Morphometry and Intracranial Relations of the Sphenoid Sinus in Context to Endoscopic Transnasal Transsphenoidal Surgery.

Introduction Due to the variable degree of pneumatization, the shape and size of the sphenoid sinus are irregular. An endoscopic intranasal transsphenoidal approach is made in sphenoid sinus pathologies, sphenoid sinusitis, and sellar and parasellar diseases. A diagnostic approach to the sphenoid sinus is also done to get a better MRI scan of the pituitary. The present study aims to describe the variant types of sphenoid sinus, morphometry, anatomy, and relations of sphenoid sinus, which will be helpful to surgeons during an endoscopic approach to the sphenoid sinus. Materials and methods We studied 76 cadaveric sphenoid sinuses that were exposed by taking a sagittal section of 38 formalin-fixed cadaveric heads. After examining the inter-sphenoidal septum, it was removed to observe the inside aspect of the sphenoid sinus. Different dimensions of the sinus were noted down. The bulges inside the sinus due to neurovascular structures in relation to the sinus were observed. Results  The most prominent type found was the sellar in 68.4% of cases preceded by the postsellar in 23.7% of cases. Presellar type of pneumatization was seen only in 7.9% of cases and the conchal type was absent. Intersphenoid septum was seen in 92,1% of cases, out of which 11.4% of septums were deficient on the posterior aspect. An internal carotid artery bulge in the sphenoid sinus was seen in 46% of cases. In 27.6% and 19.7% of sphenoid sinuses, bulging of the optic and vidian nerves, respectively, were seen. Some of these structures were dehiscent in the sphenoid sinus. Conclusions To get more space in the sphenoid sinus, the septa in the sinus are removed by surgeons, which may damage the walls of the sphenoid sinus. Knowledge of the relations of neurovascular structures with the sphenoid sinus will be helpful to surgeons during the transsphenoidal endoscopic approach to avoid any injury to these structures.

Absence of musculocutaneous nerve with variations in course and distribution of the median nerve.

Variations in the brachial plexus and its terminal branches are not uncommon. A communicating branch arising from the musculocutaneous nerve to the median nerve is a frequent variation, but complete merging of musculocutaneous nerve into the median nerve is very rare. Here, we observed variations in the origin, course and distribution of the median nerve in the left upper limb. The musculocutaneous nerve was absent. The median nerve was formed in the upper part of the arm, in front of the brachial artery. The median nerve supplied the biceps, coracobrachialis and brachialis muscles and gave the lateral cutaneous nerve of the forearm. The present report provides evidence of variation in important nerves of the anterior compartment of the arm.

Applicability of Greulich and Pyle skeletal age standards to Indian children.

A total 375 Indian children of age 1 day to 19 years were studied (male 194 and female 181). For determining the bone age (skeletal age), wrist and hand radiographs were taken. The skeletal age was determined by blinded review of radiograph using Greulich and Pyle atlas (2nd edition, 1959). If we consider all age group (1-19 years), the Indian boys were retarded in skeletal age by 0.7 years and females by 0.33 years. Male and female children skeletally lag behind the American standard (GP Atlas) in all age groups except 12-13 years age group in which girls are accelerated by 0.22 years. Chronological age and skeletal age difference of more than 1 year is seen between age group 7 years and 12 years in males. Females after second year showed a retardation, which ranged from 0.2 to 0.8 years, up to the age of 19 years. The present study concludes that, Greulich and Pyle atlas is not applicable to the Indian children of both sexes especially in middle and late childhood.

Bilateral malrotation and lobulation of kidney with altered hilar anatomy: a rare congenital variation.

Variations of the structure and position of the kidney along with the variations of renal vessels are the most frequently reported. Rotational variations form a rare entity that is not cited in most of the embryology textbooks. During educational cadaveric dissection of a 57-year-old female, a complex picture of bilateral anatomical variants was encountered. Bilateral malrotation of kidney, bilateral lobulated kidneys along with open hilum of kidney was observed, so that the contents of the sinus were exposed. The renal pelvis was present anterior to the renal vessels instead of posterior position.The right kidney in addition showed lower lumbar position with three supplementary arteries and two veins. The right ovarian vein arched over the laterally rotated hilum of kidney and drained into superior renal vein instead of inferior vena cava. This is a rare case in which such numbers of congenital variations are seen. These variations of kidney have embryological base. Rotational variation though comparatively rare assumes great importance in view of the present day surgical procedures like percutaneous nephrectomy, renal transplantation, etc.