Management of patients with a neurovascular conflict involving the optic nerve and a non-diseased intracranial artery: Three cases.

Introduction: Determining whether a neurovascular conflict (NVC) involving the anterior visual pathway (AVP) and a non-diseased intracranial artery is amenable for microvascular decompression is challenging. Moreover, it is unclear whether microvascular decompression of the optic nerve is an effective therapy. Research question: What are the outcomes of different treatment strategies for NVCs involving the AVP and a non-diseased intracranial artery? Material and methods: Data on patients with symptomatic NVCs involving the AVP and a non-diseased intracranial artery was collected and included treatment and outcome parameters. The case series was drafted in accordance with the CARE guidelines. Results: Three patients aged 53,53 and 55 visited our out-patient clinic with a suspected symptomatic NVC between the optic nerve and a non-diseased intracranial artery. A conservative treatment was opted for in the first patient aimed at treating her glaucoma, with temporary improvement of symptoms. Microvascular decompression of the optic nerve was performed in two patients. One operated patient developed post-operative complications resulting in posterior circulation perfusion decline, while the other experienced a worse tunnel vision with a decrease in visual acuity. Discussion and conclusion: The diagnosis of a symptomatic NVC between the AVP and a non-diseased intracranial artery should be considered with caution, i.e. after exclusion of all other causes. Microvascular decompression can be performed but does not necessarily improve symptoms. A better understanding of the pathophysiological mechanisms underlying these NVCs is warranted to determine the benefit of microvascular decompression of the optic nerve.

Through the orbit and beyond: Current state and future perspectives in endoscopic orbital surgery on behalf of the EANS frontiers committee in orbital tumors and the EANS skull base section.

Introduction: Orbital surgery has always been disputed among specialists, mainly neurosurgeons, otorhinolaryngologists, maxillofacial surgeons and ophthalmologists. The orbit is a borderland between intra- and extracranial compartments; Krönlein's lateral orbitotomy and the orbitozygomatic infratemporal approach are the historical milestones of modern orbital-cranial surgery. Research question: Since its first implementation, endoscopy has significantly impacted neurosurgery, changing perspectives and approaches to the skull base. Since its first application in 2009, transorbital endoscopic surgery opened the way for new surgical scenario, previously feasible only with extensive tissue dissection. Material and methods: A PRISMA based literature search was performed to select the most relevant papers on the topic. Results: Here, we provide a narrative review on the current state and future trends in endoscopic orbital surgery. Discussion and conclusion: This manuscript is a joint effort of the EANS frontiers committee in orbital tumors and the EANS skull base section.

[Undergraduate teaching in ophthalmology. Do standardized practical examinations make sense?]. / Studentische Lehre in der Augenheilkunde. Sind standardisierte praktische Prüfungen sinnvoll?

BACKGROUND: University teaching in ophthalmology has tended to focus on imparting knowledge rather than practical skills. The new skills laboratory at the University Medical Center in Göttingen enables practical skills to be taught. The focus is on basic skills that could help all physicians. The learning goals set are techniques considered basic in ophthalmology that can be mastered without requiring any physician to operate major equipment. METHODS: The design and results from four semesters of an ophthalmological objective structured clinical examination (OSCE) following students engaged in peer-teaching, as well as feedback from a student questionnaire are described. RESULTS: Practical skills can successfully be taught and mastered within 1 week and 68-100 % of all students achieved the maximum scores in the individual tests. The OSCE and peer- eaching were well received by the students. CONCLUSIONS: Practical skills and peer teaching fulfill student educational goals in ophthalmology and are well accepted by undergraduates.

Generation of oxoiron (IV) tetramesitylporphyrin pi-cation radical complexes by m-CPBA oxidation of ferric tetramesitylporphyrin derivatives in butyronitrile at - 78 degrees C. Evidence for the formation of six-coordinate oxoiron (IV) tetramesitylporphyrin pi-cation radical complexes FeIV = O(tmp*)X (X = Cl-, Br-), by Mössbauer and X-ray absorption spectroscopy.

The generation of six-coordinate oxoiron (IV) tetramesitylporphyrin pi-caption radical complexes by m-CPBA (meta-chloroperbenzoic acid) oxidation of ferric tetramesitylporphyrin derivatives in butyronitrile at - 78 degrees C was investigated. UV-Vis and EPR spectroscopies indicate that the axial ligand present in the ferric starting derivatives is retained in the high-valent iron complexes. Indirect evidence for the formation of six-coordinate oxoiron (IV) tetramesitylporphyrin complexes FeIV = O(tmp*)X (X=Cl-, Br-) by m-CPBA oxidation of FeX(tmp) (X=Cl-, Br-) in butyronitrile at - 78 degrees C was also obtained by Mössbauer spectroscopy. Direct confirmation of the presence of a halide ion as second axial ligand of iron in these high-valent iron species was obtained by X-ray absorption spectroscopy. The EXAFS spectra of the samples obtained by m-CPBA oxidation of FeX(tmp) (X=Cl-, Br-) were refined using two different coordination models including both four porphyrinato-nitrogens and the axial oxo group. The two models include (model I) or exclude (model II) the axial halogen. The statistical tests indicate the presence of a halide ion as second axial ligand of iron in both derivatives. The refinements led to the following bond distances: FeIV=O(tmp*)Cl(3):Fe-O=1.66(1),Fe-Cl=2.39(2) and Fe-Np=1.99(1) A;FeIV=O(tmp*)Br(4):Fe-O=1.65(1),Fe-Br=2.93(2), Fe-Np=2.02(1) A. The lengthening of the Fe-X(X=Cl-, Br-) distances relative to those occurring in the ferric precursor porphyrins is, most probably, related to the strong trans influence of the oxoiron(IV) fragment present in 3 or 4.

Compound I and Compound II Analogues from Porpholactones.

The tetraaza macrocycles 2-oxa-3-oxotetramesitylporphine (|H(2) 1|) and 2-oxa-3-oxotetrakis(2,6-dichlorophenyl)porphine (|H(2) 2|) and the corresponding iron complexes (|Fe(III)(X) 1| and |Fe(III)(X) 2|; X= Cl(-), OH(-), or SO(3)CF(3)(-)) have been synthesized. These macrocycles are derived from porphyrins by transformation of one pyrrole ring to an oxazolone ring. The resulting lactone functionality serves to restrict but not completely block pi-conjugation around the periphery. These complexes thus share properties with both porphyrins and chlorins. The ferric and high-valent iron complexes have been characterized by a variety of spectroscopic techniques. The molecular structure of |Fe(III)(Cl) 2| has been obtained by X-ray crystallography and shows that the structural changes at the macrocycle periphery do not perturb the coordination sphere of iron relative to the corresponding porphyrin complexes. This is illustrated by the observation that Fe-O frequencies in the resonance Raman spectra of the porpholactone analogues of compounds I and II are not substantially different from those of porphyrins and by the axial appearance of the EPR signals of the high-spin ferric complexes. This is consistent with reports that the Fe=O unit of oxidized porphyrins and chlorins is relatively insensitive to alteration of macrocycle symmetry. Nevertheless, probes of properties of the porpholactone macrocycle ((1)H NMR, resonance Raman skeletal modes) show effects of the asymmetry induced by the oxazolone ring. On the basis of (1)H NMR, EPR, Mössbauer, and resonance Raman data, the singly occupied molecular orbital of oxoferryl porpholactone pi-cation radicals correlates with the a(1u) molecular orbital of porphyrins under D(4)(h)() symmetry. Moreover, the paramagnetic properties and the intramolecular exchange interaction of ferryl iron and the porpholactone pi-radical have been characterized by EPR and magnetic Mössbauer measurements and spin-Hamiltonian analyses. The values J(0) = 17 cm(-)(1) and J(0) = 11 cm(-)(1) obtained for the exchange coupling constants of the oxoferryl porpholactone pi-cation radical complexes |Fe(IV)=O 1|(+) and |Fe(IV)=O 2|(+), respectively, are among the lowest found for synthetic compound I analogues.

Influence of Meso Substituents on Electronic States of (Oxoferryl)porphyrin pi-Cation Radicals.

A series of (oxoferryl)porphyrin pi-cation radicals generated from porphyrins substituted at the meso positions with highly electron-withdrawing aryl groups has been characterized: tetrakis-5,10,15,20-(2,6-dichlorophenyl)-, 5-(2-chloro-6-nitrophenyl)-10,15,20-tris(2,6-dichlorophenyl)-, and 5-(2,6-dinitrophenyl)-10,15,20-tris(2,6-dichlorophenyl)porphyrins (porphyrins 1-3, respectively). The physical-chemical properties of the oxidized complexes of 1-3 are compared to those of two (oxoferryl)porphyrin pi-cation radical complexes substituted with electron-releasing aryl groups: tetramesitylporphyrin (TMP) and 2-iodotetramesitylporphyrin (2-iodoTMP). While all of the complexes examined show close correspondance in a number of spectroscopic parameters, some significant differences were observed. In contrast to observations for the oxidized complexes of TMP and 2-iodoTMP, the resonance Raman marker bands nu(2) and nu(11), which are indicators of symmetry state of porphyrin pi-cation radicals of 1-3, do not show the expected downfrequency shifts for oxidation to compound I analogs in a(2u) symmetry states. The upfield hyperfine NMR shifts of the pyrrole beta-proton signals of the compound I analogs of 1-3 are much larger than those for TMP and 2-iodoTMP. These data may be explained by admixture of some a(1u) character into the ground state of radical cations of 1-3, consistent with the hypothesis that electron-withdrawing meso substituents lower the energy of the a(2u) molecular orbital, favoring an a(1u) admixture.