Multiple coexisting variations of skull and cervical spine anatomy in a symptomatic patient - uncommon or uncommonly noticed? A CT-based case study.

INTRODUCTION: Among many anatomical variations of the skull and cervical spine, some may be an underlying cause of a disease, while others remain clinically silent. The estimated individual prevalences of them differ, but given the available data it is impossible to clarify how frequently they coexist with each other. The following study presents an example of seven anomalies, amongst which at least few have manifested clinically in the examined patient. CASE REPORT: A 35 y.o. Polish woman who suffered from chronic sinusitis was subjected to a computed tomography scan. Mild thickening of the anterior ethmoidal cells' mucosa, bilateral concha bullosa, paradoxical right middle turbinate, bilateral uncinate process pneumatization and arrested pneumatization of sphenoid sinus were found and addressed in context of the reported symptoms. Simultaneously other, clinically silent anatomical anomalies, were found - namely ossification of the anterior petroclinoid ligament, incomplete medial basal canal and bilateral arcuate foramen. CONCLUSION: To the best knowledge of the authors, this case report is the first to present such a coexistence of this many various anatomical anomalies, among which some played a crucial part in the chronic sinusitis experienced by the patient. Concurrence of multiple variations in the same anatomical area or functional unit may exacerbate clinical presentation of a patient. Identifying a single anomaly ought to warrant a thorough investigation into any other potentially existing variants.

Two simultaneous anatomical variations of the cervical spine - a case report discussing the concept of tandem anomalies.

forming a bony opening through which the vertebral artery (VA) enters the vertebral canal. Block vertebra is a synostosis of at least two vertebral bodies that did not separate during the embryological development. It is worth distinguishing it from the Klippel-Feil syndrome, as the latter oftentimes involves other abnormalities (namely skeletal) and is typically diagnosed in childhood. Both variants could potentially lead to an impairment of the blood flow through the VA. Case report: The following case report presents a finding of two anomalies of the cervical spine, found in a 38 y.o. female patient suffering from dizziness. A synostosis of the C4 and C5 vertebral bodies, arches and zygapophysial (facet) joint, was noted by the examining radiologist, with marked narrowing of the intervertebral foramen. Furthermore, second anatomical variation in the form of the complete bilateral arcuate foramen was identified superior to the groove for the VA on the upper surface of the posterior arch of the atlas. Conclusions: To the best knowledge of the authors, this case report is the first to present a co-existing block vertebra and bilateral complete arcuate foramen. Common presence of at least two anatomical variations that could have a synergistic clinical effect could possibly be termed 'tandem anomaly.' Notwithstanding, identification of a single anomaly explaining a patient's symptoms does not absolve the medical professionals from searching for any other potential variations that could also be present and could further influence the clinical picture.

The total number of septa and antra in the sphenoid sinuses - evaluation before the FESS.

PURPOSE: The purpose of this research is to define the total number of septa and the total number of antra in the sphenoid sinuses (created as a result of the presence of additional septa), as well as the relation between the number of the septa and their location in the adult population. MATERIALS AND METHODS: e study was conducted as a retrospective analysis of the computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females and 149 males), who did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were done with the spiral CT scanner (Siemens Somatom Sensation 16) by using a standard procedure, in the option Siemens CARE Dose 4D, without using any contrast medium. A er obtaining the transverse planes, the frontal and sagittal planes were created using secondary reconstruction tool (multiplans reconstruction - MPR). RESULTS: The analysis of the obtained images in the transverse plane and secondary CT reconstructions has shown the presence of only one sphenoid septum (main septum - MS) in 21.96% of the patients, which divided the sphenoid sinus into two sphenoid antra. In 78.04% of the patients, there were more than one sphenoid septa present in the posterior part of the sphenoid sinuses, hence there were additional septa (AS) present. One AS was present in 22.97% of the patients. The most common variant - two AS - was found in 32.09% of the cases. The presence of more than two AS was found in the following number of patients: three AS in 9.8%, four AS in 7.09%, five AS in 1.69%, six AS in 3.04% and seven AS in 1.01%. The rarest variant was the presence of more than seven AS: eight AS in 0.34% and nine AS also in 0.34%. There were no sphenoid sinuses that would have more than nine AS in the researched material. CONCLUSIONS: Due to the high incidence of the anatomical variants of the paranasal sinuses, a CT scan is recommended in all patients before a planned surgery in order to avoid the potential complications that might arise as a result of the complicated structure of the paranasal sinuses.

Autonomic nervous system of the pelvis - general overview.

Autonomic nervous system of the pelvis is still poorly understood. Every year more and more pelvic procedures are carried out on patients suffering from different pelvic disorders what leads to numerous pelvic dysfunctions. Authors tried to review, starting from historical and clinical background, the most important reports on anatomy of the pelvic autonomic plexuses. We also pay attention to complete lack of knowledge of students of medicine on the autonomic nervous structures in the area studied. We present anatomical description of the pelvic plexuses including their visceral branches and anatomy of surrounding pelvic tissues which still remains unclear. More and more attention is paid to the topography of the plexuses specially because of new pain releasing techniques - neurolysies.

Residua of thymus in the mediastinum - clinical aspects - cadaveric study.

The main goal of this study was to investigate possible residua of thymic tissue in 100 adult cadavers with no thoracic pathology known before, by dissection of standard locations of thymic tissue in perithyroid, periaortic, peritracheal and retrotracheal spaces, as well as areas located next to the course of phrenic, vagus and left recurrent laryngeal nerves. Thus obtained tissue samples were studied by two pathologists independently. The remnants of the thymic tissue were found in 61 out of 100 specimens studied. It means that residua of ectopic thymic tissue is common, which may have a huge impact on the results of treatment of many diseases i.e. myasthenia gravis in course of thymoma.

Vascular density of inferior tibiofibular joint - cadaveric experimental study.

The study was carried out on 50 human lower legs obtained during autopsies (KBET: 122.6120.315.2016). The anatomy of the joint was studied using classical anatomical description methods. Based also on literature we have reviewed the current knowledge on the inferior tibiofibular joint blood supply considering the important clinically aspect - vascular density. Authors of this paper postulate relatively low vascular density of the region described and potential worse condition for healing in case of injury or after surgical procedures performed. We also postulate that ligament screws should be positioned with special respect to time limit which enables proper healing of the syndesmosis.

[The Cracow Physicians Society and the medical faculty of Jagiellonian University--the past and the present]. / Towarzystwo Lekarskie Krakowskie a Wydzial Lekarski Uniwersytetu Jagiellonskiego--przeszlosc i terazniejszosc.

The Cracow Physicians Society (CPS) since inception in 1866, maintain close liaison with the Faculty of Medicine of the Jagiellonian University by the person of president, board members and ordinary members of the Society who are also employees of the University. They share a number of common initiatives. Many distinguished professors are honorary members of the Society. CPS annually rewards outstanding doctoral and postdoctoral works award named professor Sych, and also awards diplomas and medals to deserving individuals for professional, scientific and organizational work. CPS cooperates with the Association of Graduates of the Medical Faculties of the Jagiellonian University, Polish Academy of Learning and the Division of Krakow Polish Academy of Sciences and numerous specialized medical societies in the medical integration and to focus physicians around deontological and ethical problems, basic sciences, medical diagnostics, therapeutics, medical history and culture.

[History of Jagiellonian University Clinic for Nervous and Mental Diseases in 100 anniversary]. / Zarys historii Kliniki Neurologiczno- Psychiatrycznej w 100 rocznice powstania.

In the paper there have been presented the creation and activities of the Clinic of Neuropsychiatry in the period of 1914-1950 and the scientific and organizational work of professor J. Piltz (1870-1930).

Detailed 3D-morphometry of the anterior communicating artery: potential clinical and neurosurgical implications.

PURPOSE: Although a site common for pathology and of great importance to the neurosurgeon, the three-dimensional (3D) morphometry of the anterior communicating artery (ACoA) has had incomplete descriptions in the literature. METHODS: Using a novel 3D digital-image computer data analysis system, 115 patients underwent evaluation of their ACoA based on DICOM files derived from CT angiography. Measurements included the length, internal diameter, volume, deviation index (DI) and tortuosity index (TI). RESULTS: Of 115 samples, 85 were visualized clearly enough for morphometric analysis. The mean internal diameter was 1.86 mm and this tended to be greater in males (P < 0.05). The mean length of the ACoA was 3.99 mm and the mean volume was 11.61 mm(3). The mean TI for the ACoA was 0.84 and the mean DI was 0.62 mm. A significant relationship between DI and length, DI and volume, and DI and TI were found. The significant correlation of diameter to volume, and length related to volume, DI and TI, as well as TI related to length, volume and DI were noticed. There were no relationship between any parameter and age. CONCLUSIONS: A detailed knowledge of the 3D-morphometry of the ACoA demonstrates that in almost 50% of individuals the ACoA is straight in their course. Detailed data regarding arterial topography and trajectory as found in our study may be also of use in detecting early changes in this vessel due to pathology and may assist in the treatment of vascular lesions and planning of neurosurgical or interventional radiological procedures in the region including ACoA aneurysms.

Three-dimensional morphometry of the A2 segment of the anterior cerebral artery with neurosurgical relevance.

Most prior morphometry data regarding the A2 segment of the anterior cerebral artery (ACA) have been based on cadaveric measurements. With newer imaging modalities, surgical techniques, and minimally invasive procedures, new standards for the anatomy of this vessel are necessary. A novel computer-based data system was used to analyze the three-dimensional (3D) morphometry of 230 A2 segments. In addition, tortuosity (TI) and deviation indices (DI) for this segment were calculated. The mean internal diameter of the A2 segment was 1.86 mm, and segments tended to be larger in men and on left sides. A2 segments were asymmetrical in 43%, and this was more common in women. Lengths tended to be greater on right sides and in men. Volumes were greater in men and increased with age, which was statistically significant. These gender differences were found to be statistically significant (P < 0.05), for both volume and diameter. TI was equal among sides, but DI was more often greater on right sides. The correlation coefficient ratio for length and DI was statistically significant. It is important to understand various 3D morphometrical differences particularly between genders. By constructing blood flow simulation models and during revascularization procedures, surgeons are able to gain a better understanding of each patient's vascular anatomy. These additional 3D data regarding the anatomy of the postcommunicating parts of the ACA may be useful to the neurosurgeon and interventional neuroradiologist. These data may assist with an earlier diagnosis of pathologies affecting the 3D morphology of the ACA.

[Cervical vertebral column--anatomy, fractures, treatment]. / Kregoslup szyjny--anatomia, zlamania, leczenie.

The paper deals with anatomy of human cervical spine. It shows close relation between knowledge on the normal structure and methods of treatment of different kinds of spine injuries. It describes detailed anatomy and mechanical features of cervical vertebral column, including the structure of distinct vertebrae, their joints and arrangement of muscles. It reviews also historical methods of treatment of fractures in this region considering current methods.

[Anatomical aspects and procedures in plateau fractures]. / Uwarunkowania anatomiczne i taktyka postepowania w zlamaniach plateau piszczeli.

The paper deals with anatomy of proximal extremity of tibia and specially focuses on the problem of its fractures and methodology of orthopedic procedures. Fractures of tibial plateaus are mostly intracapsular and may cause long-lasting consequences. They account for about 7% of all fractures in the limbs and affect both young and adult individuals. Current classification and descriptions of fractures, methods of diagnostics and treatment are also given.

Interactive 3D stereoscopic digital-image analysis of the basilar artery bifurcation.

The goal of this study was to analyze morphometrical variations of the basilar artery bifurcation (BAB), so that physicians could map out a patients anatomical structure prior to delicate neurosurgical procedures. The CT-angio files of 98 patients ranging from 12 to 78 years of age were retrieved. These files were evaluated using Gradual Angiographic Image Data Analyzer (GAIDA) software, where a new interactive three-dimensional (3D) stereoscopic visualization method was used to reconstruct computer images of the BAB complex. Subsequently the measurements of the BAB angles and BAB distances in relation to the dorsum sellae (DS), posterior clinoid processes (PCPs), and posterior biclinoid plane (PBP) were carried out. The average BAB angle was determined to be 117.7 degrees (30.93 degrees -172.2 degrees ). The three types of BAB were classified as type T with a BAB angle greater than 145 degrees (mean 154.4 degrees ), type Y for an angle being equal or less than 145 degrees but greater than 100 degrees (mean 121.5 degrees ) and type V for angles less than 100 degrees (mean 83.28 degrees ). The mean distances between BAB and DS (9.55 mm), BAB and left PCP (12.97 mm), and BAB and right PCP (13.01 mm), BAB and PBP (2.2 mm) were evaluated. Furthermore, the BAB is of great importance when examining basilar artery aneurysm development, particularly at the point of greatest hemodynamic stress, as well as the BAB distances in relation to the bony landmarks used for different approach methods in neurosurgical procedures.

Haematoma of the tentorium cerebelli - new pathology or new prognostic factor in neurotraumatology? A preliminary report.

BACKGROUND AND PURPOSE: The aim of the study was to establish the frequency of haematoma of the tentorium cerebelli, to elucidate the possible pathomechanism related to its formation, and to assess its clinical significance. MATERIAL AND METHODS: 84 patients with haematoma of the tentorium cerebelli were selected out of the 1159 patients treated in our Department from 2003 to 2005 due to craniocerebral trauma. All patients had computed tomography (CT) performed on admission. In selected cases, magnetic resonance imaging (MRI) was performed. Additionally, 4 autopsies were performed using a special technique for better recognition of blood location within the region of the tentorium. RESULTS: The study group comprised 61 men (73%) and 23 women (age range: 18-84 years). Fall on the occiput was the main cause of trauma. The clinical status of patients was rather serious (53% of patients scored below 8 pts on the Glasgow Coma Scale on admission), as was the clinical course (39% of patients eventually died). The following co-existing pathologies were found in CT: traumatic subarachnoid haemorrhage and cerebral contusion (60% of patients), subdural haematoma (45%), intracerebral haematoma (31%), pathology in posterior fossa (12%), and epidural haematoma (8%). MRI revealed subdural collection of blood above or below the tentorium or the subarachnoid haemorrhage beneath the occipital lobes and/or over the cerebellar hemisphere. CONCLUSIONS: The progress in neuroimaging, especially in CT scanning, enables haematoma of the tentorium cerebelli to be discerned as a distinct clinical entity.

A note on the morphology of the metopic suture in the human skull.

The metopic suture of 24 adult skulls investigated showed recognisable varied morphological patterns. The metopic suture resembled wavy lines and was sometimes highly convoluted, especially in the superior part of the frontal bone. The mean suture length was computed as 123.1 mm (SD = 5.307) and the mean fractal dimension was 1.17 (SD = 0.076). Visual inspection of the morphological character of the metopic sutures revealed complex variation in their course between the nasion and the bregma. Comparison of the fractal dimensions indicated a two-fold increase in complexity between the anterior half of the suture terminating in the nasion (FD = 1.10) and the second half of the suture beginning in the bregma (FD = 1.21). The Mann-Whitney test confirmed the statistical significance of the differences in the fractal dimensions calculated. The variety and complexity of the interdigitations in the anterior and posterior part of the suture point to possible alterations to local strains, which occur during the growth of the braincase.

[Diagnostic difficulties in neuroendocrine carcinoma of the larynx]. / Trudnosci diagnostyczne neuroendokrynnego raka krtani.

The rare case of the large cell neuroendocrinic carcinoma of larynx was described. 66 years old man was treated by total laryngectomy because of melanoma. Postoperative, immunohistochemical study shoved large cell neuroendocrinic carcinoma. A special emphasis was put on the preoperative misdiagnose, limiting neck dissection. The authors point out, however, the difficulties of the pathologic differentiation caused by similarity of these tumors. The treatment and prognosis are discussed.