Evaluating the relationship of the pB–C2 line to clinical outcomes in a 15-year single-center cohort of pediatric Chiari I malformation

OBJECT The clinical significance of radiological measurements of the craniocervical junction in pediatric Chiari I malformation (CM-I) is yet to be fully established across the field. The authors examined their institutional experience with the pB–C2 line (drawn perpendicular to a line drawn between the basion and the posterior aspect of the C-2 vertebral body, at the most posterior extent of the odontoid process at the dural interface). The pB–C2 line is a measure of ventral canal encroachment, and its relationship with symptomatology and syringomyelia in pediatric CM-I was assessed. METHODS The authors performed a retrospective review of 119 patients at the Monroe Carell Jr. Children's Hospital at Vanderbilt University who underwent posterior fossa decompression with duraplasty, 78 of whom had imaging for review. A neuroradiologist retrospectively evaluated preoperative and postoperative MRI examinations performed in these 78 patients, measuring the pB–C2 line length and documenting syringomyelia. The pB–C2 line length was divided into Grade 0 (< 3 mm) and Grade I (≥ 3 mm). Statistical analysis was performed using the t-test for continuous variables and Fisher's exact test analysis for categorical variables. Multivariate logistic and linear regression analyses were performed to assess the relationship between pB–C2 line grade and clinical variables found significant on univariate analysis, controlling for age and sex. RESULTS The mean patient age was 8.5 years, and the mean follow-up duration was 2.4 years. The mean pB–C2 line length was 3.5 mm (SD 2 mm), ranging from 0 to 10 mm. Overall, 65.4% of patients had a Grade I pB–C2 line. Patients with Grade I pB–C2 lines were 51% more likely to have a syrinx than those with Grade 0 pB–C2 lines (RR 1.513 [95% CI 1.024–2.90], p = 0.021) and, when present, had greater syrinx reduction (3.6 mm vs 0.2 mm, p = 0.002). Although there was no preoperative difference in headache incidence, postoperatively patients with Grade I pB–C2 lines were 69% more likely to have headache reduction than those with Grade 0 pB–C2 lines (RR 1.686 [95% CI 1.035–2.747], p = 0.009). After controlling for age and sex, pB–C2 line grade remained an independent correlate of headache improvement and syrinx reduction. CONCLUSIONS Ventral canal encroachment may explain the symptomatology of select patients with CM-I. The clinical findings presented suggest that patients with Grade I pB–C lines2, with increased ventral canal obstruction, may experience a higher likelihood of syrinx reduction and headache resolution from decompressive surgery with duraplasty than those with Grade 0 pB–C2 lines.

Female gametophyte development and embryogenesis in Taxus baccata L.

Crassinucellate ovules are initiated in <em>Taxus</em>, directly from the shoot apex. The rudimentary pollen chamber is formed in the nucellus. A linear tetrad of megaspores with a functional chalazal megaspore is formed. A free-nuclear stage is charac-teristic at the beginning of megagametophyte development. Archegonia without ventral canal cell are solitary or in complexes. The embryo has a very long suspensor even after maturation. Two types of polyembryony have been revealed: i) embryogenic redifferentiation of suspensor cells and ii) cleavage of embryonic region in the early embryo. In the northern temperate climate of St. Petersburg one month delay in development of reproductive structures has been noted.

Accuracy of the freehand technique for 3 fixation methods in the C-2 vertebrae

Object Intraoperative imaging often does not provide adequate visualization to ensure safe placement of screws. Therefore, the authors investigated the accuracy of a freehand technique for placement of pars, pedicle, and intralaminar screws in C-2. Methods Sixteen cadaveric specimens were instrumented freehand by 2 experienced cervical spine surgeons with either a pars or pedicle screw, and bilateral intralaminar screws. The technique was based on anatomical starting points and published screw trajectories. A pedicle finder was used to establish the trajectory, followed by tapping, palpation, and screw placement. After placement of all screws (16 pars screws, 16 pedicle screws, and 32 intralaminar screws), the C-2 segments were disarticulated, radiographed in anteroposterior, lateral, and axial planes, and meticulously inspected by another spine surgeon to determine the nature and presence of any defects. Results A total of 64 screws were evaluated in this study. Pars screws exhibited 2 critical defects (1 in the foramen transversarium and 1 in the C2–3 facet) and an insignificant dorsal cortex breech, for an overall accuracy rate of 81.3%. Pedicle screws demonstrated only 1 insignificant violation (inferior facet/medial cortex intrusion of 1 mm) with an accuracy rate of 93.8%, and intralaminar screws demonstrated 3 insignificant violations (2 in the ventral canal, 1 in the caudad lamina breech) for an accuracy rate of 90.6%. Pars screws had significantly more critical violations than intralaminar screws (p = 0.041). Conclusions Instrumentation of the C-2 vertebrae using the freehand technique for insertion of pedicle and intralaminar screws showed a high success rate with no critical violations. Pars screw insertion was not as reliable, with 2 critical violations from a total of 16 placements. The freehand technique appears to be a safe and reliable method for insertion of C-2 pedicle and intralaminar screws.

The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience

A number of operative techniques have been described for the treatment of herniated thoracic discs. The transfacet pedicle-sparing approach allows for complete disc removal with limited spinal column disruption and soft-tissue dissection. Fifteen cadaveric spinal columns were used for evaluation of exposure, development of thoracic microdiscectomy instrumentation, and establishment of morphometric measurements. This approach was used to remove eight thoracic discs in six patients. Levels of herniation ranged from T-7 through T-11. Preoperatively, all patients had moderate to severe axial pain, and three (50%) of the six had radicular pain. Myelopathy was present in four (67%) of the six patients. Through a 4-cm opening, the ipsilateral paraspinal muscles were reflected, and a partial facetectomy was performed. The disc was then removed using specially designed microscopic instrumentation. Postoperatively, the radiculopathy resolved in all patients. Axial pain and myelopathy were completely resolved or significantly improved in all patients. The minimal amount of bone resection and muscle dissection involved in the operation allows for: 1) decreased operative time and blood loss; 2) diminished perioperative pain; 3) shorter hospitalization time and faster return to premorbid activity; 4) avoidance of closed chest tube drainage; and 5) preservation of the integrity of the facet-pedicle complex, with potential for improvement in outcome related to axial pain. This technique appears best suited for the removal of all centrolateral discs, although it has been used successfully for treating a disc occupying nearly the entire ventral canal. The initial experience suggests that this approach may be used to safely remove appropriately selected thoracic disc herniations with good results.

The transfacet pedicle-sparing approach for thoracic disc removal: cadaveric morphometric analysis and preliminary clinical experience

✓ A number of operative techniques have been described for the treatment of herniated thoracic discs. The transfacet pedicle-sparing approach allows for complete disc removal with limited spinal column disruption and soft-tissue dissection. Fifteen cadaveric spinal columns were used for evaluation of exposure, development of thoracic microdiscectomy instrumentation, and establishment of morphometric measurements. This approach was used to remove eight thoracic discs in six patients. Levels of herniation ranged from T-7 through T-11. Preoperatively, all patients had moderate to severe axial pain, and three (50%) of the six had radicular pain. Myelopathy was present in four (67%) of the six patients. Through a 4-cm opening, the ipsilateral paraspinal muscles were reflected, and a partial facetectomy was performed. The disc was then removed using specially designed microscopic instrumentation. Postoperatively, the radiculopathy resolved in all patients. Axial pain and myelopathy were completely resolved or significantly improved in all patients. The minimal amount of bone resection and muscle dissection involved in the operation allows for: 1) decreased operative time and blood loss; 2) diminished perioperative pain; 3) shorter hospitalization time and faster return to premorbid activity; 4) avoidance of closed chest tube drainage; and 5) preservation of the integrity of the facet—pedicle complex, with potential for improvement in outcome related to axial pain. This technique appears best suited for the removal of all centrolateral discs, although it has been used successfully for treating a disc occupying nearly the entire ventral canal. The initial experience suggests that this approach may be used to safely remove appropriately selected thoracic disc herniations with good results.

Sexual reproduction of mountain hemlock (Tsuga mertensiana)

Meiosis of pollen mother cells begins in October of the year in which cones are initiated. They reach pachytene then become dormant until the next March. Meiosis is complete and the winged pollen mature by mid-June. Meiosis of the megaspore mother cell occurs in May, forming a linear tetrad of megaspores. The female gametophyte undergoes free nuclear division at pollination in mid-June. No pollination drop is present; rather, the pollen adheres to the sticky, splayed edge of the micropyle, where it germinates and pollen tubes grow toward the nucellus. The nucellus elongates into the micropylar canal, forming a nucellar beak, which makes contact with the pollen tubes. Several pollen tubes penetrate the nucellus.At the time of fertilization early in August, each ovule contains two to four aichegonia each having two to four neck cells in one tier. Pollen tubes penetrate the neck cells and two male gametes are formed. The ventral canal cell breaks down and fusion occurs in the center of the archegonium. Four free nuclei form and migrate to the base of the archegonium. cell walls form, and a 16-celled proembryo develops. Both simple and cleavage polyembryony occur. Rosette cells divide but do not form complex embryos. The embryo and seed are mature in October and the cones dry and open during October and November. Mature cones averaged 70 seeds, of which 46% were filled.Reproduction in mountain hemlock (Tsuga mertensiana (Bong.) Carr.) is similar to that in other species of Tsuga except for the presence of winged pollen. Any attempt to place the species in the genus Picea or place it as a hybrid midway between Picea and Tsuga is unfounded based on all of the more-conservative reproductive and embryological characteristics.

Elektronenmikroskopische Untersuchungen über die Eizellbildung und Eizellreifung des Lebermooses Sphaerocarpus donnellii Aust.

The formation and maturation of the egg of the liverwort, Sphaerocarpus donnellii, was investigated by light, phase contrast and particularly by electron microscopy. The division of the central cell into the egg and the ventral canal cell, and the maturation of the egg, is completed within four days. All stages of this formation and maturation were examined under the electron microscope after fixation in KMnO4 or OsO4. — In the maturing egg there always occur the endoplasmic reticulum, well recognisable plastids with a poorly developed lamellar system, numerous mitochondria and dictyosomes, a rising number of lipid droplets, unknown small bodies limited by a unit membrane, and numerous ribosomes. During maturation the nucleus considerably enlarges and forms evaginations into the cytoplasm. Starch is increasingly deposited in the plastids. A degeneration of plastids has not been found.

On the cytological features of fertilisation and related phenomena in Pinus silvestris , L

This paper gives a fairly complete account of the minute cytological details of the act of fertilisation and of the processes surrounding from the formation of the ventral canal cell up to the period of cl wall formation at the base of the egg. As the oosphere nucleus, after separation of the nucleus of the ventral canal cell, moves rapidly back towards the centre of the e it increases greatly in size, as described by Strasburger. Ts increase in size is shown to be due to the appearance in the nucleus of a peculiar metaplasmic substance, which fills up the nucleus, and owing to its attraction for stains, ultimately obscures the chromatin.