Literature

A 52-year-old woman presented with frontal headaches, panhypopituitarism, and right cranial nerve VI palsy. MRI of the brain with gadolinium revealed a destructive process involving the clivus and bilateral petrous apices, and extending into bilateral cavernous sinuses with encasement and narrowing of the bilateral cavernous carotids. There was soft tissue enhancement of the pre-pontine cistern with extension into the sella and enlargement of the pituitary gland. CT scan showed bony erosion of the skull base. Transnasal transsphenoidal biopsy showed friable bone in the rostrum of the sphenoid sinus. Pathology revealed connective and adipose tissue with acute and chronic inflammation and granulation tissue. Cultures were negative. Patient was also diagnosed with HIV during her hospital stay. She responded well clinically and radiographically to steroids. A 3-month follow-up MRI revealed persistent erosive lesion in the base of the occiput and clivus with decreased extension into the cavernous sinus, sella, and suprasellar region. Inflammatory pseudotumor of the anterior skull base is a rare entity that can be diagnostically challenging. Few cases are present in the literature and are idiopathic or caused by inflammatory or autoimmune diseases. We present the first case of inflammatory pseudotumor of the anterior skull base associated with HIV with a review of the literature and stress the importance of endoscopic transnasal biopsy for the diagnosis and management of this disease

Orbital Exenteration for Advanced Peri-orbital Skin Cancer: Prognostic Factors and Survival

Objectives: Orbital exenteration for advanced periorbital malignancies is a relatively rare but highly morbid procedure, often done for cancers arising from periorbital skin. The purpose of this research is to investigate and describe cases of cutaneous malignancy of the periorbital skin for which orbital exenteration was done. Methods: This is a retrospective single institution case series at a tertiary care university hospital, including all cases of orbital exenteration for advanced periorbital malignancies performed between January 2002 and January 2012 at the University of Miami/Bascom Palmer Eye Institute/Jackson Memorial Hospital. Patient demographics, tumor characteristics, operative reports, histologic, radiologic and clinical follow-up data were recorded. Outcome measures were overall survival and disease free survival, univariate analysis for multiple clinical factors including prior surgery, bony erosion on pre-operative CT scan, intracranial involvement, and surgical margins. Results: There were 64 patients with a mean age of 70 years (41 male, 23 female) who underwent orbital exenteration for periorbital skin cancers. Of these, 24 patients had squamous cell carcinoma, 24 basal cell carcinoma, 11 sebaceous carcinoma, and 5 cases of malignant melanoma. The most common sites of origin were facial skin (17), medial canthus (14), inferior lid (14), and upper lid (11). Conclusions: Surgical outcome and survival were reviewed with relation to significant prognostic variables

Open airway reconstruction in adults: Outcomes and prognostic factors

The purpose was to assess the success of open tracheal resection and re-anastomosis for non-malignant tracheal stenosis in adults. Successful operations were defined as T-tube or tracheostomy-free status by 6months post-operatively. Retrospective chart review was performed and data were recorded in a de-identified manner. The primary outcome was T-tube or tracheostomy-free status by 6months following tracheal resection. Clinical and demographic characteristics were evaluated as potential prognostic variables. Thirty-two patients met inclusion criteria, with a median age of 46. Seven patients underwent tracheal resection with primary closure, without stenting. Successful tracheal resection was defined as tracheostomy or T-tube free by 6months post-operation, and this was possible in 21 patients (66%). Eighty-two percent of patients with cricoid cartilage-sparing tracheal resection had a successful outcome, versus 30% of patients who underwent cricoid cartilage resection (HR 5.02, 95% CI 1.46-17.3; p=0.011). Patients with a history of tracheostomy-dependence were four times more likely to remain tube-dependent at 6months (HR 4.15, 95% CI 1.56-10.86; p=0.004). Tracheal stenosis remains a very difficult problem to treat. In our series, we confirm that patients with cricoid involvement or with a history of tracheostomy were more likely to be tube dependent at 6-months post-operation