scholarly journals A Case of Adult Jejunal Mesenteric Lymphangioma Requiring Combined Resection including the Uncinate Process of the Pancreas

2021 ◽  
Vol 82 (4) ◽  
pp. 742-748
Author(s):  
Yusuke MAEDA ◽  
Yudai YOSHINO ◽  
Fumiki TORIUMI ◽  
Takashi ENDO ◽  
Shigemichi HIROSE ◽  
...  
Keyword(s):  
Uncinate Process ◽  
Combined Resection ◽  
Mesenteric Lymphangioma

A Comparative Study of Endoscopic Finding and Radiological Appearance in Paranasal Sinus Disease

2018 ◽  
Vol 2 (S1) ◽  
pp. e000128
Author(s):  
Anjani Agarwal ◽  
Alpesh Fefar ◽  
Manish Mehta
Keyword(s):  
Ct Scan ◽  
Paranasal Sinus ◽  
Uncinate Process ◽  
Nasal Endoscopy ◽  
High Association ◽  
Sinus Disease ◽  
Radiological Appearance ◽  
Highly Sensitive ◽  
Operative Findings ◽  
Paranasal Sinus Disease

Aims and Objectives: The study is carried out with an objective to compare the diagnostic nasal endoscopic findings and radiological appearance in patients with paranasal sinus disease. Methods: 50 cases of chronic sinusitis not responding to routine medical line of treatment were selected and operated after being thoroughly investigated by means of nasal endoscopy and CT scan.  Results: Out of 50 cases, 35 underwent bilateral surgery and 15 underwent unilateral surgery, so a total of 85 procedures were carried out. Findings of both the CT scan as well as diagnostic nasal endoscopy were compared to each other and ultimately correlated with operative findings.  Conclusion: In our study, a high association is found between both the modalities of investigation i.e CT scan and diagnostic nasal endoscopy with one scoring over the other in different parameters. Diagnostic nasal endoscopy is found to be highly sensitive investigatory modality for parameters like frontal recess, spheno-ethmoid recess and hiatus semilunaris, where as CT scan is found to be highly sensitive for parameters like maxillary sinus, uncinate process and posterior ethmoids. So, a case of sinus disease should be diagnosed as early as possible using both these modalities as together they complement each other. Early diagnosis and effective management cures the pathology and prevents disastrous complications.  

Total uncinectomy of the cervical spine with an osteotome: technical note and intraoperative video

2019 ◽  
Vol 31 (6) ◽  
pp. 831-834 ◽  
Author(s):  
Anand H. Segar ◽  
Alexander Riccio ◽  
Michael Smith ◽  
Themistocles S. Protopsaltis
Keyword(s):  
Vertebral Artery ◽  
High Speed ◽  
Thermal Injury ◽  
Technical Note ◽  
Uncinate Process ◽  
Foraminal Stenosis ◽  
Cervical Kyphosis ◽  
Kyphosis Correction ◽  
Direct Injury ◽  
High Speed Burr

Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.

Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations

2021 ◽  
pp. 194589242110205
Author(s):  
Gian Luca Fadda ◽  
Alessio Petrelli ◽  
Federica Martino ◽  
Giovanni Succo ◽  
Paolo Castelnuovo ◽  
...  
Keyword(s):  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Horizontal Plane ◽  
Uncinate Process ◽  
Cribriform Plate ◽  
Sinus Surgery ◽  
Evaluation Methodology ◽  
Anatomic Variations ◽  
Imaging Evaluation ◽  
Plane Passing

Background Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS. Objective To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation. Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). Results The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP. Conclusions According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.

scholarly journals Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Tadao Kuribara ◽  
Tatsuo Ichikawa ◽  
Kiyoshi Osa ◽  
Takeshi Inoue ◽  
Satoshi Ono ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Hepatic Artery ◽  
Locally Advanced ◽  
Pancreatic Head ◽  
Arterial Embolization ◽  
Arterial Blood Flow ◽  
Temporary Increase ◽  
Combined Resection ◽  
Arterial Blood ◽  
Arterial Resection

Abstract Background Pancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment. Case presentation A 61-year-old man with back pain was diagnosed with pancreatic head and body cancer. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery; therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery; therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. Immediately after embolization, collateral arterial blood flow to the liver was observed. Operation was performed 19 days after embolization. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery. Conclusions In PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.

scholarly journals What comprises the plate-like structure between the pancreatic head and the celiac trunk and superior mesenteric artery? A proposal for the term “P–A ligament” based on anatomical findings

2021 ◽  
Author(s):  
Satoru Muro ◽  
Wachirawit Sirirat ◽  
Daisuke Ban ◽  
Yuichi Nagakawa ◽  
Keiichi Akita
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Dorsal Side ◽  
Uncinate Process ◽  
Anatomical Basis ◽  
The Right ◽  
Upper Abdomen ◽  
Macroscopic Examination

AbstractA plate-like structure is located posterior to the portal vein system, between the pancreatic head and roots and/or branches of two major arteries of the aorta: the celiac trunk and superior mesenteric artery. We aimed to clarify the distribution and components of this plate-like structure. Macroscopic examination of the upper abdomen and histological examination of the plate-like structure were performed on 26 cadavers. The plate-like structure is connected to major arteries (aorta, celiac trunk, superior mesenteric artery) and the pancreatic head; it contains abundant fibrous bundles comprising nerves, vessels, collagen fibers, and adipose tissue. Furthermore, it consists of three partly overlapping fibrous components: rich fibrous bundles (superior mesenteric artery plexus) fused to the uncinate process of the pancreas; fibrous bundles arising from the right celiac ganglion and celiac trunk that spread radially to the dorsal side of the pancreatic head and superior mesenteric artery plexus; and fibrous bundles, accompanied by the inferior pancreaticoduodenal artery, entering the pancreatic head. The plate-like structure is the pancreas–major arteries (aorta, celiac trunk, superior mesenteric artery) ligament (P–A ligament). The term “P–A ligament” may be clinically useful and can facilitate comprehensive understanding of the anatomy surrounding the pancreatic head and provide an anatomical basis for further pancreatic surgery studies.

scholarly journals Transsphenoidal Optic Canal Decompression for Traumatic Optic Neuropathy Assisted by a Computed Tomography Image Postprocessing Technique

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
J. Li ◽  
Q. S. Ran ◽  
B. Hao ◽  
X. Xu ◽  
H. F. Yuan
Keyword(s):  
Optic Nerve ◽  
Sphenoid Sinus ◽  
Uncinate Process ◽  
Medial Wall ◽  
Optic Canal ◽  
Wide Field ◽  
Anatomical Landmarks ◽  
Invasive Approach ◽  
Ethmoidal Sinus ◽  
Less Invasive

The endoscopic transethmoidal approach is favored for the lack of external scars, a wide field of view, and rapid recovery time. But the effect of iatrogenic trauma should not be ignored due to the removal of the uncinate process and anterior and posterior ethmoidal sinus. Anatomically, the optic nerve is close to the sphenoid sinus and Onodi cell. In order to preserve the uncinate process and ethmoidal sinus, we perform endoscopic transsphenoidal optic canal decompression (ETOCD), which is less invasive. However, the anatomy of sphenoid sinus is quite variable, and the anatomical landmarks are rare. Therefore, identifying the position of optic canal is particularly important during surgery. To solve this, we use a postprocessing technique to identify the position of the optic nerve and internal carotid artery on the sphenoid sinus wall. Our results find that VA in 13 patients improved, with a total improve rate of 59.1%. No serious complications were found. We also found that the length of optic canal is different and the medial wall of the optic canal was the longest (p<0.05). The middle section of the optic canal is the narrowest, which was significantly different from cranial mouth and orbital mouth (p<0.05). We assumed that decompression may not require removal of all medial wall. If we remove the length of the shortest wall on the medial wall of the optic canal, the compression may be relieved. Thus, ETOCD was a feasible, safe, effective, and less-invasive approach for patients with TON. The CT postprocessing imaging facilitated recognition of the optic canal during surgery. The decompression length of the medial wall may not need to be completely removed, especially near the cranial mouth.

Complete resection of a massive mesenteric lymphangioma in an adult

2020 ◽  
Vol 13 (3) ◽  
pp. e233714 ◽  
Author(s):  
Dominic Robert Parker ◽  
Philip Kiely ◽  
Richard Smith
Keyword(s):  
Patient Outcome ◽  
Preoperative Diagnosis ◽  
Lymphatic Vessels ◽  
Complete Resection ◽  
Surgical Team ◽  
Cystic Tumour ◽  
Good Patient ◽  
Mesenteric Lymphangioma ◽  
Good Patient Outcome ◽  
Massive Resection

Mesenteric lymphangioma is a benign cystic tumour of the lymphatic vessels that occurs rarely in adults. Due to the infrequency of cases and the insidious presentation, these tumours can be diagnosed late and become massive. Resection of mesenteric lymphangioma in its entirety is the recommended management in order to prevent recurrence. This case report describes the finding of a massive mesenteric lymphangioma (dimensions 420×470×100 mm) in a young man, the investigations leading to diagnosis, and the subsequent surgical management. The substantial size of this tumour produced considerable challenges for the surgical team, including involvement of adjacent small bowel and mesenteric vasculature. Preoperative diagnosis and assessment of the anatomy was pivotal in achieving a complete resection and a good patient outcome.

Paranasal Sinus Development in Chronic Sinusitis, Cystic Fibrosis, and Normal Comparison Population: A Computerized Tomography Correlation Study

1997 ◽  
Vol 11 (4) ◽  
pp. 275-282 ◽  
Author(s):  
Hung Jeff Kim ◽  
Ellen M. Friedman ◽  
Marcelle Sulek ◽  
Newton O. Duncan ◽  
Charles McCluggage
Keyword(s):  
Cystic Fibrosis ◽  
Maxillary Sinus ◽  
Paranasal Sinus ◽  
Chronic Sinusitis ◽  
Correlation Study ◽  
Uncinate Process ◽  
Ct Scans ◽  
Lateral Nasal Wall ◽  
Transverse Diameter ◽  
Sinus Disease

Chronic sinus disease in patients with and without cystic fibrosis may have an impact on the pattern of paranasal sinus pneumatization. Arrest of pneumatization has been reported in both of these conditions. To assess the development of the paranasal sinuses in relationship to chronic sinusitis and cystic fibrosis (CF), a retrospective review of coronal CT scans of the age-matched patients with no previous sinus disease, patients with chronic sinusitis, and cystic fibrosis patients was conducted. The patients’ ages ranged from 4 to 17 years. The maxillary sinus volume, anteroposterior diameter, and greatest transverse diameter and height were determined using image analysis software after the coronal CT scans were scanned into Macintosh computer. The size of the maxillary sinus increased with advancing age in the control and chronic sinusitis group, but not in the patients with cystic fibrosis. The patients with cystic fibrosis had a statistically significant smaller maxillary sinus size. Approximately 50% of the patients with chronic sinusitis had anatomic anomalies, the most common being paradoxical middle turbinates. The CT scans of CF patients were characterized by uncinate process demineralization and medial displacement of the lateral nasal wall in the middle meatus, and decreased maxillary sinus pneumatization.

scholarly journals Giant Mesenteric Lymphangioma

2009 ◽  
Vol 26 (4) ◽  
pp. 289-290 ◽  
Author(s):  
Eva Schest ◽  
Herwig Cerwenka ◽  
Bernd H&ouml;fler ◽  
Marcus Rigler ◽  
Thomas Auer ◽  
...  
Keyword(s):  
Mesenteric Lymphangioma

Giant cavernous mesenteric lymphangioma in adult

2012 ◽  
Vol 65 (4) ◽  
pp. 317-319
Author(s):  
Giovanni Vennarecci ◽  
Cecilia Ceribelli ◽  
Andrea Laurenzi ◽  
Enrico Moroni ◽  
Giuseppe Maria Ettorre
Keyword(s):  
Mesenteric Lymphangioma
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