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Pain Physician May 2024Glossopharyngeal neuralgia (GPN) is a condition that causes simultaneous headache and facial pain. The treatment for GPN is similar to the treatment for trigeminal... (Comparative Study)
Comparative Study
Computed Tomography-Guided Radiofrequency Ablation for Glossopharyngeal Neuralgia: Comparison of Cervical Computed Tomography Angiography, Transverse Process of Atlas, and Styloid Process Localization to Styloid Process Localization Alone.
BACKGROUND
Glossopharyngeal neuralgia (GPN) is a condition that causes simultaneous headache and facial pain. The treatment for GPN is similar to the treatment for trigeminal neuralgia. Craniotomy microvascular decompression (MVD) or radiofrequency (RF) therapy is needed if conservative treatment with oral drugs fails. Therefore, the choice of radiofrequency therapy target is essential when treating GPN. However, finding the glossopharyngeal nerve simply by styloid process positioning is challenging.
STUDY DESIGN
Prospective, clinical research study.
SETTING
Department of Anesthesiology and Pain Medical Center, Jiaxing, China.
OBJECTIVE
To compare the clinical effects of computed tomography (CT)-guided RF treatments on GPN when the triple localization of cervical CT, the transverse process of the atlas, and the styloid process is used to those achieved when the treatments are guided by the styloid process alone.
METHODS
From August 2016 to December 2019, 19 cases of GPN neuralgia were treated by radiofrequency under the guidance of CT guided by the styloid process only. (These patients comprised the single localization (SL) of styloid process group, in whom the target of the RF treatments was the posterior medial side of half of the styloid process). From January 2020 to December 2022, 16 cases of GPN were treated by RF under the guidance of CT with cervical CTA (CT angiography), the transverse process of the atlas, and the styloid process. (These patients were placed in the TL group, in whom the target of RF therapy was the gap between the internal carotid artery and the internal jugular vein behind the horizontal styloid process at the lower edge of the transverse process of the atlas). Two percent lidocaine was injected subcutaneously at the needle insertion site, and a stylet with a 21-gauge blunt RF needle (model: 240100, manufacturer: Englander Medical Technology Co., Ltd.) was slowly advanced toward the target. After that, an RF probe was introduced, then low (2 Hz)- and high (50 Hz)-frequency currents of the RF instrument (model: PMG-230, Canada Baylis company) were applied to stimulate. A successful test was defined as a 0.5-1.0 mA current stimulation that could induce the original pain area in the pharynx, the inner ear, or both, without any abnormal irritation of the vagus or accessory nerves. If the first test was unsuccessful, then in the SL group, the needle tip's position was adjusted to the distal end of the styloid process, and in the triple localization (TL) group, the needle tip depth's was fine-tuned. A continuous RF treatment was given after a successful test. The RF temperature was 95ºC for 180 seconds. The time that the first puncture reached the target, the puncture paths, the success rate of the first test, the time that the glossopharyngeal nerve was found, the frequency of adjustments to the position of the RF needle, the incidence of intraoperative and postoperative complications, and the therapeutic effects were recorded.
RESULTS
There were no significant differences in demographic data such as age, medical history, lateral classification, and pain score between the groups, but the TL group had a higher proportion of women than did the SL group. All patients' puncture targets were identified according to the designed puncture path before the operation. There was no difference between the 2 groups in the time of the first puncture to the target (5.05 ± 1.22 vs. 5.82 ± 1.51, P = 0.18), and the designed puncture depth (3.65 ± 0.39 vs. 4.04 ± 0.44). The difference in puncture angles (13.48 ± 3.56 vs. 17.84 ± 3.98, P < 0.01) was statistically significant, and in 8 cases in the SL group, the glossopharyngeal nerve could not be found after 60 minutes of testing, so the RF treatment was terminated. Meanwhile, this problem occurred in only 2 cases in the TL group. There were 3 cervical hematoma cases and 2 cases of transient hoarseness and cough in the SL group, whereas the TL group had, respectively, 0 and one cases of those issues. There was no death in either group.
LIMITATIONS
More clinical data should be collected in future studies.
CONCLUSION
When using RF as a treatment for GPN, the glossopharyngeal nerve is easier to find by using the triple positioning of the cervical CTA, the transverse process of the atlas and the styloid process as the target to determine the anterior medial edge of the internal carotid artery behind the styloid process at the level of the lower edge of the atlas transverse process. The glossopharyngeal nerve is more difficult to locate when only the posterior medial edge of the styloid process is targeted. The single-time effective rate of 180 seconds of RF ablation at 90ºC for GPN can reach 87.5% (14/16), suggesting the treatment's potential for clinical application.
Topics: Humans; Glossopharyngeal Nerve Diseases; Radiofrequency Ablation; Prospective Studies; Computed Tomography Angiography; Female; Middle Aged; Male; Cervical Atlas; Aged; Temporal Bone
PubMed: 38805535
DOI: No ID Found -
Frontiers in Veterinary Science 2024The mini-hemilaminectomy is a frequently used surgical technique for decompressive disk surgery on dogs. The aim of the study was to assess landmarks in the canine...
The mini-hemilaminectomy is a frequently used surgical technique for decompressive disk surgery on dogs. The aim of the study was to assess landmarks in the canine thoracolumbar spine to perform a mini-hemilaminectomy, with the aim of achieving optimal exposure of the ventral aspect of the vertebral canal. We hypothesized that the accessory process is a useful landmark for the identification of the level of the vertebral canal floor (VCF) and for decreasing surgical time. To define the level of the VCF, different landmarks and their distance to the VCF from computed tomography images of 40 mature chondrodystrophic dogs were evaluated in the first part of the study. To test the predefined landmarks, a cadaveric experiment was subsequently performed in the second part of the study. An experienced surgeon and a second-year surgical resident performed mini-hemilaminectomies as precisely as possible, with and without using the landmark values. Surgery time, precision of the mini-hemilaminectomy, and iatrogenic damage of the spinal nerve roots were compared between the two groups. Based on the results in the first part of the study, the distance from the dorsal border of the accessory process to the VCF (DBAP-VCF) was chosen as a landmark due to the good intra- (0.96) and interobserver (0.83) agreement. However, the distance is highly variable between breeds. In the second part of the study, using the DBAP-VCF landmark value did not influence the surgery time in both surgeons ( = 0.467, > 0.99). An improved accuracy of the VCF was seen for the surgical resident with limited experience ( = 0.014), but not for the experienced surgeon ( = 0.926). For both surgeons, the spinal nerve roots were injured in 20% of the cases unrelated to the use of landmark values. In conclusion, this study suggests that the DBAP-VCF has been described as a breed-specific landmark that can be determined in CT with good agreement. Using the previously evaluated landmark values can help improve precision in decompressive spinal surgery for a surgeon with limited experience without prolonging surgical time.
PubMed: 38803801
DOI: 10.3389/fvets.2024.1385249 -
JB & JS Open Access 2024Acute flaccid myelitis (AFM) is a disabling, poliomyelitis-like illness that mainly affects children. Although various surgical interventions are performed for...
BACKGROUND
Acute flaccid myelitis (AFM) is a disabling, poliomyelitis-like illness that mainly affects children. Although various surgical interventions are performed for intractable paralysis due to AFM, the timing of surgery and its long-term outcomes have yet to be established, especially for shoulder reconstruction. This study aimed to analyze the midterm outcomes of nonsurgically and surgically treated upper-extremity AFM and the factors influencing shoulder functional outcomes after surgical reconstruction.
METHODS
We retrospectively examined 39 patients with AFM in 50 upper extremities between 2011 and 2019. The degree of spontaneous recovery of completely paralyzed muscles was evaluated at a median of 3, 6, and 37 months after the onset of paralysis. Twenty-seven patients with 29 extremities underwent surgery involving nerve transfer, muscle-tendon transfer, or free muscle transfer for shoulder, elbow, and hand reconstruction.
RESULTS
Patients with complete paralysis of shoulder abduction at 6 months did not show later recovery. Twenty-two patients with 24 extremities underwent shoulder surgery, and all but 1 were followed for at least 24 months after surgery. Although postoperative shoulder abduction recovery was similar between transfer of the spinal accessory nerve and of the contralateral C7 nerve root to the suprascapular nerve, the outcomes obtained with spinal accessory nerve transfer had more variability, likely related to latent spinal accessory nerve paralysis, shoulder instability related to pectoralis major paralysis, and the type of paralysis. Shoulder abduction recovery was also greatly affected by scapulothoracic joint movement. In contrast, the outcomes of the elbow flexion and hand reconstructions were more consistent and acceptable.
CONCLUSIONS
All patients had loss of shoulder abduction, and restoration of shoulder function was less predictable and depended on the quality of the donor nerves and recovery of the synergistic muscles. Strict donor nerve selection and additional nerve transfer for shoulder reconstruction are imperative for satisfactory outcomes.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
PubMed: 38774108
DOI: 10.2106/JBJS.OA.23.00143 -
Cureus Apr 2024The spinal accessory nerve manipulation or sacrifice during neck dissection results in trapezius muscle denervation and atrophy, leading to shoulder disability. Patients...
The spinal accessory nerve manipulation or sacrifice during neck dissection results in trapezius muscle denervation and atrophy, leading to shoulder disability. Patients start experiencing pain and weakness while moving their shoulders, including elevation, rotation, and abduction, as well as reduced range of motion (ROM) and dropping of the shoulders. There are several ways to treat the condition, including using painkillers or undergoing physical therapy. Physical therapy plays a major role in improving shoulder function. Dry needling (DN) is an emerging treatment modality that involves eliciting a local twitch response in the region of myofascial trigger points, which can reduce pain and increase the ROM. This case report documents how DN improved shoulder function in a 51-year-old female who had pain when moving the shoulders and limited ROM after undergoing a modified radical neck dissection.
PubMed: 38765452
DOI: 10.7759/cureus.58541 -
Prague Medical Report 2024Anatomical variations of the forearm flexor muscles are occasionally encountered. Though usually observed incidentally during autopsies or imaging studies, they may at...
Anatomical variations of the forearm flexor muscles are occasionally encountered. Though usually observed incidentally during autopsies or imaging studies, they may at times cause concern due to associated clinical symptoms. This report presents a case of unilateral accessory flexor carpi ulnaris (AFCU) muscle observed in a human male cadaver aged 78 years. During routine cadaveric dissection, an anomalous AFCU muscle was observed in the left forearm of a human male cadaver aged 78 years. Standard institutional guidelines pertaining to the use of human cadaver for teaching and research were followed. A thorough literature review about the flexor carpi ulnaris (FCU) through the PubMed, Embase and Google scholar databases was undertaken, using the keywords - accessory flexor carpi ulnaris muscle, aberrant flexor carpi ulnaris muscle and anatomical variation of flexor carpi ulnaris muscle. Relevant gross anatomical findings were recorded and photographed. AFCU was identified on the medial aspect of the distal third of the left forearm. The AFCU was found originating from the ante-brachial fascia and the fascia covering the FCU on the left forearm, forming a small separate belly deep to the main muscle. It terminated as a thin tendon running alongside the hypothenar muscles and attached distally to the base of the proximal phalanx of the little finger. The AFCU was found to be innervated by a branch of the ulnar nerve. Awareness about the rare AFCU muscle is clinically important as a possible cause of ulnar nerve compression but also as a possible graft in reconstruction surgeries.
Topics: Humans; Male; Aged; Muscle, Skeletal; Forearm; Cadaver
PubMed: 38761050
DOI: 10.14712/23362936.2024.16 -
Folia Morphologica May 2024The muscles of mastication derive from a common embryological source, and the presence of accessory muscles in the infratemporal fossa (ITF) is uncommon. Here, we...
The muscles of mastication derive from a common embryological source, and the presence of accessory muscles in the infratemporal fossa (ITF) is uncommon. Here, we present findings from postmortem dissection of the ITF revealing a unilaterally present muscle extending from the greater wing of the sphenoid to blend inferiorly with the medial and lateral pterygoid muscles before attaching to the lateral pterygoid plate. This muscle is most consistent with the pterygoideus proprius muscle initially described in 1858. Though the exact embryological origin and function of this muscle remain speculative, these topics are nonetheless worth investigating as it may provide insight regarding the ontogeny of muscles descending from the first pharyngeal arch. Additionally, presence of the pterygoideus proprius muscle may have clinical implications and impact surrounding structures such as the mandibular division of the trigeminal nerve, maxillary artery, pterygoid venous plexus, masticatory muscles, and temporomandibular joint (TMJ).
PubMed: 38757501
DOI: 10.5603/fm.95708 -
Case Reports in Plastic Surgery & Hand... 2024Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity. Palmaris longus, flexor digitorum superficialis, and lumbricals have infrequently...
Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity. Palmaris longus, flexor digitorum superficialis, and lumbricals have infrequently been reported as causes of nerve compression. During routine Korean cadaver dissection, we incidentally identified an anatomic variant of first lumbrical muscle within the carpal tunnel in both wrists. The aberrant musculature originated from the radial side of the second FDS muscle at distal forearm level, running separately across the wrist beneath the flexor retinaculum. The dissected anomalous muscle was identified as an additional muscle belly of the first lumbrical muscle. Compression of the median nerve at the wrist might rarely be caused by the presence of such a tendon or muscle anomaly found in this study. Surgeons should be aware of possible anatomic variations in the carpal tunnel, and be prepared to modify their surgical plan accordingly.
PubMed: 38751547
DOI: 10.1080/23320885.2024.2351130 -
Surgical Case Reports May 2024Accessory scrotum is a congenital scrotal anomaly that is usually located anterior to the anus and frequently presents with a lipoma in a bead-like shape. Herein, we...
BACKGROUND
Accessory scrotum is a congenital scrotal anomaly that is usually located anterior to the anus and frequently presents with a lipoma in a bead-like shape. Herein, we present an unusual case of an accessory scrotum with a lipoma connected by a narrow stalk and located posterior to the anus.
CASE PRESENTATION
A 1-month-old boy was referred to our hospital for a perineal mass present at birth. He was born at 37 weeks and 2 days, with a birth weight of 2962 g. No abnormalities occurred during the perinatal period, and the birth was uneventful. The mass had an unusual shape, comprising two masses connected by a narrow stalk. The base of the mass was posterior to the anus and was connected to the rectal mucosa. The proximal mass was elastic and soft without skinfolds, whereas the distal mass was elastic and soft with a scrotum-like skinfolds. Magnetic resonance imaging showed no spina bifida. High-intensity adipose tissues in both masses and low-intensity vessels or fibrous stroma in cord-like structures between the two masses were found on T2-weighted images. At 3 months of age, the patient underwent resection in the prone jackknife position. No tumorous lesions were connected to the mass on the rectal and coccyx sides, and the mass was completely removed, preserving the anal sphincter. Histologically, the distal mass had characteristics of a scrotum, whereas the proximal mass was exclusively a lipoma. The connecting stalk had normal skin structures and a blood vessel with parallel-running nerve bundles. The postoperative course was uneventful, and the patient was discharged on postoperative day 6.
CONCLUSIONS
This case of accessory scrotum was unusual in its location and the presence of a stalk connecting the accessory scrotum and lipoma. The mechanism underlying accessory scrotum development remains unclear, and our report may impact the discourse regarding the embryological development of the accessory scrotum.
PubMed: 38691310
DOI: 10.1186/s40792-024-01906-w -
BioRxiv : the Preprint Server For... Apr 2024In order to forage for food, many animals regulate not only specific limb movements but the statistics of locomotor behavior over time, for example switching between...
In order to forage for food, many animals regulate not only specific limb movements but the statistics of locomotor behavior over time, for example switching between long-range dispersal behaviors and more localized search depending on the availability of resources. How pre-motor circuits regulate such locomotor statistics is not clear. Here we took advantage of the robust changes in locomotor statistics evoked by attractive odors in walking to investigate their neural control. We began by analyzing the statistics of ground speed and angular velocity during three well-defined motor regimes: baseline walking, upwind running during odor, and search behavior following odor offset. We find that during search behavior, flies adopt higher angular velocities and slower ground speeds, and tend to turn for longer periods of time in one direction. We further find that flies spontaneously adopt periods of different mean ground speed, and that these changes in state influence the length of odor-evoked runs. We next developed a simple physiologically-inspired computational model of locomotor control that can recapitulate these statistical features of fly locomotion. Our model suggests that contralateral inhibition plays a key role both in regulating the difference between baseline and search behavior, and in modulating the response to odor with ground speed. As the fly connectome predicts decussating inhibitory neurons in the lateral accessory lobe (LAL), a pre-motor structure, we generated genetic tools to target these neurons and test their role in behavior. Consistent with our model, we found that activation of neurons labeled in one line increased curvature. In a second line labeling distinct neurons, activation and inactivation strongly and reciprocally regulated ground speed and altered the length of the odor-evoked run. Additional targeted light activation experiments argue that these effects arise from the brain rather than from neurons in the ventral nerve cord, while sparse activation experiments argue that speed control in the second line arises from both LAL neurons and a population of neurons in the dorsal superior medial protocerebrum (SMP). Together, our work develops a biologically plausible computational architecture that captures the statistical features of fly locomotion across behavioral states and identifies potential neural substrates of these computations.
PubMed: 38659800
DOI: 10.1101/2024.04.15.589655 -
Plastic and Reconstructive Surgery.... Apr 2024The upper part of the trapezius muscle attaches to the acromion and elevates the shoulder, so a defect in the trapezius muscle greatly impairs shoulder-brachial...
The upper part of the trapezius muscle attaches to the acromion and elevates the shoulder, so a defect in the trapezius muscle greatly impairs shoulder-brachial movement. We encountered a case in which the upper trapezius muscle was completely resected due to myxofibrosarcoma that occurred in the upper part of the left trapezius muscle, and reconstruction was performed using a pedicled latissimus dorsi flap with the accessory nerve transferred, resulting in favorable motor function. A 74-year-old woman developed myxofibrosarcoma in her left neck 1 year and 4 months ago, and underwent two surgical excisions at a nearby hospital. However, two months prior, she relapsed again, and was referred to our hospital, where she underwent submandibular lymph node dissection, wide tumor resection, and reconstruction using a latissimus dorsi flap. For latissimus dorsi myocutaneous flap transfer, the stump of the thoracodorsal nerve and accessory nerve were anastomosed to facilitate nerve transfer. Four months after surgery, she was able to raise her shoulder, and surface electromyography showed potentials comparable to her unaffected side. The innervated latissimus dorsi myocutaneous flap is frequently used for dynamic reconstruction of facial, brachialis, rectus abdominis, and deltoid muscles, but this is the first case report describing its use for dynamic reconstruction of the trapezius muscle.
PubMed: 38633506
DOI: 10.1097/GOX.0000000000005748