scholarly journals Do different surgical techniques in tibia pilon fractures change the results of the midterm?

2020 ◽  
Vol 50 (6) ◽  
pp. 1559-1565
Author(s):  
Vedat BİÇİCİ ◽  
İzzet BİNGÖL
Keyword(s):  
Surgical Techniques ◽  
Functional Results ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Pilon Fracture ◽  
Significant Difference ◽  
One Step ◽  
Type 3 ◽  
Pilon Fractures

Background/aim: Pilon fracture is difficult to treat fractures due to many complications that can develop after surgery. To achieve the best results, different surgical approaches are used.In our study, we aimed to compare the functional results and complication rates of our treatments in patients treated with 3 different surgical tecniques.Materials and methods: 89 pilon fractures of 87 patients treated for pilon fracture were evaluated. Patients were examined in 3 different groups (one step, two step surgery and Ilizarov). Functional results, postoperative complications and ankle AOFAS scores were evaluated.Results: The mean AOFAS score of the all patients was 77.67. There was no significant difference between 3 surgical techniques (P = 0,880). While skin complication was not seen in patients who underwent double-stage surgery and Ilizarov (0%); It was seen in 6 (15.7%) patients who underwent single-stage surgery. Treatment results were found to be better in type 1 and type 2 fractures, while in type 3 fractures (P = 0.004).Conclusion: Despite the different surgical approaches and implants applied, no difference was found between the midterm ankle functional results of the patients. Two-stage surgery and Ilizarov is a safe and effective treatment approach to reduce morbidity and early complications in pilon fractures.

scholarly journals A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

2018 ◽  
Vol 12 (5) ◽  
pp. 509-514 ◽  
Author(s):  
M. Troy ◽  
B. Shore ◽  
P. Miller ◽  
S. Mahan ◽  
D. Hedequist ◽  
...  
Keyword(s):  
Operative Time ◽  
Surgical Techniques ◽  
Leg Length Discrepancy ◽  
Complication Rates ◽  
Leg Length ◽  
Treatment Groups ◽  
Length Discrepancy ◽  
Baseline Activity ◽  
Significant Difference

Purpose To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved. Results A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001). Conclusion Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED. Level of Evidence: III

scholarly journals CNNM2-Related Disorders: Phenotype and Its Severity Were Associated With the Mode of Inheritance

2021 ◽  
Vol 9 ◽  
Author(s):  
Han Zhang ◽  
Ye Wu ◽  
Yuwu Jiang
Keyword(s):  
De Novo ◽  
Serum Magnesium ◽  
Brain Magnetic Resonance Imaging ◽  
Functional Studies ◽  
Pathogenic Variants ◽  
Significant Difference ◽  
Domain Variations ◽  
Type 3

CNNM2 (Cystathionine-β-synthase-pair Domain Divalent Metal Cation Transport Mediator 2) pathogenic variants have been reported to cause hypomagnesemia, epilepsy, and intellectual disability/developmental delay (ID/DD). We identified two new cases with CNNM2 novel de novo pathogenic variants, c.814T&gt;C and c.976G&gt;C. They both presented with infantile-onset epilepsy with DD and hypomagnesemia refractory to magnesium supplementation. To date, 21 cases with CNNM2-related disorders have been reported. We combined all 23 cases to analyze the features of CNNM2-related disorders. The phenotypes can be classified into three types: type 1, autosomal dominant (AD) inherited simple hypomagnesemia; type 2, AD inherited hypomagnesemia with epilepsy and ID/DD; and type 3, autosomal recessive (AR) inherited hypomagnesemia with epilepsy and ID/DD. All five type 1 cases had no epilepsy or ID/DD; they all had hypomagnesemia, and three of them presented with symptoms secondary to hypomagnesemia. Fifteen type 2 patients could have ID/DD and seizures, which can be controlled with antiseizure medications (ASMs); their variations clustered in the DUF21 domain of CNNM2. All three type 3 patients had seizures from 1 to 6 days after birth; the seizures were refractory, and 1/3 had status epilepticus; ID/DD in these AR-inherited cases was more severe than that of AD-inherited cases; they all had abnormalities of brain magnetic resonance imaging (MRI). Except for one patient whose serum magnesium was the lower limit of normal, others had definite hypomagnesemia. Hypomagnesemia could be improved after magnesium supplement but could not return to the normal level. Variations in the CBS2 domain may be related to lower serum magnesium. However, there was no significant difference in the level of serum magnesium among the patients with three different types of CNNM2-related disorders. The severity of different phenotypes was therefore not explained by decreased serum magnesium. We expanded the spectrum of CNNM2 variants and classified the phenotypes of CNNM2-related disorders into three types. We found that DUF21 domain variations were most associated with CNNM2-related central nervous system phenotypes, whereas hypomagnesemia was more pronounced in patients with CBS2 domain variations, and AR-inherited CNNM2-related disorders had the most severe phenotype. These results provide important clues for further functional studies of CNNM2 and provide basic foundations for more accurate genetic counseling.

scholarly journals Global sagittal spinal alignment in patients with degenerative low-grade lumbar spondylolisthesis

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901988519
Author(s):  
Hiroto Kobayashi ◽  
Kenji Endo ◽  
Yasunobu Sawaji ◽  
Yuji Matsuoka ◽  
Hirosuke Nishimura ◽  
...  
Keyword(s):  
Sacral Slope ◽  
Low Grade ◽  
Spinal Alignment ◽  
Sagittal Spinal Alignment ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis ◽  
Type 3

Purpose: Global sagittal spinal alignment undergoes changes on the basis of sagittal malalignment (trunk inclined forward) in natural degenerative progression. We hypothesized that this change would associate with the disease state of the degenerative lumbar spondylolisthesis (DS). This study aimed to evaluate the global sagittal spinal alignment of low-grade DS by classifying in accordance with sagittal vertical axis (SVA). Methods: The DS group was classified into three types according to the adult spinal deformity classification: type 1, SVA < 40 mm; type 2, 40 mm ≤ SVA < 95 mm; and type 3, 95 mm ≤ SVA. Age and sagittal spinal parameters (thoracic kyphosis, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were compared among three types. Results: There were statistically significant differences in age, LL, PI, and PT among the three types. In comparison between two types, there was a statistically significant difference between type 1 and type 2 and between type 1 and type 3, but not between type 2 and type 3 in these parameters. PI tended to increase as the type increases. Furthermore, there was significant difference between types 1 and 3. Conclusion: We evaluated the features of the DS types classified by sagittal alignment. Large PI is one of the risk factors for SVA deterioration of DS. PI may be involved in the onset and progression of DS.

scholarly journals Analysis of the Characteristics and Number of Bicycle–Passenger Conflicts at Bus Stops for Improving Safety

2019 ◽  
Vol 11 (19) ◽  
pp. 5263 ◽  
Author(s):  
Xingchen Yan ◽  
Tao Wang ◽  
Jun Chen ◽  
Xiaofei Ye ◽  
Zhen Yang ◽  
...  
Keyword(s):  
Video Recording ◽  
Longitudinal Direction ◽  
Percentage Error ◽  
Significant Difference ◽  
Conflict Duration ◽  
Passenger Volume ◽  
Bus Stops ◽  
Type 3

This study aimed to analyze the characteristics of bicycle–passenger conflicts at bus stops and develop a model to predict the number of conflicts accurately. This paper investigated the traffic flow operation at bus stops by video recording. Duration and distribution characteristics of bicycle–passenger conflicts were statistically analyzed. Then four types of conflicts defined based on evasive behavior (cyclist yielding as Type 1, cyclist bypassing as Type 2, passenger yielding as Type 3, and passenger bypassing as Type 4) were compared. A generalized event count (GEC) model was established for bicycle–passenger conflict estimation and analysis. The main results indicated that: (1) The average conflict duration was 1.716 s, whilst 60.9% of conflicts existed near the accesses of bus stops in longitudinal direction; (2) Type 1 conflict was significantly different from Type 2, 3, and 4 conflicts in duration, whilst the three had no significant difference; (3) the proposed GEC model showed good performance in predicting bicycle–passenger conflicts, with 15.71% of mean-absolute-percentage-error and 0.8772 of R2; and (4) bicycle volume, bus passenger volume, and passenger crossing time were critical factors impacting the number of bicycle–passenger conflicts. Finally, transport agencies may consider installing separations and crosswalks to improve the safety of the stop area.

scholarly journals Computed Tomographic Analysis of Aortic Arch Branching Patterns - Revisited

2021 ◽  
Author(s):  
Iroshani Kodikara ◽  
Dhanusha Gamage ◽  
Sampath De Soyza ◽  
Isurani Ilayperuma
Keyword(s):  
Aortic Arch ◽  
Surgical Approaches ◽  
Branching Pattern ◽  
Computed Tomographic ◽  
Geographical Variations ◽  
Population Type ◽  
Branching Patterns ◽  
Type 3

Abstract Background /ObjectivesBranching pattern of aortic arch (AA) has a direct impact on the outcome of thoracic surgical and angiographic procedures. Geographical variations in the branching pattern of AA has been described. Hence, this descriptive cross sectional study describes the AA variations in a Sri Lankan population compared to the available global statistics.MethodsContrast-enhanced computed tomographic studies (CTC) of thorax (n=219) performed in males (49.3%) and females (50.7%); aged 59±17 years (range: 4 to 96 years), were evaluated. Branching patterns of AA were categorized into seven types as described by Popieluszko et al.ResultsFour AA types were identified in the study population: Type 1 (90%; n=197), Type 2 (n=10, 4.6%), Type 3 (n=8, 3.7%) and Type 6 AA (n=4; 1.8%). The prevalence of AA variations was 10%. Type 1 was the most prevalent pattern in both genders: female-91%; males-88.9%. The most prevalent AA variant in females was Type 2 (n=6; 5.4%); males Type 3 (n=5; 4.6%). However, the branching pattern of AA has not demonstrated a significant gender influence (Odds: 0.792; 95% CI: 0.327 - 1.917; p=0.605). ConclusionVariations in branching pattern of AA is as high as 10% among Sri Lankans. Thus, an in-depth knowledge on population specific prevalence of AA variants would influence the modifications surgical approaches and the choice of angiographic catheters to be utilized, which in turn, would minimize inadvertent vascular injuries during thoracic surgical and angiographic interventions.

scholarly journals Proposed Classification of Periampullary Diverticulum and its Role on Performing ERCP and Post ERCP Complication

2020 ◽  
Author(s):  
Hasan Salmanroghani ◽  
Mohammad Hassan Rouzegari ◽  
Mahmud Baghbanian
Keyword(s):  
Success Rate ◽  
Cross Sectional Study ◽  
Intestinal Wall ◽  
P Value ◽  
Complication Rates ◽  
Cross Sectional ◽  
Type 3 ◽  
The Impact

Introduction: Duodenal diverticula are pouches of the mucosa, submucosa, and scattered muscle cells that extend through the intestinal wall. In this study, we aimed to classify the papilla position according to presence of PAD and evaluate the impact of papilla position on the success rate and post ERCP complication in the patients with PAD. Methods: This cross-sectional study was performed on 1260 patients with bile duct problems underwent ERCP. Patients with diverticulum were considered as the first group and the patients without diverticulum as the second group. In this study, SPSS Version 18 software, Chi-square and Students T-test were used, respectively. Results: 239 patients had peripheral diverticula. The mean age of participants was 68.9±10.3. In 239 patients with diverticulum Type 1=48.2%, Type 2 =37.6%, Type 3 =5.1%, Type 4 =9.1% the success rate in Type 1 was 97% (p-value: 0.003). In the patients with type 3, the cannulation was difficult and had a low success rate, with more complications. Conclusion: Classification of PAD can predict success rate in the patients with PDA, and can predict post ERCP complication rates.

Disparities in NOSE Scores and Surgical Approaches among Patients Undergoing Functional Rhinoplasty

2018 ◽  
Vol 35 (01) ◽  
pp. 090-095 ◽  
Author(s):  
Mingyang Gray ◽  
Joseph Rousso ◽  
Matthew Hirsch ◽  
Joshua Rosenberg ◽  
Collin Rozanski
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Surgical Techniques ◽  
Determinants Of Health ◽  
Surgical Approaches ◽  
Delivery Of Care ◽  
Score Improvement ◽  
Significant Difference ◽  
Patient Reported

AbstractSocial determinants of health have been widely studied throughout medicine; however, their role relating to functional rhinoplasty has not been previously evaluated. The records of 178 patients who underwent functional rhinoplasty in a single health network from 2013 to 2016 were reviewed. The Nasal Obstruction Symptom Evaluation (NOSE) score was used to assess patient-reported symptoms, and patients with both preoperative and postoperative NOSE scores were included in this study. Basic demographics and surgical techniques were also collected. Differences between NOSE scores and surgical approaches to functional rhinoplasty on the basis of insurance type were measured. One hundred and sixteen patients were included for analysis, the mean age was 34.7 years (standard deviation [SD] = 16.2) and 57 (49.1%) were female. Twenty-one (18.1%) patients had public insurance and, of these, 18 patients had Medicaid. Patients (mean, SD) with Medicaid insurance (56.39, 15.6) had a slightly greater improvement in NOSE scores compared with patients with non-Medicaid insurance (47.90, 25.6) (p = 0.067). There was no statistically significant difference in preoperative NOSE scores or postoperative improvement in NOSE scores between patients with different health insurance. Furthermore, there was no statistically significant difference in surgical approaches. The majority of patients receiving functional rhinoplasty had private insurance. Medicaid patients trended toward a greater NOSE score improvement after functional rhinoplasty, but also had a closer association with a history of nasal trauma and prior surgery. Future study is needed to better understand the association between socioeconomic status and disparities in care. Understanding how social determinants of health affect patients may reveal potential inherent biases, improve delivery of care, and translate to better patient outcomes.

Lactoseries carbohydrate antigen, Gal beta 1-4GlcNAc-R, is expressed by a subpopulation of capsaicin-sensitive rat sensory neurons

1996 ◽  
Vol 76 (4) ◽  
pp. 2192-2199 ◽  
Author(s):  
L. P. Del Mar ◽  
R. S. Scroggs
Keyword(s):  
Carbohydrate Antigen ◽  
Current Amplitude ◽  
Membrane Properties ◽  
High Threshold ◽  
Outer Cell ◽  
Inward Current ◽  
Significant Difference ◽  
Type 3

1. The membrane properties of dorsal root ganglion (DRG) cells expressing the lactoseries carbohydrate antigen Gal beta 1-4GlcNAc-R were studied and compared with those of DRG cells lacking this antigen. Acutely dissociated rat DRG cells that expressed Gal beta 1-4GlcNAc-R on their outer cell membranes were detected with the use of a primary monoclonal mouse IgM antibody (A5), directed against Gal beta 1-4GlcNAc-R, and a fluorescent secondary antibody (fluorescein-conjugated goat anti-mouse IgM). We found 12.8 micrograms/ml of A5 to be a saturating concentration of primary antibody that labeled approximately 19% of the DRG cells. A battery of membrane properties including action potential (AP) duration; sensitivity to capsaicin; expression of H current (IH), A current (IA), and Ca2+ current subtypes (L, N, and T); and inhibition of high-threshold Ca2+ currents by serotonin (5HT) or 8-hydroxy-2-(di-N-propylamino)-tetralin (8-OH-DPAT) was measured in DRG cells labeled (A5+) and unlabeled (A5-) by a saturating concentration of A5. 2. There was a significant difference in the number of capsaicin-sensitive DRG cells and a significant difference in the magnitude of the capsaicin-induced inward current in A5+ versus A5- DRG cells. Of 35 A5+ cells tested, 33 were sensitive to 1 microM capsaicin, which produced an inward current averaging 4 +/- 0.46 (SE) nA (n = 33). In contrast, only 12 of 33 A5- cells were sensitive to 1 microM capsaicin, which produced an inward current averaging 1.2 +/- 0.52 nA (n = 12). 3. There were also significant differences between A5+ and A5- cells regarding average AP duration, N- and T-type Ca2+ current amplitude, and number of cells that expressed IH and IA. A5+ cells had significantly larger N-type Ca2+ currents and expressed IA more frequently than A5- cells. Conversely, A5- cells had significantly longer AP duration and larger T-type Ca2+ currents, and expressed IH more frequently compared with A5+ cells. 4. A5+ and A5- cells differed regarding the inhibition of high-threshold Ca2+ currents by maximal concentrations of 5HT1A agonists (10 microM 5HT or 1 microM 8-OH-DPAT). Inhibition of Ca2+ currents in A5+ cells by 1 microM 8-OH-DPAT (n = 15) or 10 microM 5HT (n = 18) averaged 4 +/- 0.9%. In contrast, inhibition of Ca2+ currents in A5- cells by 10 microM 5HT (n = 33) averaged 20 +/- 3.8%. 5. Cells for which sufficient data were collected were categorized as type 1, 2, 3, or 4 on the basis of sensitivity to capsaicin and expression of IH, IA, and T-type Ca2+ current amplitude, and the distribution of A5+ and A5- cells among the various groups was observed. The categories were defined as follows: type 1 (capsaicin sensitive, no IH or IA); type 2 (capsaicin sensitive, significant IA); type 3 (capsaicin insensitive, T-type Ca2+ currents < 1 nA, significant IH but no IA); and type 4 (capsaicin insensitive, T-type Ca2+ currents > 2.4 nA). On the basis of this criteria, 6 of 15 type 1 cells and all type 2 cells (n = 19) were A5+. All type 3 cells (n = 8) and all type 4 cells (n = 11) were A5-. 6. As indicated above, the expression of the Gal beta 1-4GlcNAc-R antigen differentiated two subgroups of DRG cells in the type 1 category (A5+, n = 6 and A5-, n = 9). These two groups varied regarding the sensitivity of Ca2+ currents to maximally effective concentrations of 5HTIA agonists. In type 1 A5+ DRG cells, high-threshold Ca2+ currents were not significantly inhibited by 1 microM 8-OH-DPAT (average inhibition = 1.2 +/- 0.8%, n = 6). However, in type 1 A5- cells, high-threshold Ca2+ currents were reduced 47 +/- 6.0% (n = 9) by 10 microM 5HT. 7. The several significant differences in membrane properties between A5+ and A5- DRG cells suggest that the Gal beta 1-4GlcNAc-R antigen is expressed by a distinct subset of DRG cells, consisting predominately of type 1 and type 2 cells. The observation that most A5+ DRG cells were capsaicin sensitive suggests that the Gal beta 1-4GlcNAc-R antigen is expressed primarily by n

scholarly journals Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Annemarie Uhlig ◽  
Johannes Uhlig ◽  
Lutz Trojan ◽  
Marc Hinterthaner ◽  
Alexander von Hammerstein-Equord ◽  
...  
Keyword(s):  
Ureteropelvic Junction Obstruction ◽  
Treatment Options ◽  
Operating Time ◽  
Surgical Techniques ◽  
Ureteropelvic Junction ◽  
Surgical Approaches ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Success Rates ◽  
Urinary Leakage

Abstract Background Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. Methods A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. Results A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003). Conclusions Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.

scholarly journals Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions

2019 ◽  
Vol 81 (06) ◽  
pp. 686-693
Author(s):  
Haiyong He ◽  
Meiqin Cai ◽  
Manting Li ◽  
Lei Wei ◽  
Lun Luo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Optic Nerve ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Modified Rankin Scale ◽  
Pterional Approach ◽  
Total Resection ◽  
Significant Difference

Abstract Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA (p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group (p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.

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