Anterior communicating artery aneurysm surgery: which is the most appropriate head position?

Head positioning and the degree of rotation for anterior communicating artery aneurysm surgery is controversial. With this anatomic study, we aimed to give a broad description of head positioning for various aneurysm dome projections. In addition, with the use of a corrosion-cast technique, a three-dimensional arterial tree was demonstrated, an anterior communicating artery region aneurysm model was prepared, and pictures were taken at various angles. According to our observations, 30-degree head rotation was found to be the most suitable position for the anterior and superior projected aneurysms. For posterior projection, aneurysm neck was best viewed with 15-degree head rotation. Aneurysms projecting inferiorly necessitated the greatest rotation at 45 degrees. Each aneurysm dome projection of the anterior communicating artery aneurysm should be individually considered, and the head position should be adjusted accordingly. The use of appropriate head positions during surgery will prevent the development of postoperative ischemic complications and will increase the success of surgery by preventing unnecessary tissue manipulation

Surgical Results of the Use of Expanded Polytetrafluor Ethylene as an Adhesion Inhibitory Membrane in Anastomosis Surgery for Total Peripheral Nerve Cut

The fibrotic tissue that appears following nerve damage can prevent axonal regeneration. Expanded polytetrafluor ethylene (ePTFE) is a synthetic polymer with antiadhesive properties and a safe history of use in neurosurgery. The aim of this study was to use ePTFE to prevent postsurgical adhesions in patients undergoing anastomosis surgery and report the results. Between January 2014 and May 2018, six patients with primary and secondary peripheral nerve cuts underwent anastomosis (one with allograft and five with autografts). The anastomotic region was wrapped with ePTFE to form a barrier. The mean follow-up period was 28 months (minimum 3 months, maximum 4 years). In three of six patients whose nerve integrity was lost due to various reasons, there was an improvement in electrophysiological recordings. The allograft was used in a patient with peroneal nerve injury; the sural nerve was used as a graft in other patients. In three patients, the defect was more than 4 cm. Early surgery and defect size are important factors to consider when treating peripheral nerve anastomosis. Development of intraneural and perineural adhesions postsurgery can be problematic. ePTFE is an inert polymer that prevents adhesions from forming after anastomosis surgery. © 2020, Association of Surgeons of India

Arterial vascularization of the pineal gland

Purpose: The arterial vascularization of the pineal gland (PG) remains a debatable subject. This study aims to provide detailed information about the arterial vascularization of the PG. Methods: Thirty adult human brains were obtained from routine autopsies. Cerebral arteries were separately cannulated and injected with colored latex. The dissections were carried out using a surgical microscope. The diameters of the branches supplying the PG at their origin and vascularization areas of the branches of the arteries were investigated. Results: The main artery of the PG was the lateral pineal artery, and it originated from the posterior circulation. The other arteries included the medial pineal artery from the posterior circulation and the rostral pineal artery mainly from the anterior circulation. Posteromedial choroidal artery was an important artery that branched to the PG. The arterial supply to the PG was studied comprehensively considering the debate and inadequacy of previously published studies on this issue available in the literature. Conclusions: This anatomical knowledge may be helpful for surgical treatment of pathologies of the PG, especially in children who develop more pathology in this region than adults. © 2013 Springer-Verlag Berlin Heidelberg

New practical landmarks to determine sigmoid sinus free zones for suboccipital approaches: An anatomical study

Literature defines the landmarks to identify the courses and locations of the transverse and sigmoid sinuses on the outer surface of the skull and inner surface of the scalp. These natural landmarks may only be helpful after skin incision and are inadequate to determine the length and size of the skin incision. Still, there is a need to identify palpable landmarks easily to determine the ideal location to open the initial burr hole before an operation. Twenty-eight dried adult human skulls and 2 cadavers were evaluated. The zygomatic root, the inion, and the mastoid process were identified on the external, and the grooves for sigmoid and transverse sinuses, on the internal surfaces. The distances between the 3 landmarks and the midpoints, and the shortest distances of the midpoints to the border of the groove for sigmoid sinus and groove for transverse sinus were measured. Statistically significant differences were evaluated for both sides. Based on the measurements, the defined "artificial landmarks" can be considered safe points that involve no vascular structures and may be used to perform the initial burr hole during posterolateral approaches. Identification of the midpoints and palpation of the defined landmarks easily before the operation render the study feasible and practical unlike with natural landmarks. To avoid venous injury, the midpoints of mastoid-inion line and zygomatic root-inion line can be used safely in skin incision during posterior fossa approaches and craniotomy. Copyright © 2013 by Mutaz B. Habal, MD

New practical landmarks to determine sigmoid sinus free zones for suboccipital approaches: An anatomical study

Literature defines the landmarks to identify the courses and locations of the transverse and sigmoid sinuses on the outer surface of the skull and inner surface of the scalp. These natural landmarks may only be helpful after skin incision and are inadequate to determine the length and size of the skin incision. Still, there is a need to identify palpable landmarks easily to determine the ideal location to open the initial burr hole before an operation. Twenty-eight dried adult human skulls and 2 cadavers were evaluated. The zygomatic root, the inion, and the mastoid process were identified on the external, and the grooves for sigmoid and transverse sinuses, on the internal surfaces. The distances between the 3 landmarks and the midpoints, and the shortest distances of the midpoints to the border of the groove for sigmoid sinus and groove for transverse sinus were measured. Statistically significant differences were evaluated for both sides. Based on the measurements, the defined "artificial landmarks" can be considered safe points that involve no vascular structures and may be used to perform the initial burr hole during posterolateral approaches. Identification of the midpoints and palpation of the defined landmarks easily before the operation render the study feasible and practical unlike with natural landmarks. To avoid venous injury, the midpoints of mastoid-inion line and zygomatic root-inion line can be used safely in skin incision during posterior fossa approaches and craniotomy. Copyright © 2013 by Mutaz B. Habal, MD

Adjuvant radiotherapy for gastric carcinoma: 10 years follow-up of 244 cases from a single institution.

BACKGROUND: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among high- risk patients. This study was undertaken to analyse long-term survival probability and the impact of certain covariates on the survival outcome in affected individuals. MATERIALS AND METHODS: Between January 2000 and December 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Data were retrieved retrospectively from patient files and analysed with SPSS version 21.0. RESULTS: A total of 244 cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years (range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperative adjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range, 2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probability for 1-, 3-, 5- and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS) probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotal gastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses. Surgical margin status or lymph node dissection type were not prognostic for survival. CONCLUSIONS: Postoperative CRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-known prognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy was an important prognostic factor in our series. With our findings we add to the discussion on the definition of required surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patients in our clinic can be useful in the future randomised trials to point the way to improved outcomes