Transposition Technique Research Articles

Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar dolichoectasia: interposition technique versus transposition technique.

Various techniques of microvascular decompression have been proposed for trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia (VBD) with two main modalities: interposition and transposition. This retrospective study compares the outcomes of two techniques belonging to different modalities for VBD-associated TN. From January 2011 to April 2017, 39 patients underwent MVD for VBD-associated TN. The transposition method chosen was the biomedical glue sling technique. Patients were divided into the interposition group (n = 16) and the transposition group (n = 23). The radiologic data, intraoperative findings, complications, and outcomes were analyzed. The 1-, 3-, and 5-year pain-free (BNI class I) maintenance rates were 100.0, 91.1, and 91.1%, respectively, in the transposition group and 87.5, 74.5, and 58.7% in the interposition group (p = 0.032). Postoperative complications were similar in both groups, but there was a trend for higher incidence of postoperative facial hypoesthesia using the interposition technique (p = 0.06). In cases of VBD-associated TN, the transposition technique using biomedical glue was superior to the traditional interposition technique in maintaining a pain-free status, with no increase in the incidence of complication.

Technique and Quality Translation of Idhafi in The Matan Hadits of Arba'in al-Nawawi

The accuracy of translation from the source language (SL) to the targeted language (TL) is not easy work. The translator should act as the connector between the writer of the work and the reader of the translation. The paper tries to analyses the translation of Arbai'n An-Nawawi by using the techniques offered by Molina Albir. This is a qualitative study that focuses on how the translator translated the Idhofi case in the Matan of Araba'in as the material object of this paper. Besides, the authors distributed questionnaires to assess the quality of the translation. The paper found that the translator uses 11 techniques that consist of 64 data of literal, 25 data of amplification, 21 data of borrowing, 12 data adaptation techniques, 6 data of compensation, 2 data of discursive creation, 2 data of reduction, 1 data of generalization, 1 data of modulation, and 1 data of transposition technique. Meanwhile, from the quality of the translation, it can be concluded that the compensation technique is much more acceptable, with 81% very accurate, 73% acceptable, and 77% rated high legibility. It is because the method helps the reader to understand the meaning, message, and goals to be conveyed.

Eficacia y complicaciones de las transposiciones musculares en el síndrome de Duane con esotropía

ObjectiveTo study the long-term efficacy and the complications of several transposition techniques for the treatment of Duane syndrome. These included, full vertical rectus transposition, partial vertical rectus transposition, transposition without muscle disinsertion, and superior rectus transposition. Material and methodsA retrospective study of the patients diagnosed with Duane syndrome, and who underwent any of the different transposition techniques associated or not to the medial rectus recession with a follow-up longer than 12 months. A good result was considered a final deviation≤10 prism dioptres (pd) in primary position, anomalous head posture<10°, and an improvement of the abduction without diplopia. ResultsSeven cases were included (6 women, 6 unilateral), and a mean age of 37.71 years. Pre-operative central gaze esotropia of 28±11.68pd decreased to 6±4.62pd at the final visit (P=.009). The anomalous head posture decreased in 6 patients, and the abduction improved one degree from −3.14 to −2.14 (mean). An induced vertical deviation≤8pd was observed in 4 cases. None experienced diplopia at the final visit. The percentage of reoperations was 71.42%. Only 28.57% had a favourable outcome with a single surgery, which increased to 71.42% with further surgeries at the final follow-up. Mean evolution time was 52±31.65 months. ConclusionsVertical rectus transpositions in Duane syndrome with moderate or severe clinical signs have only been effective in a small percentage of the cases. Most of them required further surgeries to resolve the complications or the under-corrections.

Augmented vertical rectus transpositions: Intraoperative measurement of torsion following sequential muscle detachment.

After vertical recti transposition surgery, a torsional change may occur. We hypothesized that step-by-step monitoring of the intraoperative torsional position of the eye can avoid any unexpected complications and identify critical moments of surgery that may have adverse effects. Nine patients with sixth nerve palsy that underwent complete transposition of the superior (SR) and inferior rectus (IR) muscles to the lateral rectus muscle by means of the technique of augmented vertical recti transposition were prospectively included. The torsional position of the eye was recorded at eight stages of the procedure. We observed two distinct patterns of induced torsional deviation during partial disinsertion of a vertical rectus muscle depending on whether disinsertion began medially or laterally, after cutting about 3/4 of the muscle fibers: ¾ nasal disinsertion of the SR and ¾ temporal disinserton of the IR caused intorsion, ¾ temporal disinsertion of the SR and ¾ nasal disinsertion of the IR caused extorsion. Torsion improved after the vertical rectus was attached temporally to the sclera along the spiral of Tillaux with tying of the augmentation suture to the LR. The greatest change in torsion was from ¾ temporal disinsertion of the SR (5°extorsion), to reattachment along the spiral of Tillaux temporally (5°intorsion). The SR and IR have different torsional effects, which only appears when more than half of the fibers are detached. Augmented transposition does not cause any additional torsional effects. This intraoperative monitoring system can be used to detect unintended torsional complications, especially during transposition surgery.

Biceps Transposition for Biological Superior Capsular Reconstruction

Reconstruction of the superior capsule is a valuable intervention for some patients in whom massive, irreparable posterosuperior rotator cuff tears are identified. Superior capsular reconstruction techniques most commonly use either tensor fascia lata autograft or dermal allograft. As an alternative to more traditional superior capsular reconstruction, we commonly transpose and incorporate the biceps tendon into the rotator cuff repair construct in such patients instead. This biological superior capsular reconstruction biceps transposition technique (”bio-SCR”), described herein, provides increased structural integrity and supplemental tendon graft using viable cells while potentially serving the role of the superior capsule. As such, transposition of the biceps tendon may offer unique and significant advantages over other techniques and can be an effective and valuable alternative in appropriate cases.

Chaos based Encryption of Image for Secure Communication

The 20th century is known as the Information age. Development of technology led to the storing and communication of information in the digital form. Digital technology provides easy access to the information through internet and other forms of technology. Transmission of information is also become easy using digital technology. The information stored or communicated may be vulnerable to attacks from the adversaries. All the organizations and individuals are facing the threat of the insecurity of the information of data over the internet. Development of communication media and insecure media emphasizes the requirement to secure the data. The method of securing the information so that it is not stolen by the hackers is known as encryption. The development of multimedia technology has increased the images as the carriers of information. The conventional encryption algorithms are not well suited for the image encryption. Image encryption has developed in the past recent years as an important field. In the image encryption, the substitution and transposition techniques are performed on the pixel values of the image based on the key. One of the mechanisms for image encryption is based on chaos theory. Chaos sequence is used as a key for encryption because of its properties. This method of encryption is more secure and robust.

Cubital Tunnel Syndrome: Current Concepts.

Compressive neuropathy of the ulnar nerve across the elbow is a common diagnosis encountered frequently within a hand and upper extremity clinical practice. Appropriate and timely evaluation, diagnosis, objective testing, and evidence-based decisions regarding treatment options are paramount in the optimal care of the patient with this pathology. An understanding of current literature is critical in determining and understanding best practices. A thorough review of the recent literature regarding physical examination, diagnostic testing, and nonoperative versus operative results was performed. Regarding physical examination, the glenohumeral internal rotation test and scratch collapse test are more effective and sensitive than traditional maneuvers such as Tinel's testing and the elbow flexion test. Electrodiagnostic testing, magnetic resonance imaging, and ultrasound evaluation have all been shown to be effective in diagnosing cubital tunnel syndrome. However, no single test has proven itself to be superior. Nonoperative treatment can be successful for mild cases of cubital tunnel syndrome. Surgical release techniques comparing open with endoscopic release are equivocal, and in situ release versus transposition techniques show that transposition should not be performed routinely. The diagnosis and treatment of cubital tunnel syndrome do not have a well-defined algorithm based on current literature. The treating physician must therefore utilize the available information to determine a diagnostic and treatment plan individualized to the patient. More rigorous scientific studies are needed to determine the most effective surgical approaches for cubital tunnel syndrome.

Amplification and Transposition in English Commands and Its Translations into Indonesian with Reference to the Novel Entitled Harry Potter and The Order of Phoenix

Every human has their own characteristics of languages and in order to understand one language to another languages, then, translation was essential and fully needed. In order to avoid the awkward translation, therefore the translator must use a technique in translating the texts. The research aimed at analyzing the equivalence between the source language and its translations based on the translation techniques applied by translator. This research focused on the amplification and transposition techniques could be seen on the imperative sentences especially command. The research was conducted by applying qualitative method. The research was conducted by applying library research and observation methods. The collected data were analyzed using descriptive qualitative method. The study applied two methods to present the analysis of data as follows informal and formal method. Target of research did not involve participants however, this research focused on analyzing data was English commands and its translation into Indonesian by using amplification and transposition found in the novel. The result of research showed amplification and transposition were dominant used in translating the English commands (SL) into Indonesian (TL). The translator applied amplification and transposition to find equivalences when transferring the meaning from the source language (SL) into target language (TL). Therefore, the overlapping translation could be minimized. Amplification had a role especially the addition of information. The phenomena occurred when the detail information did not contain in the SL and the translator must be sensitive by putting the necessary information in TL. Transposition created three parts of shift: structure, unit, and class of shift.&#x0D;

Expansion sphincter pharyngoplasty: analyzing the technique based on anatomy.

The purpose of this study is to evaluate the effect of the different surgical techniques of expansion sphincter pharyngoplasty (ESP) on the dimensions of the oropharyngeal airway. The techniques that were evaluated included the preservation and transection of the palatopharyngeus (PP) and superior pharyngeal constrictor (SPC) muscle attachment and transposition of the PP muscle to the hamulus of the medial pterygoid plate and the palatal musculature. Surgical techniques were applied in twenty half heads. The preservation of the PP-SPC attachment inhibited the transposition of the PP muscle to the hamulus and resulted in comparable enlargement in the medial-lateral dimension in the oropharyngeal airway when the PP muscle was transposed to the palatal musculature. After transection of the PP-SPC attachment, significant enlargement was observed in anterior-posterior and medial-lateral directions in the oropharyngeal airway when the PP muscle was transposed both to the hamulus and the palatal musculature. The distances measured after both the transposition techniques were similar. The present study is a basic study demonstrating how different techniques of ESP affect the position of the soft palate. The PP-SPC attachment can be transected in the patients with anterior-posterior palatal and lateral wall collapse to pull the soft palate anteriorly in addition to prevent the lateral wall collapse. The PP-SPC attachment can be preserved in the patients with only lateral wall collapse. Nevertheless, the clinical consequences of these static changes need to be evaluated in clinical studies.

MP29-05 EXTRAVAGINAL TRANSPOSITION OF URETHRA – THE RESULTS OF 412 OPERATIONS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP29)1 Apr 2020MP29-05 EXTRAVAGINAL TRANSPOSITION OF URETHRA – THE RESULTS OF 412 OPERATIONS Boris Komyakov, Viktor Ochelenko*, and Vladimir Tarasov Boris KomyakovBoris Komyakov More articles by this author , Viktor Ochelenko*Viktor Ochelenko* More articles by this author , and Vladimir TarasovVladimir Tarasov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000868.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The presence of the urethral meatus inside the vaginal cavity immediately below the vaginal vestibule (urethral ectopia or hypospadia) is the main cause of postcoital cystitis. Surgical treatment is the most effective option in such patients, but conventional intervention developed by O'Donnell R.P. has some potential drawbacks. High rate of suture dehiscence and recurrence of disease make this surgical method unpopular. In order to improve the results of surgical treatment we have modified classic method of urethral transposition. METHODS: from 2005 to 2019 in our clinic we have observed 412 female patients with localization of external urethral orifice in vagina and recurrent postcoital cystitis. 32 (7.8%) females underwent conventional distal urethroplasty according to O’Donnell technique and in 380 (92.2%) we’ve performed modified extravaginal transposition of urethra (B.K. Komyakov technique patent No 2408296 since 10.01.2011). There are some features of modified method. At first, urethra should be mobilized almost all long. Secondly, replacement of urethra occurs through submucosal tunnel in vaginal vestibule wall. Thirdly, the new place of external urethral orifice should be as close as possible to the clitoris. The wound on the old place of urethral orifice should be sutured in the longitudinal direction. RESULTS: Thirteen (3.1%) patients experienced suture dehiscence, back up displacement of urethra and recurrence of pathological condition. Five of them were operated using conventional technique. From all 32 patients, treated by O’Donnell intervention satisfactory results were achieved in 23 (71.9%), unsatisfactory – in 9 (28.1%). In women, who underwent new modified transposition of distal urethra, satisfactory results were reached in 385 (93.4%) and relapses were in 11 (26.6%) patients (р<0.05). CONCLUSIONS: our technique of extravaginal urethral transposition compared with conventional operation enable to increase the reliability of urethra binding and decrease morbidity of intervention and risk of recurrence of disease. Source of Funding: no © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e430-e431 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Boris Komyakov More articles by this author Viktor Ochelenko* More articles by this author Vladimir Tarasov More articles by this author Expand All Advertisement PDF downloadLoading ...

Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach.

The sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)-posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique. The authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed. With the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed. The SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.

Treatment of large, chronic and persistent macular hole with internal limiting membrane transposition and tuck technique

BackgroundLarge, chronic full thickness macular holes which failed previous treatments are difficult to manage and even left untreated due to poor prognosis. A retrospective review of consecutive cases with chronic (at least 1 year) full thickness macular holes and internal limiting membrane (ILM) free flap transposition with tuck technique, after previously failed vitrectomy.MethodsThis was a retrospective and interventional study conducted in a single centre by a single surgeon. Patients with full thickness macular hole for at least 1 year and at least one previously failed vitrectomy with ILM peeling were recruited. A 25G vitrectomy with ILM free flap transposition was done without assistance of PFCL, viscoelastic or autologous blood. The free flap was manually tucked into the macular hole free space and gas fluid exchange was performed with 20% SF6 as tamponade. The patients were postured prone for 2 weeks postoperatively. Best corrected visual acuity, macular hole duration, previous surgeries, optical coherence tomography (OCT) appearance, hole size and closure rate were recorded.Results8 consecutive patients were included from May 2016 to Feb 2018. Transposition surgery was performed an average of 1481 days (SD 1096) after diagnosis of macular hole and average of 1226 days (SD 1242) after first vitrectomy. Macular hole mean size was 821 μm (SD 361.3), preoperative VA was logMAR 1.038 (SD 0.19), postoperative VA was logMAR 0.69 (SD 0.19) at 3 months. There were 1.13 lines gained and a significant improvement of logMAR 0.33 (p = 0.0084) at 6 months. Hole closure was seen in 7 out of 8 eyes (87.5%). The OCT with failed closure showed ILM flap within a flat hole, however no overlying neurosensory layers was seen. The duration from diagnosis to surgery was 2349 days in this case.ConclusionFree flap ILM transposition tuck without the use of additional intraoperative tamponade is an effective technique in treating large chronic macular holes with previously failed primary macular hole surgeries.Trial registration (IRB of the Hong Kong University and Hospital Authority Hong Kong West Cluster, ref UW19-440), June 17, 2019.

A Modified Technique of Transposition of Temporalis Muscle in Selected Cases of Longstanding Facial Paralysis.

The authors present a modified technique of temporalis muscle transposition technique in cases of longstanding facial paralysis. Slips of the temporalis fascia were passed through the tunnels to reach the contralateral para-median plane. The procedure provides 2 point of fixation to the transferred muscle. Local flaps were used for temporal hollow obliteration and for temporalis muscle elongation.This case series included 11 patients. The modified technique was performed for all patients to reanimate the lower face while gold weight impanation in the upper eye lid was used for re-animation of the eye in 9 patients. By the end of follow up, the procedure was considered successful in 9 patients. Eight patients expressed their satisfaction and 7 patients were happy with the regained facial movement.The modified temporalis muscle transfer technique might be a valuable option in cases of longstanding facial paralysis. The lips would be camouflaged, non-stretched and would move with the whole mid-face.

Martius graft transposition: a successful procedure for the ultimate repair of the anovaginal/rectovaginal fistula

Background Recto/ano-vaginal fistula (RAVF) is one of the worst medical conditions that could lead a lady to suffer in her life. It represents a horrendous experience that might put the lady suffering that ailment not only on the brink of abandoning her social life, but even disrupting her marital life and breaking the integrity of her family. There are various operative methods implemented all over the past decades aiming to cure such medical condition. Of those, interposing a vascularized tissue flap is suggested as an operative solution to guarantee long term successful healing. Of which the most commonly tried is the bulbocavernous flap technique. Patients and methods Eighteen patients with both low and mid recto/ano-vaginal fistula,were repaired using martius graft transposition technique. And all fistulas were at least 8 months old. All patients were followed up for around one year postoperative for assessment of fistula healing and any associated persistent complications and side effects. Results All of the 18 patients included in the current study, were fully cured with no recurrence of fistula on one year follow up term, with 13 patients complaining mild dyspareunia that didn't hamper them resuming their sexual life. Out of eight patients with low fistula, of whom four had an old complete perineal tear with severed sphincter. five patients almost regained full control over flatus and stools. While two patients reported appreciably partial control over flatus and liquid stools. Conclusion Dissection and mobilization of fibrofatty graft (Martius graft) from the labia majora with intact blood supply for enforcing and supporting the site of repaired fistula is better than gracilis and gluteus grafts in surgical repair of recto/ano-vaginal fistula.

Comparison of different tendon transposition techniques for the treatment of monocular elevation deficiency type 2

To compare results of three different tendon transposition techniques (Knapp procedure and two modified techniques) for the treatment of type 2 monocular elevation deficiency (MED) patients. The medical records of patients with MED type 2 operated on at a single institution from 2000 to 2016 were reviewed retrospectively. Patients were divided into three vertical transposition groups: (1) full tendon width, (2) augmented surgery; and (3) partial tendon width. Surgical success was defined as no severe limitation of upgaze, hypotropia of <6Δ, and no hypertropia in primary position. Pre- and postoperative vertical deviations in the primary position and limitations in elevation levels were compared. A total of 39 patients were included. The pre- and postoperative deviations in the full-tendon group were 22.50Δ ± 4.17Δ and 3.50Δ ± 1.27Δ, respectively; in the augmented surgery group, 23.75Δ ± 4.78Δ and 1.75Δ ± 1.14Δ; and in the partial-tendon group, 20.50Δ ± 3.98Δ and 4.12Δ ± 2.78Δ. Corrected vertical deviations were 19Δ, 23Δ, and 16Δ, respectively. The pre- and postoperative limitation of elevations were -2.80 and -0.80 in the full-tendon group, -3.20 and -0.90 in the augmented surgery group, and -2.37 and -1.12 in the partial-tendon group. The pre- and postoperative vertical deviation improvements and limitations of elevation were statistically significant (P<0.05) in all groups. Success was achieved in 29 patients (74%). In this study cohort, all three procedures were reasonably effective in improving vertical deviations and limitation of elevation.

Management of cubital tunnel syndrome by anterior trans-muscular transposition of the ulnar nerve

BackgroundVarious surgical options are used for the treatment of ulnar nerve entrapment at the elbow. In this study, anterior trans-muscular transposition of the ulnar nerve was used for the treatment of cubital tunnel syndrome.ObjectivesTo evaluate the surgical results of anterior trans-muscular transposition technique for the treatment of cubital tunnel syndrome with particular emphasis on clinical outcome.MethodsForty patients with cubital tunnel syndrome were operated using anterior trans-muscular transposition technique. Patients were classified into post-operative clinical outcome grades according to the Wilson & Krout criteria, and they were followed up by visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and post-operative clinical evaluation.ResultsForty patients with cubital tunnel syndrome who underwent anterior trans-muscular transposition of the ulnar nerve show a significant clinical improvement at 24 months post-surgery regarding visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and the Wilson & Krout grading as 87.5% of the patients recorded excellent and good outcome.ConclusionAnterior transmuscular transposition of the ulnar nerve is a safe and effective treatment for ulnar nerve entrapment at the elbow.

Augmented medial transposition of split lateral rectus in the management of synergistic divergence

Synergistic divergence is a congenital disorder with abnormal ocular motility. Various management options have been described but with few satisfactory outcomes. We describe 3 cases of synergistic divergence a technique of medial transposition of split lateral rectus augmented with equatorial fixation sutures in 3 children. Postoperatively the synergistic divergence disappeared, and eyes were aligned in the straight-ahead gaze with improvedadduction and convergence in all 3 cases.

Transposition of Superior Cerebellar Artery for Microvascular Decompression in Trigeminal Neuralgia Using an In Situ Superior Petrosal Vein Sling Technique

Several microvascular decompression technical variations for the treatment of medically refractory trigeminal neuralgia have been proposed that can be categorized generally as interposition and transposition techniques. These latter approaches, so-called slinging techniques, have been increasing in popularity, because they can possibly reduce the long-term recurrence rates by preventing the formation of fibrosis and granulomas at the decompression site. We have reported a technique for transposition of the superior cerebellar artery for microvascular decompression in trigeminal neuralgia using the superior petrosal vein as an in situ sling to anchor and reroute the artery away from the nerve. We have presented a technical report with illustrative intraoperative images and video from 2 cases of trigeminal neuralgia in which the superior petrosal vein was used as a simple and straightforward in situ sling for transposition of the superior cerebellar artery. The technique was applied successfully in 2 patients with complete and immediate remission of trigeminal neuralgia, without surgical morbidity. The most frequent neurovascular conflict in trigeminal neuralgia involves the superior cerebellar artery, and the strategic location of the superior petrosal vein relative to this neurovascular complex allows for its use as a natural in situ sling that reroutes the artery and prevents its recoil against the nerve. This technique can be added to the increasing armamentarium of transposition techniques for microvascular decompression, with the advantage of simplicity and no requirement for a complex prosthesis to secure the transposition.

Microsurgical Strategies for the Treatment of Compression Neuropathies Secondary to Vertebrobasilar Dolichoectasia: From Simple Decompression to Sling Transposition

Vertebrobasilar artery dolichoectasia may result in neural element compression anywhere along its course within the cervical region, the craniocervical junction or in the posterior fossa. The clinical syndromes most often observed include cranial neuropathy, bulbar dysfunction, myelopathy and cervical radiculopathy. When indicated, the operative techniques utilized to address vertebrobasilar artery dolichoectasia must be individually tailored, can be technically challenging, and have been rarely expounded. To share selected cases that demonstrate the variety of pathological states caused by vertebrobasilar artery dolichoectasia as well as our experience in managing this condition. Here we review examples of pathological impingement of neural elements compressed by ectasia within the vertebrobasilar arterial system throughout its anatomic course. The surgical techniques we have employed to alleviate the compression, including simple decompression as well as sling-assisted arterial transposition, are described. The evolution and refinement of our transposition technique are detailed. A wide range of pathological conditions may result from compression of neural structures throughout the course of the vertebrobasilar system. Compression of cervical nerve roots, the spinal cord, brainstem, and cranial nerves can be seen. Microsurgical management may be indicated in selected cases with gratifying results. Pathological compression of neural structures throughout the course of the vertebrobasilar system should be recognized. When indicated, microsurgical decompression must be tailored to the individual symptomology and the unique anatomic relationship in each case with the potential to prevent neurological worsening and, in many cases, improve functional outcome.

Дозированное хирургическое лечение вертикального косоглазия с применением методики передней транспозиции нижней косой мышцы

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