No abstract

No abstract

Complex craniovertebral junctional anomalies can be daunting to treat surgically, and preoperative information regarding the osseous abnormalities, course of the vertebral arteries, size of the pedicles, and location of the transverse foramina is invaluable to surgeons operating on these challenging cases. The authors present their experience with the emerging technology of 3D model acquisition for surgery in 11 cases of complex craniovertebral junction region anomalies. For each case, a 3D printed model was made from thin CT scans using a 64-slice CT scanner. The inclination of the joints, the presence of false articulations, the size of the pedicles, and the course of the vertebral arteries were studied preoperatively on the 3D models. The sizes of the plates and screws to be used and the angle of insertion of the screws were calculated based on the data from the models. The model was scaled to actual size and was kept beside the operating surgeon in its anatomical position during surgery. The potential uses of the models and their advantages over conventional radiological investigations are discussed. The authors conclude that 3D models can be an invaluable aid during surgery for complex craniovertebral junction anomalies. The information available from a real life-size model supersedes the information available from 3D CT reconstructions and can also be superior to virtual simulation. The models are both cost effective and easy to build and the authors suggest that they may form the basis of investigations in the near future for craniovertebral junction surgery.

Objective:The authors evaluate the significance of atlantoaxial instability in the management of idiopathic syringomyelia.Background:We recently observed that atlantoaxial dislocation can be present even when the atlantodental interval was within normal range. Atlantoaxial instability can be identified on the basis of facetal mal-alignment or even by direct observation of status of joint during surgery. Our observations are discussed in nine patients where we identified and treated atlantoaxial instability in cases that would otherwise be considered as having “idiopathic” syrinx.Materials and Methods:The authors report experience with nine cases that were diagnosed to have “idiopathic” syrinx. The main bulk of the syrinx was located in the cervico-dorsal spinal region in all cases. One patient had been treated earlier by syringo-subarachnoid shunt surgery and one patient had undergone foramen magnum decompression.Results:On radiological evaluation, eight patients had posterior atlantoaxial facetal (Type B) dislocation. In one patient there was no facetal mal-alignment and was labeled to have axial or central (Type C) facetal instability. All patients were treated by atlantoaxial fixation. All patients improved symptomatically in the immediate postoperative period and the improvement was progressive and sustained on follow-up. In one case, the size of syrinx reduced in the immediate postoperative imaging. In the period of follow-up (range 6–42 months - average 19 months), reduction in the size of syrinx was demonstrated on imaging in three cases.Conclusions:The positive clinical outcome suggests that atlantoaxial instability may be the defining phenomenon in development of previously considered “idiopathic” syringomyelia.

Lipomas are benign tumors composed of mature fat, usually encapsulated. Vast majority of lipomas are small, weighing only a few grams, and grow slowly. Lipoma occur rarely in breast causing diagnostic dilemma. Chondroid lipoma is a rare variant of lipoma which is benign in nature. We present a case of 65 year old female patient presented with lump in right breast, underwent surgical excision and histopathology reported as chondroid lipoma.