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Cervical artery dissection

Tsunehiko Konomi, Kota Suda, Satoko Matsumoto, Miki Komatsu, Masahiko Takahata, Norimasa Iwasaki, Akio Minami
Introduction: There are considerable risks for vertebral artery (VA) injury in case of corrective surgery for a severe and rigid cervical kyphotic deformity. This case report describes a rare case of surgical management for pre-existing traumatic rigid cervical kyphosis associated with unilateral VA occlusion. Case presentation: A 73-year-old male fell down and injured his neck. He was referred to our hospital 10 months after injury because his degree of head drop progressed gradually to a chin-on-chest position such that he could not look straight forward...
2018: Spinal Cord Series and Cases
Lars Kellert, Armin Grau, Alessandro Pezzini, Stéphanie Debette, Didier Leys, Valeria Caso, Vincent N Thijs, Anna Bersano, Emmanuel Touzé, Turgut Tatlisumak, Christopher Traenka, Philippe A Lyrer, Stefan T Engelter, Tiina M Metso, Caspar Grond-Ginsbach, Manja Kloss
BACKGROUND AND PURPOSE: We investigated whether university education is more likely in cervical artery dissection (CeAD)-patients than in age- and sex-matched patients with ischemic stroke (IS) due to other causes (non-CeAD-IS-patients). METHODS: Patients from the Cervical Artery Dissection and Ischemic Stroke Patients study with documented self-reported profession before onset of IS due to CeAD (n = 715) or non-CeAD causes (n = 631) were analyzed. In the reported profession, the absence or presence of university education was assessed...
February 24, 2018: Journal of Neurology
Tamir Tawfik, Joe Iwanaga, Emre Yilmaz, Paul Choi, Charlotte Wilson, Emily Simonds, Jared J Marks, Haynes L Harkey, Rod J Oskouian, R Shane Tubbs
OBJECTIVE: Pedicle screws placed into C2 necessitate a thorough understanding of this bone's unique anatomy. Although multiple landmarks and measurements have been used by surgeons, these are often varied in the literature with no consensus. Herein, we studied one recently proposed landmark using the nutrient foramina of the posterior aspect of C2 for pedicle screw placement. METHODS: On 19 (38 sides) C2 dry bone specimens, the presence, size, location, and distance from the midline of the nutrient foramina found at the junction between the isthmus and lamina were documented and measured...
February 14, 2018: World Neurosurgery
Misato Kawaguchi, Kouhei Nii, Kimiya Sakamoto, Kanae Kawahara, Ritsurou Inoue, Fumihiro Hiraoka, Yusuke Morinaga, Takafumi Mitsutake, Hayatsura Hanada, Masanori Tsutsumi
A 73-year-old man was admitted at another hospital after a traffic accident. The diagnosis was cervical vertebral fracture. Despite conservative treatment, 5 days later he manifested dysarthria due to cerebellar infarction and was transferred to our hospital. Imaging studies revealed right vertebral arterial dissection at the level of the axial fracture. We performed percutaneous transluminal angioplasty with stenting to address his subacute vertebral artery dissection prior to treating the cervical vertebral fracture using external fixation...
February 2018: No Shinkei Geka. Neurological Surgery
Philipp Erhart, Tobias Brandt, Beate K Straub, Ingrid Hausser, Sabine Hentze, Dittmar Böckler, Caspar Grond-Ginsbach
BACKGROUND AND PURPOSE: A recurrent duplication of chromosome 16p13.1 was associated with aortic dissection as well as with cervical artery dissection. We explore the segregation of this duplication in a family with familial aortic disease. METHODS: Whole exome sequencing (WES) analysis was performed in a patient with a family history of aortic diseases and ischemic stroke due to an aortic dissection extending into both carotid arteries. RESULTS: The index patient, his affected father, and an affected sister of his father carried a large duplication of region 16p13...
February 14, 2018: Molecular Genetics & Genomic Medicine
Juan A Sanchis-Gimeno, Susanna Llido, Marcos Miquel-Feutch, Laura Quiles-Guinau, Luis Rios, Mayte Murillo-Llorente, Marcelino Perez-Bermejo, Shahed Nalla
BACKGROUND: The arcuate foramen (AF), or ponticulus posticus, is an anatomic variant of the first cervical vertebra that consists of a complete or partial osseous bridge over the groove for the vertebral artery and extends from the posterior aspect of the superior articular facet to the superior lateral border of the posterior arch. The AF has been associated with clinical symptoms, such as headache, migraine, neck pain, shoulder pain, arm pain, and vertebral artery dissection. We aimed to test whether the prevalence of the AF has decreased in the modern human population over the past centuries as a result of reduction in inbreeding and endogamy...
February 2018: World Neurosurgery
Daniel Vázquez-Vicente, Bárbara Fernández Del Bas, José García Villayzán, Javier Plaza Arranz, Luis Chiva
STUDY OBJECTIVE: The objective was to review/learn a surgical technique not very well known by gynecologic oncologists. DESIGN: Level of evidence: III SETTING: Review of a surgical technique with emphasis on the paraaortic sentinel lymph nodes using indocyanine green. INTERVENTION: The film features the following steps to perform the procedure: 1. Creating a retroperitoneal window. 2. What to do if the peritoneum is torn. 3. Finding the psoas muscle, right ureter, and common iliac artery...
February 7, 2018: Journal of Minimally Invasive Gynecology
Stephen W English, Theodore J Passe, E Paul Lindell, James P Klaas
Cervical artery dissection is an underrecognized cause of lower cranial neuropathies and diagnosis can remain elusive if not properly investigated. We present a case of an internal carotid artery dissection that was initially missed in a 48-year-old man who presented with subacute-onset of dysarthria, dysphagia, and unilateral tongue weakness. Knowledge of the most common presenting symptoms, relevant neuroanatomy, and neuroimaging techniques is essential to avoid misdiagnosis. Pseudoaneurysm formation from subadventitial carotid artery dissection may result in compressive neuropathies of cranial nerves IX, X, XI, and XII without associated cerebral ischemia...
February 5, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Andreas Schicho, Lukas Luerken, Ramona Meier, Antonio Ernstberger, Christian Stroszczynski, Andreas Schreyer, Lena-Marie Dendl, Stephan Schleder
Purpose: The aim of this study was to evaluate the true incidence of cervical artery dissections (CeADs) in trauma patients with an Injury Severity Score (ISS) of ≥16, since head-and-neck computed tomography angiogram (CTA) is not a compulsory component of whole-body trauma computed tomography (CT) protocols. Patients and methods: A total of 230 consecutive trauma patients with an ISS of ≥16 admitted to our Level I trauma center during a 24-month period were prospectively included...
2018: Therapeutics and Clinical Risk Management
Akihiko Okamura, Masayuki Watanabe, Masami Yuda, Yoshiaki Shoji, Kotaro Yamashita, Masaru Hayami, Yu Imamura, Shinji Mine
BACKGROUND: Esophageal cancer frequently metastasizes to lymph nodes along the recurrent laryngeal nerve (RLN),1 therefore it is essential to dissect RLN nodes for curative esophagectomy.2 Right-sided aortic arch (RAA), a rare congenital anomaly, occurs in approximately 0.1% of adults.3 Because RAA forms a vascular ring encircling both the esophagus and the trachea at the cervicothoracic junction, its surgical anatomy is difficult to understand; hence, thoracoscopic dissection of RLN nodes is technically challenging...
February 6, 2018: Annals of Surgical Oncology
Charlotte Wilson, Emily Simonds, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs
BACKGROUND: Pseudoaneurysms are less common than true aneurysms. Herein, we present a very rare case of a mass of the right posterior ascending artery. CASE DESCRIPTION: This was identified during routine dissection of an adult female cadaver. Histology demonstrated that the mass was a pseudoaneurysm. The mass was located posterior to the right alar ligament superior to the right portion of the transverse ligament and measured 7.37mm and 2.97mm. CONCLUSIONS: To our knowledge, such a case has not previously been reported...
January 29, 2018: World Neurosurgery
Brian Ngure Kariuki, Fawzia Butt, Pamela Mandela, Paul Odula
Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29...
March 2018: Craniomaxillofacial Trauma & Reconstruction
M Gavid, J M Dumollard, C Habougit, Y Lelonge, F Bergandi, M Peoc'h, J M Prades
PURPOSE: The aim of this study was to determine whether the alar fascia is a distinct layer of the deep cervical neck fasciae. The present study also aimed to elucidate the anatomical limits of this fascia. METHODS: Neck dissections of ten adult cadavers were performed, layer by layer, in the retropharyngeal region, under a powered operating microscope. Detailed dissections revealed the anatomical limits of the deep neck fasciae. Histological descriptions were also performed on large tissue samples collected from three cervical dissections...
January 29, 2018: Surgical and Radiologic Anatomy: SRA
Peter B Sporns, Thomas Niederstadt, Walter Heindel, Michael J Raschke, René Hartensuer, Ralf Dittrich, Uta Hanning
INTRODUCTION: Cervical artery dissection (CAD) is an important etiology of ischemic stroke and early recognition is vital to protect patients from the major complication of cerebral embolization by administration of anticoagulants. The etiology of arterial dissections differ and can be either spontaneous or traumatic. Even though the historical gold standard is still catheter angiography, recent studies suggest a good performance of computed tomography angiography (CTA) for detection of CAD...
January 26, 2018: Clinical Neuroradiology
Shailesh Puntambekar, Milind Telang, Pankaj Kulkarni, Seema Puntambekar, Sanjeev Jadhav, Mangesh Panse, Ravindra Sathe, Nikhil Agarkhedkar, Neeta Warty, Sandesh Kade, Manoj Manchekar, Hirav Parekh, Kajal Parikh, Riddhi Desai, Mehul Mehta, Mihir Chitale, Bhushan Kinholkar, Joy Shankar Jana, Avinash Pare, Abhay Sadre, Swapnil Karnik, Abhay Mane, Giriraj Gandhi, Shailendra Kanade, Uday Phadke
OBJECTIVE: To report the first ever laparoscopic-assisted live donor uterus retrieval in two patients for uterus transplant DESIGN: Case study (Canadian Task Force Classification Level III) SETTING: Galaxy CARE Laparoscopy Institute, Pune, India PATIENT(S): Two patients with AUFI with their mothers as donors. INTERVENTION(S): A twelve member team was formed and approval for transplant was obtained from Institutional Review Board (IRB). Pre transplant, In Vitro Fertilization (IVF) for both patients was done...
January 20, 2018: Journal of Minimally Invasive Gynecology
Toru Takino, Satoshi Shibuma, Yu Kanemaru, Koji Okamura, Aki Oshima, Manami Tazawa, Takeo Nashimoto, Naoto Tsuchiya, Junichi Yoshimura, Kiminori Netsu, Takafumi Saito
We report a case of bilateral internal carotid artery(ICA)dissection associated with bilateral elongated styloid processes(ESPs). A 46-year-old man presented with transient aphasia and left visual disturbance at a business meeting. He complained of a foreign body sensation in his throat during swallowing for two years. Magnetic resonance imaging(MRI)demonstrated fresh small infarcts in the left corona radiata. Magnetic resonance angiography(MRA)revealed string signs bilaterally in the cervical ICAs. The patient was diagnosed with bilateral idiopathic ICA dissection and was treated with ozagrel and clopidogrel...
January 2018: No Shinkei Geka. Neurological Surgery
Yuanling Wu, Wenxian Li, Xiaomei Xie, Zhen Jing, Weibiao Lu, Li'an Huang
CONTEXT: Cervical spinal cord infarction is a rare and severe complication of vertebral artery dissection (VAD). We report a case of VAD in an acute stage followed by cervical spinal cord infarction that was treated using direct endovascular tirofiban infusion via digital subtraction angiography (DSA) monitoring. FINDINGS: A 48-year-old man presented with vertigo, neck pain, numbness and weakness in four limbs with subsequent cardiac and respiratory arrest. Neurological examination revealed hypoesthesia below the neck with grade one myodynamia on the right side of the limbs and zero on the left side...
January 11, 2018: Journal of Spinal Cord Medicine
Gracia U Musigazi, Stéphanie De Vleeschauwer, Raf Sciot, Eric Verbeken, Bart Depreitere
Tissue fixation methods are well established for rodents, but not for large animals. We present a simple technique for in situ brain perfusion fixation in a male porcine model, using cervical vessels for inflow and outflow and achieving a closed system. Thirty-four pigs, aged 4.7 ± 0.6 months and weighing 60.7 ± 10.9 kg, were anaesthetised and mechanically ventilated. The ipsilateral common carotid artery and external jugular vein were dissected and constituted the inflow and outflow access, respectively...
January 1, 2018: Laboratory Animals
Imanda M E Alons, Ben F J Goudsmit, Korne Jellema, Marianne A A van Walderveen, Marieke J H Wermer, Ale Algra
BACKGROUND: Patients with acute severe headache, normal neurological examination, and a normal noncontrast head computed tomography (NCCT) may still have subarachnoid hemorrhage, cerebral venous thrombosis (CVT), cervical arterial dissection, or reversible cerebral vasoconstriction syndrome (RCVS). Computed tomography angiography (CTA) is used increasingly in the emergency department for evaluating this, but its added value remains controversial. METHODS: We retrospectively collected data on the diagnostic yield of CTA in patients with acute severe headache, normal neurological examination, and normal NCCT who received additional CTA in the acute phase in 2 secondary referral centers for vascular neurology...
December 23, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Hubert Fornalik, Nicole Fornalik
OBJECTIVE: To study the safety and feasibility of robotic dissection of deep pelvic vessels as applied to the robotic harvesting of a uterus from live transplant donor. DESIGN: Surgical video. SETTING: Gynecologic oncology practice of a tertiary community cancer center. PATIENT(S): Two patients undergoing robotic nerve-sparing radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage Ib1 cervical cancer...
February 2018: Fertility and Sterility
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