Usefulness of External Carotid Artery Angiogram with Manual Carotid Compression in Ophthalmic Artery Aneurysm

OBJECTIVE: Identifying collaterals from external carotid artery (ECA) is necessary before treatment of ophthalmic artery (OphA) aneurysm. We present a manual carotid compression test to verify collaterals in ophthalmic artery aneurysms, and evaluate its usefulness.MATERIALS AND METHODS: From March 2013 to December 2017, endovascular coiling was performed 19 consecutive patients with 20 OphA aneurysms. We performed manual carotid compression test for patients who had aneurysms incorporating entry of OphA. Clinical and angiographic outcomes were investigated.RESULTS: Of 13 cases underwent manual carotid compression test, 12 cases were confirmed collateral flow from ECA to OphA. During the coil embolization, we tried to maintain the original OphA flow even if it has a collateral anastomosis. Among them, OphA occlusion occurred in one patient during coiling. Recurrence of aneurysm was occurred in a ruptured case and additional embolization was required.CONCLUSIONS: The manual carotid compression test is useful method to identify the collaterals from ECA in patients with OphA aneurysm. This test can be used as a screening test for confirming collateral flow in OphA aneurysms or as an alternative for patients who are difficult to perform BTO.

Can the Zero-Profile Implant Be Used for Anterior Cervical Discectomy and Fusion in Traumatic Subaxial Disc Injury? A Preliminary, Retrospective Study

OBJECTIVE: The zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury.METHODS: Data from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients’ clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom’s criteria.RESULTS: The C2–7 Cobb and operative segmental angles increased by 3.45±7.61 and 2.94±4.59 in group A; and 2.46±7.31 and 2.88±5.49 in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than “good” using Odom’s criteria.CONCLUSION: The application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

Can the Zero-Profile Implant Be Used for Anterior Cervical Discectomy and Fusion in Traumatic Subaxial Disc Injury? A Preliminary, Retrospective Study

OBJECTIVE: The zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. METHODS: Data from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients’ clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom’s criteria. RESULTS: The C2–7 Cobb and operative segmental angles increased by 3.45±7.61 and 2.94±4.59 in group A; and 2.46±7.31 and 2.88±5.49 in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than “good” using Odom’s criteria. CONCLUSION: The application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

Minimally Invasive Removal of an Intradural Cervical Tumor : Assessment of a Combined Split-Spinous Laminectomy and Quadrant Tube Retractor System Technique

Conventional laminectomy is the most popular technique for the complete removal of intradural spinal tumors. In particular, the central portion intramedullary tumor and large intradural extramedullary tumor often require a total laminectomy for the midline myelotomy, sufficient decompression, and adequate visualization. However, this technique has the disadvantages of a wide incision, extensive periosteal muscle dissection, and bony structural injury. Recently, split-spinous laminectomy and tubular retractor systems were found to decrease postoperative muscle injuries, skin incision size and discomfort. The combined technique of split-spinous laminectomy, using a quadrant tube retractor system allows for an excellent exposure of the tumor with minimal trauma of the surrounding tissue. We propose that this technique offers possible advantages over the traditional open tumor removal of the intradural spinal cord tumors, which covers one or two cervical levels and requires a total laminectomy.

Simultaneous Vertebral Artery Dissection and Contralateral Posterior Inferior Cerebellar Artery Dissecting Aneurysm

The optimal treatment and appropriate follow-up period for an unruptured vertebral artery (VA) and/or posterior inferior cerebellar artery (PICA) dissection have not been established. Decisions regarding treatment of these vascular lesions are usually based on the manifesting symptoms and changes in radiologic findings during the follow-up period. We experienced a patient who had a simultaneous unruptured VA dissection and a contralateral PICA dissecting aneurysm. We did not find such a case in other literature.