Wyniki wyszukiwania

1

Dural adhesion as a cause of late clip slippage from the medial cerebral artery aneurysm

100%

Szmuda T., Sloniewski P.

Folia Morphologica

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2019

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tom 78

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nr 3

Background: A properly placed clip may slip off the aneurysm during the postoperative period. Many factors have been attributed to this complication, although clip adherence to the dural stitch has not been reported. Materials and methods: Following the single occurrence of such unusual complication, 64 similar medial cerebral artery (MCA) aneurysms were retrospectively investigated at a single institution. Clip adherence to the dura demonstrated in early postoperative computed tomography (CT) was a presumed factor of a late clip migration in this study. Results: In the series, there were 4 (6.3%) aneurysm remnants and 1 slipped clip that firmly adhered to the dura. In this particular case, the revision surgery revealed the spring coil firmly adhering to the dura in the previous suture line. Neither the occurrence of an aneurysm neck remnant nor clip slippage were related to the clip’s adherence to the dura in the analysis of the entire group (p > 0.05). On the contrary, application of a fenestrated clip did contribute to that finding in multivariate analysis (p < 0.01). Unlike the rest, two surgeons unintentionally tended to position the clip close to the dura (p < 0.01). The clip-to-dura distance measured in the follow-up CT angiography 1 year after the surgery differed from that in the postoperative CT in 83.8% of the cases and decreased by an average of 0.5 mm. Conclusions: Clip-to-dura adherence should be regarded as a normal finding in the postoperative CT following MCA aneurysm clipping. Surgeons should consider the possibility of clip head protrusion into the dural stitch line. (Folia Morphol 2019; 78, 3: 501–507)

2

Future of the nerve fibres imaging: tractography application and development directions

81%

Krakowiak M., Sloniewski P., Dzierzanowski J., Szmuda T.

Folia Morphologica

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2015

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tom 74

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nr 3

Tractography is a tool available in a growing number of centres, to enable planning of neurosurgical interventions. This method has some drawbacks and due to its increasing availability is causing a growing controversy over the possibility of an anatomical mapping of the nerve fibres. This article aims at summarising the application of the diffusion magnetic resonance in contemporary neurosurgery method, showing the usefulness and merits of its performance before surgical procedures, limitation of its application and recommendations for its improvement and more effective use for diagnostic purposes. (Folia Morphol 2015; 74, 3: 290–294)

3

Quantification of white matter fibre pathways disruption in frontal transcortical approach to the lateral ventricle or the interventricular foramen in diffusion tensor tractography

71%

Szmuda T., Sloniewski P., Szmuda M., Waszak P. M., Starzynska A.

Folia Morphologica

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2014

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tom 73

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nr 2

Pathologies occupying the interventricular foramen (foramen of Monro — FM) or the anterior part of lateral ventricle (LV) are accessed by the transcortical or transcallosal route. As severing of rostral corpus callosum has been deemed inferior to cortical incision, the approaches through various points of frontal lobe have been developed. Superior (F1), middle (F2) frontal gyrus or occasionally superior frontal sulcus are used as an entry of neurosurgical corridor. In spite of the fact that every approach to LV or FM causes its characteristic irreversible damage to white matter, to date all of transcortical routes are regarded as equivalent. The current study compared the damage of main neural bundles between virtual trans-F1 and trans-F2 corridors by means of diffusion tensor tractography method (DTT) in 11 magnetic resonance imaging (MRI) exams from clinical series (22 hemispheres, regardless of dominance). Corpus callosum, cingulum, subdivisions I and II of superior longitudinal fasciculus (SLF I and SLF II), corticoreticular as well as pyramidal tracts crossing both approaches were subjected to surgical violation. Both approaches served a similar total number of fibres (0.94 to 1.78 [× 10³]). Trans-F1 route caused significantly greater damage of total white matter volume (F1: 8.26 vs. F2: 7.16 mL), percentage of SLF I fibres (F1: 78.6% vs. F2: 28.6%) and cingulum (F1: 49.4% vs. F2: 10.6%), whereas trans-F2 route interrupted more corticoreticular fibres (F1: 4.5% vs. F2: 30.7%). Pyramidal tract (F1: 0.6% vs. F2: 1.3%) and SLF II (F1: 15.9% vs. F2: 26.2%) were marginally more vulnerable in case of the access via middle frontal gyrus. Both approaches destroyed 7% of callosal fibres. Summarising the above DTT findings, trans-F2 route disrupted a greater number of fibres from eloquent neural bundles (SLF II, pyramidal and corticoreticular tracts), therefore is regarded as inferior to trans-F1 one. Due to lack of up-to-date guidelines with recommendations of the approaches to LV or FM, an individual preoperative planning based on DTT should precede a surgery. (Folia Morphol 2014; 73, 2: 129–138)

4

Orbital size measurement based on computed tomography imaging for surgical safety

71%

Skorek A., Szurowska E., Raczynska D., Szmuda T., Stodulski D.

Folia Morphologica

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2014

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tom 73

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nr 3

Determining the orbital size makes it possible to manoeuvre safely within the orbit during a surgical procedure. Based on the measurements performed on a multi-layer head computed tomography images, the length was determined of the medial, superior, inferior and lateral orbital walls. Also angles were determined between the superior and inferior walls, between the medial and lateral walls, between the inferior wall and Frankfurt plane and between the anterior and posterior segments of the orbital wall. With these measurements it was possible to establish that the safe space for surgical exploration of the orbit (that is the space between the orbital margin and optic canal) is approximately 40 mm. Moreover, it was determined that the medial wall is parallel to the vertical axis of the body and that the angle between the inferior wall and the Frankfurt plane is 19.7°. The angle between the posterior segment of the inferior wall (posterior to the inferior orbital fissure) and the anterior segment is 130.8°. These data will significantly increase the safety of orbital surgeries. (Folia Morphol 2014; 73, 3: 314–320)

5

The posterior communicating artery: morphometric study in 3D angio-computed tomography reconstruction. The proof of the mathematical definition of the hypoplasia

61%

Dzierzanowski J., Szarmach A., Sloniewski P., Czapiewski P., Piskunowicz M., Bandurski T., Szmuda T.

Folia Morphologica

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2014

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tom 73

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nr 3

Background: The aim of this study was to investigate the morphometry of the posterior communicating artery (PCoA), on the basis of angio-computed tomography (CT), and to give proof of the mathematical definition of the term “hypoplasia of the PCoA“. Materials and methods: One hundred 3-dimensional (3D) angio-CT images, performed in adult patients with bilateral reconstruction of the PCoA (200 results) were used to calculate the morphometry of the vessel. Results: The average length of the vessel on the right side was 14.48 ± 3.47 mm, and on the left side 14.98 ± 4.77 mm (in women 14.75 mm, in men 14.70 mm). The mean of the diameter at the “proximal” point (the junction with P1) on the right side was 1.49 ± 0.51 mm, and on the left 1.46 ± 0.47 mm (in women 1.44 mm and in men 1.51 mm). The mean of the diameter in the “distal” part (the connection with ICA) on the right side was 1.4 ± 0.49 mm, and on the left 1.37 ± 0.41 mm (in women 1.38 mm, and in men 1.39 mm). No statistical correlation between the length and the diameter of the PCoA in relation to the sex and side was shown. On the basis of our measurements, we defined the hypoplasia of the artery as the estimated value less than the average diameter minus the standard deviation. The percentage distribution was as follows: the left artery 15.5%, the right artery 24%, women 11.5%, and the men 9%. Similarly to the above parameters, we have not found any statistical differences. The presence of the foetal origin was noted in 25% of the radiological examinations. The infundibular widening was visualised in 11.5% of cases of 3D reconstructions. The agenesis of PCoA was found in 9% (never bilaterally), and in 1 case the unilateral duplication of the artery was observed. No statistical differences between those parameters in relation to sex and the examined side were revealed. Conclusions: Morphological calculation of the PCoA on the basis of angio-CT from adult patients did not show any statistical differences depending on sex or the investigated side. The presented method of the calculations proved to be useful for the mathematical definition of the term “hypoplasia of the PCoA”. (Folia Morphol 2014; 73, 3: 286–291)

6

Frontal aslant tract projections to the inferior frontal gyrus

51%

Szmuda T., Rogowska M., Sloniewski P., Abuhaimed A., Szmuda M., Springer J., Sabisz A., Dzierzanowski J., Starzynska A., Przewozny T.

Folia Morphologica

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2017

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tom 76

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nr 4

Background: Frontal aslant tract (FAT) is a white matter bundle connecting the pre-supplementary motor area (pre-SMA) and the supplementary motor area (SMA) with the inferior frontal gyrus (IFG). The purpose of the present study was to evaluate the anatomical variability of FAT. Materials and methods: Total number of fibres and the lateralisation index (LI) were calculated. We attempted to find factors contributing to the diversity of FAT regarding IFG terminations to the pars opercularis (IFG-Op) and to the pars triangularis (IFG-Tr). Magnetic resonance imaging of adult patients with diffusion tensor imaging (DTI) with total number of 98 hemispheres composed a cohort. V-shaped operculum was the most common (60.5%). Results: Total number of FAT fibres had widespread and unimodal distribution (6 to 1765; median: 160). Left lateralisation was noted in 64.3% of cases and was positively correlated with total number of FAT fibres and the bundle projecting to IFG-Op (p < 0.01). LI correlated with total number of FAT fibres (r = 0.43, p < 0.01). FAT projected predominantly to IFG-Op (88.9%; 88 of 99). Only in 3 (3.1%) cases more fibres terminated in IFG-Tr than in IFG-Op. Total number of FAT fibres and number of fibres terminating at IFG-Op did not correlate with the ratio of fibre numbers: FAT/IFG-Op, FAT/IFG-Tr and IFG-Op/IFG-Tr (p > 0.05). The greater total number of fibres to IFG-Tr was, the higher were the ratios of IFG-Tr/ /FAT (r = 0.57, p < 0.01) and IFG-Tr/IFG-Op (r = 0.32, p = 0.04). Conclusions: Among the IFG, the major termination of FAT is IFG-Op. Whereas the IFG-Tr projection seems to be related to the expansion of the entire FAT bundle regardless of side, domination and handedness. Nevertheless, FAT features a significant anatomical variability which cannot be explained in terms of DTI findings. (Folia Morphol 2017; 76, 4: 574–581)

7

The pneumatisation of anterior clinoid process is not associated with any predictors that might be recognised preoperatively

51%

Szmuda T., Sloniewski P., Baczalska A., Cabala M., Czapski B., Gorczynski A., Kreja N., Kindrachuk M.

Folia Morphologica

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2013

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tom 72

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nr 2

The anterior clinoid process (ACP) is usually removed during surgeries of proximal internal carotid artery (ICA) aneurysms. However, some ACPs present with air cells originating from the sphenoid or/and ethmoid sinus. In surgeries containing a clinoidectomy of a pneumatised process, up to 40% of patients experience cerebrospinal fluid (CSF) rhinorrhoea. The aim of this study was to explore the potential predictors of pneumatisation of the ACP, as well as to compare the occurrence of CSF rhinorrhoea between total and partial anterior clinoidectomies. This study comprised 2 different groups, with 2 different analyses. Firstly, the pneumatisation of the ACP was evaluated in 496 ACPs and was based on 248 computer tomography exams (CT). The χ² test and ROC curve comparisons were utilised in conjunction, to explore possible predictors of air cell accumulation in the ACP. The overall pneumatisation rate was 9.7%, unilateral and bilateral aerial ACP was found in 4.4% and 2.6% of all patients respectively, while at least one pneumatised ACP was found in 14.1% of examined patients. The route of pneumatisation was established in 87.5% of cases. The side of the ACP, gender, and patient age were not significantly associated with both pneumatisation of ACP or route of pneumatisation. Secondly, a clinical group of 23 patients after operative securing of an ICA aneurysm were retrospectively assessed with regards to the extent of anterior clinoidectomy and the occurrence of CSF rhinorrhoea. A total of 23 ACPs were removed, 17 ACPs were totally resected, and 6 underwent partial resection. CSF rhinorrhoea was not noted in any patients, thus the comparison between clinical groups was not valid. Moreover, we described a novel method of partial removal of the lateral aspect of ACP, which was applied in 6 patients treated for an ICA — ophthalmic artery junction aneurysm. (Folia Morphol 2013; 72, 2: 100–106)

8

Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness

42%

Dzierzanowski J., Szarmach A., Bascik B., Czapiewski P., Muc A., Piskunowicz M., Krakowiak M., Szmuda T., Sloniewski P., Szurowska E., Winklewski P. J.

Folia Morphologica

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2017

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tom 76

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nr 3

Background: The aim of this study was to analyse the morphometry of the intracranial segment of the vertebral artery in the context of clinical usefulness. The results were compared with published data available in full-text archived medical journals. Materials and methods: More than 100 digital subtraction angiography (DSA) and 3-dimensional (3D) angio-computed tomography (CT) examinations were used to measure the following parameters: the whole and partial length of V₄ in characteristic anatomical points, the diameter in three places (on the level of foramen magnum, in point of exit to the posterior inferior cerebellar artery, and in the vertebro-basilar junction), the angle of connection to the vertebral arteries, and all anatomical variations including fenestration, duplication, dolichoectasia or absent artery. Results: The left V₄ section was predominant over the right artery, which is manifested by length, width, cases of ectasia and fewer cases of hypoplasia. The incidences of V₄ ectasia were identified more often than those documented in the accessible literature, and they were found in the natural location of formation of saccular aneurysms. Conclusions: The presented knowledge of anatomical variation and abnormalities of vertebral circulation can improve the accuracy and “safety” of the surgical procedures in this region, help to determine the range of surgical approach and avoid associated complications. The radiological examinations using 3D CT, DSA reveal unlimited observation of anatomical structures in contrast to studies based on cadavers, and can complement the morphometry in anatomical preparations. (Folia Morphol 2017; 76, 3: 379–387)

Ograniczanie wyników

Dural adhesion as a cause of late clip slippage from the medial cerebral artery aneurysm

Future of the nerve fibres imaging: tractography application and development directions

Quantification of white matter fibre pathways disruption in frontal transcortical approach to the lateral ventricle or the interventricular foramen in diffusion tensor tractography

Orbital size measurement based on computed tomography imaging for surgical safety

The posterior communicating artery: morphometric study in 3D angio-computed tomography reconstruction. The proof of the mathematical definition of the hypoplasia

Frontal aslant tract projections to the inferior frontal gyrus

The pneumatisation of anterior clinoid process is not associated with any predictors that might be recognised preoperatively

Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness