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Hooper Sehested posted an update 6 months, 4 weeks ago
Viral infections of the central nervous system (CNS) are the most common cause of hospital admission in worldwide and remain a challenging disease for diagnosis and treatment. The most common infectious agents associated with viral CNS infections are cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella zoster virus (VZV), Japanese encephalitis virus (JEV), Dengue virus (DENV),West Nile virus(WNV), and Chandipura virus(CHPV). The aim of the present work was to find the etiology of CNS viral infection in the Central India population by transcriptase PCR (RT-PCR) comparing real-time polymerase chain reaction (PCR) method in cerebrospinal fluid (CSF) and blood samples of CNS viral infections patients.
One-step and two-step real-time PCR assays were evaluated in CSF and parallel blood samples from patients with viral CNS infections for detection of DNA and RNA viruses. A comparative analysis was also done between gDNA, gRNA, cDNA, and plasmid-based rn to two-step RT-PCR.
Anatomy of the temporal region is complex with controversy over the relationship of fascial planes with the upper division of the facial nerve.
This study aimed to identify the safe surgical landmarks to preserve the frontotemporal branch of the facial nerve during surgery and define the safest approach for surgical procedures in this region.
The anatomical relationship of the frontal branch of the facial nerve, superficial temporal artery (STA), fascial planes, and fat pads was determined after dissection on 10 cadaveric heads, that is (20 sides) Dissection was performed layer by layer from skin to bone.
The temporoparietal fascia was made up of multiple (3-4) layers above the zygomatic arch and these layers were integrated with thin fibrous septa. The frontotemporal branch of the facial nerve (FTFN) was observed in a deeper part of temporoparietal fascia and superficial fat pad. The frontotemporal branch of the facial nerve (FTFN) crossed the zygomatic arch as two branches in 25%, as three branches in 65% and as four branches in 10% of specimens.
Interfascial dissection between two layers of deep temporal fascia through the intermediate fat pad is superior to other approaches because of the lack of facial nerve branches in this plane. The Intermediate fat could be easily separated from deep layer of deep temporal fascia.
Interfascial dissection between two layers of deep temporal fascia through the intermediate fat pad is superior to other approaches because of the lack of facial nerve branches in this plane. The Intermediate fat could be easily separated from deep layer of deep temporal fascia.
Endoscopic anterior cervical approach has several advantages compared to conventional anterior cervical discectomy and fusion (ACDF).
This video demonstrates a step-by-step procedure for endoscopic anterior cervical discectomy.
The patient is placed supine with the neck extended. A standard anterior cervical approach using about 3 cm skin incision is made and under “Easy Go” (Karl Storz, Tuttlingen, Germany) endoscopic vision, the uncinate process and uncus are drilled. Only a small portion of the normal disc, posterior longitudinal ligament (PLL), and compressing disc is removed. The closure is done in a standard manner.
In 240 patients, the average postoperative reduction in disc height, operating time, and blood loss were 1.1 ± 0.2 mm, 110 ± 17 min, and 30 ± 11 mL, respectively. The average postoperative VAS score and Nurick grading improved significantly. There were no permanent complications or any mortality.
Endoscopic technique is an effective and safe alternative to ACDF after attaining the learning curve.
Endoscopic technique is an effective and safe alternative to ACDF after attaining the learning curve.
The standard microscopic supracerebellar infratentorial approach for the pineal region is limited by tunnel vision. Herein, we describe endoscopic supracerebellar infratentorial surgery in a patient with quadrigeminal cistern epidermoid presenting with hydrocephalus.
In the sitting position, following a 6 cm longitudinal incision and small suboccipital craniotomy, the dura was cut in V shape and kept reflected. The bridging veins were coagulated and cut, taking the 0° endoscope inside. A sharp incision is given over the thickened arachnoid over the inferior paramedian area. The precentral cerebellar vein is exposed at the lower part, coagulated and divided. Gentle bimanual intracapsular removal of the epidermoid flakes is performed with intermittent saline irrigation and suction. Assisted by rotating the angled endoscope, curved coaxial instruments help remove the cerebello-mesencephalic and lateral extensions of the epidermoid.
Endoscopic supracerebellar infratentorial approach provides a panoramic and angled view of the pineal region, through a narrow corridor, avoiding cerebellar retraction.
Endoscopic supracerebellar infratentorial approach provides a panoramic and angled view of the pineal region, through a narrow corridor, avoiding cerebellar retraction.
Aneurysms arising in relation to perforators of the basilar artery (basilar perforator aneurysms or BPA) are very rare. Prior literature indicates the need for typically more than one angiogram for diagnosis, and argues for the utility of delayed angiograms in cases of subarachnoid hemorrhage (SAH) with initial negative studies. Different treatment modalities for BPA including endovascular, microsurgical, and conservative management have been described. Contemporary management appears to favor endovascular therapy. We discuss the topic by presenting a case which represents the first instance of BPA diagnosis after a fourth angiogram and subsequent successful endovascular occlusion. A literature review is provided.
To discuss the unique presentation and management dilemmas in the rare entity of basilar artery perforator aneurysms by presentation of a case that was managed successfully by endovascular means. We also indirectly highlight the need for multiple follow-up angiograms in initial angiographically negative subarachnoid hemorrhage.
We describe a 62-year-old male presenting with good clinical grade SAH and three negative angiograms, whose hospital course was complicated by repeat intraventricular hemorrhage. A fourth angiogram revealed a BPA. Multiple overlapping stents placed in the basilar artery achieved successful aneurysm exclusion. A comprehensive review of the literature was performed on PubMed.
Only 57 cases of BPAs have been described in literature. Multiple angiograms may be necessary for diagnosis. These aneurysms present with SAH. Endovascular flow modification is the current treatment of choice by means of overlapping stents or flow diversion.
Only 57 cases of BPAs have been described in literature. Multiple angiograms may be necessary for diagnosis. check details These aneurysms present with SAH. Endovascular flow modification is the current treatment of choice by means of overlapping stents or flow diversion.
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