Aneurysm Arising at the Origin of a Duplicated Middle Cerebral Artery

A duplicated middle cerebral artery (DMCA) is a common anomaly. However, aneurysms arising from the origin of a DMCA are extremely rare. A 22-year-old female was admitted to our hospital with a World Federation of Neurosurgical Societies grade 2 subarachnoid haemorrhage. Four-vessel angiography revealed a DMCA and an aneurysm arising from the origin of this artery. The aneurysm was successfully treated by embolization, and the patient was discharged 2 weeks later. Ruptured aneurysms arising from the origin of a DMCA can be successfully treated by embolization. These aneurysms are small and 3D-computed tomography reconstruction is mandatory to detect them. It is important to preserve the DMCA during the treatment procedure.

Can Craniometry Play a Role in Cluster Headache Diagnosis? A Pilot Exploratory TC-3D Based Study

Background Since the pioneering reports of the so-called leonine face in cluster headache (CH) patients, cranial and facial features of these patients have been poorly investigated with conflicting results. We aimed to investigate whether abnormalities in craniometric measurements could characterize male CH patients and represent reliable and reproducible diagnostic biomarkers able to identify CH patients. Methods Brain CT images were recorded between 2018 and 2020 in 24 male patients with CH and in 24 matched healthy controls (HC). Then, craniometric measurements were obtained, and logistic regression and receiver operating characteristic curves analyses were used to identify the craniometric abnormalities able to distinguish CH patients from HC. Results Logistic regression analyses showed that frontal bone height and facial width were able to discriminate, one independently from the other, CH patients from HC with an overall accuracy of 77%. The optimal cutoff score in detecting the probable presence of CH was 11.50 cm for frontal bone height and 13.30 cm for facial width. Discussion In the present study we found, for the first time by means of brain 3D computed tomography approach, abnormal craniometric measurements in CH patients when compared with HC. The absence of differences in smoke and alcohol intake suggests that the observed craniometric abnormalities may represent a specific feature of CH patients. Conclusion The craniometric evaluation by means of brain 3D computed tomography could represent a widespread, noninvasive, and accurate tool to support CH diagnosis to avoid frequent misdiagnosis or delay in the diagnostic process.

Feasibility of three-dimensional CT reconstruction in assessing mandibular fractures

Aim: Evaluation of the reliability of 3D computed tomography (3D-CT) in the diagnosis of mandibular fractures. Methods: A cross-sectional, quantitative and qualitative study was carried out, through the application of a questionnaire for 70 professionals in the area of Oral and Maxillofacial Surgery and Radiology. 3D-CT images of mandibular fractures were delivered to the interviewees along with a questionnaire. Participants answered about the number of traces, the region and the type of fracture. The correct diagnosis, that is, the expected answer, was based on the reports of a specialist in oral and maxillofacial radiology after viewing the images in the axial, sagittal and coronal sections. The resulting data from the interviewees was compared with the expected answer and then, the data was analyzed statistically. Results: In the sample 56.9% were between 22 and 30 years old, 52.8% were oral and maxillofacial surgeons (OMF), 34.7% were residents in OMF surgery and 12.5% OMF radiologists. Each professional answered 15 questions (related to five patients) and 50.8% of the total of these was answered correctly. Specialists in Oral and Maxillofacial Surgery and Traumatology correctly answered 53.9%. Interviewees with experience between 6 and 10 years correctly answered 58.2%. In identifying fracture traces, 46.1% of the questions were answered correctly. In terms of location, 5.6% of interviewees answered wrongly while 14.2% answered wrongly regarding classification. Conclusion: 3D computed tomography did not prove to be a reliable image for diagnosing mandibular fractures when used alone. This made necessary an association with axial, sagittal and coronal tomographic sections.

Usefulness of Intraoperative C-Arm Image Intensifier in Reducing Errors of Acetabular Component During Primary Total Hip Arthroplasty: An Application of Widmer’s Method

Background: Acetabular prosthesis positioning in total hip arthroplasty (THA) is crucial in reducing the risk of dislocation. There has been minimal research on the proper way to put the acetabular components into the safe zone intraoperatively. Assessment of version by intraoperative imaging intensifier is very valuable. The value of Widmer’s method, using the intraoperative C-arm available to determine cup anteversion was assessed.Methods: 101 hips in 91 patients who underwent primary THA were eligible for inclusion. Utilizing intraoperative C-arm images, measurement was performed using the technique described by Widmer. The values obtained using 3D computed tomography postoperatively, which determined the anteversion of the acetabular component, were regarded as the reference standard.Results: The method of Widmer obtained values similar to those obtained using 3D computed tomography and was considered accurate (n.s.). All 101 hips were positioned in the set target zone. Among the 101 hips, the cup position in nine hips (8.9%) was changed. The dislocation rate in our study was 1.0% with all dislocations occurring in hips placed in the target zone. The mean Harris hip score after THA in one year was 94.2 (82-98).Conclusions: The method of Widmer was accurate using intraoperative imaging intensifier for the measurement of the anteversion of the acetabular component during THA, with reference to the anteversion obtained from the 3D computed tomography. Also, utilizing intraoperative C-arm imaging was very useful because it allowed for correction of the position of the acetabular cup.