Endoscopic Transorbital Approaches to Anterior and Middle Cranial Fossa: A Laboratory Investigation on Surgical Anatomy and Potential Routes.

Background Transorbital neuroendoscopic (TONES) approaches promise to open up new horizons for skull base surgery, offering alternative routes to reach the anterior and middle cranial fossa (ACF and MCF, respectively). Objective The aim of this anatomical study is to acquire new surgical anatomy knowledge and exploit it for the refinement of TONES approaches, as an alternative to open surgery, to reduce the distance to the target, and the risk of neurovascular lesions in pathological conditions extending beyond the orbital cavity. Materials and Methods Six head specimens (12 orbits) were studied/dissected. The orbit was approached and divided in a four clockwise quadrants manner to simulate three transconjunctival routes: the precaruncular (PC), preseptal (PS), and lateral retrocanthal (LRC), and one transpalpebral route-the superior eyelid crease (SLC). The boundaries and the most important anatomical landmarks were identified and are herein duly detailed with particular attention to the neurovascular structures encountered in each of those routes. Results The dissections showed that the PC approach facilitates the treatment of optic nerve and frontal sinus pathologies, whereas LRC appears safer to reach ACF and MCF allowing for a free multiplanar working channel (up to 180 degrees) to the floor, roof, and lateral-to-medial walls. Conclusion The plane of tendon lateral canthal's insertion and the sphenofrontal suture (SFS) were identified as the key anatomical landmarks for TONES approaches. Further studies are warranted to establish a practical clinical algorithm based on the anatomical four clockwise quadrants herein implemented/proposed, and the key surgical landmarks identified.

A new method of real-time skin dose visualization. Clinical evaluation of fluoroscopically guided interventions.

INTRODUCTION: We have conducted a prospective study to clinically evaluate a new radiation dose observing tool that displays patient's peak skin dose (PSD) map in real time. METHODS: The skin dose map (SDM) prototype quantifies the air kerma based on exposure parameters from the X-ray system. The accuracy of this prototype was evaluated with radiochromic films, which were used as a mean for PSD measurement. RESULTS: The SDM is a reliable tool that provides an accurate PSD estimation and location. CONCLUSION: SDM also has many advantages over the radiochromic films, such as real-time dose evaluation and easy access to critical operational parameters for physicians and technicians.

Cannabis use, ischemic stroke, and multifocal intracranial vasoconstriction: a prospective study in 48 consecutive young patients.

BACKGROUND AND PURPOSE: Our objective was to evaluate the relationship between cannabis use and ischemic stroke in a young adult population. METHODS: Forty-eight consecutive young patients admitted for acute ischemic stroke participated in the study. First-line screening was performed, including blood tests, cardiovascular investigations, and urine analysis for cannabinoids. If no etiology was found, 3D rotational angiography and cerebrospinal fluid analysis were performed. A control was planned through neurovascular imaging within 3 to 6 months. RESULTS: In this series, there was multifocal intracranial stenosis associated with cannabis use in 21% (n=10). CONCLUSIONS: Multifocal angiopathy associated with cannabis consumption could be an important cause of ischemic stroke in young people.

Relevance of the anatomical location of the Adamkiewicz artery in spine surgery.

PURPOSE: The aim of this study was to describe the preoperative topography of the Adamkiewicz artery and the blood supply of the lumbosacral spinal cord in patients who underwent spinal surgery. The relevance for anterior approaches of the thoracolumbar spine was then analyzed. METHODS: One hundred consecutive spinal angiographies were reviewed. Surgical indications were: 26 vertebrectomies, 30 anterior fusions in fractures, 13 malunions, 16 anterior releases in scoliosis, 11 pedicle subtraction osteotomies and 4 thoracic disc hernias. The level and the side of the Adamkiewicz artery and the presence of additional radiculomedullary arteries were determined. Modifications of surgical planning owing to the Adamkiewicz artery were analyzed. RESULTS: The Adamkiewicz artery was always located between T8 and L3, at T9 or T10 in 50%, and coming from the left side in 75% of the cases. Additional radiculomedullary arteries were found in 43% of the cases. A concordance between the topography of the Adamkiewicz artery and the planned surgical approach was noted in 15%, which led to ten side changings and three modifications of surgical technique with segmental vessel preservation. An ischemic syndrome of the anterior spinal cord did not occur. CONCLUSIONS: Spinal cord ischemia is rarely reported after segmental vessel ligation. Spinal angiography allows determining the topography of the Adamkiewicz artery safely. If the planned surgical approach is located at the same level, a contralateral approach or selective surgical techniques without vessel ligation could avoid possible damage to the Adamkiewicz artery if the pathology does not dictate the side and the extent of the surgical approach.

[Chronic fever revealing an urachal cyst]. / Fièvre au long cours révélant un kyste de l'ouraque.

In the adult, the urachus remains as a non-specific fibrous formation extended from the bladder dome to the Retzius space. This urachal remnant is commonly asymptomatic or may be revealed by a cyst. This later may also be asymptomatic or lead to local inflammation or inflammatory pseudo-tumor. We report an original observation of chronic fever revealing an urachal cyst in a 21-Year-old male.