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Animal model for cerebral arteriovenous malformation.

BACKGROUND: The present study was conducted to establish an animal model for the investigation of the pathophysiology and haemodynamics of cerebral arteriovenous malformation (AVM) but also to assess therapeutic aspects. METHOD: For anatomic and haemodynamic reasons, dogs were chosen as the animal model. An arteriovenous fistula was created by interposing a segment of the superficial temporal artery between one of the main branches of the middle cerebral artery and the dorsal sagittal sinus. A temporal muscle graft supplied by this artery was implanted intracerebrally in the ischaemic area. FINDINGS: The angiographic and histopathologic findings obtained in the animal model are comparable with the situation found in intracerebral AVM in humans. INTERPRETATION: The animal model of intracerebral AVM established in this study allows for further investigation of the pathophysiology and dynamics of this disorder. It may help to develop better therapeutic options and thus improve the prognosis of affected patients.

Animals↗

Sarcomere lesion damage occurs mainly in slow fibers of reloaded rat adductor longus muscles.

Sarcomere lesions were previously observed with reloading of rat adductor longus muscles after spaceflight and hindlimb unloading (HU). Spaceflown rats displayed more lesioned fibers in the "slow-fiber" region, suggesting a damage-susceptible fiber type. Unloading induces fast myosin expression in some slow fibers, generating hybrid fibers. We examined whether lesion damage differed among slow-, hybrid-, and fast-fiber types in HU-reloaded adductor longus muscles. Temporal HU for 5, 8, 11, 14, and 17 days revealed that hybrid fiber percent, detected by antimyosin immunostaining, peaked at 29 +/- 12% by 14 days. A 14-day HU followed by 12-14 h of voluntary reloading was performed to induce lesions. chi2 analysis showed that slow fibers were preferentially damaged, accounting for 92 +/- 5% of lesioned fibers; hybrid and fast fibers accounted for 7 +/- 4 and <0.5%, respectively. Atrophy did not explain differential lesion damage across fiber types, as slow and hybrid fibers atrophied to a similar extent. Because active myofiber contractions are requisite for lesion formation, selective recruitment of slow fibers most likely explains their damage susceptibility.

Animals↗

Surgical treatment for pediatric moyamoya disease: use of the superficial temporal artery for both areas supplied by the anterior and middle cerebral arteries.

OBJECTIVE: To revascularize ischemic territories of both the anterior cerebral artery (ACA) and the middle cerebral artery (MCA), a simple and effective combined bypass operation was performed in 36 pediatric patients with moyamoya disease during the past 8 years. METHODS: The branches of the superficial temporal artery (STA) were used to revascularize the ACA and MCA territories. In children older than 5 years, the parietal branch of the STA was usually used for an end to side anastomosis with a cortical branch of the MCA. In children who were younger than 5 years, the parietal branch of the STA was used for an encephaloduroarteriosynangiosis instead of a direct anastomosis. Encephaloduroarteriosynangiosis, using the proximal part of the intact frontal branch of the STA, and encephalomyosynangiosis, using the temporal muscle, were also performed in all patients to stimulate spontaneous anastomosis. In addition, bilateral frontal burr holes were made in all patients to induce vascularization of the ACA territories from the distal part of the intact frontal branch of the STA. The first operation was performed on the dominant side, then a similar procedure was performed on the opposite side after an interval of at least 3 months. RESULTS: Postoperative clinical symptoms and the findings from magnetic resonance imaging, magnetic resonance angiography, angiography, and electroencephalography demonstrated improvement in all patients. CONCLUSION: These results suggest that the placement of bilateral burr holes (while leaving the frontal branch of the STA intact), in addition to the STA-MCA anastomosis, encephaloduroarteriosynangiosis, and encephalomyosynangiosis, is very effective in vascularizing the ischemic ACA and MCA territories in pediatric patients with moyamoya disease.

Adolescent↗

Anatomy and blood supply of the subgaleal fascia flap.

The subgaleal fascia (SGF) is a distinct layer in the temporal fossa situated between the superficial fascia and galea aponeurotica and the temporal fascia covering the superficial surface of the temporal muscle. The SGF is used most frequently for otologic reconstruction. Reviewing the literature, however, showed many contradictory findings about dissection of an independent SGF layer, its blood supply, and the possibility of harvesting it as part of a combined flap. Our study, carried out on ten fresh cadavers, presents a detailed view of the blood supply of the SGF to develop a safe method of harvesting an inferior-based SGF. Our systematic plane-by-plane approach, associated with a transparent grid applied on each dissection, allowed us to quantify the branches from each plane and to localize precisely their entering sites from a reference "zygomatic point." The SGF had no ascending axial vascular supply entering from its base; according to our results, therefore, the SGF could not be harvested alone as an inferior pedicled flap down to the zygomatic arch. It may be feasible, however, to harvest a SGF flap when a strip of the superficial fascia is associated with its middle third. Therefore, we suggest that an average height of 5.4 cm of superficial fascia should be included in an inferior-based pedicle of a SGF.

Aged↗

A review of 25-year experience of nasal septal perforation repair.

OBJECTIVE: To report the long-term follow-up of 25 years of experience in 100 consecutive cases of septal perforation (SP) repair using the technique of the senior author (F.P.). DESIGN: From 1981 to 2006, a total of 100 consecutive patients were surgically treated and followed up for 1 to 10 years. The medical records of 68 of the patients were retrospectively examined. Outcomes were assessed based on comparison of the results of preoperative and last follow-up assessment of SP size and symptoms. The SP repair technique consists of subperichondrial/periosteal dissection, rotation of nasal mucosa for tension-free closure, with no mucosa incision if possible, and a multilayer closure with interposition graft. RESULTS: The most common symptoms were nasal obstruction (72%), crusts (50%), and epistaxis (31%). Previous nasal surgery was the pathogenetic factor in 39 cases (57%). Fifty-two patients (76%) presented with SPs measuring 1.0 to 3.0 cm in diameter. The internal approach was used in 54 cases (79%), and temporal muscle fascia and conchal cartilage were concomitantly used in 45 cases (66%). The great majority of patients (40 [59%]) received more than 5 years of follow-up. The success rate of closure was 97%. Two patients (3%) presented with reperforation measuring less than 1.0 cm in diameter. CONCLUSIONS: The senior author's SP repair technique is easily accomplished, provides good visualization, and is low in cost. Also, in our experience, the success rate of closure has been 97%.

Bone Transplantation↗

Osteopontin and bone sialoprotein distribution at the bone graft recipient site.

BACKGROUND: The area in close proximity to a bone graft is subject to marked remodeling activity, which may dramatically affect graft survival. OBJECTIVE: To specifically analyze the effects at the recipient bed-onlay graft interface. DESIGN: In 22 adult Lewis rats, bicortical grafts were positioned below the temporal muscle and subperiosteally over the parietal bone. The recipient bone was left intact or ground to remove the external cortical layer, thereby exposing the graft to the osteopotent cells of the bone marrow. The rats were killed after 4 or 20 weeks. The outcome was assessed by routine histologic examination and immunohistochemical labeling for 2 bone matrix proteins, osteopontin and bone sialoprotein, which are involved in bone resorption and formation, respectively. RESULTS: Placement of the grafts submuscularly or grinding of the outer cortical layer of the host bed increased recipient site resorption. Resorptive activity (labeling) was concentrated to a subzone below the surface of the recipient bone; neither the graft surface nor the interface soft tissues were labeled. CONCLUSION: The successive loss of skeletal contour after bone grafting, in many cases, may largely result from recipient site failure rather than graft size reduction.

Animals↗

Recurrent meningitis due to a congenital fistula in the stapedial footplate.

A patient with recurrent meningitis had spontaneous CSF leakage from the fistula of the stapedial footplate. The patient was a 7-year-old boy with profuse CSF otorrhea, proved by myringotomy. A roentgenographic examination and computed tomography scan of the temporal bone demonstrated an abnormal bony labyrinth. During the operation, a leak was found at the fistula of the stapedial footplate. Surgical obliteration of the fistula with temporal muscle and fascia has prevented the recurrence of meningitis.

Cerebrospinal Fluid Otorrhea↗

In vivo and in vitro bone strain in the owl monkey circumorbital region and the function of the postorbital septum.

Anthropoids and tarsiers are the only vertebrates possessing a postorbital septum. This septum, formed by the frontal, alisphenoid, and zygomatic bones, separates the orbital contents from the temporal muscles. Three hypotheses suggest that the postorbital septum evolved to resist stresses acting on the skull during mastication or incision. The facial-torsion hypothesis posits that the septum resists twisting of the face about a rostrocaudal axis during unilateral mastication; the transverse-bending hypothesis argues that the septum resists caudally directed forces acting at the lateral orbital margin during mastication or incision; and the tension hypothesis suggests that the septum resists ventrally directed components of masseter muscle force during mastication and incision. This study evaluates these hypotheses using in vitro and in vivo bone strain data recorded from the circumorbital region of owl monkeys. Incisor loading of an owl monkey skull in vitro bends the face upward in the sagittal plane, compressing the interorbital region rostrocaudally and "buckling" the lateral orbital walls. Unilateral loading of the toothrow in vitro also bends the face in the sagittal plane, compressing the interorbital region rostrocaudally and buckling the working side lateral orbital wall. When the lateral orbital wall is partially cut, so as to reduce the width of its attachment to the braincase, the following changes in circumorbital bone strain patterns occur. During loading of the incisors, lower bone strain magnitudes are recorded in the interorbital region and lateral orbital walls. In contrast, during unilateral loading of the P3, higher bone strain magnitudes are observed in the interorbital region, and generally lower bone strain magnitudes are observed in the lateral orbital walls. During unilateral loading of the M2, higher bone strain magnitudes are observed in both the interorbital region and in the lateral orbital wall ipsilateral to the loaded molar. Comparisons of the in vitro results with data gathered in vivo suggest that, during incision and unilateral mastication, the face is subjected to upward bending in the sagittal plane resulting in rostrocaudal compression of the interorbital region. Modeling the lateral orbital walls as curved plates suggests that during mastication the working side wall is buckled due to the dorsally directed component of the maxillary bite force which causes upward bending of the face in the sagittal plane. The balancing side lateral orbital wall may also be buckled due to upward bending of the face in the sagittal plane as well as being twisted by the caudoventrally directed components of the superficial masseter muscle force. The in vivo data do not exclude the possibility that the postorbital septum functions to improve the structural integrity of the postorbital bar during mastication. However, there is no reason to believe that a more robust postorbital bar could not also perform this function. Hypotheses stating that the postorbital septum originally evolved to reinforce the skull against routine masticatory loads must explain why, rather than evolving a postorbital septum, the stem anthropoids did not simply enlarge their postorbital bars.

Animals↗

Distribution of mesencephalic trigeminal nucleus neurons in the reeler mutant mouse.

BACKGROUND: Reeler (gene symbol, rl) is an autosomal recessive mutation occurring in mice and characterized by the abnormal positioning of neurons in the central nervous system. In this mutant, however, the cytoarchitecture of the peripheral nervous system is normal, implying that the reeler genetic locus does not affect migration of neurons in the peripheral system. Mesencephalic trigeminal nucleus (Me5) neurons are unique in that they are derived from the neural crest like other neurons in the peripheral nervous system, but enter secondarily into the central nervous system. MATERIALS AND METHODS: Me5 neurons were labeled by injecting horseradish peroxidase or Fast Blue into the temporal muscle of normal and reeler mice to determine whether the migration of these neurons is affected by the reeler genetic locus. RESULTS AND CONCLUSIONS: Labeled Me5 neurons of the reeler mouse were more widely scattered in comparison with their normal counterparts, suggesting that the reeler genetic locus affects migration of neurons which originate in the neural crest and then migrate into the central nervous system.

Amidines↗

Masseteric nerve: a possible donor for facial nerve anastomosis?

In the medical treatment of facial nerve paralysis a large number of different techniques have been developed to restore the function of the facial nerve. These include (a) the ipsilateral nerve grafting (e.g., partial hypoglossal-facial, spinal accessory-facial, partial glossopharyngeal-facial), (b) crossfacial nerve grafting and (c) temporal muscle flaps or even free muscle transfers. None of these techniques uses the masseteric nerve as a graft for reconstruction of the facial nerve. This preliminary report deals with the anatomical basis, which could lead to a new technique. The masseteric nerve leaves the infratemporal fossa through the mandibular notch, accompanied by the masseteric artery. At this level the nerve consists in nine of 36 cases studied of only one branch (25.0%), in 17 cases of two branches (47.0%), in nine cases of three (25.0%), and in the remaining case of four branches (2.8%). There are three main reasons for considering the masseteric nerve as a possible donor for at least the orbicular branch of the facial nerve: (1) The approach to the mandibular notch is quite simple; (2) since the nerve consists of two or more branches in 75.0% of the cases, severe dysfunction of the masseter muscle should not occur; (3) if there is complete denervation of the masseter muscle, its function may be taken over by the temporalis muscle.

Anastomosis, Surgical↗

Anatomical knowledge and clinical evaluation of the muscles of mastication.

In this survey, we identify the positive role that an instructional anatomy course has prior to a workshop on temporomandibular dysfunction. Not only did it result in enhanced clinical evaluation of the muscles of mastication acquired by the participants, but it also approximated the skills of dental and medical practitioners.

Anatomy↗

Cranial morphology of Aegyptopithecus and Tarsius and the question of the tarsier-anthropoidean clade.

New crania of the Oligocene anthropoidean Aegyptopithecus provide a test of the hypothesized tarsier-anthropoidean clade. Three cranial characters shared by Tarsius and some modern anthropoideans (apical interorbital septum, postorbital septum, "perbullar" carotid pathway) were examined. 1) An apical interorbital septum is absent in Aegyptopithecus. A septum does occur in Galago senegalensis (Lorisidae) and Microcebus murinus (Cheirogaleidae), so the presence of a septum is not strong evidence favoring a tarsiiform-anthropoidean clade. 2) In Aegyptopithecus and other anthropoideans, the postorbital septum is formed mainly by a periorbital flange of the zygomatic that extends medially from the lateral orbital margin onto or near the braincase. The postorbital plate of Tarsius is formed by frontal and alisphenoid flanges that extend laterally from the braincase to the zygomatic's frontal process, which is not broader than the postorbital bars of other prosimians. Periorbital flanges evolved in Tarsius for support or protection of the enormous eyes, as suggested by the occurrence of maxillary and frontal flanges that cup portions of the eye but do not separate it from temporal muscles. 3) The internal carotid artery of Aegyptopithecus enters the bulla posteriorly and crosses the anteroventral part of the promontorium. The tympanic cavity was probably separated from the anteromedial cavity by a septum stretching from the carotid channel to the ventrolateral bullar wall. In Tarsius, the carotid pathway is prepromontorial, and a septum stretches from the carotid channel to the posteromedial bullar wall. Quantitative analyses indicate that anterior carotid position has evolved because of erect head posture. The cranium of Oligocene anthropoideans thus provides no support for the hypothesized tarsier-anthropoidean clade.

Animals↗

Aberrant muscle between the temporalis and the lateral pterygoid muscles: M. pterygoideus proprius (Henle).

During examination of the positional relationships between the lateral pterygoid and the temporalis muscles and the innervating nerves, an aberrant muscle was observed in three of 66 head halves. The aberrant muscle originated from the medial surface of the anteromedial muscle bundle of the temporalis (Shimokawa et al. 1998, Surg. Radiol. Anat. 20:329-334) and inserted into the inferolateral surface of the lower head of the lateral pterygoid. Due to its location, origin and insertion this aberrant muscle slip is considered to correspond to the pterygoideus proprius described by Henle (1858, Handbuch der Anatomie des Menschen). Based on the innervation findings, the present aberrant muscle might be considered as a remnant muscle bundle between the anteromedial muscle bundle of the temporalis and the lateral pterygoid during differentiation of the lateral masticatory muscle anlage.

Adult↗

Analysis and visualization of single-trial event-related potentials.

In this study, a linear decomposition technique, independent component analysis (ICA), is applied to single-trial multichannel EEG data from event-related potential (ERP) experiments. Spatial filters derived by ICA blindly separate the input data into a sum of temporally independent and spatially fixed components arising from distinct or overlapping brain or extra-brain sources. Both the data and their decomposition are displayed using a new visualization tool, the "ERP image," that can clearly characterize single-trial variations in the amplitudes and latencies of evoked responses, particularly when sorted by a relevant behavioral or physiological variable. These tools were used to analyze data from a visual selective attention experiment on 28 control subjects plus 22 neurological patients whose EEG records were heavily contaminated with blink and other eye-movement artifacts. Results show that ICA can separate artifactual, stimulus-locked, response-locked, and non-event-related background EEG activities into separate components, a taxonomy not obtained from conventional signal averaging approaches. This method allows: (1) removal of pervasive artifacts of all types from single-trial EEG records, (2) identification and segregation of stimulus- and response-locked EEG components, (3) examination of differences in single-trial responses, and (4) separation of temporally distinct but spatially overlapping EEG oscillatory activities with distinct relationships to task events. The proposed methods also allow the interaction between ERPs and the ongoing EEG to be investigated directly. We studied the between-subject component stability of ICA decomposition of single-trial EEG epochs by clustering components with similar scalp maps and activation power spectra. Components accounting for blinks, eye movements, temporal muscle activity, event-related potentials, and event-modulated alpha activities were largely replicated across subjects. Applying ICA and ERP image visualization to the analysis of sets of single trials from event-related EEG (or MEG) experiments can increase the information available from ERP (or ERF) data.

Alpha Rhythm↗

Selective enhancement of experimental rat brain tumors with Gd-TPPS.

The synthetic metalloporphyrin gadolinium (III)-tetraphenylporphine sulfonate (TPPS) was successfully used as a contrast agent for in vivo magnetic resonance (MR) imaging of rat brain glioma. After injection of Gd-TPPS, the signal intensity of experimental rat brain glioma distinctly increased on T1-weighted MR images, an effect similar to that produced by the clinically applied MR imaging contrast agent gadolinium diethylenetriaminepentaacetic acid (DTPA). In contrast to other contrast agents studied (Gd-DTPA, manganese [III]-TPPS), Gd-TPPS produced hypointensity in glioma on T2-weighted images. The tumor-selective accumulation of paramagnetic Gd-TPPS in glioma shortened T1 by 53%, from 1,315 msec +/- 199 to 628 msec +/- 106, and T2 by 34%, from 86 msec +/- 4 to 57 msec +/- 5 (2 days after injection of 0.25 mmol/kg Gd-TPPS). The relaxation times of normal cortex, striatum, corpus callosum, and temporal muscle were not significantly affected. As a result, gliomas appeared hyperintense on T1-weighted images and hypointense on T2-weighted images. Owing to the strong effect of Gd-TPPS on the T2 of glioma, normal brain tissue, tumor, and peritumorous edema could be distinguished on T2-weighted images alone.

Animals↗

Mild hypothermia enhances the neuroprotective effects of a selective thrombin inhibitor following transient focal ischemia in rats.

The aim of this study is to determine whether a selective thrombin inhibitor, Argatroban, would prevent neuronal cell death and whether extra-mild hypothermia (35 degrees C) would enhance the neuroprotective effect of a selective thrombin inhibitor following transient focal ischemia in rats. Sprague-Dawley rats were subjected to MCAo using an intraluminal suture technique for 2 hrs. The rats were reperfused for 24 h and decapitated for infarct and edema analysis. Argatroban-treated animals received a continuous injection of argatroban (3.0 mg/kg) for 24 hrs after onset of ischemia, while vehicle-treated groups received same dose of vehicle. During ischemia, temporal muscle and rectal temperatures were monitored and maintained at 37 degrees C in the normothermic animals and at 35 degrees C in the hypothermic animals. Argatroban ameliorated the cortical ischemic damage significantly (p < 0.05). Moreover, argatroban with mild hypothermia decreased the cortical infarct or edema volume significantly compared with those of groups I and III (p < 0.05). Argatroban improved neurological symptoms significantly and also improved survival rate. These results demonstrate that extra-mild hypothermia (35 degrees C) enhances neuroprotective effects of a selective thrombin inhibitor, argatroban, suggesting that this combined therapy may be a new therapeutic strategy for the treatment of acute stroke.

Animals↗

Intraoperative monitoring of the motor function: experimental and clinical study.

Manipulation of the lesions adjacent to the primary motor area or the motor pathway is troublesome for neurosurgeons because they lack an effective method to determine the primary motor area or to monitor motor function in the operative room. It will be of great value to establish a monitoring method of the corticospinal tract under general anaesthesia. We recorded the motor evoked potential (MEP) from direct motor cortex stimulation in cats and showed that it derives almost purely from the corticospinal tract. Then we used this technique during the operation of the resection of tumours near the primary motor area or the motor pathway. 1. Experimental study: Twenty adult cats were used in this study. Recording electrodes were flexible bipolar catheter electrodes inserted into the spinal epidural space. Stimulating electrodes were silver ball electrode on the cortex (anode) and needle electrode in the temporal muscle (cathode). Stimulation of 4-24 V, 5-10 Hz and 0.2 msec in duration were done and evoked potentials signals were averaged 60 to 512 times. MEP with multiple peaks was obtained that had a 112 msec conduction velocity in the spinal cord. We found the same signals from the stimulation of ipsilateral cerebral peduncle. Radiofrequency lesioning of ipsilateral cerebral peduncle produced a loss of MEP. These results show that MEP derives from the corticospinal tract. Significant wave form change, with components of short latency, was noted by the excessively intense stimuli. We supposed that superimposition of the signals from the extrapyramidal pathways, excited in the brain stem, results in this change.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗