Anatomic variations of surgical importance in ethmoid labyrinth and sphenoid sinus. A study of radiological anatomy

Summary The present study was performed on axial and coronal CT scans of 100 patients, most of whom were affected by nasal polyposis. Five observers had to analyse the radiograms and answer a questionnaire including the following items: presence of a supraorbital recess; identification of anterior and posterior ethmoidal canals; dehiscences in the lamina papyracea; pneumatized middle turbinate; presence of a spheno-maxillary plate; presence of Haller's cells; presence of Onodi's cells; relationships of the optic canal; relationships of the internal carotid artery; relationships of the maxillary nerve; relationships of the vidian nerve; level difference between the ethmoid roof and nasal vault; depth of the sphenoethmoidal recess. The data obtained were compared with those drawn from anatomical studies. The fair agreement between them proves the value of CT as an alternative method for studying paranasal sinuses anatomy.

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Anatomie radiologique des variations du labyrinthe ethmoïdal et du sinus sphénoïdal et leurs conséquences chirurgicales

Résumé Cette étude a été réalisée sur 100 patients dont la plupart présentait une polypose nasale étudiée en coupes T D M axiale et coronale. Cinq lecteurs ont revu les clichés et répondu au questionnaire suivant: présence d'un récessus supra orbitaire; identification des canaux ethmoïdaux antérieur et postérieur; déhiscence de la lame papyracée; pneumatisation du cornet moyen; présence d'un plateau sphéno maxillaire; présence de cellules de Haller; présence de cellules d'Onodi; rapports du canal optique; rapports de l'artère carotide interne; rapports du nerf maxillaire; rapports du nerf vidien; dénivelé entre le toit ethmoïdal et le toit nasal; profondeur du récessus sphéno-ethmoïdal. Les données obtenues ont été comparées avec celles provenant de travaux anatomiques. La concordance acceptable entre les deux démontre la valeur du scanner comme méthode d'étude alternative de l'anatomie des sinus para nasaux.

     

蝶窦前壁的外科解剖学研究

目的　探讨蝶窦前壁区的解剖特征及其在经蝶窦入路手术中的意义。 方法　用15例（30侧）成人头部标本及20例（40侧）成人头骨标本,在手术显微镜下对蝶窦前壁骨质、蝶腭动脉及其分支等结构进行观察和测量。 结果 蝶窦前壁的基本形态酷似鸟头,正中线棱状高起,两侧为鸟眼样的蝶窦口,下方为鸟喙样的蝶嘴。蝶窦口距上鼻道末端（14.5±1.1）mm,距后鼻孔上缘（12.2±1.0）mm,距鼻后中隔动脉上支（8.2±0.5)mm。自鼻孔伸入探条探测蝶窦前壁时,所探及的“最浅点”大致位于蝶窦口与后鼻孔之间的中点附近。蝶腭孔位于蝶窦口的外下方和中鼻甲的后端区域,与蝶窦口间距(6.9±1.3)mm,两侧蝶腭孔内侧缘间距(18.2±2.5)mm。 结论 蝶窦前壁具有特征性的形态,蝶窦口大致位于蝶窦前壁的上中1/3交界处,其下方的骨质向前方突起。蝶腭孔位于蝶窦口下外侧方约7 mm处,经蝶窦入路手术中可以依此定位蝶腭孔。     

Agenesis of sphenoid sinus: three cases

Paranasal sinus agenesis is an unusual clinical condition. The frontal sinus agenesis is more frequently seen, whereas agenesis of the sphenoid sinus is extremely rare. This report presents three new cases of sphenoid sinus agenesis. The absence of the sphenoid sinus was demonstrated by computed tomography (CT) in all cases.     

The paratemporal segment of the maxillary sinus: A new sign for assessment of size

Summary The area of the maxillary antrum in Waters' view has been measured in 68 patients using a mechanical planimeter. The mean area was 6.04±0.25 cm². The part of the antrum lateral to the innominate line (defined as the paratemporal segment) has a mean area of 0.72±0.07 cm². The latter diminishes in small antra and approches zero when the total antral area falls below 3.48 cm². It is proposed that the innominate line (Stenvers), or its extension, descends lateral to the field of the small maxillary sinus and may be used as an additional sign of such abnormality.

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Segment paratemporal du sinus maxillaire: Un nouvel élément de mesure de la taille du sinus

Résumé La surface du sinus maxillaire étudiée en incidence de Waters a été mesurée chez 68 malades en utilisant un planimètre mécanique. La surface moyenne était de 6,04±0,25 cm². La portion du sinus située en dehors de la ligne de Stenvers (définissant le segment paratemporal) avait une surface moyenne de 0,72±0,007 cm². Cette dernière diminue avec la taille du sinus et approche une valeur nulle lorsque la surface totale du sinus est inférieure à 3,48 cm². Les auteurs proposent que la ligne de Stenvers ou sa situation en dehors de la projection d'un petit sinus maxillaire soit utilisée comme un signe supplémentaire de cette anomalie.

     

蝶窦体积与蝶窦内颈内动脉隆凸相互关系的CT研究

目的通过高分辨率CT影像学研究,探讨蝶窦内的颈内动脉隆凸与蝶窦体积的关系。方法利用无鼻旁窦异常的350例进行螺旋CT扫描,观察蝶窦内的颈内动脉隆凸出现率,然后将观察的结果分成无颈内动脉隆凸、单侧隆凸和双侧隆凸3组,每组30例,测量每组的蝶窦体积,分析蝶窦体积与颈内动脉隆凸的关系。结果蝶窦内无颈内动脉隆凸的占70.75%(258例);蝶窦内有一侧隆凸的占8.49%(31例);有二侧隆凸的占20.74%(108例)。无颈内动脉隆凸的蝶窦体积(11.16±1.60)cm3;单侧隆凸的蝶窦体积(14.20±1.80)cm3;双侧隆凸的蝶窦体积(25.03±2.21)cm3;其组与组之间比较均有统计学意义。结论蝶窦体积与蝶窦内隆凸出现率有直接相关关系,蝶窦体积小,隆凸出现率就低;蝶窦体积大,隆凸出现率就高。     

Pneumatization of the sphenoid sinus in Chinese: the differences from Caucasian and its application in the extended transsphenoidal approach

In recent years, the transsphenoidal approach has been extensively used surgically to treat parasellar, suprasellar, clival, and even petrous lesions. Extended pneumatization of the sphenoid sinus (SS) is considered an indispensable element for the extended transsphenoidal (ETS) approach. Because most anatomical studies of the ETS approach use Caucasian subjects, the present study aims to clarify the pneumatic extension types in Chinese individuals as well as any differences from those in Caucasians and analyze these differences with respect to the application of the ETS approach. A total of 200 computed tomography (CT) images of SSs and 18 adult cadaveric heads were selected for observation and measurement. The conchal, presellar, and sellar types comprised 6, 28.5, and 65.5% of subjects, respectively; according to the extra extension, the prevalence of the lateral, clival, lesser wing, and combined extension sinus types was 11.4, 21.4, 0.8, and 48.1% of subjects, respectively. The percentages of pneumatization of the anterior and posterior clinoid processes, pterygoid process, and optic strut were 5.0, 1.0, 22.3, and 7.0%, respectively. Onodi cells were observed in 61.1% of the sides of the cadaveric heads, including 30.6% with good pneumatization with identifiable optical or ICA bulges. These features were related to poor lateral and clival gasification in Chinese compared with Caucasians, which might make extended surgery more dangerous. However, the anterior pneumatization, especially the higher presentation of Onodi cells, ensures that the anterior ETS approach can be performed safely in Chinese patients. In general, measurements showing smaller sinus volumes and thicker bones with identifiable bone landmarks that are hard to find compared with those in Caucasians suggest increased surgical risks in the Chinese population. In this situation, carefully analysis of presurgical CT and magnetic resonance imaging scans is important. Furthermore, in the ETS approach, the use of stricter intraoperative technological devices such as neuronavigation and ultrasound Doppler is advisable.     

手舟骨血供3D可视化模型的制备

目的　建立手舟骨动脉血供三维数字可视化模型,为基础研究及临床应用提供形态学基础。 方法　8具尸体行一次性全身动脉造影、螺旋CT扫描,运用Mimics软件构建腕骨及手舟骨滋养动脉的3D可视化模型。 结果　（1）该模型能够清晰显示桡骨、尺骨远端与手部各骨及其周围血管网,并可任意旋转观察与测量;（2）手舟骨有3支主要的滋养动脉;（3）通过选择性透明或隐藏处理后,对手舟骨营养血管入骨点及其在骨内的分布情况得到了很好的显示。 结论　该模型可清晰的显示手舟骨及其滋养动脉的来源、分布、及空间毗邻,可为手舟骨疾患的临床诊治提供直观的数字化解剖学依据。     

不同节段椎弓根内部结构的测量和比较

目的:提供国人椎弓根内部结构的量化数据以及随节段变化的规律.方法:20具成人防腐C3～L5脊柱标本,螺旋CT扫描后行多平面重建,在椎弓根峡部横截面上测量椎弓根高度(PH),宽度(PW),内、外、上、下缘皮质厚度(MCT、LCT、SCT、ICT),及椎弓根内部松质骨的宽度和高度(SBW、SBH).运用统计软件系统比较椎弓根内部各个参数的变化.结果:椎弓根左右两侧没有显著性差异,男女间除LCT外,各参数均无显著性差异.LCT/PW为(20.72±5.77)%,MCT/PW为(32.87±7.47)%,SCT/PH为(24.33±6.07)%,ICT/PH为(22.51±5.17)%,SBW/PW为(46.41±11.76)%,SBH/PH为(53.17±10.15)%.MCT绝对值及所占的比例在各个节段上均显著大于LCT.各个节段椎弓根皮质骨与松质骨的比例有所不同.C6～T1,T8～T12为椎弓根内部结构变化较大的区域.结论:(1)薄层螺旋CT可较好的呈现椎弓根内部的情况;(2)上胸椎椎弓根是置入椎弓根螺钉的危险区域;(3)椎弓根外侧皮质较内侧皮质薄,在置入椎弓根螺钉时外侧更容易破裂.     

Carpal bone maturation during childhood and adolescence: Assessment by quantitative computed tomography

The aim of our study was to measure the volume of each carpal bone during childhood and adolescence by image processing from computed tomography (CT) scans, and to analyze the relationship between the eight carpal bones. Thirteen CT scans were performed in nine normal prepubertal, peripubertal and post-pubertal children, six boys and three girls, aged 5-14 years. Each scan was processed in order to extract the carpal bones. The volume was computed for each bone. There was a significant correlation between carpal bone volume and age (0.55 < r < 0.79), and a very strong correlation between the volume of a given carpal bone and the volume of all the others, whatever the age (0.87 < r < 0.99, p < 0.01). Image processing is a potentially useful method for assessing bone maturation. The constant ratio between carpal bone volumes indicates that these bones interact with each other in wrist bone maturation     

The development of consistency and flexibility in manual pointing during middle childhood

Goal‐directed actions become truly functional and skilled when they are consistent yet flexible. In manual pointing, end‐effector consistency is characterized by the end position of the index fingertip, whereas flexibility in movement execution is captured by the use of abundant arm‐joint configurations not affecting the index finger end position. Because adults have been shown to exploit their system's flexibility in challenging conditions, we wondered whether during middle childhood children are already able to exploit motor flexibility when demanded by the situation. We had children aged 5–10 years and adults perform pointing movements in a nonchallenging and challenging condition. Results showed that end‐effector errors and flexibility in movement execution decreased with age. Importantly, only the 9‐10‐year‐olds and adults showed increased flexibility in the challenging condition. Thus, while consistency increases and flexibility decreases during mid‐childhood development, from the age of nine children appear able to employ more flexibility with increasing task demands.     

舌下神经管的影像解剖学研究

目的通过影像解剖学对照研究,探讨舌下神经管影像学表现及其检查方法。方法选择5例经福尔马林固定的成年人头颅标本,经CT和MRI扫描后,1例行大体解剖,2例行横断面切片,2例行冠状面切片,切片厚度均为1mm。结果舌下神经管的外侧与颈静脉孔相邻,CT、MRI均可清晰显示舌下神经管;在舌下神经管中部层面,管内可见舌下神经影像。舌下神经管内径为(4.85±1.17)mm,舌下神经管外壁至颈静脉孔距离(2.03±0.51)mm。结论CT和MRI可作为舌下神经管的常规检查手段。     

面神经在颞骨内改道以延长其可利用长度的应用解剖

目的:探讨将面神经在颞骨内改道,以延长面神经颅外段(总干)可利用长度,解决颌面部外科手术中面神经总干长度不足问题。方法:在手术显微镜下,对20例(40侧)经福尔马林固定尸体头部标本进行解剖,观测面神经在颞骨内改道后颅外段延长的可利用长度。结果:①仅作乳突段向外耳道后壁及向颞骨浅面改道,可延长面神经总干长(7.1±0.3)mm。②鼓室段及乳突段联合向外耳道后壁及向颞骨浅面改道,可延长面神经总干长(13.4±0.6)mm,经统计学处理两者有显著性差异(P<0.05)。结论:将面神经鼓室段及乳突段联合向外耳道后壁及颞骨浅面改道,能有效延长面神经总干长度,是解决颌面部外科手术中面神经长度不足的有效方法。     

Evaluating the transferability of a hospital-based childhood obesity clinic to primary care: a randomised controlled trial

Background

The Care Of Childhood Obesity (COCO) clinic at the Bristol Royal Hospital for Children (BRHC) uses a multidisciplinary approach comprising a consultant, dietitian, and exercise specialist. The clinic has demonstrated efficacy in managing children''s weight but similar clinics are scarce in the UK.

Aim

This pilot randomised controlled trial (RCT) aimed to examine the feasibility of undertaking a fully powered RCT and to gauge whether the COCO model could be effective as a nurse-led clinic in primary care settings.

Design and setting

Patients were randomised to a hospital-based childhood obesity clinic or a nurse-led clinic in a primary care setting in south-west England.

Method

Children aged 5–16 years with a body mass index (BMI) ≥98th centile were referred by GPs to the consultant in charge of the COCO clinic at BRHC. Referred children were clinically screened for suitability and invited into the study. Consenting families were randomised to BRHC or a primary care clinic (PCC) and offered five appointments over 12 months. Clinical effectiveness was measured by change in body mass index standard deviation score (BMI SDS) at 12 months. Other measures included: treatment adherence, quality of life (QOL), and satisfaction. Feasibility was examined by assessing referral, screening, and recruitment data.

Results

A total 152 patients were referred by GPs: 31 (20%) were screened out; 45 (30%) declined to participate. Seventy-six (50%) patients were randomised and 68 provided baseline data (PCC = 42; BRHC = 26); 52 provided outcome data (PCC = 29; BRHC = 23). Mean change in BMI SDS was PCC –0.17 (95% confidence interval [CI] = –0.27 to –0.07); BRHC –0.15 (95% CI = –0.26 to –0.05). QOL, adherence, and satisfaction data indicated similar positive patterns in both trial arms.

Conclusion

Screening and recruitment data indicate that primary care is a clinically appropriate setting and acceptable to families. The primary clinical outcome measure (reduction in BMI SDS), along with secondary outcome measures, indicate that primary care has the potential to be effective in providing weight management for children, using the COCO model.     

The genetic era of childhood cancer: Identification of high-risk patients and germline sequencing approaches

Childhood cancer is a leading cause of death by disease in children ages 5–14, for which there are no preventive strategies. Due to early-age of diagnosis and short period of exposure to environmental factors, increasing evidence suggests childhood cancer could have strong association with germline alterations in predisposition cancer genes but, their frequency and distribution are largely unknown. Several efforts have been made to develop tools to identify children with increased risk of cancer who may benefit from genetic testing but their validation and application on a large scale is necessary. Research on genetic bases of childhood cancer is ongoing, in which several approaches for the identification of genetic variants related to cancer predisposition have been used. In this paper, we discuss the updated efforts, strategies, molecular mechanisms and clinical implications for germline predisposition gene alterations and the characterization of risk variants in childhood cancer.     

Three-dimensional CT analysis of atlantoaxial rotation: results in the normal subject

Summary A three-dimensional analysis of atlantoaxial rotation was made by computed tomography in ten healthy subjects. The method described allowed study of spatial relations between C1 and C2 interspace under both static and dynamic conditions, using a projection in a fixed transverse plane. The results demonstrated an axis of rotation for C2 slightly anterior to that for C1. Asymmetric rotation was observed, the separation between the transverse formaina of C1 and C2 being less marked on the side opposite to the direction of rotation of the head. This use of CT and these anatomic findings may be useful in the study of disorders of atlantoaxial rotation and their effect on the vertebral arteries.

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Analyse tridimensionnelle de la rotation atloido-axoidienne : méthode tomodensitometrique et résultats chez le sujet normal

Résumé Une analyse tridimensionnelle de la rotation atloïdo-axoïdienne est effectuée en tomodensitométrie chez dix sujets sains. La méthode présentée permet une étude des rapports dans l'espace de C1 et C2, en position statique et dynamique, par projection dans un plan transversal fixe. Les résultats mettent en évidence un axe de rotation de C2 légèrement antérieur à celui de C1. Une rotation asymétrique est observée avec une ouverture entre les foramens transversaires de C1 et C2 plus faible du côté controlatéral au sens de rotation de la tête. Cette méthode tomodensitométrique et ces résultats anatomiques peuvent être utilisés dans l'étude de la pathologie de la rotation atloïdo-axoïdienne et de son retentissement sur les artères vertébrales.

     

正常女性静息及最大用力下盆底结构改变的MRI表现

背景：MRI因其具有无放射性、良好的软组织对比及多层面多轴向扫描成像等特点,可对盆底的整体结构进行精确的评估。 目的：利用MRI观察无症状女性静息状态及最大盆腔用力时盆底解剖结构的变化,为进一步评价盆底功能障碍性疾病建立正常标准。 方法：对23例无盆底功能障碍及其他盆腔疾患的女性行动态、静态盆腔MRI检查,常规观察盆腔器官及盆底结构,在正中矢状位上分别测量不同状态下膀胱颈、子宫颈、肛直肠连接与耻尾线的距离及HMO分度系统中分别测量肛直肠连接到耻尾线的距离(M线)、肛直肠连接与耻骨联合下缘连线(H线);经肛管中部的冠状位上测量肛提肌板的角度的变化,在经耻骨联合下缘的横断位图像上测量盆隔裂孔的面积的变化。 结果与结论：盆腔用力时膀胱颈、子宫颈及肛直肠连接较静息状态下均有不同程度的下降;盆腔用力时肛提肌板的角度及盆膈裂孔面积轻度增大;盆腔用力时H线及M线均有轻度的增大;与静息状态比较,动态时膀胱颈、子宫颈、肛直肠连接的下降、肛提肌板角度的增大及盆膈裂孔面积的增大、H线及M线的增大差异均有显著性意义(P < 0.05)。提示无症状女性静息时及盆腔用力时盆腔器官的位置会有所改变,在耻尾线系统测量和HMO系统上测量,盆腔器官的下降程度均未超过正常范围。盆腔用力时肛提肌板的角度及盆膈裂孔面积均可见轻度的增大。