Dynamic 3D contrast-enhanced T1-weighted MR angiography is a fast, efficient, and minimally invasive imaging method with which to diagnose intracranial aneurysms.
Since the description of transanal endoscopic microsurgery (TEM) by Buess [1] and the later appraisal of transanal endoscopic operation(TEO) and tranasnal minimally invasive surgery (TAMIS) [2], these approaches have been used for the treatment of rectal neoplasms such as benign or early stage rectal cancer [3,4].Moreover, the transanal approach continues to evolve, and new indications are emerging, such as the removal of foreign bodies and repair of rectourethral fistula [4].In this video, we present our experience with the TAMIS approach for the treatment of a rectal stenosis non-suitable for endoscopic dilatation.A 48-year-old woman had a history of rectal stenosis and pelvic sepsis after transanal resection of a large polyp with high-grade dysplasia located in the mid rectum. Due to this process, a diverting colostomy was fashioned, drainage of the perirectal abscess was performed and a loose seton was placed.After failure of conservative management, we decided to proceed with a TAMIS approach to the rectal stenosis. A proctoscopy and colonoscopy were done, and biopsies were also taken to rule out malignancy. The patient was prepared for surgery and informed consent was obtained.A GelPOINT Path (Applied Medical) for rectal access was used. The stenosis was located around 6 cm from the anal verge.A posterior rectotomy was carried out. Normal mucosa of the upper rectum was seen, and the presence of a rectal stenosis measuring 3-4 cm in length was confirmed.The rectotomy was enlarged until the perirectal fat was seen and then a Foley catheter (18 F).The patient was discharged uneventfully 1 day after the operation, and a proctoscopy with dilation was performed 1 month after surgery. The patient is now awaiting colostomy closure.The TAMIS approach may be used as an alternative for the treatment of rectal stenosis in selected cases, if conservative treatment and endoscopic dilatation are not feasible.
The Susceptibility-weighted (SWI) imaging is a recent MRI sequence that shows the magnetic susceptibility differences of various tissues. A large number of neurological / neurosurgical diseases can benefit with this MRI sequence. The basic physics principles are reviewed and also its clinical application in several brain pathologies in adults and in paediatrics, mainly vascular, tumors and neurodegenerative/genetic disorders. Some clinical cases show the utility of SWI. The anatomic detail of some brain structures, the deep venous system and mesencephalic structures is shown.
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