Right trisectionectomy for posterior liver tumors engaging the right and middle hepatic veins may lead to post-hepatectomy liver failure if the anticipated liver remnant is small. In such patients we developed a paren...Right trisectionectomy for posterior liver tumors engaging the right and middle hepatic veins may lead to post-hepatectomy liver failure if the anticipated liver remnant is small. In such patients we developed a parenchymasparing one-step approach, that includes extrahepatic right portal vein ligation accompanied by en bloc resection only of segments 7, 8 and 4a and resection of the right and middle hepatic veins. The technique was applied in 3 patients with normal liver function, where according to the preoperative computed tomography the volume of segments 1, 2 and 3 ranged between 17% and 20% of the total liver volume. In all patients liver biochemistry improved rapidly postoperatively and a doubling of volume of segments 1, 2 and 3 was achieved by the third postoperative week, as extrahepatic right portal vein ligation ameliorated reperfusion injury of the remaining segments 5 and 6 and induced hypertrophy of segments 1, 2, 3 and 4b. There was no mortality or long-term complications.Patients are alive and free of disease 74, 50 and 17 months after the operation, respectively. We propose that the term ＂extended upper right sectionectomy＂ may be considered for the en bloc resection of segments 7, 8 and 4a, in future revisions ofthe Brisbane 2000 terminology of hepatic anatomy and resections.展开更多
Objective: In the embryonic period, several developmental anomalies of the posterior cerebral circulation might occur. Digital subtractive angiography used to be the imaging technique of choice for the illustration of...Objective: In the embryonic period, several developmental anomalies of the posterior cerebral circulation might occur. Digital subtractive angiography used to be the imaging technique of choice for the illustration of such variations. Nowadays, the development of MR imaging has led to a new entry in the diagnostic archer’s quivery, the MR an- giography, with which most of these variations may be diagnosed. Purpose of this study is to illustrate these anatomic variants, their incidence and their potential clinical significance. Materials and Methods: We retrospectively reviewed 282 MR angiographies performed in our institution, in order to assess the posterior cerebral circulation. The imaging findings (including both normal development and variations) were depicted. Results: In our study 61/282 (21.63%) MR angiographies were positive for imaging findings concerning variations of the vertebrobasilar system. These variations included abnormal origin of the vertebral artery (0.7%), unilateral aplasia or hypoplasia (8.86%), unilateral aplasia or hypoplasia of the distal part of the vertebral artery (3.85%), and unilateral or bilateral fetal posterior cerebral artery (7.7%). These results show that anatomic variations of the posterior cerebral circulation are not very uncommon in the population. Conclusion: High resolution Magnetic Resonance Angiography provides excellent interpretation of the vertebral arteries, allowing depiction of all anatomic variations. Knowing these anatomic variations is important, espe- cially for clinicians and patients planning a surgical operation or an interventional radiology technique. Furthermore, it contributes to avoiding potential diagnostic pitfalls or to explaining unusual acute vascular cerebral events.展开更多
文摘Right trisectionectomy for posterior liver tumors engaging the right and middle hepatic veins may lead to post-hepatectomy liver failure if the anticipated liver remnant is small. In such patients we developed a parenchymasparing one-step approach, that includes extrahepatic right portal vein ligation accompanied by en bloc resection only of segments 7, 8 and 4a and resection of the right and middle hepatic veins. The technique was applied in 3 patients with normal liver function, where according to the preoperative computed tomography the volume of segments 1, 2 and 3 ranged between 17% and 20% of the total liver volume. In all patients liver biochemistry improved rapidly postoperatively and a doubling of volume of segments 1, 2 and 3 was achieved by the third postoperative week, as extrahepatic right portal vein ligation ameliorated reperfusion injury of the remaining segments 5 and 6 and induced hypertrophy of segments 1, 2, 3 and 4b. There was no mortality or long-term complications.Patients are alive and free of disease 74, 50 and 17 months after the operation, respectively. We propose that the term ＂extended upper right sectionectomy＂ may be considered for the en bloc resection of segments 7, 8 and 4a, in future revisions ofthe Brisbane 2000 terminology of hepatic anatomy and resections.
文摘Objective: In the embryonic period, several developmental anomalies of the posterior cerebral circulation might occur. Digital subtractive angiography used to be the imaging technique of choice for the illustration of such variations. Nowadays, the development of MR imaging has led to a new entry in the diagnostic archer’s quivery, the MR an- giography, with which most of these variations may be diagnosed. Purpose of this study is to illustrate these anatomic variants, their incidence and their potential clinical significance. Materials and Methods: We retrospectively reviewed 282 MR angiographies performed in our institution, in order to assess the posterior cerebral circulation. The imaging findings (including both normal development and variations) were depicted. Results: In our study 61/282 (21.63%) MR angiographies were positive for imaging findings concerning variations of the vertebrobasilar system. These variations included abnormal origin of the vertebral artery (0.7%), unilateral aplasia or hypoplasia (8.86%), unilateral aplasia or hypoplasia of the distal part of the vertebral artery (3.85%), and unilateral or bilateral fetal posterior cerebral artery (7.7%). These results show that anatomic variations of the posterior cerebral circulation are not very uncommon in the population. Conclusion: High resolution Magnetic Resonance Angiography provides excellent interpretation of the vertebral arteries, allowing depiction of all anatomic variations. Knowing these anatomic variations is important, espe- cially for clinicians and patients planning a surgical operation or an interventional radiology technique. Furthermore, it contributes to avoiding potential diagnostic pitfalls or to explaining unusual acute vascular cerebral events.
