Search

Cluster headache (CH) is a debilitating, severe form of headache. A novel non-systemic therapy has been developed that produces therapeutic electrical stimulation to the sphenopalatine ganglion (SPG). A transoral surgical technique for inserting the Pulsante SPG Microstimulator into the pterygopalatine fossa (PPF) is presented herein. Technical aspects include detailed descriptions of the preoperative planning using computed tomography or cone beam computed tomography scans for presurgical digital microstimulator insertion into the patient-specific anatomy and intraoperative verification of microstimulator placement. Surgical aspects include techniques to insert the microstimulator into the proper midface location atraumatically. During the Pathway CH-1 and Pathway R-1 studies, 99 CH patients received an SPG microstimulator. Ninety-six had a microstimulator placed within the PPF during their initial procedure. Perioperative surgical sequelae included sensory disturbances, pain, and swelling. Follow-up procedures included placement of a second microstimulator on the opposite side (n=2), adjustment of the microstimulator lead location (n=13), re-placement after initial unsuccessful placement (n=1), and removal (n=5). This SPG microstimulator insertion procedure has sequelae comparable to other oral cavity procedures including tooth extractions, sinus surgery, and dental implant placement. Twenty-five of 29 subjects (86%) completing a self-assessment questionnaire indicated that the surgical effects were tolerable and 90% would make the same decision again.

Udgivelsesdato: 1999-Mar, A previous investigation indicated that the chief cells of the endolymphatic sac produce an endogenous inhibitor of sodium re-absorption in the kidneys, which has tentatively been named "saccin". In this study, the ultrastructure of the endolymphatic sac and in particular the chief cells is described, demonstrating that this organ fulfils the morphological criteria of a potential endocrine gland. Accordingly, the chief cells are shown to exhibit all the organelles and characteristics of cells that simultaneously synthesize, secrete, absorb and digest proteins.

Udgivelsesdato: 1996-Jun, Cytoplasmic granules have been demonstrated in epithelial cells from the endolymphatic sac, an extraosseus part of the inner ear located in the posterior cranial fossa. Intravenously infused extracts from endolymphatic sacs in anesthetized rats elicited a potent natriuresis and diuresis without effects on blood pressure, glomerular filtration rate, or lithium clearance. Only a minor kaliuresis was observed. Extracts of dural tissue adjacent to the endolymphatic sacs had no effect. It is concluded that the endolymphatic sac contains as endogenous inhibitor of sodium reabsorption and could be the sensory organ/mediator of "cerebral" natriuresis. Furthermore, this substance, tentatively named saccin, may influence the homeostasis of the inner ear fluids and accordingly play a significant role in the pathogenesis of Mèniére's disease.

The ultrastructure of the epithelial cells of the endolymphatic duct in the rat is described, following vascular perfusion-fixation of live, anaesthetised and artificially respirated animals. The animals were fixed by means of a pressure feed-back controlled peristaltic pump and an isotonic perfusate-fixative containing glutaraldehyde and Dextran. The endolymphatic duct was isolated by microdissection after the perfusion-fixation, to omit the step of a demineralization procedure. The proximal, intermediate and juxta-saccular parts of the endolymphatic duct were embedded, sectioned and studied separately in the electron microscope. Postfixation in a solution containing OsO4 and potassium ferricyanide revealed a well-developed tubulo-cisternal endoplasmic reticulum (TER), not previously described. Serial sectioning and computerized three-dimensional reconstruction demonstrated a continuity of the TER through the cell from subsurface cisterns abutting on the apical cell membrane to subsurface cisterns abutting on the basolateral cell membrane. The TER resembles that found in solute transporting epithelia, e.g., renal proximal tubule, gall bladder, small intestine and choroid plexus. A fluid resorptive capacity of the epithelial cells of the endolymphatic duct is compatible with the fine structure revealed in the present study. Epithelial cells in the juxta-saccular part of the duct display morphological indications of a secretory activity; furthermore, multivesicular bodies were observed in the epithelial cells throughout the endolymphatic duct.

The ultrastructure of Reissner's membrane in the rabbit is described following vascular perfusion-fixation of live, anesthetized and artificially respirated healthy animals. A new and improved technique of fixation is employed that includes a pressure feedback controlled peristaltic pump and an oxygen-carrying fixative. In ultrathin sections capillaries were observed between the two cell layers comprising Reissner's membrane. The mesothelial cells facing the scala vestibuli were connected by junctional complexes and neither pores nor discontinuities were observed in the cell layer. In the epithelial cells a well-developed tubulocisternal endoplasmic reticulum (TER) was noted. Computerized three-dimensional reconstruction documented the continuity of this TER, from prominent disc-shaped subsurface cisterns lining the luminal cell membrane to smaller subsurface cisterns lining the abluminal and lateral cell membranes, forming a transcellular canalicular pathway. The possible function of the TER in Reissner's membrane is discussed with reference to endolymph/perilymph homeostasis.

Ten rats were vascular-perfused at subphysiologic as well as physiologic pressures, 80 mmHg and 120 mmHg, respectively, employing a pressure feed-back controlled peristaltic pump and an isotonic perfusate/fixative with colloids (2% Dextran) and a hypertonic perfusate/fixative without colloids, 300 and 530 mOsm, respectively. In both experiments the endolymphatic duct and sac were isolated by microdissection after primary fixation. When comparing micrographs from the two experiments we observed that rats perfused at low pressure in isotonic fixative with colloids added had non-dilated lateral intercellular spaces and a subepithelial ground substance loaded with uniformly arranged microfibrils, not previously discovered. In rats perfused at high pressure in hypertonic fixative with no colloids added, we observed an edematous state in the subepithelial space between the solid bony aqueduct and the endolymphatic duct, with a concomitant derangement of previously well organized microfibrils. Furthermore, the epithelium was quite clearly displaced from the capillaries, the intercellular spaces were widely dilated and the endolymphatic duct was compressed into its lumen. Methods of fixation and current theories of endolymph resorption by the endolymphatic duct are discussed.

A new improved technique for whole-body perfusion-fixation of rats and other small animals is described. The driving force is a peristaltic pump which is feedback regulated by a pressure transducer that monitors the blood-perfusion pressure in the left ventricle of the heart. The primary perfusate-fixative is composed of a blood substitute--13.3% oxygenated fluorocarbon FC-75--in 0.05 M cacodylate buffer (pH 7.4) with a 2% glutaraldehyde. The secondary perfusate-fixative is composed of 2% glutaraldehyde in 0.05 M cacodylate buffer (pH 7.4) with 20 mM CaCl2. A double-barrelled, self-holding cannula is used to cannulate the heart; the outer and inner barrels of the cannula are connected to the peristaltic pump and to the pressure transducer, respectively. The tissue oxygen tension in the rat is monitored by a subcutaneous oxygen electrode. Measurements showed that tissue hypoxia/anoxia did not develop before or during the perfusion-fixation. Thus, the technique permits study of specimens which do not exhibit fixation gradients and do not contain cells fixed in a state of asphyxia. This is substantiated by electron micrographs of cells from different organs, revealing new fine structural elements. By adding oxygenated fluorocarbon to glutaraldehyde perfusate-fixatives, enough oxygen is made accessible for cellular respiration as well as for the oxygen-consuming chemical reactions of glutaraldehyde with the tissue. Data on anaesthesia, operative manoeuvres, mechanical components of the system, preparation of fixatives and flow of the perfusate-fixatives are furnished and discussed.