Neglected epiphyseal injuries of the distal end of the radius with ulnar impaction: analysis of distal osteotomy of both bones using a dorsal midline approach

Patients with von Hippel Lindau (VHL) disease develop multiple central nervous system hemangioblastomas (HB). The surgical resection of VHL-HBs is the standard of clinical care when these HBs become symptomatic due to tumor growth, edema, or cyst formation. VHL-HBs frequently present at the obex of the brainstem, making this a challenging surgical problem. Here, we present a case of a large symptomatic brainstem VHL-HB that was resected using a dorsal midline approach and midline myelotomy. This 35-year-old man with VHL disease and multiple prior resections of cerebellar hemangioblastomas presented with progressive bilateral upper extremity weakness, ataxia, and dysphagia. The accompanying two-dimensional (2D) video demonstrates the key techniques for resection of this brainstem hemangioblastoma, including recognizing the pial presentation, sharp pial/subpial dissection, and en bloc removal. Subsequently, we discuss circumferential dissection, identification, and division of feeding vessels. We also demonstrate key maneuvers to recognize and divide the main arterial pedicle while preserving the anterior spinal artery. The patient tolerated the resection without complication and the patient was discharged home after 6 days at his baseline neurologic function. This work was supported by the Intramural Research Program of the National Institutes of Health.The link to the video can be found at: https://youtu.be/mb2VqcLpxDQ.

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Scanning electron microscopy of the integument of schistosoma rodhaini

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010014230x ◽

1986 ◽

Vol 44 ◽

pp. 132-133

Author(s):

P. Evers ◽

C. Schutte ◽

C. D. Dettman

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Oral Sucker ◽

Adult Male ◽

Dorsal Surface ◽

Ventral Surface ◽

Sensory Receptors ◽

East African ◽

Dorsal Midline ◽

Scanning Electron

S.rodhaini (Brumpt 1931) is a parasite of East African rodents which may possibly hybridize with the human schistosome S. mansoni. The adult male at maturity measures approximately 3mm long and possesses both oral and ventral suckers and a marked gynaecophoric canal. The oral sucker is surrounded by a ring of sensory receptors with a large number of inwardly-pointing spines set into deep sockets occupying the bulk of the ventral surface of the sucker. Numbers of scattered sensory receptors are found on both dorsal and ventral surfaces of the head (Fig. 1) together with two conspicuous rows of receptors situated symmetrically on each side of the midline. One row extends along the dorsal surface of the head midway between the dorsal midline and the lateral margin.

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Posterior Midline Approach for Large Anterior/Anterolateral Foramen Magnum

Skull Base ◽

10.1055/s-2007-981788 ◽

2007 ◽

Vol 17 (S 2) ◽

Author(s):

Virender Khosla ◽

Sunil Gupta ◽

Rajesh Chhabra ◽

Kanchan Mukherjee

Keyword(s):

Foramen Magnum ◽

Midline Approach ◽

Posterior Midline

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Oblique Step Ulnar Shortening Osteotomy for Management of Posttraumatic Ulnar Impaction

Journal of Surgical Orthopaedic Advances ◽

10.3113/jsoa.2012.0067 ◽

2012 ◽

Vol 21 (02) ◽

pp. 67-77

Author(s):

Edward K. Rodriguez ◽

W. Andrew Eglseder

Keyword(s):

Ulnar Shortening Osteotomy ◽

Ulnar Impaction ◽

Shortening Osteotomy

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Posterior Midline Approach for a C2 Schwannoma: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa409 ◽

2020 ◽

Author(s):

Sorin Aldea ◽

Abdu Alkhairy ◽

Irina Joitescu ◽

Caroline Le Guerinel

Keyword(s):

Posterior Approach ◽

Main Step ◽

Surgical Removal ◽

Posterior Arch ◽

Favorable Result ◽

Lateral Compression ◽

Bone Removal ◽

Far Lateral ◽

Midline Approach ◽

Posterior Midline

Abstract C2 schwannomas are rare lesions that may develop in the spinal canal, in the area of the C2 ganglion situated posterior to the C1C2 articulation, in the extraspinal area or in a combination of these 3 sectors.1,2 The surgical removal of these lesions is delicate because of the intimate relationships the schwannomas develop with the V3 segment of the vertebral artery. A variety of lateral, far-lateral, or extreme lateral approaches have been described in order to tackle these lesions. We use a posterior midline approach that takes advantage of the predominantly extradural development of C2 schwannomas. In this technique, the main step is the debulking of the posterior articular sector of the tumor, which is easily accessible through a midline posterior approach and necessitates minimal bone removal. In most cases, removal of the homolateral posterior arch of C1 is sufficient in order to create an adequate access. These maneuvers create the necessary space for dissecting both the intradural and extraspinal sectors of the schwannoma. We present this technique through a case with a minimal intradural component exerting mainly a lateral compression of the spinal cord. The tumor was operated through the midline mini-invasive posterior approach with a favorable result. We demonstrate the surgical technique in video and discuss the nuances.

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Distal Metaphyseal Ulnar Shortening Osteotomy for Ulnar Impaction

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(11)60061-0 ◽

2011 ◽

Vol 36 (8) ◽

pp. 52-53

Author(s):

John C. Hildenbrand ◽

Jeffrey A. Greenberg

Keyword(s):

Ulnar Shortening Osteotomy ◽

Ulnar Impaction ◽

Shortening Osteotomy

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Pronated Grip View With Wrist Deviation: A Pilot Study on the Effect on Ulnocarpal Relationships

Hand ◽

10.1177/15589447211028928 ◽

2021 ◽

pp. 155894472110289

Author(s):

Anthony L. Logli ◽

Beth A. Schueler ◽

Laurel A. Littrell ◽

Sanjeev Kakar

Keyword(s):

Pilot Study ◽

Surface Area ◽

Coronal Plane ◽

Ulnar Deviation ◽

Radial Deviation ◽

Wrist Position ◽

Standardized Protocol ◽

Ulnar Impaction ◽

Lunate Surface ◽

Adult Volunteers

Background We hypothesize that different positions of the wrist in the coronal plane makes the carpus susceptible to ulnar impaction. Methods We prospectively enrolled 10 adult volunteers and obtained fluoroscopic images of each wrist in 12 different positions using a standardized protocol. Distances from the ulna to the lunate (UL) and ulna to the triquetrum (UT) were digitally measured as was the portion of the lunate surface area that was uncovered (LUR) with wrist deviation. Results A wrist position of Pronation, Neutral Deviation, and Grip (P-ND-G) significantly shortened the ulnocarpal distance when compared to a position of Neutral Rotation, Neutral Deviation, and No Grip (NR-ND-NG). Radial deviation during pronation and gripping (Pronated, Radial Deviation, Gripping [P-RD-G]) resulted in the lowest mean UL distance (1.2 mm). UT distance was minimized by a position of ulnar deviation during a pronated grip (Pronated, Ulnar Deviation, Gripping [P-UD-G]) (3.1 mm). The lunate becomes more uncovered with radial deviation. Conclusion Radial deviation minimizes the UL distance while ulnar deviation minimizes the UT distance during a wrist position of pronation and gripping. Further, there is more proximal lunate surface area uncoverage during all positions of radial deviation compared to ulnar deviation.

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