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Microsurgical Anatomy

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https://www.readbyqxmd.com/read/28589068/endovascular-treatment-of-large-unruptured-fusiform-fenestrated-vertebrobasilar-junction-aneurysm
#1
Saeed A Alqahtani, Daniel R Felbaum, Alex Tai, Ai-Hsi Liu, Rocco A Armonda
Fenestrated vertebrobasilar junction aneurysms are rare vascular lesions. Microsurgical intervention is extremely difficult due to the complex anatomy in the vicinity of these aneurysms. Endovascular neurosurgery appears to be safe and should be considered as the first modality of treatment. This case study details the treatment of an unruptured fusiform fenestrated vertebrobasilar junction aneurysm with endovascular occlusion with stent-assisted coiling. The optimal angiographic exposure and selective microcatheterization of the aneurysm were challenging due to the patient's body habitus, and the aneurysm was large with one dominant fenestrated limb...
May 3, 2017: Curēus
https://www.readbyqxmd.com/read/28584917/morphometry-and-microsurgical-anatomy-of-bochdalek-s-flower-basket-and-the-related-structures-of-the-cerebellopontine-angle
#2
Laszlo Barany, Gabor Baksa, Lajos Patonay, Oliver Ganslandt, Michael Buchfelder, Peter Kurucz
BACKGROUND: Bochdalek's flower basket (Bfb) is the distal part of the horizontal segment of the fourth ventricle's choroid plexus protruding through the lateral aperture (foramen of Luschka). The microsurgical anatomy of the cerebellopontine angle, fourth ventricle and its inner choroid plexus is well described in the literature, but only one radiological study has investigated the Bfb so far. The goal of the present study was to give an extensive morphometric analysis of the Bfb for the first time and discuss the surgically relevant anatomical aspects...
June 6, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28583461/repair-of-v2-vertebral-artery-injuries-sustained-during-anterior-cervical-discectomy
#3
Evgenii Belykh, David S Xu, Kaan Yağmurlu, Ting Lei, Vadim A Byvaltsev, Curtis A Dickman, Mark C Preul, Peter Nakaji
BACKGROUND: The V2 segment of the vertebral artery (VA) typically runs through the transverse foramen of C2-C6. V2 injury may occur during anterior approaches to the cervical spine and can cause significant morbidity. We aimed to describe landmarks and microsurgical V2 repair techniques through the standard anterolateral cervical discectomy approach. METHODS: Five silicone-injected cadaveric heads (necks-C7) were dissected bilaterally. An anterolateral approach with C3-4, C4-5, and C5-6 discectomies and an ipsilateral VA injury were simulated...
June 2, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28579577/evaluation-of-venous-drainage-patterns-for-skull-base-meningioma-surgery
#4
Kazuhide Adachi, Mitsuhiro Hasegawa, Yuichi Hirose
The evaluation of venous drainage patterns prior to surgery for skull base meningioma is important owing to their deep location and the vulnerability of surrounding vascular structures. In recent years, the microsurgical skull base approach has matured as a surgical technique, making it an important option for reducing complications related to skull base meningioma surgery. In addition, knowledge of the venous anatomy can prevent venous drainage route disturbance and potentially life-threatening complications...
June 5, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28565992/pipeline-flow-diversion-of-ruptured-blister-aneurysms-of-the-supraclinoid-carotid-artery-using-a-single-device-strategy
#5
Robert W Ryan, Amir S Khan, Rebecca Barco, Armen Choulakian
OBJECTIVE Ruptured blister aneurysms remain challenging lesions for treatment due to their broad, shallow anatomy and thin, fragile wall. Historical challenges with both open microsurgical approaches and intrasaccular endovascular approaches have led to increased use of flow diversion for management of these aneurysms. However, the optimum paradigm, including timing of treatment, use of dual antiplatelet therapy, and number of flow-diverter devices to use remains unknown. The authors describe their experience with ruptured blister aneurysms treated with flow diversion at their institution, and discuss rates of rebleeding and number of devices used...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28556192/microsurgical-anatomy-of-the-maxillary-artery-for-extracranial-intracranial-bypass-in-the-pterygopalatine-segment-of-the-maxillary-artery
#6
O Akiyama, A Güngör, E H Middlebrooks, A Kondo, H Arai
The extracranial-intracranial (EC-IC) bypass using the maxillary artery (MA) has been successfully completed using a radial artery graft but the complicated anatomy and narrow exposure make it difficult. The purpose of this article is to define the microsurgical exposure of the MA through the middle fossa and describe the branches, diameter, and length of the MA available for the EC-IC bypass in the sphenopalatine fossa and anterior part of the infratemporal fossa. 5 cadaveric specimens were dissected bilaterally (10 MA dissections) to define the microsurgical anatomy of the MA through an intracranial approach...
May 27, 2017: Clinical Anatomy
https://www.readbyqxmd.com/read/28552136/epidemiology-clinical-presentation-diagnostic-evaluation-and-prognosis-of-spinal-arteriovenous-malformations
#7
Alp Ozpinar, Gregory M Weiner, Andrew F Ducruet
Spinal arteriovenous malformations (sAVM) are rare vascular pathologies whose natural history remains incompletely understood. Advances in diagnostic imaging, coupled with the evolution of endovascular and microsurgical techniques have led to the description of a number of classification schemes for these lesions. An updated method has changed AVM classification from five categories of lesion based on source and location of feeder vessels to three categories based on pathophysiology. These categories include extradural arteriovenous fistulae (AVFs), intradural AVFs, extradural-intradural AVFs, intramedullary AVMs, and conus medullaris AVM each with individual subclassifications...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28540232/genital-pain-algorithm-for-management
#8
REVIEW
Nahomy Calixte, Jamin Brahmbhatt, Sijo Parekattil
Chronic testicular pain although becoming very common in our patient population poses a challenge to the physician, the patient and his family. The pathogenesis of chronic orchialgia (CO) is not well understood. The objective of this paper is to review the current literature on chronic testicular pain and its management and to propose an algorithm for its treatment. Abstracts, original papers and review articles were reviewed during a literature search using words such as testicular pain, CO, and microsurgical anatomy of spermatic cord...
April 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28512043/endoscopic-assisted-supraorbital-keyhole-approach-or-endoscopic-endonasal-approach-in-case-of-tuberculum-sellae-meningioma-which-surgical-route-should-be-favoured
#9
Stefan Linsler, Gerrit Fischer, Volodymyr Skliarenko, Axel Stadie, Joachim Oertel
OBJECTIVE: Keyhole approaches are currently under investigation for skull base tumor surgery. They are expected to have a low complication rate with the same successful resection rate compared to endoscopic endonasal procedures. In this study, the authors compare their current series of tuberculum sellae meningiomas resected via an endoscopic endonasal or microsurgical supraorbital keyhole approach. METHODS: Between 2011 and 2016, 16 patients were treated using the supraorbital keyhole procedure and 6 patients received an endoscopic endonasal procedure...
May 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28484528/extradural-anterior-clinoidectomy-technical-nuances-from-a-learner-s-perspective
#10
Shashwat Mishra, Baltazar Leão, Diego Mendez Rosito
BACKGROUND: Extradural removal of the anterior clinoid process (ACP) is a crucial step in the proper surgical exposure of various pathologies in and around the central skull base. Since the pioneering description by Dolenc, the technique of extradural clinoidectomy has undergone several refinements in the light of improved understanding of microsurgical anatomy and maturation of neurosurgical techniques. Mastery of the surgical nuances involved in performing this surgical exercise will allow the young neurosurgeon to execute this step without undue reluctance and trepidation...
April 2017: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/28441854/-correlation-between-anatomical-factors-of-spermatic-vessels-and-varicocele
#11
L Y Zhao, R H Tian, Y H Huang, H X Chen, P Li, Z Wan, C C Yao, C Yang, E L Zhi, Z Li
Objective: To analyze the correlation between anatomy of spermatic vessels and varicocele, providing reference for the preoperative assessment and treatment of varicocele. Methods: A total of 156 patients who underwent microsurgical left subinguinal varicocelectomy at Shanghai General Hospital between May 2015 and July 2016 were included in this study. The severity of varicocele and number of spermatic vessels detected in operations were recorded. According to the number of internal spermatic arteries (ISAs), the patients were divided into three groups: single-ISA group (55 cases), double-ISAs group (63 cases) and multi-ISAs group (38 cases), to analyze the correlation among spermatic vessels and to compare varicocele grade, the volume of testes, the parameter of semen analysis, serum reproductive hormone, surgery time, and hospital stay among the three groups...
April 25, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28435113/microsurgical-and-endoscopic-anatomy-for-intradural-temporal-bone-drilling-and-applications-of-the-electromagnetic-navigation-system-various-extensions-of-the-retrosigmoid-approach
#12
Ken Matsushima, Noritaka Komune, Satoshi Matsuo, Michihiro Kohno
OBJECTIVE: The use of the retrosigmoid approach has recently been expanded by several modifications including the suprameatal, transmeatal, suprajugular, and inframeatal extensions. Intradural temporal bone drilling without damaging vital structures inside or beside the bone, such as the internal carotid artery and jugular bulb, is a key step for these extensions. This study aimed to examine the microsurgical and endoscopic anatomy of the extensions of the retrosigmoid approach, and to evaluate the clinical feasibility of an electromagnetic navigation system during intradural temporal bone drilling...
April 20, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28386838/minimally-invasive-medial-supraorbital-combined-subfrontal-interhemispheric-approach-to-the-anterior-communicating-artery-complex-a-cadaveric-study
#13
Alexander Spiessberger, F Baumann, E Nevzati, K F Kothbauer, J Fandino, C Muroi
INTRODUCTION: In selected cases, microsurgical clipping remains a valuable treatment alternative to endovascular occlusion of anterior communicating artery (AComA) aneurysms. Their clipping is challenging and carries a risk of postsurgical cognitive impairment. We evaluate the microsurgical anatomy of a new, minimally invasive combined interhemispheric-subfrontal approach to the AComA complex via a medial supraorbital craniotomy. METHODS: In this descriptive anatomic study, four alcohol-embedded, silicon-injected human cadaver heads were used...
June 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28340659/exploring-new-frontiers-of-microsurgery-from-anatomy-to-clinical-methods
#14
REVIEW
Zeng Tao Wang, You Mao Zheng, Lei Zhu, Li Wen Hao, Ya Bin Zhang, Chao Chen, Li Feng Xia, Lin Feng Liu
This article presents the authors' understanding and experience concerning anatomic studies and clinical methods in microsurgical hand reconstruction. The 4 parts of this article include anatomic study of the hand for developing new flaps; application of miniflaps from the hand, including clinical experience with 8 unique flaps in the hand; anatomic and clinical considerations concerning several flaps from other parts of the human body; And our experience with vascularized free toe joint transfer.
April 2017: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/28338438/learning-brain-aneurysm-microsurgical-skills-in-a-human-placenta-model-predictive-validity
#15
Marcelo Magaldi Ribeiro de Oliveira, Carlos Eduardo Ferrarez, Taise Mosso Ramos, Jose Augusto Malheiros, Arthur Nicolato, Carla Jorge Machado, Mauro Tostes Ferreira, Fellype Borges de Oliveira, Cecília Félix Penido Mendes de Sousa, Pollyana Helena Vieira Costa, Sebastiao Gusmao, Giuseppe Lanzino, Rolando Del Maestro
OBJECTIVE Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model...
March 24, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28327921/the-superior-cerebellar-artery-aneurysm-a-posterior-circulation-aneurysm-with-favorable-microsurgical-outcomes
#16
Ana Rodríguez-Hernández, Brian P Walcott, Harjus Birk, Michael T Lawton
BACKGROUND: Superior cerebellar artery (SCA) aneurysms are usually grouped with aneurysms that arise from the upper basilar artery or more broadly, the posterior circulation. However, the SCA aneurysm has distinctive anatomy that facilitates safe surgical management, notably few associated perforating arteries, and excellent exposure in the carotid-oculomotor triangle. OBJECTIVE: To demonstrate the outcomes of patients treated with microsurgery in a continuous surgical series...
June 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28319260/the-second-time-flap-from-the-previously-used-anterior-thigh-donor-site-for-head-and-neck-microsurgical-reconstruction
#17
Nidal Farhan Al Deek, Chun-Ta Liao, Shiang-Fu Huang, Chung-Jan Kan, Kai-Ping Chang, Ku-Hao Fang, Chung-Kan Tsao
BACKGROUND: Multiple free tissue transfer from the same donor site is not well described for microsurgical head and neck reconstruction. METHODS: Between (8/2011 and 11/2012), 103 patients received 103 free ALT flaps for head and neck reconstruction; flaps were called first-time ALT flaps. Intra-operative findings were used to assess the presence of a favorable anatomy for a future second flap from the same donor site. And, between 9/2009 and 12/2013, second-time flaps from previously used anterior thighs were attempted either freely or guided by the intra-operative data from the previous surgery...
March 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28317283/radiological-and-microsurgical-anatomy-for-variation-of-the-mandible-comparative-study-of-human-and-macaca-fascicularis
#18
Joe Iwanaga, Koichi Watanabe, Tsuyoshi Saga, Yoko Tabira, Eishi Hirasaki, Christian Fisahn, R Shane Tubbs, Jingo Kusukawa, Koh-Ichi Yamaki
Recent studies using cone-beam computer tomography (CBCT) have added to our understanding of anatomical variation in the mandible of humans. However, the distribution of nerves cannot be revealed by CBCT. There have been investigations of the distribution of nerves relating to the mandible, but some proposed causes of these variations remain controversial. In this study, we observed a total of 10 sides from five mandibles of Macaca fascicularis of unknown age and sex using CBCT and dissection under stereomicroscopy...
March 20, 2017: Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology
https://www.readbyqxmd.com/read/28302367/lateral-thigh-perforator-flap-for-breast-reconstruction-computed-tomographic-angiography-analysis-and-clinical-series
#19
Marco A Maricevich, Michael R Bykowski, M Asher Schusterman, Evan B Katzel, Michael L Gimbel
PURPOSE: Although abdominal-based flaps remain the first choice for autologous breast reconstruction, alternative donor sites are necessary when the abdomen is unavailable. Abdominal donor site suitability is determined, at times, according to deep inferior epigastric perforator (DIEP)-protocol computed tomographic angiography (CTA) results. CTA provides information about the pelvis/upper thigh that can be used to evaluate the suitability of other donor sites. This study aimed to examine the utility of DIEP-protocol CTA in the assessment of a lateral thigh perforator (LTP) flap...
May 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28272279/preoperative-computed-tomography-angiogram-cta-measurement-of-abdominal-muscles-is-a-valuable-risk-assessment-for-bulge-formation-after-microsurgical-abdominal-breast-reconstruction
#20
Elisabeth A Kappos, Jeff Jaskolka, Kate Butler, Anne C O'Neill, Stefan Op Hofer, Toni Zhong
BACKGROUND: A major shortcoming associated with abdominal tissue breast reconstruction is the long-term abdominal wall morbidity. Although abdominal core muscle size on computed tomography angiogram (CTA) has been correlated with morbidity following many abdominal surgeries, it has not been studied for abdominal breast reconstruction. Therefore, we evaluated the association between preoperative CTA-derived measurements of abdominal core muscles and postoperative abdominal wall morbidity after abdominal tissue breast reconstruction...
March 6, 2017: Plastic and Reconstructive Surgery
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