Background: Hinge-Door Cervical laminoplasty is commonly performed procedure in patients with cervical spondylotic myelopathy. Most available studies have established restriction of flexion and ...extension motion post laminoplasty but the literature on post-laminoplasty axial rotation is sparse.
Objective: To study the axial neck rotation on either side following hinge door cervical laminoplasty.
Materials and Methods: Twenty consecutive patients of cervical spondylotic myelopathy planned for cervical laminoplasty were included in the study. Preoperative and postoperative radiological data was recorded for each patient and analysed by an experienced neuroradiologist. The clinical and radiological follow-up was recorded at 6 months post surgery. All patients underwent standard hinge door C3-C6 laminoplasty preserving the muscle attachments to C2 and C7 vertebra.
Results: There were 13 men and 7 women with a mean age of 60.5 years, age range 58-70 years. The mean preop C1 C2 rotation was 46.5 degrees and mean post-operative C1-C2 rotation was 44.3 degrees. The average subaxial cervical spine rotation was 11.66 degrees preoperatively and 12.47 degrees postoperatively. The global cervical spine rotation was 80.95 degrees preoperatively and 76.82 degrees postoperatively. There is no significant change in segmental, subaxial and global cervical spine rotation following hinge door C3-C6 laminoplasty preserving the muscle attachments to C2 and C7 vertebra.
Conclusion: Cervical laminoplasty preserves cervical ROM and is a motion-preserving surgery as far as axial rotation is concerned.
Extended endoscopic endonasal approaches (EEAs) to petroclival chondrosarcomas (PCs) require a thorough understanding of skullbase anatomy, especially the anatomy of petrous internal carotid artery ...(pICA), as ICA injury is the most dreaded complication of extended EEAs. We conducted this study to determine the displacement patterns of pICA in patients with PCs.
Contrast enhanced computed tomography scan and angiography images of patients with PCs were analyzed for following parameters—antero-posterior, cranio-caudal, medio-lateral, and direct distances between anterior genu of petrous internal carotid artery (AGpICA) and posterior end of Vidian canal (pVC). pICA encasement/narrowing by tumor was noted on magnetic resonance imaging.
We studied 11 patients with histopathologically proven PCs. pICA encasement/narrowing and pVC destruction were observed in one patient each. The mean antero-posterior and cranio-caudal distances on tumor side/normal side were 7.7 ± 1.9/6.4 ± 1.0 mm & 4.5 ± 1.5/3.4 ± 0.9 mm, respectively. The overall displacement was posterior & superior. Medio-lateral displacement was seen in 4 patients (lateral in 3 and medial in 1). In rest, AGpICA was centered on pVC. The mean direct distance was 9.4 ± 2.5 mm. In 3 patients with displacement seen in all three axes, direct distance was measured by the “cuboid method.” Overall, posterior-superior-lateral, posterior-superior, and anterior-inferior were the common displacement patterns of AGpICA relative to pVC.
The displacement patterns of AGpICA in PCs are variable. An individualized approach with meticulous analysis of preoperative imaging can help in determining the relation between AGpICA and pVC. This detailed morphometric information can facilitate better orientation to altered anatomy, which can be helpful in preventing pICA injury during extended EEAs.
•Massive nasal bleeding and have a history of preceding trauma must raise suspicion & require probing for bleed from ICA.•Intraarterial digital subtraction angiogram & coiling is the treatment of ...choice for ICA injury.
Epistaxis is a commonly managed emergency by the ENT specialty. Although successfully managed in most of the times, internal carotid artery (ICA) aneurysms are among the rare causes that require prompt diagnosis, management and interdisciplinary intervention for saving the patient’s life.
We report the presentation and management of four cases of ICA pseudoaneurysm bleeds, out of which three of them were successfully managed with endovascular coiling by interventional neuroradiology.
Endovascular coiling of the PA (pseudonaurysm) with preservation of patency of ICA is the preferred treatment option when possible. Being a new technique, studies are required to assess the long term complications and failure rate.
Endovascular treatment is a standard mode of treatment for traumatic cavernous internal carotid artery (ICA) pseudoaneurysms with good results and relatively low rates of complications. We describe a ...case of an unusual, potentially fatal, delayed postoperative event happening in a case of post-traumatic pseudoaneurysm of ICA, which had been previously managed with endovascular coiling.
The automatic segmentation of blood vessels in fundus images can help analyze the condition of retinal vasculature, which is crucial for identifying various systemic diseases like hypertension, ...diabetes, etc. Despite the success of Deep Learning-based models in this segmentation task, most of them are heavily parametrized and thus have limited use in practical applications. This paper proposes IterMiUnet, a new lightweight convolution-based segmentation model that requires significantly fewer parameters and yet delivers performance similar to existing models. The model makes use of the excellent segmentation capabilities of Iternet (Li et al (2020)) architecture but overcomes its heavily parametrized nature by incorporating the encoder-decoder structure of MiUnet (Hu et al. (2019) IEEE Access 7:174167-174177) model within it. Thus, the new model reduces parameters without any compromise with the network's depth, which is necessary to learn abstract hierarchical concepts in deep models. This lightweight segmentation model speeds up training and inference time and is potentially helpful in the medical domain where data is scarce and, therefore, heavily parametrized models tend to overfit. The proposed model was evaluated on three publicly available datasets: DRIVE, STARE, and CHASE-DB1. Further cross-training and inter-rater variability evaluations have also been performed. The proposed model has a lot of potential to be utilized as a tool for the early diagnosis of many diseases.
Spinal arteriovenous shunts and spinal dysraphism both have a different underlying cause, disease spectrum and developmental process; hence, these entities rarely coexist in a patient. Here, we ...reported four cases of coexistence of adult-onset spinal arteriovenous shunt and spinal dysraphism in the same patient along with their therapeutic embolisation. Additionally, we conducted an extensive literature review to explore the potential theories and explanations for this coexistence.BACKGROUNDSpinal arteriovenous shunts and spinal dysraphism both have a different underlying cause, disease spectrum and developmental process; hence, these entities rarely coexist in a patient. Here, we reported four cases of coexistence of adult-onset spinal arteriovenous shunt and spinal dysraphism in the same patient along with their therapeutic embolisation. Additionally, we conducted an extensive literature review to explore the potential theories and explanations for this coexistence.We retrospectively searched our imaging database from January 2015 to December 2023 to identify instances of spinal arteriovenous shunts occurring in patients with spinal dysraphism or neural tube defect disorders. MRI and angiographic imaging, clinical presentation, treatment and follow-up were analysed.METHODSWe retrospectively searched our imaging database from January 2015 to December 2023 to identify instances of spinal arteriovenous shunts occurring in patients with spinal dysraphism or neural tube defect disorders. MRI and angiographic imaging, clinical presentation, treatment and follow-up were analysed.Four patients with arteriovenous fistula/shunt and spinal dysraphism were included in the study. The mean age of presentation was 35.5 years. The most common symptoms were sensory disturbance and motor weakness. Arteriovenous fistula or shunt was located at the lumber region in one patient and at the sacral region in three cases. Two patients have a prior history of surgery in first decade. Two patients were treated with glue embolisation. The internal iliac artery was a common feeder in all cases.RESULTSFour patients with arteriovenous fistula/shunt and spinal dysraphism were included in the study. The mean age of presentation was 35.5 years. The most common symptoms were sensory disturbance and motor weakness. Arteriovenous fistula or shunt was located at the lumber region in one patient and at the sacral region in three cases. Two patients have a prior history of surgery in first decade. Two patients were treated with glue embolisation. The internal iliac artery was a common feeder in all cases.The rare coexistence of neural tube defects with spinal vascular abnormalities should be considered when assessing a middle-aged patient with neural tube defect and myelopathy. Correct diagnosis can help in treatment planning and thereby improve prognosis.CONCLUSIONSThe rare coexistence of neural tube defects with spinal vascular abnormalities should be considered when assessing a middle-aged patient with neural tube defect and myelopathy. Correct diagnosis can help in treatment planning and thereby improve prognosis.
Cerebral venous thrombosis (CVT) is an uncommon cause of stroke with extremely varied clinical presentations, predisposing factors, imaging findings, and outcomes, and thus can be extremely ...challenging to diagnose. Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term squel. In this article, we have reviewed the epidemiology, causative factors, clinical features, diagnosis and treatment of CVT from an Indian perspective. Over the last decade, a change in trends in the causative factors has been noted from India.
Although intracranial aneurysms are rare in the paediatric population, the proportion of those involving posterior circulation is higher than that of adults (approximately 25% vs. 8%, respectively). ...Moreover, posterior circulation aneurysms in kids tend to be larger in size, many of them being giant dissecting types, and treatment of them is often challenging. Treatment of giant dissecting aneurysms, especially involving the Basilar artery is difficult due to strategic location and haemodynamic factors. Use of reconstructive techniques viz. flow-diverters and braided stents is difficult in children because of the lack of standard protocol for use of antiplatelet therapy and the need for prolonged use of the same. Continuous growth of parent vessel is also suggested as a pitfall for the use of a flow diverter/ braided stent which has a fixed caliber. Carefully planned endovascular parent or feeder branch artery occlusion (FAO) is a time-tested method to achieve flow reversal or favourable flow modifications in an arterial segment harbouring dissecting aneurysm. Here, in this case report, we describe a case of a ruptured distal giant basilar artery dissecting aneurysm in a 10-year-old boy treated with flow diversion by FAO. The dominant left vertebral artery was occluded, thereby diverting flow from the right vertebral artery towards the left posterior inferior cerebellar artery and decreasing flow through the aneurysm. On 1-year follow-up, the patient was asymptomatic and on check angiography, there was complete involution of the aneurysm with increased flow through bilateral posterior communicating arteries to distal posterior circulation which proved our hypothesis correct.
Background:
Moyamoya disease (MMD) is a chronic progressive cerebrovascular occlusive disease affecting commonly the anterior circle of Willis. Matushima grade inadequately reflects the angiographic ...changes postrevascularization procedure.
Aims:
To analyze the clinical and angiographic outcome of revascularization procedures (direct ST-middle cerebral artery (MCA) anastomosis and indirect encephalo-duro-arterio-myo-synangiosis (EDAMS)) in MMD and validate a new angiographic scoring system.
Materials and Methods:
Retrospective study included symptomatic patients of MMD who underwent revascularization; both indirect and combined methods between January 2002 and April 2012. Follow-up angiography was done after at least 3 months. We devised a novel scoring system the "angiographic outcome score" (AOS) including reformation of distal MCA and anterior cerebral artery, regression of basal moyamoya vessels, leptomeningeal collaterals and overall perfusion. AOS was applied to the angiograms independently by a neuroradiologist and a neurosurgeon that were blinded toward its preoperative or postoperative status.
Results:
Totally 33 patients underwent 36 EDAMS and 4 combined procedures (EDAMS + ST-MCA bypass). The mean follow-up was 20 months. None had recurrent transient ischemic attack or fresh infarct. Postoperative AOS was significantly higher than preoperative AOS. The Spearman rho showed positive correlation between Matushima grade and postoperative AOS. Significant regression of basal moyamoya vessels and increase in number of loci of transdural collaterals was seen.
Conclusions:
EDAMS is a simple yet effective method of revascularization in both pediatric as well as adult age groups. AOS is a simple, precise and easily reproducible scoring system, which reflects the favorable angiographic changes after revascularization.
Objective: Resection of large Vestibular Schwannomas (VSs) can be associated with postoperative facial nerve injury. Diffusion-based tractography has emerged as a powerful tool for three-dimensional ...imaging and reconstruction of white matter fibers; however, tractography of the cranial nerves has not been well studied. In this prospective study, we aim to predict the position of facial nerve in large VSs (>3 cm) using Diffusion Tensor Imaging (DTI) tractography and correlate it with the intraoperative finding of the position of facial nerve.
Materials and Methods: Twenty patients with a large VS (>3 cm) undergoing surgery were subjected to preoperative DTI to predict the position of the facial nerve in relation to the tumor. The surgeon was blinded to the results of the preoperative DTI tractography. A comparative analysis was then made during operation. The location of the facial nerve in relation to the tumor was recorded during surgery using facial nerve stimulator.
Results: Of the 20 patients who underwent DTI tractography, it was not possible to preoperatively identify facial nerve in one patient. In another patient, although DTI tractography predicted the position of facial nerve, it was not identified intraoperatively. In the remaining 18 patients, DTI tractography accurately predicted the facial nerve position. The predicted position was in synchronization with the intraoperative facial nerve position in 16 patients (89% concordance). It was discordant in two patients (11%), but this was not found to be statistically significant (P = −0.3679).
Conclusion: This study validates the reliability of facial nerve DTI-based fiber tracking for prediction of the facial nerve position in patients with large VSs. The reliable preoperative visualization of facial nerve location in relation to the VS will allow surgeons to plan tumor removal accordingly and may increase the safety of surgery.
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