Anterosuperior Portion Research Articles

Delamination Cysts: A Predictor of Acetabular Cartilage Delamination in Hips with a Labral Tear

The treatment and prognosis of labral tears of the hip depend primarily on whether there is concomitant injury of the adjacent acetabular articular cartilage. We asked whether a delamination cyst on the preoperative plain radiographs correlated with delamination of the acetabular articular cartilage at the time of hip arthroscopy. We reviewed the preoperative radiographs of 125 consecutive hips that had a labral tear at hip arthroscopy for the presence of a delamination cyst. A delamination cyst was defined as an acetabular subchondral cyst either directly adjacent to a lateral acetabular cyst or in relation to a subchondral crack in the anterosuperior portion of the acetabulum. All patients with acetabular cartilage delamination at arthroscopy were identified. There were 16 patients with delamination cysts on radiographs and 15 patients with cartilage delamination at arthroscopy. A delamination cyst on the preoperative anteroposterior and/or frog lateral radiographs of the hip accurately predicted acetabular cartilage delamination, especially in hips with labral tears not caused by a major trauma. A delamination cyst is a previously unrecognized and novel radiographic sign that can preoperatively identify acetabular cartilage delamination in patients with labral tears, thereby facilitating the selection of the appropriate surgery and determining prognosis. Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

A Narrow Internal Auditory Canal with Duplication in a Patient with Congenital Sensorineural Hearing Loss

A narrow internal auditory canal (IAC) with duplication is a rare anomaly of the temporal bone. It is associated with congenital sensorineural hearing loss. Aplasia or hypoplasia of the vestibulocochlear nerve may cause the hearing loss. We present an unusual case of an isolated narrow IAC with duplication that was detected by a CT scan. In this case, the IAC was divided by a bony septum into an empty stenotic inferoposterior portion and a large anterosuperior portion containing the facial nerve that was clearly delineated on MRI.

Tensile properties of the human glenoid labrum

Human fresh-frozen cadaveric glenoid labrae from 16 donors were harvested and ten of these had no gross degeneration. These ten were divided into eight equal circumferential sections. Each section was cut to produce test-samples from the core layer with a cross-section of 1 x 1 mm. Tensile testing was performed within a controlled environment unit at 37 +/- 1 degrees C and 100% relative humidity. Each test-sample was precycled to a quasi-static state to alleviate the effects of deep-freezing, prior to final testing. The tangent modulus was calculated for each test-sample before and after a 5-min period of stress relaxation and at yield. The mean elastic modulus and yield stress of the glenoid labrum were 22.8 +/- 11.4 and 2.5 +/- 2.1 MPa, respectively. The anterosuperior portion had a lower elastic modulus and lower yield stress than the inferior portion (both P < 0.02). The pre-stress relaxation tangent modulus was significantly lower than the post-stress relaxation tangent modulus for all portions of the labrum. The glenoid labrum has similar tensile material properties to articular cartilage. Its elastic modulus varies around its circumference. This suggests that the labrum may encounter different forces at different positions.

L’intervalle des rotateurs : des lésions cachées ?

The rotator interval corresponds to a defined triangular shaped anatomical region at the anterosuperior portion of the shoulder where specific pathological processes may occur. First, the morphological and functional anatomy of the region will be reviewed. Then, the role of different imaging modalities will be described along with pathological imaging features. Normal structures of the rotator interval may be imaged with modern techniques, including MR and CT arthrography. On the other hand, clinical evaluation of rotator interval pathology remains difficult; and no consensus exists concerning their management. Imaging characterization of rotator interval pathology could be a key factor for pre-therapeutic work-up.

Bilateral Sequential Lung Transplantation

Bilateral Sequential Lung Transplantation

Volumetric reduction of the corpus callosum in Alzheimer's disease in vivo as assessed with voxel-based morphometry

Several recent magnetic resonance imaging studies have employed voxel-based morphometry (VBM) to detect regional gray matter volume abnormalities in Alzheimer's disease (AD). However, investigations of corpus callosum (CC) abnormalities in AD using this automated methodology have been scarce, and no VBM study investigated correlations between regional CC atrophy and cognitive measurements in AD subjects at mild disease stages. We used VBM to compare the topography of CC volume differences between 14 AD subjects (MMSE 14–25) and 14 healthy volunteers. Images were acquired using a 1.5-Telsa scanner, and were spatially normalized and segmented using optimized VBM. Statistical comparisons were performed using the general linear model. Significant CC atrophy was detected in the antero-superior portion of the splenium, the isthmus, the anterior and posterior portions of the CC body, and the rostral portion of the genu. Voxels showing peak statistical difference were all left-sided ( P < 0.001, uncorrected for multiple comparisons). A cluster of significant positive correlation with MMSE scores was seen on the left anterior CC body. Our results confirm previous findings of diffuse volumetric CC reductions early in the course of AD, and warrant further evaluation of the relevance of atrophic changes in anterior CC portions to the cognitive impairments that characterize the disorder.

Surgical closure of the larynx for intractable aspiration, using double hinged flaps of the vocal folds and false vocal folds

We report a new surgical procedure to treat intractable aspiration: closure of the larynx, using double hinged flaps of the vocal folds and false vocal folds. The anterosuperior portion of the thyroid cartilage is ablated. A small horizontal incision is made just above the anterior commissure and is continued posteriorly along the laryngeal ventricle; these incisions are continued across the posterior wall of the glottis. Incisions are made into the bilateral vocal folds and false vocal folds in order to create the hinged flaps. The glottis and the supraglottis are closed by approximating the bilateral vocal folds and false vocal folds hinged flaps. Superiorly or inferiorly based sternohyoid muscle pedicles are then inserted into the dead space between the approximated bilateral vocal folds and false vocal folds hinged flaps. The removed lamina of the thyroid cartilage is obliterated between both sternohyoid muscle flaps to enforce the closure of the larynx.

Nocturnal Hypermotor Seizures, Suggesting Frontal Lobe Epilepsy, Can Originate in the Insula

To report three patients with drug-resistant nocturnal hypermotor seizures (NHSs), no detectable brain lesion, and clinically defined nocturnal frontal lobe epilepsy (NFLE) or autosomal dominant NLFE (ADNFLE), whose intracerebral EEG ictal onset primarily involved the insula, rather than the mesial or orbital frontal cortex. Fourteen to 15 intracerebral electrodes were implanted in each patient, primarily sampling the frontal lobes with 80 to 91 recording leads covering the most likely side of seizure onset, and two to six leads placed within the ipsilateral insula. Electrical stimulation was used to test the epileptic threshold of frontal and insular brain regions at the various recording sites. In all three patients, a low-voltage fast activity was recorded within the anterosuperior aspect of the insula at ictal onset, either in isolation, or extending to the nearby frontal operculum in the ADNFLE patient. The role of the insula was further supported in all three patients either by the presence of high-amplitude spikes that clearly predominated over that region (n = 2) or by triggering the patient's typical aura or seizure when applying an electrical stimulation at that site, selectively (n = 2). The anterosuperior portion of the insula might play a pivotal role in generating nocturnal hypermotor seizures in some patients with nonlesional drug-resistant epilepsy suggesting NFLE or ADNFLE. Whether these patients are amenable to successful surgery remain an open issue.

Arterial supply of the glenoid: An anatomic study

Surgery is performed on the glenoid for a variety of pathologic conditions, and an adequate blood supply is required to achieve good healing of soft tissue and bone. The objective of this investigation was to study the arterial supply of the glenoid in 24 fresh human cadaveric specimens. The vascular supply originates from branches of the anterior and posterior circumflex arteries and the suprascapular artery and branches directly from the infraspinatus and teres minor muscles. The antero-superior portion of the glenoid is poorly vascularized, with a specific area that is completely devoid of blood supply. In addition, circumferentially around the glenoid rim, there is an area of approximately 5 mm from the edge that is completely devoid of vascularity. Adequate bone and soft-tissue healing in the glenoid, particularly in its anterosuperior portion, after fracture repair, osteotomy, total shoulder arthroplasty, and capsular procedures may be compromised by the demonstrated hypovascularity.

The Transverse Humeral Ligament

Background No study to date has isolated the anatomical nature of the transverse humeral ligament and its relationship to the biceps tendon and the anterosuperior portion of the rotator cuff. Hypothesis There is no separate identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed by fibers from the subscapularis and supraspinatus tendons. Study Design Descriptive laboratory study. Methods A total of 14 shoulder examinations were performed on 7 matched pairs of fresh-frozen cadaveric shoulders. Magnetic resonance imaging scans were performed, followed by gross and microscopic anatomical dissection. Results In the location of the transverse humeral ligament, magnetic resonance imaging and gross dissection revealed the continuation of superficial fibers of the subscapularis tendon from the tendon body across the intertubercular groove to attach to the greater tuberosity, whereas deeper fibers of the subscapularis tendon inserted on the lesser tuberosity. Longitudinal fibers of the supraspinatus tendon and the coracohumeral ligament were also noted to travel the length of the groove, deep to the other interdigitating fibers but superficial to the biceps tendon. Histologic studies confirmed these gross dissection patterns of fiber attachment and also revealed the absence of elastin fibers, which are more commonly seen in ligamentous structures and are typically absent from tendinous structures. Conclusion There is no identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed mainly by the fibers of the subscapularis tendon, with contributions from the supraspinatus tendon and the coracohumeral ligament. Clinical Relevance According to our findings, dislocations of the long head of the biceps must disrupt at least the deep fibers of the annular sling created mainly by the subscapularis tendon insertion. This finding provides anatomical support for the findings of a positive biceps tendon subluxation or dislocation and subscapularis tear during glenohumeral arthroscopy with a normal-appearing subscapularis during open surgery or subacromial arthroscopy.

Trans-tympanic silicone plug insertion for chronic patulous Eustachian tube

Conclusion. Trans-tympanic insertion of a new silicone plug seems to be useful for controlling the distressing symptoms of patients with a chronic patulous Eustachian tube (PET). Objective. To evaluate the effectiveness of a new silicone plug for blocking the isthmus of a PET in patients whose symptoms were resistant to other therapies for > 6 months. Material and methods. The silicone plug (total length 23–25 mm; tip diameter 1.0–2.0 mm) was inserted in 44 ears of 37 patients with chronic PET. It was inserted through the tympanic orifice of the ET to obstruct the isthmus of the tube via an incision in the anterosuperior portion of the tympanic membrane. Results. Insertion of the plug was possible in all except two ears, in which it failed because of a narrow tympanic orifice of the ET. In 11 ears of 10 patients, the plug was replaced by a larger one using the same approach to improve efficacy. Of the 42 ears in which the silicone plug was successfully inserted, 30 (71.4%) achieved relief from symptoms of PET without additional treatment. In > 60% of these cases, the symptoms of PET were well controlled with an aerated middle ear. The follow-up period ranged from 6 to 68 months (mean 38.9 months).

Probabilistic map of blood flow distribution in the brain from the internal carotid artery

Brain single photon emission computed tomographic (SPECT) images acquired after injecting Tc-99m-HMPAO into the internal carotid artery (ICA) during an intracarotid amobarbital procedure (IAP SPECT) provide anatomical information on the blood flow distribution from the ICA. In this study, probabilistic maps of the distribution of blood supply from the ICA were developed using the IAP SPECT images. Twenty-two sets of basal and IAP SPECT were collected from an existing database. IAP SPECT images were coregistered to basal SPECT images, and spatial normalization parameters used for basal SPECT images were reapplied to IAP SPECT for anatomical standardization. Pixel counts of IAP SPECT images were then normalized, and the probabilistic map of cerebral perfusion distribution (perfusion probabilistic map) for each hemisphere was determined by averaging the spatial/count-normalized IAP SPECT images. Population-based probabilistic maps representing the extent of ICA territory (extent probabilistic map) were also composed by averaging the binary images obtained by thresholding the spatially normalized IAP SPECT images. The probabilistic maps were used to quantify cerebral perfusion and reserve change after arterial bypass surgery in 10 patients with ICA stenosis. In the probabilistic maps, blood supply from the ICA was found to be most likely in the dorsolateral frontal lobe, the anterosuperior portion of the temporal lobe, and in the frontoparietal area. Of the subcortical regions, the striatum was found to be most likely to derive its blood supply from ICA. In patients with cerebral occlusive disease, improvements in basal perfusion and perfusion reserve in the bypass-grafted ICA territory were well identified and were increased by 6.2% and 4.6%, respectively, on average. The probabilistic maps developed in this study illustrate the perfusion distribution and extent of vascular territory for ICA and would be useful for objective evaluations of perfusion status in cerebrovascular disease.

Intravertebral clefts in osteoporotic vertebral compression fractures.

To describe the characteristics, radiographic appearance, and significance of intravertebral clefts in vertebral compression fractures (VCFs) of patients with osteoporosis presenting for vertebroplasty. This was a prospective radiographic study of 50 consecutive patients with 82 VCFs who underwent vertebroplasty at a tertiary referral center. Patients underwent imaging preoperatively with standing lateral and supine cross-table lateral radiographs and magnetic resonance imaging (MRI). Standing lateral radiographs were also obtained postoperatively. Clefts were defined at the time of vertebroplasty as confluent reservoirs for polymethylmethacrylate (PMMA). Postoperatively, all images were reexamined for the presence and characterization of intravertebral clefts. Twenty-four of 50 patients (48%) had clefted VCFs, and 30 of 82 VCFs (37%) contained clefts. Clefted VCFs were severe, dynamically mobile, and occurred primarily in the thoracolumbar junction. Clefts were detectable by standing lateral radiography in 14%, by supine cross-table radiography in 64%, and by MRI in 96% of fractured vertebrae. Clefts occurred primarily in the anterosuperior portion of the vertebral body, and cleft margins appeared increasingly sclerotic in persistently mobile VCFs. PMMA fill patterns of clefted and unclefted VCFs were distinct. Intravertebral clefts occur frequently in osteoporotic VCFs of patients who present for vertebroplasty. The radiographic characteristics of clefts evolve over time and can be indistinguishable from Kümmell's disease in severe, persistently mobile, clefted osteoporotic VCFs.

Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases.

Anterosuperior labral variations of the glenohumeral joint have been previously described and are thought to represent normal anatomical variants without any known clinical importance. The goals of this study were to characterize anterosuperior labral anatomical variations and to determine their prevalence and clinical importance. A total of 546 patients who had an arthroscopic procedure in the shoulder were prospectively evaluated for variations of the anterosuperior aspect of the labrum. Structural characteristics of the anatomical variants were noted and recorded intraoperatively. The relationships of these anterosuperior labral variations to demographic data, preoperative symptoms, findings on physical examination, and associated intra-articular abnormalities were analyzed statistically and compared with findings in patients with normal anterosuperior labral anatomy. Three distinct variations of the anterosuperior portion of the labrum were found in seventy-three patients (13.4%): a sublabral foramen only (eighteen patients; 3.3%), a sublabral foramen with a cord-like middle glenohumeral ligament (forty-seven; 8.6%), and an absence of labral tissue at the anterosuperior portion of the labrum with a cord-like middle glenohumeral ligament (eight; 1.5%). In multivariate analysis, the presence of one of these three variations revealed a significant positive association with anterosuperior labral fraying (p = 0.000), an abnormal superior glenohumeral ligament (p = 0.012), and increased passive internal rotation with the arm in 90 degrees of abduction (p = 0.046). These lesions were negatively associated with a painful arc sign and the presence of either a partial or full-thickness supraspinatus tendon tear. Statistical analysis revealed a clinical difference between the cord-like middle glenohumeral ligament variants and the sublabral foramen variant. Anterosuperior labral variants may influence glenohumeral biomechanics and may predispose the shoulder to other abnormalities. These variants are associated with increased internal rotation, which may predispose the shoulder to lesions of the superior glenohumeral ligament and anterosuperior portion of the labrum. These variations themselves do not appear to contribute to instability.

Quiste coloide del tercer ventrículo: descripción de un caso y revisión de la bibliografía

Colloid cysts are intracranial lesions with an estimated incidence of three individuals per million people per year. They are benign tumours in the anterosuperior portion of the third ventricle. The normal flow of cerebrospinal fluid may be interrupted by a large cyst that obstructs the foramen of Monro. The associated signs and symptoms cover a wide range of features, from non specific headaches to intracranial hypertension data; some colloid cysts occur at the acute onset of hydrocephalus and can lead to a sudden death. We present the case of a patient with a colloid cyst in the anterior roof of the third ventricle, with the presence of a dysfunctional ventriculo peritoneal bypass valve, which had been introduced three years earlier. Both events contributed to the development of a hydrocephalus with clinical manifestations of intracranial hypertension. The images obtained by magnetic resonance (MR) revealed the presence of a hyperintense mass of variable density in the roof of the third ventricle and in its rostral face; the image was hyperintense in T1 and isointense in T2. The patient was submitted to an endoscopic cisternoventriculostomy to allow the surgical drainage of the colloid cyst, and management was continued in the outpatients department of the Neurosurgery Service. In this paper we discuss the main characteristics of the colloid cyst, some considerations on its presentation in MRI are presented and a brief survey of the literature is also conducted.

Colloid cyst of the third ventricle: cytomorphologic features on stereotactic fine-needle aspiration.

Stereotactic brain fine-needle aspiration (FNA) is a valuable diagnostic modality for evaluating space-occupying central nervous system disorders. Colloid cyst (CC) is a rare nonneoplastic lesion thought to arise from misplaced endodermal tissue in the anterosuperior portion of the third ventricle. This study summarizes cytomorphologic features of CC on FNA along with clinical, radiologic, and histopathologic correlation. Ten cases of CC of the third ventricle diagnosed on FNA were retrospectively reviewed for a period of 12 yr (1989-2000). Material was obtained under stereotactic radiologic guidance. Smears were stained with Diff-Quik and Papanicolaou stains and cell block sections with hematoxylin and eosin. The aspirates showed a characteristic sticky and viscous quality on gross examination. Smears showed abundant, amorphous, proteinaceous material with staining qualities similar to colloid aspirated from thyroid. This included a purplish, filmlike coating of the slide with occasional "cracking" artifact; thick, globular, eosinophilic fragments; and granular, ropelike, and somewhat viscous, mucinous material. Pathognomonic radiating hyphae-like structures were not seen. The cellular components varied from isolated cuboidal/columnar cells to large tissue fragments of glandular-type epithelium with focal ciliated border. Goblet cells were frequently identifiable, as were fragments of collagenous cyst wall. Stereotactic FNA of the CC of the third ventricle is an accurate and cost-effective diagnostic modality. Cytomorphology coupled with the radiologic features is sufficiently unique for the diagnosis of this rare pathologic entity.

放射状ＭＲＩと股関節鏡の関節唇所見の比較

Between February and September of 2000, we carried out radial magneic resonance imaging (MRI) on 8 hips consisting of 5 pre-osteoarthritis and 3 early stage osteoarthritis. There were 7 female patients with a mean age of 28 years (age range: 16-50 years). The radial MRI results were compared with intraoperative arthroscopic findings. In the weight-bearing portion, from 45° ante rosuperior to 45° posterosuperior, all patients had various tears of the acetabular labrum. In the anterosuperior portion, 4 hips (50%) showed imcomplete tears, 3 hips (38%) showed complete tears, and only 1 hips (18%) showed intact labrum. In the superior portion, each of the 3 hips (38%) showed imcomplate and complete tears. In the posterosuperior portion, each of the 3 hips (38%) showed imcomplete tears and intact labrum. The arthroscopic normal labrum was clearly depicted as a homogenous triangular area of low signal intensity. The incomplete tears were depicted as a moderate signal intensity or central high signal intensity. The complete tears were depicted as a diffuse and obscure high signal intensity. We conclude that radial MRI may be a useful non-invasive diagnostic method for tears of the acetabular labrum in oseoarthritis.

Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging

Size and location of a necrotic lesion are considered important factors predicting collapse of the femoral head in the early stages of osteonecrosis. However, few analytical studies have performed a three-dimensional quantification of lesions to clarify how these two morphological factors are related to the occurrence of collapse. We evaluated the relevance of lesion size and location for prediction of collapse quantitatively using new three-dimensional indexes. Magnetic resonance (MR) imaging was performed in 65 hips in a consecutive series of 47 patients with osteonecrosis without radiological evidence of collapse. Lesion volume as well as latitude and longitude of the center of gravity of the lesion within the femoral head were calculated. Thirty-three hips developed radiological collapse, while in the remaining 32 hips collapse did not occur over 2 years. Multiple logistic regression analysis showed a significant relationship between lesion volume and radiological collapse. In 35 hips in which the lesion volume was less than 30% of the femoral head, only 9 collapsed. In comparison with non-collapsed hips, collapsed hips had a significantly higher combined value for latitude and longitude of the lesion, corresponding to the anterosuperior portion of the femoral head. Quantitative analysis of lesion morphology demonstrated that lesion volume is strongly correlated with risk of collapse, and that lesion location is an important prognostic indicator of collapse in small necrotic lesions.

Characteristic Features of the Acetabular Labrum in Healthy Children

Summary: Radial magnetic resonance images of the acetabular labrum were obtained on 40 hips of healthy children. There were no right-left or male-female differences. In children aged 11 years or younger, the labrum on the antero-superior weightbearing portion was triangular in shape, and there was an insular-shaped or linear high-intensity area inside; on the mid-superior portion, the labrum appeared as a regular triangular, low-intensity area; and on the postero-superior portion, it was flat. In children aged 12 and 13 years, the shape of the labrum in each portion was similar to that of the younger children, but the high signal intensity area on the antero-superior portion appeared less frequently. The size of the labrum relative to the femoral head was greater in younger children.

Characteristic Features of the Acetabular Labrum in Healthy Children

Summary: Radial magnetic resonance images of the acetabular labrum were obtained on 40 hips of healthy children. There were no right-left or male-female differences. In children aged 11 years or younger, the labrum on the antero-superior weightbearing portion was triangular in shape, and there was an insular-shaped or linear high-intensity area inside; on the mid-superior portion, the labrum appeared as a regular triangular, low-intensity area; and on the postero-superior portion, it was flat. In children aged 12 and 13 years, the shape of the labrum in each portion was similar to that of the younger children, but the high signal intensity area on the antero-superior portion appeared less frequently. The size of the labrum relative to the femoral head was greater in younger children.