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Background: Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses.Methods: This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher’s exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden’s Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level

Objective: Both atrial fibrillation (AF) and patent foramen ovale (PFO) has been associated with occurrences of ischemic stroke. The aim of this study was to investigate whether patients with concomitant AF and PFO were at an increased risk of stroke, and whether PFO closure was necessary for the prevention of stroke in AF patients who underwent left atrial appendage closure (LAAC). Method: We retrospectively analyzed 614 patients who underwent LAAC at Wuhan Asia Heart Hospital from May 2014 to April 2021. We compared the baseline clinical characteristics and ischemic stroke rates before LAAC, major adverse cardiovascular events (MACEs) and other long-term outcomes between AF patients with and without PFO after LAAC. The predictor for ischemic stroke or TIA after LAAC was analyzed with univariate and multivariable Cox regression, and the long-term cumulative survival rates of AF patients with PFO compared to those without PFO after LAAC were analyzed with the Kaplan–Meier graph. Results: A total of 614 patients who underwent LAAC and had completed follow-up data were included in our study. Among them, 74 patients were diagnosed with AF with PFO, and 540 with AF without PFO. There was no significant difference between their baseline clinical data, including ischemic stroke rates (p = 0.961). Patients with and without PFO had similar device implantation success rates (98.6 % vs 99.4 %, P = 0.403) and procedure-related complications. During follow-up (medium follow-up period 36.9 months), no significant difference was observed in the incidence of MACEs (8.1 % in PFO group vs 5.7 % in non-PFO group, P = 0.432) or the cumulative ischemic stroke/TIA rates (5.4 % in PFO group vs 4.3 % in non-PFO group, P = 0.554). The Cox multivariable regression analysis indicated that the presence of PFO in patients with AF had no correlation with ischemic stroke or TIA after LAAC implantation (HR 1.685, 95 % CI 0.570–4.978, P = 0.345). The only predictor for ischemic stroke/TIA events after LAAC was major leakage (>5 mm) seen on transesophageal echocardiography (TEE) or left atrial CTA at the 45-day follow-up (HR 10.352, 95 % CI 1.221–87.736, P = 0.032). Conclusion: AF patients with PFO are not at increased risk for ischemic stroke or TIA before LAAC. The presence of PFO in AF patients did not affect the success rate and safety of LAAC. The presence of mild PFO is not a viable predictor of stroke events in AF patients who underwent LAAC during long-term follow-up. Major leakage (>5 mm) is associated with a higher ischemic stroke/TIA rate in AF patients who underwent LAAC.

Objective The application of the da Vinci Surgical System in neurosurgery is limited due to technical difficulties requiring precise maneuvers and small instruments. This study details the advantages and disadvantages of robotics in neurosurgery and the reachable range of the transoral approach to lesions of the skull base and upper cervical spine. Methods In a cadaver study, the da Vinci Xi robot, lacking haptic feedback, was utilized for sagittal and coronal approaches on 5 heads, facilitating dura suturing in 3, with a 30°-angled drill for bone removal. Results Perfect exposure of all the nasopharyngeal sites, clivus, sellar, and choana, including the bilateral eustachian tubes, was achieved without any external incisions using this palatal split approach of transoral robotic surgery. The time required to perform a single stitch, knot, and complete single suture in robotic suturing of deep-seated were significantly less compared to manual suturing via the endonasal approach. Conclusion This is the first report to show the feasibility of suturing the dural defect in deep-seated lesions transorally and revealed that the limit of reach in the coronal plane via a transoral approach with incision of the soft palate is the foramen ovale. This preclinical investigation also showed that the transoral robotic approach is feasible for lesions extending from the sellar to the C2 in the sagittal plane. Refinement of robotic instruments for specific anatomic sites and future neurosurgical studies are needed to further demonstrate the feasibility and effectiveness of this system in treating benign and malignant skull base lesions.

Paradoxical embolism through the foramen ovale is a rare and devastating event requiring urgent treatment. Herein, we present the case of a 23-year-old male who presented with a pulmonary embolism complicated by a left renal artery paradoxical embolism. Urgent vacuum-assisted thrombo-aspiration restored normal perfusion of the left kidney within 5 hours. The patient had a patent foramen ovale and heterozygous thrombophilia. However, a radioisotopic scan performed 2 years later revealed an unexpected decrease in left renal perfusion. Therefore, despite the angiographic success, functional evaluation using a renal scan should be performed to assess renal function.

The foramen ovale is a structure that allows for the extracranial passage of multiple significant intracranial structures, most notably the mandibular branch of the trigeminal nerve (CN V3). Here we report the case of a 12-year-old male who presented to the emergency department (ED) with a two-day history of nausea and emesis and a one-day history of altered mental status. Prior to presentation, he started speaking only Spanish, which was unusual because he primarily speaks English. He was also showing signs of absence seizures. Computed Tomography (CT) showed his orthodontic wire had migrated and was entering his skull through the foramen ovale, terminating within the inferior temporal lobe. Associated with the wire was an intraparenchymal hemorrhage. Imaging indicated the sparing of the internal carotid artery and its major branches, suggesting the hemorrhage was likely venous in nature. The wire was then safely removed with no complications. Same day and follow-up neurologic exams all demonstrated no deficit in CN V3 or any of the other surrounding structures. To our knowledge, this is the first case described in the literature in which a foreign object penetrated the skull floor through the foramen ovale.

Objective To investigate the clinical efficacy and application value of an improved 3D-printed guide plate for the treatment of primary trigeminal neuralgia (PTN) by percutaneous microballoon compression (PMC). Methods This prospective study included 42 patients with primary trigeminal neuralgia treated at the Department of Stomatology, Xuzhou Central Hospital, from September 2019 to January 2022. The group was divided by the random number table method into the experimental group (adopting 3D printing technology to make guide plates to guide the puncture, 22 cases) and the control group (adopting the traditional Hartel anterior approach to position the puncture, 20 cases). The intraoperative success rate of the first puncture, puncture time, operative time, radiation exposure of patients and postoperative complications were compared between the two groups. Postoperative Barrow Neurological Institute Scale (BNI) scores, facial numbness, diminished corneal reflexes and chewing weakness were recorded. The t-test, rank-sum test and chi-square test were used for statistical analysis, with P0.05). In the experimental group, 16 patients had postoperative masseter weakness, 1 had keratitis and 10 had perilabial herpes, while in the control group, 18 patients had postoperative masseter weakness, 2 had keratitis, 11 had perilabial herpes and 1 had monocular blindness. There was no significant difference in postoperative complications between the two groups (P>0.05). At 12 months of follow-up, there was no recurrence in either the experimental or control group. Conclusions 3D digital guide plate-guided percutaneous microballoon compression for primary trigeminal neuralgia can improve the accuracy and safety of puncture to a certain extent, obviously shorten the operation time, reduce radiation exposure of the patients, improve the success rate of the operation, meaning it has a high clinical application value.

Percutaneous closure of the patent foramen ovale (PFO) is increasingly performed in specific patients with cryptogenic stroke or clinical evidence of a paradoxical embolism. This study was performed to determine the safety of same-day discharge (SDD) following such procedures. This is a prospective, observational study of patients undergoing elective percutaneous PFO closure in a single tertiary center in Portugal between January 2020 and July 2023. AmplatzerTM devices (St. Jude Medical, St. Paul, MN, USA) and NobblestichTM EL (HeartStitch, Inc., Fountain Valley, CA, USA) were used. After 6 months, the following events were looked at: post-procedural paroxysmal atrial fibrillation, stroke, unplanned cardiac re-hospitalization, urgent cardiac surgery, major vascular complications, pericardial effusions, device embolization, and death. We studied 122 consecutive patients (52% female, 68; 48±12 years old) who had elective percutaneous closure with success and no complications. Forty-nine (40%) had SDD. AmplatzerTM devices were used more frequently in the SDD group, while NobblestichTM EL was more common in the overnight group. During the overnight group's follow-up period, there was one non-cardiovascular death; there were no further events. SDD after elective percutaneous closure of PFO was shown to be a safe and successful patient management method, including NobblestichTM, which we describe for the first time. Our results prove the safety of this same-day discharge strategy. We hypothesize that in the near future, in selected cases, PFO closure might become an ambulatory procedure.

Abstract Objectives This study aims to discuss the availability of robot-assisted percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) and share our preliminary experiences. Methods Patients with TN who underwent robot-assisted PBC from June to September 2022 were enrolled. We designed a fixing plug for robot-assisted PBC, three-dimensional structured light registration was used, puncture trajectory was the line connects the medial third of inner and outer aperture of foramen ovale. Numerical Rating Scale (NRS), Barrow Neurological Institute (BNI) pain and numbness intensity score were used to evaluate the facial pain and numbness. Results Eventually, nine patients were enrolled, the structured light registrations were successfully finished in all patients with a mean registration error of 0.68 mm. All the punctures of foramen ovales were successfully done one-time. Of note, the balloons were all got pear-shaped followed by 150 to 180 s compression. Though, postoperatively, all the patients complained of facial numbness and four patients suffered from transient masseter weakness, all patients got fully or mostly pain relief. It should be noted that is the numbness and weakness gradually relieved during follow-up. Conclusion Three-dimensional structured light registration and robot assisted PBC is an effective choice for patients with TN. Extension line between the medial third of the inner and outer aperture of foramen ovale might be a safe and effective puncture trajectory to this procedure.

BackgroundThe pathogenesis of concomitant continuous pain remains unclear and is worthy of further study. In this clinical study, we aimed to explore the potential role of a narrow foramen ovale in the development of concomitant continuous pain.MethodsA total of 108 patients with classical trigeminal neuralgia affecting the third branch of the trigeminal nerve and 46 healthy individuals were enrolled in this study. Three-dimensional reconstructed computerized tomography images of all participants were collected, and the morphometric features of the foramen ovale were examined by two investigators who were blinded to the clinical data of the patients.ResultsIn this cohort, patients with concomitant continuous pain suffered from more sensory abnormalities (18.4% vs. 2.9%, p = 0.015) and responded more poorly to medication (74.3% vs. 91.9%, p = 0.018) than patients without concomitant continuous pain. While no significant differences regarding the mean length (5.02 mm vs. 5.36 mm, p > 0.05) and area (22.14 mm2 vs. 23.80 mm2, p > 0.05) were observed between patients with and without concomitant continuous pain, the mean width of the foramen ovale on the affected side in patients with concomitant continuous pain was significantly narrower than that in patients without concomitant continuous pain (2.01 mm vs. 2.48 mm, p = 0.003).ConclusionThis neuroimaging and clinical study demonstrated that the development of concomitant continuous pain was caused by the compression of the trigeminal nerve owing to a narrow foramen ovale rather than responsible vessels in classical trigeminal neuralgia.

Background. The purpose of the study is to determine the dynamics of growth and differentiation of cortical and perimedullary nephrons in children with pathology of the cardiovascular system. Materials and methods. We researched the histological material of the kidneys painted by hematoxylin-eosin and obtained from postmortem, from pediatric patients with congenital heart disease (open foramen ovale, ventricular septal defect and without pathology this patients has age range from 0 to 12 months) patients divided into three age groups (0‒2, 4‒6, 10‒12 months). During microscopy, the number of nephrons in the field of view in the subcortical zone and separately in the perimedullary zone of the cortical substance was counted, the data obtained were subjected to statistical processing. Results. In patients without pathology of the cardiovascular system, the differentiation of subcortical nephrons during the first year of life occurs linearly. There is a clear trend towards a decrease in the number of nephrons per unit area with age. The development of pericerebral nephrons in the same group up to 6 months is similar, but by the age of 10‒12 months, the number of bodies of perimedullary nephrons per conventional unit of area increases to values determined at 2 months of age. Conclusions. In patients with pathology of the cardiovascular system, the dynamics of differentiation of nephrons in the subcapsular zone differs from those found in the first group and repeats the dynamics of differentiation of perimedullary nephrons. The presence of congenital malformations of the cardiovascular system during the first year of a child's life leads to changes in the differentiation of the renal parenchyma. In children without pathology of the cardiovascular system, there is a decrease in the number of nephrons per conventional unit of area during the first year of life. Changes in the differentiation of nephrons in the subcapsular zone of the kidneys in the presence of congenital malformations of the cardiovascular system can become one of the pathogenetic stages in the development of arterial hypertension.

Context: The foramen ovale is an obliquely placed, oval-shaped opening at the base of the skull in the greater wing of sphenoid. As the foramen transmits mandibular nerve, accessory meningeal artery, lesser petrosal nerve, and emissary veins, it knowledge of its variations is of supreme interest for surgeons. Aims: The aim of this study is to study the metric and nonmetric variations, of the foramen ovale of 40 dry adult human dried skulls. Settings and Design: The study was conducted in the dissection hall of Chettinad Academy of Research and Education. The study undertaken here is an observational study. Subjects and Methods: Human skulls were studied for location, patency, and various morphometric parameters bilaterally. The materials used were thin copper wire and a digital Vernier caliper of precision 0.01 mm. Statistical Analysis Used: Metric and nonmetric data were analyzed using the SPSS software. Results: The shape of foramen ovale was D shaped in most of the skulls (35%) followed by almond (21%), elongated oval (15%), and oval shape (11%). The presence of bony variations like spur was seen in 27.5% foramina, bony septa in 3.75%, and duplication in 21.25% foramina. The mean length and width of foramen ovale were 6.51 ± 1.24 mm and 3.66 ± 0.82 mm on right and 6.59 ± 1.33 mm and 3.75 ± 0.68 mm on the left, respectively. The mean area of foramen ovale was 19.08 ± 5.71 mm2 and 17.88 ± 5.85 mm2 on the right and the left, respectively. Conclusions: A sound knowledge on the morphometric variations of the foramen ovale helps the operating surgeon to avoid damage to the adjacent structures.

BackgroundMeningioma is a common non-glial tumor of the brain. Extracranial meningiomas in the parapharyngeal space are especially rare. Herein we report a case of extracranial meningioma in the parapharyngeal space and give a comprehensive description of its complete clinical course and radiological findings, which may provide helpful information in the diagnosis and treatment of extracranial meningiomas in the parapharyngeal space.Case PresentationA 61-year-old man presented a slowly increased mass under the left ear without pain and numbness over one year. Ultrasound examination detected a hypoechoic uneven mass behind the left parotid gland with a clear boundary, and color Doppler flow imaging revealed blood flow signals within the mass. Unenhanced computed tomography (CT) of the craniofacial region revealed a homogenous soft tissue mass in the parapharyngeal space without calcification. Magnetic resonance imaging (MRI) showed that a homogenous soft tissue mass was hyperintense on T2-weighted image, hypointense on T1-weighted image, and obviously enhanced after contrast enhancement in the parapharyngeal space. Coronal MRI showed that the lesion originated from basicranial dura extending into parapharyngeal space through the left foramen ovale at the skull base. Finally, histopathological and immunohistochemical analyses confirmed the final diagnosis of extracranial meningiomas in the parapharyngeal space.ConclusionExtracranial meningiomas of the parapharyngeal space are rare and often pose a diagnostic challenge. Preoperative imaging examinations, especially CT and MRI, can aid in the accurate preoperative diagnosis, especially when intracranial extensions and dural tail signs are observed.

Melanotic schwannoma (MS) is a rare peripheral nerve sheath tumor commonly found in the thoracic paraspinal region. It is present in an intracranial location rarely, with 18 out of 105 MS cases described in the literature. Trigeminal nerve was involved in only six of these cases. Fifty percent of psammomatous melanotic schwannoma (PMS) patients have Carney complex. Carney complex is an autosomal dominant disorder featuring peripheral nerve tumors (schwannomas), myxomas (heart, skin, and breast), skin pigmentation (lentigines and blue nevi), and endocrine tumors (adrenal, testicular, and pituitary). We present a case of left trigeminal nerve PMS as a part of Carney complex. Patient had diffuse lentiginosis. Magnetic Resonance Imaging revealed enhancing lesion along left trigeminal nerve with widened Meckel's cave and foramen ovale. Final diagnosis of PMS was derived on clinical, radiological, and histopathological findings with immunohistochemistry correlation. Key Message Trigeminal nerve can be rarely involved in melanotic schwannoma (MS). Knowledge of typical radiological features of MS is crucial for its diagnosis. Its association with Carney complex should be sought.

The balloon cryoablation (CA) procedure is an established method for the permanent treatment of atrial fibrillation (AF). Like other surgical interventions, it is associated with the potential development of early and late complications, including neurological ones such as migraine. We report a case of migraine headaches after the CA procedure. 25-year-old man with paroxysmal AF, without comorbidities, underwent balloon CA. On the second day after the procedure, the patient developed visual symptoms typical of migraine aura. After 30 minutes, these symptoms disappeared and appeared classic migraine headache attack. Similar episodes occurred over the following days. A focal central nervous system lesion was ruled out and a diagnosis of migraine with aura was made. The patient received a typical migraine attack treatment. The attacks ceased within two weeks. 3 months later during the follow-up visit at the neurology clinic no abnormalities were detected. We decided to check if the migraine is a rare complication of AF ablation surgery. Many studies do not include migraine headaches at all in the neurological complications of ablation. However, based on some studies, it may seem that the incidence of migraine as a complication of ablation is underestimated.

Abstract Purpose Routinely collected administrative data is widely used for population-based research. However, although clinically very different, atrial septal defects (ASD) and patent foramen ovale (PFO) share a single diagnostic code (ICD-9: 745.5, ICD-10: Q21.1). Using machine-learning based approaches, we developed and validated an algorithm to differentiate between PFO and ASD patient populations within healthcare administrative data. Methods Using data housed at ICES, we identified patients who underwent transcatheter closure in Ontario between October 2002 and December 2017 using a Canadian Classification of Interventions code (1HN80GPFL, N = 4680). A novel random forest model was developed using demographic and clinical information to differentiate those who underwent transcatheter closure for PFO or ASD. Those patients who had undergone transcatheter closure and had records in the CorHealth Ontario cardiac procedure registry (N = 1482) were used as the reference standard. Several algorithms were tested and evaluated for accuracy, sensitivity, and specificity. Variable importance was examined via mean decrease in Gini index. Results We tested 7 models in total. The final model included 24 variables, including demographic, comorbidity, and procedural information. After hyperparameter tuning, the final model achieved 0.76 accuracy, 0.76 sensitivity, and 0.75 specificity. Patient age group had the greatest influence on node impurity, and thus ranked highest in variable importance. Conclusions Our random forest classification method achieved reasonable accuracy in identifying PFO and ASD closure in administrative data. The algorithm can now be applied to evaluate long term PFO and ASD closure outcomes in Ontario, pending future external validation studies to further test the algorithm.

Migraine is a common neuro⁃vascular disease with a global prevalence of about 15% and a heavy burden. Patent foramen ovale (PFO) is the most common congenital cardiac abnormality consisting of the main cause of right⁃to⁃left shunt (RLS). There is a correlation between PFO and migraine, especially migraine with aura (MA). The comorbidity rate of PFO and migraine is significantly higher than that of the general population. The exact pathophysiological mechanism of comorbidity between PFO and migraine is unclear. At present, it is considered that paradoxical embolism and vasoactive peptides may underlie this comorbidity. Some studies suggest that percutaneous closure of PFO can reduce the frequency and duration of migraine, but the effectiveness of closure of PFO is still controversial. At present, limited evidence suggests that migraine with aura, antiplatelet drugs, large amount of RLS, and comorbid with ischemic stroke and transient ischemic attack (TIA) may benefit more from closure of PFO. In the future, more multicenter, prospective, double⁃blind, randomized controlled large⁃scale clinical studies are needed to clarify the long⁃term efficacy and predictive factors of closure of PFO on migraine prophylactic treatment, so as to provide criteria for screening the eligible patients treated with closure of PFO.

Background: The mandibular nerve exits the cranial cavity by traversing through the foramen ovale (FO) which is located in the greater wing of sphenoid, posterolateral to foramen rotundum. This foramen also provides an entry portal to the accessory middle meningeal artery and helps exit the lesser petrosal nerve apart from the emissary veins. Tumors and masses in infratemporal region require an accurate and precise morphometry of FO, before planning any surgical procedure. The aim of this study is to record and analyze the metric and nonmetric data and compares the morphometry of FO with gender and age. Methodology: Type of study – Retrospective observational study. The sample size was 200 computerized tomography head axial section scans without any disease which might alter the anatomy of foramen, from picture archiving and communication system. Bilateral foraminal parameters were obtained with the help of computer-assisted software. Results: The mean length, breadth, distance from mid-sagittal plane, and size of FO in males were 7.75 ± 1.16, 3.98 ± 0.91, 21.40 ± 1.75, and 30.94 ± 8.79, and in females, measurements were 6.90 ± 0.78, 3.57 ± 1.04, 20.36 ± 1.62, and 24.86 ± 9.08, respectively. Septation was observed in 2% of cases and the most common shape observed was oval (84%). Totally 26% of accessory foramina were observed. Conclusion: Significant gender differences were seen in the morphometry in all the four parameters. A significant difference with age was seen only with distance of foramen from midsagittal plane. Variations in morphometry and shapes of the FO may affect clinical and diagnostic procedures.

ObjectiveTrigeminal neuralgia (TN) is one of the leading causes of facial pain and seriously affects patients' quality of life. Foramen ovale (FO) radiofrequency thermocoagulation is a classic approach for the treatment of TN that has failed pharmacological therapy. This study summarized the safety and efficacy of transforaminal radiofrequency thermocoagulation for TN by comparing puncture approaches or guidance techniques, thereby providing higher-quality clinical evidence.MethodsDatabases including PubMed, Embase, Cochrane Library, CNKI, and Wanfang were searched for relevant studies published before May 2022. Relevant data were extracted for analysis to compare methodological variables and clinical outcomes.ResultsThis meta-analysis included 27 studies with a total of 1,897 patients. In terms of puncture approaches, FO had a significant advantage in reducing VAS at 12 months postoperatively (P = 0.019) and efficacy (P = 0.043). However, FO performed poorly on complications (P

Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.

BackgroundThe etiology of primary trigeminal neuralgia remains unclear and is worthy of further study; In this study, the morphometric characteristics of ovale foramina between various groups were compared and analyzed to explore the novel cause of primary trigeminal neuralgia.MethodsHigh-resolution three-dimensional reconstruction images from head computed tomography of 109 patients with primary trigeminal neuralgia affecting the third branch of the trigeminal nerve and 46 healthy controls were retrospectively reviewed. Among the 109 primary trigeminal neuralgia patients, 79 patients with apparent neurovascular compression (not simply contact) demonstrated on MRI or during surgery were divided into the classical trigeminal neuralgia group and 30 patients with MRI showing no significant abnormalities were divided into idiopathic trigeminal neuralgia group. The morphometric parameters including the area, width and length of ovale foramina were examined through the use of radiologic methods.ResultsIn this study, the average minimum area, width and length of 79 ovale foramina on the affected and unaffected sides in the classical trigeminal neuralgia group were 21.83 ± 8.45, 21.94 ± 7.93 mm2, 2.32 ± 0.91, 2.58 ± 0.81, 5.32 ± 1.29, and 5.26 ± 1.21 mm, respectively. No significant difference in these parameters was observed (p > 0.05). However, in the idiopathic trigeminal neuralgia group, the average minimum area, width and length of 30 ovale foramina were 21.33 ± 8.21, 22.85 ± 8.36 mm2, 2.25 ± 0.90, 2.79 ± 0.96, 5.20 ± 1.27, and 5.28 ± 1.19 mm, respectively. The width on the symptomatic side was significantly smaller (p = 0.03) than that on the asymptomatic side. No significant difference in area (p = 0.48) or length (p = 0.79) was observed. In addition, when compared with the healthy control group, the area and width of ovale foramina on the symptomatic side in both groups were significantly smaller. No significant difference in length was observed.ConclusionsBy comparing and analyzing the statistical data, it can be inferred that a narrow foramen ovale is associated with primary trigeminal neuralgia, as well as its recurrence after microvascular decompression.

The importance of the location of the foramen ovale (FO) is particularly evident in external approaches to the skull base. Neighboring structures are of great importance in surgical interventions such as approaches used for trigeminal neuralgia (percutaneous trigeminal rhizotomy), transfacial fine needle aspiration in perineural spread of the tumor, and electroencephalographic analysis for seizures. This study aimed to investigate the morphometry, morphology and anatomical relations of the FO. Eighty hemicraniums of osteological collection of the Department of Anatomy, Faculty of Medicine, Istanbul University, in Turkey were investigated. In the study, the morphological features of the foramen ovale and their distance to the surrounding anatomical structures were measured. Oval (70%), almond (18.75%), slit (6.25%), round (5%) shaped foramen ovale were observed. The average length of foramen ovale on the right side was 7.09+1.07mm and 7.06+1.01mm on the left side, while the width was 4.16+0.79mm and 4.15+0.5mm, right and left respectively. The transverse distance of posterolateral edge of foramen ovale to lateral edge of articular tubercle was 33.06+3.25mm, the transverse and vertical distances of foramen ovale to mastoid proccess were, 17.36+3.09mm and 32.40+3.43mm. Finally, measurements of foramen ovale to the carotid canal, the inferior orbital fissure, and the pterygopalatine fossa were 16.70+1.9mm, 27.94+3.2mm and 14.88+1.91mm, respectively. Regional differences in morphometric and morphological analysis of foramen ovale are of clinical and anatomical significance for medical practitioners in neurosurgical procedures, treatment of trigeminal neuralgia, and diagnostic detection of tumors. [Med-Science 2021; 10(3.000): 1039-46]

Abstract Objective The objective of this study was to determine fetal foramen ovale blood flow utilizing pulsed Doppler combined with spatiotemporal image correlation. Methods A cross-sectional study was performed in 440 normal fetuses between 20 and 40 weeks of gestation. In order to calculate foramen ovale blood flow, the foramen ovale flow velocity–time integral was obtained by pulsed Doppler ultrasonography, and the foramen ovale area was measured by using spatiotemporal image correlation rendering mode. Foramen ovale blood flow was calculated as the product of the foramen ovale area and the velocity–time integral. Results Gestational age-specific reference ranges are given for the absolute blood flow (ml/min) of foramen ovale, showing an exponential increase from 20 to 30 weeks of gestation, and a flat growth trend during the last trimester, while the weight-indexed flow (ml/min/kg) of foramen ovale decreased significantly. The median weight-indexed foramen ovale blood flow was 320.82 ml/min/kg (mean 319.1 ml/min/kg; SD 106.33 ml/min/kg). Conclusions The reference range for fetal foramen ovale blood flow was determined from 20 to 40 weeks of gestation. The present data show that the volume of foramen ovale blood flow might have a limited capacity to increase during the last trimester.

The foramen ovale is an important structure that ensures the functioning of the fetal circulatory system. The work describes process of atrial septum formation from the embryonic stage to the neonatal period. Human atrial septation is inefficient process resulting in a persistent foramen ovale in quarter of adult population. Imaging of the foramen ovale is a valuable parameter for the assessment of the fetal circulatory system with the possibility of capturing life-threatening conditions. The dynamic process of adaptation to extrauterine life is also reflected at the foramen ovale in the postnatal period. The persistent foramen ovale is usually clinically silent in the pediatric population, while in the perspective of adulthood it may be a factor contributing to thromboembolic stroke. The aim of this article is to describe the essential differences in the function of the foramen ovale in the fetal and neonatal period.

The sphenoid bone development occurs in both prenatal and postnatal periods. Sphenoid bone openings are used as surgical landmarks and are of great importance for neurosurgeons in everyday practice. The aim of this study was to identify morphological characteristics, postnatal development and remodeling, as well as clinical aspect of the sphenoid bone openings and to investigate their relationship and difference in size. The macerated sphenoid bones analyzed in this study were scanned by micro-computed tomography. Areas and distance in-between foramen ovale and foramen rotundum were measured. In addition, different shapes of foramen ovale were described. The most common shape of foramen ovale on both sides was oval, followed by the round, almond and elongated shapes. Modest to strong positive correlations between all foramina and age for the whole sample and both subsamples were presented, except for the right foramen rotundum area in the male subsample, which did not show significant correlation with age. Our study revealed changes in postnatal development and anatomy of foramen ovale and foramen rotundum, primarily in the aspects of size and shape, and should contribute to reducing the risk of damage to neurovascular structures during surgical procedures.

Migraine is a common clinical chronic neurovascular disease, which seriously affects the quality of life of patients. Studies have shown that patent foramen ovale (PFO) may be related to migraine, such as transient hypoxemia caused by patent foramen ovale related right ⁃ to ⁃ left shunt, or vasoactive substances passing through an unclosed oval foramen, avoiding lung tissue metabolism and directly entering the arterial system, and contradictory micro ⁃ embolism and other mechanisms may be related to migraines related to patent foramen ovale, especially migraine with aura. The closure of patent foramen ovale can benefit some migraine patients. This article intends to outline the relationship between patent foramen ovale and migraine, and its mechanism, prevention and treatment.

Objectives: Ossification of the various ligaments at the base of the skull is quite common. Ossified pterygospinous and pterygoalar ligaments have been extensively described in the literature. We observed some bony outgrowths extending from the bar of bone between foramen spinosum (FS) and foramen ovale (FO). The objective of the present study was to report the incidence of these bony outgrowths near the FS. Materials and Methods: Fifty-five dried adult skulls and 20 sphenoid bones were examined for the bony outgrowths (if present) near the FS. Results: Bony outgrowths extended posteriorly from the bar of bone between FO and FS in 60% of cases. These bony outgrowths when long were seen meeting the spine extending from the spine of the sphenoid, forming a complete or incomplete bar of the bone. At times, a thick bony plate joined the bar of bone between FO and FS to the spine of the sphenoid. Conclusions: The bony outgrowths near FS become clinically important in surgeries involving middle meningeal artery. In spite of such implications, these bony outgrowths are neither named nor have they received the due attention in the literature. Detailed studies of these bony outgrowths could be of interest to radiologists, anesthetists, and neurosurgeons.

The foramen ovale (FO) is a crucial feature of the skull base, serving as a passage for clinically important neurovascular structures. The present study aimed to provide a comprehensive morphometric and morphologic analysis of the FO and highlight the clinical significance of the anatomical characterization. A total of 267 FO were analyzed in skulls obtained from deceased inhabitants of the Slovenian territory. The anteroposterior (length) and the transverse (width) diameters were measured using a digital sliding vernier caliper. Dimensions, shape, and anatomical variations of FO were analyzed. The mean length and width of the FO were 7.13 and 3.71 mm on the right side and 7.20 and 3.88 mm on the left side. The most frequently observed shape was oval (37.1%), followed by almond (28.1%), irregular (21.0%), D-shaped (4.5%), round (3.0%), pear-shaped (1.9%), kidney-shaped (1.5%), elongated (1.5%), triangular (0.7%), and slit-like (0.7%). In addition, marginal outgrowths (16.6%) and several anatomical variations were noted, including duplications, confluences, and obstruction due to a complete (5.6%) or incomplete (8.2%) pterygospinous bar. Our observations revealed substantial interindividual variation in the anatomical characteristics of the FO in the studied population, which could potentially impact the feasibility and safety of neurosurgical diagnostic and therapeutic procedures.

Resumen: La endocarditis infecciosa es una enfermedad mortal, que a pesar de las mejoras en su manejo sigue estando asociada a gran mortalidad y complicaciones graves. Es una complicación excepcional del cierre percutáneo de foramen oval permeable. Se presenta un caso clínico de un hombre de 52 años intervenido de cierre percutáneo de foramen oval permeable detectado en el estudio etiológico de un ictus. Tres años después, el paciente presentó un cuadro clínico compatible con endocarditis, encontrándose una gran vegetación endocardítica anclada a la vertiente auricular izquierda del dispositivo de cierre de foramen oval permeable. Los hemocultivos fueron positivos para Staphylococcus aureus. Se realizó cirugía con resección del dispositivo. La evolución postoperatoria fue satisfactoria. Abstract: Infective endocarditis is a fatal disease that, despite improvements in its management, is still associated with a high rate of mortality and complications. It is an exceptional complication of percutaneous patent foramen ovale closure. A case report is presented of a 52-year-old man who underwent percutaneous closure of a percutaneous patent foramen ovale diagnosed during the aetiological study of a stroke. Three years after the procedure, the patient presented with symptoms of endocarditis. A large endocarditic growth was found to be anchored to the left atrial surface of the percutaneous patent foramen ovale closure device. Blood cultures were positive for Staphylococcus aureus. Surgery was performed and the device was removed. Postoperative recovery was satisfactory.

Myxomas are rare cardiac neoplasms and may present as single or multiple tumors. Only a few cases of single biatrial myxomas have been reported. We report a very rare case of this condition in a middle-aged woman, presenting with exertional dyspnea and cough. The patient had a resting tachycardia of 105 beats per minute, and cardiac auscultation discovered a mid-diastolic murmur across the mitral valve, followed by a tumor plop focused on the apex and elevated levels of C-reactive protein (1+) and creatine phosphokinase in lab data. The diagnosis was made via transesophageal and transthoracic echocardiographic examinations, showing the tumor extension through a patent foramen ovale (PFO). The operation was undertaken, the myxoma was excised, and the PFO was repaired. She was discharged with no further complications. Although myxomas are rare, considering this condition before surgery is significant. The involvement of both atria via a PFO is possible.

ABSTRACT The treatment of cryptogenic stroke patients with a patent foramen ovale (PFO) is controversial. A critical review of these studies is presented. Methods A description of all trials comparing medical and endovascular treatment with closing devices is given. Additional pertinent studies are discussed to help construct a rational basis for treatment decisions. Results Initial negative trials evaluating PFO closure were followed by positive studies published in 2017 and 2018. All trials evaluated young patients (up to 60 years). Methodological problems are present in all trials including their open label construction. Most positive trials developed strategies to increase the percentage of patients with interatrial septal aneurysms or hypermobility and large right-to-left shunts. Even in these positive trials, large numbers of patients need to be treated to avoid one stroke. Atrial fibrillation occurred in 2-6% and other adverse effects related to the procedure and to the devices occurred in a substantial number of patients. Incomplete occlusion of the PFO is also frequent. Anticoagulant treatment has not been adequately studied as a therapeutic option. Conclusion Young patients with cryptogenic strokes seem to benefit from endovascular closure of a PFO in the presence of a large right-to-left shunt or an associated atrial septum aneurysm. For most other patients, a highly-individualized decision must be made, taking into account the low risk of recurrence in patients with a cryptogenic stroke attributable to a PFO, the high numbers needed to treat and the risks related to the procedure.

Background:The floor of middle cranial fossa shows several foramina through which vital neural and vascular structures pass. Thus, the knowledge of normal and variant anatomy of these foramina is important. One such foramen is Foramen ovale which allows the passage of certain important structures. Aims and Objective:This study also aimed to provide a base line data to neurosurgeons for easy and safe approach to middle cranial fossa. Thus, to fulfill the above, the morphometric and morphologic characteristics of the foramenovalewere studied and the observed metric and non-metric parameters were compared with those of previous studies. Materials and Methods:The study has been conducted on 160 adult non-pathological dry human skulls of unknown age and sex. Those parts of broken skulls were included in the study in which the area of Foramen ovale was intact. All the parameters were obtained by one observer only to avoid inter-observer error. The foramen ovale was identified and different metric and non-metric parameters were observed and measured. Results:The most common shape on both sides was noted to be transversely oval. Out of 160 skulls, 2 skulls (1.25%) showed accessory FO bilaterally. 4 skulls showed divided FO on left side. Out of 4, 2 skulls( 1.25%) were noted to have bony bar and in 2 skulls (1.25%) the main FO were divided by bony plate. Conclusion: The morphologic variations of Foramen Ovale in the form of accessory foramen and presence of bony bar / bony plate are common. This study will provide a baseline data as well as frequency of related variations in our population for a safer approach by the surgeons.

Bing Huang,1 Keyue Xie,1 Yajing Chen,1 Jiang Wu,2 Ming Yao11Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang 314000, People’s Republic of China; 2Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, University of Washington, Seattle, WA 98195, USABackground: Percutaneous trans-foramen ovale (FO) radiofrequency ablation (RFA) of Gasserian ganglion (GG) is commonly used to treat V3 trigeminal neuralgia (TN). However, this intracranial approach is less selective and safe.Objectives: To report a novel percutaneous within-FO RFA of the V3 under CT-guidance and outcomes with both bipolar and monopolar techniques.Patients and methods: Twenty-six patients with isolated V3 primary TN and FO >6 mm in diameter underwent either monopolar (n=12) or bipolar RFAs (n=14) based on their preference. Successful analgesia over V3, residual pain, recurrent pain, and complications were compared between the two groups. The ex vivo egg albumen model was used to demonstrate the size difference in the thermocoagulation lesion created by monopolar vs bipolar electrodes.Results: In the bipolar group, there were more cases of masticatory atonia as compared to the monopolar (P=0.104), but no residual pain was observed. In the monopolar group, there were two cases of residual pain found, which led to immediate repeat RFAs. Therefore, during the immediate post-operative period, both groups obtained 100% complete V3 analgesia with a similar risk of facial hematoma (P=0.641). During up to 27-months of post-operative follow-up, in the bipolar group, complete pain relief persisted in all patients; in the monopolar group, 1 case of recurrent pain was found at 14 months. Ex vivo study demonstrated that, at 90 °C/90 seconds of RFA, the width of lesions is significantly larger by the 6-mm spacing parallel-tip bipolar electrodes compared to the monopolar electrode (9.5±0.567 vs 5.5±0.07 mm).Conclusion: In treating patients with isolated V3 TN and FO >6mm in diameter, this percutaneously within-FO RFA of the V3 under CT guidance is both clinically practical and effective, while bipolar RFA is associated with a lower incidence of residual and recurrent pain likely due to larger lesion sizes.Keywords: trigeminal neuralgia, mandibular nerve, foramen ovale, radiofrequency ablation, bipolar

Central venous catheterization is a routinely performed procedure in clinical practice. While cerebral air embolism after the removal of the central venous catheter is very rare, it is one of the most serious complications that can lead to fatal outcomes. In this report, we present a rare case of a cerebral air embolism after the removal of the central venous catheter in a patient with a patent foramen ovale.

The Pterygospinous Ligament (PSL) extends from the Pterygospinous process of the lateral Pterygoid plate to the spine of the sphenoid bone. Sometimes, it may be ossified forming a bar of bone bounding the pterygospinous foramen to which mandibular nerve and its branches are variably related. Mandibular and chorda tympani nerves may get compressed depicting various clinical symptoms, which in turn depend upon dimensions of the foramen and grades of compression. Therefore, knowledge of the position and extent of ossification of PSL and its relation to the important structures in the deep infratemporal fossa is important for radiologists, neurologists, maxillofacial surgeons, dental surgeons and anesthesiologists during various anesthetic and surgical procedures.

Background and Aim The foramen ovale is a clinically significant foramen present in the skull base. The mandibular nerve is an important structure traversing this foramen and the trigeminal ganglion is also located just above the foramen ovale in the Meckel’s cave. These two structures are targeted by neurosurgeons and pain physicians in patients with trigeminal neuralgia. Clinical procedures for treating trigeminal neuralgia necessitate very precise knowledge about the foramen ovale. Hence, this study was designed to evaluate the morphology and morphometry of foramen ovale and its variations in dry skulls of India. Materials and Methods This study was conducted in 100 adult dry skulls of either sex. The foramen ovale was assessed for morphology and morphometry bilaterally using digital Vernier calipers. The summary data for all the measurements are presented in this study. The statistical analysis was performed using SPSS version 19. Results The most common shape of the foramen ovale was found to be oval. Oval-shaped foramen ovale was present in 72% (right side) and 68% (left side) of dry skulls that were examined. A mean length of 6.62 ± 1.11 mm (right side) and 6.72 ± 1.08 mm (left side) and width of 3.78 ± 0.89 mm (right side) and 3.89 ± 0.73 mm (left side) were observed. The distance between the foramen ovale and the zygomatic point was 35.65 ± 3.24 mm (right side) and 34.91 ± 2.58 mm (left side). The distance between the zygomatic point and the anterior margin of the external auditory meatus was 21.79 ± 3.25 mm (right side) and 18.62 ± 2.37 mm (left side). Conclusion An in-depth knowledge of the morphology and morphometry which include the different metric and nonmetric parameters and the variations in foramen ovale in dry skulls has been studied, which will be helpful to neurosurgeons and pain physicians to plan their clinical procedures which involve the base of skull.

Background Anatomical knowledge of bony bridges around the foramen ovale may be helpful for diagnostic and invasive neurosurgical procedures like electroencephalogram analysis, trigeminal rhizotomy, biopsy of cavernous sinus tumors, and mandibular nerve block. Lateral pterygoid plate forms an important landmark for mandibular anesthesia; therefore, any variation related to lateral pterygoid plate is likely to create confusion during the maneuver of anesthesia. Aims and Objective The aim of the study was to explore any bony obstacle within and around Foramen ovale. Obstacles in form of ossified complete or incomplete ligaments. Additional foramina formed by ligaments or any bony enlargement might disturb the structures passing through the Foramen ovale. Methods Around 530 dried crania (from medical colleges in Uttarakhand and Uttar Pradesh) were observed to find ossified ligaments and foramen formed by them. Crania associated with bilateral enlarged lateral pterygoid plate other than the average width of 1.5 cm were included in this study. Length of ligaments and width of pterygoid plate were measured by digital Vernier calipers. Results Out of 530 crania, unilateral 52 ossified pterygospinous ligament (incomplete 31 and complete 21) were observed. Among them some rare variation was found along with ossified pterygospinous and pterygoalar ligament, one cranium along with unilateral pterygospinous bar was also having bar within foramen ovale, forming an accessory osseous compartment, found to be rare kind of variation. Another unilateral complete pterygospinous bar was enclosing two foramens instead of one. Only single cranium was found to have pterygoalar bar, related medial to foramen ovale. One cranium was associated with bilateral enlarged lateral pterygoid plate (i.e., 2.5 cm) was also found to be obliterating the space, that is, retropharyngeal and parapharyngeal space for surgeons. Conclusion This study would provide the anatomical knowledge of these bony bridges around the foramen ovale and may be helpful for diagnostic and neurosurgical procedure like microvascular decompression by percutaneous trigeminal rhizotomy for trigeminal neuralgia, percuatneous biopsy of cavernous sinus tumor and mandibular nerve block by lateral subzygomatic route. Thus, lateral pterygoid plate forms an important landmark for mandibular anesthesia.

Paradoxical embolism is an uncommon phenomenon, accounting for only 2% of all cases of systemic arterial embolism. This condition suggests the presence of a patent foramen ovale, present in 20% - 25% of the adult population. The authors report the case of a 63-year-old male patient with a history of lung adenocarcinoma and hereditary thrombophilia admitted to hospital with acute onset of dyspnea, diplopia, confusion and decreased motor strength of the right limbs. Cranial computed tomography scan showed acute ischemic injury in the left posterior cerebral artery and computed tomography pulmonary angiography revealed bilateral pulmonary thromboembolism. A transesophageal echocardiogram confirmed the presence of patent foramen ovale. The patient was treated with anticoagulant therapy with progressive clinical improvement. Due to a high risk of recurrent thromboembolic episodes, the percutaneous closure of patent foramen ovale was performed and anticoagulant therapy was maintained indefinitely.

Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD. Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups. Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P

Background: Surface landmarks of the temporal bone are related to various anatomical structures. The surgical exposure of the middle cranial fossa, transpetrosal and transmastoid approaches for skull base surgeries would require identification of various surface landmarks for approaching the structures. Aim and Objectives: To determine whether Henle's spine could be used as a reliable and multipurpose landmark for the important structures and foramen of the skull base during surgeries. Materials and Methods: This study was done on 170 dry human skulls. Two imaginary lines and a parapetrosal triangle was constructed which encompasses nearly all the main structures and foramina of the skull base. The distance from the Henle's spine to certain useful surgical landmarks on the skull base was measured and tabulated. Results: The measurements were analysed and compared by student't' test both the sides and found to be have slight variations in the measurements of right and left. Distance from Henle's spine to stylomastoid foramen and jugular foramen were found to high when compared to earlier studies other measurements showed only a slight deviations. Conclusion: Henle's spine when present (85%) can be used as a reliable anatomical landmark for approaching various foramina during skull base surgeries when other land mark fails.

Introduction A 46-year-old female with a postoperated case of carcinoma left upper alveolus diagnosed in March 2018, with recurrence, was presented to the hospital. She had lancinating pain around left facial pain, which gradually increased over 10 months. On numerical rating scale, her pain was 9 on 10. Her chief complaint was continuous dull pain above and below the left eye, with sudden, brief, paroxysmal episodes of intolerable burning and stabbing type of pain. This episodic pain lasted for 30 to 40 seconds. On examination, she had left III, V, and VI nerve palsy with ptosis. Magnetic resonance imaging of face and brain revealed an enhancing infiltrative mass in left maxillary sinus extending to base of skull. Clinical diagnosis of left-sided painful trigeminal neuropathy in ophthalmic and maxillary (V1 and V2) division was made. Aim This study was aimed to relieve patient’s pain and improve her quality of life. Materials and Methods Gasserian neurolysis was successfully completed under computed tomography (CT) guidance because of the distortion of skull base anatomy using a 22-G, 10-cm long spinal needle directed towards foramen ovale (FO) from a lateral approach. Conclusion CT-guided identification of foramen ovale can be labeled as a novel method of locating FO for precise percutaneous techniques to the trigeminal ganglion in advanced head and neck cancers.

The study aimed to establish and evaluate anatomoradiological landmarks in trigeminal neuralgia patients using computed tomography (CT) and cone-beam CT. CT images of 40 trigeminal neuralgia (TN) and 40 healthy individuals were retrospectively analyzed and enrolled in the study. The width and length of the foramen rotundum (FR), foramen ovale (FO), foramen supraorbitale, and infraorbitale were measured. The distances between these foramen, between these foramen to the median plane, and between the superior orbital fissure, FO, and FR to clinoid processes were also measured bilaterally. Variations were evaluated according to groups. Significant differences were found for width and length of the foramen ovale, length of the foramen supraorbitale, and infraorbitale between TN and control subjects (p < 0.05). On both sides, FO gets narrower and the length of the infraorbital and supraorbital foramen shortens in the TN group. In most of the control patients, the plane which passes through the infraorbital and supraorbital foramen intersects with impression trigeminale; 70% on the right-side, and 67% in the left-side TN groups. This plane does not intersect with impression trigeminale and deviates in certain degrees. The determination of specific landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures in trigeminal neuralgia patients.

Abstract Background The authors herein report a case of paradoxical cerebral infarction by spraying thrombus in the catheter for dialysis. The clinical manifestations of paradoxical cerebral infarction are nonspecific, and the diagnosis is sometimes difficult to establish. Patients with paradoxical cerebral infarction may present with neurologic abnormalities or features suggesting arterial embolism. And paradoxical cerebral infarction has been associated with foramen ovale (PFO). Case presentation A multi-lumen catheter for dialysis was inserted into the right internal jugular vein. After injecting heparin-added physiological saline solution to confirm the patency of the catheter, paradoxical cerebral infarction developed. Detailed examination revealed PFO. PFO patent is a common condition that affects one in four people. Conclusion The size of multi-lumen catheter for dialysis is relatively large. We learned from this case that the use of multi-lumen catheter poses a potential risk of paradoxical infarction. Clinicians should be aware that central venous catheter is a risk factor for paradoxical cerebral infarction.

In fetuses, the Eustachian valve directs oxygenated blood returning from the inferior vena cava into the left atrium via the foramen ovale. If too large, the Eustachian valve can restrict right ventricular inflow, as well as induce postnatal cyanosis via an interatrial right-to-left shunt. We report a fetal case of postnatal amelioration of the tricuspid valve and right ventricle hypoplasia, despite significant right ventricular hypoplasia associated with a large Eustachian valve. Application of an appropriate respiratory management regimen to help reduce pulmonary vascular resistance is of particular importance for the reversal of the right-to-left shunt via the foramen ovale and associated increases in right ventricular inflow.

Transposition of the great arteries type I is a severe congenital heart disease that induces serious cyanosis immediately after birth and death within 24 hours, unless proper treatment is administered. A few cases have presented with reversed differential cyanosis, manifesting as separated cyanosis with high SpO2 values in the lower limbs. However, there have been few reports of survivors of transposition of the great arteries type I presenting with reversed differential cyanosis. We experienced a case of transposition of the great arteries type I presenting with reversed differential cyanosis immediately after birth. The infant was urgently transported because of postnatal SpO2 of 40% in the upper limbs and 90% in the lower limbs. The echocardiographic diagnosis was transposition of the great arteries type I with a narrow foramen ovale. We immediately performed balloon atrioseptostomy, and the reversed differential cyanosis was improved. The infant seems to have presented with reversed differential cyanosis because of the foramen ovale narrowing and complicating pulmonary hypertension due to fetal circulation and characteristic of transposition of the great arteries type I. Congenital heart disease, presenting with reversed differential cyanosis, is a clinical condition requiring emergency management.

Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15–35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.

A patent foramen ovale (PFO) is a common, incidental echocardiographic finding in otherwise healthy and asymptomatic infants and children. However, a variety of clinical conditions have been ascribed to the presence of a PFO in childhood, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine, although the data on these are controversial and sometimes contradictory. This review discusses embryology and correlation with post-natal anatomy, anatomical variations of the atrial septum, diagnostic modalities in special circumstances of PFO associated clinical syndromes, and the role of PFO in congenital heart disease, pulmonary hypertension, dilated cardiomyopathy and heart failure in children who require an extracorporeal membrane oxygenator or ventricular assist device as life support.

Foramen Spinosum (FS) is one of the chief foramens in the infratemporal surface of greater wing of the sphenoid which is situated just posterior and lateral to foramen ovale. It is a significant landmark in cases of damage to the base of skull particularly in the middle cranial fossa and infratemporal fossa. It is usually needed as a landmark in neurosurgery because of its adjacent relations with other cranial foramina. So, this study was undertaken to determine the precise range of dimensions, the variations, asymmetry, and dissimilarity of the size seen in the foramen spinosum in the South Indian population. Sixty eight dry skulls of unknown sex were used for the study. Various measurements and distance from various surgical landmarks were taken to assess the position of foramen spinosum on both sides of skull. We also calculated the area of foramen spinosum. Various shapes of foramen spinosum were also noted, i.e. round, oval, pin hole or irregular. Statistical Analysis was done for the all the measurements using spss software. The mean anteroposterior diameter of foramen spinosum was 2.955±1.132 mm, 3.226±0.813 mm on the right and left sides. The mean transverse diameter of foramen spinosum came out to be 2.169±0.804 mm on right side and 2.274±9.174 mm on left side. There was no statistical significance in any parameter measured on the right and left side. This study will be helpful for neurosurgeons while doing surgery in the middle cranial fossa.

Objectives: In this study, we aimed to evaluate the effect of percutaneous closure of patent foramen ovale (PFO) on the recurrence of stroke and new cardiac arrhythmia using magnetic resonance imaging (MRI) and Holter monitoring. Study design: Patients with PFO had >1 previous stroke or transient ischemic attack documented with MRI in the first event. PFO with right to left shunt was detected by transesophageal echocardiography (TEE) and transcranial Doppler ultrasound. MRI examinations were performed on patients before and one year after PFO closure was applied. A twenty-four hour Holter monitoring was performed in all patients within 1 month before and 6 months after the procedure. Results: Percutaneous PFO closure was performed on 47 patients (25 female, mean age: 38.7 years) who had cerebral ischemic events detected by MRI. A year after the procedure, TEE showed that there was no residual interatrial right-to-left shunting. After a 14 month follow-up, no new cerebrovascular event and no new lesion on MRI were recorded. The incidence of arrhythmia did not increase significantly after the procedure on Holter monitoring (p=0.917). Conclusion: One-year clinical and MRI follow-up study of patients with cerebral ischemic events and percutaneous closure of PFO showed no recurrent event and no significant complication associated with the procedure. In addition, Holter monitorization demonstrated that the procedure did not increase the incidence of arrhythmias compared with pre-procedural monitoring.

Background: Among various foramina affecting alisphenoid (greater wings of sphenoid), Foramen ovale (FO) and Foramen spinosum (FS) are two important foramina concerned to different advanced diagnostic and therapeutic procedures involving middle cranial fossa like placement of electrodes for EEG analysis, trigeminal radiofrequency rhizotomy, microsurgical procedure using middle meningeal artery as graft etc. Objective: FO and FS vary in shape and size. That’s why; we performed this study to provide data from the region of West Bengal, India. Methods: Forty adult human skulls having 80 intact greater wings collected from different medical colleges in Kolkata were meticulously examined for both morphologic and morphometric parameters about the foramina like shape, anteroposterior diameter, transverse diameter, any bony outgrowth affecting their margins by digital photographs and electronic caliper. Result: Regarding FO, it was not classically oval in 42.5% cases, somewhere it was irregular (6.25%) or semilunar (2.5%) also. FS other than variation in shape and size was found either partially (3.75%) or completely divided (5%). Emissary sphenoidal foramen was also observed in 5% cases. Appropriate statistical analysis was done. Conclusion: Considering clinical importance, recognition and knowledge of such possible variation will be definitely helpful in the field of diagnostic medicine and neurosurgery.