scholarly journals Quantification of Subdural Electrode Shift Between Initial Implantation, Postimplantation Computed Tomography, and Subsequent Resection Surgery

2018 ◽  
Vol 16 (1) ◽  
pp. 9-19
Author(s):  
Xiaoyao Fan ◽  
David W Roberts ◽  
Yasmin Kamal ◽  
Jonathan D Olson ◽  
Keith D Paulsen
Keyword(s):  
Computed Tomography ◽  
Case Series ◽  
Cortical Surface ◽  
Lateral Direction ◽  
Subdural Electrode ◽  
Initial Placement ◽  
Preoperative Magnetic Resonance ◽  
The Times ◽  
Initial Implantation ◽  
Intracranial Electrodes

Abstract BACKGROUND Subdural electrodes are often implanted for localization of epileptic regions. Postoperative computed tomography (CT) is typically acquired to locate electrode positions for planning any subsequent surgical resection. Electrodes are assumed to remain stationary between CT acquisition and resection surgery. OBJECTIVE To quantify subdural electrode shift that occurred between the times of implantation (Crani 1), postoperative CT acquisition, and resection surgery (Crani 2). METHODS Twenty-three patients in this case series undergoing subdural electrode implantation were evaluated. Preoperative magnetic resonance and postoperative CT were acquired and coregistered, and electrode positions were extracted from CT. Intraoperative positions of electrodes and the cortical surface were digitized with a coregistered stereovision system. Movement of the exposed cortical surface was also tracked, and change in electrode positions was calculated relative to both the skull and the cortical surface. RESULTS In the 23 cases, average shift of electrode positions was 8.0 ± 3.3 mm between Crani 1 and CT, 9.2 ± 3.7 mm between CT and Crani 2, and 6.2 ± 3.0 mm between Crani 1 and Crani 2. The average cortical shift was 4.7 ± 1.4 mm with 2.9 ± 1.0 mm in the lateral direction. The average shift of electrode positions relative to the cortical surface between Crani 1 and Crani 2 was 5.5 ± 3.7 mm. CONCLUSION The results show that electrodes shifted laterally not only relative to the skull, but also relative to the cortical surface, thereby displacing the electrodes from their initial placement on the cortex. This has significant clinical implications for resection based upon seizure activity and functional mapping derived from intracranial electrodes.

scholarly journals Axillary Nerve Position in Humeral Avulsions of the Glenohumeral Ligament

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881104 ◽  
Author(s):  
Desmond J. Bokor ◽  
Sumit Raniga ◽  
Petra L. Graham
Keyword(s):  
Safety Margin ◽  
Case Series ◽  
Free Edge ◽  
Axillary Nerve ◽  
Level Of Evidence ◽  
Glenohumeral Ligament ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri ◽  
Potential Damage ◽  
Hagl Lesion

Background: The axillary nerve is at risk during repair of a humeral avulsion of the glenohumeral ligament (HAGL). Purpose: To measure the distance between the axillary nerve and the free edge of a HAGL lesion on preoperative magnetic resonance imaging (MRI) and compare these findings to the actual intraoperative distance measured during open HAGL repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 25 patients with anterior instability were diagnosed as having a HAGL lesion on MRI and proceeded to open repair. The proximity of the axillary nerve to the free edge of the HAGL lesion was measured intraoperatively at the 6-o’clock position relative to the glenoid face. Preoperative MRI was then used to measure the distance between the axillary nerve and the free edge of the HAGL lesion at the same position. Distances were compared using paired t tests and Bland-Altman analyses. Results: The axillary nerve lay, on average, 5.60 ± 2.51 mm from the free edge of the HAGL lesion at the 6-o’clock position on preoperative MRI, while the mean actual intraoperative distance during open HAGL repair was 4.84 ± 2.56 mm, although this difference was not significant ( P = .154). In 52% (13/25) of patients, the actual intraoperative distance of the axillary nerve to the free edge of the HAGL lesion was overestimated by preoperative MRI. In 36% (9/25), this overestimation of distance was greater than 2 mm. Conclusion: The observed overestimations, although not significant in this study, suggest a smaller safety margin than might be expected and hence a substantially higher risk for potential damage. We recommend that shoulder surgeons exercise caution in placing capsular sutures in the lateral edge when contemplating arthroscopic repair of HAGL lesions, as the proximity of the nerve to the free edge of the HAGL tear is small enough to be injured by arthroscopic suture-passing instruments.

scholarly journals SPLENIC CYST

2014 ◽  
Vol 2 (3) ◽  
Author(s):  
Larissa L. Garcia ◽  
Fernanda L. Lomanto ◽  
Felipe Simões da Rocha Mata ◽  
Dilton Mendonça
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Clinical Case ◽  
Standard Treatment ◽  
Clinical Status ◽  
Exploratory Laparotomy ◽  
Splenic Cyst ◽  
Splenic Cysts ◽  
The Times ◽  
Total Splenectomy

Background: Splenic cysts are rare in children. They are classified into primary and secondary, also called pseudocysts. The primary feature capsule and can be congenital, vascular or neoclassical. The diagnosis, in most cases, is incidental because it is asymptomatic clinical status. The diagnosis is confirmed by Ultrasound and / or Computed Tomography (CT) of the abdomen. Case Report: Patient, I.T.S.A, female, 11 years old, complains of increasing abdominal size. The diagnosis of splenic cyst was confirmed with an exploratory laparotomy. The pathology suggests reactive mesothelial hyperplasia. The patient underwent a total splenectomy and recovered without complications. Conclusions: Splenic cysts are incidental findings, most of the times it has been an asymptomatic clinical status. In the clinical case described, the patient showed a significant increase in the abdomen. She underwent exploratory laparotomy and, consequently, total splenectomy, which is the standard treatment in cases of giants splenic cysts.

scholarly journals Ultrasound evaluation of complications after cardiovascular surgery in pediatric patients: A case series

2020 ◽  
Vol 1 (1) ◽  
pp. 108 ◽  
Author(s):  
Takahiro Hosokawa ◽  
Sio Suzuki ◽  
Yutaka Tanami ◽  
Yumiko Sato ◽  
Yoshihiro Ko ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Early Diagnosis ◽  
Radiation Exposure ◽  
Pediatric Patients ◽  
Cardiovascular Surgery ◽  
Case Series ◽  
Early Initiation ◽  
Site Infection ◽  
Ultrasound Evaluation ◽  
Selection Of

In contrast to computed tomography, ultrasound can be performed without radiation exposure, repeatedly performed by the patients’ bedside. Hence, in this case series, we describe the evaluation of complications including hematoma, superficialsurgical site infection, mediastinitis, and pseudoaneurysm associated mediastinitis using ultrasound in pediatric patients after cardiovascular surgery. To our knowledge, no previous reports have evaluated such complications using ultrasound. Ultrasound may be useful for the early diagnosis of these complications, and in the selection of subsequent examinations such as computed tomography, resulting in the early initiation of intervention.

ISOLATED ILIAC ARTERY ANEURYSM- 10 YEARS INSTITUTIONAL EXPERIENCE

2021 ◽  
pp. 28-30
Author(s):  
Prashant Raman ◽  
Prathap Kumar S ◽  
Velladuraichi B ◽  
N Sritharan
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Iliac Artery ◽  
Case Series ◽  
Artery Aneurysm ◽  
Preoperative Imaging ◽  
Abdominal Ultrasonography ◽  
Iliac Artery Aneurysm ◽  
Elective Repair ◽  
Risk Patients

Objective: To review the experience of our institution in repairing isolated iliac artery aneurysm (isolated IAA) in the last 10 years. Introduction: Unlike abdominal and combined aortoiliac artery aneurysms, isolated iliac artery aneurysms (IIAAs) are uncommon. An isolated iliac artery aneurysm is dened as a twofold increase in the diameter of the iliac artery without a coexisting aneurysm at another location. IIAA was encountered infrequently in the past, comprising 0.9% to 4.7% of all intra-abdominal aneurysms according to a review of previous studies; however, in recent times, many asymptomatic IIAAs have been detected incidentally because of the widespread use of abdominal ultrasonography and computed tomography. Methods: The medical records of patients who underwent isolated IAA repair at Institute of vascular sciences, MMC and RGGGH, Chennai, India, were reviewed, to obtain information on patients' demographics, vascular risk factors, type of treatment and outcome Results: A total of 13 patients with 18 aneurysms, 11 men(84.6%) 2 women(15.4%), with a mean age of 58.1±6 years, and two paediatric patients of age 11yrs (Female) and 3 months (Male) were treated. The mean diameter was 4.6 ± 1.0 for non-ruptured at elective repair; 5.5±2.1 cm on the emergency cases. The majority of aneurysms were at the common iliac artery. All of them except one, underwent open repair.Ten (84%) had elective operations, and two (16%) emergency repair for ruptured aneurysm. Hypertension and diabetes were seen as the most common risk factors with most of the patients were smokers. One was a known case of CKD and the paediatric female was a known case of RHD. There was one postoperative death in this series, patient succumbed on POD 1. Conclusion: This case series reviews the literature with regard to the natural history, diagnostic workup, and treatment of iliac artery aneurysms. For patients undergoing elective repair, preoperative imaging with computed tomography or magnetic resonance is advocated. Repair is recommended for good-risk patients with aneurysms larger than 3.5 cm as there is high chances of rupture with increasing diameter.

Diagnosis of lung cancer: a necropsy-based study of 128 cases (1997–2016)

2020 ◽  
pp. 030089162094966
Author(s):  
Pietro Gino Barbieri ◽  
Dario Mirabelli
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Case Series ◽  
The Elderly ◽  
Positive Finding ◽  
Chest Computed Tomography ◽  
Pleural Plaques ◽  
High Prevalence ◽  
Diagnosis Of Lung Cancer ◽  
Clinical Records

Background: The diagnosis of lung cancer (LC) may be difficult to make in the elderly. We report on the diagnostic elements available in life in an LC necropsy case series of asbestos-exposed workers and describe the frequency of non-neoplastic asbestos-related diseases as biological exposure indices. Methods: We reviewed pathologic and clinical records of an unselected series of autopsies (1997–2016) in patients with LC employed in the Monfalcone shipyards. We assessed the consistency with autopsy results of diagnoses based on, respectively, radiologic, cytologic, and histologic findings. Results: Data on 128 autopsy-confirmed LC cases were available; in life, 119 had been diagnosed as LC. Among these, 49 had histologic confirmation of diagnosis (17 with immunophenotyping); histology had been negative in 4. Cytology had been the main positive finding and the basis for diagnosis in 24 cases, but had been negative in 13. Chest computed tomography had been the basis for diagnosis in 45; in 18 cases, it had been negative. Nine patients had received a diagnosis different from LC, among whom 4 had been suspected to have malignant pleural mesothelioma by chest computed tomography. Pleural plaques were found in 124 and histologic asbestosis in 46 cases. Conclusions: Autopsies confirmed all LC diagnoses received in life, including 46 that would have been considered only possible LC based on clinical workup. The overall survival in this case series was poor. The high prevalence of pleural plaques and asbestosis suggest severity of asbestos exposures.

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