World Neurosurg
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Degenerative changes in the upper cervical spine may be age related degeneration or a pathological process such as rheumatoid arthritis. However, to our knowledge, the relationship between the apical and alar ligaments and these anomalies has not been discussed. We present anatomical variations of the anterior atlantodental joint observed during cadaveric dissection of adult craniovertebral junctions, the relationship with the alar and apical ligaments and discuss possible origins and clinical implications. ⋯ The possible etiologies and the clinical applications of these craniovertebral anomalies in a geriatric population should be appreciated by the clinician treating patients with disease in this area or interpreting imaging in the region.
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Lesions at the skull base warrant careful evaluation of imaging and meticulous preoperative planning. Unnecessary radical resection of these lesions could add to surgical morbidity. Occasionally, dural-based inflammatory or infectious lesions at this site radiologically mimic meningiomas, which are commonly encountered entities at this site. Not all lesions require excision, and it could be harmful in a few cases. ⋯ This report underscores the usefulness of intraoperative frozen section to decide on a further course of treatment when faced with such unexpected situations. Frozen sections and crush smears hold great potential to avoid unwarranted surgical morbidity, particularly for skull base lesions.
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Craniocervical junction arachnoiditis (CCJA) is an uncommon cause of syringomyelia. The pathophysiology of syrinx formation is uncertain, and the appropriate management unclear. A series of cases is reported to demonstrate variations in etiology, uniformity of functional cerebrospinal fluid obstruction at the foramen magnum, and results of surgical intervention. ⋯ Most syrinx cavities associated with CCJA communicate with the fourth ventricle. Posterior fossa decompression and fourth ventricle to spinal subarachnoid space shunting appears a reasonable treatment for this form of syringomyelia.
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Animal models using rodents are frequently used for practicing microvascular anastomosis-an essential technique in cerebrovascular surgery. However, safely and efficiently exposing rat's target vessels is technically difficult. Such difficulty may lead to excessive hemorrhage and shorten animal survival. This limits the ability to perform multiple anastomoses on a single animal and may increase the overall training time and costs. We report our model for microsurgical bypass training in rodents in 2 consecutive articles. In part 1, we describe the technical nuances for a safe and efficient exposure of the rat abdominal aorta and common iliac arteries (CIAs) for bypass. ⋯ Applying the aforementioned technical nuances enables safe and efficient preparation of the rat abdominal aorta and CIAs for microvascular anastomosis.