Foramen Area Research Articles

Risk factor of contralateral radiculopathy following microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion.

Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is an advantageous method for treating lumbar degenerative disease; however, some patients show contralateral radiculopathy postoperatively. This study aims to investigate its risk factor. A total of 130 cases who underwent microendoscopy-assisted MIS-TLIF at L4-5 level were divided into symptomatic and asymptomatic groups according to the presence of postoperative contralateral radiculopathy. Both preoperative and postoperative radiographic parameters, as well as their changes were compared between the two groups, including lumbar lordosis (LL), surgical segmental angle (SSA), disc height (DH), contralateral foramen area (CFA) and contralateral canal area (CCA). Screw breach on contralateral L4 pedicle and decompression method (ipsilateral or bilateral canal decompression through unilateral route) were also analyzed as potential risk factors. Receiver operating characteristic (ROC) curve was drawn for the risk factor to determine the optimal threshold for predicting postoperative contralateral radiculopathy. Besides, clinical outcome assessment, involving Visual Analog Score (VAS) for back and leg, Japanese Orthopaedics Association Score (JOA) and Oswestry Disability Index (ODI), was also compared between the two groups before surgery and at final follow-up (at least 3months after the surgery for asymptomatic patients or final treatments of contralateral radiculopathy for symptomatic cases). Postoperative contralateral radiculopathy occurred in 11 (8.5%) of the 130 patients. Both preoperative and postoperative CFA as well as its change were significantly decreased in symptomatic group compared with asymptomatic group (all P<0.05). For the remaining four parameters (LL, SSA, DH, CCA), their preoperative, postoperative and change values showed no statistical difference between the two groups (all P>0.05). Neither screw breach nor decompression method revealed statistical association with this complication (both P>0.05). Based on ROC curve, the optimal threshold of preoperative CFA was 0.76cm2. At final follow-up, significant improvement in VAS (back and leg), JOA and ODI was observed in both groups compared with preoperative baseline (all P<0.05), while no difference was found between the two groups (all P>0.05). Preoperative contralateral foramen stenosis is the risk factor of contralateral radiculopathy following microendoscopy-assisted MIS-TLIF. If preoperative CFA at L4-5 level is not larger than 0.76cm2, prophylactic measures, including both indirect and direct decompression of contralateral foramen, are recommended.

Area of Ostectomy in Posterior Percutaneous Endoscopic Cervical Foraminotomy: Images and Mid-term Outcomes.

Study DesignRetrospective.PurposeTo analyze whether the cross-sectional area of the intervertebral foramen at the outermost edge of the resection site is associated with postoperative outcomes and whether our fluoroscopic method for determining the resection area is appropriate.Overview of LiteratureThere is no consensus on the criteria for determining an optimal resection area to obtain sufficient decompression while maintaining intervertebral stability in posterior percutaneous endoscopic cervical foraminotomy. Previous reports have recommended a facet resection rate (FRR) of ≤50%. Intervertebral foramen stenosis often extends to the exit zone. The cross-sectional area of the intervertebral foramen is occasionally small at the outermost edge of the resection site. No report has analyzed whether these aspects are associated with postoperative outcomes.MethodsLateral margins of the resection area were set at lateral borders of the vertebral body on frontal fluoroscopic view. Because the percutaneous endoscope has a small diameter, surrounding structures can easily be identified using frontal view fluoroscopy to determine the resection area. FRRs were calculated from postoperative computed tomography images. The smallest cross-sectional area of the intervertebral foramen around the lateral edge of the resection area (SALE) was measured and compared wit clinical outcomes.ResultsThe mean FRR was 41.7% at C5–C6 and 48.9% at C6–C7. SALE was not correlated with clinical outcomes.ConclusionsResidual stenosis in the lateral portion of the intervertebral foramen is weakly associated with postoperative outcomes. Our process achieved adequate FRRs and favorable postoperative outcomes, suggesting that our criteria for determining the resection area are appropriate.

Juvenile Nasopharyngeal Angiofibroma: Our Experience in a Tertiary Hospital.

Nasopharyngeal angiofibroma is a highly vascular tumor seen typically in young adolescent males. It is an uncommon tumor accounting for less than 0.5% of all head and neck tumors. This peculiar tumor is thought to arise from the area of the sphenopalatine foramen and it classically presents with progressive nasal obstruction and epistaxis. This is a retrospective study of angiofibroma treated at our hospital over 3years. The study discusses about clinical features, management options and the role of embolization in reducing the intra-operative blood loss.

The interperiosteodural concept applied to the jugular foramen and its compartmentalization.

OBJECTIVE The dura mater is made of 2 layers: the endosteal layer (outer layer), which is firmly attached to the bone, and the meningeal layer (inner layer), which directly covers the brain and spinal cord. These 2 dural layers join together in most parts of the skull base and cranial convexity, and separate into the orbital and perisellar compartments or into the spinal epidural space to form the extradural neural axis compartment (EDNAC). The EDNAC contains fat and/or venous blood. The aim of this dissection study was to anatomically verify the concept of the EDNAC by focusing on the dural layers surrounding the jugular foramen area. METHODS The authors injected 10 cadaveric heads (20 jugular foramina) with colored latex and fixed them in formalin. The brainstem and cerebellum of 7 specimens were cautiously removed to allow a superior approach to the jugular foramen. Special attention was paid to the meningeal architecture of the jugular foramen, the petrosal inferior sinus and its venous confluence with the sigmoid sinus, and the glossopharyngeal, vagus, and accessory nerves. The 3 remaining heads were bleached with a 20% hydrogen peroxide solution. This procedure produced softening of the bone without modifying the fixed soft tissues, thus permitting coronal and axial dissections. RESULTS The EDNAC of the jugular foramen was limited by the endosteal and meningeal layers and contained venous blood. These 2 dural layers joined together at the level of the petrous and occipital bones and separated at the inferior petrosal sinus and the sigmoid sinus, and around the lower cranial nerves, to form the EDNAC. Study of the dural sheaths allowed the authors to describe an original compartmentalization of the jugular foramen in 3 parts: 2 neural compartments-glossopharyngeal and vagal-and the interperiosteodural compartment. CONCLUSIONS In this dissection study, the existence of the EDNAC concept in the jugular foramen was demonstrated, leading to the proposal of a novel 3-part compartmentalization, challenging the classical 2-part compartmentalization, of the jugular foramen.

The shor-term clinical outcomes and safety of extreme lateral interbody fusion combined with percutaneous pedicle screw fixation for the treatment of degenerative lumbar disease

To evaluate the early efficacy and safety of extreme lateral interbody fusion (XLIF) combined with percutaneous pedicle screw fixation for lumbar degenerative disease. From January 2013 to June 2014, 13 patients with degenerative lumbar disease were treated with XLIF combined with percutaneous pedicle screw fixation, including 8 cases of lumbar instability, 5 cases of mild to moderate lumbar spondylolisthesis;there were 5 males and 8 females, aged from 56 to 73 years with an average of 62.1 years. All patients were single segment fusion. Operation time, perioperative bleeding and perioperative complications were recorded. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. Interbody fusion rate was observed and the intervertebral foramen area changes were compared preoperation and postoperation by X-rays and CT scanning. The mean operation time and perioperative bleeding in the patients respectively was(62.8±5.2) min and(82.5±22.6) ml. One case occurred in the numbness of femoribus internus and 1 case occurred in the muscle weakness of hip flexion after operation, both of them recovered within 2 weeks. All the patients were followed up from 12 to 19 months with an average of 15.6 months. VAS was decreased from preoperative 7.31±0.75 to 2.31±0.75 at final follow-up(P<0.05); ODI was decreased from preoperative (42.58±1.55)% to (12.55±0.84)% at final follow-up(P<0.05). At final follow-up, CT scanning confirmed 8 cases completely fused and 5 cases partly fused;the intervertebral foramen area was increased from preoperative (94.86±2.44)mm2 to (150.70±7.02)mm2(P<0.05). Extreme lateral interbody fusion combined with percutaneous pedicle screw fixation is an ideal method and can obtain early good clinical effects in treating lumbar degenerative disease.

MULTICENTER ANALYSIS OF THE RESULTS OF APPLICATION OF DIRECT LATERAL INTERBODY FUSION (DLIF) AND TRANSCUTANEOUS TRANSPEDICULAR FIXATION IN PATIENTS WITH DEGENERATIVE DISC DISEASES OF THE LUMBAR SPINE

Background: The technique of lateral lumbar interbody fusion for the surgical treatment of patients with degenerative diseases of the lumbar spine was developed in the early 2000s. But at the same time in modern literature there is no uniform approach to the use this technique, clinical outcomes and radiological findings are contradictory. Aims: to conduct a multicenter analysis of clinical outcomes and instrumental data of direct lateral interbody fusion (DLIF) approach combined with transcutaneous pedicle fixation in patients with single-level degenerative disc diseases of the lumbar spine. Materials and methods: The study included 103 patients (63 men and 40 women, mean age 45.8±9.7 years) who underwent surgery followed by DLIF transcutaneous pedicle fixation. The surgery was performed at neurosurgical and vertebrological departments in Irkutsk (Russia), Omsk (Russia), and Astana (Kazakhstan). Dynamic observation and comprehensive clinical and instrumental evaluation of the treatment results were carried out for an 18-month period after surgery. Results: After the simultaneous decompressive-stabilizing intervention, in all patients we detected a decrease in the severity of pain syndrome on VAS — from 6.9±1.6 to 1.7±1.2 cm (p0.001), and improved quality of life index (Oswestry) — from 21.3±6.8 to 12.3±4.4% (p0.001). The instrumental methods of examination determined the effective indirect decompression: an increase in the size of interbody gap in the middle of its department compared with the preoperative value from 8.6±3.1 to 15.7±4.2 mm (p0.001) and an increase in the area of the intervertebral foramen (on the left with an average of 98.7±32.3 and 156.8±45.1 mm2, p0.001; on the right —99.7±37.3 to 153.4±38.7 mm2, p0.001). We also registered the restoration of both the segmental (from 10.2±3.8 to 13.6±6.7°, p0.001) and regional (from 32.8±5.9 to 48.2±7.3°, р0.001) lumbar lordosis. Complete interbody fusion was diagnosed in 87 (86.4%) patients. Complications were observed in 8.7% of cases. Conclusions: DLIF technique combined with transcutaneous transpedicular stabilization has high clinical efficacy confirmed by significant reduction in the severity of pain according to VAS. The studied approach improves the quality of life of patients by Oswestry index and reveals a low number of postoperative complications. The described simultaneous minimally invasive method of surgical treatment in patients with degenerative disc diseases allows to restore the sagittal profile of the lumbar spine and implement an effective stabilization of the operated vertebral-motor segments with a high degree of formation of interbody bone block.

Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion

Objective To analyze the incidence and risk factors of contralateral radiculopathy in patients after unilateral transforaminal lumbar interbody fusion (TLIF) surgery. Methods A retrospective study was conducted within 587 patients (average age 57.1 years, range 19-71 years) who underwent unilateral TILF from January 2010 to January 2014 in our hospital, including 334 males and 253 females. Patients were divided into a symptomatic group and an asymptomatic group. The causes of contralateral neurological symptom were evaluated according to the radiological data. The difference of pre- and post-operative contralateral foramen area (CFA), segmental angle (SA) and the clinical treatment outcomes (VAS, JOA score) were compared between two groups. Results Patients were followed up for 9-21 months, average 15.1 months. Post-operative contralateral radiculopathy occurred in 28 (4.8%) of the patients who underwent unilateral TLIF, including contralateral foraminal stenosis in 16 (57.1%, 16/28), screw malposition in 5 (17.9%, 5/28), contralateral lateral recess stenosis and/or newly developed disc herniation in 3 (10.7%, 3/28), hematoma in 1 (3.6%, 1/28), cement compression in 1 (3.6%, 1/28), and unknown origin in 2 patients (7.1%, 2/28). Nineteen (3.2%, 19/587) of the 28 patients received revision surgery because of ineffective conservative treatment. Compared with the asymptomatic group, the difference of pre-and post-operative CFA was significantly smaller (-13.8±13.2 mm2) in symptomatic group, while the SA was significantly greater (7.0°±9.8°) in symptomatic group. The JOA score at 3 months after the surgery was significantly improved in asymptomatic group (63.0%±18.1%, P<0.05). Conclusion The incidence rate of contralateral neurological symptom was 4.8% in the present study. The potential risk factors associated with contralateral radiculopathy were predominantly contralateral foraminal stenosis and screw malposition. The excessive restoration of SA might have an effect on contralateral nerve compression, which should arouse the attention of the surgeon. Key words: Lumbar vertebrae; Spinal fusion; Postoperative complications; Radiculopathy

Spatial evaluation of Mental Foramen among UAE locals attending UDHS using CBCT

Aim: Mental foramen could be an area subjected to trauma due to surgery or implant placement in mental area. Our aim is to measure the different parameters of the mental foramina of males and females among UAE Nationals visiting the University Dental Hospital Sharjah to enhance our knowledge of the possible locations of the mental foramen in order to prevent iatrogenic injuries through periodontal and endodontic surgeries, local anesthesia and implant placement. Materials and Methods: This study was a retrospective study and samples included in the study were UAE nationals who already underwent a CBCT examination in the University Dental Hospital Sharjah in the period of 2010 till 2015. All samples were for nationals of the United Arab Emirates between the age of 18 and 65 whose CBCT scans shows the mental foramen area and the adjacent teeth (lower canines and first molars). Parameters measured in the mental foramen included height of foramen, width of foramen, shortest distance from foramen to adjacent tooth. Results: There was a statistically significant gender difference between the mean value of mental foramen height(3.77 mm±0.86 mm for males) and 3.10 mm ± 0.8mm for females) (P = 0.002).The shortest distance of the foramen to the adjacent tooth also showed statistically significant gender differences(4.68mm ± 3.23mm for males) and (4.71 mm±1.94 mm for females), f (p= 0.012). Conclusion: The height of the foramen and the distance of MF to the most adjacent tooth were greater in UAE males than in females. Discrepancy in the height of the foramen when dealing with different ethnicities should betaken into consideration. Clinical Significance: MF is an important anatomical landmark for dental surgeons performing periapical surgery in the mental region such as endodontic and periodontal procedures. In order to avoid any nerve damage during oral surgery, MF location should be identified while keeping in mind the possibility of an anterior loop of the mental nerve being present mesial to the mental foramen. This should also be noted whilst performing surgery for implant placement.

Foramen Changes following Over Instrumentation of Curved Canals with Three Engine-Driven Instruments: An In Vitro Study.

Introduction:The present in vitro study aimed to evaluate and compare the changes in shape and surface area of the major foramen following shaping of curved canals with three new generation NiTi engine-driven instruments naming ProTaper Next, BT RaCe and WaveOne Gold- with 3 different levels of protrusion beyond the major apical foramen. Methods and Materials:A total of 45 extracted human molars with at least one curved canal were distributed in 3 comparable groups of 15 that were instrumented using either ProTaper Next (PTN), BT RaCe (BTR) or WaveOne Gold (WOG). The canals were instrumented to the major foramen and then over instrumented with the final file 0.5 mm, 1 mm and 1.5 mm beyond the foramen. Standardized pre- and post-instrumentation photographs of the foramen were obtained for all groups using a stereomicroscope. Foramen shape and surface area were evaluated using the AmScope software for measurements and compared between groups and levels of instrumentation applying binary conditional logistic regression and repeated measures ANOVA. The level of significance was set at 0.05. Results: Foramen shape tended to gradually change from circular to oval as the level of instrumentation increased in all groups. The original foramen shape in WOG group remained better than other groups. Foramen surface areas increased in all groups with Group BTR demonstrating significantly greater values than the other 2 groups. Conclusion:Over instrumentation resulted in apical enlargement and ovalization in all 3 groups but with different patterns. These differences can be attributed to the final file size, design characteristics and kinematics of the 3 systems.

Establishing Apical Patency: To be or not to be?

The apical portion of the root canal is very complex and challenging during endodontic treatment. Root canal preparation and obturation to the apical constriction may provide the best prognosis. Incomplete debridement, foramen transportation, and inadequate seal in the apical portion are considered to be responsible for treatment failure. The technique "apical patency" is considered as a way for maintaining the apical part the free of the debris by recapitulation, using a small K-file through the area of the apical foramen. This term was firstly proposed by Buchanan. In this technique, the smallest diameter file is set 1 mm longer than working length and recapitulated after each instrument to prevent packing of debris in the apical part. Apical patency has been found to be effective in achieving an apical seal with gutta-percha. Teeth prepared with a step back method and with maintained apical patency may show less leakage when obturated with cold lateral condensation technique. Data regarding the effect of apical patency on the healing of periapical tissue are very scarce, and it has been shown that the patency file has detrimental effect on the healing of periapical tissues in animal studies. However, using patency file in endodontic treatment is controversial and further studies are needed. The purpose of this article is to review the effect of using a patency file on the extrusion of root canal contents, the apical seal, postoperative pain, and healing of periapical tissues. Furthermore, the effect of establishing patency on reaching irrigation solutions to the apical portion of the canal and prognosis of root canal treatment are discussed. Keywords: Apical patency, Apical seal, Apical transportation, Postoperative pain, Prognosis.

Unique case of dental practice negligence using calcium hydroxide intracanal medicament: A case report

Safe dental practice is based on the rule of do no harm. Procedural errors in endodontics are mainly based on wrong case selection with underestimation of case difficulty. The aim of this report was to discuss a case of negligence in dental practice leading to multidisciplinary treatment and pain management approach. This case reported to emergency clinics at King Khalid University, College of Dentistry (KKUCOD) after an accident of overextrusion of calcium hydroxide (Ca(OH)2) from tooth # 22 extended distally to greater palatine foramen area without sinus communication. Patient pain was unbearable and needed strong acting pain medication. The tooth was treated with nonsurgical endodontic with buccal perforation repair followed by surgical endodontic to establish apical seal and remove the extruded material. Then a full thickness palatal flap was needed to remove the extended material. This approach was effective in alleviating patient pain. Such incidence could have been avoided if a safe practice rules were strictly followed thus case difficulty assessment form must be used in such cases.

Is 2 mm a safe distance from the inferior alveolar canal to avoid neurosensory complications in implant surgery?

The aim of the present study was to compare the neurosensory complications related to implants inserted closer than 2 mm to the inferior alveolar canal (IAC) with those inserted further than 2 mm. A total of 474 implants in 314 patients placed posterior to mental foramen area were evaluated retrospectively on panoramic radiographs. Patients were divided into two groups regarding implant proximity to the IAC (Group 1, distance ≤2 mm, Group 2, distance >2 mm). Postoperative neurosensory complications (pain and paresthesia) were recorded. Chi-square test was used for statistical comparison and P ≤ 0.05 was considered significant. One hundred and fifty-three implants (32.2%) were inserted closer than 2 mm to the IAC whereas 321 implants (67.8%) were inserted further than 2 mm. Three implants which had a distance of 0 mm to the IAC (0.63%) caused paresthesia after surgery. Implant distance to IAC did not show a significant difference regarding pain and paresthesia (P = 0.06 and P = 0.08, respectively). When 2 mm is considered as a safety distance, the distance of the implants to the IAC did not yield any statistical difference regarding postoperative neurosensory complications.

Sex Variations by Linear Measurements of Palatal Bones and Skull Base Using 3D Reconstructed Computed Tomographic Scan among Iraqi Sample

Background: The skull base and the hard palate contain many anatomical features that make them rich in information which are useful in sex differentiation; in addition to that they have the ability to resist the hardest environmental conditions that support them in making sex differentiation. Three dimensional computed tomographic techniques has important role in differentiation between sex since it offers images with very accurate data and details of all anatomical structures with high resolution. This study was made to study sex variations among Iraqi sample by craniometric linear measurements of the hard palate and the skull base using 3D reconstructed Computed Tomographic scan. Materials and methods: This study composed of 100 Iraqi subjects (50 male and 50 female) aged between 20-59 years. The sample collected from patients attending Al-Shaheed Ghazi hospital in Baghdad city to for spiral CT scanner. The craniometrical linear measurements of the hard palate and the skull base in this study were including: Maxillo-Alveolar Breadth, Maxillo-Alveolar Length, the distance between incisive foramen and greater palatine foramen (right and left), the distance between the incisor foramen and B point (the median point located at the anterior area of the magnum foramen), the distance between the incisor foramen and the anterior root of the mastoid notch on both sides (right and left), Maxillo-Alveolar Index and size of Palate. All these measurements were done by (mm) unit. Results: The statistical analysis of linear measurements of the hard palate and the skull base showed that the mean values of all measurements were significantly higher in males than females except for Maxillo-Alveolar Index was not significant and also showed that the size of the palate was the best indicator for sex variation and making the diagnosis of male with accuracy 93.3%. The age had none significant effect on these measurements. Conclusion: Three dimensional Computed Tomographic scanners is the best diagnostic tool for sex variation by the craniometrical linear measurements for the anatomical landmarks points of the hard palate and the skull base.

Meningioma in the Middle Ear: An Unusual Case of Hearing Loss

Meningioma in the Middle Ear: An Unusual Case of Hearing Loss

Nasal packing in sphenopalatine artery bleeding: therapeutic or harmful?

The aim of this study is to present our management protocol of sphenopalatine artery bleeding, demonstrating that nasoendoscopic cautery (NC) was a more effective method than the nasal packing, in terms of shorter inpatient stay and reduced complications rate. We present ten posterior epistaxis not resolved by nasal packing. Tabotamp® was placed in the area of sphenopalatine foramen and/or in those parts of the posterior nasal cavity, where it was suspected that bleeding origins. In two cases, the bleeding was resolved in this way, instead eight cases needed of subperiosteal cauterization of sphenopalatine artery by Dessi bipolar forceps (MicroFrance®). 4 of these 8 patients evidenced a remarkable bleeding removing nasal packing (Hb before-nasal packing=15±0.69 versus Hb after-nasal packing=13.3±0.81; t student=2.94; p value=0.025). These four patients showed a deviation of the nasal septum ipsilateral to epistaxis, and according our experience, a traumatism of sphenopalatine area can be caused by Merocel® nasal packing in this condition. During follow-up, no recurrences of nasal bleeding have been observed in such patients. Nasal packing must be considered if posterior epistaxis is severe, but always taking into account the specific anatomy of patient and in particular septal spurs that can further compromise sphenopalatine artery. In our experience, the endoscopic endonasal cauterization of the sphenopalatine branches represented a safe and effective procedure.

Application of oblique lateral interbody fusion in the degenerative lumbar disease

Objective To investigate the operation key points and clinical efficacy of oblique lateral interbody fusion (OLIF) for the treatment of degenerative lumbar disease. Methods The clinical data of 22 patients with degenerative lumbar disease treated with OLIF at the Department of Neurosurgery, Sichuan Provincial People’s Hospital from December 2014 to October 2015 were analyzed retrospectively. Eight patients were treated with the combined posterior percutaneous pedicle screw fixation, 11 were treated with the combined anterior percutaneous pedicle screw fixation, and 3 did not treated with the screw-rod system fixation. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score, and imaging findings before and after procedure were compared. The clinical efficacy of the surgical method was evaluated. The follow-up time ranged from 3 to 9 months (mean, 6.6 months). Results Postoperative VAS score (2.73±0.84) and ODI score (20.97±3.83) were significantly decreased compared with before procedure (VAS score: 7.10±0.97; ODI score: 60.86±6.88; all P<0.05). The average operation time was 92.5±14.8 min, the average blood loss was 78.4±29.6 ml, and the average length of stay was 8.2±2.4 d. Compared with before procedure, the postoperative intervertebral space height was increased (after procedure: 9.12±1.09 mm, before procedure: 5.24±1.07 mm, P<0.001) and the intervertebral foramen area was increased in 22 cases (after procedure: 1.81±0.25 cm2, before procedure: 0.83±0.10 cm2, P<0.001). None of them had severe complications, such as vascular injury, lumbar plexus nerve injury, ureteral injury and infection. Conclusions OLIF is a safe, effective, and minimally invasive surgical method for the treatment of lumbar degenerative disease. Its clinical efficacy is reliable in the near future. It has the advantages of short operation time, less intraoperative blood loss, less trauma, and quick recovery. Strict selection of patients and grasping the technical details are the keys to the success of surgery. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Surgical procedures, minimally invasive; Oblique lateral interbody fusion

Quantitative analysis of unusual entrance of the vertebral artery into the cervical foramen (V2 segment) and its clinical implications.

Unusual entrance of the vertebral artery into the cervical transverse foramen (UE-V2S) is a relatively common clinical anomaly. Because spinal surgeons should understand the anatomical characteristics and clinical implications of this condition, we aimed to provide a description based on a very large number of UE-V2S anomaly cases. We retrospectively analyzed 2207 three-dimensional head-and-neck computed tomographic angiograms (CTAs) that did not have specific vascular abnormalities. After confirming which cases had an unusual vertebral artery (VA) entrance into the transverse foreman (TF), we measured their vertebral artery diameter (VAD), transverse foramen area (TFA) and bilateral pedicle width (PW) from C3 to C7. The shortest horizontal distance from the vertical line in the medial margin of the TF to VA (D-TFVA) was measured in the extra-osseous region to estimate the exact location of the extra-osseous VA, except at the C7 level. An unusual V2 entrance was observed in 11.4% (252 patients) of all 2207 consecutive patients and 6.5% (268 courses) of all 4414 courses. The prevalence rankings for the different measures were as follows: unilateral UE-V2S=E5>E4>E7>E3; bilateral UE-V2S=E5 (bilateral)>E4 (Rt) with E5 (Lt)>E4 (bilateral). Generally, the VAD of the anomaly side was statistically smaller than the normal contralateral side, which can induce a smaller TFA value at all sub-axial levels. Cervical pedicle fixation was preferable in the adjacent lower segment of unusual VA entrance level than the normal side in this study due to a broader PW, which was evident on the anomaly side. However, there was no statistical evidence that the side of the C7 entrance of the VA had a narrow PW. The lowest D-TFVA value was -3.8, indicating that we should take care not to exceed 3.8mm medially into the vertical line of the medial TF wall during dissection when taking an anterior cervical approach. To avoid an unexpected VA injury and to improve the efficiency of even routine cervical operations, spinal surgeons should determine whether the patient has a UE-V2S and have a full understanding of the clinical characteristics of this anomaly.

Rules of anatomic morphology changes between the vertebral artery tortuosity and transverse foramen

To explore the rules of the anatomic morphology between vertebral artery tortuosity and transverse foramen. From January 2012 to December 2015, 60 patients with vertebral artery tortuosity by means of analyzing the image data and basic clinic information as the observation group, and 50 patients randomly selected exclusive of vertebral artery tortuosity, absence of vertebral artery, vertebral artery aneurysm, cervical decomposition incomplete deformity and oral cavity prosthesis artifacts as the control group, the basic clinical information was collected; the transverse foramen area (TF) and vertebral artery cross-sectional area (VA) of the vertebral artery were measured in the observation group and the control group; internal diameter of vertebral artery tortuosity, length of vertebral artery were measured and; twisting coefficient (s)of the vertebral artery was calculated.Then the difference of the above-mentioned statistics was acquired. The C4 TF (25.91±10.13) mm and C6 TF(31.93±17.91) mm of the affected segment of the observation group were significantly higher than those in the control group[(22.11±8.67) mm, (27.19±7.89) mm] (P<0.05); VA and TF were positively correlated.The average age[(68.25±12.03) years], blood pressure (45 cases)of the observation group and the proportion of the menopausal women (39 cases)were higher than those in the control group[(61.32±11.32) years, 23/22](P<0.05). The area of transverse foramen of C4 and C6 could be affected by vertebral artery tortuosity. It might be related to the occurrence of bone degeneration around C6 and C4.The risk factors of the expansion of the transverse foramen might be advanced age, hypertension and menopausal women.

Clinical anatomy and clinical significance of the cervical intervertebral foramen: a review.

The aim of this paper is to summarise the knowledge about the anatomy of the cervical intervertebral foramen as a whole. Such reviews are rare in the literature. The intervertebral or neural foramen is the opening between the spinal canal and the extraspinal region. It is located between the vertebral pedicles at all spinal levels. A number of structures pass through the foramen: nerves, vessels and ligaments. We describe the bony borders and dimensions of the foramen, the adjacent ligaments, the arteries and veins passing through or neighbouring it, and the neural components. Many procedures are performed in the area of the cervical intervertebral foramen. Knowledge of the anatomy of the foramen is essential in order to operate to the area and to minimize iatrogenic injuries.

Inner Ear Volume in Craniosynostotic Mice

Craniosynostosis is a congenital defect causing premature fusion of cranial sutures. These skull abnormalities can cause developmental delays, cranial venous hypertension, raised intracranial pressure, hearing impairments, and facial deformities. The temporal bone, specifically, plays a crucial role in the development in many of the features affected by craniosynostosis. The jugular foramen is an interosseous foramen formed by the temporal and occipital bones. Stenosis of the jugular foramen has been reported in individuals suffering from both syndromic and non‐syndromic complex (multi‐suture) craniosynostosis. Children with complex craniosynostosis also exhibit anomalous basicranial venous drainage in the form of persistent condylar and mastoid emissary veins uniting the sigmoid dural venous sinus with the suboccipital venous plexus and posterior auricular vein, respectively. The otic capsule is crucial for proper establishment of the sigmoid dural venous sinus during development. The petrous portion of the temporal bone is a significant branch point for dural venous sinuses and is altered in children with craniosynostosis syndromes. This study aimed to compare the volume of the otic capsule in syndromic craniosynostotic mice and their wild‐type littermates for possible effects on basicranial venous drainage. Using the otic capsule as a proxy for temporal bone volume and symmetry, we hypothesize that craniosynostosis causes a change in otic capsule volume throughout ontogeny that may also alter dural venous drainage pathways.The Fgfr2+/C342Y mouse model of Crouzon's syndrome along with wild‐type littermates were analyzed using serial micro‐computed tomography sections of whole heads at embryonic day 17.5 (E17.5), postnatal day 14 (P14), and postnatal day 42 (P42). Further, a subset of mouse crania were immersed in potassium iodine solution (Lugol's solution) to stain soft tissue structures. Immersion was performed to enable measurement of the unossified otic capsule of the earliest stages. Amira 3D analysis software was used to reconstruct three dimensional isosurface structures and compute volumes from complete two‐dimensional CT image stacks.While we did not find evidence of otic capsule volumetric differences in the earliest stages examined, significant differences between Fgfr2+/C342Y and WT littermates did emerge in the sub adult population (P42; p = 0.0455). Further investigations will examine the surface area of the jugular foramen, as well as, emissary foramina.