BACKGROUND: Neurovascular conflict between the oculomotor nerve and a posterior circulation cerebral artery is a relatively frequent radiologic finding; however, it manifests minimally clinically (by slower photoreaction on the ipsilateral side). Sustained paresis of the oculomotor nerve that arose directly due to neurovascular conflict between the superior cerebral artery (SCA) and the oculomotor nerve, and resolved after microvascular decompression, is extremely rare and has not yet been published. METHODS: A 34-year-old female patient presented with an advancing ptosis and downward gaze on one side. Differential diagnostics ruled out all other causes of the oculomotor paresis. Magnetic resonance imaging showed significant compression of the oculomotor nerve by an aberrant SCA on the ipsilateral side. Neurovascular decompression performed microsurgically resulted in near complete resolution of the symptoms. RESULTS: This case report aims to present a case of a rare clinical condition caused by a generally common anatomical variation. This variation proved to be the only cause of the patient's symptoms, which resolved after microsurgical restoration of the neuroanatomy. CONCLUSIONS: Oculomotor nerve paresis caused directly by neurovascular conflict is an extremely rare diagnosis. Microvascular decompression should be considered in these cases, if other causes have been excluded.
- MeSH
- Adult MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Microvascular Decompression Surgery methods MeSH
- Cerebellum * blood supply MeSH
- Oculomotor Nerve Diseases * etiology surgery MeSH
- Oculomotor Nerve * surgery MeSH
- Paresis * etiology surgery MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Každý rok cestujú na palube komerčných leteckých spoločností takmer 2 miliardy ľudí. Poskytovatelia zdravotnej starostlivosti a cestujúci si musia byť vedomí potenciálnych zdravotných rizík spojených s leteckou dopravou. Zmeny vyplývajúce z troch zákonov o plynoch sa vyskytujú počas bežných komerčných letov, vedú najčastejšie k miernej hypoxii a expanzii plynu (riziko hypoxémie, barotraumy a dekompresie). Môžu sa zhoršiť chronické zdravotné stavy alebo vyvolať akútne zdravotné situácie počas letu. Súvislosť medzi venóznou tromboembóliou a diaľkovými letmi, trapping gas, jet lag a kvalitou vzduchu v kabíne sú rastúce problémy zdravotnej starostlivosti spojené s leteckou dopravou. Zdravotné ťažkosti počas letu sú čoraz častejšie, pretože rastúci počet jedincov (vrátane starších ľudí a detí) cestuje letecky s už existujúcimi zdravotnými problémami. Na palube komerčných lietadiel máme k dispozícii len prostriedky, ktoré pomáhajú posádke lietadla a dobrovoľným lekárom pri riadení núdzových zdravotných problémov počas letu. Spôsobilosť na cestovanie lietadlom je narastajúcim problémom, pretože mnohí cestujúci si neuvedomujú zdravotné dôsledky spojené s komerčnou leteckou dopravou. Od lekárov sa často očakáva, že identifikujú jednotlivcov nevhodných na cestovanie lietadlom a poskytnú im užitočné rady.
Almost 2 billion people travel aboard commercial airlines every year. Health-care providers and travellers need to be aware of the potential health risks associated with air travel. Changes resulting from three physical laws about gas occur during routine commercial flights. They lead most often to mild hypoxia and gas expansion (risk od hypoxemia, barotrauma and decompression), which can exacerbate chronic medical conditions or incite acute in-flight medical events. The association between venous thromboembolism and long-haul flights, trapping gas, jet lag, and cabin-air quality are growing health-care issues associated with air travel. In-flight medical events are increasingly frequent because a growing number of individuals (incl. elderly people and children) with pre-existing medical conditions travel by air. Resources are available onboard to assist flight crew and volunteering physicians in the management of in-flight medical emergencies. Fitness for air travel is a growing issue because many passengers are unaware of health implications associated with commercial air travel. Physicians are often expected to identify individuals unfit for air travel and give them useful advice.
Spinal cord injury (SCI) results in paralysis, driven partly by widespread glutamate-induced secondary excitotoxic neuronal cell death in and around the injury site. While there is no curative treatment, the standard of care often requires interventive decompression surgery and repair of the damaged dura mater close to the injury locus using dural substitutes. Such intervention provides an opportunity for early and local delivery of therapeutics directly to the injured cord via a drug-loaded synthetic dural substitute for localized pharmacological therapy. Riluzole, a glutamate-release inhibitor, has shown neuroprotective potential in patients with traumatic SCI, and therefore, this study aimed to develop an electrospun riluzole-loaded synthetic dural substitute patch suitable for the treatment of glutamate-induced injury in neurons. A glutamate-induced excitotoxicity was optimized in SH-SY5Y cells by exploring the effect of glutamate concentration and exposure duration. The most effective timing for administering riluzole was found to be at the onset of glutamate release as this helped to limit extended periods of glutamate-induced excitotoxic cell death. Riluzole-loaded patches were prepared by using blend electrospinning. Physicochemical characterization of the patches showed the successful encapsulation of riluzole within polycaprolactone fibers. A drug release study showed an initial burst release of riluzole within the first 24 h, followed by a sustained release of the drug over 52 days to up to approximately 400 μg released for the highest loading of riluzole within fiber patches. Finally, riluzole eluted from electrospun fibers remained pharmacologically active and was capable of counteracting glutamate-induced excitotoxicity in SH-SY5Y cells, suggesting the clinical potential of riluzole-loaded dural substitutes in counteracting the effects of secondary injury in the injured spinal cord.
- MeSH
- Drug Implants MeSH
- Glutamic Acid metabolism MeSH
- Humans MeSH
- Cell Line, Tumor MeSH
- Neurons drug effects MeSH
- Neuroprotective Agents * administration & dosage chemistry pharmacology MeSH
- Polyesters chemistry MeSH
- Spinal Cord Injuries * drug therapy MeSH
- Riluzole * administration & dosage chemistry pharmacology MeSH
- Drug Liberation MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Osteopetrosis is a rare genetic disorder causing excessive skeletal density, with a predilection to affect the skull base. This commonly leads to optic canal stenosis, optic nerve compression, and atrophy and vision loss. Timely optic nerve decompression can be an effective surgical intervention to preserve vision. METHODS: Pterional approach combining both extra- and intradural optic nerve decompression was performed. Intradural optic nerve identification proved a helpful and safe way to facilitate adequate decompression while dissecting in the region of hypertrophic anterior clinoid process. CONCLUSION: Precise surgical technique and anatomical awareness are crucial for minimizing complications and aiding recovery.
- MeSH
- Osteopetrosis * complications surgery pathology MeSH
- Decompression, Surgical * methods MeSH
- Adult MeSH
- Humans MeSH
- Optic Nerve Diseases * surgery etiology pathology MeSH
- Optic Nerve * surgery pathology MeSH
- Neurosurgical Procedures * methods MeSH
- Nerve Compression Syndromes * surgery etiology pathology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
PURPOSE: This study provides an insight on the extent of muscular variability at the suprascapular notch and elaborates on its anatomical interference in suprascapular nerve arthroscopic decompression procedures. METHODS: The suprascapular notch was dissected and its muscular topography was observed in 115 cadaveric specimens. High resolution imaging of the suprascapular notch was captured by a handheld digital microscope (Q-scope). The supraspinatus and subscapularis muscles were traced as they course at the suprascapular notch vicinity. The omohyoid muscle attachment onto the suprascapular ligament was measured. A scoping review and meta-analysis were done to investigate the observed rare muscular variants. RESULTS: In 3.48%, the suprascapular notch anterior surface was fully covered by the subscapularis muscle. The omohyoid muscle inserted onto the suprascapular ligament in 31.25% and extended up to 3/4th of the suprascapular ligament length in 2.61%. Two rare variant muscles were encountered: subclavius posticus muscle and a newly reported "coracoscapularis muscle". CONCLUSIONS: Four categories of muscles with topographical relationship to the suprascapular notch and its arthroscopic feasibility have been classified: (1) constant muscles not intervening with the suprascapular notch space - supraspinatus muscle; (2) constant muscles with variable positions that can intervene with the suprascapular notch space - subscapularis muscle; (3) constant muscles with variable positions that can intervene with the surgical approach - omohyoid muscle; (4) variable muscles intervening with the suprascapular notch space and surgical approach - subclavius posticus and coracoscapularis muscles. This study elucidates the necessity to assess/secure the omohyoid muscle attachment onto the suprascapular ligament in suprascapular nerve decompression ligamentectomy. LEVEL OF EVIDENCE: V Basic Science Research.
- MeSH
- Anatomic Variation * MeSH
- Arthroscopy * methods MeSH
- Decompression, Surgical methods MeSH
- Muscle, Skeletal * innervation anatomy & histology MeSH
- Middle Aged MeSH
- Humans MeSH
- Scapula innervation anatomy & histology MeSH
- Cadaver * MeSH
- Shoulder Joint innervation surgery anatomy & histology MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Feasibility Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
OBJECTIVES: Thyroid eye disease (TED) seriously affects patients' quality of life (QoL), even if the disease is stable and nonactive. Data on clinical factors negatively influencing the QoL of patients with TED and long-term outcomes are limited. This study aims to evaluate the lasting impact of TED on QoL, focusing on the effects of previous TED treatments and identifying factors influencing long-term outcomes. METHODS: A retrospective cohort study included 151 patients treated for active, moderate-to-severe and severe TED, with a mean follow-up of 8 years. RESULTS: Higher clinical activity scores at diagnosis correlated with lower QoL scores. Thyroidectomy before immunosuppressive treatment was associated with lower QoL and an increased likelihood of orbital decompression. Any disease progression necessitating second-line treatments also negatively affected QoL. A decrease in thyrotropin receptor antibodies during active treatment and early treatment initiation positively affected visual functioning. Time-dependent regression analysis demonstrated no significant trend in QoL changes over time. CONCLUSION: Our data reveal that disease severity, the timing of interventions and disease progression contribute to less favorable long-term QoL outcomes, extending years beyond active treatment. Early and accurate diagnosis and appropriate treatment can minimize poor long-term QoL in patients with TED.
- MeSH
- Adult MeSH
- Graves Ophthalmopathy * psychology therapy MeSH
- Cohort Studies MeSH
- Quality of Life * MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Disease Progression MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Thyroidectomy MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
A case report of a 68-year-old otherwise-healthy female patient with Spetzler-Martin (SM) grade I arteriovenous malformation (AVM) in her left frontal region is presented. After an uneventful surgery, cerebral venous infarction developed, and the patient was rendered hemiparetic with motor aphasia. After bony decompression, slow improvement was seen, and 3 months after surgery, the patient was neurologically intact. Six months after AVM resection, cranioplasty was performed. Infarction was caused by the thrombosis of a long primary draining vein, which finished its course in the normal cortical venous system. The case supports the venous origin of postoperative bleeding after AVM resection instead of the normal perfusion pressure phenomenon.
- MeSH
- Cerebral Infarction * etiology surgery MeSH
- Intracranial Arteriovenous Malformations * surgery complications MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Cerebral Veins surgery diagnostic imaging MeSH
- Postoperative Complications etiology surgery MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
This review aims to enrich our understanding of Chiari-like malformation (CLM) by combining human and veterinary insights, and providing a detailed cross-species overview. CLM is a developmental abnormality characterised by caudal displacement of the hindbrain into the foramen magnum due to an entire brain parenchymal shift caused by insufficient skull volume. This malformation leads to a progressive obstruction at the craniocervical junction, which disrupts the normal cerebrospinal fluid flow, leading to secondary syringomyelia. The clinical signs of CLM and syringomyelia include phantom scratching, head tilt, head tremor, ataxia, tetraparesis, pain, muscle atrophy, and scoliosis or torticollis. Magnetic resonance imaging remains the gold standard for diagnosing CLM, since it allows the visualisation of abnormal findings such as the caudal cerebellar herniation, caudal cerebellar compression from occipital dysplasia, and attenuated cerebrospinal fluid cisternae. Although various medical and surgical interventions, including foramen magnum decompression, can provide temporary symptomatic/clinical sign relief, current literature shows a lack of sustained long-term efficacy. Therefore, additional research is needed to evaluate the long-term effects of existing treatment strategies and to compare different techniques utilised in conjunction with foramen magnum decompression.
Several muscle variations have been observed in flexor aspect of forearm which can hamper normal functioning of hand or may remain silent. One such unreported variation has been described in this report. An accessory muscle in the left forearm was found involving flexor carpi ulnaris (FCU) and palmaris longus (PL). This muscle was originating from the distal part of both FCU and PL through a slip from each tendon. After merging, it passed above the ulnar nerve and artery in the roof of Guyon's canal. This type of variation can cause neurovascular compression and can also mimic soft tissue mass, tumour or neuroma and can be misdiagnosed. Knowledge about this type of variation is important in cases of neurovascular decompression, forearm, and hand surgeries and these can be utilized in tendon transfer or free muscle flap for reconstruction purposes.
- MeSH
- Anatomic Variation MeSH
- Adult MeSH
- Muscle, Skeletal * abnormalities MeSH
- Humans MeSH
- Forearm * abnormalities MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Cíl: Retrospektivní observační analýza přesnosti zavedení pedikulárních šroubů, komplikací, chirurgického času a technických zákonitostí 100 pacientů operovaných pomocí robotického systému ExcelsiusGPS. Metodika: Sto dospělých pacientů podstupující stabilizační výkony lumbosakrální páteře v průběhu období 2021–2024. Pacienti podstoupili jednu z tří možných operací – otevřená meziobratlová fúze, minimálně invazivní meziobratlová fúze nebo kombinace otevřené meziobratlové fúze s neinstrumentovanou mikrodekompresí. Všechny operační výkony byly provedeny za asistence robotického systému ExcelsiusGPS s následnou intraoperační kontrolní CT. Pacienti byli sledováni v intervalech 6 týdnů, 3 měsíců a 6 měsíců. Výsledky: Celkem bylo zavedeno 418 pedikulárních šroubů, z nichž 413 (99 %) mělo optimální zavedení (Gerzbein- -Robbins A) a zbylých pět vykazovalo drobné asymptomatické narušení kortikalis stěny pediklu (Gerzbein-Robbins B). Jednou byla narušena horní hrana pediklu a ve čtyřech případech došlo k narušení spodní plochy pediklu. V sedmi případech bylo nutné opakovat navigační CT sken v důsledku chyb přenosu mezi CT a robotickou platformou, ve dvou případech bylo nutné přeplánovat trajektorie pedikulárních šroubů v důsledku pohybu dynamické reference v průběhu zavádění šroubů. Průměrný chirurgický čas byl 154 min pro jednoprostorový stabilizační výkon a 202 min pro vícepatrový stabilizační výkon. Naše práce neprokázala významný pokles chirurgického času v obrazu učební křivky. V časném pooperačním období byla nutná revize dvou pacientů pro přítomnost seromu operační rány. Závěr: Druhá generace robotických systémů vykazuje vysokou přesnost zavádění pedikulárních šroubů, čímž snižuje výskyt komplikací souvisejících s malpozicí. Hlavní nevýhodou je prodloužení chirurgického času v důsledku nastavení robotické a navigační platformy.
Aim: Retrospective observation analysis of pedicle screw accuracy, complications, surgical time, and technical nuances of 100 patients operated via the ExcelsiusGPS robotic system. Methods: One-hundred adult patients undergoing lumbosacral interbody fusion between 2021 and 2024. Patients underwent either open interbody fusion, minimally invasive interbody fusion, or open interbody fusion combined with a non-instrumented decompression. All surgeries were assisted by the ExcelsiusGPS robot, and an intraoperative control CT scan was performed in all cases. Patients were followed at 6-week, 3-month, and 6-month intervals. Results: A total of 418 pedicle screws were implanted and 413 (99%) had optimal placement (Gerzbein-Robbins A) with the remaining five having minor asymptomatic cortical breaches of the pedicle wall violation (Gerzbein-Robbins B). The superior pedicle wall was breached once, and the inferior pedicle wall was breached four times. In seven cases, the CT scan had to be repeated due to transferring errors between the CT and robotic platform, and in two cases, screw trajectories had to be replanned due to dynamic reference base shift during screw implantation. The mean surgical time was 154 min for single-level procedures and 202 min for multiple-level procedures; our study did not show a significant decrease in surgical time throughout the learning curve. During early follow-up, two patients underwent surgical revisions due to the presence of seromas. Conclusion: Second generation robotic platforms have a high percentage of optimally implanted pedicle screws decreasing malposition-related complications. The main drawback is an increase in surgical time due to set-up of the robotic and navigation platforms.
- MeSH
- Operative Time MeSH
- Adult MeSH
- Spinal Fusion * methods instrumentation adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Lumbosacral Region surgery MeSH
- Pedicle Screws MeSH
- Robotic Surgical Procedures * methods instrumentation adverse effects MeSH
- Aged MeSH
- Statistics as Topic MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Clinical Study MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
