Quantitative anatomical analysis and clinical experience with mini-pterional and mini-orbitozygomatic approaches for intracranial aneurysm surgery

OBJECTIVEThe aim of this investigation was to modify the mini-pterional and mini-orbitozygomatic (mini-OZ) approaches in order to reduce the amount of tissue traumatization caused and to compare the use of the 2 approaches in the removal of circle of Willis aneurysms based on the authors' clinical experience and quantitative analysis.METHODSThree formalin-fixed adult cadaveric heads injected with colored silicone were examined. Surgical freedom and angle of attack of the mini-pterional and mini-OZ approaches were measured at 9 anatomical points, and the measurements were compared. The authors also retrospectively reviewed the cases of 396 patients with ruptured and unruptured single aneurysms in the circle of Willis treated by microsurgical techniques at their institution between January 2006 and November 2014.RESULTSA significant difference in surgical freedom was found in favor of the mini-pterional approach for access to the ipsilateral internal carotid artery (ICA) and middle cerebral artery (MCA) bifurcations, the most distal point of the ipsilateral posterior cerebral artery (PCA), and the basilar artery (BA) tip. No statistically significant differences were found between the mini-pterional and mini-OZ approaches for access to the posterior clinoid process, the most distal point of the superior cerebellar artery (SCA), the anterior communicating artery (ACoA), the contralateral ICA bifurcation, and the most distal point of the contralateral MCA. A trend toward increasing surgical freedom was found for the mini-OZ approach to the ACoA and the contralateral ICA bifurcation. The lengths exposed through the mini-OZ approach were longer than those exposed by the mini-pterional approach for the ipsilateral PCA segment (11.5 ± 1.9 mm) between the BA and the most distal point of the P2 segment of the PCA, for the ipsilateral SCA (10.5 ± 1.1 mm) between the BA and the most distal point of the SCA, and for the contralateral anterior cerebral artery (ACA) (21 ± 6.1 mm) between the ICA bifurcation and the most distal point of the A2 segment of the ACA. The exposed length of the contralateral MCA (24.2 ± 8.6 mm) between the contralateral ICA bifurcation and the most distal point of the MCA segment was longer through the mini-pterional approach. The vertical angle of attack (anteroposterior direction) was significantly greater with the mini-pterional approach than with the mini-OZ approach, except in the ACoA and contralateral ICA bifurcation. The horizontal angle of attack (mediolateral direction) was similar with both approaches, except in the ACoA, contralateral ICA bifurcation, and contralateral MCA bifurcation, where the angle was significantly increased in the mini-OZ approach.CONCLUSIONSThe mini-pterional and mini-OZ approaches, as currently performed in select patients, provide less tissue traumatization (i.e., less temporal muscle manipulation, less brain parenchyma retraction) from the skin to the aneurysm than standard approaches. Anatomical quantitative analysis showed that the mini-OZ approach provides better exposure to the contralateral side for controlling the contralateral parent arteries and multiple aneurysms. The mini-pterional approach has greater surgical freedom (maneuverability) for ipsilateral circle of Willis aneurysms.

Body mass index, general fatness, lipid profile and bone mineral density in young women and men

The bone tissue is metabolically active. Throughout the entire life, it undergoes changes in the form of bone resorption processes which are successive, with the participation of the resorbing cells and bone formation processes. The aim of the study was to evaluate mineral density and bone mass tissue and the lipid profile, BMI, total body fat in young females and males. The study involved 100 people (50 females and 50 males) studying in Warsaw at the age of 23,2 ± 4,0 years. The densitometry method of the forearm was used for the assessment of bone mineral density (BMD) and bone mass (BMC). The method of bioelectrical impedance was used for the assessment of body components. Basic body dimensions and indicators were assessed using anthropometric measurements. Body height, body mass and the needs for the densitometry study of the forearm were measured. The total cholesterol concentration was determined in the blood serum using diagnostic kits, as well as high-density lipoprotein (HDL-C) and triglycerides. The concentration of the low-density lipoprotein (LDL-C) was calculated. While in men the occurrence of a significant, positive correlation was stated between the concentration of the HDL cholesterol fraction and the mineral density and T-score index in the ultra-distal point, the analysis of the compounds of mineral density (BMD), bone mass (BMC) of the forearm, T-score index with somatic features in women showed a significant, positive relation between the body weight and the bone mass mineral density and T-score indicator in the proximal point. Also, a significant weak, positive correlation was observed between the BMI, the mineral density and T-score indicator in the proximal point. In men, the occurrence of significant, positive correlations was stated between the body weight and BMC, BMD, T-score indicator in the proximal point of the forearm bone and ultra-distal point. Similar relations were observed between the BMI, mineral density, T-score and bone mass in the proximal point and in the ultra-distal point. Based on several noted weak, positive correlations between the lipid profile and BMD, the results of this study of women and men cannot unequivocally indicate the dependence of the bone tissue state on the lipid level in the blood serum of young women and men. Therefore, the issues raised require further investigation.

Radiographic cephalometry analysis of condylar position after bimaxillary osteotomy in patients with mandibular prognathism

Background/Aim. Postoperative condylar position is a substantial concern in surgical correction of mandibular prognathism. Orthognathic surgery may change condylar position and this is considered a contributing factor for early skeletal relapse and the induction of temporomandibular disorders. The purpose of this study was to evaluate changes in condylar position, and to correlate angular skeletal measurements following bimaxillary surgery. Methods. On profile teleradiographs of 21 patients with mandibular angular and linear parametres, the changes in condylar position, were measured during preoperative orthodontic treatment and 6 months after the surgical treatment. Results. A statistically significant difference in values between the groups was found. The most distal point on the head of condyle point (DI) moved backward for 1.38 mm (p = 0.02), and the point of center of collum mandibulae point (DC) moved backward for 1.52 mm (p = 0.007). The amount of upward movement of the point DI was 1.62 mm (p = 0.04). Conclusion. In the patients with mandibular prognathism, the condyles tend to migrate upward and forward six months after bimaxillary surgery.

Regression equation for estimation of total humeral length using measurements of its proximal segments among Indian population

Background: The aim of the present study was to calculate regression equation for the estimation of total length of the humerus using the measurements of its proximal fragments in Indian population. This equation is essential for forensic investigators for estimating the humeral length and also height of individual using humeral length when fragments ofhumerus are available in forensic investigation. Materials and Methods: In the present study 150 (75 left and 75 right) adult, fully ossified, dry and processed humerii were taken to analyze the morphometric details of the humeral segments which were measured using osteometric board and scale. The distance between three different segments namely, from most proximal point in the head to most distal point of the circumference of the head (segment­1), from most distal point of the circumference of the head to the convergence of two areas of muscle attachment (segment-2), the convergence of two areas of muscle attachment to the deltoid tuberosity (segment-3) and maximum length of humerus were measured to the nearest millimeter. The association between the humeral segments and maximum humeral length was calculated using Pearson's correlation coefficient (r) and later linear regression was applied considering left and right humerii separately. Results: The regression equation of humerus segments -1, 2 and 3 were MHL­ Maximum humeral length= 175.05 + [3.58(Hl)], MHL = 185.80 + [2.18(H2)], MHL = 161.44 + [2.18(H3)] on left and MHL = 171.91 + [3.74(Hl)], MHL = 195.54 + [1.95(H2)], MHL = 229.03 + [1.24(H3)] on right side of humerus respectively. This regression equation of Mean total length of humerus using its proximal fragmentary bone length will help for the stature estimation of individual Conclusion: This study helps in forensic, anatomic and archeological fields in order to identify human remains of unknown persons.

Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter- and intra-observer validity and reliability study

Four methods for measuring volar angulation in 5th metacarpal neck fractures were tested for validity and reliability. Mid-medullary canal measurement in the lateral view (method MC-90) has previously been proven valid in a cadaveric study, hence used as a reference to test validity of the latter three. These three yielded a significant different mean fracture angle compared with MC-90, with only minor enhancement in reliability. Therefore, none of these three methods is recommended as a better standard method than the MC-90, where reliability was found to be substantial (intraclass correlation coefficient 0.53–0.81). Two methods for measuring shortening in 5th metacarpal neck fractures were compared, and stipulation of shortening by drawing a line through the most distal point of the heads of the neighbouring 3rd and 4th metacarpals (method SH-Stip) is a simple method with excellent reliability (intraclass correlation coefficient 0.81–0.96) for estimating shortening, requiring only radiological examination of the injured hand.

Locating the Acupoint Baihui (GV20) Beneath the Cerebral Cortex with MRI Reconstructed 3D Neuroimages

Baihui (GV20) is one of the most important acupoints of the Du meridian (the government vessel) and is commonly used in neurology and psychiatry and as a distal point of anorectal disorders by general practitioners. The anatomical relationship between the scalp region of the acupoint and the underlying corresponding cortex remains obscure. In this study, we first prepared the indicator for MRI scanning on a GE 1.5 T excite machine in a mode suitable for 3D reconstruction. The 3D Avizo software system (version 6.0, Mercury Computer Systems, Inc., Germany) was then used for image processing and the resulting data subsequently analyzed using descriptive statistics and analysis of variance (ANOVA). The mean distance from the Baihui anterior to the central sulcus in the adult group was greater than that in the child group (22.7 ± 2.2 and 19.7 ± 2.2 mm, resp.,P= .042), whereas in the child group the distance between the Baihui anterior and the precentral sulcus was greater than in the adult group (6.8 ± 0.8 and 3.8 ± 0.8 mm, resp.,P< .001). This MRI presentation demonstrates that the location of Baihui (GV20) can be identified using the distance from the central or precentral sulcus.