Evaluating Scapular Notching after Reverse Total Shoulder Arthroplasty

BACKGROUND: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. METHODS: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of glenosphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. RESULTS: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. CONCLUSIONS: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck.

Evaluating Scapular Notching after Reverse Total Shoulder Arthroplasty

BACKGROUND: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. METHODS: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of glenosphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. RESULTS: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. CONCLUSIONS: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck.

Clinical Assessment of Surgical Approaches for the High Positioned Anterior Communicating Artery Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: The aim of this study was to determine the safe distance from anterior clinoid process (ACP) when the frontotemporal approach (FTA) was used for clipping of anterior communicating artery aneurysms (Acom ANs) and eventually to confirm whether the interhemispheric approach (IHA) was more effective in a certain Acom ANs. We defined the high positioned (HP) Acom AN as more than 18mm and the usual positioned (UP) Acom AN as less than 18 mm above the ACP on the lateral view of the conventional carotid artery angiogram. METHODS: Two hundred thirty four cases of Acom ANs were treated surgically either FTA or IHA by the same operator during last 14 years. The UP Acom ANs were 187 cases and the HP Acom ANs were 47 cases. We analysed the postoperative status of not only clinical conditions but also radiological findings in all cases retrospectively. RESULTS: FTA or IHA was chosen in 187 (182/5) cases of UP Acom ANs. But FTA or IHA was performed in 47 (21/26) cases of HP Acom ANs. The prognosis was better in UP Acom ANs than HP Acom ANs when FTA was chosen. But if the AN located more than 18 mm above the ACP, so called the HP Acom AN, IHA was made better prognosis than FTA. CONCLUSION: The safe distance from ACP to AN neck was lower than 18mm when FTA was chosen for the Acom ANs. IHA showed better results in the cases of AN neck higher than 18 mm from the ACP, ANs associated with a significant hematoma at the frontal lobe, moyamoya like diseases on the middle cerebral artery territory, another ANs at the distal anterior cerebral artery or aneurysmal projection of superoposterior type.

A Case of Septo-Optic Dysplasia

The septo-optic dysplasia, or de Morsier syndrome is a developmental anomaly characterized by involvement of the septum pellucidum, optic system and hypothalamic-pituitary axis. We had experienced a case of septo-optic dysplasia in 8 month-old female. A magnetic resonance imaging of the brain showed isolated absent septum pellucidum. And ophthalmoscopic examination showed right optic nerve hypoplasia, exotropia of right eye.

Cellular Schwannoma of the Cervical Spine in an Infant: A Case Report

Cellular schwannoma is a very rare benign tumor involving peripheral nerves, mimicking malignant nerve sheath tumor in histological appearance. It is a clinico-pathological variant of benign schwannoma characterized by a high cellularity, increased mitotic figures and occasional presence of bone destruction. A 6-month-old female patient was admitted with progressive quadriparesis. Magnetic resonance imaging of the cervical spine showed a well-enhancing extramedullary mass on the C4 to C6 area. Total laminectomy was performed on C4-7, and intradural extramedullary tumor was removed. Histologically, the tumor was composed of proliferated spindle cells. Most of the tumor was composed of Antoni A area with hypercellular spindle cells arranged in fascicular pattern. The tumor cells showed mild atypism with mitotic figure upto 4/10HPF and diffuse, strong S-100 protein immunostaining. The patient was improved postoperatively.