Cagatay Han Ulku

Radial Artery Graft for Bypass of the Maxillary to Proximal Middle Cerebral Artery: An Anatomic and Technical Study

OBJECTIVEIn this study, we aimed to investigate the use of a radial artery graft for bypass of the maxillary artery (MA) to the proximal middle cerebral artery (MCA) as an alternative to superficial temporal artery-to-MCA anastomosis or extracranial carotid-to-MCA bypass using long grafts. METHODSFive adult cadavers were used bilaterally. After a frontotemporal craniotomy and a zygomatic arch osteotomy, the MA was found easily 1 to 2 cm inferior to the infratemporal crest. A hole was created with a 4-mm-tip drill in the sphenoid bone 2 to 3 mm lateral to the foramen rotundum extradurally, and the dura over the hole was opened. After the carotid and sylvian cisterns had been opened, the M2 segment of the MCA was exposed. The graft was passed through the hole to reach the M2 segment. Then, the MA was freed from the surrounding tissue and was transected before the infraorbital artery branch. The radial artery graft was anastomosed end-to-end to the MA proximally and end-to-side to the M2 segment of the MCA distally. RESULTSThe mean thickness of the MA before the infraorbital artery branch was 2.6 ± 0.3 mm. The mean thickness of the largest trunk of the MCA was 2.3 ± 0.3 mm. The average length of the graft was 36 ± 5.5 mm. CONCLUSIONMA-to-MCA bypass is as feasible as proximal MCA revascularization using long vein grafts. The thickness of the MA provides sufficient flow; the length of the graft is short, and it has a straight course. MA-to-proximal MCA bypass may be an alternative to superficial temporal artery-to-MCA as well as extracranial carotid-to-MCA bypasses.

Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery: An anatomical and technical study

Objective To examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to the external carotid artery (ECA) to PCA anastomosis used in posterior circulation bypass surgery. Materials and methods The method was applied to five adult cadaver sides bilaterally. The MA was easily found 1–2 cm beneath the infratemporal crest after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally, 2–3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, the interpedincular and ambient cisternae were opened and the P2 segment of the PCA appeared. The graft was passed through the hole and dura to reach the P2 segment. Proximal to the infraorbital artery branch, the MA was freed from the surrounding tissue and transected. The proximal side of the radial artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the P2 segment of the PCA. Results The average diameter of the MA proximal to the infraorbital artery branch was 2.6±0.3 mm. The average diameter of the P2 was 2.2±0.2 mm. The average length of the graft was 47±5.2 mm. Conclusion As MA to proximal PCA bypass uses a short radial graft and as the calibers of the MA and PCA are >2 mm such a bypass may provide sufficient blood flow and represents a reasonable alternative to “ECA to PCA” bypass.

Chromosome 8 Aneuploidy in Acquired Cholesteatoma

Objective To investigate the incidence of chromosome 8 aneuploidy in acquired cholesteatoma. Material and Methods Cholesteatoma tissue and postauricular skin as a control were surgically obtained from 12 patients with acquired cholesteatoma. Fluorescence in situ hybridization (FISH) analysis using a chromosome 8-specific α-satellite DNA probe was performed on the interphase nuclei. Two hundred cells were analyzed for each of the samples. Results Chromosome 8 aneuploidy was found in 9/12 patients whereas a normal cell structure with 2 signals was observed in the remaining 3 patients. In samples with chromosome 8 aneuploidy, the mean proportion of aneuploidy was 25.6%, including monosomy (3.2%), trisomy (16.1%), tetrasomy (4.9%) and more than tetrasomy (1.4%). The number of aneuploid cells in recurrent cases was more than that in non-recurrent cases. Conclusion A numerical aberration of chromosome 8 was found in patients with acquired cholesteatoma. Our results support the hypothesis that chromosome 8 may be a prognostic factor for cholesteatoma and an indicator in the follow-up of patients with cholesteatoma.

A modified technique to bypass the maxillary artery to supraclinoid internal carotid artery by using radial artery graft: an anatomical study

OBJECTIVE This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to the supraclinoid internal carotid artery (ICA) in treating ICA occlusions. STUDY DESIGN AND SETTING This method was carried out on five adult cadaver sides. The MA was reached 1-2 cm inferior to the crista infratemporalis, following a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2-3 cm lateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4 mm tipped drill. A radial artery graft was passed through the hole to the inside of the dura. Before giving the infraorbital artery branch, the MA was dissected from the surrounding tissue and transected. The proximal end of the graft was anastomosed end-to-end with the MA and the distal end of the graft end-to-side with the supraclinoid ICA. RESULTS The mean calibre of the MA was 2.6 +/- 0.3 mm. The mean calibre of the proximal end of the radial artery graft was 2.5 +/- 0.25 mm and the distal end was 2.35 +/- 0.2 mm. The mean length of the radial artery graft was 4.0 +/- 0.5cm. CONCLUSION This study suggested that the cases with ICA occlusion, which require high blood flow, may be treated as an alternative to current bypass methods requiring long vein grafts.

Angiosarcoma of the Submandibular Salivary Gland: Case Report and Review of the Literature

Objective The purpose of this report is to describe an example of angiosarcoma (AS) of the submandibular salivary gland. The clinical and immunohistopathologic features of these lesions are also reviewed. Material and Methods A 17-year-old male high school student was admitted to our clinic with a 1-year history of a slow-growing, tender mass in the left submandibular region. Physical examination on initial presentation revealed a diffuse soft tissue mass 6 cm in diameter involving the left submandibular region. MRI analysis revealed a mass located superolateral to the submandibular salivary gland, measuring 4.0 x 2.0 cm2. The mass was excised completely together with the left submandibular salivary gland. Histopathologic analysis led to a diagnosis of AS. Immunohistochemical studies were also used to determine endothelial cell differentiation. Owing to the lateralized nature of the lesion, a left functional neck dissection was performed and postoperative radiotherapy was planned. Results AS is a malignant tumor of endothelial cell origin that may occur in any region of the body. The commonest sites include the extremities and the retroperitoneal space, with only 4% of AS tumors arising in the head and neck area. The submandibular salivary gland is an extremely rare location for this tumor. Based on a literature review, this case report represents only the second reported case of AS of the submandibular salivary gland. Conclusion In most cases, radical surgery and postoperative radiotherapy are advocated to treat patients with AS tumors, with lymph node clearance recommended in cases of lateralized lesions In some patients, distant metastasis may occur after many years, which necessitates long-term follow-up. The prognosis is poor in most cases of AS.

Biocompatibility of vitallium as ossicular reconstruction material in the middle ear: experimental animal study.

Conclusion Although long-term data will be necessary for confirmation, the result of this preliminary study indicates that vitallium may be a good alternative material for ossicular replacement prostheses in the middle ear. Objectives To investigate the biocompatibility of vitallium (Co–Cr–Mo) as ossicular reconstruction material in the rabbit middle ear, and to compare the results with those obtained with titanium, well known as a highly biocompatible material, and non-implanted control groups. Material and methods Eighteen female New Zealand White rabbits were anesthetized. The tympanomeatal flap was elevated and 12 vitallium and 12 titanium implants were placed in the bulla away from the ossicles in 24 middle ears. Six rabbits were used as non-implanted controls. All animals were sacrificed under general anesthesia on the 180th day after implantation. The temporal bones were removed, fixed in 10% buffered paraformaldehyde and decalcified for a week in EDTA. Tissue samples were then prepared using an Autotechnicon and embedded in paraffin. Sections (30-μm thick) were cut with a microtome, stained with hematoxylin–eosin, von Giesons stain and fibroblast growth factor (FGF) and examined under a light microscope. The numbers of lymphocytes, collagen fibers and FGF-positive cells were determined in all three groups. Results There was no significant difference in the numbers of collagen fibers between the groups (p>0.05). No significant differences were found in the numbers of lymphocytes and FGF-positive cells between the titanium and vitallium groups (p>0.05). The differences in the numbers of lymphocytes and FGF-positive cells between the control and other groups were found to be significant (p<0.05).

A different technique used for the closure of sigmoid sinus during infratemporal approach

OBJECTIVE Glomus jugulare tumors and neuromas frequently affect the jugular foramen area and necessitate special surgical approaches. It is often essential to stop blood flow by occluding internal jugular vein from below and the sigmoid sinus from above. Obviously, injury to the venous structures without proximal and distal control results serious haemorrhage. We describe here, a different technique for the closure of sigmoid sinus during infratemporal approach and compare it with the other techniques. METHODS During the infratemporal approach, for closing the sigmoid sinus, we removed the bone over the sinus and from the posterior fossa dura located anteriorly and posteriorly to the sigmoid sinus. Then a 2/0 atraumatic silk suture was passed horizontally through dura which is behind and in front of the sinus. A muscle graft was then placed between the suture and sigmoid sinus. RESULTS We used that technique in 7 patients who had a glomus jugulare tumor. In that technique, the blood flow was completely stopped without penetrating the sinus. CONCLUSION Sigmoid sinus can be closed without incision of the sinus or the dura. This decreases the chances of injury to the sinus and dura resulting in less bleeding and less chances of CSF leak.

Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery

Objectives: Patients complaining with vertigo or dizziness, the pathology may be originated from central or peripheric compartment. These cases frequently apply to the Neurology, Neurosurgery, or ENT Clinics. The vertebro-basilar insufficiency is one of the most common pathologic causes of central vertigo or dizziness. This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to external carotid artery (ECA) to PCA anastomosis used for posterior circulation bypass surgery. Methods: This method was applied to 5 adult cadaver sides bilaterally. The MA was easily found 1−2 cm beneath to infratemporal crest, after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2−3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4−mm tipped drill. After sylvian fissure, interpedincular and ambient cisterns were opened, the P2 segment of the PCA appeared. The graft was passed through the hole and the dura to reach the P2 segment. Before giving the infraorbital artery (IOA) branch, the MA was freed from the surrounding tissue and transsected. The proximal side of the radial artery graft was anastomosed end-to-end with MA and distal side end-to-side with P2 segment of PCA. Results: The average diameter of the MA before giving the IOA branch was 2.6

Saphenous vein graft for bypass of the external carotid artery to supraclinoid internal carotid artery using a modified technique: An anatomical and technical study

pT 0.3 mm. The average diameter of the P2 was 2.2

Radial artery graft for bypass of the maxillary to proximal middle cerebral artery

pT 0.2 mm. The average length of the graft was 47