World Neurosurg
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Assessment of transverse ligament (TL) competence in patients with suspected atlantoaxial instability is performed via indirect radiograph measurements or direct TL visualization on magnetic resonance imaging (MRI). Interpretation of these images can be limited by unique patient anatomy or imaging technique variability. We report a novel technique for evaluating TL competence using flexion-extension computed tomography (feCT) scan with 3-dimensional (3D) segmentation and quantitative analysis. ⋯ 3D segmentation and quantitative analysis of feCT scan allow objective indirect assessment of TL integrity. Results are consistent with MRI findings and offer additional biomechanical information regarding the direction and distribution of atlantoaxial motion.
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Ruptured blister aneurysms of the internal carotid artery are challenging to treat because of their difficult diagnosis and the fragility of the wall structure. Here, we sought to clarify the efficacy of extracranial-intracranial bypass followed by trapping (bypass/trapping) for ruptured blister aneurysms. ⋯ Bypass/trapping is effective to prevent rebleeding. Early surgery may be beneficial, because most patients in the elective surgery group showed rebleeding or aneurysmal growth. Vessel wall magnetic resonance imaging is a useful adjunct for early diagnosis and may contribute to prompt early surgery.
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Traditionally, full spine standing radiographs have been the reference standard for diagnostic imaging in adolescent idiopathic scoliosis (AIS). However, recent advances in diagnostic imaging have the potential to reduce radiation exposure and preserve the image quality and utility. ⋯ As such, these emerging techniques might prove beneficial in diagnosing and monitoring AIS and its progression, without high levels of continued radiation exposure. To understand the historical perspective and current state of advanced imaging techniques for AIS, a search of PubMed electronic database was conducted to identify studies that had examined these new techniques in the diagnosis of idiopathic scoliosis in children and adolescents.
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Review Historical Article
Endovascular Approach to Cerebral Revascularization: Historical Vignette.
From their origins as cardiovascular research tools, endovascular techniques have evolved to provide a minimally invasive means of diagnosis and therapy for individuals suffering from occlusive artery disease. The techniques were pioneered by William Harvey, whose work set the stage for all subsequent endovascular experiments. These included the bold self-catheterization procedure performed by Werner Forssmann in 1929, which would lead to his dismissal by his superiors, only to regain respect within the medical community in 1956 on receiving the Nobel Prize. ⋯ Having been meticulously evaluated and compared with open vascular procedures, endovascular neurosurgery has continued to be refined and optimized. Understanding the history and development of these techniques and their applications in neurosurgery is necessary to appreciate the current clinical utility of these procedures, serving to provide the vascular neurosurgeon a greater array of treatment options for patients. Here we explore the major scientific and technological advancements that facilitated the development of the endovascular approach to cerebral revascularization, as well as current indications and ongoing clinical trials.
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Semmelweis reflex is a human behavioral tendency to stick to preexisting beliefs and to reject fresh ideas that contradict them (despite adequate evidence). We aim to familiarize the readers with the term that not only has a significant historical background but also grave clinical implications. ⋯ The age-old prejudice that is Semmelweis reflex is explored in this review. With careful and thorough study design, scientific rigor, and critical self-analysis of the manuscript, one can avoid being victimized by this reflex. The dual edged nature of this reflex lays unveiled when its importance is highlighted in the prematurely accepted medical failures. Understanding that any new idea goes through the grill of being critically analyzed and perceived encourages the scientist to hold on to the original thought as it may rather be practice changing.