scholarly journals Developing a Method to Precisely Locate the Keypoint During Craniotomy Using the Retrosigmoid Keyhole Approach: Surgical Anatomy and Technical Nuances

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhi-heng Jian ◽  
Min-feng Sheng ◽  
Jia-yan Li ◽  
De-zhu An ◽  
Zhi-jian Weng ◽  
...  
Keyword(s):  
Transverse Sinus ◽  
Surgical Anatomy ◽  
Venous Sinus ◽  
Mastoid Process ◽  
Inferior Margin ◽  
Straight Line ◽  
Significant Difference ◽  
Minimal Invasion ◽  
Keyhole Approach ◽  
Frankfort Horizontal Plane

Objective: To explore the precise location of the keypoint during craniotomy using the retrosigmoid keyhole approach.Methods: This study included 20 dry skulls and 10 wet cadaveric specimens. On the inner surface of dry skulls, the junction between the inferior margin of the transverse sinus (ITS) and the posterior margin of the sigmoid sinus (TSJ) was marked. The keypoint (D) was identified as the TSJ's corresponding point on the external surface of the temporal mastoid process (MP). The distance from the keypoint to the top point of the digastric groove, mastoidale, and asterion were noted (AD, BD, CD, respectively). A method to accurately locate the keypoint was developed based on these relationships. The developed method was used on the wet cadaveric specimens to evaluate its accuracy, safety, rapidity, and minimal invasion.Results: No significant difference was found between the AD, BD, and CD of the left and right sides. The drilling point was oriented on a straight line 12 mm above the top point of digastric groove, perpendicular to the Frankfort horizontal plane (FHP). In the cadaveric specimens, the operative area was clearly exposed. No venous sinus rupture occurred. The average craniotomy time was 28.74 ± 3.89 min.Conclusions: A potentially safe, accurate, and rapid craniotomy procedure was developed with the added advantage of preserving the visibility of the operating field and preventing venous sinus injury.

scholarly journals Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (3) ◽  
pp. 382
Author(s):  
Dinesh Ramanathan ◽  
Zachary D. Travis ◽  
Emmanuel Omosor ◽  
Taylor Wilson ◽  
Nikhil Sahasrabudhe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Subdural Hygroma ◽  
Presenting Symptoms ◽  
Minimal Improvement ◽  
Sinus Stenosis ◽  
Work Up

We describe a case of severe headaches, double vision, and progressive vision loss secondary to a ruptured intracranial cyst (IAC) in a 31-year-old woman with no relevant past medical history. The case is peculiar because drainage of the subdural hygroma led to a minimal improvement in vision with persistent elevated intracranial pressure (ICP). Further exploration revealed transverse sinus stenosis necessitating stenting. Evaluation post-stenting showed marked reduction of ICP and improvement in symptoms. This report underscores the importance of comprehensive work-up and suspicion of multiple underlying etiologies that may be crucial to complete resolution of presenting symptoms in some cases. We provide an overview of the clinical indications and evidence for venous sinus stenting in treating idiopathic intracranial hypertension (IIH).

Conversion Furlow Palatoplasty and the Use of Preoperative Video Nasendoscopy

2021 ◽  
pp. 105566562110150
Author(s):  
Alison Kaye ◽  
Meghan Tracy ◽  
Janelle Noel-MacDonnell ◽  
Kathryn Dent
Keyword(s):  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Time To Surgery ◽  
Number Of Children ◽  
Straight Line ◽  
Improved Outcomes ◽  
Additional Surgery ◽  
Significant Difference ◽  
Palatal Surgery ◽  
Line Repair

Objective: To assess outcomes after conversion Furlow palatoplasty with and without routine preoperative flexible fiberoptic video nasendoscopy (FFVN). Design: Retrospective cohort study. Setting: Tertiary Children’s Hospital. Patients: Greater than 3 years of age with cleft palate and velopharyngeal insufficiency (VPI) after straight-line palatoplasty requiring secondary surgery performed with a Furlow palatoplasty. Main Outcome Measures: The number of children with and without routine FFVN prior to conversion Furlow palatoplasty for VPI after initial straight-line palatoplasty. Groups were compared for surgical timing, speech outcomes, and need for additional surgery after conversion Furlow palatoplasty. Results: Fifty-eight patients underwent preoperative FFVN versus 29 without. Mean age at FFVN was 73.8 (SD 34) months. Mean age for secondary palatal surgery by conversion Furlow palatoplasty was 81.5 (SD 34.8) months with FFVN versus 73.4 (SD 34.0) months without FFVN. There was a significant difference ( P < .001) for VPI diagnosis and time to surgery between the groups. Preoperative hypernasality ratings were similar between groups. Postoperatively 65.5% of FFVN and non-FFVN patients corrected to normal resonance. Only 6.9% of all patients rated moderate-severe hypernasality after surgery compared to 42.5% preoperatively. Of total, 5.7% of patients had unchanged hypernasality and only 1 patient rated worse. Seven patients ultimately required additional surgery in attempt to normalize their resonance. Conclusions: Routine preoperative FFVN does not offer any advantage for improved outcomes in children undergoing conversion Furlow palatoplasty after straight-line repair. Routine preoperative FFVN was associated with increased time to surgery after diagnosis of VPI compared to those without FFVN.

scholarly journals Cerebral venous sinuses thrombosis in both transverse sinus and torcula: Multistep endovascular treatment and stenting

2016 ◽  
Vol 23 (1) ◽  
pp. 84-89 ◽  
Author(s):  
G Cabral de Andrade ◽  
A Lesczynsky ◽  
VM Clímaco ◽  
ER Pereira ◽  
PO Marcelino ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Endovascular Treatment ◽  
Clinical Symptoms ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Severe Form ◽  
Venous Sinus ◽  
Lateral Sinus ◽  
Mechanical Thrombolysis

Purpose Cerebral venous sinus thrombosis (CVST) is an unusual and potentially life-threatening condition with variable and nonspecific clinical symptoms and high morbimortality rates. Standard therapy consists of systemic anticoagulation; although there is no clear evidence about the best choice for treatment, intravenous heparin is used as the first-line treatment modality. Intravenous sinus thrombolysis can be an effective and relatively safe treatment for acutely deteriorating patients who have not responded to conventional therapy. This case report presents the possibility of endovascular treatment in multiple steps with mechanical thrombolysis with balloon, local pharmacological thrombolysis and stenting, in a patient with a severe form of CVST. Case summary A 67-year-old woman presented severe headache, agitation and confusion with diagnosis of venous sinus dural thrombosis in both lateral sinus and torcula. After 24 h there was neurological worsening evolving with seizures and numbness even after starting heparin, without sinus recanalization; CT scan showed left temporal intracerebral hemorrhage. We decided to take an endovascular approach in multiple steps. The first step was mechanical static thrombolysis with balloon; the second step was dynamic mechanical thrombolysis with a balloon partially deflated and “pulled”; the third step was local thrombolysis with Actilyse™; finally, the fourth step was angioplasty and reconstruction of the sinuses using multiple carotid stents and complete angiographic recanalization of both sinuses and torcula. After 24 h of endovascular treatment there was full clinical recovery and no tomographic complications. Conclusion This result shows that mechanical clot disruption, intrasinus thrombolysis and reconstruction of wall sinuses with stenting can be an endovascular option in the severe form of CVST with intracerebral hemorrhage and rapid worsening of neurological symptoms. Although this type of treatment can re-channel the occluded sinuses, further comparative and randomized studies are needed to clarify its efficacy versus other therapeutic modalities.

A Comparison of the Effects of Veau-Wardill-Kilner Palatoplasty and Furlow Double-Opposing Z-Plasty Operations on Eustachian Tube Function

2000 ◽  
Vol 37 (3) ◽  
pp. 266-270 ◽  
Author(s):  
Ethem Güneren ◽  
Zafer Özsoy ◽  
Mithat Ulay ◽  
Erhan Eryilmaz ◽  
Haluk Özkul ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Eustachian Tube ◽  
Soft Palate ◽  
Surgical Anatomy ◽  
Eustachian Tube Function ◽  
Secretory Otitis Media ◽  
Significant Difference ◽  
Before And After ◽  
Tube Function

Objective The purpose of this study was to compare the effects of Veau-Wardill-Kilner (VWK) two-flap palatoplasty and Furlow double-opposing Z-plasty operations on eustachian tube (ET) opening in patients with cleft palate (CP). Design Twenty-six patients underwent CP repair between 1993 and 1997. VWK and Furlow operations were used in 13 patients each. All patients were examined by the otorhinolaryngologist before and after the operations; mean follow-up time was 27.3 months. Secretory otitis media (SOM), as identified by tympanograms, was the comparison criterion used. Results The prevalence of SOM was 69% (n = 18) in all CP patients pre-operatively. Among those with preoperative SOM, we did not find any statistically significant difference in the frequency of postoperative SOM between the two techniques. Conclusion This study suggests that there is no difference in postoperative ET function between patients undergoing either VWK or Furlow operations, in spite of the differences in muscle positioning in these operations. We discuss the implications of this finding in relation to surgical anatomy and histology of the soft palate muscles.

Abstract 1122‐000122: The Role of the Venous System in Infarct Burden in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Shail S Thanki ◽  
Elliot Pressman ◽  
Shail S Thanki ◽  
John D Mayfield ◽  
Maximilian J Rabil ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
False Negative ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Post Stroke ◽  
Number Of Patients ◽  
Ct Head

Introduction : Acute ischemic stroke (AIS) is a leading cause of disability internationally. Most therapies focus on intra‐arterial treatment to improve post‐stroke deficits and neurologic status. However, if a relationship between venous anatomy and post‐stroke deficits or infarct size can be shown, then venous augmentation strategies represent a possibility for future interventions as an adjunct to intra‐arterial treatment. Methods : We retrospectively reviewed all ischemic infarcts at our institution that underwent thrombectomy from January 2018 – October 2020. From these, we selected cases that were demonstrated as M1 occlusions on intra‐procedural angiogram and those who had a CT Head obtained within six hours of the patient’s last known normal (LKN). Patients without a CT Head or CT Angiogram of their head were excluded. Using axial and sagittal reconstructed views of 0.9mm slices, cross‐sectional area measurements were taken of the superior sagittal sinus 1cm above the Torcula, in three locations of the ipsilateral and contralateral transverse sinus, in three locations of the ipsilateral and contralateral sigmoid sinus, and of the ipsilateral and contralateral internal jugular vein (IJV) at the external surface of the skull. For the transverse and sigmoid sinuses, the three measurements were averaged together. These measurements were then compared against patient’s Alberta Stroke Program Early CT Score (ASPECTS). Results : 77 patients were identified in the study period. Average ASPECTS was 8.9, ranging from 5–10. There were three patients included with ASPECTS < 6. Average ipsilateral transverse sinus area was 34.4mm ± 3.34, average ipsilateral sigmoid sinus area was 32.8mm ± 2.74, average ipsilateral IJV area was 46.9 mm ± 5.00. Correlation tests to identify relationships between venous sinus area and ASPECTS was unremarkable (ipsilateral transverse sinus p = 0.574, ipsilateral sigmoid sinus p = 0.548, ipsilateral IJV p = 0.798). When assessed as a ratio of ipsilateral venous sinus area to contralateral sinus area to assess correlation with ASPECTS, results were unremarkable (transverse sinus p = 0.891, sigmoid sinus p = 0.292, IJV p = 0.499). Conclusions : Venous sinus size was not found to be predictive or associated with predominantly favorable ASPECTS for strokes found within six hours. We believe this may be due to our cohort lacking significant numbers of patients with low ASPECTS, yielding a false negative result. We are currently expanding this project to include a comparable number of patients with ASPECTS < 6 to determine the role of venous collateral system in infarct progression.

Surgical Anatomy of the Parotid Gland

2021 ◽  
pp. 13-23
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
External Auditory Meatus ◽  
Styloid Process ◽  
Terminal Segment ◽  
External Carotid Artery ◽  
Surgical Anatomy ◽  
Mastoid Process ◽  
External Carotid ◽  
Superficial Lobe

The parotid gland consists of two lobes: superficial and deep with regard to its relation with the facial nerve. It is wrapped around the mandibular ramus and secretes saliva through the parotid (Stensen's) duct. It is a paired organ, weighing 15-30g each. Its superficial lobe overlies the lateral surface of the masseter muscle and is bounded superiorly by the zygomatic arch, while its deep lobe is located in the pre-styloid compartment of the parapharyngeal space between the mastoid process posteriorly, ramus of mandible anteriorly, and external auditory meatus superiorly. Medially, the gland reaches to the styloid process. Inferiorly, the parotid tail extends down to the anteromedial margin of sternocleido-mastoid muscle. Several structures run through the parotid gland, namely, terminal segment of external carotid artery, retro-mandibular vein, parotid lymph nodes, and facial nerve, which soon gives two divisions (temporo-facial and cervico-facial) that give off five branches inside the gland radiating forwards. This chapter explores the surgical anatomy of the parotid gland.

Internal Jugular Microembolic Signal Detection in a Patient with Cerebral Sinus Thrombosis Complicated by Pulmonary Embolism

2017 ◽  
Vol 41 (2) ◽  
pp. 74-75
Author(s):  
Laligam Sekhar ◽  
Kyra Becker ◽  
Anne Moore ◽  
Vanessa Tran
Keyword(s):  
Pulmonary Embolism ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Prior History ◽  
Sagittal Sinus ◽  
Microembolic Signal ◽  
Significant Difference ◽  
History Of ◽  
Blurry Vision ◽  
Clot Burden

A 40-year-old woman with prior history of headaches, left-sided weakness, and diplopia was diagnosed with right sigmoid and transverse sinus thrombosis; increased intracranial pressure and associated cerebral venous infarction that underwent 12 months anticoagulation and then stopped. She has been off anticoagulation for about a year then started not “feeling right,” and was diagnosed with pneumonia and pulmonary embolism. During her course of hospitalization, she presented with progressive headache, possible left-sided weakness, associated blurry vision, nausea, and vomiting. Magnetic resonance venogram (MRV) shows lack of flow-related signals within the left half of the distal superior sagittal sinus, left transverse sinus, and nonocclusive thrombus in the left sigmoid sinus. Mechanical sinus thrombectomy attempted without significant difference in clot burden. A transcranial Doppler (TCD) emboli monitoring exam was ordered and was performed on the bilateral internal jugular for 15 min each. Microembolic signals detected: 52 emboli per hour right internal jugular vein (IJV), and 32 emboli per hour left IJV. She was discharged on methazolamide, furosemide, topiramate, and lifelong warfarin. No major events have been reported since discharge from 2008 to 2016.

scholarly journals Sinus Tarsi Volume Changes with Hindfoot Position on Weight-Bearing CT Scan

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Michael Hull ◽  
Tyler Rutherford ◽  
Clifford Jeng ◽  
John T. Campbell ◽  
Rebecca Cerrato
Keyword(s):  
Critical Angle ◽  
Clinical Symptoms ◽  
Weight Bearing ◽  
Lateral Process ◽  
Sinus Tarsi ◽  
Straight Line ◽  
Sinus Tarsi Syndrome ◽  
Significant Difference ◽  
The Mean ◽  
Varus Position

Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Sinus Tarsi syndrome is a frequent cause of anterolateral foot pain following injury. Chronic lateral subtalar pain, often referred to as “Sinus Tarsi Syndrome”, is commonly reported to occur following trauma. One hypothetical epidemiological predisposing factor for sinus tarsi syndrome is flatfoot deformity with valgus hind foot alignment. Common conservative treatment includes medial heel posting to attempt to widen the sinus tarsi space and alleviate synovitic pain. Although treatment with operative intervention has been reported, no data exists to evaluate if hindfoot realignment functionally opens the sinus tarsi volume. Methods: Weight-bearing Computed Tomography (CT) scans were obtained in 5 healthy volunteers standing at rest on slanted platforms, 25 degree valgus and 25 degree varus. The volume of the sinus tarsi was measured on each scan. Cross sectional area of the sinus tarsi was measured in 3.6 mm slices from the most lateral fully enclosed image to the most lateral aspect of the middle facet of the subtalar joint. Area measurements were multiplied by cut depth (3.6 mm) and summed. Critical angle distance was measured as a straight line from the most lateral point of the lateral process of the talus to the base of the critical angle of Gissane. Subfibular distance was then measured from the most distal tip of the fibula in a straight line to the nearest point of the lateral calcaneal wall. Data were compared using a one way ANOVA and Tukey’s multiple comparison test. Results: The mean sinus tarsi volume in the valgus position was 325.1 mm3 (±88) and 313.3 (±71) for the left and right foot, respectively. In the varus position, the mean sinus tarsi volume increased to 646.8 mm3 (±169) and 599 mm3 (±203). There was a significant difference between the varus and valgus position for both feet (left p<0.01 / right p<0.05). The critical angle distance increased from 28.1 mm (±7.5) to 91.3 mm (±26) for the left foot and 26.3 mm (±7.6) to 87 mm (±27.9) for the right foot when realigned to the varus position (p<0.0001). There was not a significant increase in the sub fibular distance when repositioned from valgus to varus (p=0.06 / p=0.35). Conclusion: This study confirms that moving from a valgus to a varus position significantly increases the volume of the sinus tarsi as well as significantly increases the distance from the lateral process of the talus to the calcaneal angle of Gissane. Interestingly, subfibular distance did not significantly increase, although this may reach significance with increased samples. With confirmation that adjusting hindfoot positioning impacts lateral osseous impingement, future studies are warranted to correlate these findings with clinical symptoms.

scholarly journals Straight Line Scoring by Clinical Competency Committees Using Emergency Medicine Milestones

2017 ◽  
Vol 9 (6) ◽  
pp. 716-720 ◽  
Author(s):  
Michael S. Beeson ◽  
Stanley J. Hamstra ◽  
Melissa A. Barton ◽  
Kenji Yamazaki ◽  
Francis L. Counselman ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Descriptive Analysis ◽  
Chi Square ◽  
Residency Programs ◽  
Reporting Requirement ◽  
Straight Line ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
Academic Year ◽  
Nominal Variables

ABSTRACT Background  In 2013, milestone ratings became a reporting requirement for emergency medicine (EM) residency programs. Programs rate each resident in the fall and spring on 23 milestone subcompetencies. Objective  This study examined the incidence of straight line scoring (SLS) for EM Milestone ratings, defined as a resident being assessed the same score across the milestone subcompetencies. Methods  This descriptive analysis measured the frequencies of SLS for all Accreditation Council for Graduate Medical Education (ACGME)–accredited EM programs during the 2015–2016 academic year. Outcomes were the frequency of SLS in the fall and spring milestone assessments, changes in the number of SLS reports, and reporting trends. Chi-square analysis compared nominal variables. Results  There were 6257 residents in the fall and 6588 in the spring. Milestone scores were reported for 6173 EM residents in the fall (99% of 6257) and spring (94% of 6588). In the fall, 93% (5753 residents) did not receive SLS ratings and 420 (7%) did, with no significant difference compared with the spring (5776 [94%] versus 397 [6%]). Subgroup analysis showed higher SLS results for residents' first ratings (183 of 2136 versus 237 of 4220, P &lt; .0001) and for their final ratings (200 of 2019 versus 197 of 4354, P &lt; .0001). Twenty percent of programs submitted 10% or more SLS ratings, and a small percentage submitted more than 50% of ratings as SLS. Conclusions  Most programs did not submit SLS ratings. Because of the statistical improbability of SLS, any SLS ratings reduce the validity assertions of the milestone assessments.

67 EFFECTS OF ANTIOXIDANTS LACTOFERRIN AND CATALASE ON STALLION FROZEN SEMEN

2015 ◽  
Vol 27 (1) ◽  
pp. 126
Author(s):  
H. S. Martins ◽  
M. F. Brito ◽  
I. B. M. Sampaio ◽  
R. Stahlberg ◽  
M. R. Souza ◽  
...  
Keyword(s):  
Sperm Motility ◽  
Seminal Plasma ◽  
Skim Milk ◽  
Straight Line ◽  
Frozen Semen ◽  
Significant Difference ◽  
Sperm Membrane ◽  
Positive Effect ◽  
Artificial Vagina ◽  
Motility Parameters

During cryopreservation, the sperm were submitted to an increased generation of reactive oxygen species. Furthermore, because of the large portion of seminal plasma removal, there is a decrease of sperm antioxidant protection. Addition of antioxidants proteins found in seminal plasma, such as lactoferrin (Lf) and catalase (Cat), to the freezing semen extenders could protect the sperm during cryopreservation. Lactoferrin is a transferrin, which prevents the hydroxyl radicals generation, and Cat plays an antioxidant role. The aim of this study was to determine the effects of Lf and Cat supplementation to the INRA 82 freezing extender (Battelier et al. 1997) on sperm motility parameters and membrane functionality of stallion frozen semen. Semen from 6 stallions was collected with an artificial vagina, diluted with Kenney extender (1 : 1), and centrifuged (500 × g, 10 min). The supernatant was discarded, and sperm number per milliliter was calculated. Semen was resuspended with 3 extenders to 100 × 106 sperm mL–1. The treatments were distributed in (F1) control, INRA 82 freezing extender (Battelier et al. 1997), (F2) F1+ 500 μg mL–1 lactoferrin, and F3) F1 + 200 IU mL–1 catalase. Semen samples were packaged in 0.5-mL straws and cooled to 5°C (0.27°C min–1). For semen freezing, the straws were laid over the LN vapor for 20 min and plunged into the LN. The straws were thawed at 37°C for 30 s. Motility parameters of frozen semen were determined using a computer sperm cell analysis, and sperm membrane functionality was assessed by the hyposmotic swelling test (Lagares et al. 1998). The data were analysed using Friedman test using stallion as a block. A probability of P < 0.05 was considered significant. There was no significant difference between the percentage of total sperm motility (median, minimum-maximum value; F1: 29.9, 11.0–82.7; F2: 49.8, 7.7–55.2; F3: 39.8, 5.7–92) and progressive sperm motility (F1: 7.1, 3.2–23.3; F2: 13.4, 2.6-22.4; F3: 15.6, 1.1–29.6), and functional sperm membrane (F1: 26.7, 14.7–56.2; F2: 50.5, 15.7–61.7; F3: 46.6, 13.8–50.9) with regard to the treatment. However, the velocity parameters: velocity average path (F1: 29.3, 22.1–33.80; F2: 34.6, 24.8–44; F3: 35.7, 18.2–42.6), velocity curvilinear (F1: 36.9, 30.5–45.1; F2: 42.5, 34.7–51; F3: 44.6, 25.5–50.9), and velocity straight line (F1: 23.4, 17–3.60; F2: 28.9, 18.8–38.2; F3: 26.6, 13.6–37.2) in the treatment with Lf (F2) were higher compared with the control (F1; P < 0.05). These results corroborate with studies reporting the lack of positive effect on equine sperm motility when antioxidants were added to skim milk-based extenders. Although the addition of Lf or Cat to skim milk-based extenders did not improve the motility sperm characteristics and sperm membrane functionality, more studies about the positive effect of Lf on the velocity parameters are necessary. Lactoferrin could then play an important role on the oxidative metabolism, which provides energy to the sperm movement.Acknowledgments to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil, for the financial support.

Sign in / Sign up

Export Citation Format

Share Document