• Posterior atlantoaxial fixation: A cadaveric and fluoroscopic step-by-step technical guide

      Baaj, AliA; Sattarov, Kamran; Skoch, Jesse; Abbasifard, Salman; Patel, AparS; Avila, MauricioJ; Walter, ChristinaM; Department of Surgery, Division of Neurosurgery, University of Arizona Medical Center (MedKnow, 2015)
      Background: Atlantoaxial surgical fixation is widely employed treatment strategy for a myriad of pathologies affecting the stability of the atlantoaxial joint. The most common technique used in adults, and in certain cases in children, involves a posterior construct with C1 lateral mass screws, and C2 pars or pedicle screws. This technical note aims to provide a step‑by‑step guide to this procedure using cadaveric and fluoroscopic images. Methods: An embalmed, human, cadaveric, specimen was used for this study. The subject did not have obvious occipital‑cervical pathology. Dissections and techniques were performed to mimic actual surgical technique. Photographs were taken during each step, and the critical aspects of each step were highlighted. Fluoroscopic images from a real patient undergoing C1/C2 fixation were also utilized to further highlight the anatomic‑radiographic relationships. This study was performed without external or industry funding. Results: Photographic and radiographic pictures and drawings are presented to illustrate the pertinent anatomy and technical aspects of this technique. The nuances of each step, including complication avoidance strategies are also highlighted. Conclusions: Given the widespread utilization of this technique, described step‑by‑step guide is timely for surgeons and trainees alike.
    • Spontaneous resolution of choledochal cyst

      Kurland, Yonatan; Kylat, Ranjit, I; Desoky, Sarah; Bader, Mohammad, Y.; Department of Pediatrics, School of Medicine, University of Arizona, Tucson,; Department of Radiology, School of Medicine, University of Arizona, Tucson, AZ (MedKnow, 2017-06)
      Choledochal cysts (CCs) are rare, congenital cystic dilations of the hepatobiliary tree that require surgical resection to avoid complications such as increased risk of malignancy. A 25‑week gestational age male infant developed acholic stools, elevated alkaline phosphatase, and ultrasound findings consistent with CC Todani Type IVA. Surgery was deferred due to the patient’s low weight. The patient’s symptoms and radiographic findings subsequently resolved spontaneously. CCs have not been previously reported in extremely preterm infants. There are rare reported cases of spontaneously resolving hepatic cysts, all containing key differences from our patient. In patients in whom immediate surgery is not feasible, conservative management with close follow‑up and serial ultrasound examinations would appear to be a reasonable course of action.