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OBJECTIVE The pedicle-rib unit is regarded as an "expanded" pedicle and is a new approach to thoracic pedicle fixation. read more Previous studies were mostly focused on anatomic, radiographic and biomechanical assessment. However, there is no study on anatomical relationship of bony structures in pedicle-rib unit. This article aims to investigate the anatomical relationships between transverse process, pedicle, rib and corresponding vertebrae body in pedicle-rib unit, so as to improve the clinical safety of the pedicle-rib unit screw placement. METHODS Forty-five normal dry adult cadaver specimen were included. Anatomical parameters were measured. Anatomical parameters 1. the anatomical relationship between transverse process and pedicle the distance from the horizontal center line of transverse process to the center and the superior and inferior border of the pedicle. 2. the anatomical relationship between transverse process and rib the overlap portion between the costal neck and the transverse process. 3. the anatome. The pedicle, transverse process, and rib are not completely in the same plane, and their position are varying in different segments. The pedicle-rib unit screw fixation is anatomically feasible. Setting screw in upper-middle thoracic spine is safer than that in lower thoracic spine. BACKGROUND Aneurysms associated with brain arteriovenous malformations (AVMs) represent a hemorrhage risk in addition to that of the AVM nidus. In high risk or unresectable cases, targeted treatment of an aneurysm causing hemorrhage may effectively decrease future hemorrhage risk. The objective of this report is to describe our series of patients with intraventricular AVM-associated aneurysms treated surgically. We highlight technical nuances of the surgical approaches to aneurysms in the lateral and third ventricles. METHODS Retrospective review of cases in which an intraventricular aneurysm rupture was responsible for hemorrhage. In each case, the aneurysm was excluded surgically via an interhemispheric approach - including transcallosal, transchoroidal or transcingulate corridors. Aneurysm, AVM characteristics, surgical approach and outcomes were reviewed. RESULTS Six patients were included in the series. In 5 cases, the pathology was located on the left and approached from the right. Aneurysms were located in, or projecting into the lateral ventricle in 4 cases (trans-cingulate approach), and in the third ventricle in 2 cases (trans-choroidal fissure approach). The aneurysm was clipped in 1 case and resected in 5 cases. The associated AVM was resected in 2 cases. In all cases, the surgical approach allowed adequate treatment of the aneurysm without new neurological morbidity. No patients experienced recurrent intraventricular hemorrhage during follow-up. CONCLUSIONS Ruptured intraventricular aneurysms associated with brain AVMs can be treated surgically to reduce the risk of rebleeding in cases in which the aneurysms are not accessible to endovascular treatment and in which the AVM nidus may not be safely resected. BACKGROUND Intradural ependymal cysts are benign, fluid-filled cysts usually situated along the ventral surface of the spinal cord. There are prior reports of 19 intradural cysts in the literature, including one cyst of the filum terminale. Here we report for the first time the presence of a radiographically occult filum terminale cyst associated with a myxopapillary ependymoma. We propose that mobility of the tumor maybe provide indirect evidence of the presence of a cyst. CASE DESCRIPTION A 65-year-old male presented with a homogenously enhancing ovoid mass measuring 25 mm x 10 mm within the thecal sac at the L3 through L4 levels. Repeat MRI demonstrated migration of the tumor 12 mm rostrally. Following the L2 through L4 laminectomy and resection of the intradural tumor we identified a filum terminale ependymal cyst superior to the tumor which was also resected. CONCLUSION Ependymal cysts associated with spinal tumors are rare and may be radiographically occult. The change in cyst size may explain tumor mobility. Complete resection of the cyst and histopathologic analysis is recommended in order to differentiate between ependymal cyst and cystic tumor tissue. Published by Elsevier Inc.BACKGROUND It can sometimes be challenging to find a suitable clip to treat an unusual aneurysm, or when the surrounding anatomy is unusual, especially in resource-limited environments. We describe a method to modify aneurysm clips based on the method originated by Sugita, et al. in 1985. Herein clip modification (Clip-Mod) is used to treat anatomically difficult anterior communicating artery aneurysms. METHODS The Department of Neurological Surgery database was reviewed to find aneurysm patients treated using modified aneurysm clips. Clip-Mod was performed during surgery by shortening the tines of titanium aneurysm clips by abrasion applied from the side of a standard 3mm surgical diamond drill bit under constant irrigation. Note that the thickness of the tines and the clip spring were not modified or contacted by the drill. RESULTS Four cases used modified aneurysm clips, from 648 total clip-treated aneurysms (0.6%) by 2 surgeons over a 14-year period. Three patients presented with subarachnoid hemorrhages that were determined to be due to anterior communicating artery aneurysms. One patient presented with an incidental unruptured anterior communicating artery aneurysm. All four patients were treated with 3mm titanium clips shortened intraoperatively to 1-2mm lengths, to achieve aneurysm obliteration without stenosing parent or perforating vessels. CONCLUSIONS All four patients have done well clinically with no reoccurrences after 2 to 6-years follow-up, which included angiographic evaluation. The use of this "Clip-Mod" technique thus appears useful for anterior communicating artery aneurysms. Clip-Mod could also be considered for treating other aneurysms when the "perfect" length clip is not available. OBJECTIVE To evaluate the position of the aorta relative to spine and the risk of aortic injury during correction surgery in patients with idiopathic severe and rigid scoliosis (main curve Cobb angle >90° and flexibility less then 30%). METHODS Twenty-seven patients with severe right thoracic/thoracolumbar scoliosis were recruited. The entry point-aorta distance (EAD), the left pedicle-aorta angle (α), the left aorta angle (β), and the vertebral rotation angle (γ) were measured from four vertebras above (A4) to four below (B4) the apical vertebra (Apex) to quantify the spatial relationship between aorta and spine. We simulated the pedicle screw misplacement with variable direction error, length and diameter, to analyze the potential risk of aortic injury. RESULTS The aorta shifted laterally and posteriorly as it descended from A4 and moved back medially and anteriorly from Apex. The potential risk of aortic injury elevated with the augment of direction error and/or length of the screw, but the tendency was not significant with the augment of diameter.

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