Unusual Anastomosis between Branches of the Ulnar Nerve (Kaplan Type Anastomotic Variant) - Case Report.

The Kaplan anastomosis is a rare communication originally described between the superficial and dorsal branches of the ulnar nerve, distal to the ulnar tunnel, and in strict relation with the pisiform bone. It reveals, by its particular location, a formation of high clinical-surgical expressiveness. In this paper, we describe a Kaplan-type communication from a left upper limb with an unusual loop conformation between branches of the ulnar nerve in the pisiform bone.

Unusual Anastomosis between Branches of the Ulnar Nerve (Kaplan Type Anastomotic Variant) - Case Report / Anastomose incomum entre ramos do nervo ulnar (variante anastomótica de Kaplan) - Relato de caso

Abstract The Kaplan anastomosis is a rare communication originally described between the superficial and dorsal branches of the ulnar nerve, distal to the ulnar tunnel, and in strict relation with the pisiform bone. It reveals, by its particular location, a formation of high clinical-surgical expressiveness. In this paper, we describe a Kaplan-type communication from a left upper limb with an unusual loop conformation between branches of the ulnar nerve in the pisiform bone.

Resumo A anastomose de Kaplan é uma rara comunicação originalmente descrita entre os ramos superficial e dorsal do nervo ulnar, distal ao túnel ulnar e em estreita relação com o osso pisiforme. O que revela, pela sua particular localização, uma formação de alta expressividade clínico-cirúrgica. Neste trabalho, uma comunicação do tipo Kaplan, porém, ainda não relatada, é descrita a partir de um membro superior esquerdo com uma inusual conformação em alça, ou um looping, entre ramos do nervo ulnar, no osso pisiforme.

Morphometric analyses of the caroticoclinoid and interclinoid foramina: a study in Brazilian dry skulls / Análisis morfométricos del foramen caroticoclinoideo e interclinoideo: un estudio en cráneos secos brasileños

SUMMARY: The caroticoclinoid (CF) and the interclinoid (IF) foramina are variant formations of the middle cranial fossa, which result from idiopathic and possibly atavistic ossifications of the caroticoclinoid and interclinoid ligaments, respectively. Topographically, these foramina are intimately associated, to varying degrees, depending on their conformations, with the neurovascular elements of the paraclinoid region and have important clinical and surgical significance. Thus, this study, conducted from 38 dry skulls belonging to the shared collection of the Federal University of Juiz de Fora, Governador Valadares campus, revealed 11 skulls (28.95 %) with one of the two complete formations - the caroticoclinoid or the interclinoid, and in 6 skulls the caroticoclinoid foramen occurred uni or bilaterally. As a result, 50 % of these skulls presented the CF exclusively on the right (or 62.5 % of the total number of variant foramina), with an average transverse diameter of 4.91 mm and 5.8 mm AP (anteroposterior) diameter and an average area of 22.5 mm2. Concerning the IF, the findings occurred in 5 skulls with variable distributions between the clinoid processes and lateralities. The average length of the bone bridges in the IF was 7.7 mm. In conclusion, detailed anatomical knowledge of the caroticoclinoid and the interclinoid foramina is fundamental to the practice of neurosurgical procedures, since they have intimate relationships at a location of high structural complexity.

RESUMEN: El foramen caroticoclinoideo (FC) y el foramen interclinoideo (IC) son formaciones variables de la fosa craneal media, que resultan de osificaciones idiopáticas y posiblemente atávicas de los ligamentos caroticoclinoideo e interclinoideo, respectivamente. Estos forámenes están íntimamente asociados topográficamente en diversos grados, dependiendo de sus conformaciones, con los elementos neurovasculares de la región paraclinoidea y tienen importancia clínica y quirúrgica. Así, este estudio, realizado a partir de 38 cráneos secos pertenecientes a la colección compartida de la Universidad Federal de Juiz de Fora, campus Governador Valadares, reveló 11 cráneos (28,95 %) con una de las dos formaciones completas: el FC o el IC, y en 6 cráneos el FC se presentó uni o bilateralmente. Como resultado, el 50 % de estos cráneos presentaba el FC exclusivamente a la derecha (o el 62,5 % del total de forámenes variantes), con un diámetro transversal medio de 4,91 mm y un diámetro anteroposterior medio de 5,8 mm y un área promedio de 22,5 mm2. En cuanto a la FI, los hallazgos se presentaban en 5 cráneos con distribuciones variables entre los procesos clinoides y lateralidades. La longitud media de los puentes óseos en el FI fue de 7,7 mm. En conclusión, el conocimiento anatómico detallado de los forámenes caroticoclinoideo e interclinoideo resulta fundamental para la práctica de procedimientos neuroquirúrgicos, ya que presentan relaciones íntimas en un lugar de alta complejidad estructural.