Knowledge and Surgical Strategies for Successful Laparoscopic Caudate Lobectomy, a Comprehensive Literature Review

Laparoscopic approach in patients presenting caudate lobe lesions has always been considered prohibitive as technically demanding, so that the role of minimally invasive surgery for this posterior and deep location is still debated. Recently some studies presented cases of laparoscopic caudate lobectomy discussing how to manage technical challenges and providing excellent results. Innovative technologies for laparoscopic liver surgery are likely to improve the feasibility and reproducibility of laparoscopic liver resections in the near future especially for lesions located in the so called “difficult segments”.Still, laparoscopic caudate lobectomy remains unfamiliar to many surgeons and there are relatively few reports in the literature on this subject. For this reason, we conducted a comprehensive review of the literature to understand the safety and feasibility of LCL resections and discuss current and future perspectives.

A hemangioma in the masseter muscle: a case report

Intramuscular hemangiomas of the masseter muscle are uncommon tumors and therefore can be difficult to accurately diagnose preoperatively, due to the unfamiliar presentation and deep location in the lateral face. A case of intramuscular hemangioma of the masseter muscle in a 66-yearold woman is presented. Doppler ultrasonography showed a 34× 15 mm hypoechoic and hypervascular soft tissue mass in the left masseter muscle, suggesting hemangioma. The mass was excised via a lateral cervical incision near the posterior border of the mandibular ramus. The surgical wound healed well without complications.

Resection of a pineal region papillary tumor using robotic exoscope: improved visualization and ergonomics for deep seeded tumor

Surgery for pineal region tumors is technically challenging due to their deep location and close proximity to critical deep venous structures, midbrain, and thalamus. A high-definition video exoscope was recently proposed as an alternative to the operating microscope. The authors illustrate a case of the midline supracerebellar infratentorial approach to resect a pineal region tumor using the Modus V exoscope and demonstrate the improved visualization of critical structures in this deep location. Additionally, the marked improvement in surgeon comfort suggests that this system may have significant advantages over traditional microscope-based surgery for tumors of the pineal region. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2127.

STUDY ON THE RHINOPHARYNX NEOPLASMS

In order to receive the food bolus, the muscular-fibrous walls of the pharynx contract by reflex, first widening the pharynx, and the palatine veil rises, closing the passage to the rhinopharynx. Then the base of the tongue rises, the piers approach, closing the bucco-pharyngeal passage in the isthmus. The airway is simultaneously interrupted by the posterior displacement of the base of the tongue, the folding of the mucosa of the posterior pharynx, and the lifting and closing of the larynx. The food bolus is thus forced to follow the hypopharyngeal-esophageal pathway, the only one that remains open. In case of paralysis of the nerves that coordinate the swallowing process, the laryngeal sphincter remains open, favoring the false pathway and aspiration bronchopneumonias. The paralysis of the palatine veil prevents its horizontalization during swallowing, which favors the discharge of fluids into the nose, which is significant when the paralysis is bilateral and more discrete when it is unilateral. The clinical prospective and retrospective study material was represented by a number of 190 individuals aged 0 to 80 years, who were hospitalized between 01.01.2011 and 31.12.2019 in the ENT Department of the Teaching Hospital in Galați for follow-up of malignant rhinopharyngeal tumors. Most of these patients subsequently underwent sequential examination to determine their treatment response. Due to its deep location and limited clinical accessibility, onset symptoms are often absent or inconclusive for both the physician and the patient. CT scan is superior to clinical examination in primary tumor evaluation, especially in advanced T3 and T4 cases, which are largely clinically under-rated. Performing the coronal rhinopharynx sections and double-window recording greatly increase the accuracy of examination and they should be considered at least for the initial assessment procedure.

Intramuscular ancient schwannoma of the axillary nerve

We present the case of an adolescent with an intramuscular ancient schwannoma of the axillary nerve which, to the best of our knowledge, has not been reported before. Due to its deep location, intramuscular schwannoma has less clinical signs and hence, is difficult to diagnose. Ancient schwannoma, characterised by degeneration due to long course, is rare and can be mistaken for malignancy due to heterogeneous intensity and degeneration evident on MRI and nuclear atypia on histopathology. It is important to differentiate it from malignancy based on a clinically benign swelling with a long history, well-encapsulated mass on MRI with the split fat sign and absence of significant mitotic activity despite nuclear atypia. The aim of surgery should be enucleation of the tumour while preserving the function of the parent nerve.

An AI-Powered Blood Test to Detect Cancer Using NanoDSF

Glioblastoma is the most frequent and aggressive primary brain tumor. Its diagnosis is based on resection or biopsy that could be especially difficult and dangerous in the case of deep location or patient comorbidities. Monitoring disease evolution and progression also requires repeated biopsies that are often not feasible. Therefore, there is an urgent need to develop biomarkers to diagnose and follow glioblastoma evolution in a minimally invasive way. In the present study, we described a novel cancer detection method based on plasma denaturation profiles obtained by a non-conventional use of differential scanning fluorimetry. Using blood samples from 84 glioma patients and 63 healthy controls, we showed that their denaturation profiles can be automatically distinguished with the help of machine learning algorithms with 92% accuracy. Proposed high throughput workflow can be applied to any type of cancer and could become a powerful pan-cancer diagnostic and monitoring tool requiring only a simple blood test.

The physiological and pathophysiological aspects of the sphenoid sinus: a review

<p class="abstract">The sphenoid sinus among the paranasal sinuses, with its deep location and obstruction at the level of its ostium, is the commonest cause of occipital or vertex headache. Limited intervention reverts the intricate mucociliary physiology of the sinus. The surgery, a sphenoidotomy, is aptly captioned, the “functional endoscopic sinus surgery”, for the Sphenoid. The unique physio-pathology of the Sphenoid sinus shall be elaborated. </p>

Anatomographic Variants of Sphenoid Sinus in Ethiopian Population

Neurosurgeons often neglect the sphenoid sinus due to its deep location and difficulties in accessing during surgical interventions. Disease of the sphenoid sinus is difficult to diagnose since its presenting symptoms are difficult to recognize. Moreover, compared with other paranasal sinuses, the sphenoid sinus is considered the most variable air sinus in terms of its degree of pneumatization, number and position of inter-sinus septa, and its relationship with the surrounding anatomical structures. Anatomical variations of the sphenoid sinus are significant from a neurosurgical point of view. Understanding of these variations and its relationships with surrounding structures such as the internal carotid artery, optic nerve, and pituitary gland are clinically relevant to minimize injuries associated with surgical procedures that involve sphenoid sinus. We implemented principles of imaging using computed tomography to elucidate any anatomical variations of the sphenoid sinus in the Ethiopian population. We conducted a prospective study in 200 patients with ages 18–79, who underwent scans of the sphenoid sinus at the Tikur Anbessa Referral Teaching Hospital in 2017–2018. Our findings revealed an incidence of anatomographical variations in terms of pneumatization that varied between 2–50%. These variants include 2% conchal, 25.5% presellar, 50% sellar, and 22.5% postsellar pneumatization. We also demonstrated anatomographic variants in terms of septation, 77.5% single complete septa, 11.5% single incomplete, 10% double septa, and 1% absence of septa. In summary, the sellar pneumatization was found to be the most clinically relevant anatomographic variant among Ethiopians participating in the study, of which 90% were tomographically single septated. These variants must be taken into consideration during trans-sphenoidal surgery and knowledge of the variations has clinical implication in minimizing injuries during invasive surgical procedures involving the sphenoid sinus.

Impact of beef carcass size on chilling rate, pH decline, display color, and tenderness of top round subprimals

Beef carcass weights in the United States have continued to increase over the past 30 yr. As reported by the United States Department of Agriculture, grid-based carcass weight discounts begin when carcasses exceed 408 kg. Despite weight discounts, beef carcass weights continue to increase. At the same time, an increased prevalence of discoloration and color variability in top round subprimals has been observed throughout the industry which may be influenced by the increases in carcass weights. The objectives of this study were to assess the effects of beef carcass size and its relationship to chill time, color, pH, and tenderness of the beef top round. In the current study, eight industry average weight beef carcasses (AW, 341–397 kg) and eight oversized beef carcasses (OW, exceeding 432 kg) were evaluated. Temperatures and pH measurements were observed on both sides of all carcasses for the initial 48 h postharvest at a consistent superficial and deep anatomical location of the respective top rounds. Carcasses were fabricated into subprimals at 48 h and top rounds were aged at 2 °C for an additional 12 d. The superficial location of both AW and OW carcasses cooled at a faster rate (P &lt; 0.01) than the deep locations. The deep location of OW carcasses had a lower pH and a more rapid (P &lt; 0.01) initial pH decline. Quantitative color of steaks from OW carcasses had greater mean L* (lightness; P = 0.01) and initial b* (yellowness; P &lt; 0.01) values. The delayed temperature decline and the accelerated pH decline of the deep location of the top round of OW carcasses occur at different rates than AW carcasses. Delayed rate of cooling leads to irreversible impacts on steak appearance of top round steaks fabricated from OW beef carcasses when compared with AW carcasses.

Management of Anterocapitis and Anterocollis: A Novel Ultrasound Guided Approach Combined with Electromyography for Botulinum Toxin Injection of Longus Colli and Longus Capitis

Chemodenervation of cervical musculature using botulinum neurotoxin (BoNT) is established as the gold standard or treatment of choice for management of Cervical Dystonia (CD). The success of BoNT procedures is measured by improved symptomology while minimizing side effects and is dependent upon many factors including: clinical pattern recognition, identifying contributory muscles, BoNT dosage, and locating and safely injecting target muscles. In patients with CD, treatment of anterocollis (forward flexion of the neck) and anterocaput (anterocapitis) (forward flexion of the head) are inarguably challenging. The longus Colli (LoCol) and longus capitis (LoCap) muscles, two deep cervical spine and head flexor muscles, frequently contribute to these patterns. Localizing and safely injecting these muscles is particularly challenging owing to their deep location and the complex regional anatomy which includes critical neurovascular and other structures. Ultrasound (US) guidance provides direct visualization of the LoCol, LoCap, other cervical muscles and adjacent structures reducing the risks and side effects while improving the clinical outcome of BoNT for these conditions. The addition of electromyography (EMG) provides confirmation of muscle activity within the target muscle. Within this manuscript, we present a technical description of a novel US guided approach (combined with EMG) for BoNT injection into the LoCol and LoCap muscles for the management of anterocollis and anterocaput in patients with CD.