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Anaesthetic Management of Early-Onset Scoliosis
Published in Alaaeldin (Alaa) Azmi Ahmad, Aakash Agarwal, Early-Onset Scoliosis, 2021
Damarla Haritha, Souvik Maitra
The anterior one third of the spinal cord is supplied by a single anterior spinal artery originating from vertebral artery and the posterior two third is supplied by two posterior spinal arteries originating from posterior inferior cerebellar artery [49]. Segmental arteries originating from the ascending cervical artery, posterior intercoastal arteries, and the lumbar arteries that join these spinal arteries form a plexus of vessels around the spinal cord. In the setting of hypoperfusion, the most prone area for ischaemia is the watershed zone at the T4 to T7 level, which is sparsely perfused [50]. The damage to the spinal cord depends on the length of the procedure, stretching of the nerve roots leading to reduced blood supply, systemic hypotension, direct contusion of the cord, blood loss, etc. This can be prevented by real-time monitoring of spinal cord perfusion with SSEP or MEP. As soon as any change in the evoked potentials is noted, the surgeon and anaesthesiologist should be alerted immediately. Any inhalational agent should be discontinued, and hypothermia, anaemia, and hypotension should be treated appropriately. Failure to improve the evoked potential should alert the surgeon to either remove the screw or decrease the traction. Treatment with methylprednisolone 30mg/kg bolus followed by 5.4 mg/kg infusion for 23 hours given within 8 hours of insult has been shown to improve neurological outcomes in patients with traumatic spinal cord injury but not specifically in scoliosis surgery [51].
Thoracic outlet syndromes
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Hugh A. Gelabert, Erdogan Atasoy
The scalenectomy is clearly facilitated following comple- tion of the transaxillary first rib resection. The cut end of the anterior scalene muscle is gently pulled upward to expose the subclavian artery. Following further elevation of the muscle, additional dissection is carried out along the brachial plexus on the lateral side, the ascending cervical artery on the medial side, and the anterior scalene muscle sheath on the posterior aspect. When the junction between the phrenic nerve and the C5 nerve root is reached, additional dissection is carried out inferior to the junction, and the muscle is pulled down and away from the junction and cut with scissors, allowing it to be freed from the phrenic nerve (see Figure 5.20aand b).
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
In adult humans, the subclavian artery is one of the two structures (together with the roots of the branchial plexus) deep to the anterior scalene muscle, contrary to the subclavian vein, which is one of the major four structures superficial to this muscle together with the phrenic nerve, suprascapular artery, and transverse cervical artery (the anterior scalene muscle is a major landmark in the neck and follows the “4 superficial vs. 2 deep” rule: See Box 3.10). Because these two latter arteries are branches of the subclavian artery (which is deep to the anterior scalene muscle), they must run superficially and appear anteriorly to the anterior scalene muscle and run posteriorly and superficially to it (Plate 3.22). The 1st, 2nd, and 3rd parts of the subclavian artery are medial, posterior, and lateral to the anterior scalene muscle, respectively. The 1st part has three branches: (1) the vertebral artery running superiorly between the anterior scalene muscle and the longus colli muscle and entering the transverse foramen of vertebra C6; (2) the internal thoracic artery running inferiorly to supply the anterior thoracic wall; and (3) the thyrocervical trunk giving rise to the suprascapular artery (described in Chapter 4) and transverse cervical artery (which supplies the trapezius muscle) described earlier, and to the inferior thyroid artery, which passes posterior to the cervical sympathetic trunk toward the thyroid gland and gives rise to the ascending cervical artery. The 2nd part of the subclavian artery has one branch: the costocervical trunk, which gives rise to the deep cervical artery and the supreme intercostal artery (which gives rise to the posterior intercostal arteries 1 and 2). Lastly, the third part of the subclavian artery gives off a single branch—the dorsal scapular artery—before changing its name to the axillary artery at the level of the 1st rib (both the dorsal scapular and the axillary arteries are described in Chapter 4). It should be noted that the thoracic duct lies in this region of the root of the neck, draining into the junction of the left subclavian vein and the left internal jugular vein.
Surgical management of primary parapharyngeal space tumors in 103 patients at a single institution
Published in Acta Oto-Laryngologica, 2018
Fenglin Sun, Yan Yan, Dongmin Wei, Wenming Li, Shengda Cao, Dayu Liu, Guojun Li, Xinliang Pan, Dapeng Lei
Imaging is essential to evaluate the location and extent of PPS neoplasms because of the limitations of physical examination in this anatomical area [11]. Arteriography is performed infrequently for the diagnostic purposes. In rare instances, it can be used to evaluate cervicocerebral collateral circulation, which may necessitate the sacrifice of major blood vessels [5]. DSA is helpful for surgeons to understand the compensation of the blood supply to the brain and Wills rings and then to properly assess the safety of resection of tumor adhering to the internal carotid artery. In this study, five patients underwent DSA and were diagnosed with carotid body paraganglioma postoperatively. Among them, three cases could not be resected directly because of severe adhesion to the internal carotid artery and common carotid artery, so vascular prosthesis bypass grafting was performed after resection. To reduce intraoperative blood loss, one patient with neurilemoma that invaded the intervertebral foramen underwent ascending cervical artery superselective embolization and vertebral artery balloon embolization. This provided strong protection for the complete resection of the tumor.