World Neurosurg
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The purpose of this study was to examine the thoracic inlet angle (TIA) and its related parameters in the cervical and cervical-thoracic vertebrae in patients with degenerative cervical spondylosis (DCS) and explore the association of the TIA, tilt angle of the neck, and tilt angle of the first thoracic spine with the cervical degeneration score. ⋯ Age was positively correlated with thoracic inlet parameters in patients with DCS. Men had significantly higher thoracic inlet parameters than women because the men had higher VHs and IVDHs. However, the TIA was not associated with the level of cervical disk degeneration. The clinical relevance of these findings has not been established.
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Case Reports
Combined Transarterial and Transvenous Onyx Embolization of Jugular Foramen Paragangliomas.
Jugular foramen paragangliomas are highly vascular tumors known to have significant venous hemorrhage during resection even after conventional transarterial embolization. The authors report a novel technique to the endovascular embolization of jugular foramen paragangliomas using a combined transarterial and transvenous access for better intraoperative control of blood loss and visualization. ⋯ The initial experience with simultaneous transvenous and transarterial paraganglioma embolization demonstrated the safety of the technique and superior embolic agent penetration. This was supported by our observations during embolization and intraoperatively during tumor resection. Additional patients need to be treated with this technique for better assessment of long-term efficacy and incidence of embolization-related cranial neuropathies.
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At present, no consensus has been reached on the compartmental subdivision of the jugular foramen (JF), which can complicate surgical planning in this area and hinder understanding of foraminal tumor growth patterns. The extradural neural axis compartment (EDNAC) might aid in producing a standardized model in the future. In the present review, we have summarized the models of JF compartmentalization and analyzed how sound they are anatomically. ⋯ The bipartite model has been criticized as being oversimplified and lacking surgical validity. However, support for this compartmentation has persisted despite the increasing popularity of the tripartite model. The 3-part subdivision of Bernard can be considered the most anatomically faithful model to date owing to the consideration of the dura and EDNAC. It is important that future studies consider the entire anatomy of the JF, which may generate an anatomically accurate and surgically applicable compartmental model.
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In microvascular decompression (MVD) surgery for hemifacial spasm (HFS), preservation of the lesser occipital nerve (LON) will prevent occipital sensory disturbance, a frequent complication of MVD, but the long-term outcome is unknown. This study was designed to evaluate the long-term efficacy of LON preservation. ⋯ Our long follow-up study has demonstrated that preservation of the LON during MVD prevents sensory disturbance of the occipital scalp. Efforts to preserve the LON appear to be worthwhile when the suboccipital approach is chosen.