Kaima Suzuki, Hiroki Sato, Shun Suzuki, H. Ooigawa, H. Kurita
Introduction: The insonation angle consideration is important in the Doppler-sonographic evaluation of blood flow velocities and volume, however, the concept is rarely applied to the intraoperatively used micro-Doppler.This technical note aims to emphasize the possibility and necessity of insonation angle correction and preservation for the blood flow assessment in cerebrovascular surgery.Methods: Bi-directional surgical Doppler with a 20MHz flexible bayonet 1.2mm diameter probe was used for the intraoperative blood flow assessment, with the variable insonation angle on the straight parts of the arteries, and the results were recorded to demonstrate the importance.Results: The measurements performed confirmed that the blood flow features, including the direction, velocity, and especially the volume, are highly susceptible to the insonation angle variations. Although there were significant alterations, positioning the probe at an angle of ~60 degrees resulted in the variable but less altering measurements.Conclusion: Positioning the probe at ~60 degrees is desirable; however, it appears that it is even more important to maintain the same insonation angle and probe position when assessing the vessels repeatedly for blood flow alterations that might occur in the course of cerebrovascular surgery.
{"title":"Insonation angle impact on micro-Doppler evaluation in cerebrovascular surgery: technical note","authors":"Kaima Suzuki, Hiroki Sato, Shun Suzuki, H. Ooigawa, H. Kurita","doi":"10.55005/v3i1.9","DOIUrl":"https://doi.org/10.55005/v3i1.9","url":null,"abstract":"Introduction: The insonation angle consideration is important in the Doppler-sonographic evaluation of blood flow velocities and volume, however, the concept is rarely applied to the intraoperatively used micro-Doppler.This technical note aims to emphasize the possibility and necessity of insonation angle correction and preservation for the blood flow assessment in cerebrovascular surgery.Methods: Bi-directional surgical Doppler with a 20MHz flexible bayonet 1.2mm diameter probe was used for the intraoperative blood flow assessment, with the variable insonation angle on the straight parts of the arteries, and the results were recorded to demonstrate the importance.Results: The measurements performed confirmed that the blood flow features, including the direction, velocity, and especially the volume, are highly susceptible to the insonation angle variations. Although there were significant alterations, positioning the probe at an angle of ~60 degrees resulted in the variable but less altering measurements.Conclusion: Positioning the probe at ~60 degrees is desirable; however, it appears that it is even more important to maintain the same insonation angle and probe position when assessing the vessels repeatedly for blood flow alterations that might occur in the course of cerebrovascular surgery.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"422 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126713761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The progress of “Our Journal” in anticipation of the centennial anniversary of neurosurgery in Serbia","authors":"L. Rasulić, M. Lepić","doi":"10.55005/v3i1.1","DOIUrl":"https://doi.org/10.55005/v3i1.1","url":null,"abstract":"","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"445 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125846557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Arévalo-Sáenz, F. Rascón-Ramírez, M. Pedrosa Sánchez
Introduction: Temporomandibular joint syndrome is defined by a triad of intense joint pain together with restriction of mouth opening and jaw clicking. The objective of this study is to evaluate the efficacy and safety of peripheral nerve stimulation for the treatment of this pathology. Material and Methods: A retrospective study was conducted. All patients met selection criteria that include prior resistance to medical or surgical treatment and completion of a series of pre-surgical tests. An octopolar electrode was implanted in the affected preauricular region. The results were measured using the Analog Pain Scale, a short questionnaire on pain, improvement of restriction in mouth opening and reduction of analgesic medication.Results: A total of 10 patients with 14 performed procedures were included. The mean reduction in pain measured by VAS was 86.2% at one month and 79% at one year after surgery. All patients experienced a drastic improvement in pain and its impact according to the Brief Pain Inventory, the mean improvement being 90% at 4 weeks and 82% at one year. There was an improvement in the mean oral opening of 10.14 mm (minimum of 4 and maximum of 13 mm). One case was excluded due to the complication demanding the system removal.Conclusions: Patients with temporomandibular joint syndrome who do not respond to conventional treatments are ideal candidates for peripheral nerve stimulation, showing improvement in pain, oral restriction, and quality of life with a low percentage of serious complications.
{"title":"Temporomandibular joint syndrome treatment with peripheral nerve stimulation","authors":"A. Arévalo-Sáenz, F. Rascón-Ramírez, M. Pedrosa Sánchez","doi":"10.55005/v3i1.8","DOIUrl":"https://doi.org/10.55005/v3i1.8","url":null,"abstract":"Introduction: Temporomandibular joint syndrome is defined by a triad of intense joint pain together with restriction of mouth opening and jaw clicking. The objective of this study is to evaluate the efficacy and safety of peripheral nerve stimulation for the treatment of this pathology. Material and Methods: A retrospective study was conducted. All patients met selection criteria that include prior resistance to medical or surgical treatment and completion of a series of pre-surgical tests. An octopolar electrode was implanted in the affected preauricular region. The results were measured using the Analog Pain Scale, a short questionnaire on pain, improvement of restriction in mouth opening and reduction of analgesic medication.Results: A total of 10 patients with 14 performed procedures were included. The mean reduction in pain measured by VAS was 86.2% at one month and 79% at one year after surgery. All patients experienced a drastic improvement in pain and its impact according to the Brief Pain Inventory, the mean improvement being 90% at 4 weeks and 82% at one year. There was an improvement in the mean oral opening of 10.14 mm (minimum of 4 and maximum of 13 mm). One case was excluded due to the complication demanding the system removal.Conclusions: Patients with temporomandibular joint syndrome who do not respond to conventional treatments are ideal candidates for peripheral nerve stimulation, showing improvement in pain, oral restriction, and quality of life with a low percentage of serious complications.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116418006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keiji Yoshida, Tomonari Suzuki, Hiroki Sato, Hiroki Kobayashi, Reina Mizuno, M. Shirahata, T. Ozawa, K. Mishima
Introduction: Primary pituitary lymphoma (PPL) is a rare disease characterized by lymphoma confined to the sella or parasellar region without systemic involvement. The clinical symptoms of PPL may include headache, hypopituitarism, visual field disturbance and visual impairment. To date, there is no established standard treatment for this condition. Here, we present a case of successful treatment with a Bruton’s tyrosine kinase (BTK) inhibitor. Case report: A 78-years-old man with a history of severe left renal insufficiency caused by retroperitoneal fibrosis, and sequential right nephrostomy, underwent brain magnetic resonance imaging (MRI) due to the altered hormonal status. An enlarged pituitary stalk was noted and led to a diagnosis of lymphocytic hypopituitarism. Six months later, visual field disturbance and visual acuity deterioration developed, and an MRI revealed a neoplastic lesion and further enlargement of the stalk and the pituitary itself, with an obvious optic nerve compression. Expedited transsphenoidal partial resection was performed to relieve the compression. Pathohystology led to the diagnosis of the large B-cell lymphoma of the germinal center origin. Because of the patient’s poor renal function, high-dose methotrexate therapy was not an option; rather, the patient was treated with a BTK inhibitor - tirabrutinib. Symptoms improved within a week, and a follow-up MRI confirmed a marked reduction of the pituitary lesion. Conclusion: BTK inhibitors may be considered as a first-line treatment option for PPL, especially in patients with contraindications for other treatment protocols.
{"title":"Primary pituitary lymphoma successfully treated with Bruton’s tyrosine kinase inhibitor monotherapy: case report","authors":"Keiji Yoshida, Tomonari Suzuki, Hiroki Sato, Hiroki Kobayashi, Reina Mizuno, M. Shirahata, T. Ozawa, K. Mishima","doi":"10.55005/v3i1.7","DOIUrl":"https://doi.org/10.55005/v3i1.7","url":null,"abstract":"Introduction: Primary pituitary lymphoma (PPL) is a rare disease characterized by lymphoma confined to the sella or parasellar region without systemic involvement. The clinical symptoms of PPL may include headache, hypopituitarism, visual field disturbance and visual impairment. To date, there is no established standard treatment for this condition.\u0000Here, we present a case of successful treatment with a Bruton’s tyrosine kinase (BTK) inhibitor.\u0000Case report: A 78-years-old man with a history of severe left renal insufficiency caused by retroperitoneal fibrosis, and sequential right nephrostomy, underwent brain magnetic resonance imaging (MRI) due to the altered hormonal status. An enlarged pituitary stalk was noted and led to a diagnosis of lymphocytic hypopituitarism.\u0000Six months later, visual field disturbance and visual acuity deterioration developed, and an MRI revealed a neoplastic lesion and further enlargement of the stalk and the pituitary itself, with an obvious optic nerve compression. Expedited transsphenoidal partial resection was performed to relieve the compression. Pathohystology led to the diagnosis of the large B-cell lymphoma of the germinal center origin. Because of the patient’s poor renal function, high-dose methotrexate therapy was not an option; rather, the patient was treated with a BTK inhibitor - tirabrutinib. Symptoms improved within a week, and a follow-up MRI confirmed a marked reduction of the pituitary lesion.\u0000Conclusion: BTK inhibitors may be considered as a first-line treatment option for PPL, especially in patients with contraindications for other treatment protocols.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121705215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The article describes a clinical case of a dissection aneurysm of the basilar artery in a SARS-COV-2 patient. The patient was treated in the hospital for infectious diseases due to bilateral poly-segmental pneumonia complicating a COVID-19 infection. A focal neurological deficit suddenly appeared and rapidly progressed, including paresis of the abducens nerve, bulbar disorders, and a right-sided hemiparesis. During the course of treatment, the patient underwent CT and CT angiography of the cerebral arteries several times. During the first examination, no pathology of the cerebral vessels was discovered. During the examination 10 days later, a fusiform aneurysm of the basilar artery trunk with a daughter sac was detected. Its rupture led to massive subarachnoid hemorrhage and an unfavorable outcome. The occurrence of primary symptoms in this patient could be due to a violation of the blood flow in the short branches of the basilar trunk in the area of the dissection.
{"title":"Appearance and rupture of a dissection aneurysm of the basilar trunk in a SARS- CoV-2 patient","authors":"P. Shnyakin, A. Dubovoy","doi":"10.55005/v3i1.6","DOIUrl":"https://doi.org/10.55005/v3i1.6","url":null,"abstract":"\u0000\u0000\u0000\u0000The article describes a clinical case of a dissection aneurysm of the basilar artery in a SARS-COV-2 patient. The patient was treated in the hospital for infectious diseases due to bilateral poly-segmental pneumonia complicating a COVID-19 infection. A focal neurological deficit suddenly appeared and rapidly progressed, including paresis of the abducens nerve, bulbar disorders, and a right-sided hemiparesis. During the course of treatment, the patient underwent CT and CT angiography of the cerebral arteries several times. During the first examination, no pathology of the cerebral vessels was discovered. During the examination 10 days later, a fusiform aneurysm of the basilar artery trunk with a daughter sac was detected. Its rupture led to massive subarachnoid hemorrhage and an unfavorable outcome. The occurrence of primary symptoms in this patient could be due to a violation of the blood flow in the short branches of the basilar trunk in the area of the dissection.\u0000\u0000\u0000\u0000","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123413473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Chaulagain, V. Smolanka, A. Smolanka, T. Havryliv, Abdalrahman Nassar, Mujahed Ayasi
Introduction: The peak age for the development of pilocytic astrocytoma (PA), a type of benign cerebellar tumor, is between 10 and 20 years. Adult PA is extremely rare, and consequently, very little is understood about its characteristics. Methods: We retrospectively reviewed the records of patients older than 18 years with pathologically proven PA who had surgery to remove the tumor between January 2010 and January 2020 and were followed until January 2022. Results: Although 32 cases were initially flagged as PA, we included 4 patients (2 male and 2 female) with adult PA. The average age of a male patient at diagnosis was 26.75 years old, and there was no mortality or recurrence. The mean age of female patients at diagnosis was 25 years old. One female was still living after the follow-up period ended. The cause of death in one female patient was unrelated to tumor. Women had a median follow-up of 36 months, and their mean overall survival was 42 months. Conclusion: PA in adults acts differently than in children. The extent of surgical resection and the location of the tumor influenced the prognosis. When possible, total resection should be the primary treatment, as it promotes good survival rates and low recurrence risk.
{"title":"A monocenter retrospective study of the surgical outcomes of adult pilocytic astrocytoma: a small case series and review of the literature","authors":"D. Chaulagain, V. Smolanka, A. Smolanka, T. Havryliv, Abdalrahman Nassar, Mujahed Ayasi","doi":"10.55005/v3i1.5","DOIUrl":"https://doi.org/10.55005/v3i1.5","url":null,"abstract":"Introduction: The peak age for the development of pilocytic astrocytoma (PA), a type of benign cerebellar tumor, is between 10 and 20 years. Adult PA is extremely rare, and consequently, very little is understood about its characteristics.\u0000Methods: We retrospectively reviewed the records of patients older than 18 years with pathologically proven PA who had surgery to remove the tumor between January 2010 and January 2020 and were followed until January 2022.\u0000Results: Although 32 cases were initially flagged as PA, we included 4 patients (2 male and 2 female) with adult PA. The average age of a male patient at diagnosis was 26.75 years old, and there was no mortality or recurrence. The mean age of female patients at diagnosis was 25 years old. One female was still living after the follow-up period ended. The cause of death in one female patient was unrelated to tumor. Women had a median follow-up of 36 months, and their mean overall survival was 42 months.\u0000Conclusion: PA in adults acts differently than in children. The extent of surgical resection and the location of the tumor influenced the prognosis. When possible, total resection should be the primary treatment, as it promotes good survival rates and low recurrence risk.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125227956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Munda, T. Velnar, B. Prestor, T. Žele, P. Spazzapan, Boštjan Matos, N. Kos, M. Benedičič, A. Jeglic, I. Tekavčič, A. Porčnik, R. Bošnjak
Introduction: The novel coronavirus disease 2019 (COVID-19) became an important and urgent threat to global health. In Slovenia, the COVID-19 struck the health system immensely. Neurosurgery experienced difficulties, not only in regular, elective surgeries, but also during emergency situations. Methods: In the article, we analyse and compare the number of elective and emergency neurosurgical procedures during the time of the pandemic (from March 2018 to February 2020) and describe our protocol in the management of neurosurgical patients in the Medical Centre in Ljubljana, Slovenia. Results: There were 2597 patients treated surgically, including 1932 emergency patients and 665 emergency patients. Overall, we recorded an 11.2% drop in all neurosurgical procedures in two years after COVID-19 was declared compared to two years before. Elective procedures decreased by 13.9%, mostly on account of spinal pathology procedures (245, 23.5%), functional neurosurgical procedures (37 cases, 24.7%), endonasal endoscopy procedures (11, 12.8%), and brain lesions (31, 4.8%). Conclusion: COVID-19 had a vast impact on the healthcare system in Slovenia, including on neurosurgery. New and improved strategies to maintain neurosurgical practice during public health emergencies are necessary for the neurosurgical service and healthcare system to run smoothly in the long term and prevent disruptions during future pandemics.
{"title":"Neurosurgical service during COVID-19 pandemics in Ljubljana, Slovenia - lessons learned","authors":"M. Munda, T. Velnar, B. Prestor, T. Žele, P. Spazzapan, Boštjan Matos, N. Kos, M. Benedičič, A. Jeglic, I. Tekavčič, A. Porčnik, R. Bošnjak","doi":"10.55005/v3i1.4","DOIUrl":"https://doi.org/10.55005/v3i1.4","url":null,"abstract":"Introduction: The novel coronavirus disease 2019 (COVID-19) became an important and urgent threat to global health. In Slovenia, the COVID-19 struck the health system immensely. Neurosurgery experienced difficulties, not only in regular, elective surgeries, but also during emergency situations.\u0000Methods: In the article, we analyse and compare the number of elective and emergency neurosurgical procedures during the time of the pandemic (from March 2018 to February 2020) and describe our protocol in the management of neurosurgical patients in the Medical Centre in Ljubljana, Slovenia.\u0000Results: There were 2597 patients treated surgically, including 1932 emergency patients and 665 emergency patients. Overall, we recorded an 11.2% drop in all neurosurgical procedures in two years after COVID-19 was declared compared to two years before. Elective procedures decreased by 13.9%, mostly on account of spinal pathology procedures (245, 23.5%), functional neurosurgical procedures (37 cases, 24.7%), endonasal endoscopy procedures (11, 12.8%), and brain lesions (31, 4.8%).\u0000Conclusion: COVID-19 had a vast impact on the healthcare system in Slovenia, including on neurosurgery. New and improved strategies to maintain neurosurgical practice during public health emergencies are necessary for the neurosurgical service and healthcare system to run smoothly in the long term and prevent disruptions during future pandemics.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123082929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The Mayfield head clamp (MHC) is a three-pin skull clamp that allows excellent cranial stabilization during head and neck surgery and is the most frequently used head clamp in neurosurgery. In many cases, surgery is performed with complete reliance on the safety of the MHC. However, potentially serious or life-threatening complications, such as scalp lacerations, depressed skull fractures, venous emboli, or extradural hematoma can rarely occur. We describe a case in which the MHC displaced downwards due to sudden loss of grip during postoperative removal with a brief review of the literature. Case report: The patient was a 60-year-old male who was scheduled to undergo tumor resection of a recurrent bilateral parasagittal parafalcine meningioma via a bicoronal approach. While removing the MHC, the lower screw stabilizing the arm of the MHC system displaced downwards (when force was applied from both directions) leading to an extension of flexed neck along with jerking of the cervical spine despite hand stabilization of the head in an intubated patient with slight upward displacement of a tightly fixed endotracheal tube. Conclusion: We emphasize the importance of properly managing and maintaining instruments to prevent fatal injury.
{"title":"Head slippage following displacement of a Mayfield head clamp leading to a unique complication of laryngeal edema in an intubated patient: case report","authors":"Tahreem Fatima","doi":"10.55005/v3i1.3","DOIUrl":"https://doi.org/10.55005/v3i1.3","url":null,"abstract":"Introduction: The Mayfield head clamp (MHC) is a three-pin skull clamp that allows excellent cranial stabilization during head and neck surgery and is the most frequently used head clamp in neurosurgery. In many cases, surgery is performed with complete reliance on the safety of the MHC. However, potentially serious or life-threatening complications, such as scalp lacerations, depressed skull fractures, venous emboli, or extradural hematoma can rarely occur.\u0000We describe a case in which the MHC displaced downwards due to sudden loss of grip during postoperative removal with a brief review of the literature.\u0000Case report: The patient was a 60-year-old male who was scheduled to undergo tumor resection of a recurrent bilateral parasagittal parafalcine meningioma via a bicoronal approach. While removing the MHC, the lower screw stabilizing the arm of the MHC system displaced downwards (when force was applied from both directions) leading to an extension of flexed neck along with jerking of the cervical spine despite hand stabilization of the head in an intubated patient with slight upward displacement of a tightly fixed endotracheal tube.\u0000Conclusion: We emphasize the importance of properly managing and maintaining instruments to prevent fatal injury.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"355 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115932876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fernando Martínez Benia, Guzmán Ripoll-Munhó, Alejandra Neirreiter, Carlos Rodríguez Aceves, Karla Jael Duarte Pérez
Introduction: The scapular notch is a depression on the superior border of the scapula, located medially to the coracoid process, through which suprascapular nerve enters the supraspinous fossa. This paper aims to describe the main anatomical aspects of scapular notch, measuring anatomical parameters for identification of this region during surgical procedures, and compare the obtained data with previous worldwide publications. Material and methods: Sixty-two dry scapulae of Uruguayan specimens were studied at the Anatomy Laboratory of the Faculty of Medicine, Universidad Centro Latinoamericano de Economía Humana (UCLAEH) in Maldonado, and the Faculty of Medicine, University of the Republic in Montevideo, Uruguay, and analyzed for variations. Results: Of the 62 studied scapulae, 33 were right sided and 29 left sided. Anatomical variations were found in 19 specimens, which included 5 flattened shape notches (8.1%), and 14 ossified notches (22.6%), from which 4 (6.5%) were complete and 10 (16.1%) were incomplete. Scapular notch is located at an average distance of 66.7 mm (SD: 4.7) medially from the lateral border of the acromion. Conclusions: Anatomy of the scapular notch is variable. The scapular notch can be located at the junction between the medial two thirds and the lateral one third of the superior scapular border. Anatomical variations of this region play an important role in the development of entrapment neuropathies and in surgical considerations for brachial plexus injuries reconstruction.
肩胛骨切迹是肩胛骨上缘的一个凹陷，位于喙突内侧，肩胛骨上神经通过它进入棘上窝。本文旨在描述肩胛骨切迹的主要解剖方面，测量手术过程中该区域的解剖参数，并将所获得的数据与以前的国际出版物进行比较。材料和方法:在马尔多纳多拉丁美洲中心大学Economía Humana医学院(UCLAEH)解剖实验室和乌拉圭蒙得维的亚共和国大学医学院对62个乌拉圭干肩胛骨标本进行了研究，并分析了差异。结果:62例肩胛骨中，右侧肩胛骨33例，左侧肩胛骨29例。19例标本发现解剖变异，其中扁平状缺口5例(8.1%)，骨化状缺口14例(22.6%)，其中完整缺口4例(6.5%)，不完整缺口10例(16.1%)。肩胛骨切迹位于距肩峰外侧缘内侧平均距离66.7 mm (SD: 4.7)处。结论:肩胛骨切迹的解剖结构是可变的。肩胛骨切迹位于内侧三分之二和外侧三分之一肩胛骨上缘的交界处。该区域的解剖变异在卡压神经病的发生和臂丛神经损伤重建的手术考虑中起着重要作用。
{"title":"The scapular notch: a Uruguayan cadaveric study of 62 dry scapulae","authors":"Fernando Martínez Benia, Guzmán Ripoll-Munhó, Alejandra Neirreiter, Carlos Rodríguez Aceves, Karla Jael Duarte Pérez","doi":"10.55005/v3i1.2","DOIUrl":"https://doi.org/10.55005/v3i1.2","url":null,"abstract":"\u0000\u0000\u0000\u0000Introduction: The scapular notch is a depression on the superior border of the scapula, located medially to the coracoid process, through which suprascapular nerve enters the supraspinous fossa.\u0000This paper aims to describe the main anatomical aspects of scapular notch, measuring anatomical parameters for identification of this region during surgical procedures, and compare the obtained data with previous worldwide publications.\u0000Material and methods: Sixty-two dry scapulae of Uruguayan specimens were studied at the Anatomy Laboratory of the Faculty of Medicine, Universidad Centro Latinoamericano de Economía Humana (UCLAEH) in Maldonado, and the Faculty of Medicine, University of the Republic in Montevideo, Uruguay, and analyzed for variations.\u0000Results: Of the 62 studied scapulae, 33 were right sided and 29 left sided. Anatomical variations were found in 19 specimens, which included 5 flattened shape notches (8.1%), and 14 ossified notches (22.6%), from which 4 (6.5%) were complete and 10 (16.1%) were incomplete. Scapular notch is located at an average distance of 66.7 mm (SD: 4.7) medially from the lateral border of the acromion.\u0000Conclusions: Anatomy of the scapular notch is variable. The scapular notch can be located at the junction between the medial two thirds and the lateral one third of the superior scapular border. Anatomical variations of this region play an important role in the development of entrapment neuropathies and in surgical considerations for brachial plexus injuries reconstruction.\u0000\u0000\u0000\u0000","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129754471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Intramedullary hemangioblastomas are usually accompanied by syringomyelia. However, a holocord syringomyelia is rare. The most common cause of syringomyelia continues to be Chiari disease, and only 10 cases of hemangioblastomas with holocord syringomyelia reported so far. Case report: We present a case of a 35-year-old patient with a two-month history of cervicobrachialgia at the C7-C8 root level, previously preceded by pain at the D1-D2 level. Cervico-dorso-lumbar MRI revealed a medullar tumor with hyper-uptake mural nodule at the conus medullaris level accompanied by an extensive syringomyelic cavity from C5 to L1 compatible with medullary hemangioblastoma. The patient underwent surgery for tumor resection with subsequent resolution of her painful symptoms. Conclusion: It is important to note that the surgery is aimed at treating the origin of this syringomyelia and not the syringomyelia itself. Although the majority of patients with holocord syringomyelia have Chiari as its cause, the possibility of focal spinal intramedullary tumors as being responsible for syringomyelia should not be forgotten.
{"title":"Dorsal hemangioblastoma with holocord syringomyelia: case report","authors":"A. Arévalo-Sáenz, M. Pedrosa Sánchez","doi":"10.55005/v2i1.4","DOIUrl":"https://doi.org/10.55005/v2i1.4","url":null,"abstract":"Introduction: Intramedullary hemangioblastomas are usually accompanied by syringomyelia. However, a holocord syringomyelia is rare. The most common cause of syringomyelia continues to be Chiari disease, and only 10 cases of hemangioblastomas with holocord syringomyelia reported so far.\u0000Case report: We present a case of a 35-year-old patient with a two-month history of cervicobrachialgia at the C7-C8 root level, previously preceded by pain at the D1-D2 level. Cervico-dorso-lumbar MRI revealed a medullar tumor with hyper-uptake mural nodule at the conus medullaris level accompanied by an extensive syringomyelic cavity from C5 to L1 compatible with medullary hemangioblastoma. The patient underwent surgery for tumor resection with subsequent resolution of her painful symptoms.\u0000Conclusion: It is important to note that the surgery is aimed at treating the origin of this syringomyelia and not the syringomyelia itself. Although the majority of patients with holocord syringomyelia have Chiari as its cause, the possibility of focal spinal intramedullary tumors as being responsible for syringomyelia should not be forgotten.","PeriodicalId":287701,"journal":{"name":"Neurohirurgija - The Serbian Journal of Neurosurgery","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131789717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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