Angiographic measurement of the superficial temporal artery for potential use in cerebral bypass surgery: a combined radiological and cadaveric study.

PURPOSE: This study aims to investigate the microsurgical anatomy of the superficial temporal artery (STA), explore the relationship between STA length and lumen diameter, and develop a reliable radiologic method for selecting STA segments for bypass surgery. METHODS: This study used 10 cadaveric dissections (20 STAs, both sides) and 20 retrospective radiological examinations (40 STAs, both sides), employing curved multiplanar reformation and flow color lookup table (CLUT) DICOM processing. Measurements included vessel lumen diameters and luminal cross-sectional thicknesses 3 mm proximal to the STA bifurcation, 3 mm distal to the frontal branch, 5 cm distal to the frontal branch, 3 mm distal to the parietal branch, and 5 cm distal to the parietal branch. The distance between the STA bifurcation and the superior zygomatic border (SZB) was also measured. In our analysis, descriptive statistics encompassed mean, standard deviation (SD), standard error, minimum and maximum values, and distributions. Comparative statistics were performed using Student's t-test, with statistical significance set at p < 0.05. RESULTS: There were no statistically significant differences between STA measurements of bifurcation distances (p = 0.88) and lumen diameters (p = 0.46) between cadavers and radiological measures. However, lumen thicknesses were larger in frontal branches than parietal branches at the seventh and eighth centimeter (p = 0.012, p = 0.039). Branches became thinner distally from the zygoma in both cadavers and radiological image measurements. CONCLUSION: The CLUT DICOM processing radiological measures provided the high-precision required to enable pre-surgical vessel selection for extracranial-intracranial bypass. The results show that STA vessel luminal diameters are sufficient (> 1 mm) for bypass surgery in the first 9 cm but gradually decrease after that. Also shown is that the choice of frontal versus parietal branches depends on individual anatomical features; therefore, careful preoperative radiological examination is critical.

Alternative Path for Optic Nerve Decompression in Pseudotumor Cerebri With Full Endoscopic Lateral Transorbital Approach.

Endonasal endoscopic approaches are the most preferred surgical methods in patients with pseudotumor cerebri because of easy access to the optic nerve, but the choice of this technique may not apply to all endoscopic endonasal cases. Moreover, there may be difficulties in practice in some cases, including the coronavirus disease 2019 pandemic. This study aimed to suggest an alternative endoscopic approach by lateral orbitotomy for optic nerve decompression in patients with pseudotumor cerebri. The study was performed using 5 fresh-frozen cadaver heads (bilaterally, total of 10 sides) injected intravenously with colored silicone preserved in the cold chain. An average of 2.5 cm skin incision was made to fit the lateral orbitotomy. The lengths of the recurrent meningeal artery (mm), the meningo-orbital band (mm), and the optic nerve (mm) to the orbital margin were measured. After these morphometric measurements, optic nerve decompression was performed endoscopically, and the length of the decompression was measured (mm). The average length (mm) between the orbital rim and meningeal recurrent artery (or meningolacrimal branch) was 16.2 mm, between the orbital rim and the meningo-orbital band was 18.5 mm, and between the orbital rim and optic nerve was 44.1 mm. The average optic nerve decompression length was 4.4 mm. The endoscopic lateral orbitotomy approach provides easy access to the optic nerve by anatomically following the recurrent meningeal artery and the meningo-orbital band. It can be a safe second-line approach after endonasal approaches for optic nerve decompression in pseudotumor cerebri.

Thyroid Carcinoma Presenting as a Dural and Calvarial Metastasis Mimicking a Lipoma With Difficult Diagnosis of the Primary Lesion.

Calvarial and dural metastases of papillary thyroid carcinomas (PTC) are rarely reported in the medical literature. Most frequent calvarial metastases are seen to originate from lung, breast, and prostate cancers. Thyroid cancer metastases are generally well vascularized and cause destruction in the bone tissues. First choice of treatment in distant metastases of PTC is surgery and radioactive iodine treatment for the primary cause. Postsurgical radiotherapy is used in accepted and suitable patients.

Stereologic and ultrastructural comparison of human and rat amniotic membrane wrapping for rat sciatic nerve repair.

In this study we aimed to examine the effects on wound healing and nerve regeneration of human and rat amniotic membrane wraps around primary epineural anastomosis areas after a peripheral nerve transection injury in rats. We randomized 25 male adult rats with induced peripheral transection injuries into 5 groups (control, transection injury, primary epineural anastomosis [PEA] after injury, PEA with a human amniotic membrane [hAM] wrap, and PEA with a rat amniotic membrane [rAM] wrap groups and treated their injuries accordingly. We took tissue samples from the anastomosis regions, 12 weeks after the experiment, and analyzed them stereologically and ultrastructurally. We performed a statistical analysis with the recovered stereological counts and the measurement data. Our results showed that the use of amniotic membranes for allografts (between same species) instead of xenografts (between different species), along with microsurgery, provides a suitable microenvironment during the healing process with less immunological reaction on the injured site and supports axonal regeneration.

Spinal intradural-intramedullary cavernous malformation. Case report and literature review.

Cavernous angiomas or cavernomas are uncommon vascular malformations of the central nervous system and spinal involvement is much rarer especially in pediatric patients. We report a case of spinal intradural-intramedullary cavernous angioma in a 14-year-old male child. The cavernoma was located at the level of C6-C7 at the dorsal part of the spinal cord. The diagnosis was made with MRI and the patient underwent surgical treatment. The cavernoma was totally removed with laminotomy and microsurgical techniques. Somatosensory evoked potential monitoring was also used peroperatively. The clinical, radiological and surgical features of this rare case were presented and discussed with reference to the literature.

High-velocity gunshot wounds to the head: analysis of 135 patients.

Head injuries due to high-velocity missiles and shrapnel as a result of military conflicts have become a very important cause of death or severe neurological deficits. Military-type missiles have high velocities and transfer higher amounts of energy to neural tissue, compared to civil-type missiles. This physical phenomenon also causes greater neural tissue destruction. Shrapnel particles derive from blasts and cause less severe injury because of the irregular particle shape and low energy transmission. This study analyzed 135 patients with head trauma, 80 patients (59%) injured by missiles and 55 patients (41%) by shrapnel. Glasgow Coma Scale (GCS) scores at admission were 3 to 7 in 69 patients, 8 to 10 in 29 patients, and 11 to 15 in 37 patients. The most common anatomical localizations were the right frontoparietal region in 42 patients and the left frontoparietal region in 40 patients. One hundred patients (74%) were operated on immediately and 35 patients (26%) were treated conservatively in the intensive care unit. Ten of the 135 patients died (7.4%), seven from missile injury and three from shrapnel injury. In this study, we found that high mortality was associated with low GCS score at admission, presence of multilobar or skull base injuries, and involvement of ventricles. Early and aggressive surgical intervention decreased the mortality.

Reconstruction options for complex middle cerebral artery aneurysms.

OBJECTIVE: To describe techniques of reconstruction for unclippable and uncoilable middle cerebral artery aneurysms. METHODS: A retrospective review was performed of seven patients who underwent eight operations during a 9-year period to treat complex middle cerebral artery bifurcation aneurysms not amenable to direct clipping or endovascular coiling. All preoperative and postoperative clinical and imaging data were reviewed. Follow-up was obtained for all patients via clinic visit and/or telephone. RESULTS: The operative techniques used included saphenous vein graft bypass (n = 1), radial artery graft interposition (n = 2), radial artery patch (n = 1), superficial temporal artery interposition graft (n = 1), superior thyroid artery interposition graft (n = 1), direct reimplantation of branch (n = 1), and reconstruction of trifurcation (n = 1). There was no mortality. Six patients had excellent outcomes with Glasgow Outcome Scale scores of 5, and one patient had a good outcome with a Glasgow Outcome Scale score of 4. CONCLUSION: Techniques for middle cerebral artery reconstruction may remain important and useful in the age of endovascular aneurysm treatment.

Characteristics of traumatic spinal cord injuries in south-eastern Anatolia, Turkey: a comparative approach to 10 years' experience.

The purpose of this study was to determine the demographic and epidemiological characteristics of traumatic spinal cord-injured patients. The hospital records of 539 patients (416 men, 123 women) with spinal cord injuries (SCIs) admitted to four hospitals that were major referral centers for trauma in the south-eastern region of Turkey from 1990 to 1999 were reviewed retrospectively. The patients with SCI were investigated for two periods; the first period covered patients admitted between 1990 and 1994 during which time an influx of people from rural to urban areas occurred and firearm injuries were common. In the second period (1995-1999) the influx of people declined and firearm injuries were reduced. The most common causes of injuries were road traffic accidents (200, 37.12%), followed by falls (172, 31.90%) and bullet wounds (115, 21.34%). In the first period, incomplete paraplegia was encountered more often than in the second period (P<0.001). In conclusion, in our series, while the leading cause of SCI for the two time periods was road traffic accidents, firearm injuries for the first period and falls for the second period were second-most frequent causes of SCI. In addition, the present study suggests that demographic and epidemiological factors may affect the characteristics of SCI in a region-based population even in a 10-year period of time.

Preventive effects of intracisternal alphatochopherol on cerebral vasospasm in experimental subarachnoid haemorrhage.

Vasospasm is an important cause of morbidity and/or mortality with a subarachnoid haemorrhage (SAH). The roles of lipid peroxidation in a vasospasm caused by a SAH remain to be investigated. The effect of an intracisternal administration of alphatochopherol on a cerebral vasospasm was investigated in an experimental model. The authors assessed whether the administration of alphatochopherol reduced the vasospasm. By means of an intracisternal blood injection model, a SAH was induced in 30 rats, which were randomly divided into three groups, as follows: group I (G1), without a SAH and drug, group II (G2), a SAH alone, group III (G3), a SAH and alphatochopherol. Following the withdrawal of cerebrospinal fluid (CSF), a fresh unheparinized arterial blood was injected into the cisterna magna to induce a SAH. In G3, 20 U (0.4ml) alphatochopherol was intracisternally injected forty-five hours after induction of the SAH. All rats were sacrificed 72 hours after the induction. The basilar artery, with surrounding tissue, was removed from the cranium. The cross-sectional diameter of the lumen and vessel wall of the rat basilar artery was assessed from a planimetric analysis, and changes compared with G1 and G2. The reduction in the luminal cross-sectional diameter of the vessels exposed to subarachnoid blood was found to be 29.01 % (p=0.001). The group treated with alphatochopherol had a 9% reduction (p=0.004). The role of lipid peroxidation on a vasospasm caused by SAH is well known to be critical. Data from the present study indicated that antioxidant therapy, with topical alphatochopherol, may be promising on a vasospasm caused by a SAH.