Relevant Anatomical Structures Research Articles

Pearls and Pitfalls of Epicardial Echocardiography for Implantation of Impella CP Devices in Ovine Models.

The Impella CP is a percutaneously inserted temporary left ventricular assist device used in clinical practice and in translational research into cardiogenic shock, perioperative cardiac surgery, acute cardiac failure and mechanical circulatory support. Fluoroscopic guidance is usually used for insertion of an Impella, thus limiting insertion to within catheterization laboratories. Transthoracic, transoesophageal and intracardiac echocardiography have been reported to guide Impella CP implantation with identified specific limitations stemming from the surgical, anatomical and equipment factors. We conducted translational prospective descriptive feasibility investigation as a part of two other hemodynamic Impella studies. It showed the successful application of epicardial echocardiographic scanning for implantation of Impella CP devices in ovine models, from which details of the technique and identified pitfalls are described with practical solutions for future investigators and clinicians. Many described findings are relevant to any other echocardiographic techniques when adequate imaging of the Impella and relevant anatomical structures is achievable.

Immersive Photorealistic Three-Dimensional Neurosurgical Anatomy of the Cerebral Arteries: A Photogrammetry-Based Anatomic Study.

Neurosurgeons need a profound knowledge of the surgical anatomy of the cerebral arteries to safely treat patients. This is a challenge because of numerous branches, segments, and tortuosity of the main blood vessels that supply the brain. The objective of this study was to create high-quality three-dimensional (3D) anatomic photorealistic models based on dissections of the brain arterial anatomy and to incorporate this data into a virtual reality (VR) environment. Two formaldehyde-fixed heads were used. The vessels were injected with radiopaque material and colored silicone and latex. Before the dissections, the specimens were computed tomography scanned. Stratigraphical anatomic dissection of the neck and brain was performed to present the relevant vascular anatomy. A simplified surface scanning method using a mobile phone-based photogrammetry application was used, and the data were incorporated into a VR 3D modeling software for post-processing and presentation. Fifteen detailed layered photorealistic and two computed tomography angiography-based 3D models were generated. The models allow manipulation in VR environment with sufficient photographic detail to present the structures of interest. Topographical relevant anatomic structures and landmarks were annotated and uploaded for web-viewing and in VR. Despite that the VR application is a dedicated 3D modeling platform, it provided all necessary tools to be suitable for self-VR study and multiplayer scenarios with several participants in one immersive environment. Cerebral vascular anatomy presented with photogrammetry surface scanning method allows sufficient detail to present individual vessel's course and even small perforating arteries in photorealistic 3D models. These features, including VR visualization, provide new teaching prospects. The whole study was done with simplified algorithms and free or open-source software platforms allowing creation of 3D databases especially useful in cases with limited body donor-based dissection training availability.

Transorbital Approach Clipping of Middle Cerebral Artery Aneurysm: A Virtual Reality Morphometric Anatomic Study

The transorbital approach (TOA) has a unique advantage to the more common lateral approaches as it provides direct access to the anterior middle fossa and medial sylvian fissure (SF) without significant dissection or retraction. However, when to use the TOA for surgical treatment of MCA aneurysms remains unclear. This study details the feasibility of clipping unruptured middle cerebral artery (MCA) aneurysms via the TOA by highlighting the anatomic features that either facilitate or hinder the approach. Virtual reality (VR) models of 25 MCA aneurysms from CT angiograms of actual patients were rendered with the relevant anatomic structures, including the neighboring temporal lobe and SF. TOA was performed on the models in VR and the globe was translated medially and inferiorly, replicating retraction used intraoperatively. Anatomic data, including the area of surgical freedom (AOF) at the aneurysm, were recorded. Trials of aneurysm clipping were conducted in VR and each aneurysm was classified as "possible" or "impossible" candidates for clipping via TOA. Separately, the relationship between surgical view and SF visualized was analyzed. Sixteen aneurysms were eliminated as candidates for TOA treatment either through VR clip trial and/or because the SF was inaccessible. The remaining 9 (36%) were candidates for TOA. Comparing the details of these two aneurysm categories with Mann Whitney U tests, there was a statistically significant difference in the AOF of the TOA approach and the width of the aneurysm dome. A clinical case report is also provided highlighting the VR rehearsal similarity with surgery. Given the minimally-invasive, technically-challenging approach, the feasibility and safety of TOA for MCA aneurysms must be evaluated before wide clinical adoption. This study identified AOF, aneurysm width, and SF accessibility as three features that may significantly impact the possibility of clipping MCA aneurysms via TOA.

Augmented reality and optical navigation assisted orbital surgery: a novel integrated workflow

Abstract Objectives Due to the close topographical relationship of functional relevant anatomic structures, limited space and cosmetic aspects orbital surgery will remain a challenging discipline. Therefore, novel technical capabilities are necessary for further surgical progress. We here tested the integration of augmented reality and optical navigation in one workflow for interdisciplinary decision-making, feasibility and intraoperative guidance. Methods High-resolution contrast-enhanced MRI and CT scans were automated and manual-assisted segmented to achieve a detailed three-dimensional (3D) model of the individual patho-anatomical relationships. Augmented reality was used for interdisciplinary preoperative planning and intraoperative intuitive navigation. Mayfield clamp head holder in combination with optical surface matching registration assured navigation assisted microsurgery. Results Combinations of different MRI-sequences and CT-scans were necessary for detailed 3D-modeling. Modeling was time consuming and only viable in the hands of medical, surgical and anatomical trained staff. Augmented reality assured a quick, intuitive interdisciplinary orientation. Intraoperative surface matching registration enabled precise navigation in the orbital space. Conclusions Optical Navigation and microscope integration achieved a straightforward microsurgical workflow and should be implemented regularly. Augmented reality represented a useful tool for preoperative interdisciplinary planning and intraoperative intuitive orientation. It further stated an excellent educational tool.

Precision in practice: Exploring the impact of AI and machine learning on ultrasound guided regional anaesthesia.

Ultrasound Guided Regional Anaesthesia (UGRA) is a commonly utilized practice in both elective and emergency situations during surgical procedures and for pain management. Its benefits include, being non-invasive, cost-effective, readily accessible, and providing the anaesthetist with clear visualization of essential anatomical landmarks, needle progression, and the spread of local anaesthetic. Ultrasonography has been shown to increase success rates for regional anaesthesia and decrease complications. One of the critical steps during UGRA is identifying relevant anatomical structures like nerves or vertebras. However, this aspect can be hindered by external influences such as variations in nerve structure and position, interference from noise, and positional instability. Machine learning is a promising branch of artificial intelligence. It is used to conduct predictive tasks without programming instructions by creating algorithms. Extensive research has been conducted to evaluate the influence of machine learning on innovative anaesthesia methods. In 2023, Lopez et al. published a systematic review on how Artificial Intelligence could positively impact traditional anaesthesia practices.1 Various studies included in the review employed different models to achieve variable targets during the induction of anaesthesia. In one experiment, Alkhatib et al. used Convolutional neural network (CNN) based deep trackers to track the median and sciatic nerve with a surprising accuracy of 0.87.2 Another study employed the same CNN model to locate and discriminate accurate images of sacrum, vertebral levels and intervertebral gaps during percutaneous spinal needle insertion.3 Another study used a different AI model called SVM (support vector machine) classification, image processing, and template matching to locate lumbar level L3-L4 and the ideal puncture site for epidural anaesthesia in real-time. In this experiment, anaesthetists with minimal experience in ultrasonography were able to successfully determine needle puncture sites accurately.4 All these studies utilizing AI models not only yielded beneficial results but also led to significant time savings. Considering this, anaesthesiologists nationwide must integrate effective AI models to improve their clinical practice. This would minimize adverse outcomes in regional anaesthesia and ultimately enhance patient care and satisfaction.

Perforator versus Non-Perforator Flap-Based Vulvoperineal Reconstruction-A Systematic Review and Meta-Analysis.

Patients with advanced vulvoperineal cancer require a multidisciplinary treatment approach to ensure oncological safety, timely recovery, and the highest possible quality of life (QoL). Reconstructions in this region often lead to complications, affecting approximately 30% of patients. Flap design has evolved towards perforator-based approaches to reduce functional deficits and (donor site) complications, since they allow for the preservation of relevant anatomical structures. Next to their greater surgical challenge in elevation, their superiority over non-perforator-based approaches is still debated. To compare outcomes between perforator and non-perforator flaps in female vulvoperineal reconstruction, we conducted a systematic review of English-language studies published after 1980, including randomized controlled trials, cohort studies, and case series. Data on demographics and surgical outcomes were extracted and classified using the Clavien-Dindo classification. We used a random-effects meta-analysis to derive a pooled estimate of complication frequency (%) in patients who received at least one perforator flap and in patients who received non-perforator flaps. Among 2576 screened studies, 49 met our inclusion criteria, encompassing 1840 patients. The overall short-term surgical complication rate was comparable in patients receiving a perforator (n = 276) or a non-perforator flap (n = 1564) reconstruction (p* > 0.05). There was a tendency towards fewer complications when using perforator flaps. The assessment of patients' QoL was scarce. Vulvoperineal reconstruction using perforator flaps shows promising results compared with non-perforator flaps. There is a need for the assessment of its long-term outcomes and for a systematic evaluation of patient QoL to further demonstrate its benefit for affected patients.

Diagnostic yield of dental radiography and digital tomosynthesis for the identification of anatomic structures in cats.

Digital tomosynthesis (DT) has emerged as a potential imaging modality for evaluating anatomic structures in veterinary medicine. This study aims to validate the diagnostic yield of DT in identifying predefined anatomic structures in feline cadaver heads, comparing it with conventional intraoral dental radiography (DR). A total of 16 feline cadaver heads were utilized to evaluate 19 predefined clinically relevant anatomic structures using both DR and DT. A semi-quantitative scoring system was employed to characterize the ability of each imaging method to identify these structures. DT demonstrated a significantly higher diagnostic yield compared to DR for all evaluated anatomic structures. Orthogonal DT imaging identified 13 additional anatomic landmarks compared to a standard 10-view feline set obtained via DR. Moreover, DT achieved statistically significant higher scores for each of these landmarks, indicating improved visualization over DR. These findings validate the utility of DT technology in reliably identifying clinically relevant anatomic structures in the cat skull. This validation serves as a foundation for further exploration of DT imaging in detecting dentoalveolar and other maxillofacial bony lesions and pathologies in cats.

Two-view topogram-based anatomy-guided CT reconstruction for prospective risk minimization

To facilitate a prospective estimation of the effective dose of an CT scan prior to the actual scanning in order to use sophisticated patient risk minimizing methods, a prospective spatial dose estimation and the known anatomical structures are required. To this end, a CT reconstruction method is required to reconstruct CT volumes from as few projections as possible, i.e. by using the topograms, with anatomical structures as correct as possible. In this work, an optimized CT reconstruction model based on a generative adversarial network (GAN) is proposed. The GAN is trained to reconstruct 3D volumes from an anterior-posterior and a lateral CT projection. To enhance anatomical structures, a pre-trained organ segmentation network and the 3D perceptual loss are applied during the training phase, so that the model can then generate both organ-enhanced CT volume and organ segmentation masks. The proposed method can reconstruct CT volumes with PSNR of 26.49, RMSE of 196.17, and SSIM of 0.64, compared to 26.21, 201.55 and 0.63 using the baseline method. In terms of the anatomical structure, the proposed method effectively enhances the organ shapes and boundaries and allows for a straight-forward identification of the relevant anatomical structures. We note that conventional reconstruction metrics fail to indicate the enhancement of anatomical structures. In addition to such metrics, the evaluation is expanded with assessing the organ segmentation performance. The average organ dice of the proposed method is 0.71 compared with 0.63 for the baseline model, indicating the enhancement of anatomical structures.

Machine learning-based automated scan prescription of lumbar spine MRI acquisitions

PurposeHigh quality scan prescription that optimally covers the area of interest with scan planes aligned to relevant anatomical structures is crucial for error-free radiologic interpretation. The goal of this project was to develop a machine learning pipeline for oblique scan prescription that could be trained on localizer images and metadata from previously acquired MR exams. MethodsA novel Multislice Rotational Region-based Convolutional Neural Network (MS-R2CNN) architecture was developed. Based on this architecture, models for automated prescription sagittal lumbar spine acquisitions from axial, sagittal, and coronal localizer slices were trained. The automated prescription pipeline was integrated with the scanner console software and evaluated in experiments with healthy volunteers (N = 3) and patients with lower-back pain (N = 20). ResultsExperiments in healthy volunteers demonstrated high accuracy of automated prescription in all subjects. There was good agreement between alignment and coverage of manual and automated prescriptions, as well as consistent views of the lumbar spine at different positions of the subjects within the scanner bore. In patients with lower-back pain, the generated prescription was applied in 18 cases (90% of the total number). None of the cases required major adjustment, while in 11 cases (55%) there were minor manual adjustments to the generated prescription. ConclusionsThis study demonstrates the ability of oriented object detection-based models to be trained to prescribe oblique lumbar spine MRI acquisitions without the need of manual annotation or feature engineering and the feasibility of using machine learning-based pipelines on the scanner for automated prescription of MRI acquisitions.

Using positional tracking to improve abdominal ultrasound machine learning classification

Diagnostic abdominal ultrasound screening and monitoring protocols are based around gathering a set of standard cross sectional images that ensure the coverage of relevant anatomical structures during the collection procedure. This allows clinicians to make diagnostic decisions with the best picture available from that modality. Currently, there is very little assistance provided to sonographers to ensure adherence to collection protocols, with previous studies suggesting that traditional image only machine learning classification can provide only limited assistance in supporting this task, for example it can be difficult to differentiate between multiple liver cross sections or those of the left and right kidney from image post collection. In this proof of concept, positional tracking information was added to the image input of a neural network to provide the additional context required to recognize six otherwise difficult to identify edge cases. In this paper optical and sensor based infrared tracking (IR) was used to track the position of an ultrasound probe during the collection of clinical cross sections on an abdominal phantom. Convolutional neural networks were then trained using both image-only and image with positional data, the classification accuracy results were then compared. The addition of positional information significantly improved average classification results from ∼90% for image-only to 95% for optical IR position tracking and 93% for Sensor-based IR in common abdominal cross sections. While there is further work to be done, the addition of low-cost positional tracking to machine learning ultrasound classification will allow for significantly increased accuracy for identifying important diagnostic cross sections, with the potential to not only provide validation of adherence to protocol but also could provide navigation prompts to assist in user training and in ensuring adherence in capturing cross sections in future.

The Value of Using Patient-Specific 3D-Printed Anatomical Models in Surgical Planning for Patients With Complex Multifibroid Uteri

ObjectivesTo compare surgeon responses regarding their surgical plan before and after receiving a patient-specific three-dimensional (3D)-printed model of a patient’s multifibroid uterus created from their magnetic resonance imaging. Methods3D-printed models were derived from standard-of-care pelvic magnetic resonance images of patients scheduled for surgical intervention for multifibroid uterus. Relevant anatomical structures were printed using a combination of transparent and opaque resin types. 3D models were used for 7 surgical cases (5 myomectomies, 2 hysterectomies). A staff surgeon and 1 or 2 surgical fellow(s) were present for each case. Surgeons completed a questionnaire before and after receiving the model documenting surgical approach, perceived difficulty, and confidence in surgical plan. A postoperative questionnaire was used to assess surgeon experience using 3D models. ResultsTwo staff surgeons and 3 clinical fellows participated in this study. A total of 15 surgeon responses were collected across the 7 cases. After viewing the models, an increase in perceived surgical difficulty and confidence in surgical plan was reported in 12/15 and 7/15 responses, respectively. Anticipated surgical time had a mean ± SD absolute change of 44.0 ± 47.9 minutes and anticipated blood loss had an absolute change of 100 ± 103.5 cc. 2 of 15 responses report a change in pre-surgical approach. Intra-operative model reference was reported to change the dissection route in 8/15 surgeon responses. On average, surgeons rated their experience using 3D models 8.6/10 for pre-surgical planning and 8.1/10 for intra-operative reference. ConclusionsPatient-specific 3D anatomical models may be a useful tool to increase a surgeon’s understanding of complex gynaecologic anatomy and to improve their surgical plan. Future work is needed to evaluate the impact of 3D models on surgical outcomes in gynaecology.

Developing a Radiomics Atlas Dataset of normal Abdominal and Pelvic computed Tomography (RADAPT)

Atlases of normal genomics, transcriptomics, proteomics, and metabolomics have been published in an attempt to understand the biological phenotype in health and disease and to set the basis of comprehensive comparative omics studies. No such atlas exists for radiomics data. The purpose of this study was to systematically create a radiomics dataset of normal abdominal and pelvic radiomics that can be used for model development and validation. Young adults without any previously known disease, aged > 17 and ≤ 36 years old, were retrospectively included. All patients had undergone CT scanning for emergency indications. In case abnormal findings were identified, the relevant anatomical structures were excluded. Deep learning was used to automatically segment the majority of visible anatomical structures with the TotalSegmentator model as applied in 3DSlicer. Radiomics features including first order, texture, wavelet, and Laplacian of Gaussian transformed features were extracted with PyRadiomics. A Github repository was created to host the resulting dataset. Radiomics data were extracted from a total of 531 patients with a mean age of 26.8 ± 5.19 years, including 250 female and 281 male patients. A maximum of 53 anatomical structures were segmented and used for subsequent radiomics data extraction. Radiomics features were derived from a total of 526 non-contrast and 400 contrast-enhanced (portal venous) series. The dataset is publicly available for model development and validation purposes.

Surgical Considerations in Inner Ear Gene Therapy from Human Temporal Bone Anatomy.

Recently directed methods of inner ear drug delivery underscore the necessity for understanding critical anatomical dimensions. This study examines anatomical measurements of the human middle and inner ear relevant for inner ear drug delivery studied with three different imaging modalities. Post-mortem human temporal bones were analyzed using human temporal bone histopathology (N = 24), micro computerized tomography (μCT; N = 4), and synchrotron radiation phase-contrast imaging (SR-PCI; N = 7). Nine measurements involving the oval and round windows were performed when relevant anatomical structures were visualized for subsequent age-controlled analysis, and comparisons were made between imaging methods. Combined human temporal bone histopathology showed the mean distance to the saccule from the center of the stapes footplate (FP) was 2.07 ± 0.357 mm and the minimum distance was 1.23 mm. The mean distance from the round window membrane (RWM) to the osseous spiral lamina (OSL) was 1.75 ± 0.199 mm and the minimum distance was 1.43 mm. Instruments inserted up to 1 mm past the center of the FP are unlikely to cause saccular damage, provided there are no endolymphatic hydrops. Similarly, instruments inserted up to 1 mm through the RWM in the trajectory toward the OSL are unlikely to cause OSL damage. The combined analyses of inner-ear dimensions of age-controlled groups and imaging modalities demonstrate critical dimensions of importance to consider when inserting delivery vehicles into the human cochlea. N/A Laryngoscope, 134:2879-2888, 2024.

The impact of the size and angle of the cochlear basal turn on translocation of a pre-curved mid-scala cochlear implant electrode

Scalar translocation is a severe form of intra-cochlear trauma during cochlear implant (CI) electrode insertion. This study explored the hypothesis that the dimensions of the cochlear basal turn and orientation of its inferior segment relative to surgically relevant anatomical structures influence the scalar translocation rates of a pre-curved CI electrode. In a cohort of 40 patients implanted with the Advanced Bionics Mid-Scala electrode array, the scalar translocation group (40%) had a significantly smaller mean distance A of the cochlear basal turn (p < 0.001) and wider horizontal angle between the inferior segment of the cochlear basal turn and the mastoid facial nerve (p = 0.040). A logistic regression model incorporating distance A (p = 0.003) and horizontal facial nerve angle (p = 0.017) explained 44.0–59.9% of the variance in scalar translocation and correctly classified 82.5% of cases. Every 1mm decrease in distance A was associated with a 99.2% increase in odds of translocation [95% confidence interval 80.3%, 100%], whilst every 1-degree increase in the horizontal facial nerve angle was associated with an 18.1% increase in odds of translocation [95% CI 3.0%, 35.5%]. The study findings provide an evidence-based argument for the development of a navigation system for optimal angulation of electrode insertion during CI surgery to reduce intra-cochlear trauma.

Update on central oculomotor disorders and nystagmus

The diagnosis of ocular motor disorders and the different forms of a nystagmus is based on a systematic clinical examination of all types of eye movements: eye position, spontaneous nystagmus, range of eye movements, smooth pursuit, saccades, gaze-holding function, vergence, optokinetic nystagmus, as well as testing of the function of the vestibulo-ocular reflex (VOR) and visual fixation suppression of the VOR. Relevant anatomical structures are the midbrain, pons, medulla, cerebellum, and cortex. There is a simple clinical rule: vertical and torsional eye movements are generated in the midbrain, horizontal in the pons. The cerebellum is relevant for almost all types of eye movements; typical pathological findings are saccadic smooth pursuit, gaze-evoked nystagmus or dysmetric saccades.Nystagmus is defined as a rhythmic, most often involuntary eye movement. It normally consists of a slow (pathological) drift of the eyes and a fast central compensatory movement of the eyes back to the primary position (re-fixation saccade). There are three major categories: first, spontaneous nystagmus, i. e. nystagmus which occurs in the gaze straight ahead position as upbeat or downbeat nystagmus; second, nystagmus that becomes visible at eccentric gaze only and third, nystagmus which can be elicited by certain maneuvers, e. g. head-shaking, head positioning, air pressure or hyperventilation, most of which are of peripheral vestibular origin. The most frequent central types of spontaneous nystagmus are downbeat and upbeat, infantile, pure torsional, pendular fixation, periodic alternating, and seesaw nystagmus. Many types of central nystagmus allow a precise neuroanatomical localization: for instance, downbeat nystagmus, which is most often caused by a bilateral floccular lesion or dysfunction, or upbeat nystagmus, which is caused by a lesion in the mesencephalon or medulla oblongata. Examples of pharmacotherapy are the use of 4-aminopyridine for downbeat and upbeat nystagmus, memantine or gabapentin for fixation pendular nystagmus or baclofen for periodic alternating nystagmus.

Study on the Consistency Between Automatic Measurement Based on Convolutional Neural Network Technology and Manual Visual Evaluation in Intracavitary Ultrasonic Cine of Anterior Pelvic.

This study was to evaluate the application of automatic measurement based on convolutional neural network (CNN) technology in intracavitary ultrasound cine of anterior pelvic. A total of 500 patients who underwent pelvic floor ultrasound examination at Peking University Shenzhen Hospital from July 2021 to February 2022 were retrospectively retrieved by the picture archiving and communication system (PACS) system, and 300 cases were used as a training set. The training set was labeled by three experienced ultrasound physicians to train CNN models and develop an automatic measurement software. The remaining 200 cases were used as a test set. Automatic measurement software identified relevant anatomical structures frame by frame and determined the two frames with the greatest difference, calculated the bladder neck descent (BND), urethral rotation angle (URA), and retrovesical angle (RA). Meanwhile, two experienced ultrasound physicians evaluated the resting frame and the maximum Valsalva frame on the cines by manual visual evaluation, labeled the anatomical structures in the corresponding frame, such as the inferoposterior margin of pubic symphysis, the mid-axis of pubic symphysis, bladder contour, and urethra in the front, and calculated BND, URA, and RA. Considering that the residual urine volume (RUV) in the bladder may affect the results, enrolled patients were grouped according to the RUV (10-50 mL, 50-100 mL, and >100 mL). The consistency of the results by automatic measurement and manual visual evaluation was evaluated using the intraclass correlation coefficient (ICC) and the Bland-Altman graph. Of the 200 cases in the test set, 120 cases were successfully identified by the CNN automatic software with a 60% recognition rate. In the case of successful identification, the ICC of manual visual evaluation measurement and automatic measurement was 0.936 (BND), 0.911 (URA), 0.756 (RA in rest), and 0.877 (RA at maximum Valsalva), respectively. In addition, the RUV had a negligible effect on the consistency. The Bland-Altman plot shows the proportion of samples outside the limit was below 5%. CNN-based automatic measurement software exhibited high reliability in anterior pelvic measurement, which results in a significantly enhanced measurement efficiency.

Visualization of anatomical structures in the fetlock region of the horse using cone beam computed tomography in comparison with conventional multidetector computed tomography.

Cone-beam computed tomography (CBCT) is regarded as a convenient and suitable alternative to conventional computed tomography. However, in the horse, the quality of obtained data sets needs to be evaluated. Therefore, the aim of this study was to compare the visibility and accessibility of clinically relevant anatomical structures displayed in CBCT and conventional multidetector computed tomography (MDCT). Twenty-nine limbs from horses euthanized for reasons unrelated to this study were used. Native and intraarticular contrast scans of the fetlock (CBCT vs. MDCT) were performed. The visibility and accessibility of selected anatomical structures were blindly scored by three independent experienced observers using a scoring system previously reported and adapted to the fetlock joint. Only minor differences between CBCT and MDCT were identified concerning the diagnostic quality of images for osseous structures. Soft tissue structures were better evaluated on MDCT images. In CBCT as well as in MDCT articular cartilage could only be visualized after intraarticular injection of contrast medium. Cone beam computed tomography of the fetlock is a useful and reliable diagnostic tool when evaluating osseous structures and delineating articular cartilage with contrast medium. However, this modality is limited for assessing soft tissues structures.

Direct brow lift – indications, diagnostics, operating techniques

Eyebrow lift is one of the most effective rejuvenating procedures in facial plastic surgery. Lifting the aging soft structures around the eye socket yields both cosmetic and, in some cases, therapeutic effects. Regardless of the indications, preoperative assessment of the patient should be based on a thorough interview, establishing the patient’s expectations, determining the achievable outcome of the procedure, and anticipating potential complications. During the physical examination, it is crucial to identify relevant anatomical structures, assess facial symmetry, scope, and the technique of the procedure. Often, patients opt for combining direct eyebrow lift with eyelid surgery, significantly enhancing the overall result. The primary complication of direct eyebrow lifting is a visible scar, which may be a contraindication for individuals prone to keloid formation and those with a brow deficit. The aim of this study is to define the indications, diagnostics, and describe the surgical techniques used in eyebrow lift procedures.

One-lung ventilation with a bronchial blocker in thoracic patients

BackgroundLung isolation is a technique used in a multitude of surgeries to ensure single-lung ventilation with collapse of the contralateral lung, as to achieve improved access and visualization of relevant anatomical structures. Despite being accepted and having favorable outcomes, bronchial blockers (BBs) are not to this day the main device of choice among anaesthesiologists.MethodsIn this retrospective and descriptive study, we analyzed the safety and efficacy of a BB in all types of thoracic surgeries in our centre between 2015 and 2022, excluding patients with massive hemoptysis or empyema, or who had undergone a prior pneumonectomy.ResultsOne hundred and thirty-four patients were intervened due to lung cancer (67.9%), respiratory disease (23.9%), and non-respiratory disease (8.2%) undergoing lung surgeries (65.7%), pleural and mediastinal surgeries (29.9%), chest wall surgeries (3.0%) and other surgeries (1.5%). In most cases, lung collapse was considered excellent (63.9%) or good (33.1%) with only 4 cases (3.0%) of poor lung collapse. More than 90% of patients did not present intraoperative or immediate postoperative complications. No statistically significant differences were found between lung collapse and the demographic, clinical or BB-related variables (p > 0.05). However, we found a significatively higher proportion of excellent lung collapses in VATS surgeries and lateral decubitus positioning, as well as a significatively less proportion of poor lung collapses (p < 0.05). Moreover, there was a significantly higher proportion of excellent lung collapses when the BB was placed in the left bronchus (p < 0.05).ConclusionsWith these results, in our experience BBs constitute an effective alternative, capable of achieving pulmonary collapse in all kinds of thoracic procedures with satisfactory safety rates due to their minimal complications.

Sonographic assessment of the tarsal tunnel compared to cadaveric findings: a pictorial study.

To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination. Anatomical dissection was performed on a defrosted cadaveric model to demonstrate relevant anatomical structures of the tarsal tunnel, namely tendons, vessels and nerves. The tibial nerve division was demonstrated; the bifurcation of the tibial nerve into the medial and lateral plantar nerve, two medial calcaneal nerve branches were identified originating from the tibial nerve and the Baxter's nerve was identified as the first branch of the lateral plantar nerve. An ultrasound examination of the tarsal tunnel region was performed on a healthy volunteer. A linear probe was used and sonographic images were obtained at different levels of the tarsal tunnel: the proximal tarsal tunnel, the tibial nerve division into the medial and lateral plantar nerves, the distal tarsal tunnel, the Baxter's nerve branching point and the Baxter's nerve crossing between the abductor hallucis and quadratus plantae muscle. Sonographic images were correlated with anatomical structures exposed during cadaveric dissection. We presented the anatomic-sonographic correlation of the tarsal tunnel and showed that high-resolution ultrasound is a useful imaging modality for tarsal tunnel assessment.