International consensus for a dissection room quality system (DRQS): A Delphi panel study.

Dissection Rooms (DRs) are key facilities that allow teaching and research on human anatomy, where students and researchers work with human bodies to acquire, increase, or create new knowledge. Usually, DRs work with a Body Donation Program (BDP), where living donors bequeath their bodies for use in teaching and research after they expire. Despite DRs being part of universities worldwide, no common guidelines, regulations, or quality management systems (QMS) exist that could be applied to different countries. With that purpose in mind, we aimed to develop a QMS that could be applied to DRs globally, using a Delphi panel to achieve consensus about the items that should constitute the QMS. The panel was constituted by 20 anatomy professors from 20 different countries, and the 167 standards to create the rules or guidelines that constitute the QMS were divided in five categories: direction, body donation, students, instructors, and research. After two rounds of revisions, 150 standards were considered "essential" or "important" by more than 70% of the participants, thus being incorporated to the Dissection Room Quality System (DRQS). The results of this panel represent a minimum list of items of the DRQS for improving the functioning of DRs globally.

An unusual origin of a papillary muscle of the right ventricle.

Knowledge of anatomical variations of the heart are important to cardiac surgeons, cardiologists, and radiologist. During routine dissection of a 77-year-old male cadaver, we observed an unusual origin of a papillary muscle of the right ventricle arising from the atrioventricular aspect of the moderator band. This papillary muscle was 6.7mm long and 2.6mm wide. It gave rise to two chordae tendineae: one to the inferior (posterior) papillary muscle of the right ventricle and one directly to the inferior (posterior) leaflet of the tricuspid valve. Variants of the internal anatomy of the heart as exemplified in the present case report should be born in mind during image interpretation and invasive procedures of the right ventricle of the heart.

Duplication of the foramen rotundum: A rare case report.

Variations at the skull base can result in misinterpretation of radiological imaging and occasionally, iatrogenic injury. Here, we describe, to our knowledge, the second reported case of a duplicated foramen rotundum. The morphometrics of this finding are documented and the anatomy and potential clinical consequences of such an anatomical variation discussed. Such a finding is of archival value. Additionally, foramen rotundum duplication such as found in our case might also lead to complications while using, for example, transsphenoid approaches to the middle cranial fossa as well as various transfacial treatments for trigeminal neuralgia which rely on observing the foramina around the foramen ovale on fluoroscopy for correct positioning of needles and catheters.

A previously unreported variant of the auriculotemporal nerve.

Venous fenestrations are rare and when present often are not pierced by regional nerves. Herein, we report an unusual case of a fenestrated superficial temporal vein (STV). Anterior to the external ear, where the STV and superficial temporal artery normally travel with the auriculotemporal nerve (ATN), the nerve was found to pierce the STV. The fenestration within the STV was approximately 0.35mm in diameter, and there was no sign of compression of the ATN as it traversed this vessel. Following the site of penetration of the STV by the ATN, the nerve had a normal course into the skin and surrounding fascia. To our knowledge, this is the first report of a fenestrated STV being pierced by the ATN. Such an anatomical variation might be considered by clinicians who treat patients with pathology of this region.

Iliacus minor and psoas quartus muscles traversing the femoral nerve.

Anatomical variations of the nerves of the body can be relevant to surgical approaches anesthetic blockade, and other region procedures. Herein, we report a case of three muscle fascicles of the variant psoas quartus and iliacus minor muscles traversing the femoral nerve. Salient literature is reviewed regarding this phenomenon. Variations in the femoral nerve, such as illustrated in the current case, could also help explain hip and thigh pain, and failure of traditional anesthetic placement to block sensation from the femoral nerve completely. Given the procedural relevance of variations in the femoral nerve, further characterizations of nontraditional courses could help to avoid nerve injury during interventions.

An unusual location of the ansa cervicalis.

The ansa cervicalis (AC) is part of the cervical plexus and is formed by the ventral rami of spinal nerves C1-C3. It is usually formed by two roots that run parallel to each other and then form a loop anterior to the internal jugular vein. Herein, we report a rare case where the AC was found deep to the internal carotid artery and common carotid artery and had sympathetic contributions.

The jugular nerve: A review of this enigmatic structure.

The jugular nerve (JN) is described as joining the superior cervical ganglion to the vagus nerve. It has been studied extensively in many different animal species; however, there is very limited literature about humans. This review delves into various descriptions of this nerve's anatomy and animal studies aimed at deciphering its function. The goal is to shed more light on this understudied structure in humans.

Clinical anatomy of the lumbar sinuvertebral nerve with regard to discogenic low back pain and review of literature.

PURPOSE: Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. METHODS: Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. RESULTS: 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. CONCLUSION: A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Postfixed lumbosacral plexus with split L5 ventral ramus and furcal nerve arising from L5.

Variations of the peripheral nerve plexuses are important to those clinicians who diagnose and treat patients with pathology of their parts. During routine dissection, a postfixed lumbosacral plexus with a furcal nerve arising from L5, not L4, was discovered. In addition, the case was found to have a split L5 ventral ramus. Such a variation might become clinically significant during clinical presentations of radiculopathy. With a better understanding of the fucal nerve variation presented here, along with previously documented variations, the diagnostic and treatment procedures for atypical radiculopathy can be refined, reducing the rates of nerve injury and failed back surgery.

Rare variation of the furcal nerve.

Variations in the course of the lumbar plexus and lumbosacral trunk have been explored with respect to variant nerve roots being indicated in atypical sciatic pain. Typically, the furcal nerve emerges from the L4 nerve root, with a single contribution. However, we report a case where the furcal nerve was found to arise not only from the L4 nerve but also from the obturator nerve. This anatomical variation is explored in terms of its clinical significance and implications in lumbar and sacral plexus associated procedures.

Chiari I malformation with craniosynostosis and persistent falcine sinus draining into the straight sinus.

Owing to the interconnected nature of the brain, anatomical variations in one area often coincide with, or are caused by, abnormalities in another. During dissection of a specimen with both Chiari I malformation and craniosynostosis, a persistent falcine sinus was observed to drain into the straight sinus. Such a variant should be noted by physicians as it could alter treatment plans and require more detailed imaging procedures prior to surgical correction. Herein, we report the case and discuss the possible embryological origins and clinical significance of the variant.

What is the suboccipital nerve? Tracking this confusing historical nomenclature.

Since its initial description in the 2nd century, the suboccipital nerve has maintained a number of varying terminologies. Many of these terms were created in the 18th and 19th centuries to describe the first set of cervical spinal nerves that exited the spinal cord between the cranium and the atlas. Though the many terminologies have been reduced to mainly the suboccipital nerve, there are still two prevalent definitions used for this nerve. Herein, we discuss the history of the first spinal nerve and its branches with special attention to varying terminologies over time. Recent literature has described the suboccipital nerve as the entire nerve or as simply the dorsal ramus of the C1 spinal nerve. This interchangeability may lead to confusion about the specific part of the nerve being discussed. Following a review of the literature, we recommend the term C1 spinal nerve be applied to the entire nerve, whereas, suboccipital nerve be reserved solely for the posterior branch of the C1 spinal nerve.

Dual innervation of the mylohyoid muscle by the trigeminal and hypoglossal nerves: A case report.

During the routine dissection of a cadaveric specimen, the left mylohyoid muscle was found to be innervated by both the trigeminal and hypoglossal nerves. This variation was found unilaterally. To our knowledge this dual innervation of the mylohyoid muscle is an extremely rare variation. The possibility of these variants may lead to clinical consequences such as anesthesia failure and iatrogenic injury during surgical procedures in this region. We discuss this anatomical variation and possible developmental etiologies.

Previously undescribed variant muscle connecting longissimus and semispinalis capitis muscles.

Thelongissimus capitis and the semispinalis capitis both function to bilaterally extend and unilaterally rotate the head. Typically, these muscles are distinct with origins and insertions at independent locations along the vertebral column. During a routine cadaveric dissection, an unusual muscle strip was identified between the longissimus capitis andsemispinalis capitismuscles on the left, posterior neck. This anatomical variation may have developed due to an incomplete or abnormal columnar segregation during gestation. The presence of this muscle strip contributes to previous case reports that have identified abnormal musculature between and along the longissimus and semispinalis muscles. Awareness of this muscular variant should be kept in mind by clinicians and surgeons who treat/operate this area of the body.

Dual innervation of the submandibular gland by nerve to mylohyoid and chorda tympani.

The chorda tympani typically utilises the lingual nerve and submandibular ganglion to transmit parasympathetic fibres to the submandibular gland. During a routine anatomy dissection, the submandibular gland was found to be innervated by both the lingual nerve and the nerve to mylohyoid. The clinical implications of this variant dual innervation to the submandibular gland is not clear due to its rarity: however, recognising such a variation should be borne in mind during surgical intervention near the nerve to mylohyoid.

Simultaneous duplication of the tendon of plantaris with multiple tendinous connections into the crural fascia.

The plantaris muscle (PM) typically begins with a short, fusiform muscle belly and continues as a slim tendon traversing distally between the gastrocnemius and soleus to attach into the calcaneus directly or Achilles tendon. Conventionally, it has been of most interest as a donor for surgeons plantaris tendon (PT) grafting and recent studies have implicated the PT in the development of Achilles tendinopathy. During routine cadaveric dissection, one such anatomical variation was identified in a cadaver with two distal tendons of the PM and also multiple tendon connections into the crural fascia. While similar variants have been reported before in isolation, to our knowledge, this has been rarely reported illustrating the coexistence of a duplicated PT with simultaneous fascial connections into the crural fascia. The clinical implications of such a finding are discussed.

Superficial fibular nerve variations of fascial piercing: A meta-analysis and clinical consideration.

The superficial fibular (peroneal) nerve (SFN) is one of the successive branches of the common fibular (peroneal) nerve and goes on to bifurcate into the medial dorsal cutaneous (MDN) and intermediate dorsal cutaneous (IDN) nerves. The SFN is a main contributor to sensory innervation of the foot and lower leg. It varies widely in its penetrance of the deep (crural) fascia, and differences in its subsequent course can result in iatrogenic injuries. Articles on the prevalence of this anatomical variation were identified by a comprehensive database search. The data collected were extracted and pooled into a meta-analysis. A total of 14 articles (n = 665 lower limbs) were included on the meta-analysis of SFN variations in fascial piercing. The normal Type 1 variation, where the SFN pierces the deep fascia as a single entity and later bifurcates into the MDN and IDN, had a pooled prevalence of 82.7% (95%CI: 74.0-89.4). The Type 2 variant, where the SFN bifurcates early and then pierces the fascial layer separately as the MDN and IDN, had a pooled prevalence of 15.6% (95%CI: 8.9-23.6). Type 3, when the SFN penetrates the deep fascia and courses similar to the MDN with absent IDN was noted in 1.8% (95%CI: 0.0-4.9) of cases. A substantial portion of the population has a pattern of SFN piercing that deviates from the normal Type 1 anatomy. It is recommended that possible SFN variants in patients should be addressed thoroughly to help prevent iatrogenic injuries and postoperative complications. Clin. Anat. 30:120-125, 2017. © 2016 Wiley Periodicals, Inc.

Ectopic arachnoid granulation involving a rare intracranial venous sinus variant.

Arachnoid granulations are hypertrophied arachnoid villi, which extend from the subarachnoid space into the venous system and aid in the passive filtration and reabsorption of cerebrospinal fluid. These macroscopic structures have been described in various locations, with the transverse and sigmoid sinuses seen as normal variants on imaging. Here we present the occurrence of an enlarged arachnoid granulation at the foramen rotundum where a variant intracranial venous sinus was identified during routine dissection. Variations, such as the one described herein, should be recognised by those who operate or interpret images of the skull base.

A previously undescribed variant of the confluence of sinuses.

An 8-year-old female with a history of chronic headaches and uncertain papilloedema was found to have a variant of the posterior intracranial dural venous sinuses on magnetic resonance imaging assessment of the brain. Magnetic resonance venography included in the imaging revealed a circular formation of the confluence of sinuses and absent right-sided transverse sinus. The confluence of sinuses is a highly variable structure; however, to the authors' knowledge, a circular confluence of sinuses variant has not been reported in the literature.

The Foot-Reading Cult of Japan.

Ho-no-Hana-Sanpogyo was a Japanese new religious movement referred to as the "foot-reading cult" in the media. Its founder, Fukunaga Hogen, claimed to have divine authority and the ability to diagnose physical illness by studying the soles of an individual's feet. The purpose of this paper is to provide an overview of the history of Ho-no-Hana-Sanpogyo and Fukunaga's practice of foot reading.