RESUMEN
BACKGROUND: Forensic age estimation is a procedure which utilises many methods to estimate the age of both living and deceased individuals, including those who have died in natural disasters or man-made catastrophes. The pattern and closure of spheno-occipital synchondrosis (SOS) fusion, along with subchondral ossification of the mandibular condyle, can be used to estimate age. AIM AND OBJECTIVES: This study aims to estimate age using computed tomographic (CT) images of spheno-occipital synchondrosis fusion (SOS) and mandibular condylar cortication (MCC), and to correlate these findings with chronological age. MATERIALS AND METHODS: The present study included 435 CT images of individuals aged 10-25 years. SOS fusion was assessed using a four-stage system, and MCC was assessed bilaterally using a three-stage system on the sagittal plane. Data on fusion stages and cortication types were entered along with chronological age, and then statistically analysed. RESULTS: SOS fusion stage 2 occurred at similar age in males (19.82 ± 2.67 years) and females (19.23 ± 2.93 years). Earlier fusion of other stages was observed in females by a mean age of 2 years. MCC was completed 1 year earlier in females, with statistically significant differences (p ≤ 0.001). When comparing cortication types and different fusion stages, only type II cortication showed statistically significant differences compared to different fusion stages (p ≤ 0.001). CONCLUSION: Mandibular condylar cortication (MCC) and spheno-occipital synchondrosis (SOS) fusion were positively correlated with chronological age, suggesting that these parameters can be used as an adjunct method for age estimation.
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Determinación de la Edad por el Esqueleto , Cóndilo Mandibular , Hueso Occipital , Hueso Esfenoides , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Adolescente , Hueso Occipital/diagnóstico por imagen , Hueso Occipital/crecimiento & desarrollo , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/crecimiento & desarrollo , Niño , Estudios Transversales , Determinación de la Edad por el Esqueleto/métodos , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/crecimiento & desarrollo , Adulto , Adulto Joven , India , Antropología Forense/métodosRESUMEN
BACKGROUND: Spheno-orbital meningioma (SOM) represents a unique variant of sphenoid wing meningiomas, distinguished by its propensity for bone infiltration and cranio-orbital involvement. SOM exhibits a considerable incidence of misdiagnosis and recurrence. PURPOSES: To elucidate the clinical, radiological, and pathological characteristics of SOM. METHODS: Review of electronic medical records, histopathology, radiological images and follow-up information of 100 SOM patients. RESULTS: Of the 100 patients (28 males, 72 females) with SOM, mean age was 46.8 ± 12.6 years and prevalent symptoms were proptosis (99%). All the CT scans showed hyperostosis with 89.3% of the hyperostosis having an irregular edge. In MRI scans, dural tail sign was observed across all patients and the cranio-orbital tumors often penetrated temporal muscle (74.1%), extraocular muscle (74.1%) and lacrimal gland (63%). All the 100 patients underwent surgical intervention, and among them, 62 individuals received postoperative radiotherapy. Grade I resections had a lower recurrence rate(16.7%), which further decreased with the addition of radiotherapy(13.9%). In contrast, all patients with grade II or higher grade resections without radiotherapy experienced recurrence, indicating a higher risk associated with less complete tumor removal. The pathological examination revealed that intraorbital sections exhibited comparable tumor density to intraorbital SOM tumors, along with increased fibrous density but decreased vascular distribution. CONCLUSIONS: Radiological characteristics of SOM included cranio-orbital tumors, hyperostosis of the sphenoid wing with an irregular edge, and dural tail sign. Combination of gross total resection and adjuvant radiotherapy was recommended to minimize recurrence rate. Intracranial SOM tumors tended to be softer and more bleed-prone than intraorbital sections, necessitating surgical precision.
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Imagen por Resonancia Magnética , Neoplasias Meníngeas , Meningioma , Neoplasias Orbitales , Hueso Esfenoides , Tomografía Computarizada por Rayos X , Humanos , Meningioma/diagnóstico por imagen , Meningioma/patología , Meningioma/diagnóstico , Masculino , Persona de Mediana Edad , Femenino , Adulto , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/patología , Neoplasias Orbitales/diagnóstico , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/diagnóstico , Hueso Esfenoides/patología , Hueso Esfenoides/diagnóstico por imagen , Estudios Retrospectivos , Anciano , Recurrencia Local de Neoplasia , Estudios de Seguimiento , Adulto JovenRESUMEN
BACKGROUND: Transsphenoidal surgery (TSS) is the main method to remove pituitary neuroendocrine tumor (PitNET), but large or multi-lobulated one is still challenging. OBJECTIVE: The less invasive simultaneous combined keyhole mini-transcranial approach and standard transsphenoidal approach was used to remove multi-lobulated or hourglass-shaped non-functioning PitNET to avoid the specific complications related to extended TSS. METHODS: Twenty-one patients of large multi-lobulated or hourglass-shaped PitNET (6 patients were recurrent cases after TSS or transcranial approach) were treated by this simultaneous combined approach. The supraorbital or midline keyhole approach was performed under the operating microscope so that the fine arteries feeding optic apparatus were dissected from the tumor capsule safely and securely and the suprasellar part of the tumor was removed in the extra-capsular fashion in combination with transsphenoidal approach. RESULTS: Visual function improved after the surgery in 14 (74â¯%) of 19 patients with preoperative disturbance of the visual fields. Four patients (19â¯%) developed postoperative deterioration of pituitary endocrine functions requiring permanent hormonal replacement. One patient (4.2â¯%) suffered cortical laminar necrosis without permanent disorders and another patient (4.2â¯%) suffered cerebrospinal fluid rhinorrhea but neither was permanent. Postoperative computed tomography detected no subarachnoid hemorrhage in any patient. Gross total removal was achieved in 15 patients (71â¯%). Five patients (24â¯%) with subtotal removal and one patient (4.2â¯%) with partial removal had lateral tumor extension with Knosp classification 3 or 4. CONCLUSION: The combined method is an effective treatment option to remove complex PitNET safely and securely with dissecting fine arteries on the tumor capsule.
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Tumores Neuroendocrinos , Neoplasias Hipofisarias , Humanos , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana Edad , Adulto , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/patología , Anciano , Procedimientos Neuroquirúrgicos/métodos , Resultado del Tratamiento , Craneotomía/métodos , Neuroendoscopía/métodos , Adulto Joven , Complicaciones Posoperatorias , Hueso Esfenoides/cirugíaRESUMEN
BACKGROUND: The sphenoid wing dural arteriovenous fistula (AVF) is rare, and can manifest with severe symptoms, particularly in cases classified as greater sphenoid wing type. Endovascular therapy is generally employed, however, open surgical intervention could be warranted in cases with complex fistula. METHOD: We present a case with ruptured greater sphenoid wing dural AVF (Cognard type IV), in which endovascular embolization using liquid material was performed, followed by open surgery to concurrently disconnect the fistula and evacuate the hematoma. CONCLUSION: The sphenoid wing dural AVFs may be effectively cured by open surgery for fistula disconnection in conjunction with endovascular embolization.
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Malformaciones Vasculares del Sistema Nervioso Central , Embolización Terapéutica , Humanos , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Embolización Terapéutica/métodos , Masculino , Procedimientos Endovasculares/métodos , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Resultado del Tratamiento , Persona de Mediana Edad , Femenino , Angiografía CerebralRESUMEN
BACKGROUND AND IMPORTANCE: Spheno-orbital meningiomas (SOMs) pose a challenge to the skull base neurosurgeon because of their variable presentation and involvement of critical structures within the orbit. There is no consensus on optimal management of these patients and how to achieve maximal safe resection. The authors share an illustrative case with an accompanying video to demonstrate their aggressive approach to resect SOMs and their intraorbital components. CLINICAL PRESENTATION: A 75-year-old-woman presented with progressive vision loss and proptosis. Magnetic resonance imaging was consistent with a large, left-sided sphenoid wing meningioma with extension to the orbital wall and compression of the optic nerve medially. The patient elected to undergo surgical excision and optic nerve decompression. She did well postoperatively with resolution of proptosis and good resection margins on follow-up imaging. CONCLUSION: Aggressive resection of SOMs is possible with an understanding of the underlying anatomy. Familiarity with the orbit can facilitate a maximal safe resection with optic nerve decompression.
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Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Neoplasias Orbitales , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Femenino , Anciano , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Descompresión Quirúrgica/métodos , Órbita/cirugía , Órbita/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Rhinorrhea is a common complication after endoscopic endonasal transsphenoidal pituitary surgery (EETPS). This study evaluates the effectiveness of our sellar reconstruction technique in preventing rhinorrhea. METHODS: From June 2020 to March 2024, a surgical team performed 490 EETPS procedures on 458 pituitary adenoma patients. Demographic data, surgery status, and radiological and histopathological classifications were retrospectively analyzed. 4 grades for sellar reconstruction were defined based on intraoperative cerebrospinal fluid (CSF) leakage and diaphragm sella defect size. Grade 0: no CSF leakage; cavity filled with absorbable material. Grade 1: small defect; covered with fat and fascia lata grafts. Grade 2: large defect; added lumbar drainage. Grade 3: extended approach; added nasoseptal flap. RESULTS: Of the 490 operations, 433 were primary and 57 recurrent. Patients were 50.2% male, mean age 49.01 years. Follow-up averaged 20.5 months. Postoperative rhinorrhea occurred in 8 cases (1.6%). In 404 surgeries (82.5%) without intraoperative CSF leakage, 3 cases (0.7%) developed postoperative rhinorrhea. CSF leakage was detected in 86 cases (17.5%), with postoperative rhinorrhea in 5 cases (5.8%). The risk of rhinorrhea was 8.3 times higher with intraoperative CSF leakage (P = 0.005). Rhinorrhea rates: 0.7% in Grade 0, 3% in Grade 1, 8.7% in Grade 2, and 0% in Grade 3 (P = 0.017). Meningitis occurred in 8 patients (1.7%) and pneumocephalus in 4 (0.9%), with one death (0.2%). The average hospital stay was 17.4 days with rhinorrhea and 5.2 without (P = 0.024). CONCLUSIONS: Intraoperative CSF leakage is highly correlated with rhinorrhea. Multilayered and graded closure strategies significantly reduce postoperative rhinorrhea rates in EETPS.
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Rinorrea de Líquido Cefalorraquídeo , Neoplasias Hipofisarias , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Silla Turca , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Neoplasias Hipofisarias/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Rinorrea de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/prevención & control , Rinorrea de Líquido Cefalorraquídeo/epidemiología , Anciano , Silla Turca/cirugía , Procedimientos de Cirugía Plástica/métodos , Algoritmos , Adulto Joven , Adenoma/cirugía , Adolescente , Pérdida de Líquido Cefalorraquídeo/etiología , Pérdida de Líquido Cefalorraquídeo/epidemiología , Pérdida de Líquido Cefalorraquídeo/prevención & control , Resultado del Tratamiento , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/efectos adversos , Hueso Esfenoides/cirugía , Neuroendoscopía/métodos , Neuroendoscopía/efectos adversosAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/educación , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Temporal/diagnóstico por imagenAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/educación , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Temporal/diagnóstico por imagenAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/educación , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Temporal/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: Morning glory disc anomaly (MGDA) is a congenital malformation characterized by a funnel-shaped optic disc excavation with radiating vessels and a central glial tuft. Imaging is essential to evaluate associated cephalocele and steno-occlusive vasculopathy. The goal of this study was to assess optic nerve, chiasmatic, and sphenoid bone morphology in MGDA. MATERIALS AND METHODS: This retrospective study examined all subjects with funduscopically confirmed MGDA diagnosed and imaged with brain MR imaging between 2008 and 2023. RESULTS: Thirty-two children met inclusion criteria. Ocular involvement was unilateral in 29 subjects and bilateral in 3. Segmental optic nerve enlargement ipsilateral to the MGDA was seen in 21 subjects, with 3 also demonstrating a segmental reduction in the size of the ipsilateral optic nerve. Segmental reduction in the size of the ipsilateral optic nerve was present in 3 additional subjects, one with bilateral MGDA. The optic chiasm appeared asymmetrically thickened in 21 subjects, often with deformity. The optic nerves appeared normal in signal intensity in all subjects, with faint peripheral chiasmatic enhancement in 4 of 20 patients who received contrast. Optic nerve findings were stable in 15 subjects with multiple examinations. A persistent craniopharyngeal canal was identified in 17 subjects with sphenoid cephalocele in 1 and mild inferior pituitary gland displacement in 4. Tubular or nodular nasopharyngeal lesions were seen in 10 subjects. One subject had an off-midline sphenoid bone cleft, midbrain deformity, and abnormal thickening of and enhancement around the left oculomotor nerve; the oculomotor nerve finding was present in 1 additional patient. CONCLUSIONS: MGDA often manifests with ipsilateral optic nerve thickening, leading to a potential misdiagnosis as optic glioma. MGDA is also commonly associated with a persistent craniopharyngeal canal with variable pituitary gland and infundibular deformity, cephalocele, and tubular or nodular nasopharyngeal lesions.
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Imagen por Resonancia Magnética , Disco Óptico , Humanos , Femenino , Masculino , Estudios Retrospectivos , Niño , Imagen por Resonancia Magnética/métodos , Disco Óptico/diagnóstico por imagen , Disco Óptico/anomalías , Disco Óptico/patología , Preescolar , Adolescente , Lactante , Fenotipo , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anomalías , Hueso Esfenoides/patología , Quiasma Óptico/diagnóstico por imagen , Quiasma Óptico/anomalías , Quiasma Óptico/patología , Anomalías del Ojo/diagnóstico por imagen , Anomalías del Ojo/patologíaRESUMEN
Objective:To study the clinical anatomy of the sphenopalatine foramina by dissecting the sphenopalatine foramina during Vidian nerve branch neurotomy. The anatomy and CBCT images of sphenopalatine foramen were analyzed to facilitate the navigational of clinical operation using CBCT images. Methods:From October 2017 to September 2023, 84 casesï¼168 sidesï¼ of Vidian nerve branch neurotomy in our department were collected. The clinical summary was made according to the anatomy of sphenopalatine foramen during the operation. Preoperative CBCT imaging findings of the sphenopalatine foramina were also studied. Results:The clinical anatomy of sphenopalatine foramen could be divided into four types: middle meatus typeï¼1.19%ï¼, trans-meatus typeï¼62.29%ï¼, superior meatus typeï¼33.33%ï¼ and double foramen typeï¼1.19%ï¼. The incidence of ethmoidal ridge was 98.81%. The distance from sphenopalatine foramina to posterior nasal canal wereï¼14.63±2.66ï¼ mm to left andï¼14.65±2.63ï¼ mm to right, The position Angle â a of lower margin of sphenopalatine foramina wereï¼62.36±10.05ï¼° to left andï¼61.51±11.82ï¼° to right, respectively. Axial CT images can be used to divide the sphenopalatine foramen into five levels: the upper edge of the sphenopalatine foramen level, the Vidian nerve level, the basal plate interaction level, the lower edge of the sphenopalatine foramen level and the pterygopalatine canal level. The agreement between endoscopic anatomy of sphenopalatine foramen and imaging navigation was 100%. Conclusion:The sphenopalatine foramina exhibit various anatomical types. The preoperative navigational CBCT reading can effectively identify the type of sphenopalatine foramina, guide the choice of surgical method, and help avoid serious complications. This has significant clinical application value.
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Tomografía Computarizada de Haz Cónico , Endoscopía , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Endoscopía/métodos , Masculino , Femenino , Persona de Mediana Edad , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Adulto , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/anatomía & histologíaRESUMEN
Many studies revealed that the sphenoid sinus pneumatization (SSP) affects the protrusion/dehiscence of adjacent structures including optic canal (OC), foramen rotundum (FR), vidian canal (VC), and carotid canal (CC). Knowledge of this relationship bears vital importance to identify the safest surgical route during transsphenoidal procedures. Therefore, we aimed to determine the individualized prevalence of the protrusion/dehiscence of adjacent structures based on sagittal and coronal SSP (SSSP and CSSP) patterns. Computed tomography images of 300 patients were analysed to identify the SSSP and CSSP types, and the protrusion/dehiscence of adjacent structures was determined. The relationship between the variables was examined using statistical analysis in terms of age, gender, and laterality. The most prevalent SSSP type was postsellar (62.7%), followed by sellar (30%), presellar (6.6%), and conchal (0.7%). In 71.3% of patients, five types of CSSP were observed, with 23.6% and 21.7% exhibiting Type IV and V, respectively. Our results indicated that postsellar type, Type IV and V CSSP associated with the highest likelihood of protrusion/dehiscence of OC, FR, VC, and CC. Furthermore, no significant correlation was observed between these qualitative variables and gender, with the exception of the VC dehiscence, the protrusion of OC and CC. No notable differences were identified with respect to laterality. Also, the probability of having postsellar type, Type IV and V CSSP, as well as the protrusion of OC, VC, and CC, decreased with increasing age. Further detailed analysis of this association is required to predict the size of the surgical window and to prevent neurovascular injury.
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Seno Esfenoidal , Tomografía Computarizada por Rayos X , Humanos , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/anatomía & histología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Adolescente , Adulto Joven , Factores de Edad , Anciano de 80 o más Años , Factores Sexuales , Hueso Esfenoides/diagnóstico por imagen , Caracteres SexualesAsunto(s)
Fístula del Seno Cavernoso de la Carótida , Complicaciones Posoperatorias , Humanos , Fístula del Seno Cavernoso de la Carótida/cirugía , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Hueso Esfenoides/cirugía , Procedimientos Neuroquirúrgicos/efectos adversosAsunto(s)
Métodos de Anclaje en Ortodoncia , Humanos , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Hueso Esfenoides , Femenino , Técnicas de Movimiento Dental/instrumentación , Técnicas de Movimiento Dental/métodos , Diseño de Aparato Ortodóncico , MasculinoAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/educación , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Temporal/diagnóstico por imagenRESUMEN
BACKGROUND: An ACTH-secreting pituitary adenoma is the most common cause of excessive endogenous glucocorticoid production resulting in Cushing's Syndrome. A multidisciplinary approach is paramount. Selective adenomectomy is the treatment of choice. METHOD: Endoscopic transnasal transsphenoidal approach to the tumour, along with techniques for resection, are demonstrated. CONCLUSION: Endoscopic transsphenoidal approaches with its magnified view of the pituitary gland allows precise microsurgical dissection during selective adenomectomy. This technique increases the possibility of proving a gross total resection, leading to clinical and biochemical cure in these patients.
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Adenoma , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT) , Humanos , Adenoma/cirugía , Adenoma/diagnóstico por imagen , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/cirugía , Endoscopía/métodos , Adenoma Hipofisario Secretor de ACTH/cirugía , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/diagnóstico por imagen , Neuroendoscopía/métodos , Resultado del Tratamiento , Procedimientos Neuroquirúrgicos/métodos , Femenino , Hueso Esfenoides/cirugíaRESUMEN
BACKGROUND: At times, a regulation internal carotid artery-posterior communicating artery junction (ICA-P-Comm) aneurysm becomes a surgical hurdle owing to its close proximity to the anterior clinoid process, an immovable ICA and a concealed dominant P-Comm artery arising from the aneurysm neck. METHOD: A 70 year old patient with a low lying ICA-P-Comm aneurysm underwent a "tailored" intradural clinoidectomy for aneurysm clipping. CONCLUSION: A tailored anterior clinoidectomy to expose "just enough" allows a proximal ICA control in a suitable area, mobility of an atherosclerotic ICA and exposes the P-Comm artery origin which are essential in safe clipping of these aneurysms.
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Arteria Carótida Interna , Aneurisma Intracraneal , Anciano , Humanos , Enfermedades de las Arterias Carótidas/cirugía , Arteria Carótida Interna/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Resultado del TratamientoAsunto(s)
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/diagnóstico por imagen , Meningioma/patología , Meningioma/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Pronóstico , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/patología , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/cirugíaAsunto(s)
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/diagnóstico por imagen , Meningioma/patología , Meningioma/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Pronóstico , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/patología , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/cirugíaRESUMEN
The aim of the present study was to examine the growth dynamics of the two ossification centers of the body of sphenoid bone in the human fetus, based on their linear, planar and volumetric parameters. The examinations were carried out on 37 human fetuses of both sexes aged 18-30 weeks of gestation, which had been preserved in 10% neutral formalin solution. Using CT, digital image analysis software, 3D reconstruction and statistical methods, we evaluated the size of the presphenoid and postsphenoid ossification centers. The presphenoid ossification center grew proportionately in sagittal diameter, projection surface area and volume, and logarithmically in transverse diameter. The postsphenoid ossification center increased logarithmically in sagittal diameter, transverse diameter and projection surface area, while its volumetric growth followed proportionately. The numerical findings of the presphenoid and postsphenoid ossification centers may be considered age-specific reference values of potential relevance in monitoring the normal fetal growth and screening for congenital disorders in the fetus. The obtained results may contribute to a better understanding of the growing fetal skeleton, bringing new numerical information regarding its diagnosis and development.