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Ernst, E. "Cranial Manipulation Techniques". Focus on Alternative and Complementary Therapies 4, n. 4 (14 giugno 2010): 225. http://dx.doi.org/10.1111/j.2042-7166.1999.tb01158.x.
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Schmidt, Katja. "VIDEO REVIEW CRANIAL MANIPULATION". Complementary Therapies in Medicine 9, n. 3 (settembre 2001): 195–97. http://dx.doi.org/10.1054/ctim.2001.0461.
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Lawrence, D. "Cranial Manipulation: Theory and Practice". Focus on Alternative and Complementary Therapies 11, n. 3 (14 giugno 2010): 259–60. http://dx.doi.org/10.1111/j.2042-7166.2006.tb04704.x.
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Fletcher, Alexandra, Jessica Pearson e Janet Ambers. "The Manipulation of Social and Physical Identity in the Pre-Pottery Neolithic". Cambridge Archaeological Journal 18, n. 3 (ottobre 2008): 309–25. http://dx.doi.org/10.1017/s0959774308000383.
Testo completoAbstract (sommario):
Mortuary practices of the Pre-Pottery Neolithic Near East have been identified with skull cult and ancestor worship, as a means of creating and eliminating social boundaries. Artificial cranial modification is recognized as related to these practices, but its incidence is under-recognized and the precise nature of its significance is rarely discussed. In this study a skull, not previously reported as artificially modified, was reassessed by radiography to provide further insight on this subject. The cranial modification identified must have occurred in childhood but did not dramatically alter the cranium. We therefore argue that the post-mortem treatment of artificially modified skulls should be viewed in the context of ritual practices that were of significance during life, not just after death.
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Downey, Patricia A., Timothy Barbano, Rupali Kapur-Wadhwa, James J. Sciote, Michael I. Siegel e Mark P. Mooney. "Craniosacral Therapy: The Effects of Cranial Manipulation on Intracranial Pressure and Cranial Bone Movement". Journal of Orthopaedic & Sports Physical Therapy 36, n. 11 (novembre 2006): 845–53. http://dx.doi.org/10.2519/jospt.2006.36.11.845.
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Plaugher, Greg. "Cranial Manipulation Theory and Practice: Osseous and Soft TissueApproaches". Journal of Manipulative and Physiological Therapeutics 23, n. 5 (giugno 2000): 371. http://dx.doi.org/10.1067/mmt.2000.106861.
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Ryu, Hiroshi, Seiji Yamamoto, Kenji Sugiyama, Kenichi Uemura e Tsunehiko Miyamoto. "Hemifacial spasm caused by vascular compression of the distal portion of the facial nerve". Journal of Neurosurgery 88, n. 3 (marzo 1998): 605–9. http://dx.doi.org/10.3171/jns.1998.88.3.0605.
Testo completoAbstract (sommario):
✓ It is generally accepted that hemifacial spasm (HFS) and trigeminal neuralgia are caused by compression of the facial nerve (seventh cranial nerve) or the trigeminal nerve (fifth cranial nerve) at the nerve's root exit (or entry) zone (REZ); thus, neurosurgeons generally perform neurovascular decompression at the REZ. Neurosurgeons tend to ignore vascular compression at distal portions of the seventh cranial nerve, even when found incidentally while performing neurovascular decompression at the REZ of that nerve, because compression of distal portions of the seventh cranial nerve has not been regarded as a cause of HFS. Recently the authors treated seven cases of HFS in which compression of the distal portion of the seventh cranial nerve produced symptoms. The anterior inferior cerebellar artery (AICA) was the offending vessel in five of these cases. Great care must be taken not to stretch the internal auditory arteries during manipulation of the AICA because these small arteries are quite vulnerable to surgical manipulation and the patient may experience hearing loss postoperatively. It must be kept in mind that compression of distal portions of the seventh cranial nerve may be responsible for HFS in cases in which neurovascular compression at the REZ is not confirmed intraoperatively and in cases in which neurovascular decompression at the nerve's REZ does not cure HFS. Surgical procedures for decompression of the distal portion of the seventh cranial nerve as well as decompression at the REZ should be performed when a deep vascular groove is noticed at the distal site of compression of the nerve.
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Kalcheim, C., e M. A. Teillet. "Consequences of somite manipulation on the pattern of dorsal root ganglion development". Development 106, n. 1 (1 maggio 1989): 85–93. http://dx.doi.org/10.1242/dev.106.1.85.
Testo completoAbstract (sommario):
We have investigated dorsal root ganglion formation, in the avian embryo, as a function of the composition of the paraxial somitic mesoderm. Three or four contiguous young somites were unilaterally removed from chick embryos and replaced by multiple cranial or caudal half-somites from quail embryos. Migration of neural crest cells and formation of DRG were subsequently visualized both by the HNK-1 antibody and the Feulgen nuclear stain. At advanced migratory stages (as defined by Teillet et al. Devl Biol. 120, 329–347 1987), neural crest cells apposed to the dorsolateral faces of the neural tube were distributed in a continuous, nonsegmented pattern that was indistinguishable on unoperated sides and on sides into which either half of the somites had been grafted. In contrast, ventrolaterally, neural crest cells were distributed segmentally close to the neural tube and within the cranial part of each normal sclerotome, whereas they displayed a nonsegmental distribution when the graft involved multiple cranial half-somites or were virtually absent when multiple caudal half-somites had been implanted. In spite of the identical dorsal distribution of neural crest cells in all embryos, profound differences in the size and segmentation of DRG were observed during gangliogenesis (E4–9) according to the type of graft that had been performed. Thus when the implant consisted of compound cranial half-somites, giant, coalesced ganglia developed, encompassing the entire length of the graft. On the other hand, very small, dorsally located ganglia with irregular segmentation were seen at the level corresponding to the graft of multiple caudal half-somites. We conclude that normal morphogenesis of dorsal root ganglia depends upon the craniocaudal integrity of the somites.
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Southwell, Derek G., Jonathan D. Breshears, William R. Lyon e Michael W. McDermott. "A Method for Cranial Nerve XI Silencing During Surgery of the Foramen Magnum Region: Technical Case Report". Operative Neurosurgery 16, n. 4 (18 maggio 2018): E130—E133. http://dx.doi.org/10.1093/ons/opy134.
Testo completoAbstract (sommario):
Abstract BACKGROUND AND IMPORTANCE Skull base surgery involves the microdissection and intraoperative monitoring of cranial nerves, including cranial nerve XI (CN XI). Manipulation of CN XI can evoke brisk trapezius contraction, which in turn may disturb the surgical procedure and risk patient safety. Here we describe a method for temporarily silencing CN XI via direct intraoperative application of 1% lidocaine. CLINICAL PRESENTATION A 41-yr-old woman presented with symptoms of elevated intracranial pressure and obstructive hydrocephalus secondary to a hemangioblastoma of the right cerebellar tonsil. A far-lateral suboccipital craniotomy was performed for resection of the lesion. During the initial stages of microdissection, vigorous trapezius contraction compromised the course of the operation. Following exposure of the cranial and cervical portions of CN XI, lidocaine was applied to the course of the exposed nerve. Within 3 min, trapezius electromyography demonstrated neuromuscular silencing, and further manipulation of CN XI did not cause shoulder movements. Approximately 30 min after lidocaine application, trapezius contractions returned, and lidocaine was again applied to re-silence CN XI. Gross total resection of the hemangioblastoma was performed during periods of CN XI inactivation, when trapezius contractions were absent. CONCLUSION Direct application of lidocaine to CN XI temporarily silenced neuromuscular activity and prevented unwanted trapezius contraction during skull base microsurgery. This method improved operative safety and efficiency by significantly reducing patient movement due to the unavoidable manipulation of CN XI.
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Martinovic, Zeljko. "A bimanual manipulation technique for establishing the CR position". Serbian Dental Journal 50, n. 2 (2003): 88–95. http://dx.doi.org/10.2298/sgs0302088m.
Testo completoAbstract (sommario):
In this work, we demonstrate a modern concept of the cr position. We analyze main characteristics of the central relation position from mechanical and physiological aspects. Furthermore, we discuss the bimanual manipulation technique on the lower jaw, required for balancinh procedures or investigation of premature contacts. Since an effective manipulation technique requires a combination of gentle yet firm digital pressure in a cranial direction., with a good sense of timing, clinician needs to have ! a mental picture of what is happening in TMJs and how are muscles affected by different movements and pressure. We have specifically presented instructions on firm-digital-pressure test. With this test it is possible to effectively verify the consistency of a certain cr position as well as to exclude the intra-articulating problems. Most of the time when the patient is tense and uncooperative, it is because the pressure is applied on the mandibule before the lower jaw is gently positioned into its most cranial position with separate dental arches. It seems, at least for now, that there are no procedures which can provide so much practical benefit for both the clinican and the patient at the same time, as can routine registration of the cr position and verification of its accuracy.
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Tubbs, R. Shane, John C. Wellons, Jeffrey P. Blount e W. Jerry Oakes. "Posterior atlantooccipital membrane for duraplasty". Journal of Neurosurgery: Spine 97, n. 2 (settembre 2002): 266–68. http://dx.doi.org/10.3171/spi.2002.97.2.0266.
Testo completoAbstract (sommario):
✓ The authors describe the use of autogenetic posterior atlantooccipital (PAO) membrane for duraplasty following after posterior cranial fossa surgery. The PAO membrane is routinely exposed for procedures of the posterior cranial fossa and merely needs to be dissected free of the underlying dura mater. Recently this membrane was obtained in several pediatric patients following procedures of the posterior cranial fossa such as duraplasty in case of Chiari I malformation. No postoperative complications were found at 6-month follow-up examination. The advantages of this intervention include less manipulation of muscle and fascia than that involved in other procedures and, therefore, seemingly less postoperative pain and the negation of issues inherent with foreign-body graft sources. The authors believe this structure to be of use as a dural substitute in small dural openings of the posterior cranial fossa.
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EROK, Berrin, Kenan KIBICI e Ali ATCA. "Retrograde cerebral venous air embolism and the anatomical pathway of air bubbles: a case report". Anatomy 14, n. 3 (1 dicembre 2020): 210–15. http://dx.doi.org/10.2399/ana.20.787966.
Testo completoAbstract (sommario):
Pneumocephalus due to cerebral venous air embolism is an uncommon phenomenon. It results from retrograde progression of low weight air bubbles into dural venous sinuses during manipulation of a venous catheter, more frequently a central venous catheter through the subclavian and the jugular veins. However, it may also occur in relation with a peripheral intravenous catheter as in our case. We report a 91 year old female patient with congestive heart failure who had been examined in our emergency department two days previously due to dyspnea and received diuretic treatment through a peripheral intravenous line. She presented with vomiting and headache without obvious neurological deficits. Non-contrast cranial CT scan revealed wide spread punctate air bubbles inside and outside the cranial vault (pneumocephalus), within the venous system. The pneumocephalus was considered as iatrogenic due to the previous peripheral venous catheterization that resulted in retrograde migration of air bubbles through various venous connections into dural venous sinuses and extracranial veins. Since cerebral venous air embolism is a potentially serious complication of various medical procedures, it should be considered in differential diagnosis of nontraumatic headache and vomiting especially when there is a recent manipulation of venous lines. Cranial CT scan is helpful for early diagnosis.
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Greenman, Philip E., e John M. McPartland. "Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome." Journal of the American Osteopathic Association 95, n. 3 (1 marzo 1995): 182. http://dx.doi.org/10.7556/jaoa.1995.95.3.182.
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Lauerma, Hannu, e Päivi Paalassalo. "The need for excessive dietary sodium chloride following tympanoplasty". Journal of Laryngology & Otology 109, n. 4 (aprile 1995): 324–25. http://dx.doi.org/10.1017/s0022215100130038.
Testo completoAbstract (sommario):
AbstractLoss of a single nerve function in the peripheral network responsible for taste perception is traditionally considered clinically insignificant. However, we report the case of a 27-year-old woman who experienced significant selective taste loss for salt after manipulation of the chorda tympani during tympanoplasty. This effect may be explained by disorder of the functional neuroanatomy of salty taste perception together with strong lateralization of mastication to the affected side in this patient. Recently described inhibition of cranial nerve IX by cranial nerve VII is hypothesized as contributing to the contradiction between this case and the commonly accepted role of the chorda tympani in taste perception.
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de Divitiis, Enrico, Felice Esposito, Paolo Cappabianca, Luigi M. Cavallo, Oreste de Divitiis e Isabella Esposito. "Endoscopic transnasal resection of anterior cranial fossa meningiomas". Neurosurgical Focus 25, n. 6 (dicembre 2008): E8. http://dx.doi.org/10.3171/foc.2008.25.12.e8.
Testo completoAbstract (sommario):
Object The extended transnasal approach, a recent surgical advancements for the ventral skull base, allows excellent midline access to and visibility of the anterior cranial fossa, which was previously thought to be approachable only via a transcranial route. The extended transnasal approach allows early decompression of the optic canals, obviates the need for brain retraction, and reduces neurovascular manipulation. Methods Between 2004 and 2007, 11 consecutive patients underwent transnasal resection of anterior cranial fossa meningiomas—4 olfactory groove (OGM) and 7 tuberculum sellae (TSM) meningiomas. Age at surgery, sex, symptoms, and imaging studies were reviewed. Tumor size and tumor extension were estimated, and the anteroposterior, vertical, and horizontal diameters were measred on MR images. Medical records, surgical complications, and outcomes of the patients were collected. Results A gross-total removal of the lesion was achieved in 10 patients (91%), and in 1 patient with a TSM only a near-total (> 90%) resection was possible. Four patients with preoperative visual function defect had a complete recovery, whereas 3 patients experienced a transient worsening of vision, fully recovered within few days. In 3 patients (2 with TSMs and 1 with an OGM), a postoperative CSF leak occurred, requiring a endoscopic surgery for skull base defect repair. Another patient (a case involving a TSM) developed transient diabetes insipidus. The operative time ranged from 6 to 10 hours in the OGM group and from 4.5 to 9 hours in the TSM group. The mean duration of the hospital stay was 13.5 and 10 days in the OGM and TSM groups, respectively. Six patients (3 with OGMs and 3 with TSMs) required a blood transfusion. Surgery-related death occurred in 1 patient with TSM, in whom the tumor was successfully removed. Conclusions The technique offers a minimally invasive route to the midline anterior skull base, allowing the surgeon to avoid using brain retraction and reducing manipulation of the large vessels and optic apparatus; hastens postoperative recovery; and improves patient compliance. Further assessment and refinement are required, particularly because of the potential risk of CSF leakage. Other studies and longer follow-up periods are necessary to ascertain the benefits of the technique.
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Shimizu, Katsuyoshi. "Lateral Basal Approach to CPA in Supine No-Retractor Method: Microvascular Decompression for Hemifacial Spasm". Journal of Neurological Surgery Part B: Skull Base 80, S 03 (23 ottobre 2018): S318—S319. http://dx.doi.org/10.1055/s-0038-1675166.
Testo completoAbstract (sommario):
Objectives In this video, we demonstrate our more basal approach in microvascular decompression for hemifacial spasm. Design The patient is in supine position with the head rotated maximally to the opposite side on the U-shaped head rest. The small cranial window is made at the lateral bottom of occipital cranium with the adequate superficial manipulation on the muscles layers in the craniocervical junction. Results The more basal approach enables the surgeon to access all the segments of the VIIth nerve tract without cerebellar retraction by spatula, especially in the case with vertebral artery associated compression. Conclusion This approach safely provides the ideal operative corridor promising sufficient decompression in micorvascular decompression for the VIIth nerve.The link to the video can be found at: https://youtu.be/_nKSjGEHoB4.
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Albuquerque, Felipe C., Yin C. Hu, Shervin R. Dashti, Adib A. Abla, Justin C. Clark, Brian Alkire, Nicholas Theodore e Cameron G. McDougall. "Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management". Journal of Neurosurgery 115, n. 6 (dicembre 2011): 1197–205. http://dx.doi.org/10.3171/2011.8.jns111212.
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Object Chiropractic manipulation of the cervical spine is a known cause of craniocervical arterial dissections. In this paper, the authors describe the patterns of arterial injury after chiropractic manipulation and their management in the modern endovascular era. Methods A prospectively maintained endovascular database was reviewed to identify patients presenting with craniocervical arterial dissections after chiropractic manipulation. Factors assessed included time to symptomatic presentation, location of the injured arterial segment, neurological symptoms, endovascular treatment, surgical treatment, clinical outcome, and radiographic follow-up. Results Thirteen patients (8 women and 5 men, mean age 44 years, range 30–73 years) presented with neurological deficits, head and neck pain, or both, typically within hours or days of chiropractic manipulation. Arterial dissections were identified along the entire course of the vertebral artery, including the origin through the V4 segment. Three patients had vertebral artery dissections that continued rostrally to involve the basilar artery. Two patients had dissections of the internal carotid artery (ICA): 1 involved the cervical ICA and 1 involved the petrocavernous ICA. Stenting was performed in 5 cases, and thrombolysis of the basilar artery was performed in 1 case. Three patients underwent emergency cerebellar decompression because of impending herniation. Six patients were treated with medication alone, including either anticoagulation or antiplatelet therapy. Clinical follow-up was obtained in all patients (mean 19 months). Three patients had permanent neurological deficits, and 1 died of a massive cerebellar stroke. The remaining 9 patients recovered completely. Of the 12 patients who survived, radiographic follow-up was obtained in all but 1 of the most recently treated patients (mean 12 months). All stents were widely patent at follow-up. Conclusions Chiropractic manipulation of the cervical spine can produce dissections involving the cervical and cranial segments of the vertebral and carotid arteries. These injuries can be severe, requiring endovascular stenting and cranial surgery. In this patient series, a significant percentage (31%, 4/13) of patients were left permanently disabled or died as a result of their arterial injuries.
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Kobayashi, Kenya, Fumihiko Matsumoto, Yasuji Miyakita, Masaki Arikawa, Go Omura, Satoko Matsumura, Atsuo Ikeda et al. "Risk Factors for Delayed Surgical Recovery and Massive Bleeding in Skull Base Surgery". Biomedicine Hub 5, n. 2 (7 luglio 2020): 1–14. http://dx.doi.org/10.1159/000507750.
Testo completoAbstract (sommario):
Background: To determine factors that delay surgical recovery and increase intraoperative hemorrhage in skull base surgery. Methods: Factors related to delayed postoperative recovery were retrospectively reviewed in 33 patients who underwent open skull base surgery. Early and late recovery phases were assessed as “days required to walk around the ward (DWW)” and “length of hospital stay (LHS),” respectively. Intraoperative blood loss was calculated every hour and analyzed in 4 steps, i.e., craniotomy and intracranial manipulation, cranial fossa osteotomy, extracranial osteotomy, and reconstruction. Results: More than 4,000 mL of blood loss (B = 2.7392, Exp[B] = 15.4744; 95% CI 1.1828–202.4417) and comorbidity (B = 2.3978, Exp[B]) = 10.9987; 95% CI 1.3534–98.3810) significantly prolonged the DWW; the occurrence of postoperative complications significantly delayed the LHS (p = 0.0316). Tumor invasion to the hard palate, the maxillary sinus, the pterygopalatine fossa, the base of the pterygoid process, the sphenoid sinus, the middle cranial fossa, and the cavernous sinus and a long operation time (>13 h) were associated with increased total hemorrhage. The optimal cut-off hemorrhage volume associated with total massive blood loss in craniotomy and intracranial manipulation (AUC = 0.8364), cranial fossa osteotomy (AUC = 0.8000), and extracranial osteotomy (AUC = 0.8545) was 1,111, 750, and 913 mL, respectively. Persistent infection (6%) and neuropsychiatric disorder (6%) are direct causes of delayed LHS. Conclusion: Blood loss, comorbidity, and postoperative complications were risk factors for delayed surgical recovery. Meticulous preoperative planning, intraoperative surefire hemostasis, and perioperative holistic management are prerequisites for safe skull base surgery.
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Ong, Bonnie C., Pankaj A. Gore, Michael B. Donnellan, Thomas Kertesz e Charles Teo. "Endoscopic Sublabial Transmaxillary Approach to the Rostral Middle Fossa". Operative Neurosurgery 62, suppl_1 (1 marzo 2008): ONS30—ONS37. http://dx.doi.org/10.1227/01.neu.0000317371.92393.33.
Testo completoAbstract (sommario):
Abstract Objective: The rostral middle fossa faces the temporal pole and is the endocranial anterosuperior aspect of the greater wing of the sphenoid. Standard approaches to this region, such as the subtemporal, pterional, or orbitozygomatic approaches, require significant brain retraction or manipulation of the temporalis muscle. We report an endoscopic sublabial transmaxillary approach to this cranial base region that avoids the aforementioned pitfalls. Methods: Ten adult cadaveric half heads were used to develop the endoscopic approach and to identify the salient surgical landmarks. Results: The approach was divided into three stages: entry into the maxillary sinus, entry into the infratemporal fossa, and entry into the middle fossa. A craniotomy of greater than 20 mm in diameter can be safely created in the rostral middle fossa. When coupled with image guidance, the approach provides the flexibility to tailor the size and location of the middle fossa craniotomy. Conclusion: Although endonasal endoscopic approaches are increasing in popularity, the middle fossa has not been adequately accessed with these techniques. The endoscopic sublabial transmaxillary approach provides safe and direct access to the rostral middle fossa, eliminating the need for brain retraction, temporalis muscle manipulation, or an external incision. The approach also permits early devascularization of cranial- or dural-based lesions.
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Kawahara, Ichiro, Eri Shiozaki, Kosuke Soejima, Yuka Ogawa, Yoichi Morofuji, Tomonori Ono, Wataru Haraguchi e Keisuke Tsutsumi. "Unusual course of the vagus nerve passing anterior to the internal carotid artery during carotid endarterectomy". Surgical Neurology International 12 (14 giugno 2021): 278. http://dx.doi.org/10.25259/sni_216_2021.
Testo completoAbstract (sommario):
Background: Carotid endarterectomy (CEA) is a conventional surgical technique to prevent ischemic stroke and the effectiveness for advanced lesions is established in many large studies. The vagus nerve is one of the cranial nerves that we usually encounter during CEA manipulation, which is identified as located posterior to the vessels in a position posterolateral to the carotid artery and posteromedial to the internal jugular vein. Case Description: We experienced an extremely rare case of the vagus nerve passing anterior to the internal carotid artery during CEA. Conclusion: We should be careful not to accidentally cut off because the variation of the vagus nerve can be mistaken for an ansa cervicalis. A delicate and complete dissection to understand the variation of the vagus nerve is crucial to minimize the risk of cranial nerve injury during CEA.
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Foley, Michael J., Patrick S. Cottler, Silvia S. Blemker, Arlen D. Denny e Jonathan S. Black. "Computer Simulation and Optimization of Cranial Vault Distraction". Cleft Palate-Craniofacial Journal 55, n. 3 (14 dicembre 2017): 356–61. http://dx.doi.org/10.1177/1055665617738999.
Testo completoAbstract (sommario):
Objective: The objective of this study was to validate the proof of concept of a computer-simulated cranial distraction, demonstrating accurate shape and end volume. Design: Detailed modeling was performed on pre- and postoperative computed tomographic (CT) scans to generate accurate measurements of intracranial volume. Additionally, digital distraction simulations were performed on the preoperative scan and the resultant intracranial volume and shape were evaluated. Setting: Tertiary Children’s Hospital. Patients, Participants: Preoperative and postoperative CT images were used from 10 patients having undergone cranial distraction for cephalocranial disproportion. Interventions: None; computer simulation. Main Outcome Measure: Computer simulation feasibility of cranial vault distraction was demonstrated through creation of digital osteotomies, simulating distraction through translating skull segments, followed by simulated consolidation. Accuracy of the model was evaluated through comparing the intracranial volumes of actual and simulated distracted skulls. Results: The developed digital distraction simulation was performed on the CT images of 10 patients. Plotting the relationship between the actual and simulated postdistraction volumes for the 10 patients yielded a slope of 1.0 and a correlation coefficient of 0.99. The average actual resultant volume change from distraction was 77.0 mL, compared to a simulated volume change of 76.9 mL. Conclusions: Digital simulation of cranial distraction was demonstrated through manipulation of the CT images and confirmed by comparing the actual to simulated volume change. This process may provide objective data in designing an individual distraction plan to optimize volume expansion and resultant cranial shape as well as patient education.
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Watts, Kari Beth, e Meredith Lagouros. "Osteopathic Manipulative Treatment and Breastfeeding". Clinical Lactation 11, n. 1 (1 febbraio 2020): 28–34. http://dx.doi.org/10.1891/2158-0782.11.1.28.
Testo completoAbstract (sommario):
ObjectiveOsteopathic physicians, or doctors of osteopathic medicine (DOs), routinely counsel patients on the clinical benefits of breastfeeding in their capacity as medical doctors. However, when a mother presents with a complaint of feeding difficulty in her newborn, osteopathic physicians are uniquely equipped to assess and treat the infant with osteopathic manipulative treatment (OMT).MethodsOMT is the practice of manual medicine developed by A.T. Still in the late 19th century, founded on the principle that the human body's structure and function are reciprocally interrelated. The osteopathic discipline encompasses a variety of musculoskeletal techniques, ranging from gentle myofascial release to high-velocity/low-amplitude thrusts. A complete osteopathic assessment of a breastfeeding infant should include evaluation of the skull and cranial base, cervical spine, thoracic spine, oral cavity and tongue, hyoid bone, and mandible.ResultsAll treatments directed at newborns, infants, and children are very gentle, following the tissues in their position of ease to allow for a release of the restriction. A variety of techniques can be employed, including condylar decompression, Still technique for cervical spine dysfunction, balancing of the hyoid bone, myofascial release of the thoracic inlet, and treatments in the cranial field.ConclusionOsteopathic manipulation should be initiated when the first-line interventions do not result in improved nursing, and other causes such as hypoglycemia or maternal factors have been excluded.
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Kurbanyan, K. "180 A CASE OF INTRACRANIAL HYPOTENSION AND CRANIAL NERVE VI PALSY FOLLOWING CHIROPRACTIC NECK MANIPULATION." Journal of Investigative Medicine 54, n. 1 (1 gennaio 2006): S111.2—S111. http://dx.doi.org/10.2310/6650.2005.x0004.179.
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Cutler, Michael J., B. Shane Holland, Bernard A. Stupski, Russell G. Gamber e Michael L. Smith. "Cranial Manipulation Can Alter Sleep Latency and Sympathetic Nerve Activity in Humans: A Pilot Study". Journal of Alternative and Complementary Medicine 11, n. 1 (febbraio 2005): 103–8. http://dx.doi.org/10.1089/acm.2005.11.103.
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Powell, Wayne, e Simone F. C. Knaap. "Cranial Treatment and Spinal Manipulation for a Patient With Low Back Pain: A Case Study". Journal of Chiropractic Medicine 14, n. 1 (marzo 2015): 57–61. http://dx.doi.org/10.1016/j.jcm.2014.12.001.
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Gómez-Amador, Juan Luis, Luis Alberto Ortega-Porcayo, Isaac Jair Palacios-Ortíz, Alexander Perdomo-Pantoja, Felipe Eduardo Nares-López e Alfredo Vega-Alarcón. "Endoscopic endonasal transclival resection of a ventral pontine cavernous malformation: technical case report". Journal of Neurosurgery 127, n. 3 (settembre 2017): 553–58. http://dx.doi.org/10.3171/2016.8.jns161137.
Testo completoAbstract (sommario):
Brainstem cavernous malformations are challenging due to the critical anatomy and potential surgical risks. Anterolateral, lateral, and dorsal surgical approaches provide limited ventral exposure of the brainstem. The authors present a case of a midline ventral pontine cavernous malformation resected through an endoscopic endonasal transclival approach based on minimal brainstem transection, negligible cranial nerve manipulation, and a straightforward trajectory. Technical and reconstruction technique advances in endoscopic endonasal skull base surgery provide a direct, safe, and effective corridor to the brainstem.
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Di Somma, Alberto, Norberto Andaluz, Luigi Maria Cavallo, Matteo de Notaris, Iacopo Dallan, Domenico Solari, Lee A. Zimmer et al. "Endoscopic transorbital superior eyelid approach: anatomical study from a neurosurgical perspective". Journal of Neurosurgery 129, n. 5 (novembre 2018): 1203–16. http://dx.doi.org/10.3171/2017.4.jns162749.
Testo completoAbstract (sommario):
OBJECTIVERecent studies have proposed the superior eyelid endoscopic transorbital approach as a new minimally invasive route to access orbital lesions, mostly in otolaryngology and maxillofacial surgeries. The authors undertook this anatomical study in order to contribute a neurosurgical perspective, exploring the anterior and middle cranial fossa areas through this purely endoscopic transorbital trajectory.METHODSAnatomical dissections were performed in 10 human cadaveric heads (20 sides) using 0° and 30° endoscopes. A step-by-step description of the superior eyelid transorbital endoscopic route and surgically oriented classification are provided.RESULTSThe authors’ cadaveric prosection of this approach defined 3 modular routes that could be combined. Two corridors using bone removal lateral to the superior and inferior orbital fissures exposed the middle and anterior cranial fossa (lateral orbital corridors to the anterior and middle cranial base) to unveil the temporal pole region, lateral wall of the cavernous sinus, middle cranial fossa floor, and frontobasal area (i.e., orbital and recti gyri of the frontal lobe). Combined, these 2 corridors exposed the lateral aspect of the lesser sphenoid wing with the Sylvian region (combined lateral orbital corridor to the anterior and middle cranial fossa, with lesser sphenoid wing removal). The medial corridor, with extension of bone removal medially to the superior and inferior orbital fissure, afforded exposure of the opticocarotid area (medial orbital corridor to the opticocarotid area).CONCLUSIONSAlong with its minimally invasive nature, the superior eyelid transorbital approach allows good visualization and manipulation of anatomical structures mainly located in the anterior and middle cranial fossae (i.e., lateral to the superior and inferior orbital fissures). The visualization and management of the opticocarotid region medial to the superior orbital fissure are more complex. Further studies are needed to prove clinical applications of this relatively novel surgical pathway.
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Lhuillery, Eloise Elisabeth, e Philip Georg Witte. "Extracapsular articulating implant to treat cranial cruciate ligament disease in a dog with multiple myeloma". Veterinary Record Case Reports 7, n. 2 (aprile 2019): e000767. http://dx.doi.org/10.1136/vetreccr-2018-000767.
Testo completoAbstract (sommario):
An 11-year-old Border collie was presented for left hindlimb lameness associated with cranial cruciate ligament disease. The history included right tibial plateau levelling osteotomy performed approximately two years previously, with a subjectively good outcome. Multiple myeloma had been diagnosed approximately two months before presentation of the left hindlimb lameness. Medical treatment of multiple myeloma included glucocorticoids (prednisolone) and melphalan. Stabilisation of the left stifle was performed with the Simitri Stable in Stride extracapsular articulating implant. The dog demonstrated weightbearing on the operated limb within 24 hours following surgery. Re-examination six weeks following surgery revealed mild left hindlimb lameness, no resentment to manipulation of the left stifle, no cranial tibial thrust and a mild reduction in the range of motion. Hindlimb function was affected by various neurological events considered secondary to the malignant neoplasia; however, left stifle function was good until euthanasia 11 months following surgery.
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Kalani, M., e William Couldwell. "Retrosigmoid Craniotomy for Resection of an Epidermoid Cyst of the Posterior Fossa". Journal of Neurological Surgery Part B: Skull Base 79, S 05 (25 settembre 2018): S411—S412. http://dx.doi.org/10.1055/s-0038-1669980.
Testo completoAbstract (sommario):
This video illustrates the case of a 51-year-old woman who presented with sudden-onset headache, vertigo, and nausea. Imaging revealed an epidermoid cyst of the posterior fossa with mass effect upon the brainstem and displacement of the basilar artery. This lesion was approached using a left-sided keyhole retrosigmoid craniotomy with monitoring of the cranial nerves. This video illustrates the technique of internal debulking of the cyst contents with minimal manipulation of the cyst capsule, which is often densely adherent to the brainstem, cranial nerves, and vessels in the posterior fossa. Resection of the capsule is often associated with a higher rate of cranial nerve deficits. The tumor was removed completely, but the cyst capsule was left in place. The patient had House–Brackmann grade II facial paralysis postoperatively and complained of some diminished hearing in the left ear. Epidermoid cysts are benign tumors, but the patient may experience much morbidity from their overly aggressive resection, especially when the capsule is densely adhering to critical structures. An alternate strategy is to decompress the contents of the epidermoid cyst, thereby decompressing the brainstem and converting this disease process into a chronic disease that may require reoperation in the long term. Given the tight confines of the posterior fossa, aggressive internal decompression of tumors and mobilization from the brainstem and adjacent nerves are key to avoiding injury to the brainstem and cranial neuropathies. In patients with benign tumors, the goal of the operation should be decompression of the brainstem and preservation of cranial nerve function.The link to the video can be found at: https://youtu.be/nk8-VztB0OI.
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Harkness, P., R. Dossetor e J. Weighill. "Papilloedema, an unusual complication of mastoidectomy". Journal of Laryngology & Otology 110, n. 9 (settembre 1996): 878–80. http://dx.doi.org/10.1017/s0022215100135224.
Testo completoAbstract (sommario):
AbstractWe report a very unusual case of a patient with a previously undiagnosed congenital absence of the left dural venous drainage system and a prominent system on the right. Due to its prominence it was at risk during a cortical mastoidectomy performed as part of an endolymphatic sac decompression procedure. Manipulation of the lateral venous sinus resulted in partial occlusion of the already compromised venous drainage. The result was a rise in intra-cranial pressure and papilloedema, from which the patient recovered. The abnormality was only detected on post-operative imaging.
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Froelich, Sebastien C., Khaled M. Abdel Aziz, Nicholas B. Levine, Myles L. Pensak, Philip V. Theodosopoulos e Jeffrey T. Keller. "Exposure of the Distal Cervical Segment of the Internal Carotid Artery Using the Trans-spinosum Corridor: Cadaveric Study of Surgical Anatomy". Operative Neurosurgery 62, suppl_5 (1 maggio 2008): ONS354—ONS362. http://dx.doi.org/10.1227/01.neu.0000326019.30058.7b.
Testo completoAbstract (sommario):
Abstract Background: Exposure of the most distal portion of the cervical segment of the internal carotid artery (ICA) is technically challenging. Previous descriptions of cranial base approaches to expose this segment noted facial nerve manipulation, resection of the glenoid fossa, and significant retraction or resection of the condyle. We propose a new approach using the frontotemporal orbitozygomatic approach to expose the distal portion of the cervical segment of the ICA via the trans-spinosum corridor. Methods: Six formalin-fixed injected heads were used for cadaveric dissection. Two blocs containing the carotid canal and surrounding region were used for histological examination. Results: The ICA lies immediately medial to the vaginal process. The carotid sheath attaches laterally to the vaginal process. With use of the trans-spinosum corridor, the surgeon's line of sight courses in front of the temporomandibular joint, through the foramen spinosum, spine of the sphenoid, and vaginal process. Removal of the vaginal process exposes the vertical portion of the petrous segment of the ICA. The loose connective tissue space between the adventitia and the carotid sheath is easily entered from above. Incision of the carotid sheath exposes the ICA without disruption of the temporomandibular joint. Conclusion: Control of the cervical segment of the ICA can be critical when dealing with cranial base tumors that invade or surround the petrous segment of the ICA. This novel technique through the trans-spinosum corridor can effectively expose the distal portion of the cervical segment of the ICA without causing manipulation of the facial nerve and while maintaining the integrity of the temporomandibular joint.
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Pellet, Marie, Audrey Chenel, Michel Behr e Lionel Thollon. "Is digital image correlation able to detect any mechanical effect of cranial osteopathic manipulation? – A preliminary study". International Journal of Osteopathic Medicine 29 (settembre 2018): 10–14. http://dx.doi.org/10.1016/j.ijosm.2018.07.004.
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Crockard, Alan H., e Chandra N. Sen. "The Transoral Approach for the Management of Intradural Lesions at the Craniovertebral Junction: Review of 7 Cases". Neurosurgery 28, n. 1 (1 gennaio 1991): 88–98. http://dx.doi.org/10.1227/00006123-199101000-00014.
Testo completoAbstract (sommario):
Abstract The main difficulty in dealing with intradural lesions located ventrally in the region of the craniovertebral junction (CVJ) is related to their relative inaccessibility. Posterolateral approaches involve some manipulation of the brain stem and provide limited access because of the necessity of working between the cranial nerves. Even then, the view of the ventral midline and across is limited. The transoral approach, which has been widely used for the management of extradural lesions in this area, is also useful for the treatment of intradural lesions. It provides an unimpeded although somewhat restricted, view of the ventral aspect of the CVJ without the need for brain retraction. The cranial nerves and vertebral arteries are not interposed between the surgeon and the lesion. The risks of cerebrospinal fluid leakage and infection are greatly diminished by the use of fibrin adhesive and prolonged diversion of the cerebrospinal fluid. The use of this approach, together with its technical difficulties and results, in the management of seven purely intradural lesions located ventrally at the CVJ, is discussed.
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Crevier-Denoix, N., P. Moissonnier, V. Viateau e N. Jardel. "Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy". Veterinary and Comparative Orthopaedics and Traumatology 23, n. 02 (2010): 75–80. http://dx.doi.org/10.3415/vcot-08-08-0073.
Testo completoAbstract (sommario):
Summary Objectives: To describe the relationship of the major muscular, ligamentous and neurovascular structures in relation to standard medial elbow arthroscopic portals used in dogs, and to evaluate their potential iatrogenic lesions. Design: Anatomical study using 20 canine cadaveric elbows. Methods: Arthroscopic explorations were performed using medial portals. Three 4 mm orthopaedic pins were introduced in place of the arthroscope, egress canula and instrumental portals. Limbs were dissected. Distances between pins and neurovascular structures were measured. Muscle, ligament and cartilage lesions were recorded. Results: Minimal muscular lesions were observed. No ligament injury was evidenced. Superficial iatrogenic cartilage lesions were observed in three joints. The arthroscopic portal was 23.1 mm (range: 16 to 28.5 mm) caudal to the brachial artery, 21.0 mm (13–30.5 mm) caudal to the median nerve, and 4.0 mm (1–7 mm) cranial to the ulnar nerve. The instrumental portal was 16.3 (9–24 mm) caudal to the brachial artery, 13.5 mm (7–24.5 mm) caudal to the median nerve, and 11.8 (8–18 mm) cranial to the ulnar nerve. The egress portal was 21.4 mm (12–37 mm) caudal to the ulnar nerve. Conclusions and clinical relevance: The study confirmed the safety of elbow medial arthroscopic portals. Care must be taken when placing the camera portal so as to avoid injury of the ulnar nerve. Should extensive intra-articular procedures be needed, manipulation of instruments should be done cautiously in the cranio-medial compartment of the joint due to the proximity of the median nerve to the capsule.
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Quader, Sheikh Md Shahriar, Mohammad Shamsuzzaman, Abdul Gofur, Shakila Fatema e Mohammad Aminur Rahman. "Lateral compression splint, a guide for stabilization of mandibular arch in case of dentoalveolar fracture of children". Update Dental College Journal 3, n. 2 (18 febbraio 2014): 55–60. http://dx.doi.org/10.3329/updcj.v3i2.18001.
Testo completoAbstract (sommario):
Children (below 13 yrs of age) are usually susceptible to cranio facial trauma because of their greater cranial mass to body ratio. When compared to adults, the pattern of fractures and frequency of associated injuries are similar but the overall incidence is much lower. Treatment is usually performed without delay and can be limited to observation or closed reduction in non-displaced or minimally displaced fractures. Operative management should involve minimal manipulation and may be modified by the stage of skeletal and dental development. Open reduction and rigid internal fixation is indicated for severely displaced fractures. When tooth buds within the mandible do not allow internal fixation with plates and screws, this can be achieved with a mandibular compression splint fixed to the teeth, to the mandible with circum-mandibular wire. Children require long-term follow-up to monitor potential growth abnormalities. A case of a 9-year-old boy with fractured body of mandible managed by closed reduction using occlusal acrylic splint and circum mandibular wiring is presented. DOI: http://dx.doi.org/10.3329/updcj.v3i2.18001 Update Dent. Coll. j: 2013; 3 (2): 55-60
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Shahein, Mostafa, Thiago Albonette-Felicio, Giuliano Silveira-Bertazzo, Rafael Martinez-Perez, Marcus Zachariah, Ricardo L. Carrau e Daniel M. Prevedello. "Endoscopic endonasal resection of a clival chordoma with massive brainstem compression". Neurosurgical Focus: Video 2, n. 2 (aprile 2020): V12. http://dx.doi.org/10.3171/2020.4.focusvid.19942.
Testo completoAbstract (sommario):
Chordomas are rare tumors that occur at an incidence rate of 0.8 per 100,000. Thirty-five percent of chordomas occur in the spheno-occipital region. We present a case of a clival chordoma that had severe brainstem compression. The patient had a 1-year history of slurred speech and left facial weakness (House-Brackmann 3). The endoscopic endonasal transclival approach gave a panoramic view of the region without the necessity of brain retraction or manipulation of the surrounding cranial nerves. Gross-total resection was achieved and no CSF leak was encountered postoperatively. The left facial weakness improved to House-Brackmann 1.The video can be found here: https://youtu.be/DzW9Q6ckTHw.
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Dehdashti, Amir R., Ahmed Ganna, Ian Witterick e Fred Gentili. "EXPANDED ENDOSCOPIC ENDONASAL APPROACH FOR ANTERIOR CRANIAL BASE AND SUPRASELLAR LESIONS". Neurosurgery 64, n. 4 (1 aprile 2009): 677–89. http://dx.doi.org/10.1227/01.neu.0000339121.20101.85.
Testo completoAbstract (sommario):
Abstract OBJECTIVE The traditional boundaries of the transsphenoidal approach can be expanded to include the region from the cribriform plate of the anterior cranial fossa to the foramen magnum in the anteroposterior plane. The introduction of endoscopy to transsphenoidal surgery, with its improved illumination and wider field of view, has added significant further potential for the resection of a variety of cranial base lesions. We review our experience with the expanded endoscopic endonasal approach in a series of 22 patients with anterior cranial base and supradiaphragmatic lesions. METHODS From June 2005 to June 2007, the expanded endoscopic endonasal approach was used in 22 patients with the following pathologies: 6 craniopharyngiomas; 4 esthesioneuroblastomas; 3 giant pituitary macroadenomas; 2 suprasellar Rathke's pouch cysts; 2 angiofibromas; and 1 each of suprasellar meningioma, germinoma, ethmoidal carcinoma, adenoid cystic carcinoma, and large suprasellar arachnoid cyst. This study specifically focused on the surgical indications and approaches to these lesions and the surgical results, complications, and limitations associated with this technique. RESULTS Gross total tumor removal, as assessed by postoperative magnetic resonance imaging, was possible in the majority of patients (73%), with the exception of the craniopharyngioma group, in which only 1 lesion was completely removed. There were no permanent neurological complications except for increased visual disturbance in 1 patient. Other complications included cerebrospinal fluid fistulae in 4 patients (18%) and meningitis in 1 patient (5%). There was no operative mortality. Large lesions, significant lateral extension, encasement of neurovascular structures, and brain invasion in malignant lesions are considered some of the contraindications for this technique. CONCLUSION The expanded endoscopic endonasal approach is a promising minimally invasive alternative to open transcranial approaches for selective lesions of the midline anterior cranial base. The avoidance of craniotomy and brain retraction and reduced neurovascular manipulation with less morbidity are potential advantages. Major complications have been few, but there are also limitations with this technique. This approach should be included in the armamentarium of cranial base surgeons and considered as an option in the management of selected patients with these complex pathologies.
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Umar, Z., AS Qureshi, R. Shahid e F. Deeba. "Histological and histomorphometric study of the cranial digestive tract of ostriches (Struthio camelus) with advancing age". Veterinární Medicína 66, No. 4 (2 aprile 2021): 127–39. http://dx.doi.org/10.17221/120/2020-vetmed.
Testo completoAbstract (sommario):
The present study was conducted to determine the histological and histomorphometric variations in the tongue, oesophagus, proventriculus, and gizzard of ostriches (Struthio camelus) with regards to the sex and advancing age. A total of 40 healthy ostriches of both sexes and five age groups; young (up to 1 year, 1 to 2 years and 2 to 3 years) and adult (3 to 4 years and above 4 years) in equal numbers (n = 8) were used in this study. The organs under study were collected immediately after slaughtering the birds. Overall, the colour, shape, weight and various dimensions (length, width, and diameter) of the collected organs were recorded. The mean values of the gross anatomical variables of the studied organs increased (P < 0.05) among all the young groups (i.e., from 1 to 2 years, 2 to 3 years). Similarly, the organs under study in the adult groups (birds aged 3 to 4 years and above 4 years) grew (P < 0.05) as well. However, the differences between the adults were not significant. The histological analysis and histometric measurements were conducted on paraffin embedded tissue sections with Image J<sup>®</sup> analysis software. The statistical analysis revealed a significant increase in the thickness of the different tunics of the digestive organs in all the groups except those the adult groups. These findings may be of importance for the strategic manipulation of feed and nutrition to enhance the growth rate and also to diagnose pathological processes.
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Luño, Victoria, Marina Servián, Felisa Martínez, María Borobia, Noelia González e Lydia Gil. "Correlation of Prostatic Artery Blood Flow Assessed by Doppler Ultrasonography with Semen Characteristics in Beagle Dogs". Animals 10, n. 11 (9 novembre 2020): 2077. http://dx.doi.org/10.3390/ani10112077.
Testo completoAbstract (sommario):
Pulsed-wave Doppler ultrasonography (PwD) is a method used to rapidly and noninvasively assess blood flow dynamics of the canine prostate. Modifications in gland vascularization can affect seminal plasma production and consequently sperm quality. The aim of this study was to determine the normal blood flow parameters of the prostate artery in beagle dogs and to analyze the correlations between vascular flow and semen quality characteristics. PwD was performed on five beagle dogs (5–6 years) measuring vascular features in four different locations of the prostatic artery (cranial, subcapsular, parenchymal and caudal); the measured features were peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI). Ejaculates were obtained using digital manipulation and semen quality was evaluated by determining macroscopic (total volume, sperm-rich fraction volume, color and pH) and microscopic (sperm motility, morphology, viability and acrosome integrity) characteristics. The values of PSV, PI and RI in cranial and caudal prostatic arteries were significantly higher than in subcapsular and parenchymal arteries (p < 0.05). Moreover, a positive correlation of PSV value in the cranial region of the prostatic artery with total ejaculate volume (p < 0.01, r = 0.612) and sperm concentration (p < 0.01, r = 0.587) was determined. PI index was negatively correlated with sperm concentration (p < 0.01, r = −0.709). In conclusion, the results suggest that the prostatic artery blood flow parameters can affect macroscopic semen quality characteristics in healthy dogs.
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Sardan, Yesim Cetinkaya, Pinar Zarakolu, Belgin Altun, Aycan Yildirim, Gonul Yildirim, Gulsen Hascelik e Omrum Uzun. "A Cluster of Nosocomial Klebsiella oxytoca Bloodstream Infections in a University Hospital". Infection Control & Hospital Epidemiology 25, n. 10 (ottobre 2004): 878–82. http://dx.doi.org/10.1086/502313.
Testo completoAbstract (sommario):
AbstractBackground:On February 19, 2003, four patients (patients 1-4) in the neurology ward underwent cranial magnetic resonance angiography (MRA) and developed fever within 1 hour afterward. Klebsiella oxytoca was isolated from blood cultures of patients 1 through 3.Objective:To identify the source of this cluster of nosocomial K. oxytoca bloodstream infections.Design:Outbreak investigation.Setting:A 1,000-bed university hospital.Methods:The infection control team reviewed patient charts and interviewed nursing staff about the preparation and administration of parenteral fluids. The procedure of cranial MRA was observed. Arbitrarily primed polymerase chain reaction (AP-PCR) was performed to show the clonal relationship among these three strains.Results:AP-PCR revealed that three K. oxytoca isolates had the same molecular profile. Cranial MRA was found to be the only common source among these patients. During MRA, before injection of the contrast medium, normal saline solution was infused to check the functioning of the intravenous catheter. Use of the solution for multiple patients was routine, but the access diaphragm of the bottle was not cleansed. The bottle of normal saline solution used on February 19 had already been discarded and the culture sample taken from the solution on the day of observation was sterile.Conclusions:We speculate that normal saline solution became contaminated during manipulation and that successive uses might have been responsible for this cluster. Poor aseptic techniques employed during successive uses appear to be the most likely route of contamination. Use of parenteral solutions for multiple patients was discontinued..
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Zhao, Bing, Yu-Kui Wei, Gui-Lin Li, Yong-Ning Li, Yong Yao, Jun Kang, Wen-Bin Ma, Yi Yang e Ren-Zhi Wang. "Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases". Journal of Neurosurgery 112, n. 1 (gennaio 2010): 108–17. http://dx.doi.org/10.3171/2009.3.jns0929.
Testo completoAbstract (sommario):
Object The standard transsphenoidal approach has been successfully used to resect most pituitary adenomas. However, as a result of the limited exposure provided by this procedure, complete surgical removal of pituitary adenomas with parasellar or retrosellar extension remains problematic. By additional bone removal of the cranial base, the extended transsphenoidal approach provides better exposure to the parasellar and clival region compared with the standard approach. The authors describe their surgical experience with the extended transsphenoidal approach to remove pituitary adenomas invading the anterior cranial base, cavernous sinus (CS), and clivus. Methods Retrospective analysis was performed in 126 patients with pituitary adenomas that were surgically treated via the extended transsphenoidal approach between September 1999 and March 2008. There were 55 male and 71 female patients with a mean age of 43.4 years (range 12–75 years). There were 82 cases of macroadenoma and 44 cases of giant adenoma. Results Gross-total resection was achieved in 78 patients (61.9%), subtotal resection in 43 (34.1%), and partial resection in 5 (4%). Postoperative complications included transient cerebrospinal rhinorrhea (7 cases), incomplete cranial nerve palsy (5), panhypopituitarism (5), internal carotid artery injury (2), monocular blindness (2), permanent diabetes insipidus (1), and perforation of the nasal septum (2). No intraoperative or postoperative death was observed. Conclusions The extended transsphenoidal approach provides excellent exposure to pituitary adenomas invading the anterior cranial base, CS, and clivus. This approach enhances the degree of tumor resection and keeps postoperative complications relatively low. However, radical resection of tumors that are firm, highly invasive to the CS, or invading multidirectionally remains a big challenge. This procedure not only allows better visualization of the tumor and the neurovascular structures but also provides significant working space under the microscope, which facilitates intraoperative manipulation. Preoperative imaging studies and new techniques such as the neuronavigation system and the endoscope improve the efficacy and safety of tumor resection.
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Romstöck, Johann, Christian Strauss e Rudolf Fahlbusch. "Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery". Journal of Neurosurgery 93, n. 4 (ottobre 2000): 586–93. http://dx.doi.org/10.3171/jns.2000.93.4.0586.
Testo completoAbstract (sommario):
Object. Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance.Methods. Using a system that continuously records facial and lower cranial nerve EMG signals during the entire operative procedure, the authors examined 30 patients undergoing surgery on acoustic neuroma (24 patients) or meningioma (six patients). Free-running EMG signals were recorded from muscles targeted by the facial, trigeminal, and lower cranial nerves, and were analyzed off-line with respect to waveform characteristics, frequencies, and amplitudes. Intraoperative measurements were correlated with typical surgical maneuvers and postoperative outcomes.Characteristic EMG discharges were obtained: spikes and bursts were recorded immediately following the direct manipulation of a dissecting instrument near the cranial nerve, but also during periods when the nerve had not yet been exposed. Bursts could be precisely attributed to contact activity. Three distinct types of trains were identified: A, B, and C trains. Whereas B and C trains are irrelevant with respect to postoperative outcome, the A train—a sinusoidal, symmetrical sequence of high-frequency and low-amplitude signals—was observed in 19 patients and could be well correlated with additional postoperative facial nerve paresis (in 18 patients).Conclusions. It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.
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PLAUGHER, G. "Cranial manipulation theory and practice: Osseous and soft tissue approaches Leon Chaitow. London: Churchill Livingstone; 1999. 302 pages". Journal of Manipulative and Physiological Therapeutics 23, n. 5 (giugno 2000): 371. http://dx.doi.org/10.1016/s0161-4754(00)90220-3.
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Liu, James K., e Jean Anderson Eloy. "Expanded endoscopic endonasal transcribriform approach for resection of anterior skull base olfactory schwannoma". Neurosurgical Focus 32, Suppl1 (gennaio 2012): E3. http://dx.doi.org/10.3171/2012.v3.focus11300.
Testo completoAbstract (sommario):
Anterior skull base (ASB) schwannomas are extremely rare and can often mimic other pathologies involving the ASB such as olfactory groove meningiomas, hemangiopericytomas, esthesioneuroblastomas, and other malignant ASB tumors. The mainstay of treatment for these lesions is gross-total resection. Traditionally, resection for tumors in this location is performed through a bifrontal transbasal approach that can involve some degree of brain retraction or manipulation for tumor exposure. With the recent advances in endoscopic skull base surgery, various ASB tumors can be resected successfully using an expanded endoscopic endonasal transcribriform approach through a “keyhole craniectomy” in the ventral skull base. This approach represents the most direct route to the anterior cranial base without any brain retraction. Tumor involving the paranasal sinuses, medial orbits, and cribriform plate can be readily resected. In this video atlas report, the authors demonstrate their step-by-step techniques for resection of an ASB olfactory schwannoma using a purely endoscopic endonasal transcribriform approach. They describe and illustrate the operative nuances and surgical pearls to safely and efficiently perform the approach, tumor resection, and multilayered reconstruction of the cranial base defect. The video can be found here: http://youtu.be/NLtOGfKWC6U.
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Johnson, Dennis L., e Saul Schwarz. "Intracranial metastases from malignant spinal-cord astrocytoma". Journal of Neurosurgery 66, n. 4 (aprile 1987): 621–25. http://dx.doi.org/10.3171/jns.1987.66.4.0621.
Testo completoAbstract (sommario):
✓ A patient with postoperative intracranial seeding from a malignant spinal-cord astrocytoma is presented. This case is compared with 17 previously cited cases of intracranial dissemination from spinal-cord astrocytoma. Factors associated with tumor dissemination include histological malignancy, proximity of the tumor to cerebrospinal fluid (CSF) pathways, and surgical manipulation. Hydrocephalus with infiltration of the basal cisterns also appears to be a consistent feature in these patients. Cytological studies of the CSF in this and previous cases were noted to be misleading, whereas intravenous contrast-enhanced cranial computerized tomography was invaluable for diagnosis of tumor dissemination in each case. Prophylactic irradiation of the entire neuraxis may limit intracranial metastases from malignant astrocytomas of the spinal cord.
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Ng, C. S., e S. Norlela. "Complete 3rd cranial nerve dysfunction postdeflation/ excision of an encasing pituitary macroadenoma intrasellular cyst: A Case Report". Romanian Neurosurgery 30, n. 3 (1 settembre 2016): 382–86. http://dx.doi.org/10.1515/romneu-2016-0058.
Testo completoAbstract (sommario):
Abstract Central nervous system injury in particular cranial nerve palsy has been reported to be as high as 2%. Such prevalence of palsy generally attributed to surgical manipulation at the cavernous sinus, especially incurring the abducens nerve. We report the first case of acute oculomotor nerve sequel to the release of cystic fluid wrapping the nerve following a transsphenoidal excision of pituitary macroadenoma in a 57-year-old woman. She attended with the presentation of acute excruciating headache associated with partial drooping of right eye. The computed tomography and magnetic resonance imaging (MRI) were consistent with pituitary apoplexy of an underlying pituitary macroadenoma. Urgent transsphenoidal hypophysectomy was done. Intra-operatively, cystic fluid was aspirated during pituitary tumour dissection. At the same time, curettage was employed to removal residual tumour after the tumour biopsy. Immediate post-operative assessment noted complete right eye ptosis, with clinical evidence of complete right third and fourth nerve palsies. MRI was repeated a week later in view of such palsy non-resolution. However, no local compression or edema noted. Observation and monitoring were opted versus surgical revision. Propitiously the aforementioned cranial nerve palsies persist for a month and subsequently subsided. In this case, we highlight the potential deleterious impact of aspirating cystic component and curettaging during pituitary surgery. Likely postulated accounts for such occurrence include sudden release of fluid pressure with resultant cystic traction on its enfolding cranial nerves and subsequent neuropraxia. We aim to invite comments that could enlighten us on this gray area.
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Priddy, Blake Harrison, Cristian Ferrareze Nunes, Andre Beer-Furlan, Ricardo Carrau, Iacopo Dallan e Daniel Monte-Serrat Prevedello. "A Side Door to Meckel's Cave: Anatomic Feasibility Study for the Lateral Transorbital Approach". Operative Neurosurgery 13, n. 5 (31 marzo 2017): 614–21. http://dx.doi.org/10.1093/ons/opx042.
Testo completoAbstract (sommario):
Abstract BACKGROUND: In the last decade, endoscopic skull base surgery has significantly developed and generated a plethora of techniques and approaches for access to the cranial ventral floor. However, the exploration for the least-aggressive, maximally efficient approach continues. OBJECTIVE: To describe in detail an anatomical study, along with the technical nuances of a novel endoscopic approach to Meckel's Cave (MC) using a lateral transorbital (LTO) route. METHODS: Eighteen orbits of injected cadaveric specimens were operated on, using an endoscopic LTO approach to MC, middle cranial fossa, and paramedian skull base preserving the orbital rim. Surgical navigation and an after-the-fact infratemporal craniectomy were utilized to identify the limits of the approach. RESULTS: Following a transorbital approach opening a trapezoid window at the superolateral aspect (average 166.7 mm2), a middle fossa “peeling” and full visualization of MC was accomplished with no difficulties in all specimens. The entire approach was performed extradurally without the need to expose the temporal lobe. CONCLUSION: In a cadaveric model, the endoscopic LTO approach affords a direct route to access MC. Its main advantage is that it is minimally disruptive in nature, less brain retraction is required, and it reaches the middle fossa in an anterolateral perspective. It also requires no manipulation of the temporalis muscle, limited cosmetic incision, and rapid recovery. It seems a viable alternative to traditional approaches for lesions lateral to the cranial nerves at the cavernous sinus and MC, that is, schwannomas. Clinical utilization of this approach will challenge its efficacy and identify limitations.
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Kunori, Nobuo, e Ichiro Takashima. "An Implantable Cranial Window Using a Collagen Membrane for Chronic Voltage-Sensitive Dye Imaging". Micromachines 10, n. 11 (18 novembre 2019): 789. http://dx.doi.org/10.3390/mi10110789.
Testo completoAbstract (sommario):
Incorporating optical methods into implantable neural sensing devices is a challenging approach for brain–machine interfacing. Specifically, voltage-sensitive dye (VSD) imaging is a powerful tool enabling visualization of the network activity of thousands of neurons at high spatiotemporal resolution. However, VSD imaging usually requires removal of the dura mater for dye staining, and thereafter the exposed cortex needs to be protected using an optically transparent artificial dura. This is a major disadvantage that limits repeated VSD imaging over the long term. To address this issue, we propose to use an atelocollagen membrane as the dura substitute. We fabricated a small cranial chamber device, which is a tubular structure equipped with a collagen membrane at one end of the tube. We implanted the device into rats and monitored neural activity in the frontal cortex 1 week following surgery. The results indicate that the collagen membrane was chemically transparent, allowing VSD staining across the membrane material. The membrane was also optically transparent enough to pass light; forelimb-evoked neural activity was successfully visualized through the artificial dura. Because of its ideal chemical and optical manipulation capability, this collagen membrane may be widely applicable in various implantable neural sensors.
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Von Doersten, Peter G., e Robert K. Jackler. "Anterior Facial Nerve Rerouting in Cranial Base Surgery: A Comparison of Three Techniques". Otolaryngology–Head and Neck Surgery 115, n. 1 (luglio 1996): 82–88. http://dx.doi.org/10.1016/s0194-5998(96)70141-9.
Testo completoAbstract (sommario):
Anterior rerouting of the facial nerve is a maneuver designed to enhance exposure of the jugular foramen and carotid canal during resection of cranial base tumors. Our clinical impression is that the degree of additional exposure afforded by moving the facial nerve varies considerably according to both anatomic variations and the technique used. Three possible techniques exist based on the extent of facial nerve mobilization and point of rotation: canal wall up-second genu pivot point (CWU-2G); canal wall down-second genu pivot point (CWD-2G); and canal wall down-first genu pivot point (CWD-1G). We anatomically studied 20 human cadaver heads to establish clinically relevant guidelines for the selective use of these techniques. At the level of the dome of the jugular bulb, the facial nerve mobilized anteriorly a mean of 4.2 mm for CWU-2G, 10 mm for CWD-2G, and 14 mm for CWD-1G. Detailed analysis of numerous measurements and rotation angles suggests that the typical exposure afforded by the various rerouting techniques is as follows: CWU-2G, complete exposure of the jugular bulb; CWD-2G, exposure of the jugular bulb and a mean of 6 mm of the posterior aspect of the carotid artery; and CWD-1G, exposure of the jugular bulb and entire carotid genu. Minimizing the amount of facial nerve manipulation needed to achieve sufficient surgical exposure helps optimize postoperative functional status.
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Chai, Y., X. Jiang, Y. Ito, P. Bringas, J. Han, D. H. Rowitch, P. Soriano, A. P. McMahon e H. M. Sucov. "Fate of the mammalian cranial neural crest during tooth and mandibular morphogenesis". Development 127, n. 8 (15 aprile 2000): 1671–79. http://dx.doi.org/10.1242/dev.127.8.1671.
Testo completoAbstract (sommario):
Neural crest cells are multipotential stem cells that contribute extensively to vertebrate development and give rise to various cell and tissue types. Determination of the fate of mammalian neural crest has been inhibited by the lack of appropriate markers. Here, we make use of a two-component genetic system for indelibly marking the progeny of the cranial neural crest during tooth and mandible development. In the first mouse line, Cre recombinase is expressed under the control of the Wnt1 promoter as a transgene. Significantly, Wnt1 transgene expression is limited to the migrating neural crest cells that are derived from the dorsal CNS. The second mouse line, the ROSA26 conditional reporter (R26R), serves as a substrate for the Cre-mediated recombination. Using this two-component genetic system, we have systematically followed the migration and differentiation of the cranial neural crest (CNC) cells from E9.5 to 6 weeks after birth. Our results demonstrate, for the first time, that CNC cells contribute to the formation of condensed dental mesenchyme, dental papilla, odontoblasts, dentine matrix, pulp, cementum, periodontal ligaments, chondrocytes in Meckel's cartilage, mandible, the articulating disc of temporomandibular joint and branchial arch nerve ganglia. More importantly, there is a dynamic distribution of CNC- and non-CNC-derived cells during tooth and mandibular morphogenesis. These results are a first step towards a comprehensive understanding of neural crest cell migration and differentiation during mammalian craniofacial development. Furthermore, this transgenic model also provides a new tool for cell lineage analysis and genetic manipulation of neural-crest-derived components in normal and abnormal embryogenesis.