Branches Of Carotid Artery Research Articles

Can immediate reconstruction with submandibular gland transposition broaden indications for transoral surgery for tonsillar cancer?

e18054 Background: Stratification based on pathologic parameters allows for reduced adjuvant radiotherapy in intermediate risk and observation alone for low risk oropharyngeal p16+ cancer (E3311 ECOG-ACRIN trial). Selection for transoral surgery (TOS), usually robotically assisted, for tonsillar cancers depends on the size and invasiveness of the primary tumor, involvement of adjacent parts such as the soft palate, proximity to external carotid artery branches, medial ipsilateral carotid artery that might be exposed with radical resection, and the likelihood of substantial communication between the oropharynx and internal neck structures. Postoperative recovery can be associated with substantial pain and dysphagia and a length of stay of > 5 days. There is a paucity of simple options for sealing the neck from the pharynx to prevent neck infection, exposure of larger vessels and salivary fistula, so large and deep tonsillar cancers are usually given chemoradiation. Larger surgical defects healing secondarily tend to require longer recoveries due to dysphagia and odynophagia. Methods: A prospective study of vascularized ipsilateral submandibular gland transposition flaps to primarily repair the surgical defect after TOS to resect previously untreated tonsillar cancers was performed from 2019 to 2022. A total of 19 patients underwent resection and repair. These included those with cancers extending to the soft palate (4) and medial position of internal carotid artery adjacent to the tumor (1). All had obvious communication between the neck and the pharynx after TOS, and had branches of the facial and external carotid arteries to the deep resection site ligated with neck dissection, prior to TOS. The submandibular gland flaps were sewn in place using robot assistance and hand. One patient had an extended flap with accompanying submental skin to repair the soft palate. Results: Partial dehiscence superiorly at the palate was the most common complication at 11%. None developed salivary fistulas or deep neck infections. Iatrogenic facial artery pedicle injury that was repaired occurred in one case. Oral intake was started at 1-3 days and length of stay averaged 5 days. There were no bleeding episodes at the TOS sites of cancer resection. All resections had clear margins. All submandibular gland flaps survived, with one patient having attached adipose tissue debrided in the office, healing uneventfully thereafter. Conclusions: The ability to primarily repair after resection of more extensive tonsillar cancers, that leave large communications between the pharynx and the neck, with a readily accessible and easy to harvest submandibular gland flap may change those previously selected for chemoradiation to be able to have TOS instead as initial treatment. This would allow for more pathological risk assessment of tonsil cancers and decreased adjuvant treatment when appropriate.

Surgical Strategy for Ethmoidal Dural Arteriovenous Fistula

Ethmoidal dural arteriovenous fistula (DAVF) is a rare type of intracranial DAVF. The aim of this study was to report our experience with a unilateral approach and discuss its effectiveness for ethmoidal DAVF treatment. The study included 19 patients who underwent surgical treatment for ethmoidal DAVF between January 1999 and May2021. Median age of patients was 59.7 years; 16 (84%) patients were male. Three patients had a ruptured ethmoidal DAVF. Preoperative digital subtraction angiography showed that all ethmoidal DAVFs were supplied by the bilateral external carotid artery branches. In 18 (95%) patients, cortical draining veins were located on the unilateral side. Bilateral lesions were identified in only 1 (5%) patient. The frontobasal approach was performed in 5 patients (26%), the pterional approach was performed in 5 (26%) patients, and the lateral supraorbital approach was performed in 9 (47%) patients; median procedural times were 198 minutes, 172 minutes, and 111 minutes, respectively. Cortical draining vein was successfully disconnected in all 19 patients with 20 ethmoidal DAVFs. Complete obliteration of ethmoidal DAVF was confirmed in all patients, with no postoperative complications. No recurrence or related clinical events were reported in 13 (68%) patients over 12 months of clinical and radiological follow-up. We reconfirmed excellent outcomes of surgical treatment for ethmoidal DAVFs. Three different surgical strategies were attempted, and each had pros and cons. The lateral supraorbital approach is an efficient surgical option for unilateral ethmoidal DAVFs. Careful preoperative examination for the presence of bilateral drainage is essential.

Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation.

There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non-flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%-5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

Efficacy of non-obstructive aortic angioscopy for detecting a thoracic aortic graft rupture: a case report

BackgroundNon-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and detect the locations of abnormal findings, while aortic angioscopy can detect vulnerable plaques in the aorta, which are difficult to visualize using conventional diagnostic methods. Herein, we report the case of a patient with non-anastomotic thoracic aortic graft rupture diagnosed using non-obstructive aortic angioscopy.Case presentationAn 85-year-old man who had undergone total arch replacement 5 years prior complained of chest pain. Emergent contrast-enhanced computed tomography (CT) revealed an intra-mediastinal hematoma around the vascular graft of the ascending aorta and angiography revealed pooling of contrast medium on the dorsal side of the vascular graft. We suspected extravasation of the thoracic vascular graft. Aortic angioscopic examination revealed a red vascular graft defect that matched extravasation at the contralateral level of the prosthetic left common carotid artery branch. Subsequently, non-anastomotic thoracic aortic graft rupture was diagnosed. The patient underwent a two-debranching thoracic endovascular aortic repair (Zone 0) with a right subclavian artery-left common carotid artery-left subclavian artery bypass. Postoperative angiography revealed disappearance of the extravasation from the graft rupture site, patent grafted vessels with flow, and no endoleak. Follow-up CT at 6 months postoperatively showed no extravasation.ConclusionsTo our knowledge, this is the first report of non-anastomotic thoracic aortic graft rupture detected using non-obstructive aortic angioscopy. Aortic angioscopy can help establish a definitive diagnosis in patients with aortic graft rupture.

30-Day Morbidity and Bleeding Rates Associated with Transoral Robotic Surgery for HPV Associated Oropharyngeal Squamous Cell Carcinoma: A Retrospective Analysis of Two Prospective Adjuvant Radiotherapy Deescalation Trials (MC1273 & MC1675)

<h3>Purpose/Objective(s)</h3> MC1273 and MC1675 were phase II and III clinical trials examining deescalated adjuvant chemoradiation after margin negative resection for HPV(+)OPSCC. We examine 30-day morbidity and mortality associated with primary transoral robotic (TORS) surgical resection in patients enrolled in these trials. We hypothesize that TORS was associated with low surgical morbidity. <h3>Materials/Methods</h3> Enrollment criteria and the DART regimen utilized in MC1273/MC1675 have been reported. Patients were accrued from 2013-2020. For this analysis, patients undergoing any TORS procedure were included. Prospective study data and retrospective chart review were utilized to identify events. The severity of postoperative transoral bleeding was graded using the Hinni transoral surgery bleeding scale (Grade 0 – none, Grade 1: expected postoperative blood-tinged mucous, Grade 2: resolved without operative intervention, Grade 3: venous bleed requiring cautery, Grade 4: arterial bleed requiring ligation or embolization, Grade 5: life-threatening bleed, Grade 6: death). Continuous variables using mean (SD) and categorical variables were summarized using frequency (%). <h3>Results</h3> 218 patients were included in this retrospective analysis. The mean (SD) age of the cohort was 58.9 (8.2), and 193 (88%) were male. The majority (n=146, 67%) were never smokers. TNM 8^th Edition AJCC staging for patients was as follows: pT1: 80 (37%), pT2: 108 (50%), pT3: 24 (11%), pT4: 6 (3%), pN0: 1 (<1%), pN1: 186 (85%), pN2: 31 (14%). All patients had negative margins, underwent concurrent neck dissection, and the majority (n=196, 90%) had prophylactic ligation of external carotid artery branches in the ipsilateral neck. The mean (SD) length of hospital stay was 3 (4) days. A total of 7 (3.2%) patients required tracheostomy placement at the time of surgery, and all were decannulated within 26 (median: 5, range: 2-26) days of surgery. NGT placement occurred in 98 (45%) patients, with 92% (n=90) removed within 30 days of surgery. Two (1%) patients underwent PEG placement prior to or within 30 days of surgery. There were 32 (15%) returns to the emergency department (ED) within 30 days. 10 (5%) patients required readmission. 7 (3.2%) patients experienced ≥ Grade 3 bleeding (Grade 3: 6; Grade 4: 1), with no Grade 5/6 bleeds. Other postoperative complications included 1 cardiac event (0.5%), 5 chyle leaks (2.3%), 1 pulmonary embolus (0.5%), 1 deep venous thrombosis (0.5%), 2 surgical site infections (0.9%), 1 seroma (0.5%), and 2 hematomas (0.9%). There were no treatment related deaths. <h3>Conclusion</h3> TORS for HPV(+)OPSCC in carefully selected patients undergoing a deescalation protocol at a high volume center was associated with low morbidity and zero mortality. ED return rates of 15%, readmission rates of 5%, and intervention rates of 3% for postoperative bleeds are all comparable to rates after routine pediatric tonsillectomy.

Embolization of Skull Base Meningiomas with Embosphere Microspheres: Factors Predicting Treatment Response and Evaluation of Complications

Preoperative embolization for intracranial meningiomas can cause tumor necrosis, reduce intraoperative blood loss, and facilitate surgery. This study aimed to evaluate the efficacy of tumor embolization using Embosphere microspheres for skull base meningiomas and analyze postembolization plain computed tomography (CT) and magnetic resonance imaging (MRI) scans to identify findings that could potentially predict treatment response. Between April 2014 and April 2020, 80 patients with skull base meningiomas presenting at our medical center underwent embolization with Embosphere microspheres. The effects of tumor embolization were evaluated through a comparison of postembolization plain CT and contrast-enhanced MRI. A total of 143 vessels (102 of 108 external carotid artery branches and 41 of 65 internal carotid artery branches) from 80 skull base meningiomas were embolized with Embosphere microspheres. Microspheres 100-300 μm in size were used in 2 cases, microspheres 300-500 μm in size were used in 12 cases, and microspheres 500-700 μm in size were used in 66 cases. Postembolization contrast-enhanced MRI showed reductions in enhancing lesions within the tumor in 55 of 80 cases. Postembolization plain CT scans showed high-density lesions within the tumor in 41 of 55 cases. Thus, reductions in enhancing lesions on postembolization contrast-enhanced MRI were statistically significantly associated with the presence of high-density lesions on postembolization plain CT (P < 0.001). Embolization-related neurological complications occurred in 3 cases. Embosphere microspheres are user friendly and effective embolic materials for the embolization of skull base meningiomas. Postembolization contrast-enhanced MRI and plain CT findings may be useful for evaluating the effects of tumor embolization.

Identifying feeding artery during preoperative embolization of juvenile nasopharyngeal angiofibroma

Treatment of choice and standard of care is surgical resection of the tumor. Nasopharyngeal angiofibromas receive an abundant blood supply mainly from the external carotid branches and partly from the internal carotid artery branches. Many patients are treated with preoperative embolization to minimize the risk of intraoperative hemorrhage and related complications . This retrospective study, we obtained analysis of the medical and imaging records of 11 patients with pathologically proven juvenile nasopharyngeal angiofibroma. Who we performed preoperative endovascular embolization between January 2019 until Desember 202 in Wahidin Sudirohusodo Hospital, Makassar, Indonesia. The procedure was carried out using a cathlab monoplane Philips. A total 11 patients (only 1 female) with juvenile nasopharynx angiofibroma underwent endovascular embolization from 2019-2021 in Wahidin Sudirohusodo Hospital Makassar. Arteriography examination in patients with angiofibroma tumors revealed that the feeding arteries originate from the internal maxillary artery, ascending pharyngeal artery, fascial artery, middle meningeal artery and branches of the internal carotid artery. Identifying the feeding artery before embolization is very important to facilitate the embolization process

Giant cell arteritis involving the facial artery – A case report of an unusual presentation

Giant cell arteritis is a large vessel vasculitis. It involves the superficial temporal artery in 100% of cases.1 It has been known to involve other arteries with varying manifestations. Only a few case reports of giant cell arteritis involving the facial arteries are available. Cranial manifestations of giant cell arteritis such as jaw claudication, facial swelling, dental pain and unusually overt necrosis of the tongue are the result of involvement of branches of external carotid artery, including the facial artery.2 However, to the best of our knowledge, jaw swelling as an initial presentation of giant cell arteritis has been reported only infrequently.2 We present the case of a 71-year-old male with giant cell arteritis involving the facial artery who presented with jaw swelling as the initial presentation.

Computed tomography-assessed variations of the carotid sinus.

Previous studies have identified variations regarding the morphology and location of the carotid sinus, a phenomenon still not commonly approached or studied on computed tomography angiography (CTA). Detailed characterization of the carotid sinus was performed on CTAs, determining its position, diameter and length. The study group included 43 patients with disease-free carotid trunks subjected to cervical CTA. We measured the terminal caliber of the common carotid artery (CCA), as well as the calibers of the internal (ICA) and external carotid arteries (ECA) at their origin. The diameters were correlated with the location and the shape of the carotid sinus. We also measured the length of the sinus dilatation (carotid bulb), in regard to its location on the terminal branches of the common carotid artery. Mean diameters of the studied arteries were 7.39 ± 1.04mm for the CCA, 6.71 ± 1.49mm for the ICA and, respectively, 4.27 ± 0.75mm for the ECA. The classical position of the carotid sinus was seen in 80% of cases, the rest being considered anatomical variants. The length of the carotid bulb on the ICA was 9.99 ± 2.22mm, showing variability between genders. The carotid sinus does not always extend to the ICA, presenting different distribution patterns that might be relevant in sinus pathology from a clinical point of view, respectively from a surgical point of view during invasive or minimally invasive interventions on the carotid axis.

Carotico-cavernous fistula - From the eye of an ophthalmologist

Carotid-cavernous fistulas (CCFs) are spontaneous or acquired abnormal connections between the cavernous sinus and the carotid arterial system. It can be a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or an indirect one between the cavernous sinus, and one or more meningeal branches of the internal carotid artery, external carotid artery, or both. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features such as decreased vision, conjunctival chemosis, external ophthalmoplegia and proptosis. A high index of suspicion in a case without any history of trauma and collagen vascular disease is the key factor. Prompt diagnosis of intravascular malformations at initial presentation can prevent ophthalmological complications and vision loss. Conventional treatments include carotid ligation and embolization, with minimal significant morbidity or mortality. A team approach including neurosurgeons, emergency physicians and ophthalmologists is needed for the proper management of such patients. Ophthalmologists may be the primary attending physician; therefore, this review aims to help understand the diagnostic approach and possible modes of treatment with expected outcomes.

Hybrid Treatment of Unresectable Sublingual Hemangioma

Vascular anomalies have categorized as two groups, hemangiomas and vascular malformations. Most of vascular anomalies have located superficially in the regions of the head and the neck. The growth period of deep hemangiomas occurs later than that of superficial hemangiomas. The accepted method of treatment of vascular malformations and hemangiomas, which can be life-threatening and can not be resected in this way, is the method of ligation or occlusion of blood vessels. The feeding vessels usually originate from the branches of external carotid artery or the main trunk of the external carotid artery. The aim of this report is to describe our approach to a patient with symptomatic non-resectable sublingual hemangioma.

Buddy Catheter Technique: A Method of Guiding the Mo.Ma Ultra into a Left Common Carotid Artery That Branches off the Aortic Arch at a Steep Angle.

The Mo.Ma Ultra is an embolic protection device used in carotid artery stenting (CAS). In cases of left internal carotid artery stenosis (ICS) in which the common carotid artery (CCA) branches off the aortic arch at a steep angle, insertion of the Mo.Ma Ultra into the CCA is sometimes difficult. We introduce a "buddy catheter technique" that helps guide the Mo.Ma Ultra into the CCA, with an additional 4 Fr catheter into the external carotid artery. An 84-year-old man with left ICS whose CCA also branched off the aortic arch at a steep angle also underwent CAS. The "buddy catheter technique" was used, and the Mo.Ma Ultra was inserted smoothly. The buddy catheter technique displaces the left CCA upward. Displacement straightens the vessels anatomically, and the ledge effect can be prevented by aligning the course of the vessels with the wire. Nevertheless, this technique requires bilateral femoral puncture, and so, complications can occur. The buddy catheter technique may be considered in cases in which the left CCA branches off the aortic arch at a steep angle.

Kinetics of Mononuclear Cell Subpopulations in the Peripheral Blood of Patients with Giant Cell Arteritis During the Acute Phase of the Disease: The Role of Steroids.

Background/Aim:Giant cell arteritis (GCA) represents the most prevalent form of systemic vasculitis in the elderly, primarily affecting the temporal artery, the extracranial branches of carotid arteries, and the aorta. GCA is a highly heterogeneous disease in terms of clinical and histological findings, pathophysiology, and treatment selection strategies. The disease is highly responsive to glucocorticosteroids (GCs), but almost half of patients may relapse following GCs tapering. The main hypothesis of GCA pathogenesis includes altered immune responses and changes in the vascular microenvironment, leading to a dynamic interplay between innate and adaptive immunity. The aim of this study is to explore the effect of GCs on the phenotype of peripheral mononuclear cell subpopulations and on the major inflammatory molecules detected in the peripheral blood of patients during the acute phase of the disease.Methods:Patient PBMCs will be studied using Cytometry by time of flight (CyTOF). Following the CyTOF analysis, Luminex Assay will be performed on the same patient samples to identify the kinetics of the most prominent inflammatory mediators correlating with the subpopulations detected. Patient population consists of 8 patients with GCA, 6 with polymyalgia rheumatica, as disease control group and 5 healthy controls (sex and age matched) at 3 time points: disease diagnosis, 48 and 96 hours after treatment administration.Conclusion:The identification of potential alterations in cell subpopulations and the kinetics of inflammatory mediators are expected to lead to the production of new knowledge regarding the role of corticosteroids in the phase of acute inflammatory response.

Dual-phase contrast-enhanced CT evaluation of dural arteriovenous fistula in patients with pulsatile tinnitus as an initial symptom

PurposeIntracranial dural arteriovenous fistula (DAVF) can cause pulsatile tinnitus (PT). The purpose of this study was to investigate the diagnostic performance of dual-phase contrast-enhanced CT (DP-CECT) for DAVF in PT patients compared with digital subtraction angiography (DSA). MethodFrom February 2015 to April 2021, PT patients undergoing routine DSA examination were prospectively analyzed. Patients with and without DAVF diagnosed by DSA were included. In DP-CECT, the radiological signs related to DAVF were assessed as follows: asymmetric external carotid artery (ECA) branches, asymmetric enhancement of intracranial or extracranial veins, asymmetric venous collaterals in extracranial space, and shaggy tentorium or venous sinus on CTA; asymmetric enhancement of intracranial or extracranial veins on CTV; numerous transcalvarial channels and asymmetric size of foramen spinosum on high-resolution CT (HRCT). Results253 PT patients receiving DSA were enrolled, and these patients had previously been screened by DP-CECT. Forty-six patients were diagnosed as DAVF by DSA. Therefore, the prevalence of DAVF was 18% (46/253) in patients with PT as the initial symptom. The sensitivity and specificity of DP-CECT for diagnosis of DAVF were 96% and 100%. The sensitivity of individual CTA signs ranged from 65% to 93%, and specificities ranged from 83% to 100%. The sensitivity of CTV sign was 80%, and specificity was 100%. The sensitivity of individual HRCT signs ranged from 48 to 52% and specificities from 61 to 100%. ConclusionsDAVF is not rare in patients with PT as the initial symptom. DP-CECT can be used for screening DAVF in patients with PT.

Revisiting carotid endarterectomy: Neobulb technique using external carotid artery as a patch.

This study describes an alternative carotid bifurcation endarterectomy technique in which the external carotid artery is used as a suture patch. Charts of ten patients with atherosclerotic carotid stenosis that were treated using the neobulb technique between 2002 and 2019 were reviewed. No major surgical adverse event was observed in the postoperative assessments. No postoperative common or internal carotid stenosis was observed in the mid- or long-term follow-up. The neobulb technique allows carotid endarterectomy closure without a synthetic or venous patch, using the external carotid artery as an autologous patch, while preserving distal flow into the external carotid artery branches.

Macroanatomical comparison and examination of external carotid artery and last branches in the abaza (capra aegagrus) and gurcu (capra falconeri) goats

The aim of this research is to macroanatomically compare and examine the arteria (a.) carotis externa and its last branches that provide arterial vascularization of the head region of Abaza and Gurcu goats. For this purpose, a total of 10 Abaza and 10 Gurcu goat heads were used. In both goat breeds, a. carotis communis continued as a. carotis externa. In both goat breeds, according to the vein order not taking place in nomina veterinaria anatomica, a common stem belonging to a. temporalis superficialis and a. transversa faciei was observed. In addition to this common stem, the presence of a common stem belonging to a. malaris and a. infraorbitalis, not mentioned in the nomina, in both goat breeds was detected. In Gurcu goats, 70% of the materials disappeared by getting thinner after being seperated from a. carotis externa of a. lingualis dextra. As a result, although the distribution of a. carotis externa in the head region of Abaza and Gurcu goats is generally similar to other small ruminants, some differences were determined in the origin points, courses and the number of sub-branches of the branches originating from the a. carotis externa.

Investigation of Altered Spontaneous Brain Activities in Patients With Moyamoya Disease Using Percent Amplitude of Fluctuation Method: A Resting-State Functional MRI Study.

Background: Moyamoya disease (MMD) is a chronic progressive cerebrovascular abnormality characterized by chronic occlusion of large intracranial vessels with smoky vascular development at the base of the skull. In patients with MMD, abnormal spontaneous brain activity would be expected.Purpose: To assess the brain activity changes in patients with MMD by resting-state functional MRI (rs-fMRI), using the percent amplitude of fluctuation (PerAF) analysis method.Materials and Methods: A total of 17 patients with MMD (3 males and 14 females) and 17 healthy control (HC) subjects with matched gender and age were recruited for this study. We used rs-fMRI to scan all the patients with MMD. Spontaneous neural activity was evaluated using the PerAF approach. The receiver operating characteristic (ROC) curve analysis was used to assess the ability of the PerAF to distinguish patients with MMD from HCs. The Hospital Anxiety and Depression Scale (HADS) tests were performed to assess the emotional status of patients with MMD and retinal nerve fiber layer thickness (RNFLT) was measured using high-resolution optical coherence tomography (hr-OCT). The relationship between the HADS scores, RNFLT values, and the PerAF signals was assessed using the Pearson's correlation analysis.Results: Compared with HCs, the PerAF signals in patients with MMD were decreased in the Frontal_Sup_Medial_R and Precentral_L, whereas those in the Caudate_L were increased. The areas under the ROC curves indicated that signals in these brain regions could distinguish between patients with MMD and HCs. The PerAF value of Frontal_Sup_Medial_R was positively correlated with the left and right eye RNFLT values and negatively correlated with the HADS scores.Conclusion: In patients with MMD, reduced PerAF signals in the Frontal_Sup_Medial_R, Precentral_L, and Caudate_L may be associated with psychiatric diseases including anxiety and depression and decreased RNFLT may be associated with ophthalmic complications due to the compression of terminal branches of the internal carotid artery in the retinal fiber layer. The PerAF can be used as an effective indicator of ocular complications of MMD and to study the neural mechanism underpinning emotional complications in patients with MMD.

Effect and Mechanism of Lidocaine Pretreatment Combined with Dexmedetomidine on Oxidative Stress in Patients with Intracranial Aneurysm Clipping.

This study aimed to explore the effect and mechanism of lidocaine pretreatment combined with dexmedetomidine on oxidative stress in patients with intracranial aneurysm clipping. Many studies have used various drugs such as lidocaine to explore the effect and mechanism of lidocaine pretreatment. A total of 80 patients with intracranial aneurysm clipping surgery were randomly divided into 4 groups: the single lidocaine group, single dexmedetomidine group, lidocaine combined with dexmedetomidine group, and control group. The thread embolism method was used to establish a stable intracranial aneurysm model of Hashimoto rats. Fifty adult rats were randomly divided into a sham operation group, ligation of the left common carotid artery and bilateral posterior branch of renal artery, lidocaine group, dexmedetomidine group, and lidocaine combined with dexmedetomidine group. The colorimetric method was used to determine the oxidative stress indicators in brain tissue: MDA content, SOD activity, and T-AOC content. The western blot method characterized the protein levels related to oxidative stress: nNOS, iNOS, and NADPH oxidase subunits p22phox, gp91phox, and p47phox. The differences in each index between the groups were statistically significant (P < 0.05). Animal experiment results revealed that the content of MDA in the brain tissue of rats in the LD group was significantly lower than that in the single-drug group and sham group. The T-AOC and SOD concentrations in the LD group were significantly higher than those in the single-drug group and sham group, and the differences between the groups were statistically significant (P < 0.05). The protein expression of the LD group was significantly lower than that of the drug-alone group and model group, and the difference between groups was statistically significant (P < 0.05). To sum up, lidocaine pretreatment combined with dexmedetomidine can effectively maintain the hemodynamic stability of patients with intracranial aneurysm clipping and reduce postoperative oxidative stress response. Its mechanism of action may be related to the inhibition of oxidative stress damage mediated by nNOS, iNOS, and p22phox, gp91phox, and p47phox in the hippocampus. Our study has significant and applicable medical aspects in lidocaine pretreatment combined with dexmedetomidine on oxidative stress in patients.

The first historical description of chronic subdural hematoma: A tale of inaccurate interpretation, inaccurate quoting and inaccurate requoting

ABSTRACT Most historical articles have named Johann Jacob Wepfer as the first author to describe a case of chronic subdural hematoma (CSDH). However, the question arises whether these cases truly describe CSDH. Two other names that appear in literature as the first authors to describe a case of CSDH are Thomas Willis and Giovanni Battista Morgagni. In our attempt to find the first description of a CSDH, we studied the original cases described by Willis, Wepfer, and Morgagni. The cases described by Willis and Wepfer cannot be interpreted as cases of CSDH. Willis’s university scholar is more likely to have experienced venous infarction with an underlying septic thrombosis than a CSDH. Wepfer’s cases seem to represent an intraparenchymal hemorrhage from the rupture of a branch or branches of the internal carotid artery, a subarachnoid hemorrhage complicated with hydrocephalus, and a hydrocephalus in tuberculous meningitis. Morgagni’s case described in Letter III, Article 20 in the Sedibus in 1761 seems to be the first accurate historical description of a CSDH, and we believe it should be cited as such. With these early cases of alleged CSDH, we emphasize the importance of misquotation and blind copying of references, which are important citation errors.

EP.WE.78Variation in the Branching Pattern of the Anterior Branches of the External Carotid Artery

Abstract Aims The external carotid artery (ECA) shows a variable branching pattern of its stemming vessels. The aim of this study is to investigate the origin of the three primary anterior branches of the external carotid artery (ECA): the superior thyroid (STA), lingual (LA), and facial arteries (FA). Methods The branching pattern of the external carotid artery was studied on 15 Thiel embalmed cadavers of Scottish population (7 males and 8 females). The carotid triangle was dissected bilaterally in order to uncover the common carotid (CCA), internal carotid (ICA) and external carotid arteries (ECA). Moreover, the origin sites of the main anterior branches of the ECA (STA, LA and FA) were assessed in relation to the carotid bifurcation (CB) and with regard to sex and side. Results The STA was found to arise more frequently from the ECA (60%) than from the CCA (40%). Regarding the assessment of the branching patterns of the external carotid artery, the specimens where the STA, LA and FA emerged as individual branches were 90% of cases. The distances from the vessel origin site to the CB were found to be (8.11 ± 2.77), (19.38 ± 8.85) and (27.95 ± 10.15), for the STA, LA, and FA respectively. Conclusions In-depth knowledge of the branching pattern of the external carotid artery is of great importance. The current findings have confirmed that the ECA branching pattern is highly variable. Therefore, considering some radiological imaging before conducting any invasive procedure in the neck region could be vital to prevent iatrogenic injuries.