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Microsurgical Anatomy

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https://www.readbyqxmd.com/read/28049512/a-stab-wound-to-the-axilla-illustrating-the-importance-of-brachial-plexus-anatomy-in-an-emergency-context-a-case-report
#1
Diogo Casal, Teresa Cunha, Diogo Pais, Inês Iria, Maria Angélica-Almeida, Gerardo Millan, José Videira-Castro, João Goyri-O'Neill
BACKGROUND: Although open injuries involving the brachial plexus are relatively uncommon, they can lead to permanent disability and even be life threatening if accompanied by vascular damage. We present a case report of a brachial plexus injury in which the urgency of the situation precluded the use of any ancillary diagnostic examinations and forced a rapid clinical assessment. CASE PRESENTATION: We report a case of a Portuguese man who had a stabbing injury at the base of his left axilla...
January 4, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28039506/microsurgical-anatomy-of-branches-of-musculocutaneous-nerve-clinical-relevance-for-spastic-elbow-surgery
#2
C Thieffry, L Chenin, P Foulon, E Havet, J Peltier
PURPOSE: The neurotomy of musculocutaneous nerve is a treatment for patients who suffer from spastic elbow flexion when medical and reeducative treatments have failed. It consists in sectioning motor branches of musculocutaneous nerve which are destined to the biceps brachii and brachialis muscles, both being the main elbow flexor muscles. The aim of this study was to analyse the distance, where each motor branch arises from the musculocutaneous nerve to both biceps brachii and brachialis muscles, to establish precisely the localisation and length of the necessary incision to reach its branches for surgery...
December 30, 2016: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/28024974/dual-image-videoangiography-during-intracranial-microvascular-surgery
#3
Alberto Feletti, Xiangdong Wang, Riki Tanaka, Yasuhiro Yamada, Daisuke Suyama, Tsukasa Kawase, Hirotoshi Sano, Yoko Kato
OBJECTIVE: Indocyanine-green videoangiography (ICG-VA) is a precious tool to assess vessels and aneurysm patency during neurovascular surgical procedures. However, ICG-VA highlights vascular structures, which appear white over a black background. Therefore, anatomical relations are sometimes not easy to understand at first glance. The recently developed dual-image videoangiography (DIVA) enables the simultaneous visualization of both light and near-infrared (NIR) fluorescence images of ICG-VA...
December 23, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/28017747/complications-and-their-managements-of-large-intracranial-vestibular-schwannoma-via-retrosigmoid-approach
#4
Xiang Huang, Ming Xu, Jian Xu, Liangfu Zhou, Ping Zhong, Mingyu Chen, Kaiyuan Ji, Huiyu Chen, Ying Mao
OBJECTIVE: To investigate the common complications from the microsurgical treatment of large intracranial vestibular schwannoma (VS) via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications. METHODS: We selected all large unilateral VS patients from the collected database (1999-2013) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. Tumors larger than 30 x 20 mm were defined as large...
December 22, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27986388/-3d-anatomy-of-cerebellar-peduncles-based-on-fibre-microdissection-and-a-demonstration-with-tractography
#5
Ruben Rodríguez-Mena, José Piquer-Belloch, José Luis Llácer-Ortega, Pedro Riesgo-Suárez, Vicente Rovira-Lillo
OBJECTIVE: To perform an anatomical and radiological study, using fibre microdissection and diffusion tensor tractography (DTT), to demonstrate the three-dimensionality of the superior, middle and inferior cerebellar peduncles. MATERIAL AND METHODS: A total of 15 brain-stem, 15 cerebellar hemispheres, and 5 brain hemispheres were dissected in the laboratory under the operating microscope with microsurgical instruments between July 2014 and July 2015. Brain magnetic resonance imaging was obtained from 15 healthy subjects between July and December of 2015, using diffusion-weighted images, in order to reproduce the cerebellar peduncles on DTT...
December 13, 2016: Neurocirugía
https://www.readbyqxmd.com/read/27973959/three-dimensional-digitalized-virtual-planning-for-saphenous-artery-flap-a-pilot-study
#6
Yuan Z Zhang, Shu Z Wen, Hui Q Zhang, Ya G Li, Jian M Zhao, Yong Yang
OBJECTIVE: Since the 1970s, research and applications on flap and muscle flap had solved many problems in microsurgical reconstruction. However, the traditional flap design is completely dependent on two-dimensional (2D) images. The purpose of this study was to discuss the methods in the visualization of saphenous artery flap by digitalized technique and its applications by digitalized technique. METHODS: Two adult fresh cadaver specimens, one male and one female, were subject to radiographic computerized tomography (CT) scanning before and after perfused with lead oxide-gelatine mixture, whose collimation are 0...
December 2016: Comput Assist Surg (Abingdon)
https://www.readbyqxmd.com/read/27867120/transforaminal-resection-of-cervical-dumbbell-schwannomas-in-patients-with-additional-tumors
#7
Ji Zhang, Xiang-Heng Zhang, Zi-Feng Wang, You-Ping Li, Zheng-Quan Zhu, Ji-Cheng Sun, Zheng-He Chen, Shao-Yong Wu, Ke Sai, Jian Wang, Yong-Gao Mou, Zhong-Ping Chen
BACKGROUND: It is rare for 2 primary tumors to occur simultaneously in a patient. Management of cervical dumbbell schwannomas (CDSs) with concurrent tumors (CTs) requires a specific neurosurgical strategy. The primary objective of this study is to investigate surgical strategies for CDSs with CTs while preserving as much of the mechanically relevant bone structures as possible. METHODS: Twelve patients with concurrent CTs and CDSs were identified from 3 medical centers...
November 17, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27859787/microsurgical-anatomy-of-the-oculomotor-nerve
#8
REVIEW
Hae Kwan Park, Hyung Keun Rha, Kyung Jin Lee, Chung Kee Chough, Wonil Joo
The oculomotor nerve supplies the extraocular muscles. It also supplies the ciliary and sphincter pupillae muscles through the ciliary ganglion. The nerve fibers leave the midbrain through the most medial part of the cerebral peduncle and enter the interpeduncular cistern. After the oculomotor nerve emerges from the interpeduncular fossa, it enters the cavernous sinus slightly lateral and anterior to the dorsum sellae. It enters the orbit through the superior orbital fissure, after exiting the cavernous sinus, to innervate the extraocular muscles...
January 2017: Clinical Anatomy
https://www.readbyqxmd.com/read/27715436/midline-and-off-midline-infratentorial-supracerebellar-approaches-to-the-pineal-gland
#9
Satoshi Matsuo, Serhat Baydin, Abuzer Güngör, Koichi Miki, Noritaka Komune, Ryota Kurogi, Koji Iihara, Albert L Rhoton
OBJECTIVE A common approach to lesions of the pineal region is along the midline below the torcula. However, reports of how shifting the approach off midline affects the surgical exposure and relationships between the tributaries of the vein of Galen are limited. The purpose of this study is to examine the microsurgical and endoscopic anatomy of the pineal region as seen through the supracerebellar infratentorial approaches, including midline, paramedian, lateral, and far-lateral routes. METHODS The quadrigeminal cisterns of 8 formalin-fixed adult cadaveric heads were dissected and examined with the aid of a surgical microscope and straight endoscope...
October 7, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27685096/visualization-of-vascular-and-parenchymal-regeneration-after-70-partial-hepatectomy-in-normal-mice
#10
Chichi Xie, Weiwei Wei, Andrea Schenk, Lars Ole Schwen, Sara Zafarnia, Michael Schwier, Felix Gremse, Isabel Jank, Olaf Dirsch, Uta Dahmen
A modified silicone injection procedure was used for visualization of the hepatic vascular tree. This procedure consisted of in-vivo injection of the silicone compound, via a 26 G catheter, into the portal or hepatic vein. After silicone injection, organs were explanted and prepared for ex-vivo micro-CT (µCT) scanning. The silicone injection procedure is technically challenging. Achieving a successful outcome requires extensive microsurgical experience from the surgeon. One of the challenges of this procedure involves determining the adequate perfusion rate for the silicone compound...
September 13, 2016: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/27677522/the-paramedian-supracerebellar-transtentorial-approach-to-the-posterior-fusiform-gyrus
#11
Anthony M T Chau, Filippo Gagliardi, Adam Smith, Nicholas R Pelzer, Fiona Stewart, Pietro Mortini, Samer K Elbabaa, Anthony J Caputy, Cristian Gragnaniello
BACKGROUND: The posterior fusiform gyrus lies in a surgically challenging region. Several approaches have been described to access this anatomical area. The paramedian supracerebellar transtentorial (SCTT) approach benefits from minimal disruption of normal neurovascular tissue. The aim of this study was to demonstrate its application to access the posterior fusiform gyrus. METHODS: Three brains and six cadaveric heads were examined. A stepwise dissection of the SCTT approach to the posterior fusiform gyrus was performed...
November 2016: Acta Neurochirurgica
https://www.readbyqxmd.com/read/27667106/-microsurgery-treatment-of-midline-deep-brain-lesions-clinical-analysis-of-25-cases
#12
G Chen, W W Zhai, Z Q Yu
Objective: To explore experience and methods in the microsurgical treatment of midline deep brain lesions. Methods: The clinical data of patients with midline deep brain lesions were retrospectively analyzed. The clinical manifestation, imaging findings, lesion locations, surgical procedures, pathological diagnosis and follow-up results were summarized and analyzed. All the lesions were located deeply in the brain midline: corpus callosum (n=1), thalamus and basal ganglia (n=6), lateral ventricle (n=4), the third ventricle (n=2), pineal region (n=8), brainstem and fourth ventricle region (n=4)...
September 13, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27651974/successful-deep-inferior-epigastric-perforator-flap-harvest-despite-preoperative-therapeutic-subcutaneous-heparin-administration-into-the-abdominal-pannus
#13
Joseph W Duncumb, Kana Miyagi, Parto Forouhi, Charles M Malata
Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression...
2016: Case Reports in Surgery
https://www.readbyqxmd.com/read/27476690/microsurgical-and-tractographic-anatomy-of-the-supplementary-motor-area-complex-in-humans
#14
Baran Bozkurt, Kaan Yagmurlu, Erik H Middlebrooks, Ali Karadag, Talat Cem Ovalioglu, Bharathi Jagadeesan, Gauravjot Sandhu, Necmettin Tanriover, Andrew W Grande
OBJECTIVE: To evaluate the microsurgical anatomy of the fiber tract connections of the supplementary motor area (SMA) and pre-SMA, and examine its potential functional role with reference to clinical trials in the literature. METHODS: Ten postmortem formalin-fixed human brains (20 sides) and 1 cadaveric head were prepared following Klingler's method. The fiber dissection was performed in a stepwise fashion, from lateral to medial and also from medial to lateral, under an operating microscope, with 3D images captured at each stage...
November 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27470960/-the-causes-and-strategies-for-intraoperative-rupture-during-clipping-the-anterior-circulation-aneurysms
#15
H Y Li, H Chen, Y M Li, Y Li, X W Shi
OBJECTIVE: To investigate the causes and strategies for intraoperative rupture during clipping the anterior circulation aneurysms. METHODS: Nineteen patients with anterior circulation aneurysms ruptured during clipping, who admitted to the Department of Neurosurgery, Henan Provincial People's Hospital from November 2012 to February 2014, were enrolled. Their clinical data were analyzed retrospectively to summarize the causes and strategies for intraoperative rupture...
July 5, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27441939/reverse-sural-artery-pedicle-flap
#16
Christopher G Finkemeier, Rafael Neiman
OBJECTIVE: To demonstrate the technical aspects of a reverse sural artery (RSA) flap. DESIGN: Video case presentation. SETTING: Community Level 2 Trauma Center. PATIENTS: Single patient with a full thickness soft tissue loss over the posterior calcaneal tuberosity requiring soft tissue coverage. METHOD: Video demonstration of the stepwise planning and technical aspects of performing an RSA flap...
August 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27439458/microsurgical-resection-of-skull-base-meningioma-expanding-the-operative-corridor
#17
Amol Raheja, William T Couldwell
A better understanding of surgical anatomy, marked improvement in illumination devices, provision of improved hemostatic agents, greater availability of more precise surgical instruments, and better modalities for skull base reconstruction have led to an inevitable evolution of skull base neurosurgery. For the past few decades, many skull base neurosurgeons have worked relentlessly to improve the surgical approach and trajectory for the expansion of operative corridor. With the advent of newer techniques and their rapid adaptation, it is foundational, especially for young neurosurgeons, to understand the basics and nuances of modifications of traditional neurosurgical approaches...
July 20, 2016: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/27399554/356%C3%A2-microsurgical-anatomy-of-the-brainstem-safe-entry-zones-a-cadaveric-study-with-high-resolution-magnetic-resonance-imaging-and-fiber-tracking
#18
Debraj Mukherjee, Veysel Antar, Bora Gurer, Ulas Cikla, Gabriel Neves, Mehmet Ekici, Tomer Hananya, Aaron S Field, Shahriar M Salamat, Mustafa Kemal Baskaya
INTRODUCTION: Operative management of intrinsic brainstem lesions remains challenging despite advances in electrophysiological monitoring and neuroimaging. Surgical intervention in this region requires detailed knowledge of adjacent, critical white matter tracts and cranial nerve nuclei. Our aim was to systematically verify internal anatomy associated with each brainstem safety zone entry zone (BSEZ) using a cadaveric model supplemented with neuroimaging modalities commonly used in preoperatively planning, namely high-resolution magnetic resonance imaging (MRI) and fiber tracking...
August 2016: Neurosurgery
https://www.readbyqxmd.com/read/27345873/-the-surgical-management-of-giant-intracranial-vestibular-schwannoma-via-retrosigmoid-approach-a-retrospective-review-of-657-cases
#19
X Huang, K Y Ji, J Xu, C H Shao, W Wang, M Xu, D Q Chen, M Y Chen, P Zhong
OBJECTIVE: To discuss the surgical technique and common complications from the microsurgical treatment of giant intracranial vestibular schwannoma via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications. METHODS: Surgical outcomes and complications were evaluated in a consecutive series of 657 unilateral giant vestibular schwannomas treated in Shanghai Huashan Hospital via suboccipital retrosigmoid approach from 1999 to 2014...
June 7, 2016: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/27341050/transtentorial-transcollateral-sulcus-approach-to-the-ventricular-atrium-an-endoscope-assisted-anatomical-study
#20
Yasser Jeelani, Abdulkerim Gokoglu, Tomer Anor, Ossama Al-Mefty, Alan R Cohen
OBJECTIVE Conventional approaches to the atrium of the lateral ventricle may be associated with complications related to direct cortical injury or brain retraction. The authors describe a novel approach to the atrium through a retrosigmoid transtentorial transcollateral sulcus corridor. METHODS Bilateral retrosigmoid craniotomies were performed on 4 formalin-fixed, colored latex-injected human cadaver heads (a total of 8 approaches). Microsurgical dissections were performed under 3× to 24× magnification, and endoscopic visualization was provided by 0° and 30° rigid endoscope lens systems...
June 24, 2016: Journal of Neurosurgery
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