Dilated perivascular spaces (PVSs) are common and easily recognized on imaging. However, rarer giant tumefactive PVSs (GTPVSs) can have unusual multilocular cystic configurations, and are often ...confused for other pathologic entities, including neoplasms, cystic infarctions, and neuroepithelial cysts. Because GTPVSs are scarcely encountered and even more infrequently operated upon, many radiologists are unaware of the imaging and pathologic features of these lesions. Here, a case of a resected GTPVS is presented, highlighting both its radiologic and histologic characteristics, and discussing how such lesions can be differentiated from their closest mimickers on imaging.
Split cord malformation is a congenital condition that varies in form and severity, primarily diagnosed in pediatric patients. Surgical treatment is the most common method of correction. Herein, we ...discuss an extremely rare case of a split cord malformation associated with a midline cervical rib.
A 49-year-old male patient presented to the emergency department with cervical spine trauma. MRI and CT scans were performed of the patient, revealing an unknown cervical rib structure and underlying split cord malformation.
To our knowledge, this is the first report of an anomalous midline cervical rib related to a split cord malformation. Such a finding should prompt the clinician to further evaluate such a patient for underlying congenital occult spinal dysraphism such as split cord malformation.
•We present a rare case where a 49-year-old patient’s SCM was associated with a rib-like structure that then contributed to a bony septum.•Neurological deficit should not be the only factor used to consider SCM and findings of routine imaging should be considered.•A clinician who manages patients should consider this rare morphology and avoid excessive manipulation which could injure an underlying SCM.
INTRODUCTION: In complex spine surgery, current pedicle screw systems with 5.5 mm titanium, cobalt chromium or stainless steel rods have rod failure rates of approximately 9% with a minimum of 1-year ...follow-up. The fracture rate with these alloys increases to approximately 22% in PSO cases. 1 Molybdenum-rhenium has demonstrated superior yield strength and fatigue endurance limit compared to Ti-6Al-4V and CoCr. METHODS: Retrospective, multicenter, case series. Inclusion criteria were = 4 levels posterior instrumented fusion with 4.5 mm molybdenum-rhenium rods, age = 18 yrs and 6 months or longer radiographic and followup. RESULTS: One hundred and fifty-nine (159) consecutive patients from ten different medical centers that had spinal surgery from August 2019 until April 2022 met inclusion criteria. Mean age was 63 ± 11.8 years; 50% women; 31% smokers; 19% diabetic and the mean BMI was 30 ± 7.3. The mean number of levels fused was 5.9 ± 2.7; 22.6% 4 levels, 64.2% 5-9 levels and 13.2% 10 levels or greater. Approximately half were thoracolumbar (27.7%) or thoracolumbar to pelvis (24.5%) and approximately half were lumbar-sacral (47.2%). Thirty-eight patients (24%) had a PSO and 59 patients (39%) had a SPO. All cases were done with molybdenum-rhenium 4.5 mm diameter rods. There were no RFs reported in the 159 cases (0/159; 0.0%) at 22.36 months mean follow-up. CONCLUSIONS: There was no incidence of RF in the 159 consecutive patients who underwent complex spine surgery involving multiple levels and osteotomies. A pedicle screw system based upon molybdenum-rhenium 4.5 mm rods provides superior fracture resistance particularly in complex spine procedures. 1 Smith JS, et al., Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine. 2014 Dec; 21(6): 994-1003.
Metals from spinal implants are released into surrounding tissues by various mechanisms. Metal ion release has been associated with clinical implant failure, osteolysis, and remote site accumulation ...with adverse events. Significant corrosion and associated metal ion release has been described with currently used spinal implant alloys. A novel metal alloy, Molybdenum-47.5Rhenium alloy (MoRe®), was approved for use in medical implants in 2019 by the FDA.
To evaluate the metal ion release profile of MoRe alloy after immersion in both a stable physiologic, as well as in an inflammatory environment.
In vitro study.
The ion release profile of the MoRe alloy was comprehensively evaluated in-vitro after prolonged immersion in physiologic and inflammatory environments. Ion concentration analyses were then conducted using inductively coupled plasma-mass spectrometry (ICP-MS) methods. Comparative testing of titanium (Ti-6Al-4V) and cobalt chromium (Co-28Cr-6Mo) was also performed.
Under baseline physiologic conditions, the MoRe alloy demonstrates very low molybdenum and rhenium ion release rates throughout the 30-day test period. During the first time interval (day 0–1), low levels of molybdenum and rhenium ions are detected (<0.3 μg/cm2 day) followed by a rapid reduction in the ion release rates to <0.05 μg/cm2 day during the second time interval (days 1–3) followed by a further reduction to very low steady-state rates <0.01 μg/cm2 day during the third time interval (days 3–7), which were maintained through 30 days. In the inflammatory condition (H2O2 solution), there was a transient increase in the release of molybdenum and rhenium ions, followed by a return to baseline ion release rates (days 2–4), with a further reduction to low steady-state rates of ∼0.01 μg/cm2 day (days 4–8). The measured molybdenum and rhenium ion release rates in both steady state (<0.01 μg/cm2 day), and inflammatory environments (0.01 μg/cm2 day) were far below the established FDA-permitted daily exposure (PDE) of 1,900 μg/cm2 day for molybdenum and 4,400 μg/cm2 day for rhenium. In contrast, titanium and cobalt chromium approached or exceeded their established PDE values in an inflammatory environment.
The novel biomaterial MoRe demonstrated a lower metal ion release profile in both a physiologic and inflammatory environment and was well below the established PDE. Comparative testing of the cobalt-chromium and titanium alloys found higher levels of ion release in the inflammatory environment that exceeded the PDE for cobalt and vanadium.
COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus ...to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients', families', and society's mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University's library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer's disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.
Introduction
Graft sources for cervical fusion procedures include synthetic materials, donor grafts, and autologous bones such as the iliac crest. Considering the data that autologous bone grafts ...seem to generate the best results for fusion, the next logical step is to seek alternative donor sites so as to attempt to reduce the morbidity associated with these procedures. To our knowledge, autologous clavicle has not been explored as a potential source for cervical fusion. Therefore, the following study was performed to verify the utility of this bone for these procedures.
Materials and methods
Seven adult cadavers were used for this study. In the supine position, a standard surgical approach and dissection to the anterior cervical spine were performed. Specimens underwent a standard discectomy or corpectomy with placement of harvested ipsilateral clavicle previously dissected. An anterior cervical plating system was next placed over these sites using standard techniques. Measurements of the harvested clavicle were made.
Results
The results of our morphometric analysis were as follows: An average of 5 cm of bone was easily removed from the middle one third of the clavicle. No gross injury was found to vicinal neurovascular structures. The middle one third of the clavicle offered sufficient bone for the one to two segments fused in our study with remaining bone for at least two additional segments. The mean diameter of this part of the clavicle was 1.2 cm.
Conclusions
Based on our cadaveric study, such a bony substitute as autologous clavicle might be a reasonable alternative to the iliac crest for use in anterior cervical fusion procedures.
The COVID-19 pandemic has accelerated neurological, mental health disorders, and neurocognitive issues. However, there is a lack of inexpensive and efficient brain evaluation and screening systems. ...As a result, a considerable fraction of patients with neurocognitive or psychobehavioral predicaments either do not get timely diagnosed or fail to receive personalized treatment plans. This is especially true in the elderly populations, wherein only 16% of seniors say they receive regular cognitive evaluations. Therefore, there is a great need for development of an optimized clinical brain screening workflow methodology like what is already in existence for prostate and breast exams. Such a methodology should be designed to facilitate objective early detection and cost-effective treatment of such disorders. In this paper we have reviewed the existing clinical protocols, recent technological advances and suggested reliable clinical workflows for brain screening. Such protocols range from questionnaires and smartphone apps to multi-modality brain mapping and advanced imaging where applicable. To that end, the Society for Brain Mapping and Therapeutics (SBMT) proposes the Brain, Spine and Mental Health Screening (NEUROSCREEN) as a multi-faceted approach. Beside other assessment tools, NEUROSCREEN employs smartphone guided cognitive assessments and quantitative electroencephalography (qEEG) as well as potential genetic testing for cognitive decline risk as inexpensive and effective screening tools to facilitate objective diagnosis, monitor disease progression, and guide personalized treatment interventions. Operationalizing NEUROSCREEN is expected to result in reduced healthcare costs and improving quality of life at national and later, global scales.
Membrane adsorbers provide an attractive alternative to traditional bead-based chromatography columns used to remove trace impurities in downstream applications. A linearly scalable novel membrane ...adsorber family designed for the efficient removal of trace impurities from biotherapeutics, are capable of reproducibly achieving greater than 4 log removal of mammalian viruses, 3 log removal of endotoxin and DNA, and greater than 1 log removal of host cell protein. Single use, disposable membrane adsorbers eliminate the need for costly and time consuming column packing and cleaning validation associated with bead-based chromatography systems, and minimize the required number and volume of buffers. A membrane adsorber step reduces process time, floor space, buffer usage, labor cost, and improves manufacturing flexibility. This “process compression” effect is commonly associated with reducing the number of processing steps. The rigid microporous structure of the membrane layers allows for high process flux operation and uniform bed consistency at all processing scales.
Intracranial monitoring using electroencephalography (IC-EEG) continues to play a critical role in the assessment of patients with medically intractable localization-related epilepsy. There has been ...minimal change in grid or electrode design in the last 15-20 years, and the surgical approaches for implantation are unchanged. Intracranial monitoring using EEG allows detailed definition of the region of ictal onset and defines the epileptogenic zone, particularly with regard to adjacent potentially eloquent tissue. Recent developments of IC-EEG include the coregistration of functional imaging data such as magnetoencephalography to the frameless navigation systems. Despite significant inherent limitations that are often overlooked, IC-EEG remains the gold standard for localization of the epileptogenic cortex. Intracranial electrodes take a variety of different forms and may be placed either in the subdural (subdural strips and grids, depth electrodes) or extradural spaces (sphenoidal, peg, and epidural electrodes). Each form has its own advantages and shortcomings but extensive subdural implantation of electrodes is most common and is most comprehensively discussed. The indications for intracranial electrodes are reviewed.
Identification of a New Segment of the Trochlear Nerve Mortazavi, Martin M.; Griessenauer, Christoph J.; Cormier, Jason ...
Journal of Neurological Surgery Part B: Skull Base,
03/2013, Letnik:
74, Številka:
S 01
Conference Proceeding, Journal Article
Recenzirano
Odprti dostop
Introduction:
The trochlear nerve is important to preserve during approaches to the skull base. Traditionally, this nerve has been divided into cisternal, cavernous, and orbital segments.
Materials ...and Methods:
Twenty latex-injected cadaveric sides (10 adult cadavers) were dissected with the aid of an operating microscope. Standard microdissection techniques were employed to examine the course of the distal cisternal segment of the trochlear nerve.
Results:
In all specimens, a fourth segment of the trochlear nerve was identified. This part of the nerve coursed between the entrance of the trochlear nerve into the posterior corner of the oculomotor trigone, and the posterior wall of the cavernous sinus. This segment of trochlear nerve was, on average, 3 mm in length.
Conclusions:
We have identified a new segment of the trochlear nerve not previously described. We propose that this be referred to as trigonal segment. Hence, the new proposed classification would be cisternal, trigonal, cavernous, and orbital. Knowledge of the microanatomy of the trochlear nerve may be of assistance to the skull base surgeon, especially during entrance into the cavernous sinus.
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