Volumetric comparative analysis of anatomy through far-lateral approach: surgical space and exposed tissues

Background The three-dimensional (3D) visualization model has ability to quantify the surgical anatomy of far-lateral approach. This study was designed to disclose the relationship between surgical space and exposed tissues in the far-lateral approach by the volumetric analysis of 3D model. Methods The 3D skull base models were constructed using MRI and CT data of 15 patients (30 sides) with trigeminal neuralgia. Surgical corridors of the far-lateral approach were simulated by triangular pyramids to represent two surgical spaces exposing bony and neurovascular tissues. Volumetric comparison of surgical anatomy was performed using pair t test. Results The morphometric results were almost the same in the two surgical spaces except the vagus nerve (CN X) exposed only in one corridor, whereas the volumetric comparison represented the statistical significant differences of surgical space and bony and neurovascular tissues involved in the two corridors (P<0.001). The differences of bony and neurovascular tissues failed to equal the difference of surgical space. Conclusions For far-lateral approach, the increase of exposure for the bony and neurovascular tissues is not necessarily matched with the increase of surgical space. The volumetric comparative analysis is helpful to provide more detailed anatomical information in the surgical design.

Endoscopic Anatomy of the Zygomatic Nerve: Implications for the Endoscopic Transmaxillary Approach

Background Understanding the anatomic features of the zygomatic nerve is critical for performing the endoscopic transmaxillary approach properly. Injury to the zygomatic nerve can result in facial numbness and corneal problems. Objective To evaluate the surgical anatomy of the zygomatic nerve and its segments from an endoscopic endonasal perspective for clinical implications of performing the endoscopic transmaxillary approach. Methods The origin, course, length, and segments of the zygomatic nerve were studied in four specimens from an endonasal perspective. Results The zygomatic nerve arises 4.1 ± 1.7 mm from the foramen rotundum of the maxillary nerve in the superolateral pterygopalatine fossa (PPF). According to its anatomic region in endonasal endoscopic surgery, we divided the zygomatic nerve into two segments: the PPF segment, from origin to the point of entry under Muller's muscle, which runs superolaterally to the inferior orbital fissure (IOF) (length, 4.6 ± 1.3 mm), and the IOF segment, starting at the entry point in Muller's muscle and terminating at the exit point in the IOF, which travels between Muller's muscle and the great wing of the sphenoid bone (length, 19.6 ± 3.6 mm). In the transmaxillary approach, the zygomatic nerve is a critical landmark in the superolateral PPF. Conclusion The zygomatic nerve travels in the PPF and the IOF; better visualization and preservation of this nerve during endonasal endoscopic surgery are crucial for successful outcomes.

Ultrasound examination of myometrial changes after conservative myomectomy, with the aim of predicting the course of pregnancy and choosing the optimal method of delivery

Introduction. The article provides a methodology for assessing and predicting complications during pregnancy for selectionof the optimal method of delivery.Goals and objectives. The work assessed the degree of myometrium changes, according to ultrasound studies, after using standard instrumentation and electrocoagulation, in order to predict the course of pregnancy and select the optimal method of delivery.Materials and methods. The details of the surgical anatomy, the plan of the surgeon’s action before the operation, formed according to the data of ultrasound diagnostics and operative surgery, were analyzed. Ultrasound was performed using GE Logiq S8 (USA) and Medisan Accuvix (South Korea) devices with 3,5 MHz convex transducers for transabdominal examination and with a frequency of 5 MHz for transvaginal examination.Research results. Laparoscopic myomectomy was performed in 18 women, 31 patients underwent laparotomic myomectomy, in 11 patients a combined operation technique was used: laparoscopy with minilaparotomy. According to our data, in half of the cases considered, the effects of interventions were absent or minimal. We assigned these results to group I (A — A1, A2, A3). In all other observations, cicatricial changes were revealed — group II (B, C, D, E). To predict the possible consequences, we proposed a point assessment of the ultrasound postoperative changes in the uterus, with the help of which it is possible to assess the degree of risk when planning pregnancy for each patient individually. Each group corresponds to a certain number of points.Conclusions. The presented division according to the degree of severity into groups can make it possible to individualize the approach to each patient and ensure the safest possible management of her during pregnancy and childbirth. This assessment can be used by ultrasound doctors and obstetricians-gynecologists of antenatal clinics and hospitals. The assessment presented by us at the moment is of a recommendatory nature.