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Arthritis of scaphotrapeziotrapezoid joint is common and can be seen in association with first carpal metacarpal (CMC) arthritis. Untreated scaphotrapeziotrapezoid arthritis may be a cause of residual pain after CMC arthroplasty. There are various treatment options described in the literature ranging from arthrodesis, resection arthroplasty, interpositional arthroplasty, and implant arthroplasty. We describe a novel technique of flexor carpi radialis (FCR) tendon interposition to tackle this condition. Our common treatment for CMC arthritis is trapezium resection with ligament reconstruction and tendon interposition with half of the FCR. With this procedure, through the same exposure, the proximal part of the trapezoid is resected. An anchor is placed into the trapezoid and the sutures are passed through a remnant of the FCR. Thus the FCR is pulled in between the scaphoid and the trapezoid and secured in place. We performed this procedure in 13 hands with average follow-up of 36 months. All patients were satisfied with the procedure and were pain free at their last follow-up. The advantage of this procedure is the use of the FCR, which is already available in the field and requires very little additional procedure.

Purpose: The purpose of this study was to analyze electrophysiological properties of four main stages of ictal patterns of patients with operated temporal lobe epilepsy related to hippocampal sclerosis., Methods: We included 48 patients with temporal lobe epilepsy-hippocampal sclerosis. Seizures were classified according to their electrophysiological properties and surgical outcomes as seizure-free and not seizure-free. The EEGs with artifacts at the beginning were analyzed separately., Results: The most frequent type of ictal onset patterns was rhythmic theta/alpha activity, which was correlated to seizure-free group, whereas "switch of lateralization" and "bitemporal asynchrony" correlated to not seizure-free group. When bilateral independent ictal propagation patterns emerged, seizures tended to predict the side of epileptogenic zone wrongly. As a later significant pattern, rhythmic theta/alpha activity lateralized the focus correctly. Seizure termination was significantly concordant with hippocampal sclerosis lateralization in the seizure-free group., Conclusion: Ictal onset pattern with rhythmic theta/alpha activity correlates well with seizure freedom. Morphology of later significant patterns was more important in determining the lateralization reliability than time of appearance. The EEGs with short artifacts at the beginning are seen to be valuable in presurgical evaluation. Lateralization of ictal termination ipsilateral to MRI indicates good prognosis after surgery. Scalp EEG monitoring helps predict epileptogenic zones and postsurgical outcomes.

Sclerosing angiomatoid nodular transformation of the spleen is a recently recognized benign vascular lesion, characterized microscopically by multiple angiomatoid nodules embedded within a fibrosclerotic stroma. Although its imaging manifestations have been limited in the radiologic literature, features such as low-level increased fluorodeoxyglucose activity on a positron emission tomographic scan, near-complete blending in with normal splenic parenchyma on a delayed-phase image, and the presence of radiating scarring on a magnetic resonance image may suggest the diagnosis. We report here the computed tomographic, magnetic resonance imaging, and positron emission tomographic findings of sclerosing angiomatoid nodular transformation, along with gross and microscopic pathological correlation.

Sclerotic fibroma (SF) is an uncommon, benign fibrous neoplasm that may present either as a sporadic, small, solitary cutaneous mass, in otherwise healthy individuals, or as solitary or multiple, discrete skin nodules in patients with Cowden syndrome. Oral SF has been reported in patients with Cowden syndrome; however we now report the first documented series of sporadic SF originating within the oral mucosa. We describe 5 cases of SF arising in 3 women and 2 men with an age range of 43 to 66 years. The buccal mucosa was the site of involvement in 4 patients and the lower lip in 1 patient. Microscopically, each of the tumors was characterized by an unencapsulated, well-circumscribed, hypocellular submucosal nodule that was sharply demarcated from the surrounding tissues. The neoplasms were primarily composed of thick collagen bundles that were occasionally arranged in a storiform pattern. Prominent clefts separated many of the collagen bundles. In all cases, spindle and stellate-shaped cells containing fusiform or stellate-shaped nuclei and inconspicuous nucleoli were found scattered throughout the lesion. Occasional stellate-shaped, multinucleated cells were also seen. Many of the cells also exhibited long dendritic cytoplasmic processes. The tumor cells strongly expressed CD34 and vimentin, and occasionally factor XIIIa, but were negative for markers of myofibroblastic, neural or melanocytic differentiation. These findings confirm that oral SF represents a unique entity and should be differentiated from more commonly occurring benign fibrous lesions of the oral soft tissues.

In patients with mesiotemporal sclerosis, posterior hippocampal involvement at the ictal onset is not associated with an excellent outcome. A study confirmed that ictal onset in the posterior parahippocampal gyrus is associated with a less favorable outcome compared with ictal onset in the anterior parahippocampal gyrus in patients with mesiobasal temporal lobe epilepsy who are undergoing foramen ovale recording. The authors hypothesized that involvement of the two medial contact points of posterior basal temporal subdural (SD) strip at the ictal onset, representing ictal onset in the posterior parahippocampal gyrus, may also adversely influence the surgical outcome. With this objective, the authors assessed the incidence of posterior basal temporal SD strip (the two medial contact points) involvement at the ictal onset in patients with mesiotemporal sclerosis and determined whether presence of this finding influenced surgical outcome. Thirty-six patients with mesiotemporal sclerosis underwent a single SD grid (lateral frontotemporal) and strips (three basal temporal and one orbitosubfrontal) monitoring. Based on the earliest involvement of basal temporal strips (the two medial contact points) during the seizure, patients were classified into (1) anterior and/or middle basal temporal, or (2) posterior basal temporal (with or without involvement of anterior and/or middle basal temporal) ictal onset groups. A temporal lobectomy with adequate resection of the ictal onset zone was performed in all patients. Surgical outcome was based on Engel's classification. Six of 36 (17%) patients were classified into the posterior basal temporal ictal onset group. Only two patients from the posterior basal temporal ictal onset group experienced a good outcome compared with 26 of 30 patients from anterior and/or middle basal temporal ictal onset group (P = 0.01). In patients with mesiotemporal sclerosis who were monitored with SD electrodes, involvement of the two medial contact points of posterior basal temporal strip at the ictal onset (representing ictal onset in the posterior parahippocampal gyrus) occurred in 17% of the patients. These patients might not experience an excellent surgical outcome despite including the ictal onset zone in resection. These findings may be useful in presurgical counseling of patients with mesiotemporal sclerosis who undergo intracranial SD monitoring.

Objective: To report the hearing results of the surgical treatment of tympanosclerosis., Study Design: A retrospective review of surgically treated cases of tympanosclerosis., Setting: A tertiary referral center., Patients: One hundred fifteen patients with middle ear tympanosclerosis operated on between 1987 and 1996, with an average age of 36 years (range 18-59 years). Cases were classified into four groups according to Wielinga and Kerr. Those with an associated cholesteatoma were excluded., Intervention: Depending on the ossicular status, either mobilization of the major ossicles or epitympanic bypass procedure, mobilization of the stapes or stapedectomy., Main Outcome Measures: The postoperative pure-tone average was compared with the preoperative levels by use of conventional audiometry. The air-bone gap was measured., Results: The average postoperative air-bone gap was 18.0+/-10.21 dB in the type II group (attic fixation of the malleus-incus complex with a mobile stapes). 21.8+/-9.5 dB in the type III group (mobile malleus-incus complex, if present, with stapes footplate fixation), and 22.92+/-10.03 dB in the type IV group (fixation of both the stapes footplate and the malleus-incus complex). Patients with a fixed malleus and mobile stapes had significantly better hearing results than those with stapes fixation (p = 0.042, Mann-Whitney U test)., Conclusion: In ossicular attic fixation, atticotomy and mobilization of ossicles yielded better results than did the epitympanic bypass procedure. The difference, however, did not reach statistical significance. Patients with fixed stapes treated with stapedectomy displayed good hearing results immediately after surgery, but the air-bone gap deteriorated after some time.

Craniometaphyseal dysplasia (CMD) is a genetic bone disorder involving an abnormality of modeling of the long bones and sclerosis of the cranium. Both conductive and sensorineural hearing may be frequently associated with this syndrome. Conductive hearing loss is due to attic fixation of the lateral ossicular chain and hyperostosis formation with stapes ankylosis. Two patients with CMD were treated surgically. Two of three ears operated on had closure of the air-bone gap, whereas the third ear failed ossicular reconstruction because of hyperostosis of the promontory with deepening of the oval window.

The possible dual occurrence of hippocampal sclerosis (HS) and other structural lesions (especially cortical dysgenesis [CD]) is well established in patients with chronic partial epilepsy. We describe the frequency of additional CD in a series of 100 patients with evidence of HS, using volumetric MRI. Additional, often subtle, CD was present in 15 patients: subependymal heterotopia (six), forme fruste of tuberous sclerosis (two), focal macrogyria (two), focal cortical dysplasia (one), laminar heterotopia (one), bilateral schizencephaly (one), and simplified gyral patterns (two). In contrast, in 46 healthy volunteers, only one had possible CD (p < 0.05). Only 2 of 15 patients had a history of childhood febrile convulsions. HS is a heterogeneous condition; patients being evaluated for temporal lobe surgery should be carefully screened for additional CD using appropriate MR techniques.

Stapedectomy was performed in sixty-seven ears with tympanosclerotic footplate fixation. This was confined to the footplate in 90% of ears, and there was an association with cholesteatoma and chronic infection. Large fenestra stapedectomy was performed in 91% of cases and the surgical procedure performed was tympanoplasty in 91% of cases. Three cases (4.5%) suffered a dead ear by three years following the procedure, but only one immediately. A variety of surgical procedures were used to reconstruct the tympanic membrane to oval window connection, and the air-bone gap did not depend on the choice of prosthesis in the short term. Retention of the incus led to later increasing air-bone gap, probably due to refixation by tympanosclerosis. Long-term results are analyzed for each method of reconstruction and each category of ossicular status identified at surgery. Small fenestra procedures produced less cochlear hearing loss at high frequencies. Surgical technique is discussed with reference to the pathophysiology of tympanosclerosis, and the role of hearing aids is considered.