In recent years exploration of the canalis fasciculi optici is indicated more often because of traffic and factory worker's accidents resulting in fractures of the canalis. The canalis has also to be explored when it is injured during the paranasal sinus operation As for exploring techniques of the canalis fasciculi optici, many extranasal approaches have been reported. In our department transnasal approach is practiced since it was advocated by Prof. Takahashi in 1951. Along with our several recently encountered cases, operative technique of the transnasal approach was re-introduced. By this method, the paranasal sinuses and the osseous prominence of the canalis fasciculi optici are well exposed and their anatomical inter-relation is well recognized. Cause and effect of visual impairment due to fracture of the canalis fasciculi optici and the regional anatomy were discussed.
The first case is that of a 22 year old male whose palatopharngeal synechia was presumably due to combined effects of congenital syphilis, operation for chronic parasinusitis and irradiation for right cervical lymphoadenopathy. The another case was that of a 25-years-old female with chronic nephritis and acrocyanosis. This was apparently secondary to tuberculous pharyngitis. The patients were treated satisfactorily by punching the palatine bone in the first case and. by palatopharyngoplasty in the second. Twenty five cases of palatopharyngeal synechia were reported in the Japanese literatures-12 cases of syphilitic, 6 tuberculous, 2 severe pharyngeal inflammation, 2 congenital malformation and each one of scarlet fever, purpura and pharyngeal stenosis of unknown nature. Nine of them including our cases were those of complete obstruction.
Malignant tumors, sarcoma in particular, originating from the temporal region are rarely encountered. Our recent encounter with two such cases were reported. One case was of ossifying sarcoma which invaded both nasopharynx and mid-cranium, and metastasized to the hypophysis. The another case was of fibrosarcoma with ossifying fibroma, in which primary lesion was treated by complete excision and irradiation. But the patient developed lung and ribmetastasis. The two cases terminated in death.
In a consecutive series of 120 patients who presented with recurrent episodes of vertigo were studied by angiography. All the vertigo were ascertained not due to peripheral in etiology but to the “central” disorder of the vestibular system by means of neuro-otological studies. Among the 120 cases there were 100 with abnormal angiograms, 10 having multiple lesions. The details of all the lesions were; 1) Vertebral indentation by osteophyte due to cervical spondylosis (29 cases) (Fig. 7, 8 pre-op, Fig. 9 post-op) 2) Intermittent vertebral artery compression-Powers' syndrome (62 cases) (Fig. 10 pre-op, 11 post-op. Fig. 12) 3) Vertebral stenosis due to atherosclerosis (4 cases) (Fig. 4) 4) no visualized left vertebral artery ether by aortography or surgery or both (3 cases) (Fig. 3. A) 5) No communication between the right vertebral and the basilar. Vertebral artery terminates into the posterior inferior cerebellar artery (4 cases) (Fig. 3. B) 6) Basilar stenosis (2 cases) 7) Bilateral internal carotid occlusion (1 case) 8) Teleangiectasis juxta-basalis (occlusion of circle of Willis) (1 case) 9) Internal and external carotid stenosis (8 cases) The striking features were first, high incidence of extracranial location of the lesion, second the fact that anatomical anomalies of the vertebral artery which one of the two is not demonstrated or does not contribute to form the basilar encountered upto 7% in this series, and the third, high incidence of Powers' syndrome some of which had antecedent whip-lash injury to the neck. Surgery was performed in 66 cases and three different procedures were made based on the lesion noted on the angiogram. First, original methode described by Powers for the syndrome of Powers in 52 cases, second, removal of osteophyte and anterior hemiresection of transverse process decompressing vertebral artery as treatment of vertebral artery indentation by osteophyte in 12 cases, third, the correction of kinked vertebral artery at its origin in 2 cases. With follow-up, longest to 22 months, none had recurred the symptom except a female of 40 years with vertebral indentation by osteophyte in whom recurrence developed after extraction of her teeth. Finally, the effect of vascular insufficiency upon the oculomotor system in the brain stem was discussed with a purpose for an aid to the neurological diagnosis of brain stem dysfunction due to vascular disorder. In our opinion, presence of two findings mentioned below might suggest this kind of dysfunction of the oculomotor system in the brain stem. (1) Absence or poor development of the optokinetic after nystagmus in spite of the fact that normal or near normal activity is preceding. (Fig. 15 and 16) (2) Disturbance of smooth sinusoidal tracking movement of the eyes with ocular dysmetria and saccadic movements in one or both directions. (Fig. 17) Following further elucidation, we will report on this regard.