scholarly journals Quantitative Prediction of the Location of Carotid Bifurcation and Neurovascular Structures in the Carotid Region: A Cross-Sectional Cadaveric Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Daniel W. Griepp ◽  
Abin Sajan ◽  
Robert DiRaimo ◽  
Lev Starikov ◽  
Samuel Márquez
Keyword(s):  
Cranial Nerve ◽  
Carotid Bifurcation ◽  
Quantitative Prediction ◽  
Mastoid Process ◽  
Superior Thyroid Artery ◽  
Cross Sectional ◽  
Important Landmark ◽  
Vascular Structures ◽  
Neurological Surgery ◽  
Neurovascular Structures

Introduction. The carotid region is encountered in vascular and neurological surgery and carries a potential for vascular and cranial nerve trauma. The carotid bifurcation is an especially important landmark and difficult to predict based on currently established landmarks. This study is a detailed analysis of the carotid region and proposes a novel methodology to predict the height of the bifurcation. Materials and Methods. Superficial and deep dissections were performed on the anterior triangle of the neck to expose the carotid region in twenty-one formalin-fixed donor cadavers. Musculoskeletal and neurovascular structures were assessed in relation to the carotid bifurcation and the medial border of the clavicle (MBC). Results. The carotid bifurcation occurred, on average, 11.4 mm higher on the left ( p < 0.001 ; 95% CI: 9.28, 13.54). The superior thyroid artery ( p < 0.001 ), facial vein ( p < 0.001 ), and cranial nerve XII ( p < 0.001 ) were all more distal on the left side when measured from the MBC while the angle of the mandible and stylohyoid muscle remained symmetric. Left- and right-sided vascular structures were symmetric when measured from the carotid bifurcation. Conclusions. Neurovascular structures within the carotid region are likely to be anatomically superior on the left side while vessels are likely to remain symmetric in relation to the carotid bifurcation. When measured from the MBC, the bifurcation height can be predicted by multiplying the distance between the MBC and mastoid process by 0.65 (right side) or 0.74 (left side). This novel methodological estimation may be easily learned and directly implemented in clinical practice.

Cerebellopontine Angle Epidermoids: Comparative Results of Microscopic and Endoscopic Excision Using the Retromastoid Approach”

2021 ◽  
Author(s):  
Suyash Singh ◽  
Kuntal Kanti Das ◽  
Krishna Kumar ◽  
Kamlesh Rangari ◽  
Priyadarshi Dikshit ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Surgical Excision ◽  
Csf Leak ◽  
Tumor Extension ◽  
Endoscopic Excision ◽  
Endoscopic Assistance ◽  
Comparative Results ◽  
Neurovascular Structures

Abstract Background Densely packed neurovascular structures, often times inseparable capsular adhesions and sometimes a multicompartmental tumor extension, make surgical excision of cerebellopontine angle epidermoids (CPEs) a challenging task. A simultaneous or an exclusive endoscopic visualization has added a new dimension to the classical microscopic approaches to these tumors recently. Method Eighty-six patients (age: 31.6 ± 11.7 years, M:F = 1:1) were included. Nineteen patients (22.1%) had a multicompartmental tumor. Tumor extension was classified into five subtypes. Sixty-two patients underwent a pure microscopic approach (72%) out of which 10 patients (16%) underwent an endoscope-assisted surgery (11.6%) and 24 patients (28%) underwent an endoscope-controlled excision. Surgical outcomes were retrospectively analyzed. Results Headache (53.4%), hearing loss (46.5%), and trigeminal neuralgia (41.8%) were the leading symptoms. Interestingly, 21% of the patients had at least one preexisting cranial nerve deficit. Endoscopic assistance helped in removing an unseen tumor lobule in 3 of 10 patients (30%). Pure endoscopic approach significantly reduced the hospital stay from 9.2 to 7.3 days (p = 0.012), and had a statistically insignificant yet a clearly noticeable lesser incidence of subtotal tumor excision (0 vs. 10%, p = 0.18) with comparable cranial nerve deficits but with a higher postoperative cerebrospinal fluid (CSF) leak rate (29% vs. 4.8%, p = 0.004). Conclusion Endoscope assistance in CPE surgery is a useful addition to conventional microscopic retromastoid approach. Pure endoscopic excision in CPE is feasible, associated with a lesser duration of hospital stay, better extent of excision in selected cases, and it has a comparable cranial nerve morbidity profile albeit with a higher rate of CSF leak.

scholarly journals Variations in the Branching Pattern of External Carotid Artery in South Kerala Population – A Cadaveric Study

2021 ◽  
Vol 8 (22) ◽  
pp. 1780-1785
Author(s):  
Manju Sudhakaran ◽  
Mini Alikunju ◽  
Vandana Latha Raveendran ◽  
Umesan Kannanvilakom Govindapillai
Keyword(s):  
Carotid Artery ◽  
Head And Neck ◽  
Carotid Arteries ◽  
Carotid Bifurcation ◽  
External Carotid Artery ◽  
External Carotid ◽  
Superior Thyroid Artery ◽  
South Indian Population ◽  
Branching Pattern ◽  
South Indian

BACKGROUND External carotid arteries account for a major share of arterial supply of head and neck regions. As variations are frequently observed in the branching pattern of external carotid artery, surgeons, radiologists and anaesthetists often encounter difficulties in various procedures of head and neck. The purpose of this study is to describe the variations in the branching pattern of external carotid artery as observed in South Indian population which definitely reduces its iatrogenic injuries associated with surgical and radiological procedures of head and neck. METHODS This is cross-sectional descriptive study. Bilateral neck dissection was done on twenty-two formalin fixed cadavers to study the branching pattern of external carotid artery during a period of two years in the Department of Anatomy in Government Medical College, Alappuzha. Common carotid, external carotid and internal carotid arteries were dissected. All the branches of external carotid artery were traced and the variations were noted. The distance between carotid bifurcation and point of origin of individual branches of external carotid were measured and statistically analyzed. RESULTS In the present study along with normal branching pattern of external carotid artery, variations like origin of superior thyroid artery from common carotid artery and also from carotid bifurcation were seen. A common linguofacial trunk and direct origin of superior laryngeal artery from external carotid artery were also observed. CONCLUSIONS Prior knowledge of the variations will be helpful to surgeons and anaesthetists while dealing with these vessels during procedures of head and neck regions. KEYWORDS External Carotid Artery, Carotid Bifurcation, Superior Thyroid Artery, Linguofacial Trunk

Variations in origin of the superior thyroid artery: an update for the head and neck surgeon

2021 ◽  
Vol 103 (7) ◽  
pp. e238-e239
Author(s):  
S Shaw ◽  
K Maharaj ◽  
T Mirza
Keyword(s):  
Head And Neck ◽  
Neck Dissection ◽  
Anatomical Variation ◽  
Vascular Anatomy ◽  
Carotid Bifurcation ◽  
Classification Systems ◽  
Superior Thyroid Artery ◽  
Radial Forearm ◽  
Level I ◽  
Partial Glossectomy

Head and neck surgeons must have a thorough knowledge of head and neck vascular anatomy and its variations. This case report documents a variation in the superior thyroid artery encountered during a neck dissection and discusses the surrounding literature. A 55-year-old female with squamous cell carcinoma of the tongue underwent a partial glossectomy, right level I–IV neck dissection and reconstruction with a radial forearm free flap. During the procedure, an arterial branch was encountered arising 2–3cm caudal to the common carotid bifurcation. This variant branch was shown to represent the superior thyroid artery. On review of the literature, various classification systems of the superior thyroid artery origin have been described. Awareness of such anatomical variation is vital for the head and neck surgeon to avoid unexpected complication.

scholarly journals Radiographic study of mental foramen in Chitwan population

2019 ◽  
Vol 9 (4) ◽  
pp. 35-38
Author(s):  
Smriti Narayan Thakur ◽  
Meena Kumari Mishra ◽  
Basuraj Pandey ◽  
Harendra Singh ◽  
Shrijana Mishra
Keyword(s):  
Surgical Procedure ◽  
Panoramic Radiograph ◽  
Mental Foramen ◽  
P Value ◽  
Radiographic Study ◽  
Oral Medicine ◽  
Cross Sectional ◽  
Significant Difference ◽  
Important Landmark ◽  
Type 3

Background: Knowledge about the type & position of mental foramen is very much important landmark for dentists to perform any surgical procedure in the vicinity of mental foramen. The pur­pose of this study was to determine the most frequently occurring type & position of the mental foramen in Chitwan population using digital Panoramic Radiograph. Methods: This cross-sectional retrospective study was conducted on 500 (250 Male& 250 Female) digital panoramic radiograph which were collected from the department of Oral Medicine & Radi­ology. The type & position of Mental Foramen was analysed with Dicom viewer. The data obtained was statistically analyzed by with descriptive and inferential statistics using SPSS Version 20. Result: The most common type of mental foramen was Type 3 (diffuse with a distinct border of the foramen) & the test showed significant difference by gender. The most common position of mental foramen was position 4 (in line with second premolar) followed by position 3 (Between the first & second premolar) with no significant difference with gender with p-value <0.05. Conclusions: This study shows that the most frequent appearance of mental foramen lies in the line of second premolar. So this finding is used as a guide line in Chitwan population to perform various type of dental surgical procedure safely in mental foramen region but the accurate radio­graphic identification of mental foramen is paramount.

scholarly journals Micro-neurosurgical excision of dumbbell shaped very large jugular foramen schwannoma

2012 ◽  
Vol 18 (2) ◽  
pp. 183-192
Author(s):  
Forhad H Chowdhury ◽  
Mohammod R Haque ◽  
Mahmudul Hasan
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Young Male ◽  
Carotid Bifurcation ◽  
Short Review ◽  
Jugular Foramen ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Cervical Approach ◽  
High Cervical

Introduction: Jugular foramen tumor is a rare tumor. Jugular foramen schwannoma is rarer. This type of tumor may present in combination of different cranial nerve palsies in the form of different syndromes or may also be diagnosed incidentally. Management of such tumor is not straight forward.Case reports: Two young male presented with headache, vomiting, gait instability, right sided hearing loss. Clinically they had different cranial nerves dysfunction. Imaging showed jugular foramen tumor extending from posterior fossa to almost common carotid bifurcation at neck in both cases. Near total microsurgical excisions of the tumor were done through retrosigmoid suboccipital plus transmastoid high cervical approach with facial nerve mobilization in one case and without mobilization in other case. In case 1 combination of lower cranial nerve palsies is unique with inclusion of VIII nerve and that does not belong to any of the jugular foramen syndromes (i.e. Vernet, Collet- Sicard, Villaret, Tapia, Schmidt, and Jackson). Here IX, X, XI, XII and VIII cranial palsies was present (i.e.Collet-Sicard syndrome plus VIII nerve syndrome!). In the second case there was IX & X dysfunction with VIII dysfunction. We also went through the short review of the literature here DOI: http://dx.doi.org/10.3329/bjo.v18i2.12015 Bangladesh J Otorhinolaryngol 2012; 18(2): 183-192

scholarly journals Technical nuances in the management of tuberculum sellae and diaphragma sellae meningiomas

2013 ◽  
Vol 35 (6) ◽  
pp. E7 ◽  
Author(s):  
Anil Nanda ◽  
Sudheer Ambekar ◽  
Vijayakumar Javalkar ◽  
Mayur Sharma
Keyword(s):  
Visual Outcome ◽  
Surgical Excision ◽  
Visual Improvement ◽  
Microsurgical Techniques ◽  
Technical Details ◽  
Tuberculum Sellae ◽  
Vascular Structures ◽  
Diaphragma Sellae ◽  
Neurovascular Structures

Object Tuberculum sellae meningiomas (TSMs) and diaphragma sellae meningiomas (DSMs) are challenging lesions to treat due to their proximity to neurovascular structures. Methods The authors reviewed the medical records of patients who underwent surgical excision of TSMs and DSMs from 1990 to 2013. They also describe the technical strategies used to minimize injury to the optic apparatus, vascular structures, and pituitary stalk. Results Twenty-four patients with TSM and 6 patients with DSM were included in the study. Seventy percent of the tumors were large (≥ 5 cm). The pterional approach was employed in most cases. Optic canal involvement was observed in 4 patients. Twenty-one patients (70%) had visual dysfunction before surgery. At follow-up (median 18 months), visual improvement was noted in 10 (47.6%) of 21 patients. Gross-total excision was achieved in 22 patients (91.6%) with TSM and 5 (83.3%) with DSM. At last follow-up, 28 patients (93.3%) had a Glasgow Outcome Scale score of 5. There were no deaths in this series. Conclusions Tuberculum and diaphragma sellae meningiomas present a unique subset of tumors due to their location. They can be safely excised with minimal morbidity and mortality using microsurgical techniques. Attention to technical details during surgery leads to greater respectability and superior visual outcome.

Anatomic Considerations, Nomenclature, and Advanced Cross-sectional Imaging Techniques for Visualization of the Cranial Nerve Segments by MR Imaging

2014 ◽  
Vol 24 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Ari M. Blitz ◽  
Asim F. Choudhri ◽  
Zachary D. Chonka ◽  
Ahmet T. Ilica ◽  
Leonardo L. Macedo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Cranial Nerve ◽  
Imaging Techniques ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

scholarly journals Computer-assisted spatial reconstruction of cerebral blood vessels and intracranial aneurysms

2006 ◽  
Vol 59 (1-2) ◽  
pp. 24-27 ◽  
Author(s):  
Igor Nikolic
Keyword(s):  
Three Dimensional ◽  
Cerebral Aneurysms ◽  
Carotid Bifurcation ◽  
Computer Assisted ◽  
Three Dimensional Reconstruction ◽  
Conventional Angiography ◽  
Spatial Reconstruction ◽  
Dimensional Reconstruction ◽  
Vascular Structures ◽  
Carotid Aneurysms

Introduction. Today, many medical procedures are based on image analysis with the aim of providing accurate diagnosis and optimal treatment. The goal of this report was to present clinical implications of computer-assisted geometric design of carotid aneurysms. Material and methods. In this study, the three-dimensional reconstruction was based on the approximation power of the parametric spline function, which achieves interpolation and surface fitting of the arterial information obtained by conventional angiography. Two views of conventional angiograms (anterioposterior and lateral views) were used with a personal computer and commercial software. Results. This method of three-dimensional generated images was applied in 45 cases of cerebral aneurysms in carotid bifurcation. 3D reconstructions were made in approximately 20 minutes. They contributed to assessing vascular structures, and it was possible to rotate the three-dimensional image in different angles. Conclusion. Three-dimensional reconstruction of cerebral vessels is very useful for discussing surgical strategies preoperatively. Furthermore, it could also be used in endovascular procedures. .

scholarly journals Carotidynia: A Rare Diagnosis for Unilateral Neck Pain Revealed by Cross-Sectional Imaging

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Corrado Santarosa ◽  
Salvatore Stefanelli ◽  
Roman Sztajzel ◽  
Pravin Mundada ◽  
Minerva Becker
Keyword(s):  
Neck Pain ◽  
Correct Diagnosis ◽  
Rare Condition ◽  
Carotid Bifurcation ◽  
Emergency Setting ◽  
Imaging Features ◽  
Cross Sectional ◽  
Characteristic Imaging ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Idiopathic carotidynia (IC) is a rare and poorly understood syndrome consisting of unilateral neck pain, tenderness, and increased pulsations over the affected carotid bifurcation. A growing body of evidence supports the hypothesis that IC is a distinct clinicopathologic entity with characteristic imaging features. We report the case of a 34-year-old Caucasian male presenting with intense unilateral neck pain in the emergency setting. Computed tomography and ultrasonography revealed fusiform eccentric thickening of the ipsilateral carotid bifurcation without vessel narrowing. Contrast-enhanced magnetic resonance imaging depicted major perivascular enhancement without evidence of dissection. Further imaging and laboratory work-up excluded vasculitis. The diagnosis of IC was made. The patient was treated with nonsteroidal anti-inflammatory drugs and symptoms and imaging findings disappeared within a few weeks. Cross-sectional imaging allows not only ruling out IC mimickers but also making the correct diagnosis of this rare condition, in particular, as the clinical presentation of IC is often nonspecific.

scholarly journals The Research Status of Neurological Surgery Residents; A Survey of Iranian Residency Programs

2021 ◽  
Vol 8 (4) ◽  
pp. 193-197
Author(s):  
Mohammad Hossein Khosravi ◽  
Afsaneh Mehri ◽  
Sama Jabbaripour ◽  
Fatemeh Kazemi ◽  
Zahra Khosravi ◽  
...  
Keyword(s):  
Clinical Research ◽  
Online Survey ◽  
Survey Methods ◽  
Research Experience ◽  
Cross Sectional ◽  
Residency Programs ◽  
Research Education ◽  
Research Activities ◽  
Resident Physicians ◽  
Neurological Surgery

Background: Research activities promote the appreciation for evidence-based medicine (EBM), quality patient care and clinical competence of resident physicians. We decided to investigate the research background of Iranian neurological surgery residents and their attitude toward research through a survey. Methods: This cross-sectional study was done on Iranian neurological surgery resident physicians between February and April 2020. We provided an online survey, including 13 questions, using Google form and then sent the link to survey via WhatsApp application. Following the first post, two more reminders were sent to the groups after 2 and 4 weeks. Results: Responses were received from 89 respondents from which about 88% used to spend two hours or less per week for research. Almost equal numbers of resident physicians chose academic position (n=43) or private practice (n=39) as their future job. Only seven respondents stated immigration for assumed future job position. Clinical research (47%) was the most frequent type of research done by participants and clinical research education (43.2%) during medical school was the most common way of obtaining research experience. Agreement with doing research during residency program (45.6%) was more than disagreement (22.4%) and neutral attitude (32%). Conclusion: There is a low tendency among Iranian neurological surgery residents for conducting research projects during their programs. Lack of a proper research curriculum, heavy clinical duties and consequent shortage of time as well as insufficient encouraging points, are the main reasons. Designing a research plan for residency programs may successfully increase the research involvement rate.

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