[Show abstract][Hide abstract] ABSTRACT: Observational and quantitative study with 3-dimensional (3D) computerized tomographic (CT) analysis.
To establish the 3D configuration and morphometric data of obliquity of the lateral atlantoaxial articulations (LAA) in congenital anomaly with occipitalization.
Plane radiographs and normal CT scans cannot clearly demonstrate the configuration of LAA as the hindrance of circumambient bony structures. The morphology of anomalous LAA with occipitalization is underreported.
A series of 63 cases with occipitalization and 20 control subjects underwent thin-slice CT scanning. The 3D configuration of LAA were analyzed and categorized based on the degree of olisthy and inclination orientation of the atlantoaxial articular facets (AAF). The obliquity of the AAF was measured in reconstructed sagittal and coronal planes, respectively.
Four types of configuration of LAA with occipitalization were found: type I, characterized by slight anteversion of LAA without olisthy of the inferior and superior facets (16% of 126 sides); type II, characterized by partial olisthy of the 2 facets and evident anteversion of LAA (48%); type III, defined by the separation or complete olisthy of the 2 facets (13%); and type IV, wherein the articular facets sloped dorsally (23%). Forty-eight of 49 cases in the former 3 types wherein AAF sloped ventrally had atlantoaxial dislocation (AAD). All type IV cases wherein AAF sloped dorsally had no AAD. In control subjects, LAA had no evident obliquity of anteversion or retroversion.
Instability at the C1-C2 junction in congenital anomaly with occipitalization is likely a direct result of the anteversion of LAA and bony malformation of this region, and it aggratates with the increasing obliquity of anteversion of the AAF. Demonstrating 3D morphological changes of LAA may provide a new means to diagnosis instability in congenital anomaly at craniovertebral junction and a basis for rational surgical treatment.
[Show abstract][Hide abstract] ABSTRACT: To explore the specialty of diagnosis and surgery of tight carotid stenosis.
From January 2000 to December 2009, 53 patients with tight carotid stenosis (> 95%) were operated on. All 53 patients had tight carotid stenosis more than 95% on one side in whom 28 had contralateral carotid stenosis or occlusion. The clinical and imaging data as well as surgical outcomes of the patients were retrospectively analyzed.
Forty-five patients had postoperatively done well without any complications. There were 3 cases of hemodynamic instability and one case of cardiac ischemia which resolved in one to two days. One patient developed mild hoarseness. One complicated with bacteremia due to deep vein catheter insertion. Two patients experienced brain hemorrhage. None of this series occurred perioperative brain ischemia.
Tight carotid stenosis indicates a need for expeditious carotid endarterectomy with very low rates of brain ischemia. Intraoperative shunting is seldom necessary. Postoperative hyperperfusion syndrome and brain hemorrhage should be worried. Micro-endarterectomy can effectively prevent from restenosis.
Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2010; 48(12):908-10.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the indication, time and strategy of surgery for patients with bilateral carotid atherosclerotic stenosis.
Seventy-four patients with bilateral carotid atherosclecrotic stenosis were admitted to our hospital from February 1987 to December 2007. In 34 patients who presented with unilateral symptoms and underwent ipsilateral carotid endarterectomy (CEA), contralateral CEA or carotid artery stenting (CAS) was performed in 8 because of severe stenosis (> 70%) or unstable plaque. Thirty-eight patients presented with bilateral symptoms. Among them, 15 underwent CEA on both sides, 3 were performed CEA on one side and CAS on the other side, while 20 underwent unilateral CEA only. In 2 asymptomatic patients, CEA was also performed.
Ninety-three cases of CEA were performed in 74 patients. Sixty-eight patients were uneventful after operation. Neurological deficits deteriorated in 2 patients. Four patients developed cardiac ischemia, cerebral hemorrhage and hoarseness respectively. Sixty-seven patients were followed-up for 4.9 years. No cerebral ischemia relevant to operated carotid artery developed in 63 patients.
If the indication is obvious, CEA should be performed no matter how contralateral carotid artery is. The strategy of therapy is individual. Whether using shunt depends on intra-operative monitoring.
Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2009; 47(6):404-6.