Sagittal profile of cervical and whole spine before and after surgery of subaxial cervical spine.

INTRODUCTION: Until recently, there was a lack of information on sagittal axis parameters of the cervical spine, its relationship to the global sagittal axis of the spine, and their possible implications for long-term clinical outcomes in patients following subaxial cervical spine surgery. The aim of the authors is to provide an overview of the issue from available literature. METHODS: The authors present a complete overview of local radiological parameters of the sagittal axis of the cervical spine, an overview of radiological parameters of the total sagittal axis of the spine, and also spinopelvic parameters. Normative values ​​of the majority of individual parameters are summarized. The authors discuss several topics such as: The possible effects of sagittal axis parameters on the clinical condition of an individual before surgery; furthermore, whether a change in sagittal parameters of the cervical and whole spine after subaxial cervical spine surgery can affect the clinical condition and postoperative patient satisfaction. Finally, the methodology of specific operations is discussed, including their ability to change the parameters of the sagittal axis of the spine. CONCLUSION: Short patient monitoring times and the predominant use of retrospective methodology are common drawbacks of most studies. Also, there are no clearly determined procedures and specifications for surgical correction of the sagittal axis of the cervical spine. As it turns out, multi-stage procedures are more appropriate to achieve changes of the cervical sagittal axis. It is also gradually becoming apparent that any local change of the cervical spine may affect the sagittal axis of the entire spine.

Atlanto-occipital dissociation.

INTRODUCTION: Atlanto-occipital dissociation (AOD) is a rare and unstable injury of the craniocervical junction, associated with very high morbidity and mortality. The most common cause of this injury is high energy trauma with hyperextension of the cranium, such as car accidents. Due to specific anatomical predispositions, children and young adults are the frequently affected populations. Improving pre-hospital and early emergency care has resulted in a higher sensitivity of AOD diagnosis. METHODS: A retrospective analysis of all patients with cervical spine trauma, treated at the Masaryk Hospital Trauma Center between 2008 and 2018, identified 7 patients with AOD. The cohort consisted of 5 males and 2 females, with a mean age of 19,6 years and with the age range 9 to 35 years. All cases occurred as a result of a car accident. RESULTS: All patients in the cohort had findings of a highly unstable C0-C1 injury on their CT scans on admission. Four patients died early, while undergoing CPR in the emergency department. Two patients were in severe neurological states, with lesions of the upper cervical spinal cord and medulla oblongata on MRI. These patients were treated with external halo fixation and died within 3 days of the trauma. Only one patient with a new progressive neurological deficit was successfully treated using acute occipitocervical stabilization and fusion. CONCLUSION: The increasing incidence of AOD requires an early diagnosis, which minimizes the risk of successive clinical deterioration. The diagnostic method of choice is the C1-condyle interval (CCI) CT assessment along with cervical spine MRI. Standard treatment of stable patients with unstable AOD injuries consists in posterior occipitocervical stabilization and fusion of C0-C2.

The masaryk hospital extracranial-intracranial bypass study.

Patients with symptomatic internal carotid artery (ICA) occlusion with haemodynamic impairment are at higher risk of ischaemic stroke, and they require treatment. There are two main options: the best medical treatment and an extracranial-intracranial bypass. The aims of this study are to analyse the 30-day and 2-year risk of stroke and death in patients with extracranial-intracranial bypass performed by our department and to compare our results with major published studies. This retrospective study enrolled patients who underwent surgery from 1998 to 2012. Inclusion criteria were the following: (1) radiological diagnosis of symptomatic atherosclerotic internal carotid artery occlusion (AICAO), (2) less than 50 % stenosis of a contralateral ICA, (3) transient ischaemic attack (TIA) or ischaemic stroke in the hemispheric territory on an occluded side within 120 days and (4) haemodynamic impairment of at least stage I according to transcranial Doppler sonography (TCDS), perfusion CT and SPECT. Patients were followed up in the outpatient department with TCDS and sonography of the contralateral ICA and the anastomosis after 6 weeks and every 12 months after that. All risks of stroke and death from surgery were recorded throughout the 30 days and the following 2 years post surgery. From September 1998 to November 2012, 93 patients were selected for bypass surgery. There were 72 men and 21 women in an age range of 33 to 79 years (mean 58.9 years) and a follow-up range of 13 to 187 months (mean 108 months). The 30-day risk of stroke and death was 7.5 %. It consists of one death, one major ischaemic stroke, two reversible neurological deficits and three TIAs. The 2-year risk of stroke and death was 9.7 %. Extracranial-intracranial bypass is an effective treatment of haemodynamic impairment in patients with internal carotid occlusion. Maintaining low-level morbidity and mortality is possible with a dedicated neurovascular team. This is the only way in which we can reduce the risk of stroke and death in patients with bypass compared to patients treated medically.

Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms.

Aneurysms located on the posterior inferior cerebellar artery are rare, and treatment guidelines for them have not yet been established. In this paper, we present the results of a retrospective study which analyzes the management and treatment of 15 patients with posterior inferior cerebellar artery aneurysms from 2004 to 2013. The aneurysms were ruptured and presented with a subarachnoid hemorrhage. Of the 15 aneurysms, ten were of saccular, three fusiform, and two were dissecting. Computed tomography angiography or digital subtraction angiography revealed other aneurysms or intracerebral artery hypoplasia in seven patients. Either surgical or endovascular treatment was performed depending on the localization and morphology of the aneurysm. Six aneurysms were coiled, and surgery was performed in nine cases. Of the nine surgically treated patients, six (75%) had good outcomes. Of the six patients treated using endovascular procedures, three patients (50%) recovered. Patient outcomes were classified using the Hunt&Hess scale. Patients with Hunt&Hess 1-3 recovered without a neurological deficit. On the other hand, patients with Hunt&Hess 4-5 had a risk of up to 93% of death or a poor outcome. In two cases of endovascular and in two cases before any therapy, aneurysmal rebleeding occurred and resulted in deterioration of clinical state of the patient and a poor prognosis with high risk of death. This study shows the necessity of acute treatment of posterior inferior cerebellar artery aneurysm, of thorough diagnostic, and of interdisciplinary cooperation.

An anatomical and radiological study of the high jugular bulb on high-resolution CT scans and alcohol-fixed skulls of adults.

Although many reports mention a "high jugular bulb" (HJB), it is often not clearly defined. We examined the relationship between the jugular bulb (JB) and the internal auditory canal (IAC) in 200 temporal bones on high resolution CT scans and alcohol-fixed skull bases of adults. The average distance (+/-standard deviation) between the IAC and the JB was 7.5+/-2.3mm (range, 1-16 mm). The JB was higher on the right side than its companion in 53.3% of patients (left side only in 22%; no side dominance in 23.7% of bases). When the JB reached or exceeded the floor of the IAC (16.5%), it was defined as a HJB; 61% of HJB were found in females. Bilateral HJB was found in 0.5% of patients. The HJB was not associated with a contralateral flat JB. Preoperative multiplanar high resolution CT reconstructions make the most detailed assessment of structural topography.