Uso do laser de baixa potência para o tratamento de parestesia: uma revisão de literatura / Use of low-level laser to treat paresthesia: a literature review

Introdução: A parestesia é uma neuropatia que afeta a função sensorial. O Laser de Baixa Potência (LBP), por sua vez, apresenta propriedades analgésicas, bioestimuladoras e reparadoras. Objetivo: Realizar um levantamento na literatura científica sobre os aspectos gerais e benefícios do LBP no manejo terapêutico da parestesia, além de identificar a classificação e métodos de obtenção do diagnóstico desta condição. Materiais e Métodos: Tratou-se de uma revisão narrativa da literatura através da busca nas plataformas PubMed, SciELO, LILACS e Google Schoolar. Após o cruzamento dos descritores com os operadores booleanos e aplicação dos critérios de inclusão/exclusão, 26 estudos foram incluídos. Resultados: A parestesia pode ser classificada em neuropraxia, axonotmese e neurotmese, subdivididas em Grau I ao V. Seu diagnóstico pode ser executado através de testes subjetivos e objetivos. O LBP compreende em um dispositivo tecnológico com efeitos analgésico, anti-inflamatório e fotobiomodulador, que estimula o reparo neural. Os estudos mostram que a dosimetria nos comprimentos de onda vermelho e infravermelho, aplicação intra e extra oral, e com mais de uma sessão semanal exerce efeito modulatório positivo do reparo neural, com retorno progressivo da atividade sensitiva. Além disso, os estudos trazem uma ampla variação no número de pontos de aplicação, bem como no tempo de irradiação e quantidade de sessões, em virtude da extensão e tempo de diagnóstico da parestesia. Considerações finais: Apesar da alta complexidade da parestesia, o LBP exerce efeitos benéficos através do retorno da sensibilidade parcial ou total, além de ser um dispositivo bem tolerado pelo organismo e minimamente invasivo.

Introduction: Paresthesia is a neuropathy that affects sensory function. The Low-Level Laser (LLL), in turn, has analgesic, biostimulating and reparative properties. Purpose: Carry out a survey at the scientific literature on the general aspects and benefits of LLL in the therapeutic management of paresthesia in addition to identifying the classification and methods for obtaining a diagnosis of this condition. Materials and Methods: It was a narrative literature review through search in platforms PubMed, SciELO, LILACS and Google Schoolar. After crossing the descriptors with boolean operators and applying the inclusion/exclusion criteria, 26 articles were included in this study. Results: Paresthesia can be classified into neuropraxia, axonotmesis and neurotmesis, subdivided into Grades I to V. Its diagnostic can be carried out through subjective and objective tests. The LLL consists in a technological device with analgesic, anti-inflammatory and photobiomodulatory effects, which stimulates neural repair. Studies show that LLL in dosimetry at red and infrared wavelengths with intra and extra oral application and with more than one-week use exerts a positive modulatory effect on neural repair, with a progressive return of sensory activity. Furthermore, the studies show a wide variation in the number of application points, as well as the irradiation time and number of sessions, due to the extent and time of diagnosis of paresthesia. Final Considerations: Despite the high complexity of paresthesia, the LLL has beneficial effects through the return of partial or total sensitivity in addition being a device well tolerated by the body and minimally invasive.

Preserving medial iliofemoral ligament avoids excessive leg lengthening in total hip arthroplasty using anterolateral-supine approach.

Background: In this study, we compared postoperative leg length discrepancy (LLD) after total hip arthroplasty using the anterolateral-supine approach (ALSA THA) with or without medial iliofemoral ligament (mILFL) preservation and examined the effect of the remaining mILFL on postoperative LLD. Methods: This was a single-center, retrospective case control study. Unilateral primary THA with a preoperative LLD <15 mm, in which the contralateral side was intact, was included. After ALSA THA, we compared the absolute values of postoperative LLDs and examined the ratio of postoperative LLD >5 mm with and without mILFL preservation. Demographic data, clinical scores, and operative data were collected. Statistical significance was set at p < 0.05. Results: We included 341 hips (preservation group: 283 hips; resection group: 58 hips). The mean (range) absolute values of the postoperative LLDs were 2.3 (0-15.9) mm and 3.4 (0-14.8) mm, respectively. There was no significant difference between the two groups (p = 0.36). The proportion of postoperative LLD >5 mm differed significantly between the groups (4.4 % and 20.0 %, respectively; p < 0.01). Multiple logistic regression analysis showed that resection of the mILFL was the only significant factor that caused excessive leg lengthening (odds ratio, 5.28; 95 % confidence interval, 2.12-13.10, p < 0.01). Significant differences were reported in surgical time (81 (38-132) and 96 (54-157), respectively; p < 0.01) and intraoperative blood loss (297 (50-1170) and 388 (100-1150), respectively; p < 0.01). However, no significant differences in clinical scores, dislocation (including instability), or reoperation rates were observed between the two groups. Conclusion: In patients with a preoperative LLD <15 mm, preserving the mILFL in ALSA THA avoids excessive leg lengthening and may lead to shorter LLD without any difficulties.

Spontaneous Inferior Mesenteric Artery Occlusion after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm and its Impact on Clinical Outcomes.

OBJECTIVE: The incidence and related factors of spontaneous occlusion of a patent inferior mesenteric artery (IMA) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) without pre-emptive embolisation remain unclear. This study aimed to elucidate the incidence, clinical implications and predictors of spontaneous IMA occlusion after EVAR. METHODS: This was a single centre, retrospective cohort study. Patients who underwent elective EVAR between 2007 and 2022 were categorised into three groups (group 1, spontaneous IMA occlusion; group 2, patent IMA with no type II endoleak (T2EL) from IMA; group 3, T2EL from IMA). Endpoints were the incidence of spontaneous IMA occlusion, sac enlargement, freedom from re-intervention, and overall survival after EVAR. RESULTS: Of 372 cases of elective EVAR for AAA, 230 who had patent IMA pre-operatively were analysed, after excluding 127 with pre-occluded IMA and 15 who underwent pre-emptive IMA embolisation. Spontaneous IMA occlusion occurred in 101 patients (43.9%). Sac enlargement rate was lower in group 1 than in groups 2 and 3. Freedom from re-intervention rate was higher in group 1 than in group 3 but did not differ between groups 1 and 2. Multivariate analysis revealed the absence of antiplatelet therapy, pre-operative higher haematocrit, absence of concomitant iliac artery aneurysm, posterior thrombus in the sac, and use of Endurant as predictors associated with spontaneous IMA occlusion. Spontaneous IMA occlusion was observed in 7.1% and 77.5% of patients with zero and four or five predictors, respectively. CONCLUSION: Spontaneous IMA occlusion occurred in nearly half of cases and was associated with positive clinical outcomes. In patients with a high prediction of spontaneous IMA occlusion, pre-emptive IMA embolisation may be omitted.

Unusual nerve communication in gluteal region: embryological basis and clinical perspective.

The posterior femoral cutaneous nerve (PFCN) has been widely studied with context to its origin, distribution and mononeuropathies. Due to the vulnerability of the gluteal region to iatrogenic injuries and pressure ulcers etc., an understanding of the cutaneous innervation of the gluteal region holds immense relevance. The communication between the PFCN and the inferior gluteal nerve (IGN) was observed at the back of thigh of a 56-year-old male cadaver while exploring distribution of nerves in gluteal region during routine anatomical dissection. The above communication holds importance in numerous diagnostic and reconstructive procedures. It assumes relevance where nerve blocks in PFCN are needed for surgical procedures in the vicinity of the thigh, knee, and the postero-superior part of the leg. The grade of motor response elicited in IGN on attempted PFCN stimulation could be a reliable determinant of adequate PFCN block.

Metastatic prostate cancer presenting as generalized lymphadenopathy and progressing with inferior vena cava syndrome: A case report and literature review.

The present study describes the case of a 71-year-old male patient that presented with generalized lymphadenopathy and a pelvic mass, but no signs of bone and visceral metastasis. Their total prostate-specific antigen level was >100 ng/ml. A biopsy of the pelvic mass, situated near the left iliac vessels, confirmed the existence of an adenocarcinoma originating from the prostate and a subsequent prostate biopsy indicated a Gleason score of 4+5. Endocrine treatment with bicalutamide and goserelin (androgen deprivation therapy) resulted in only a partial response of the left iliac metastatic lesions to the treatment. The subsequent treatment plan of androgen deprivation therapy and abiraterone plus docetaxel did not change the progression of the disease. The patient finally developed inferior vena cava syndrome. Subsequently, the patient declined both a re-biopsy of the prostate and enlarged cervical lymph nodes, and interventions by a vascular surgeon. To the best of our knowledge, the present study is the first documented case of a natural progression of metastatic prostate cancer with inferior vena cava syndrome.

Left inferior phrenic arterial malformation mimicking gastric varices: A case report and review of literature.

BACKGROUND: Gastric submucosal arterial dilation resulting from splenic artery occlusion represents an exceedingly rare etiology of acute upper gastrointestinal bleeding (UGIB). Although endoscopy is a widely utilized diagnostic and therapeutic modality for gastrointestinal bleeding, it has limitations in detecting arterial abnormalities. CASE SUMMARY: This report presents a rare case of massive UGIB in a 57-year-old male with a tortuous left inferior phrenic artery accompanied by splenic artery occlusion. "Gastric varices" was identified during the patient's endoscopy one year before hemorrhage. Despite initial hemostasis by endoscopic clipping, the patient experienced massive rebleeding after one month, requiring intervention with transcatheter arterial embolization (TAE) to achieve hemostasis. CONCLUSION: This is the first case to report UGIB due to a tortuous left inferior phrenic artery. This case highlights the limitations of endoscopy in identifying arterial abnormalities and emphasizes the potential of TAE as a viable alternative for the management of arterial bleeding in the gastrointestinal tract.

Establishing universal sectioning depth and angle for surgical coronectomy of impacted mandibular third molars: an imaging-based study.

Introduction: Coronectomy is a safer option than extraction for third molars with an increased risk of injury to the inferior alveolar nerve. However, it can still cause complications due to a lack of standardized and effective tooth sectioning techniques. We proposed a standardized protocol for third molar coronectomy involving standardized tooth sectioning parameters to minimize potential complications, surgical failure, and the need for further procedures. Methods: The study was conducted on 69 eligible archived CBCTs. The coronal sections of the mandibular at the anterior-most level of the lower third molar were used to determine various axes and reference points. This was done to establish the target angle and depth for the coronectomy sectioning. The data on the depth and angle of the sectioning was presented in means and standard deviation. A multivariate analysis of variance was used to determine the impact of study variables on drill depth and angle. Linear regression and correlation between study variables were also used to predict the drill depth and angle. Results: The samples included 46 males and 23 females aged from 21 to 47 years. The mean drill angle was determined as 25.01 ± 3.28. The mean drill depth was 9.60 ± 9.90 mm. The bucco-lingual tilt had a significant effect on the drill depth, F(1, 62) = 5.15, p < 0.05, but no significant impact on the drill angle, F(1, 62) = 29.62, p > 0.05. The study results suggest that a standardized sectioning protocol can be effective during surgical coronectomy procedures. Discussion: Drilling at a 25-degree angle to a depth of 9.5 mm is advisable to obtain the desired results. This approach will ensure no remaining enamel is left, minimize the chances of root extrusion and future eruption, and improve the outcome.

Enhanced Venous Thrombosis and Hypercoagulability in Murine and Human Metabolic Dysfunction-Associated Steatohepatitis.

BACKGROUND: Patients with metabolic dysfunction-associated steatohepatitis (MASH) are at an increased risk of developing venous thromboembolic events (VTE), including deep vein thrombosis (DVT). To date, the study of DVT in MASH has been hampered by the lack of reliable models that mimic the pathological aspects of human disease. OBJECTIVES: To evaluate DVT severity and hypercoagulability in murine and human MASH. METHODS: Transcriptional changes in the liver, plasma markers of coagulation, and DVT severity were evaluated in mice fed a chow diet or a high-fructose, high-fat, and high-cholesterol, MASH diet for 24 weeks. Plasma analyses of coagulations markers and thrombin generation assay were performed in a well-characterized cohort of patients with or without MASH. RESULTS: Mice fed the MASH diet developed steatohepatitis and fibrosis, mimicking human MASH. Liver RNA-sequencing revealed a significant upregulation of pathways related to inflammation and coagulation concomitant with increased plasma coagulation markers including increased prothrombin fragment 1+2, thrombin-antithrombin complex, plasminogen activator inhibitor-1 levels, and endothelin 1. MASH exacerbated DVT severity in mice, as evidenced by increased thrombus weight and higher thrombosis incidence (15/15 vs. 11/15 in controls, p=0.0317). Higher endothelin 1 release and increased apoptosis were found in endothelial cells stimulated with supernatants of palmitate-stimulated HepG2 cells. Patients with MASH exhibited increased plasma coagulation markers and delayed thrombin generation. CONCLUSION: We report enhanced DVT severity and hypercoagulability, both in murine and human MASH. Our model of MASH-DVT can facilitate a better understanding of the fundamental mechanisms leading to increased VTE in patients with MASH.

Unilateral secondary middle turbinate and ipsilateral bifid inferior turbinate with presence of uncinate process: Is it true bifid inferior turbinate?

Anatomical variations of the nasal turbinate, such as secondary middle turbinate (SMT) and bifid inferior turbinate (BIT), are sporadic. In most cases, SMT and BIT are generally bilateral. Moreover, the uncinate process is unusual in BIT because it is widely acknowledged that BIT could be an abnormality of the uncinate process. However, we found an unusual case of a 19-year-old female with 2 compartments on the right nostril since birth. CT scan and nasal endoscopy revealed unilateral SMT and ipsilateral BIT with the presence of an uncinate process. Therefore, considering the different origins of the uncinate process and inferior turbinate, BIT with the uncinate process can be referred to as true BIT, while BIT without the uncinate process can be referred to as false, double, or accessory inferior turbinate.

Clinical outcomes of inferior oblique myectomy in age categorized patients with unilateral superior oblique palsy.

Background: Unilateral superior oblique palsy (SOP) is the most common isolated cranial nerve palsy. This report looks at the results and safety of inferior oblique (IO) myectomy for SOP. Methods: A retrospective chart review of patients with fusional ability who underwent IO myectomy for unilateral SOP over a 15-year period, at one of our university-associated health care centers. Primary outcomes were: distance hypertropia and excyclotropia in primary position, inferior oblique overaction (IOOA) and the correlation between the age at surgery and the residual distance hypertropia. Results: A total of 73 patients with unilateral SOP who underwent IO myectomy were included in the analysis. Mean pre-operative values were: distance hypertropia: 15.41 ± 6.8 Prism Diopters (range 4-30 PD), IOOA: +2.2 ± 0.7 (range 0-3.5) and excyclotropia: +5.34 ± 3.6° (range 0-12°). Mean post-operative values were: distance hypertropia: 3.7 ± 3.4PD [0-14PD], IOOA: -0.1 ± 0.8 [(-2)-2] and excyclotropia: +1.1 ± 2.3°[(-5)-10]. The younger age group (0-20 years old) had a trend toward smaller preoperative distance hypertropia (P = 0.051), and a significantly smaller distance hypertropia post-operatively (p = 0.007). There was no case of ocular complication. Conclusions: On average, IO myectomy results in a 11.7PD reduction of the distance hypertropia, and 4° reduction of excyclotropia, with an effective reduction of IOOA. While these results are comparable to other surgical methods reported in the literature, they underline an efficacy without the risks of complications such as anti-elevation syndrome and possible scleral perforation. The younger age group had a trend toward smaller preoperative deviation, and better outcomes compared to the older age group.

Infarct of the Middle Cerebellar Peduncle Mimicking Bell's Palsy: A Case Report.

The anterior inferior cerebellar artery (AICA) supplies the middle cerebellar peduncle, lower pons, upper medulla, and anterior inferior cerebellum. Ischemia in the AICA can cause the lateral inferior pontine syndrome. AICA syndrome is characterized by facial sensory loss and weakness, Horner syndrome, prolonged vertigo, audio-vestibular loss, and cerebellar signs. Many studies on AICA territory infarcts have demonstrated the rarity of complete AICA syndrome. In all cases of AICA territory infarcts, involvement of the middle cerebellar peduncle was observed, with the seventh cranial nerve (facial nerve) being the most frequently involved cranial nerve, vertigo was the most common presenting symptom, and atherosclerosis was the most common etiology. This case report aims to investigate the occurrence of middle cerebellar peduncle infarcts that mimic Bell's palsy, highlighting the importance of accurate diagnosis and appropriate management in such cases. Recognizing the unique characteristics and clinical presentation of middle cerebellar peduncle (MCP) infarcts is essential for distinguishing them from more common conditions like Bell's palsy, thereby ensuring timely and effective treatment.

Evaluation of the Predictive Character of the Expiratory Inferior Vena Cava/Abdominal Aorta (eIVC/Ao) Index for Minimum Blood Pressure Following Spinal Anesthesia With 0.5% Hyperbaric Bupivacaine.

Spinal anesthesia has many side effects, one of them being a drop in blood pressure (BP). Identifying predictive factors for this drop is a clear matter of concern. In this regard, the expiratory inferior vena cava/abdominal aorta (eIVC/Ao) index has already been spotted as such for doses of 0.5% hyperbaric bupivacaine greater than 12mg. Departing from the demonstrated correlation between this index and hypotension post-spinal anesthesia, our study aimed to (1) evaluate whether an eIVC/Ao index greater than 0.7, thus defining non-hypovolemic patients, can also predict minimal BP for doses inferior to 12mg and (2) identify other predictive factors for minimal BP post-spinal anesthesia. Lastly, we verified whether preoperative fasting induces hypovolemia.  This single-center prospective observational pilot study included 20 patients. The baseline measurements of BP, eIVC/Ao index, and fasting time were recorded at time T0'. Then spinal anesthesia was administered with 0.5% hyperbaric bupivacaine in doses inferior to 12 mg. The patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and metameric levels were each recorded at times T5', T10', T15', and T20'.  The results indicated that baseline DBP was predictive of low DBP and minimum MAP, which reflect myocardial perfusion and systemic pressures, respectively. Therefore, it should trigger prophylaxis (spinal-lateralized, continuous, or lower dose) in patients with a low DBP baseline. Additionally, baseline SBP was predictive of minimum SBP, an independent risk factor for post-anesthetic hypotension if its baseline is less than 120 mmHg. Although female gender was linked to minimum SBP, other confounding factors (size, dose administered, and type of surgery related to gender) must also be considered. Moreover, a correlation was established between height and MAP in parturients. Hypotension was not recorded at local anesthetic (LA) doses between 8 and 12 mg and the doses administered were sufficient to achieve the metameric levels required for surgery (ether tests). Since 8 mg of 0.5% hyperbaric bupivacaine achieved the same level as 12 mg, lower doses of LA might prevent a significant drop in BP and its deleterious effects. Therefore, in the current cohort, the eIVC/Ao index was not predictive of minimum BP during spinal anesthesia with doses less than 12 mg of 0.5% hyperbaric bupivacaine. However, predictive factors for minimum BP included gender and baseline SBP (for minimum SBP), height and baseline DBP (for minimum MAP), and baseline DBP (for minimum DBP). Lastly, preoperative fasting did not cause hypovolemia.

Pairing Tones with Vagus Nerve Stimulation Improves Brainstem Responses to Speech in the Valproic Acid Model of Autism.

Receptive language deficits and aberrant auditory processing are often observed in individuals with autism spectrum disorders (ASD). Symptoms associated with ASD are observed in rodents prenatally exposed to valproic acid (VPA), including deficits in speech sound discrimination ability. These perceptual difficulties are accompanied by changes in neural activity patterns. In both cortical and subcortical levels of the auditory pathway, VPA-exposed rats have impaired responses to speech sounds. Developing a method to improve these neural deficits throughout the auditory pathway is necessary. The purpose of this study was to investigate the ability of vagus nerve stimulation (VNS) paired with sounds to restore degraded inferior colliculus responses in VPA-exposed rats. VNS paired with the speech sound "dad" was presented to a group of VPA-exposed rats 300 times per day for 20 days. Another group of VPA-exposed rats were presented with VNS paired with multiple tone frequencies for 20 days. The inferior colliculus responses were recorded from 19 saline-exposed control rats, 18 VPA-exposed with no VNS, 8 VNS-speech paired VPA-exposed, and 7 VNS-tone paired VPA-exposed female and male rats. Pairing VNS with tones increased the IC response strength to speech sounds by 44% when compared to VPA-exposed rats alone. Contrarily, VNS-speech pairing significantly decreased the IC response to speech compared with VPA-exposed rats by 5%. The current research indicates that pairing VNS with tones improved sound processing in rats exposed to VPA and suggests that auditory processing can be improved through targeted plasticity.

Central Hearing Loss in a Pediatric Patient.

Sensorineural hearing loss is typically caused by dysfunction of the inner ear or auditory nerve. In pediatric patients diagnosed with sensorineural hearing loss, work-up often includes genetic testing and imaging studies of the auditory pathway. Here, we report a case of a pediatric patient with a history of sensorineural hearing loss following cisplatin and radiation therapy for brainstem medulloblastoma, developing symptoms and signs of central hearing loss based on audiometric and MRI/diffusion tensor imaging studies. Though rare, central hearing loss should be considered among the causes of sensorineural hearing loss in children. Laryngoscope, 2024.

Small cardiac vein draining into the inferior vena cava.

Cardiac venous anomalies are rare congenital anatomical anomalies which are most commonly found on computed tomography scans as an accidental finding. We report a case of a fourteen-year-old child who was operated for an atrial septal defect and during the operation we came across an anomalous drainage of the small cardiac vein into the inferior vena cava. The child's postoperative course was uneventful.

Morphometric analysis of the mental foramen in a Syrian population by using cone-beam computed tomography.

INTRODUCTION: Anatomical knowledge is crucial for addressing diagnostic challenges, ensuring safe procedures, and avoiding potential risks. Among the various mandibular anatomical landmarks, the mental foramen (MF) is particularly significant for dental procedures, especially surgeries. Therefore, it is essential to conduct a comprehensive radiographic evaluation of this region before performing such procedures. The purpose of this study was to investigate the size of MF and the distances from its border to the alveolar crest (AC) and to the inferior border of the mandible (IBM) in a selected Syrian population by using cone-beam computed tomography (CBCT), and to detect any statistically significant effect of individuals' factors, such as sex, age, dental status, and side on these anatomical parameters. MATERIAL AND METHODS: The study retrospectively analyzed 200 CBCT scans (400 hemimandibles) from 104 females and 96 males, grouped into three age categories: 20-35, 36-50, and 51-65years. The hemimandibles were classified based on dental status into three groups: dentate, partially edentate, and completely edentate, and by side as right or left. RESULTS: The study revealed that the average horizontal and vertical diameters of MF were (3.48±0.75mm) and (3.01±0.75mm), respectively. Additionally, the average distances D1 (MF-AC) and D2 (MF-IBM) were (11.01±3.68mm) and (12.51±1.56mm) respectively. The study's findings indicated that age and dental status had a statistically significant effect on all the parameters studied, except for the horizontal diameter. Furthermore, sex had a statistically significant effect on all the parameters, while the side had no effect on any of the parameters investigated. CONCLUSIONS: The results of this study suggest that an understanding of the morphometry of the mental foramen is essential for clinicians, which may assist them in performing dental procedures more safely and achieving successful local anesthesia. Moreover, individual factors should be taken into consideration.

Fgf17: A regulator of the mid/hind brain boundary in mammals.

The Fibroblast growth factor (FGFs) family consists of at least 22 members that exert their function by binding and activating fibroblast growth factor receptors (FGFRs). The Fgf8/FgfD subfamily member, Fgf17, is located on human chromosome 8p21.3 and mouse chromosome 14 D2. In humans, FGF17 can be alternatively spliced to produce two isoforms (FGF17a and b) whereas three isoforms are present in mice (Fgf17a, b, and c), however, only Fgf17a and Fgf17b produce functional proteins. Fgf17 is a secreted protein with a cleavable N-terminal signal peptide and contains two binding domains, namely a conserved core region and a heparin binding site. Fgf17 mRNA is expressed in a wide range of different tissues during development, including the rostral patterning centre, midbrain-hindbrain boundary, tailbud mesoderm, olfactory placode, mammary glands, and smooth muscle precursors of major arteries. Given its broad expression pattern during development, it is surprising that adult Fgf17-/- mice displayed a rather mild phenotype; such that mutants only exhibited morphological changes in the frontal cortex and mid/hind brain boundary and changes in certain social behaviours. In humans, FGF17 mutations are implicated in several diseases, including Congenital Hypogonadotropic Hypogonadism and Kallmann Syndrome. FGF17 mutations contribute to CHH/KS in 1.1% of affected individuals, often presenting in conjunction with mutations in other FGF pathway genes like FGFR1 and FLRT3. FGF17 mutations were also identified in patients diagnosed with Dandy-Walker malformation and Pituitary Stalk Interruption Syndrome, however, it remains unclear how FGF17 is implicated in these diseases. Altered FGF17 expression has been observed in several cancers, including prostate cancer, hematopoietic cancers (acute myeloid leukemia and acute lymphoblastic leukemia), glioblastomas, perineural invasion in cervical cancer, and renal cell carcinomas. Furthermore, FGF17 has demonstrated neuroprotective effects, particularly during ischemic stroke, and has been shown to improve cognitive function in ageing mice.

Trans-obliquus inferior capitis course of the greater occipital nerve: A potential cause of occipital neuralgia?

Occipital neuralgia can be due to multiple etiologies. One of these is potential compression of the greater occipital nerve (GON). In this regard, one relationship of the GON, its course through the obliquus inferior capitis muscle (OIC), has yet to be well studied. Therefore, the current anatomical study was performed to elucidate this relationship better. In the prone position, the suboccipital triangle was exposed, and the relationship between the GON and OIC was documented in 72 adult cadavers (144 sides). The GON was found to pierce the OIC on four sides (2.8%), unilaterally in two cadavers and bilaterally in one cadaver. Two cadavers were male, and one was female. Histological samples were taken from GONs with a normal course around the OIC, and nerves were found to pierce the OIC. The GON of all four sides identified histological changes consistent with nerve potential compression (e.g., epineurial and perineurial thickening). This is also the first histological analysis of the trans-OIC course of the GON, demonstrating signs of chronic nerve potential compression. Although uncommon, entrapment of the GON by the OIC may be an underrecognized etiology of occipital neuralgia.

Risk Factors of Pulmonary Embolism in Long-Segment Posterior Thoracolumbar Fusion: Scoring System For Prophylactic Inferior Vena Cava Filter Placement.

OBJECTIVE: To investigate the factors for PE development and the necessity of IVC filter placement. Specifically, propose a scoring system to identify patient populations who benefit from IVC filter placement. METHODS: Single-institution retrospective cohort study between 2010-2022. Inclusion criteria were open posterior thoracolumbar fusion, ≥ 7 segments, and adult patients ≥ 18 years old. Patients undergoing any surgical approach other than posterior were excluded. Risk factors such as smoking status, illicit drug use/type, body mass index (BMI), gender, age, anticoagulation history and status on presence of PE were reviewed. RESULTS: 365 patients were identified; 170 (46.6%) patients were male, and 195 (53.4%) were female. 24 (6.6%) had IVC filters placed before the surgery. The overall rate of PE was 8 (2.2%), all in patients without IVC filter. Analysis showed that gender, age, and BMI did not affect incidence of PE. Smoking status, history of illicit drug use (cocaine/cannabis), and history of deep vein thrombosis/PE significantly increased the incidence of PE. Based on multivariate logistic regression, we developed a scoring system composed of aforementioned significant risk factors to determine risk of developing PE. Our scoring system stratified risk to low-risk (0-3 points), medium-risk (4-6 points), and high-risk (7-8 points). CONCLUSION: Risk of PE is relatively low after long-segment posterior thoracolumbar fusion. Smoking (former and current), history of cocaine/cannabis use, and history of venous thromboembolism are risk factors in such patients. We recommend prophylactic IVC filter use only in high-risk subgroups and under discretion between physician and patient in medium-risk subgroups.

Section and repositioning of the inferior turbinate in the design of extended septal flaps.

BACKGROUND AND OBJECTIVE: Nasoseptal or septal flaps extended to the floor of the fossa and inferior meatus are a resource in the reconstruction of extended endoscopic approaches. We propose the technique of sectioning and repositioning the inferior turbinate to facilitate the design of these extended pedicled flaps. MATERIAL AND METHODS: We evaluated 3 cases operated with a skull base lesion: a craniopharyngioma, a petroclival meningioma and a post-surgical fistula of cerebrospinal fluid in the cribiform plate, in which sectioning and repositioning of the inferior turbinate was performed prior to the design of a septal or nasoseptal flap extended to the floor and inferior meatus. To evaluate the anatomy and function of the inferior turbinate, we analysed the results of acoustic rhinometry three months after surgery with and without vasoconstrictor. RESULTS: The pedicled flaps remained visible and vital on endoscopic examination. The area of the C notch obtained by acoustic rhinometry, in the nostril where the turbinate was manipulated, was in all three cases the narrowest area of the nasal cavity. The mean area for the C-notch was .34 cm2, .74 cm2 and .30 cm2 at a distance from the nostril of 2.20 cm, 2.31 cm and 1.93 cm respectively. CONCLUSION: Performing a section and subsequent repositioning of the inferior turbinate, prior to designing an endonasal pedicled flap that includes the mucosa of the floor and inferior meatus, can greatly facilitate obtaining a larger reconstruction flap without affecting the functionality of the inferior turbinate itself.