Search Results (20)

Background/Objectives: One of the surgical interventions applied in the cervical region is the pedicle screw method. The cervical pedicle screw is stronger than any other screw method; however, use of the cervical pedicle screw is limited due to the variability in the anatomy of the cervical vertebrae and the risks to the neurological and vascular structures in this region. This study aimed to determine the morphological features of subaxial cervical vertebrae of the adult Turkish population and to provide guidance for the pedicle screwing method. Methods: In our study, pedicle analyses were examined in the subaxial neck vertebrae of a total of 60 patients, 30 male and 30 female, using computed tomography images. In subaxial vertebrae (C3–C7), bilateral pedicle width, pedicle axis length, pedicle transverse angle, sagittal and transverse diameter of vertebral foramen, and the distance between two pedicles were measured. Results: Pedicle widths that did not fit the commonly used 3.5 mm pedicle screw were detected in both male and female patients. The mean bilateral pedicle width in male patients was found to be greater than in female patients. When the parameter results were compared according to the levels, it was found that the pedicle width, pedicle axis length, transverse diameter, and the distance between the two pedicles increased statistically significantly. Conclusions: We think that the data obtained from the study will help determine the appropriate screwing (screw selection) in subaxial vertebra pedicle surgery and increase the success of the surgical procedure. Full article

The vertebral arteries supply blood to the upper spinal cord, brainstem, cerebellum, and posterior part of the brain. These arteries are susceptible to deformation from external factors such as muscular, ligamentous, or bony structures, and any interruption of blood flow may result in vertebrobasilar insufficiency. Among the osseous variants of the cervical spine with potential pathological significance, variations in the number, shape, and size of the foramen transversarium, as well as the presence of bony bridges in the first cervical vertebra, may suggest a predisposition to vertebrobasilar insufficiency. A skeletal sample from the post-Classical cemetery of Corfinio (12th–15th centuries CE; L’Aquila, Italy) was examined. Regarding the morphology of the foramen transversarium, shape variations were identified in 32 of the 108 vertebrae analysed (a prevalence of 29.6%). Particularly noteworthy are three findings in the atlas: (i) a high prevalence of foramen transversarium variants (35.7% for hypoplastic and double foramina), (ii) a coefficient of roundness consistent with a brachymorphic shape, and (iii) a high prevalence of bony bridges —especially ponticulus posticus (52.9%) and retrotransverse foramen (64.7%). All of these findings may indicate a predisposition to vertebrobasilar insufficiency in the individuals studied. It is hypothesised that external mechanical factors, such as carrying heavy loads on the head, neck, and shoulders due to work activities, along with possible genetic influences related to kinship, may have contributed to the high prevalence of these osseous variants. Full article

Background and Objectives: Although transesophageal or intracardiac echocardiography and radiofrequency needles are employed to guide transseptal puncture, their routine utilization is associated with substantial expense. No reports have analyzed the use of the foramen ovale position to effectively guide transseptal punctures on chest X-rays or computed tomography scout views, which are more cost-effective approaches to safely and effectively guide the procedure. We aimed to find the foramen ovale position on chest computed tomography scout views to effectively guide percutaneous transseptal punctures. Materials and Methods: The study population included 31 patients treated with extracorporeal membrane oxygenation (ECMO) for cardiogenic shock, 32 patients diagnosed with atrial fibrillation (AF) who underwent MDCT, and 197 patients who underwent MDCT for non-cardiac conditions. Vertebral body units, defined as the distance between two adjacent vertebral bodies (the sixth and seventh thoracic spines) inclusive of the intervertebral disk space, were used to express the distance from the carina to the foramen ovale on computed tomography scout views. Results: The mean vertebral body units, distance from the carina to the foramen ovale (carina–foramen ovale), and distance from the carina to the foramen ovale on chest computed tomography scout views (carina–foramen ovale vertebral body units⁻¹) were 2.3 ± 0.2 cm, 6.9 ± 0.9 cm, and 3.0 ± 0.3, respectively. Multivariate analysis showed significant correlations between the carina–foramen ovale vertebral body units⁻¹ and sex (β = 0.080; p = 0.028), body mass index (β = −0.020; p < 0.001), age (β = 0; p = 0.013), and the application of extracorporeal membrane oxygenation or the presence of atrial fibrillation (β = 0.130; p = 0.004). Conclusions: Although a three-dimensional approach was not employed, the foramen ovale position may serve as a radiologic guide in various clinical settings where transseptal punctures are required. This technique may be an effective aid in transseptal puncture procedures. Full article

Background: The arcuate foramen (AF), an osseous foramen, is probably formatted from the ossification of the posterior atlanto-occipital membrane. When this morphologically ossified variant exists, it encloses the vertebral artery (VA) third segment (V3). This close relationship may cause compression to the VA with concomitant vertebrobasilar insufficiency, vertigo, headaches, or neck pain. In the published literature, no studies investigate the abovementioned potential compression pattern. The present study examines the AF ossification pattern (complete or partial type) and the variable VA diameter at the atlantal part (V3), concluding a potential risk for VA compression after correlating the relative diameters (AF and VA diameters). Materials and Methods: One hundred and fifty dried first cervical vertebrae (atlases) and one hundred fifty computed tomography (CT) scans were obtained for the present study. The presence of a complete or incomplete AF was evaluated, and when present, its diameter was measured. To correlate these findings with the vessel, 50 computed tomography angiographies (without AF presence) were obtained to measure the V3 segment diameter. Results: Out of the total 600 (N = 600) sides, 111 sides had incomplete AF (18.2%), and 67 sides had complete AF (11.1%). The AF mean diameter was 6.41 (1.12) mm. The diameter of the V3 segment ranged between 5.0 and 6.0 mm; therefore, three morphological stenosis patterns were identified. A low risk of compression (over 6.0 mm) was identified in 61.2% (N = 109 sides), a moderate risk (between 5.0–6.0 mm) was observed in 29.2% (N = 52 sides), and a high risk (under 5.0 mm) was recorded in 9.6% (N = 17 sides). There was no statistically significant correlation regarding sexes and age for the potential compression patterns. Conclusions: The present study revealed the morphological stenosis pattern of the AF to the V3 segment. The variation had a high risk of compression to the vessel in 9.6% of sides, indicating that it is not infrequent. Knowledge of these details is essential for clinicians when investigating vertebrobasilar insufficiency. Full article

Artificial intelligence has garnered significant attention in recent years as a rapidly advancing field of computer technology. With the continual advancement of computer hardware, deep learning has made breakthrough developments within the realm of artificial intelligence. Over the past few years, applying deep learning architecture in medicine and industrial anomaly inspection has significantly contributed to solving numerous challenges related to efficiency and accuracy. For excellent results in radiological, pathological, endoscopic, ultrasonic, and biochemical examinations, this paper utilizes deep learning combined with image processing to identify spinal canal and vertebral foramen dimensions. In existing research, technologies such as corrosion and expansion in magnetic resonance image (MRI) processing have also strengthened the accuracy of results. Indicators such as area and Intersection over Union (IoU) are also provided for assessment. Among them, the mean Average Precision (mAP) for identifying intervertebral foramen (IVF) and intervertebral disc (IVD) through YOLOv4 is 95.6%. Resnet50 mixing U-Net was employed to identify the spinal canal and intervertebral foramen and achieved IoU scores of 79.11% and 80.89%. Full article

Background and Objectives: Typically, the vertebral arteries (VAs) enter the posterior fossa through dural rings and further unite, forming the basilar artery. The posterior inferior cerebellar artery (PICA) is usually a branch of the V4 segment of the VA (intradural origin). It may also leave the V3 suboccipital segment of the VA (extradural origin). The transdural origin of the PICA within the VA’s dural ring has been consistently overlooked. A study was designed to determine the topographical patterns of the PICA’s origin. Materials and Methods: Determinations were performed in a retrospective sample of 225 computed tomography angiograms. Four types of PICA origin were documented: type 0, absent PICA; type 1, the extradural origin of the PICA from the V3 segment of the VA; type 2, the transdural origin of the PICA within the dural ring; and type 3, the intradural origin of the PICA from the V4 segment of the VA. The bilateral symmetry of types was also investigated. Results: Out of 450 VAs, type 0 (absent PICA) was found in 36%, type 1 (extradural) in 0.44%, type 2 (transdural) in 5.56%, and typical type 3 in just 58%. In types 1 and 2, the PICA entered the posterior fossa through the dural ring and the marginal sinus. In the overall group (N = 225), the type combinations 1_1, 1_2 and 1_3 were not found. Bilaterally absent PICAs occurred in 18.67%. The bilateral combinations 0_1/0_2/0_3/2_2/2_3/3_3 were found, respectively, in 0.89%/3.11%/30.67%/1.78%/4.44%/40.44%. Four of the seventy-eight PICAs opposite to an absent one, three intradural and one transdural, were true bihemispheric PICAs. Conclusions: The PICAs with extradural or transdural origins are facultative contents of the dural ring and are at risk during neurosurgical approaches in the foramen magnum. Rare bihemispheric PICAs could originate either intradurally or within the dural ring. Full article

Objective: to identify advanced or “so-called inoperable” cases of tympanojugular paragangliomas (PGLs) and analyze how each case is surgically managed and followed afterward. Study Design: a retrospective case series study. Methods: Out of 262 type C and D TJPs and more than 10 cases of advanced or so-called inoperable cases, files of 6 patients with a diagnosis of advanced tympanojugular PGLs who were referred to an otology and skull-base center between 1996 and 2021 were reviewed to analyze management and surgical outcomes. The criteria for choosing these cases involve having one or more of the following features: (1) a large-sized tumor; (2) a single ipsilateral internal carotid artery (ICA); (3) involvement of the vertebral artery; (4) a considerable involvement of the ICA; (5) an extension to the clivus, foramen magnum, and cavernous sinus; (6) large intradural involvement (IDE); and (7) bilateral or multiple PGLs. Results: The age range at presentation was 25–43 years old, with a mean of 40.5 years: two females and four males. The presenting symptoms were glossal atrophy, hearing loss, pulsatile tinnitus, dysphonia, shoulder weakness, and diplopia. The modified Infratemporal Fossa Approach (ITFA) with a transcondylar–transtubercular extension is the principal approach in most cases, with additional approaches being used accordingly. Conclusions: The contemporary introduction of carotid artery stenting with the direct and indirect embolization of PGLs has made it possible to operate on many cases, which was otherwise considered impossible to treat surgically. Generally, the key is to stage the removal of the tumor in multiple stages during the management of complex PGLs to decrease surgical morbidities. A crucial aspect is to centralize the treatment of PGLs in referral centers with experienced surgeons who are trained to plan the stages and manage possible surgical complications. Full article

Conjoined twins are rare congenital malformations that have been reported in mammals. Two different cases are presented in this study. Case No. 1 features monocephalic, thoracopagus-conjoined twin piglets with anencephaly and palatoschisis of the Pietrain breed, and case No. 2 features monocephalic, thoracopagus conjoined twin piglets with palatoschisis and bifid root tongue of a mixed breed. These cases were examined using post-mortem and computed tomography (CT) examinations. In both cases, the conjoined symmetrical twins had a single head, one neck, and fused thoracic cavities, while the abdominal cavities were separated. Similarly, in both cases, they had four forelimbs and four hindlimbs and duplicated foramen magnum. During CT examination, in case No. 1, severe abnormalities were observed in the skull and vertebral column. In the left twin, occult dysraphism was seen from the C2 vertebra until the end of the vertebral column, and in the right twin, from the C3 vertebra until the end of the state vertebral level. In case No. 2, the oral cavity contained a tongue with a bifid root connected with one hyoid bone, and the soft palate presented a small cleft. During CT examination, the parietal bone and the occipital bones were partially duplicated. This case also presented occult dysraphism, but only in the cervical vertebrae, C1–C6 for the left twin and C1–C5 for the right twin. In both cases, abnormalities of the internal organs were revealed during necropsy. Conjoined twins with multiple congenital anomalies presented here enhance our understanding of the various clinical forms of conjoined cases in veterinary medicine. Full article

In recent years, equine complex vertebral malformation (ECVM) has been of concern in the equine community, with studies identifying numerous associative morphological variations. Here, we examine the morphological association between C6 and C7 for dependency in ECVM cases, where the partially absent ventral process of C6 transposes on the ventral surface of C7. A C6 ventral process presents two tubercles, one cranial (CrVT) and one caudal (CVT). In this study, the C6 osseous specimens (n = 85) demonstrated a partial or completely absent CVT (aCVT) graded 1–4 that often extended cranially creating a partially absent cranial ventral tubercle (aCrVT) graded 1–3. In the 85 C6 osseous specimens examined, the corresponding C7s demonstrated either a complete or incomplete transposition of the ventral process from C6 in 44/85, with 30/44 replicating a transverse foramen. A strong statistical dependency existed between C6 grade 4 aCVTs and grades 1–3 aCrVTs and C7 transpositions with replicated transverse foramen. Sidedness was also demonstrated, where a left sided absent C6 associated with transposition on the left ventral surface of C7. This likewise applied to right sidedness and most bilateral cases. These findings might benefit practitioners when radiographing the extent of the ECVM configuration in patients presenting caudal cervical pain. Full article

The venous anatomy of the two-toed sloth (Choloepus didactylus) remains poorly understood, particularly in living specimens due to the limitations of traditional cadaveric studies. This study aims to describe the unique venous structures of Choloepus didactylus using computed tomography, enhancing our understanding of this species in a live setting. Three living Choloepus didactylus underwent CT scans as part of routine clinical assessments. The images were reconstructed using 3D Slicer software (version 5.6.2), focusing on the caudal vena cava anatomy. The reconstructions confirmed the presence of a significant intravertebral vein, showing complex venous connections through the ventral sacral foramen and vertebral foramina. These findings highlight notable anatomical variations and challenge existing literature on the species’ venous architecture. By employing modern imaging technologies, this research provides new insights into the venous anatomy of Choloepus didactylus, demonstrating the value of non-invasive techniques in studying the anatomical features of live animals, thereby offering a foundation for further comparative and evolutionary studies. Full article

Background/Objectives: The right-sided aortic arch (RAA) is an uncommon variation of the aortic arch (AA), characterized by the aorta crossing over the right main bronchus. In the RAA, the descending aorta can be found on either the right or left side of the spine. The current study comprises a comprehensive retrospective computed tomography angiography (CTA) investigation into the prevalence of the RAA within the Greek population. Additionally, we will conduct a systematic review and meta-analysis to elucidate both common and rare morphological variants of the RAA. This research is significant as it sheds light on the prevalence and characteristics of the RAA in a specific population, providing valuable insights for clinical practice. Methods: Two hundred CTAs were meticulously investigated for the presence of a RAA. In addition, the PubMed, Google Scholar, and Scopus online databases were thoroughly searched for studies referring to the AA morphology. The R programming language and RStudio were used for the pooled prevalence meta-analysis, while several subgroup analyses were conducted. Results: Original study: A unique case of 200 CTAs (0.5%) was identified with an uncommon morphology. The following branches emanated from the RAA under the sequence: the right subclavian artery (RSA), the right common carotid artery (RCCA), the left common carotid artery (LCCA), and the left vertebral artery (LVA) in common origin with the aberrant left subclavian artery (ALSA). The ALSA originated from a diverticulum (of Kommerell) and followed a retroesophageal course. Systematic Review and Meta-Analysis: Sixty-two studies (72,187 total cases) met the inclusion criteria. The pooled prevalence of the RAA with a mirror-image morphology was estimated at 0.07%, and the RAA with an ALSA was estimated at <0.01%. Conclusions: AA anomalies, specifically the RAA, raise clinical interest due to their coexistence with developmental heart anomalies and possible interventional complications. Congenital heart anomalies, such as the Tetralogy of Fallot and patent foramen ovale, coexisted with RAA mirror-image morphology. Full article

Purpose: We assess the application and advantages of modifying the trans-unco-discal (TUD) approach which we underwent for cervical myelo-radiculopathy. We present the surgical techniques of the modified TUD approach. Materials and Methods: The material was 180 cases where anterior cervical decompression (ACD) was performed by the modified TUD approach. We classified the material into four groups based on the location of the nerve root and/or spinal cord compression: I, compression of the root at intervertebral foramen (IVF); II, compression of the posterior margin of the vertebral body; III, compression of the IVF and posterior margin of the vertebral body; IV, compression of the bilateral IVF and posterior margin of the vertebral body. We applied the modified TUD approach to these four types. We present the surgical procedures and techniques for the modified TUD approach. The Japanese orthopedic association (JOA) score and neuroradiological alignment were examined. Results: The improvement rate of the JOA score was 78.4% at 6 months post-surgery and 77.5% in the most recent examinations. By the modified TUD approach, compressive lesions of the spinal cord and/or nerve roots were removed, and good alignment was acquired and sustained. Conclusions: ACD by the modified TUD approach safely achieved appropriate decompression for the spinal cord and/or nerve roots, and the patients had a high improvement rate and good alignment. Complications were less common than with other surgical procedures. If the TUD approach and endoscopic approaches can be combined, their application to new area is anticipated. Full article

Endoscopic surgery of the cervical spine is constantly evolving and the spectrum of its indications has expanded in recent decades. Full-endoscopic techniques have standardized the procedures for posterior and anterior access. The full-endoscopic approach was developed to treat degenerative diseases with the least possible invasion and without causing instability of the cervical spine. The posterior full-endoscopic approach is indicated for the treatment of diseases of the lateral part of the vertebral segment, such as herniations and stenoses of the lateral recess and vertebral foramen. There has been little discussion of this approach to the treatment of central stenosis of the cervical spine. This technical note describes a step-by-step surgical technique for central and over-the-top full-endoscopic decompression in the cervical spine, using a 3.7 mm working channel endoscope. This technique has already been shown to be effective in a recent case series with a 4.7 mm working channel endoscope, and may represent a new treatment option for central or bilateral lateral recess stenosis. There is also the possibility of a bilateral full-endoscopic approach, but this may be associated with greater muscle damage and a longer operative time. Case series and comparative studies should be encouraged to confirm the safety and utility of this technique. Full article

Cervical vertebrae may exhibit the anomalous presence of a double transverse foramen (DTF) that may impact the anatomy of related structures that traverse the cervical region, such as the vertebral artery (VA). This retrospective anatomical study utilized CT angiography cervical scans to examine the prevalence of DTF, VA, and TF areas. The subjects were separated into two groups: normal TF (NTF group; 26 males and 21 females) and double TF (DTF group; 21 males and 24 females). The males presented significantly higher TF area values (30.31 ± 4.52 mm²) than the females (27.48 ± 1.69 mm²) in the NTF group (p = 0.006). The sex differences disappeared when a DTF was present (p = 0.662). There were no differences in the VA area values between the sexes in both the NTF and DTF groups (p = 0.184). No significant differences in the VA area values between males of the NTF and DTF groups (p = 0.485) were noted. The DTF subjects presented an increased VA/TF area ratio than the NTF subjects (p < 0.001). This study showed that DTF presence reduced the TF area. In contrast, the VA area did not change despite the decreasing TF area. This might be an anatomical risk for transient vertebrobasilar insufficiency in subjects with DTF, especially in females, because VA space in the TF is less in DTF subjects than in NTF subjects. This may lead to easy VA compression in DTF subjects following neck trauma. Full article

(1) Background. The anatomical variations of the vertebral arteries (VAs) have a significant impact both in neurosurgery and forensic pathology. The purpose of this study was to evaluate the variational anatomy of the vertebral artery. We evaluated anatomical aspects regarding the V1 and V2 segments of the VA: origin, course, tortuosity, hypoplasia, and dominance, and established the prevalence of each variation. (2) Methods. We conducted a systematic search in PubMed and Google Scholar databases, up to December 2022. Sixty-two studies, comprising 32,153 vessels, were included in the current meta-analysis. We used a random-effects model with a DerSimonian-Laird estimator. The confidence intervals were set at 95%. The heterogeneity between studies was assessed using I². The funnel plot and Egger’s regression test for plot asymmetry were used for the evaluation of publication bias. Statistical significance was considered at p < 0.05. (3) Results. The most common site for the origin of both VAs was the subclavian artery. The aortic arch origin of the left VA had a prevalence of 4.81%. Other origins of the right VAs were noted: aortic arch (0.1%), right common carotid artery (0.1%), and brachiocephalic trunk (0.5%). Ninety-two percent of the VAs entered the transverse foramen (TF) of the C6 vertebra, followed by C5, C7, C4, and least frequently, C3 (0.1%). Roughly one out of four (25.9%) VAs presented a sort of tortuosity, the transversal one representing the most common variant. Hypoplasia occurred in 7.94% of the vessels. Left VA dominance (36.1%) is more common, compared to right VA dominance (25.3%). (4) Conclusions. The anatomy of the VA is highly irregular, and eventual intraoperative complications may be life-threatening. The prevalence of VA origin from the subclavian artery is 94.1%, 92.0% of the VAs entered the TF at C6, 26.6% were tortuous, and 7.94% were hypoplastic. Full article