Targeting Vascular Cross Compression of Cranial nerves by MRI - Comparing different techniques for the diagnosis, characterization, and identification of prognostic factors

Conclusion: Heavy T 2-weighted MRI 3D driven equilibrium (DRIVE) is superior to 3D bFFE sequence in detecting neurovascular compressions, depicting their pattern and evaluating nerve morphology.Objective: Compare 3D driven equilibrium (DRIVE) and 3-dimensional (3D) balanced fast-field echo (bFFE) MRI in detecting, and characterizing neurovascular cross compression as regards cause, type and effect on the affected nerve.Patients and Methods: Forty-eight patients with clinical suspicion of vascular loop compression syndromes underwent MRI scans. There were 29 patients with audiovestibular symptoms, 12 with hemifacial spasm, 6 with trigeminal neuralgia and 1 with glossopharyngeal neuralgia. The cause and pattern of compression were compared on 3D driven equilibrium (DRIVE) and 3D bFFE images. The mean diameter of the involved nerve was compared to normal side. The MRI findings were compared to surgical findings in 42 cases.Results: MRI outlined the conflict in 43/48 scanned patients (89.58%). 3D DRIVE revealed more anatomical details and more insulting vessels than 3D bFFE sequence (p < 0.05). As regards the offending vessel the concordance of MRI with surgical findings was 38/42 (84.4%) . There was strong correlation (p < 0.001) between pre-operative MRI findings and intra-operative findings regarding the type of VCC, and nerve affection

The value of using loupe magnification and methylene blue dye in intra-operative identification of thyroglossal duct tract

Background: This was a comparative randomised study to find out the value of using loupe magnification and methylene blue dye in identification of the thyroglossal duct and to compare between them. Patients and Methods: Twenty-two patients who presented with infrahyoid thyroglossal duct cyst were subjected to excision of the cyst with two methods for identification of thyroglossal duct track during the operation. Data were anlysed for identification of multiple tracts, the tract relation to the hyoid bone, incidence of complications and operative time. Results: We found that multiple tracts were present in 9.1% of the patients in Group I and 36.3% in Group II, with no statistically significant difference between the two groups. The incidence of complications was 27.2% in Group I and 9.1% in Group II, with no statistically significant difference between both groups. However, the incidence of identification of the tract, and its relation to the hyoid bone was higher in Group II (90.9%) than in Group I (45.5%) , with a statistically significant difference between both groups. Also the incidence of identification of the extension level of the tract above the hyoid bone and up to the tongue base was significantly higher in Group II (72.8%) as compared to Group I (9.1%). The operative time was significantly shorter in Group II (54.35 min) and was 76.55 min in Group I, (P = 0.0001). Conclusion: Intra-operative identification of the thyroglossal tract is an essential step in the removal of the thyroglossal duct cyst. Both loupe magnification and methylene blue dye help in the tract identification, however, the usage of surgical loupes enhances better and safe results