Objective:To retrospectively analyze and explore the indications, methods and prognosis of optic nerve decompression (OND) in endoscopic surgery for benign fibro-osseous lesions (FOLs) of the nasal and skull base.Methods:Among 217 cases of craniofacial fibro-osseous lesions from July 2008 to January 2025 who were treated in the Otolaryngology Head and Neck Surgery Department of Beijing Tongren Hospital Affiliated to Capital Medical University, 14 patients (6.45%, 14/217) who underwent endoscopic resection of the lesion and OND under image navigation were included in this study, including 8 males and 6 females, aged from 4 to 28 years old. Among the 14 patients, 8 had fibrous dysplasia, 5 had ossifying fibroma, and 1 had osteoma. Clinical data, imaging data, surgical data and follow-up results were collected. Best corrected visual acuity (BCVA) and other indicators before and after treatment were recorded for analysis. Statistical analysis was conducted using SPSS 26.0 software.Results:Among 14 patients, preoperative visual decline involved 17 eyes (all 8 fibrous dysplasia cases, 2/5 ossifying fibroma cases, and 1 osteoma case). Surgical approaches included: partial resection for fibrous dysplasia (8 cases; bilateral decompression in 5, unilateral in 3); total resection for ossifying fibroma (3 cases; bilateral decompression in 2, unilateral in 1) or partial resection with bilateral decompression (2 cases, including 1 aneurysmal bone cyst); and total resection with unilateral decompression for osteoma (1 case). After the operation, the vision of 10 eyes (58.82%, 10/17) had been improved. Among the 5 eyes with severe visual impairment before the operation (no light perception/light perception/exponential vision), 2 eyes improved (1 eye from no light perception to light perception, and 1 eye from visual perception to exponential vision). Eight cases (10 eyes) of patients with proptosis improved after the operation. The proptosis before and after the operation were (16.60±1.71) mm and (13.60±1.35) mm ( P<0.05). Conclusions:For patients with benign FOLs involving the optic canal at the nasal and skull base who have visual impairment, OND via endoscopic endonasal approach can achieve visual salvage effects. Those with better preoperative residual vision have significant improvement in BCVA, so the operation should be performed as early as possible.

Purpose To investigate the application value of MRI in distinguishing Association Research Circulation Osseous(ARCO)stage II and IIIA of osteonecrosis of the femoral head.Materials and Methods A total of 48 patients with ARCO stage II/IIIA non-traumatic osteonecrosis of the femoral head in the Fourth Medical Center of Chinese PLA General Hospital from October 2022 to September 2023 were retrospectively included,with a total of 75 hips.The hips were divided into ARCO stage II group(26 hips)and stage IIIA group(49 hips)based on CT.The MRI findings(including irregular articular surface of femoral head,similar closed-loop shape of necrotic-viable interface,fibrous granulation tissue and cystic change in necrotic area,perinecrotic bone marrow edema,articular effusion and synovitis)were compared between the two groups,and the diagnostic efficiencies were evaluated.Results Irregular articular surface of femoral head,cystic change and fibrous granulation tissue in necrotic area and synovitis were more common in stage IIIA group than in stage II group,the range of bone marrow edema was larger than that in stage II group,the grade of articular effusion was larger than that in stage II group,and similar closed-loop shape of the necrotic-viable interface was found in stage II group,but no such sign was found in stage IIIA group,with statistical difference of all the above(χ2/Z=-5.727-54.764,all P<0.001).The area under the curve of irregular articular surface of femoral head,bone marrow edema,synovitis,articular effusion,fibrous granulation tissue in necrotic area,cystic change in the necrotic area,and similar closed-loop shape of the necrotic-viable interface in distinguishing ARCO stage II and IIIA were 0.931,0.891,0.845,0.799,0.772,0.724 and 0.692,respectively.The diagnostic efficiency of irregular articular surface of femoral head was not statistically significant with bone marrow edema and synovitis(both P>0.05),and higher than articular effusion,fibrous granulation tissue in necrotic area,cystic change in necrotic area,and similar closed-loop shape of the necrotic-viable interface(Z=2.054,2.711,4.182,4.003,all P<0.05).Conclusion MRI is helpful to distinguish ARCO stage II from stage IIIA of osteonecrosis of the femoral head.The diagnostic efficiencies of irregular articular surface of femoral head,bone marrow edema and synovitis are higher.

Objective:To retrospectively analyze and explore the indications, methods and prognosis of optic nerve decompression (OND) in endoscopic surgery for benign fibro-osseous lesions (FOLs) of the nasal and skull base.Methods:Among 217 cases of craniofacial fibro-osseous lesions from July 2008 to January 2025 who were treated in the Otolaryngology Head and Neck Surgery Department of Beijing Tongren Hospital Affiliated to Capital Medical University, 14 patients (6.45%, 14/217) who underwent endoscopic resection of the lesion and OND under image navigation were included in this study, including 8 males and 6 females, aged from 4 to 28 years old. Among the 14 patients, 8 had fibrous dysplasia, 5 had ossifying fibroma, and 1 had osteoma. Clinical data, imaging data, surgical data and follow-up results were collected. Best corrected visual acuity (BCVA) and other indicators before and after treatment were recorded for analysis. Statistical analysis was conducted using SPSS 26.0 software.Results:Among 14 patients, preoperative visual decline involved 17 eyes (all 8 fibrous dysplasia cases, 2/5 ossifying fibroma cases, and 1 osteoma case). Surgical approaches included: partial resection for fibrous dysplasia (8 cases; bilateral decompression in 5, unilateral in 3); total resection for ossifying fibroma (3 cases; bilateral decompression in 2, unilateral in 1) or partial resection with bilateral decompression (2 cases, including 1 aneurysmal bone cyst); and total resection with unilateral decompression for osteoma (1 case). After the operation, the vision of 10 eyes (58.82%, 10/17) had been improved. Among the 5 eyes with severe visual impairment before the operation (no light perception/light perception/exponential vision), 2 eyes improved (1 eye from no light perception to light perception, and 1 eye from visual perception to exponential vision). Eight cases (10 eyes) of patients with proptosis improved after the operation. The proptosis before and after the operation were (16.60±1.71) mm and (13.60±1.35) mm ( P<0.05). Conclusions:For patients with benign FOLs involving the optic canal at the nasal and skull base who have visual impairment, OND via endoscopic endonasal approach can achieve visual salvage effects. Those with better preoperative residual vision have significant improvement in BCVA, so the operation should be performed as early as possible.

Purpose To investigate the application value of MRI in distinguishing Association Research Circulation Osseous(ARCO)stage II and IIIA of osteonecrosis of the femoral head.Materials and Methods A total of 48 patients with ARCO stage II/IIIA non-traumatic osteonecrosis of the femoral head in the Fourth Medical Center of Chinese PLA General Hospital from October 2022 to September 2023 were retrospectively included,with a total of 75 hips.The hips were divided into ARCO stage II group(26 hips)and stage IIIA group(49 hips)based on CT.The MRI findings(including irregular articular surface of femoral head,similar closed-loop shape of necrotic-viable interface,fibrous granulation tissue and cystic change in necrotic area,perinecrotic bone marrow edema,articular effusion and synovitis)were compared between the two groups,and the diagnostic efficiencies were evaluated.Results Irregular articular surface of femoral head,cystic change and fibrous granulation tissue in necrotic area and synovitis were more common in stage IIIA group than in stage II group,the range of bone marrow edema was larger than that in stage II group,the grade of articular effusion was larger than that in stage II group,and similar closed-loop shape of the necrotic-viable interface was found in stage II group,but no such sign was found in stage IIIA group,with statistical difference of all the above(χ2/Z=-5.727-54.764,all P<0.001).The area under the curve of irregular articular surface of femoral head,bone marrow edema,synovitis,articular effusion,fibrous granulation tissue in necrotic area,cystic change in the necrotic area,and similar closed-loop shape of the necrotic-viable interface in distinguishing ARCO stage II and IIIA were 0.931,0.891,0.845,0.799,0.772,0.724 and 0.692,respectively.The diagnostic efficiency of irregular articular surface of femoral head was not statistically significant with bone marrow edema and synovitis(both P>0.05),and higher than articular effusion,fibrous granulation tissue in necrotic area,cystic change in necrotic area,and similar closed-loop shape of the necrotic-viable interface(Z=2.054,2.711,4.182,4.003,all P<0.05).Conclusion MRI is helpful to distinguish ARCO stage II from stage IIIA of osteonecrosis of the femoral head.The diagnostic efficiencies of irregular articular surface of femoral head,bone marrow edema and synovitis are higher.

OBJECTIVE To investigate the value of magnetic resonance imaging(MRI)parameters in differentiation between olfactory neuroblastoma(ONB)and sinonasal diffusion large B cell lymphoma(DLBCL).METHODS Pathology-proven 34 ONB patients and 29 DLBCL patients with MRI examinations before treatment were included.The conventional MRI features and semi-quantitative parameters of two groups were documented and analysis.Statistical analysis between the two groups were performed.The independent sample t-test and was used for continuous variables in normal distribution,Mann-Whitney U test was used for non-normal distribution.The frequency of categorical variables were compared by Chi-square test.Logistic regression analysis was done to identify the most predictive MRI features for differentiation.RESULTS ONB often located in the nasal cavity olfactory recess and ethmoid sinus,characterized by intracranial extension through the cribriform plate,forming a'dumbbell'shape mass(P=0.004).DLBCL more often located in paranasal sinus,orbits(P<0.001,P=0.024).T2WI signal intensity of ONB were higher than DLBCL(P<0.001).ONB showed more signs of outward turbinate and lobulation(P=0.001,P=0.004).ADCave of ONB was obviously higher than DLBCL(P<0.001).On DCE-MRI,ONB showed higher CImax,WR(P<0.001,P=0.011),lower TTP than DLBCL(P=0.003).ONB presented more wash-out type TIC curve(P=0.022).Logistic regression analysis demonstrated that tumor location(olfactory cleft or maxillary sinus),T2WI intensity,ADCave with cutoff value of 0.82×10-3mm2/s and TTP with cut off value of 52 seconds were the most predictive MRI features for differentiation.CONCLUSION The multiple MRI conventional and functional parameters are helpful in differentiating ONB from DLBCL.

OBJECTIVE To Analysis of CT and MRI imaging features of arrested pneumatisation of the sphenoid sinus and differentiate from osteogenic and chondrogenic tumours of the region.METHODS Retrospective analysis of CT and MRI findings was performed of 13 patients with sphenoid sinus arrested pneumatisation and 20 patients with osteogenic and chondrogenic tumours and tumor like lesions in the same period.Evaluation indicators included location,size,density,presence of expansive changes,calcification,cortical bone changes,MRI signal characteristics,signal changes after fat suppression,degree of enhancement,and statistical analysis was conducted.RESULTS Finally,the location includes the sphenoid body(4 cases),pterygoid process(3 cases)and multiple involved areas(6 cases).The arrested pneumatisation area is mainly characterized by fat density or mixed density of adipose and soft tissue.The longest diameter of the arrested pneumatisation zone is 0.8-4.1 cm.There is internal calcification(7 cases)and without bone expansive changes(13 cases).Cases with intact bone cortex(13 cases);On MRI T1WI,high signal(11 cases),equal signal(2 cases),on T2WI,high signal(10 cases),equal signal(3 cases).Decreased signal after fat suppression(13 cases),no significant enhancement(10 cases),and slight enhancement(3 cases).CONCLUSION The arrested pneumatisation of sphenoid sinus is a rare anatomical variation characterized by a mixed density of fat or soft tissue,intact bone cortex,without bone expansive changes,decreased signal of MRI fat suppression,and no obvious enhancement,which will help to differentiate from osteogenic and chondrogenic tumours of the region.

Objective:To analyze the efficacy of endoscopic surgery for frontal sinus meningoencephalocele and cerebrospinal fluid (CSF) leaks, and to explore endoscopic surgical strategy.Methods:A total of 35 patients with frontal sinus meningoencephalocele and CSF leaks who underwent endoscopic transnasal surgery at Beijing Tongren Hospital, Capital Medical University between May 2007 and December 2023 were enrolled in this retrospective case series, including 29 males and 6 females, with the age of (35.23±15.76) years. High-resolution sinus CT and magnetic resonance cisternography were undertaken before surgery. The primary outcome measure was the success rate of endoscopic surgical repair. Statistical analysis was conducted using SPSS 27 and GraphPad Prism 8 software.Results:Of the 35 cases, 21 (60.0%) were traumatic, and 14 (40.0%) were non-traumatic. The most common defect was in the posterior frontal sinus wall (24 cases, 68.6%), with a defect size of (10.4±4.8) mm 2. Twenty-six cases (74.3%) underwent endoscopic transnasal Draf Ⅱa-Ⅲ frontal sinusotomy, and 9 cases (25.7%) underwent endoscopic transnasal Darf Ⅱb-Ⅲ frontal sinusotomy combined with frontal trephination. The average follow-up time was (84.72±57.42) months. The success rate of one-time endoscopic repair was 97.1% (34/35). One patient required a second procedure, resulting in an overall success rate of 100%. Thirty-three patients had a widely patent frontal sinus ostium postoperatively, while two experienced stenosis. Conclusions:Endoscopic surgery is effective for treating frontal meningoencephalocele and CSF leaks while preserving frontal sinus drainage. Combined frontal trephination is recommended for defects that are difficult to repair using the conventional transnasal approach.

OBJECTIVE To analyze the MSCT and MRI imaging manifestations of patients with duplication of the internal auditory canal(DIAC),improve understanding of the deformity,to provide preoperative basis for cochlear implantation.METHODS Retrospective observation of 20 cases(24 ears)of DIAC inner ear multi-spiral CT(MSCT)and MRI data,measurement and analysis of the width of the internal auditory canal(IAC)and cochlear nerve canal in the lesion group and the control group.RESULTS All DIACs had stenosis of the IAC cambined with other temporal bone malformations.MSCT shows that the 21 ears IAC,while MRI hydrography shows the 16 ears IAC divided into double tubes by bone.MRI hydrography shows a slender vestibulocochlear nerve.There were statistically significant differences(P<0.001)in the width of IAC and cochlear nerve canal between the lesion group and the control group.Six cases(8 ears)had varying degrees of hearing recovery after cochlear implant surgery.CONCLUSION DIAC shows stenosis of the IAC;The bone septa shown on MSCT are its characteristic fertures;MRI hydrography shows underdeveloped vestibular and cochlear nerves;The combination of two imaging examination methods can provide objective reference for the diagnosis of this disease and artificial auditory implantation.

Ear, Inner/diagnostic imaging* ; Temporal Bone/diagnostic imaging* ; Tomography, X-Ray Computed/methods*

Objective:To compare the diagnostic value of three quantitative evaluation methods based on three-dimensional rapid fluid attenuation inversion recovery sequence (3D-FLAIR) vein-enhanced labyrinth images in endolymphatic hydrops.Methods:From October 2017 to April 2019, a retrospective study was conducted on 86 patients with unilateral otogenic vertigo who were admitted to Beijing Tongren Hospital, Capital Medical University. MRI was performed 8 h after the single-dose Gd-DTPA intravenously injection in all patients. Three evaluation methods were used to calculate the ratio of the endolymphatic area to the total lymphatic area, the ratio of the saccule to utricle area, and the ratio of the endolymphatic volume to the total lymphatic volume, respectively. The paired t test was used to compare the three ratios between the affected and healthy ears. With clinical diagnosis as the gold standard, the receiver operating characteristic (ROC) curve analysis was used to analyze the efficacy of three methods in diagnosing endolymphatic hydrops. Results:Totally 65 cases were finally diagnosed endolymphatic hydrops clinically. There were statistically significant differences of all the 3 ratios between the affected and healthy ears ( t=9.93, 7.22, 8.20, all P<0.001). The ROC curve showed that the area under the curve (AUC) of endolymph/total lymph area ratio, saccule/utricle area ratio, endolymph/total lymph volume ratio for diagnosis of endolymphatic hydrops were 0.882, 0.768, 0.884 (all P<0.001). And there were no significant differences between each paired AUCs (all P>0.05). Conclusions:All three methods of endolymph/total lymph area ratio, saccule/utricle area ratio, endolymph/total lymph volume ratio can quantitatively evaluate endolymphatic hydrops. The endolymphatic/total lymphatic area ratio method is still the most convenient method at present.