Israel Medical Association Journal

Background: Surgery for the closure of nasal septal perforation is challenging. Numerous techniques have been described.

Objectives: To assess whether nasal septal perforations heal more consistently if a connective tissue scaffold is placed between the repaired septal flaps.

Methods: We performed closure of a septal perforation via a closed approach using oral mucosal flaps without the interposition of a connective tissue graft in seven patients.

Results: Complete perforation closure was achieved in 5 cases (83.3%). There was no significant donor site morbidity.

Conclusions: These initial results suggest that this is an effective technique for closing nasal septal perforations; it obviates the morbidity of the open approach and the added operating time and morbidity associated with the harvesting of a connective tissue graft.

Background: Spinal dural arteriovenous fistulae comprise the majority of spinal vascular malformations. The most common clinical presentation is that of progressive myelor­adicuiopathy, probably related to venous hypertension, which may lead to permanent disability and even death.

Objective: To report our clinical experience with spinal dural arteriovenous fistulae.

Methods: Nine patients with spinal dural AVF were managed at our center during a one year period (1998-1999). The patients, eight men and one woman ranging in age from 46 to 75 years, presented with initially fluctuating and eventually permanent and progressive paraparesis, sensory disturbances and sphincter dysfunction. The neurological signs generally began symmetrically and progressed from the distal to proximal limb regions. The duration of symptoms before diagnosis ranged from 6 to 36 months during which the patients underwent an extensive but fruitless work-up and even unnecessary operations due to misdiagnosis. All patients finally underwent magnetic resonance imaging and spinal angiography, which demonstrated the pathological vascular fistula. Interruption of the AVF was achieved by embolization or by surgical resection.

Results: Following treatment, six patients experienced improvement of gait and sphincter control, and the severe neurological deficits stabilized in the other three patients with long duration of illness. There was no further deterioration in any of the treated patients.

Conclusions: The history, neurological findings and radiological changes on MRI scan should alert clinicians to the possibility of spinal dural AVF, leading to diagnostic spinal angiography. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mortality.