BACKGROUND AND IMPORTANCE: Extracranial-intracranial bypass remains an enduring procedure for a select group of patients suffering from steno-occlusive cerebrovascular disease. Although the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is most familiar among neurosurgeons, particular circumstances preclude the use of an STA donor. In such cases, alternative revascularization strategies must be pursued. CLINICAL PRESENTATION: A 63-year-old female presented with symptoms of hemodynamic insufficiency and was found to have left common carotid artery occlusion at the origin. She experienced progressive watershed ischemia and pressure-dependent fluctuations in her neurological examination despite maximum medical therapy. The ipsilateral STA was unsuitable for use as a donor vessel. We performed an extracranial vertebral artery (VA) to MCA bypass with a radial artery interposition graft. CONCLUSION: This technical case description and accompanying surgical video review the relevant anatomy and surgical technique for a VA-MCA bypass. The patient was ultimately discharged home at her preoperative neurological baseline with patency of the bypass. The VA can serve as a useful donor vessel for cerebral revascularization procedures in pathologies ranging from malignancies of the head and neck to cerebral aneurysms and cerebrovascular steno-occlusive disease.
- MeSH
- arteria carotis interna chirurgie MeSH
- arteria cerebri media diagnostické zobrazování chirurgie MeSH
- arteria vertebralis diagnostické zobrazování chirurgie MeSH
- cerebrovaskulární poruchy * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- revaskularizace mozku * metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- arteria vertebralis diagnostické zobrazování MeSH
- arteriae carotides diagnostické zobrazování MeSH
- arteriae cerebrales diagnostické zobrazování MeSH
- cerebrovaskulární poruchy diagnostické zobrazování MeSH
- diagnostické zobrazování klasifikace metody MeSH
- lidé MeSH
- mozek diagnostické zobrazování MeSH
- neurologické vyšetření klasifikace metody přístrojové vybavení MeSH
- ultrasonografie dopplerovská transkraniální metody MeSH
- ultrasonografie * klasifikace metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Předkládaná kazuistika pojednává o pacientce s již diagnostikovanou autoimunitní hepati-tidou, klinicky vyjádřeným sekundárním Sjögrenovým syndromem, aneuryzmatem verte-brální arterie a ektázií vnitřní karotické arterie. Kazuistika popisuje algoritmus postupné dia-gnostiky vzácné autoimunitní mozaiky mladé ženy a diferenciálně diagnostický rozbor.
In this case, a female patient has been already diagnosed with an autoimmune hepatitis, withsecondary Sjögren's syndrome symptoms, aneurysm of vertebral arteries and ectasia of arteriacarotis interna. This case report reveals an algorithm of gradual diagnosis of this rare autoim-mune mosaic in a young woman, and its differential diagnostic analysis.
- MeSH
- aortální aneurysma diagnostické zobrazování MeSH
- arteria vertebralis diagnostické zobrazování patologie MeSH
- autoimunitní hepatitida * diagnostické zobrazování komplikace MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- komorbidita MeSH
- lidé MeSH
- protilátky proti cytoplazmě neutrofilů krev MeSH
- Sjögrenův syndrom klasifikace krev patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Manipulačná liečba algických syndrómov krčnej chrbtice, vykonávaná nielen lekármi, ale aj inými zdravotníckymi pracovníkmi, je stále viac vyhľadávaná pacientmi ako alternatíva medikamentóznej liečby. I manipulačná liečba má však riziká. Jednou z najčastejšie popisovaných komplikácií v literatúre je vznik disekcie vertebrálnej artérie často končiacej jej oklúziou. Práca podáva literárny prehľad anatomických podmienok a možných mechanizmov vedúcich počas liečebnej manipulácie krčnej chrbtice k disekcii jednej z vertebrálnych artérií. Zároveň uvádza prehľad diagnostických možnosti s dôrazom na dostupnosť a špecifiká ultrasonografickej diagnostiky oklúzií vertebrálnych arterií. V závere sa práca venuje niektorým odporúčaniam zameraným na zníženie rizika možného vzniku poškodenia krčných artérií.
Manipulation therapy of aching syndromes of vertebral column performed by physicians or other medical personnel, is increasingly sought by patients as an alternative of medicament therapy. Even the manipulation treatment is not without risk. One of the most often reported complications in literature is the development of dissection of vertebral artery, frequently resulting in occlusion. The contribution reviews literature about anatomical conditions and possible mechanisms during therapeutic manipulation of cervical spine resulting in dissection of one of vertebral arteries. Moreover, the author presents the survey of diagnostic possibilities with emphasis to availability and specific features of ultrasound diagnostic od vertebral artery occlusion. In conclusion the contribution deals with some recommendations paying attention to a decrease of the risk of possible origin of arterial artery damage.
OBJECTIVE: The aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants. METHODS: A systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed. RESULTS: A total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations. CONCLUSIONS: Although patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.
- MeSH
- aneurysma diagnostické zobrazování epidemiologie MeSH
- aorta thoracica abnormality diagnostické zobrazování MeSH
- arteria subclavia abnormality diagnostické zobrazování MeSH
- arteria vertebralis abnormality diagnostické zobrazování MeSH
- arteriae carotides abnormality diagnostické zobrazování MeSH
- černoši MeSH
- incidence MeSH
- kardiovaskulární abnormality diagnostické zobrazování epidemiologie MeSH
- lidé MeSH
- prevalence MeSH
- prognóza MeSH
- truncus brachiocephalicus abnormality diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- MeSH
- arteria vertebralis diagnostické zobrazování MeSH
- disekce arteria vertebralis diagnostické zobrazování MeSH
- dospělí MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- zobrazování trojrozměrné metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
Úvod: Poranenia krčných tepien sú imanentným javom pri poraneniach krčnej chrbtice. Metóda: Prospektívna dvojkohortová štúdia od októbra 2013 do októbra 2015. Celkovo sme vyšetrili 76 pacientov (39Ž/37M) s vekovým mediánom 77 rokov pri fraktúrach alebo diskoligamentárnych poraneniach skeletu, a to pomocou duplexnej sonografie a/alebo CT - angiografie. K tomu bolo pomocou rovnakých modalít v období od októbra 2013 do októbra 2017 vyšetrených 155 pacientov s distorziou krčnej chrbtice (49 % žien a 51 % mužov), s priemerným vekom 39 rokov, SD 19 a vekovým mediánom 34 rokov. Štatistické vyhodnotenie sme realizovali v programe Bias 11.01. Výsledok: Celková incidencia poranenia a. carotis interna predstavovala 2,5 %, z toho u 50 % (1,2 %) s neurologickou symptomatikou. Pre poranenia vertebrálnych artérií sme zistili pomerne vysokú incidenciu 10,5 %, u 25 % (2,6 %) s neurologickou symptomatológiou. Spondylofyty a stupeň dislokácie boli identifikované ako rizikové faktory u fraktúr a diskoligamentárnych poranení. Predilekčným miestom poranenia ciev sa v týchto prípadoch javia vertebrálny kanál a oblasť blízko bázy lebečnej. V skupine distorzií sme nenašli ani jedno poranenie krčných tepien. Predilekčným miestom kolaterálnych poranení bola v týchto prípadoch opätovne oblasť spondylofytárnych zmien. Záver: V prípade relevantného poranenia krčnej chrbtice je nevyhnutná diagnostika príslušných ciev a naopak, v prípade ich poranenia treba vychádzať skôr zo závažného poškodenia skeletu.
Introduction: Cervical spine injuries are immanently accompanied by trauma to cerebral neck arteries. Method: A prospective two-cohort study, from oct. 2013 to oct. 2015. Overall 76 Patients (39W/37M) of median age 77 years, with either fractures or discoligamentary injuries have been examined with duplex-sonography and or CT-angiography. From October 2013 to October 2017 we examined 155 Patients (49% female and 51% male), with the average age of 39 years, SD 19 and age median of 34 years, with cervical-spine-distortion, using the same diagnostic modalities. We used the statistics-program Bias 11.01. Results: The overall incidence of traumatic dissection of the internal carotid artery was 2.5%, in 50% of cases (1.2%) with neurological symptomatology. For the vertebral artery seems the incidence of 10.5%, with 25% of symptomatic patients (2.6%) comparably high. We have identified the osteophytes and dislocation as the significant risk factors. The canalis vertebralis and the skull-base are regions mostly prone to vascular injury. In the group of cervical spine distorsions we found no vascular trauma at all. The osteophytes were here identified as the main risk factor for collateral damage. Conclusion: One should look for vascular injuries in case of cervical relevant spine trauma. Moreover, a rather relevant osteoligamentous injury should be assumed, when cervical vascular trauma was diagnosed.
- MeSH
- arteria vertebralis diagnostické zobrazování patologie zranění MeSH
- CT angiografie MeSH
- disekce aorty diagnóza patologie MeSH
- duplexní dopplerovská ultrasonografie MeSH
- incidence MeSH
- kohortové studie MeSH
- krční obratle * diagnostické zobrazování zranění MeSH
- lidé MeSH
- poranění arteria carotis * patologie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
There are numerous indications for stabilization using instrumentation of the upper cervical spine. This area is comprised of sophisticated anatomy. There is no study describing bony and vascular anomalies of this area in the middle European population. The main aim of this study was to investigate prevalence of any vertebral artery (VA) variations and osseous anomalies in the region of the craniocervical junction in a large sample of Czech patients based on three-dimensional computed tomographic angiography (3D CTA). The VA has a variable course through C2 before it passes above its groove on the posterior arch of C1. The artery can course more medially, more posteriorly or more superiorly, thus limiting the diameter of the bony elements used as landmarks for the safe insertion of metalwork. This is known as a high-riding VA (HRVA). The VA was considered HRVA in this study if the thickness of the C2 isthmus was less than 5 mm and/or the C2 internal height was less than 2 mm and/or the width of the C2 pedicle was less than 4 mm. The prevalence of ponticulus posticus (PP) was also identified. Following the VA variations in the V3 segment of the artery were persistent first intersegmental artery (FIA), fenestration (FEN) of the VA, and the posterior inferior cerebellar artery (PICA) branch originating from the C1/2 part of VA. Records of 511 patients from our institution were analyzed. The mean age of the patients was 63.6 years. One hundred and twenty-three (24.1 %) patients were identified to have HRVA, 30 (6 %) present on both sides. The age of patient over 70 years and female sex were found to be significant risk factors for HRVA presence. The prevalence of a nearby PICA branch was 4 %, FIA was 0.4 %, and FEN was 0.2 %. The presence of PP was identified in 14.3 % of patients. The HRVA and PP are common anomalies in the Czech population, and routine preoperative high-resolution CT evaluation is mandatory to prevent the VA injury when C1-C2 instrumentation is planned. The female sex and age over 70 years were found to be the most important factors for HRVA presence. The FIA and the FEN VA were rare in our study contrary to reports published from Asia, showing as many as a 10 % the VA presence over the starting point for C1 lateral screw. On the basis of the infrequent occurrence of these anomalies, we do not recommend routine CT angiography when upper cervical spine instrumentation in the normal population is planned.
- MeSH
- arteria vertebralis diagnostické zobrazování chirurgie MeSH
- atlas (obratel) diagnostické zobrazování chirurgie MeSH
- CT angiografie MeSH
- dospělí MeSH
- kosti a kostní tkáň diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mozková angiografie MeSH
- neurochirurgické výkony MeSH
- počítačové zpracování obrazu MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
18 F-FDG PET/CT imaging is useful in patients with fever of unknown origin and can detect giant cell arteritis in extracranial large arteries. However, it is usually assumed that temporal arteries cannot be visualized with a PET/CT scanner due to their small diameter. Three patients with clinical symptoms of temporal arteritis were examined using a standard whole body PET/CT protocol (skull base - mid thighs) followed by a head PET/CT scan using the brain protocol. High18F-FDG uptake in the aorta and some arterial branches were detected in all 3 patients with the whole body protocol. Using the brain protocol, head imaging led to detection of high18F-FDG uptake in temporal arteries as well as in their branches (3 patients), in occipital arteries (2 patients) and also in vertebral arteries (3 patients).
- MeSH
- arteria vertebralis diagnostické zobrazování metabolismus MeSH
- arteriae temporales diagnostické zobrazování metabolismus MeSH
- fluorodeoxyglukosa F18 * farmakokinetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- obrovskobuněčná arteritida diagnostické zobrazování MeSH
- PET/CT * MeSH
- radiofarmaka * farmakokinetika MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: To present a method of posterior arch and lateral mass screw (PALMS) insertion and to prove its feasibility. METHODS: Four formalin-fixed specimens and 40 macerated atlas vertebras were used to describe the relevant anatomy. The height of the posterior arch was measured on 42 consecutive patients using standard CT of the cervical spine. The operative technique and the special CT reconstructions used for preoperative planning are described. Eight patients underwent posterior fixation using this technique. RESULTS: We described the relevant anatomy and important anatomical landmarks of the posterior arch of the atlas. PALMS placement was modified according to these anatomical findings. Fifteen PALMSs were placed in eight patients using this technique without vascular or neural injury. CONCLUSION: It is feasible to place PALMS using the described technique. CT angiography is of crucial importance for preoperative planning using the described special reconstructions. The arch posterior to the lateral mass (APLM) is defined as the bone stock situated posterior to the lateral mass, respecting its convergence. The ideal entry point for a PALMS is on the APLM above the center of the converging lateral mass. A complete or incomplete ponticulus posticus and a retrotransverse foramen or groove can be used as an accessory landmark to refine the entry point.
- MeSH
- arteria vertebralis diagnostické zobrazování MeSH
- arteriae carotides diagnostické zobrazování MeSH
- atlas (obratel) anatomie a histologie chirurgie MeSH
- CT angiografie MeSH
- dospělí MeSH
- fraktury páteře patologie chirurgie MeSH
- fúze páteře přístrojové vybavení metody MeSH
- implantace protézy metody MeSH
- kostní šrouby * MeSH
- krční obratle anatomie a histologie zranění chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mrtvola MeSH
- počítačová rentgenová tomografie MeSH
- protézy - design MeSH
- studie proveditelnosti MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH