Intraosseous contrast administration for emergency stroke CT

Computed tomography (CT) imaging in acute stroke is an established and fairly widespread approach, but there is no data on applicability of intraosseous (IO) contrast administration in the case of failed intravenous (IV) cannula placement. Here, we present the first case of IO contrast administration for CT imaging in suspected acute stroke providing a dedicated CT examination protocol and analysis of achieved image quality as well as a review of available literature.

A procedure for dual simple t-cannulation in the small intestine of pigs using a single right flank laparotomy

Singular cannulation in the small intestine of pigs is a common methodology for studying nutrient digestibility, delivering compounds into the gastrointestinal tract, or repeated tissue and digesta sampling. In that respect, it is an important tool for nutritionists and researchers. However, there is a dearth of detailed methodologies describing multiple intestinal cannulations using modern techniques. The objective of this experiment was to develop a single right flank laparotomy technique that allowed for imsertion of multiple cannulas in the small intestine, with minimal variation, and allowed for externalisation of both cannulas on the same lateral side as the laparotomy. Thirty gilts (L337 × Camborough) with an initial body weight of 30.2±0.78 kg underwent the procedure. Each gilt was equipped with a simple t-cannula in the terminal ileum, approximately 10 cm cranial to the ileocecal valve, and a second t-cannula in the jejunum 240 cm distal from where the duodenum is visually posterior to the transverse colon. The procedure used hallmarks of commonly implemented terminal ileal cannulation techniques, but modified the laparotomy location and cannula externalisation sites and used a novel approach for determining the more proximal cannula location to mitigate the need of a second laparotomy. Gilts were allowed to recover for a minimum of 7 d and were used for an average of 67 days in subsequent experimental trials. Cannula longevity was from 30 to 73 kg of body weight. Pigs were necropsied for surgical site gross examination and small intestine measurements at the end of the experiment. The jejunal cannula had a mean placement of 298.90±9.96 cm distal to the pyloric sphincter with a coefficient of variation of 3.33%. Hence, this procedure provided a single laparotomy technique for obtaining digesta from multiple locations of the small intestine, with minimal variation in proximal cannula placement.

Use of a novel ball-joint guide array for magnetic resonance imaging–guided cannula placement and convective delivery: technical note

OBJECTIVEThe objective of this study was to assess the feasibility, accuracy, effectiveness, and safety of an MRI-compatible frameless stereotactic ball-joint guide array (BJGA) as a platform for cannula placement and convection-enhanced delivery (CED).METHODSThe authors analyzed the clinical and imaging data from consecutive patients with aromatic l-amino acid decarboxylase (AADC) deficiency who underwent infusion of adeno-associated virus (AAV) containing the AADC gene (AAV2-AADC).RESULTSEleven patients (7 females, 4 males) underwent bilateral MRI-guided BJGA cannula placement and CED of AAV2-AADC (22 brainstem infusions). The mean age at infusion was 10.5 ± 5.2 years (range 4–19 years). MRI allowed for accurate real-time planning, confirmed precise cannula placement after single-pass placement, and permitted on-the-fly adjustment. Overall, the mean bilateral depth to the target was 137.0 ± 5.2 mm (range 124.0–145.5 mm). The mean bilateral depth error was 0.9 ± 0.7 mm (range 0–2.2 mm), and the bilateral radial error was 0.9 ± 0.6 mm (range 0.1–2.3 mm). The bilateral absolute tip error was 1.4 ± 0.8 mm (range 0.4–3.0 mm). Target depth and absolute tip error were not correlated (Pearson product-moment correlation coefficient, r = 0.01).CONCLUSIONSUse of the BJGA is feasible, accurate, effective, and safe for cannula placement, infusion MRI monitoring, and cannula adjustment during CED. The low-profile universal applicability of the BJGA streamlines and facilitates MRI-guided CED.

Percutaneous Endoscopic Lumbar Discectomy Assisted by O-Arm-Based Navigation Improves the Learning Curve

Objective. There is a steep learning curve with traditional percutaneous endoscopic lumbar discectomy (PELD). The aim of this study is to assess the safety and efficacy of PELD assisted by O-arm-based navigation for treating lumbar disc herniation (LDH).Methods. From September of 2017 to January of 2018, 118 patients with symptomatic LDH were enrolled in the prospective cohort study. The patients undergoing PELD with O-arm-based navigation technique were defined as group A (58 cases), and those undergoing traditional X-ray fluoroscopy method were defined as group B (60 cases). We recorded the operation time, cannula placement time, radiation exposure time, visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab criteria score of the 2 groups.Results. The average operation time (95.21 ± 19.05 mins) and the cannula placement time (36.38 ± 14.67 mins) in group A were significantly reduced compared with group B (operation time, 113.83 ± 22.01 mins, P<0.001; cannula placement time, 52.63 ± 17.94 mins, P<0.001). The learning curve of PELD in group A was steeper than that in group B and was lower in the relatively flat region of the end. There were significant differences of the clinical parameters at different time points (VAS of low back, P < 0.001; VAS of leg, P < 0.001; and ODI, P < 0.001). The VAS scores for low back pain and leg pain improved significantly in both groups after surgery and gradually improved as time went by. No serious complication was observed in any patients in either group.Conclusion. The study indicated that PELD assisted by O-arm navigation is safe, accurate, and efficient for the treatment of lumbar intervertebral disc herniation. It reshaped the learning curve of PELD, reduced the difficulty of surgery, and minimized radiation exposure to surgeons. This study was registered at Chinese Clinical Trail Registry (Registration Number:ChiCTR1800019586).