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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Incidence of Ossification of Caroticoclinoid Ligament in Dry Adult Human Skulls with its Surgical Implications: A Cross-sectional Study from Telangana Region, India
Correspondence Address :
Dr. K Ephraim Vikram Rao,
12-11-332, Warasiguda, Secunderabad, Hyderabad-500061, Telangana, India.
E-mail: dr.ephraimvikram@gmail.com
Introduction: The caroticoclinoid ligament extends from the Anterior Clinoid Process (ACP) to the Middle Clinoid Process (MCP). Occasionally, it gets ossified and forms the caroticoclinoid foramen. Anterior clinoidectomy is a common surgical procedure to treat internal carotid artery aneurysms or pituitary tumours. Abnormal ossification of the caroticoclinoid ligament may lead to intraoperative or postoperative complications as it is not normally present.
Aim: To find out the incidence of ossification of the caroticoclinoid ligament in adult human skulls.
Materials and Methods: This was an observational cross-sectional study which was conducted in the Department of Anatomy at Gandhi Medical College, Hyderabad, India from January 2021 to February 2023. The study had included 100 dry adult human skulls with open vault were collected from the Department of Anatomy, Gandhi Medical College, Secunderabad; Osmania Medical College, Hyderabad; Bhaskar Medical College, Moinabad, Telangana, India. All the skulls were observed and skulls damaged in the clinoid regions were excluded from the study. The skulls were observed for the presence of any ossifications of the caroticoclinoid ligaments and the observations were noted. The qualitative data was presented as number and percentage was calculated. The data was recorded in Microsoft excel version 2021.
Results: The incidence of ossification of caroticoclinoid ligament was 8 (8%). The incidence was higher on right-side when compared to the left-side. Bilateral complete ossification of the caroticoclinoid ligament was observed in 2 (2%) skulls; bilateral incomplete ossification was observed in 2 (2%) skulls, unilateral complete ossification was observed in 2 (2%) skulls on the right-side. In one skull 1 (1%), complete ossification was observed on the right-side and incomplete ossification was observed on the left-side.
Conclusion: Knowledge of the ossification of the caroticoclinoid ligament is important for neurosurgeons, while performing anterior clinoidectomies or skull base surgeries. Radiological confirmation of the ossification of the caroticoclinoid ligament is essential to avoid complications.
Carotid artery, Clinoidectomy, Internal, Paraclinoid, Sella turcica
The lesser wing of the sphenoid is an important landmark for neurosurgery. The medial projecting ends of the lesser wing of sphenoid are called ACP and the MCP are small projections present at lateral ends of the tuberculum sellae, the anterior boundary of the sella turcica. The ACP is connected to the MCP by a ligament called the caroticoclinoid ligament or sometimes by a dural fold (1). Sometimes this caroticoclinoid ligament or dural fold may undergo ossification and form caroticoclinoid foramen, as a bony bar which extends from the anterior to the MCP. The ossification of the caroticoclinoid foramen can be complete or incomplete (2). The internal carotid artery is a chief artery that supplies blood to the forebrain structures. After entering the cranial cavity, the artery passes through the cavernous sinus and curves up medial to the ACP. Here, the artery emerges through the dural roof of the cavernous sinus, where it is completely enclosed by the connective tissue (3). Any abnormal ossification of the dural folds or the caroticoclinoid ligaments may lead to internal carotid artery entrapment (4).
The surgical removal of ACP is called anterior clinoidectomy. It is performed to treat parasellar, proximal carotid region and skull base pathologies of the central part of the middle cranial fossa (5). Paraclinoid aneurysms of the internal carotid artery are usually treated by anterior clinoidectomy. This treatment procedure becomes more difficult when the caroticoclinoid foramen is present with ossification of caroticoclinoid ligament, causing a higher possibility of serious haemorrhage. Anterior clinoidectomy is one of the most critical surgical procedures done for the successful and safe management of aneurysms of the ophthalmic part of internal carotid artery and tumours located in the paraclinoid region and cavernous sinus (6). Proper knowledge of the bony bars or ossified caroticoclinoid ligaments is important for neurosurgeons while dealing with aneurysms of the internal carotid arteries in the intercavernous region and also while dealing with meningiomas of the tuberculum sellae (7). The incidence of ossification of the caroticoclinoid ligament ranged from 3-37.19% in different ethnic populations [8,9]. There is limited literature available concerning the incidence of the caroticoclinoid ligament ossification in the Telangana region (8). Thus, the present study was undertaken to find the incidence of ossification of the caroticoclinoid ligaments in Telangana region.
The present study was an observational cross-sectional study conducted in the Department of Anatomy at Gandhi Medical College, Hyderabad from January 2021 to February 2023. The samples were collected from Department of Anatomy, Gandhi Medical College, Secunderabad; Osmania Medical College, Hyderabad, and Bhaskar Medical College, Moinabad, Telangana, India. The study included 100 skulls belonging to Telangana region.
Inclusion criteria: Dry adult human skulls with vault open were included in the present study.
Exclusion criteria: The skulls which were damaged or fractured at the anterior and the MCP and sella turcica were excluded from the study.
Study Procedure
The ACP and MCP were examined for any ossifications of the caroticoclinoid ligaments forming caroticoclinoid foramen. There are three types of connections which can exist between the ACP and MCP according to classification of Keyes JEL (10).
• Type 1 (Complete type): Formation of complete foramen without having any break.
• Type 2 (Contact type): Presence of a suture between the ACP and MCP.
• Type 3 (Incomplete type): Spicules of bone present between the ACP and MCP without any contact.
All the skulls were examined for any abnormal ossifications. The presence of caroticoclinoid foramen unilateral or bilateral was also recorded. All the findings were noted and photographed. The incidence was calculated.
Statistical Analysis
The quantitative data was presented as number and percentage. The data was recorded in MS excel version 2021 and the incidence was calculated.
A total of 100 skulls were observed, 8 (8%) skulls had ossification of caroticoclinoid ligaments. Caroticoclinoid foramen was observed unilaterally in 3 (3%) skulls and bilaterally in 5 (5%) of the skulls. The incidence of ossification was observed to be high on the right-side. There were no skulls found with ossified caroticoclinoid ligament on the left-side alone (Table/Fig 1).
Type 1 or complete type was observed bilaterally in 2 (2%) of the skulls, in which one skull showed a thick bony bar extending from the ACP to MCP (Table/Fig 2) whereas in another skull on the right-side a thick bony bar was present, but on the left side, a thin bony plate was extending from the ACP to the MCP (Table/Fig 3).
Type 2 or contact type was not observed in any of the skulls. Type 3 or incomplete ossification of the caroticoclinoid ligament was observed in 2 (2%) skulls bilaterally (Table/Fig 4). Unilateral incomplete ossification of the caroticoclinoid ligament was observed in 3 (3%) skulls on the right-side only (Table/Fig 5). In 1 (1%) skull complete ossification of the caroticoclinoid ligament was observed on the right-side and incomplete ossification was observed on the left-side (Table/Fig 6).
The caroticoclinoid ligament extends between the ACP and MCP. Ossification of this ligament forms the caroticoclinoid foramen. Keyes JEL described the boundaries of the caroticoclinoid foramen as follows: laterally- ACP; medially- the body of the sphenoid bone; posteriorly- a bony bridge extending between the ACP and MCP; and anteriorly- base of the lesser wing of the sphenoid bone (10). Ossification is a normal physiological process and is age dependent (11). But, the ossification of the caroticoclinoid ligament is not age-dependent as it was also observed in foetuses and infants. Hochstetter F and Kier EL reported that the ossified caroticoclinoid ligament forms the caroticoclinoid foramen and also the interclinoid osseous bridge in foetal and infant skulls. This explains that, the caroticoclinoid foramen is a developmental anomaly which exists from foetal life (12),(13). Studies suggest that the incidence of the caroticoclinoid foramen was more in cases with hormonal imbalance or disturbances, developmental disorders, criminals, and also epileptics (14). The internal carotid artery calibre is greater in the clinoid region, which could be a causative factor for headache due to compression of the internal carotid artery (15).
There are many clinical implications related to mineralisation of the caroticoclinoid ligament and the dural ligaments attached to the dorsum sellae. Especially while planning surgeries of pituitary gland, internal carotid artery at cavernous sinus and the sellar and parasellar regions (16),(17). Anterior clinoidectomy is a surgical procedure where the ACP is removed. It is performed for better access to the optic nerve, internal carotid artery and its branches. Ossification of the caroticoclinoid ligament whether complete or incomplete requires additional drilling and may need extra care while retracting the ACP (10),(18). Sometimes, the ACP may be pneumatised or may have variation in the bone density (19),(20). So care must be taken to avoid injury to the internal carotid artery and optic nerve. Preoperative radiological examination should be done to avoid injury to internal carotid artery, oculomotor nerve, and optic nerve (14),(21),(22).
In the present study, incidence of the ossification of caroticoclinoid ligament was observed in 8% skulls which was within the range of the other Indian studies. The incidence of the caroticoclinoid ligament ossification and formation of caroticoclinoid foramen had a range between 6 to 37% in the Indian population. In South India, the incidence was reported to be between 6 to 20%. The incidence of the caroticoclinoid ligament ossification was observed to vary with ethnicity (Table/Fig 7) (4),(8),(9),(10),(11),(14),(23),(24),(25),(26),(27).
In the present study, incidence was higher on the right-side which was similar with the findings of Desai S and Sreepadma S reported in Karnataka population (9). Incomplete ossification was observed in 6% of skulls whereas complete ossification was observed only in 2% of skulls. In the present study, the incidence of incomplete ossification of the caroticoclinoid ligament was observed to be higher than the complete type which was similar with the results of the study in Turkish and Korean populations. Erturk M et al., reported the complete type, contact type and incomplete type in 4.09%, 4.68%, and 14.91%, respectively in Turkish specimens and in a Korean study, the incidence of complete caroticoclinoid canal was reported in 4.1% and incomplete in 11.6% of skulls (14),(24). The incomplete type is more dangerous than the complete type because the bony spurs may impinge on internal carotid artery during pulsations of the internal carotid artery or in case of aneurysms of internal carotid artery which may lead to severe bleeding (11).
The ossified caroticoclinoid ligament can cause compression or stretching of internal carotid artery which may lead to headache and other neurological symptoms due to lack of blood supply to brain (21),(22),(28). The treatment option for the internal carotid artery decompression in this region is the anterior clinoidectomy. The oculomotor nerve, trochlear nerve, abducent nerve, and ophthalmic division of trigeminal nerve pass within a dural fold just infero-lateral to the ACP in the lateral wall of the cavernous sinus. Any of these structures can be damaged during anterior clinoidectomy (21),(22),(28),(29). Care must be taken to avoid injury to the internal carotid artery and the nerves. Radiological investigations such as computed tomography must be performed before planning surgery to avoid intraoperative and postoperative complications related to this region.
Limitation(s)
The present study was limited to only the incidence of ossification of the caroticoclinoid ligament in dry human adult skulls. Further studies on the diameter of the caroticoclinoid foramen, thickness of the ACP and the distance between the ACP and MCP on a large sample can be carried out.
The incidence of ossification of the caroticoclinoid ligament in Telangana population was 8%. Abnormal ossifications in the interclinoid regions especially caroticoclinoid ligament ossification are important for neurosurgeons while performing anterior clinoidectomies or skull base surgeries. Even incomplete ossifications may impinge on the internal carotid artery and lead to profuse bleeding. Ossification of caroticoclinoid ligament must be confirmed by radiological investigations to avoid complications during neurosurgeries of this region.
DOI: 10.7860/JCDR/2023/63911.17997
Date of Submission: Mar 06, 2023
Date of Peer Review: Apr 21, 2023
Date of Acceptance: May 22, 2023
Date of Publishing: Jun 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
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