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Internal carotid artery (ICA) agenesis is an infrequent vascular anomaly, less than 0.01% of the population. Here we report a case of internal carotid agenesis with a rare collateral pathway, via supraclinoid ICA anastomosis to the contralateral supraclinoid ICA.
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Doença de Alzheimer/diagnóstico , Variação Anatômica , Encéfalo/irrigação sanguínea , Artéria Carótida Interna/anormalidades , Idoso , Encéfalo/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética , MasculinoRESUMO
Temporomandibular joint (TMJ) disorder is clinically important because of its prevalence, chronicity, and therapy-refractoriness of the pain. In this study, we investigated the effect of infliximab in a mouse model of TMJ pain using a specially-engineered transducer for evaluating the changes in bite force (BF). The mice were randomly divided into three groups (7 mice per group): the control group, the complete Freund's adjuvant (CFA) group, and the infliximab group. BF was measured at day 0 (baseline BF). After measuring the baseline BF, CFA or incomplete Freund's adjuvant was injected into both TMJs and then the changes in BF were measured at days 1, 3, 5, 7, 9, and 13 after the TMJ injection. For measuring the BF, we used a custom-built BF transducer. Control, CFA, and infliximab groups showed similar baseline BF at day 0. From day 1, a significant reduction in BF was observed in the CFA group, and this reduction in BF was statistically significant compared to that in the control group (P < 0.05). This reduction in BF was maintained until day 7, and BF started to recover gradually from day 9. In the infliximab group also, the reduction in BF was observed on day 1, and this reduction was maintained until day 7. However, the degree of reduction in BF was less remarkable compared to that in the CFA group. The reduction in BF caused by injection of CFA into the TMJ could be partially alleviated by the injection of anti-tumor necrosis factor alpha, infliximab.
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Antirreumáticos/uso terapêutico , Força de Mordida , Infliximab/uso terapêutico , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Animais , Modelos Animais de Doenças , Adjuvante de Freund/toxicidade , Masculino , Camundongos , Camundongos Endogâmicos ICR , Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/induzido quimicamente , Transtornos da Articulação Temporomandibular/patologia , Fatores de TempoRESUMO
Aortic dissection in pregnant patients results in an inpatient mortality rate of 8.6%. Owing to the pronounced mortality rate and speed at which aortic dissections progress, efficient early detection methods are crucial. Here, we highlight the importance of early chest computed tomography (CT) for differentiating aortic dissection from pulmonary embolism in pregnant patients with dyspnea. We present the unique case of a 38-year-old pregnant woman with elevated D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, initially suspected of having a pulmonary embolism. Initial transthoracic echocardiography did not indicate aortic dissection. Surprisingly, after an emergency cesarean section, a chest CT scan revealed a DeBakey type I aortic dissection, indicating a diagnostic error. Our findings emphasize the need for early chest CT in pregnant patients with dyspnea and elevated D-dimer and NT-proBNP levels. This case report highlights the critical importance of considering both aortic dissection and pulmonary embolism in the differential diagnosis of such cases, which will inform future clinical practice.
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BACKGROUND: Lymphedema is characterized by localized tissue swelling due to excessive interstitial space retention of lymphatic fluid. Lymphedema is easy to be misdiagnosed since itresembles other conditions of extremity swelling. We present a case of complex regionalpain syndrome (CRPS) type I with secondary lymphedema that was successfully managedwith spinal cord stimulation (SCS). CASE: A 39-year-old female patient came to our pain clinic with complaints of lower extremity pain and edema. To find out reason of leg edema, computed tomography of extremity angiography and blood test were performed. However, all of evaluations were normal. Lastlyperformed lymphoscintigraphy showed secondary lymphedema. SCS was performed and itshowed dramatic reduction subsequent to implantation of SCS. CONCLUSIONS: We could successfully manage the intractable pain and edema in CRPS combined with lymphedema. If a patient presents different nature of edema, coexistence of other disease needs to be considered.
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BACKGROUND: The high thoracic erector spinae plane block (ESPB) has been used for the management of chronic shoulder pain or arthroscopic shoulder surgery. No study has evaluated the analgesic efficacy of ESPB in patients with cervical radiculopathy although it is a favored and easy technique compared to neuraxial block. The purpose of this study was to compare the treatment outcome of cervical radiculopathy using high thoracic ESPB or cervical interlaminar epidural injection (CEPI). METHODS: This study included 82 patients with neck and arm pain who received CEPI (CEPI group) using 4 ml of 0.1% ropivacaine or high thoracic ipsilateral ESPB (ESPB group) at the T2 or T3 level using 20 ml of 0.1% ropivacaine 20 ml. The degree of pain relief and disability were assessed using an 11-point numerical scale (NRS) and neck disability index (NDI), respectively. RESULTS: The CEPI and ESPB groups demonstrated an equal number of patients with excellent pain relief (NRS reduction ≥ 50%). Significant reduction of NRS was found in both groups, and the effect of time was statistically significant in the groups (P < 0.001). The number of patients who showed an excellent improvement in NDI (NDI reduction ≥ 30%) was 20 (48.8%) and 22 (53.7%) in the CEPI and ESPB groups, respectively. CONCLUSIONS: Both the CEPI and ESPB demonstrated significant relief in neck and arm pain with improvement in disability.
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BACKGROUND: Trigeminal neuralgia (TN) is usually established using characteristic clinical features such as sudden, severe, and unilateral facial pain. Studies about diverse clinical features and epidemiologic data of TN have been reported previously; however, most of the previous studies have evaluated in and focused on Caucasian and Western populations. OBJECTIVES: The purpose of this study was to evaluate diverse clinical features, currently applied types of treatment, and brain imaging studies in patients with TN in a Korean population. STUDY DESIGN: Retrospective analysis. SETTING: An interventional pain management practice in South Korea. METHODS: Patients with a primary diagnosis of TN were identified using Clinical Data Warehouse v 2.5 (CDW, Planit Healthcare, Seoul, Korea) using the key words "trigeminal neuralgia and G50.0 (International classification of disease 10 code)." RESULTS: TN occurred predominantly between the fifth and seventh decades of life, with female predominance. The V3 division and unilateral right-side involvement were the most common affected region. An electric shock like sensation and the intraoral side (teeth and gingiva) were the most common pain description and location, respectively. Normal brain imaging studies and vascular compression on the trigeminal nerve were observed in 92 (64.7%) and 36 (25%) patients, respectively. The superior cerebellar artery was the most common offending vessel (19;13.3%). Monotherapy with carbamazepine alone was the most common (91;37.7%), whereas radiofrequency thermoablation was the most common invasive treatment. LIMITATIONS: The results of this study were based on data on TN patients from a single center. The generalizability of the findings to the Korean population is thus limited. CONCLUSION: There is little difference between Korean and other Asian patients with TN in their demographic and clinical characteristics.
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Neuralgia do Trigêmeo , Humanos , Feminino , Masculino , Neuralgia do Trigêmeo/terapia , Neuralgia do Trigêmeo/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Nervo Trigêmeo , Manejo da Dor/métodosRESUMO
RATIONALE: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use of THRIVE for managing airway obstruction during tracheostomy in patients with subglottic and tracheal stenosis, thereby addressing the current knowledge gap and exploring its potential for airway management. PATIENT CONCERNS: A 63-year-old female with subglottic and tracheal stenoses underwent tracheostomy. Multiple attempts to establish a patent airway were unsuccessful, and oxygen saturation dropped to 56%. DIAGNOSIS: Endotracheal tube was directed toward the tracheal wall, causing airway obstruction. INTERVENTIONS: THRIVE was administered to the patient. Subsequently, the tube position was adjusted to enhance ventilation. OUTCOMES: The patient's oxygen saturation increased to 99%. The postoperative complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium, resolved. The patient was discharged on postoperative day 9. LESSONS: THRIVE could be considered a temporary measure to enhance oxygenation before initiating a definitive treatment strategy.
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Obstrução das Vias Respiratórias , Insuflação , Estenose Traqueal , Feminino , Humanos , Pessoa de Meia-Idade , Traqueostomia/efeitos adversos , Estenose Traqueal/cirurgia , Estenose Traqueal/complicações , Insuflação/efeitos adversos , Administração Intranasal , Apneia/terapia , Obstrução das Vias Respiratórias/complicaçõesRESUMO
BACKGROUND: Spontaneous intracranial hypotension occurs due to cerebrospinal fluid leakage from the spinal column, and orthostatic headache is the most common clinical presentation. Recent studies showed that bilateral greater occipital nerve blockade demonstrated clinical efficacy in relieving post-dural puncture headache after caesarean section. CASE: A 40-year-old male who presented severe orthostatic headache was consulted to our pain clinic from neurology department. He initially felt a dull nature pain over the whole occipital area which then spread over the frontal and parietal areas. His headache was combined with nausea and vomiting. An epidural blood patch was delayed until final cisternography, and bilateral greater occipital nerve blockade using ultrasound guidance was performed instead. After the blockade, the previously existing headache around the occipital and parietal areas disappeared completely, but mild headache persisted around the frontal area. CONCLUSIONS: Greater occipital nerve blockade could be a good therapeutic alternative to improve headache resulting from spontaneous intracranial hypotension.
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BACKGROUND: Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an excellent treatment option for medically intractable trigeminal neuralgia. However, this procedure can manifest abrupt changes in cardiovascular responses. With abrupt cardiovascular changes, a sudden trigeminocardiac reflex can occur during RFT of the trigeminal ganglion. OBJECTIVES: The primary endpoint of this study was to identify the critical point at which RFT causes abrupt hemodynamic response changes. The secondary endpoint of this study was to evaluate the occurrence of the trigeminocardiac reflex. STUDY DESIGN: Retrospective design. SETTING: An interventional pain management practice in The Republic of Korea (South Korea). METHODS: Forty patients who received trigeminal ganglion RFT under C-arm guidance due to intractable facial pain were included. We checked and recorded the blood pressure and heart rate at baseline (before RFT), immediately before and after entering the foramen ovale (FO), during electrical stimulation, during thermal heating, and 30 minutes post-RFT. Also, we recorded the presence or absence of the trigeminocardiac reflex during RFT. RESULTS: Heart rate during thermal heating increased more than 20% compared to baseline (87.6 beats/min vs 69 beats/min, P < 0.001). The mean arterial pressure showed an increase of more than 15% compared to baseline when the cannula entered the FO (106.4 mmHg vs 90.9 mmHg, P < 0.001) and during thermal heating (106.3 mmHg vs 90.9 mmHg, P < 0.001). Sudden bradycardia was observed in 25% (10/40) of the patients. Among 10 patients who showed sudden bradycardia, it was observed when the cannula entered the FO (15%, 6/40), during electrical stimulation (5%, 2/40), and during heating (5%, 2/40). LIMITATIONS: This study included 40 patients who received trigeminal ganglion RFT, which is a low number to clarify the real incidence of the trigeminocardiac reflex during RFT. CONCLUSION: FO puncturing, electrical stimulation, and thermal heating demonstrated an abrupt increase in heart rate and mean arterial pressure. The incidence of sudden bradycardia during RFT of the trigeminal ganglion was 25%. Most cases of bradycardia were observed during FO puncturing.
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Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Estudos Retrospectivos , Bradicardia , Eletrocoagulação/métodos , HemodinâmicaRESUMO
BACKGROUND: Inadvertent intravascular injection of local anesthetics can lead to false negative results following a lumbar medial branch block (MBB) performed to diagnose facet joint origin pain. A previous study demonstrated that the type of needle could affect the incidence of intravascular injection rates. OBJECTIVES: The primary endpoint of this study was to compare the incidence of intravascular injection during lumbar MBB between the Quincke and Touhy needles. The secondary endpoint of this study was to compare the injection time, radiation dose, and patient discomfort during lumbar MBB between the needle types. STUDY DESIGN: Prospective randomized trial. SETTING: An interventional pain management practice in South Korea. METHODS: The incidence of intravascular uptake of contrast medium was compared using the Touhy and Quincke needles under real-time fluoroscopy during lumbar MBB. Injection time, radiation dose, and patient discomfort during lumbar MBB were also compared. RESULTS: The incidence of intravascular injection was 21.8% (21/102) in the Touhy needle group and 21.2% (22/99) in the Quincke needle group. The odds ratio for the association between the needle types and intravascular injection was 1.1. The injection time, radiation dose, and patient discomfort during lumbar MBB were similar between the Touhy and Quincke needle groups. LIMITATIONS: This study was performed from L2 to L4 MBB of the unilateral lumbar region. Although the type of needle assigned to the patient was randomized, 3 needles, which are used for 3 levels of MBB, were identical. CONCLUSIONS: The overall incidence rate of intravascular injection during lumbar MBB was nearly 20% under real-time fluoroscopy for both types of needle. Use of the Touhy needle did not reduce the intravascular injection rate nor the injection time, radiation dose, and patient discomfort.
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Região Lombossacral , Agulhas , Bloqueio Nervoso , Anestésicos Locais , Humanos , Manejo da Dor/métodos , Estudos ProspectivosRESUMO
BACKGROUND: Thoracic epidural analgesia is useful for postoperative pain control after upper abdominal surgery. However, epidural analgesia in patients undergoing laparoscopic surgery may potentiate an increase in intracranial pressure (ICP). ICP can be effectively evaluated by measuring the optic nerve sheath diameter (ONSD). OBJECTIVES: The purpose of this study is to investigate changes in the ONSD following thoracic epidural normal saline injection during laparoscopic surgery. STUDY DESIGN: Prospective randomized trial. SETTING: An interventional pain management clinic in South Korea. METHOD: This study included 60 patients receiving thoracic epidural catheterization for postoperative pain control following laparoscopic or open gastrectomy. Patients were divided into 3 groups. The open group consisted of patients undergoing open gastrectomy without epidural normal saline injection. The lapa-saline and lapa groups consisted of patients undergoing laparoscopic gastrectomy with and without 10 mL epidural normal saline injection, respectively. The ONSD was measured using ultrasound at 4 time points. RESULTS: The lapa-saline group showed the most pronounced increase in the ONSD compared to the open and lapa groups at the time points of T1 and T2. Only the lapa-saline group demonstrated 4 patients with ONSD values of more than 5.8 mm. The increase in the ONSD continued even after the deflation of pneumoperitoneum in the lapa-saline group, whereas the ONSD in the lapa group returned to near baseline value after the deflation of pneumoperitoneum. LIMITATIONS: Epidural normal saline was injected instead of a local anesthetic to prevent the occurrence of hypotension. However, the injection of epidural normal saline is considered to be the same physiological condition causing elevation of ICP compared with epidural injection with local anesthetics. CONCLUSIONS: The lapa-saline group showed the most pronounced increase in the ONSD. The ONSD values higher than 5.8 mm were observed only in the lapa-saline group. The increase in the ONSD continued even after the deflation of pneumoperitoneum only in the lapa-saline group.
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Hipertensão Intracraniana , Laparoscopia , Pneumoperitônio , Anestésicos Locais , Humanos , Hipertensão Intracraniana/etiologia , Laparoscopia/efeitos adversos , Nervo Óptico , Dor Pós-Operatória , Pneumoperitônio/complicações , Estudos Prospectivos , Solução SalinaRESUMO
BACKGROUND: Normal saline or contrast medium is one of the widely used injection materials during fluoroscopic guided injections. Optic nerve sheath diameter (ONSD) measurement is a reliable and noninvasive method for intracranial pressure evaluation. OBJECTIVES: The purpose of this study was to compare the increase in ONSD and cerebral oxygen saturation (rSO2) between normal saline and contrast medium when they were injected into the epidural space. STUDY DESIGN: Prospective randomized trial. SETTING: An interventional pain management clinic in South Korea. METHODS: This study included 42 patients who were scheduled to receive thoracic epidural catheterization for postoperative pain control. Patients were randomly allocated to receive 5 mL normal saline or contrast medium following successful thoracic epidural entry. The ONSD was measured using transorbital sonography at baseline (T0), 10 min (T10), 20 min (T20), and 40 min (T40) after epidural normal saline or contrast medium injection. RESULTS: Both groups demonstrated significant increases in ONSD from T10 to T40 when compared with the baseline. Although both groups showed a significant increase in ONSD compared with the baseline, group saline showed a higher increase in ONSD than group contrast. A significantly higher increase in ONSD in group saline than in group contrast was maintained from T10 to T40 (P = 0.015). LIMITATIONS: We could not determine the returning point of the normalized ONSD value. CONCLUSION: Thoracic epidural injection of 5 mL normal saline or contrast medium resulted in a significant increase of ONSD compared to baseline; however, the degree of ONSD increase was more attenuated in the contrast group than the saline group.
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Espaço Epidural , Hipertensão Intracraniana , Espaço Epidural/diagnóstico por imagem , Humanos , Nervo Óptico/diagnóstico por imagem , Estudos Prospectivos , Solução Salina , Ultrassonografia/métodosRESUMO
BACKGROUND: Previous studies of variations of the infraorbital foramen (IOF) demonstrated conflicting results regarding to the side and gender in which specific variations occur. Significant differences in some measurement points between genders have been found, whereas, other studies did not report such differences. The presence of an accessory IOF (AIOF) can result in incomplete anesthesia or treatment failure. Previous studies have demonstrated variable results regarding the prevalence of an AIOF ranging from 16.9% to 47.6%. OBJECTIVES: The purpose of this study was to perform a morphological and morphometric study of the IOF and AIOF based on images of 3-dimensional (3D) facial bone computed tomography (CT) scans. STUDY DESIGN: Retrospective study. METHODS: Identification and analysis of patients who have undergone facial bone 3D CT were performed using Clinical Data Warehouse v 2.5 (CDW, Planit Healthcare, Seoul, Korea). The search term that we used with the CDW for analysis was "facial bone 3D CT."First, the region below the infraorbital rim was examined to determine the presence of the IOF and AIOF. Second, the shape of the IOF was determined and categorized as circular or oval. Third, the vertical (VD) and horizontal (HD) diameters of the IOF were determined. Lastly, the distances between important anatomic landmarks and the IOF were measured. RESULTS: A single IOF with a circular shape was most common. The HD and VD of the IOF were significantly larger in men than in women. The distance between the IOF and the infraorbital margin was similar between men and women. The distances measured from the lateral nasal aperture (LNA) to the IOF and the anterior nasal spine (ANS) to the IOF, at both sides, were significantly shorter in women than in men. The prevalence of the AIOF on the right and left side was 7.3% and 8.9%, respectively. The most commonly observed position of the AIOF was on the inferior medial side of the IOF. LIMITATIONS: This study had an imbalance in the number of male and female patients. CONCLUSIONS: The size of the IOF was larger in men than in women. The distance of the IOF from the infraorbital margin was similar for men and women, whereas, the distances between the IOF and the ANS and the IOF and LNA were shorter in women than in men.
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Maxila , Órbita , Feminino , Humanos , Masculino , Maxila/anatomia & histologia , Órbita/anatomia & histologia , Órbita/diagnóstico por imagem , República da Coreia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Inadvertent intravascular injection of local anesthetics can lead to false-negative results following lumbar medial branch block (MBB) performed to diagnose facet joint origin pain. A previous study demonstrated that the type of approach method could affect the incidence of intravascular injections and technical ease of the procedure. OBJECTIVES: The primary objective of our study was to compare the incidence of inadvertent intravascular injection and technical ease of the MBB between anteroposterior (AP) and oblique (OB) views. STUDY DESIGN: Prospective randomized trial. SETTING: An interventional pain management practice in South Korea. METHODS: The incidence of intravascular uptake of contrast medium was compared using AP and OB fluoroscopic views during lumbar MBB. Injection time, radiation dose, and patient discomfort during lumbar MBB were also compared. Risk factors associated with a longer procedure time and a higher radiation dose were analyzed. RESULTS: The incidence of intravascular injection was 22.5% (23/102) in the AP group and 17.6% (18/102) in the OB group (P = 0.382). A significantly longer injection time and a higher dose of radiation were required to complete 3 levels of MBB in the OB group than in the AP group (45.9 seconds vs 61.9 seconds, P = 0.001; 27.4 centigray [cGy]/cm2 vs 42.2 cGy/cm2, I = 0.004). The OB approach and left side injection were the risk factors associated with a longer total procedure time (odds ratio [OR] = 6.64, 95% CI, 1.99-22.17, P = 0.002; OR = 0.20, 95% CI, 0.06-0.67, P = 0.009, OB and AP, respectively). LIMITATIONS: The physician performing the MBB could recognize the AP or OB fluoroscopic view during procedure. CONCLUSION: The overall incidence rate of intravascular injection during lumbar MBB showed nearly 20% in both approach methods groups. The OB approach and left side MBBs were associated with a longer total procedure time and a higher radiation dose.
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Bloqueio Nervoso , Articulação Zigapofisária , Humanos , Anestésicos Locais , Artralgia/etiologia , Região Lombossacral , Bloqueio Nervoso/métodos , Manejo da Dor , Estudos ProspectivosRESUMO
BACKGROUND: The development of back pain following epidural analgesia is one reason for patient refusal of neuraxial analgesia. The primary endpoint of this study was to compare the incidence and severity of back pain following midline and paramedian epidural technique. The secondary endpoint was to identify the risk factors associated with the occurrence of back pain. METHODS: This prospective randomized study included 114 patients receiving thoracic epidural catheterization for pain management following upper abdominal or thoracic surgery. Patients were allocated to either the midline or the paramedian group by computer-generated randomization. An investigator who was blinded to the patient group interviewed patients at 24, and 48 h, and 3-5 days after surgery about the existence of back pain and its severity. RESULTS: The total incidence of back pain following epidural anesthesia was 23.8% in the midline group and 7.8% in the paramedian group. The numerical rating scale of back pain was not different between the two groups at 24 h and 4 days after surgery. The paramdian technique was associated with a lower incidence of back pain than the midline technique (95% confidence interval 0.05-0.74, odds ratio 0.2, P < 0.01). However, the number of attempts, surgical position, body mass index, and duration of surgery were not associated with back pain. CONCLUSIONS: This study showed that the midline group of thoracic epidural analgesia demonstrated higher incidence of back pain than the paramedian group. However, the pain was mild in intensity and decreased with time in both groups.
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Gaucher disease (GD) is an autosomal recessive, lysosomal disorder caused by mutations in the gene for the ß-glucocerebrosidase (GBA) enzyme. Presence of the non-functional GBAP pseudogene, which shares high sequence similarity with the functional GBA gene, has made it difficult to carry out molecular analyses of GD, especially recombinant mutations. Using a long-range PCR approach that has been skillfully devised for the easy detection of GBA recombinant mutations, we identified four recombinant mutations including two gene conversion alleles, Rec 1a and Rec 8a, one reciprocal gene fusion allele, Rec 1b, and one reciprocal gene duplication allele, Rec 7b, in Korean patients with GD. Rec 8a, in which the GBAP pseudogene sequence from intron 5 to exon 11 is substituted for the GBA gene is a novel recombinant mutation. All mutations were confirmed by full sequencing of PCR amplicons and/or Southern blot analysis. These results indicate that the usage of long-range PCR may allow the rapid and accurate detection of GBA recombinant mutations and contribute to the improvement of genotyping efficiency in GD patients.
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Povo Asiático/genética , Doença de Gaucher/genética , Mutação/genética , Recombinação Genética , Adolescente , Adulto , Alelos , Criança , Pré-Escolar , Feminino , Doença de Gaucher/diagnóstico , Doença de Gaucher/mortalidade , Ordem dos Genes , Genótipo , Glucosilceramidase/genética , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fenótipo , Reação em Cadeia da Polimerase , Pseudogenes , Adulto JovemRESUMO
BACKGROUND: Gasserian ganglion radiofrequency thermoablation is a good treatment option for the management of pain in trigeminal neuralgia. We report a case in which the patient of trigeminal neuralgia combined with anterior cerebral artery aneurysm was treated successfully by gasserian ganglion thermoablation without any complication. CASE: An 85-year-old female presenting with electric shock like sensation in the gum and molar teeth was diagnosed as trigeminal neuralgia. Carbamazepine medication and trigeminal nerve blockade relieved her pain partially, but severe side effects of carbamazepine occurred. Magnetic resonance angiography of the brain showed saccular aneurysm in inferior aspect of the anterior communicating artery. Gasserian ganglion thermoablation under sedation anesthesia using nicardipine was performed carefully without any rupture of the cerebral aneurysm. CONCLUSIONS: Gasserian ganglion thermoablation could be performed safely in a patient with cerebral aneurysm without any inadvertent event.
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BACKGROUND: The supraorbital foramen or notch is located at the superior orbital rim. Previous studies have reported anatomical variations in these structures. However, the results varied depending on races and the measurement method used. OBJECTIVE: The purpose of this study is to identify the morphological features of supraorbital foramen or notch based on locational relationship using images of 3-dimensional (3D) facial bone CT scans. STUDY DESIGN: Retrospective study. SETTING: University hospital emergency department. METHODS: Identification and analysis of patients who have undergone facial bone 3D CT were performed using Clinical Data Warehouse v 2.5 (CDW, Planit Healthcare, Seoul, Korea). The search word that we used with the CDW for analysis was "facial bone 3D CT".First, the region of the supraorbital rim was examined to clarify whether or not the supraorbital foramen or notch was present. Second, the diameter of the supraorbital foramen or notch was measured. Lastly, the distance from midpoint (nasion) to the supraorbital notch or foramen was measured. RESULTS: The supraorbital notch was found more frequently than the supraorbital foramen. Among supraorbital double types, the coexistence of notch and foramen was found more frequently than the coexistence of notch and notch or foramen and foramen. The diameter of supraorbital notch was wider than the supraorbital foramen, which was located more laterally from the nasion than the supraorbital notch. LIMITATION: The actual size of the facial image or the skull size of the patient was not considered, which might affect the distance of supraorbital notch or foramen from the midline. CONCLUSION: Supraorbital notch was more frequently found than the supraorbital foramen. The supraorbital notch had a wider diameter and was more centrally located than the supraorbital foramen.
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Osso Frontal , Órbita , Osso Frontal/diagnóstico por imagem , Humanos , República da Coreia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Robot-assisted laparoscopic radical prostatectomy is an advanced and popular surgical technique. However, increased intracranial pressure which is caused by CO2 pneumoperitoneum and Trendelenburg position is the main cerebrovascular effect. Measurement of optic nerve sheath diameter using ocular ultrasound is a noninvasive and reliable method for the assessment of intracranial pressure. The primary endpoint of this study was to identify whether low blood pressure regulation has any benefit in attenuating an increase of optic nerve sheath diameter during robot-assisted laparoscopic radical prostatectomy. METHODS: Optic nerve sheath diameter and cerebral oxygen saturation were measured at baseline (supine position), one and two hours after pneumoperitoneum and Trendelenburg position respectively, and after return to supine position in normal (n = 27) and low blood pressure groups (n = 24). RESULTS: Mean optic nerve sheath diameter values measured at one and two hours after pneumoperitoneum and Trendelenburg position were significantly increased compared to the baseline value (P < 0.001 in normal blood pressure group; P = 0.003 in low blood pressure group). However, the mean optic nerve sheath diameter and cerebral oxygen saturation measured at any of the time points as well as degrees of change between the two groups did not show any significant changes. The peak values of optic nerve sheath diameter in normal and low blood pressure groups demonstrated 14.9% and 9.2% increases, respectively. CONCLUSIONS: Low blood pressure group demonstrated an effect in maintaining an increase of optic nerve sheath diameter less than 10% during CO2 pneumoperitoneum and Trendelenburg position.
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BACKGROUND: Sympathetic blocks (SBs) have been used widely to relieve the symptoms of sympathetically maintained pain (SMP). The thoracic sympathetic ganglion is not separated from somatic nerves by muscles and connective tissue. The upper thoracic ganglion runs along the posterior surface of the vertebral column in close proximity to the adjacent epidural region. This anatomical difference leads to frequent epidural and intercostal spread in cases of thoracic SBs. The purpose of this study was to investigate the incidence of inadvertent intercostal and epidural injections during thoracic SBs. METHODS: Twenty-two patients who were suffering from complex regional pain syndrome or lymphedema after breast cancer surgery were managed with two or three times of thoracic SBs. Therefore, injections of 63 thoracic SBs from 22 patients were enrolled in this study. An investigator who did not attend the procedure evaluated the occurrence of intercostal or epidural spread using anteroposterior fluoroscopic images. RESULTS: The overall incidence of inadvertent intercostal or epidural spread of contrast was 47.5%. Among the inadvertent injections, intercostal spread (34.9%) was more frequent than epidural spread (12.6%). Only 52.5% of the thoracic SBs demonstrated successful contrast spread without any inadvertent spread. The mean difference in skin temperature between the blocked and unblocked sides was 2.5 ± 1.8ºC. Fifty-nine (93.6%) injections demonstrated more than 1.5ºC difference. CONCLUSIONS: Thoracic SBs showed a high incidence (47.5%) of inadvertent epidural or intercostal injection. Thus, special attention is required for the diagnosis of SMP or the injection of any neurolytic agent around sympathetic ganglion.