Is it possible to evaluate upper and lower cervical interdependency on supine magnetic resonance imaging?

Background and purpose:

There is a significant correlation between the upper and lower cervical alignments associated with a compensatory mechanism to maintain horizontal gaze. Evaluating this correlation before cervical fusion operations is essential, particularly in the upper cervical region, to prevent the occurrence of postoperative malalignment. This study was designed to investigate whether evaluating the interdependency between the upper and lower cervical alignments on neutral supine magnetic resonance imaging (MRI) or supine MRI with neck extension is possible. 

This study included 36 male and 30 female volunteers without symptoms aged between 16 and 60 years. Cervical radiographic images and supine cervical spinal MRI scans were obtained twice on the neutral supine position and on the supine position with pillows placed at 5 cm high under the shoulder. Cervical lordosis (CL) (C2–7 Cobb angle), C0–2 Cobb angle, C2–7 sagittal vertical axis (C2–7SVA), T1 slope (T1S), and T1 slope minus CL (T1S-CL (C2S)) were measured from the imaging sets from each patient, including X-ray images and two MRI scans, and the main values were obtained. The mean values of the measurements from the radiographic images were compared with those obtained from MRI scans using Student’s t-test. The agreement between the parameters (C0–2 Cobb angle, CL Cobb angle, and T1S-CL) obtained from the radiographic images and MRI scans was evaluated using Pearson correlation analysis.

Pearson correlation analysis revealed significant correlations between the C0–2 and C2–7 Cobb angles in standing X-ray and neutral MRI values (r = −0.425 and -0.397, respectively). In plain radiography and MR studies, the T1 slope was correlated with the C2–7 angle (r = 0.4824, 0.734, and 0.702, respectively). The C2 slope values were also significantly correlated with the C0–2 Cobb angle in standing X-ray and neutral MRI images (r = 0.5595 and 0.5719, respectively). There were significant correlations between the C2 slope and C2–7 Cobb angles in all modalities (r = −0.5645, −0.7917, and −0.8526).

Negative correlations between the upper and lower cervical alignments are also present in supine MRI studies, consequently in the supine position, with statistical significance. The C2 slope is an important cervical spine parameter that is significantly correlated with both the C0–2 and CL Cobb angles. The C2 slope can be used to evaluate the interdependency of the upper and lower cervical alignments.

En Plaque Pituitary Adenoma within a Rathke's Cleft Cyst: Report of Three Cases.

Concomitant pituitary adenomas and Rathke's cleft cysts (RCCs) are rare. These coexisting lesions are difficult to diagnose preoperatively due to their variable signal intensity on magnetic resonance imaging (MRI) and position of the RCC. We describe three cases of coexisting pituitary adenoma and RCC, and review the relevant literature. In our cases, the RCCs were relatively large and the en plaque adenomas appeared as enhanced cyst walls on MRI examination. We also report the clinical, radiologic, surgical, and histopathologic findings of each case.

Chronic intradiploic hematomas of the skull without coagulopathy: Report of two cases.

BACKGROUND: Chronic intradiploic hematoma was first described by Chorbski and Davis in 1934. To date, only twelve cases have been reported in the literature. Chronic intradiploic hematomas have also been described as non-neoplastic cysts of the diploe, traumatic cysts, and giant cell repetitive granulomas. The term chronic intradiploic hematoma was coined by Sato et al. in 1994. CASE DESCRIPTION: Case 1: a 16-year-old male presented with a non-tender scalp swelling on the right fronto-orbital region. Computed tomography (CT) scans showed an intraosseous isodense lesion with surrounding sclerosis. Magnetic resonance imaging (MRI) results revealed an intradiploic mass with homogeneous cystic and abnormal signal intensities. Case 2: a 64-year-old male presented with a 6-month history of headaches and visual disturbances. CT scans showed an isodense lesion with surrounding sclerosis in the posterolateral left orbit. MRI results revealed a hypointense lesion on both the T1weighted and T2-weighted images of the posterolateral left orbit. CONCLUSION: Although rarely seen, the presence of a benign chronic hematoma should be considered as part of the differential diagnosis for each intradiploic mass lesion. When taking the medical history, all patients with such mass lesions should be asked about previous minor or major head traumas. Due to the possibility of progressive growth, surgical excision of an intradiploic hematoma is recommended after radiological diagnosis of the condition.

Morphometric and ultrastructural analysis of the effect of bromocriptine and cyclosporine on the vasospastic femoral artery of rats.

Vasospasm is the main causes of mortality and morbidity in patiens with subarachnoid hemorrhage (SAH). The arterial narrowing mechanism that develops after SAH is not yet fully understood but many studies showed that hypotension, neurogenic reflexes, clots in the subarachnoidal space, spasmogenic agents, humoral and celluler immunity play a role in the etiology. In this study we investigate the effects of Bromocriptine and Cyclosporine A in vasospasm secondary to SAH on rat femoral artery from ultrastructural and morphometric perspectives. 120 male Sprague-Dawley rats divided into 12 groups: Vasospasm (V), control (K), surgical control (CK) groups, vasospasm+Bromocriptine and/or Cyclosporine-A groups (VCyA, VBr, VBr+CyA), Bromocriptine and/or Cyclosporine-A control groups (CK, BK, Br+CyAK), Bromocriptine and/or Cyclosporine-A surgical control groups (BCK, CyCK, Br+CyACK). In order to create SAH model, 0, 1 cm(3) blood injected into silastic sheath wrapped rat femoral artery. Bromocriptine (2 mg/kg/d) and Cyclosporine A (10 mg/kg/d) combinations applied to control, surgical control and vasospastic models. Light microscopy, transmission electron microscopy and scanning electron microscopy used during this study. Statistical evaluation of the morphometric measurement data concerning vascular wall thickness and luminal cross-sectional areas of all groups were performed using Mann-Whitney U, Wilcoxon-signed rank, and Student-t tests. Cyclosporine A, whose effects in the prevention of vasospasm have been demonstrated in previous studies. In this study we discovered that Bromocriptine demonstrated strong effects similar to Cyclosporine-A. Bromocriptine and Cyclosporine A markedly prevent the development of chronic morphologic vasospasm following SAH. The combined use of both drugs does not change this preventive effect.

Anterior cervical microdiscectomy with or without fusion.

BACKGROUND: Anterior cervical microdiscectomy (ACD) is commonly applied in the surgical treatment of cervical disc herniation. However, following discectomy procedure to perform a fusion process is still controversial. Therefore, a controlled, multicentric, prospective, randomized study was designed. MATERIAL AND METHOD: Totally 20 patients were operated. Eleven patients were operated with applying simple anterior microdiscectomy technique. Nine patients were operated via ACD and fusion with a semirigid plate technique. Preoperative and postoperative [immediate; postoperative first day and postoperative 1 y (mean 13.95 mo)] computed tomography studies and plain x-rays were obtained. The cervical disc and bilateral neural foramen heights of the operated level and adjacent segments were calculated. Pain assessment was performed using visual analog pain scale. Mann-Whitney statistical analysis method was applied to compare the outcomes for both groups. RESULTS: Satisfactory result was achieved in both groups. The pain scores for major complaint (arm pain) were decreased significantly in all patients after surgery regardless of the type of technique applied. The improvement in neck pain scores was significant only in patients who were treated with fusion procedure. There were no significant changes in disc height and neural foramen height measurements for both groups in adjacent levels in immediate and 1-year postoperative periods. The patients who were operated with simple ACD technique showed no significant decrease at postoperative first day in disc height and neural foramen height. However, the 1-year postoperative radiologic studies showed a significant decrease in disc height and neural foramen dimensions compared with preoperative values. The patients who were treated with fusion process showed a significant increase in disc height and nonsignificant increase in neural foramen heights at immediate postoperative study. However, with time, all dimensions showed significant decrease compared with preoperative values. CONCLUSIONS: ACD technique offers satisfactory outcome regardless of whether fusion process is applied or not. Fusion with semirigid plate offers an advantage at operated level in immediate postoperative period in regard of disc height and neural foramen height. However, semirigid anterior plates by definition do not stop subsidence and the advantage that is offered by this technique is not persistent. On the other hand, to apply fusion process with semirigid plate system offers significantly less narrowing in disc height compared with simple ACD technique.

Cerebellopontine angle lipoma with extracranial extension.

Lipomas of the cerebellopontine angle (CPA) are rare. A recent literature review identified only 98 reported cases of CPA lipoma. We present here a case of CPA lipoma in a 28-year-old woman who was admitted to our hospital with hearing loss in her left ear. Computed tomography scan and magnetic resonance imaging revealed a CPA mass lesion with extracranial extension around the left internal carotiol artery. The patient was operated on in the sitting position via a right suboccipital craniectomy. The intracranial part of the mass was partially removed. Histopathological examination resulted in a diagnosis of lipoma. Surgical treatment of CPA lipomas is rarely indicated, and the aim of surgery must be decompression of neural structures.