Unusual anatomical variants of infrahyoid muscles - case report.

Anatomical anomalies of neck muscles are rarely observed and usually comprise variations of digastric and omohyoid muscles. Neck muscles' abnormalities might be correlated with embryological development and are observed in individuals with aneuploidies such as Edward's syndrome (18-trisomy) or Down syndrome (21-trisomy). Some infrahyoid muscles are important landmarks during surgery, therefore their anatomical variations of these muscles are related to higher risk of surgical complications. Herein, we present a rare case of infrahyoid muscles anomalies found during routine dissection of male cadaver. Redundant muscle bellies of sternohyoid muscle (sternohyoid azygos muscle), presence of levator glandulae thyroideae and also one hypoplastic superior belly of the omohyoid muscle were observed. Presence of muscle fibers within found structures was confirmed using Masson's trichrome staining method.

Embryological basis of polyorchidism including classification, reproductive potential, and risk of malignancy: A review.

Polyorchidism, a congenital malformation characterized by supernumerary testes (SNTs), is usually revealed incidentally during ultrasound or open scrotal surgery. In the approximately 200 cases so far published in the literature, the left side is affected more often than the right. Despite the rarity of this anomaly, a surgeon must have basic knowledge of its embryological basis and classifications to implement proper treatment and avoid overlooking it, since the consequences could harm the patient. This review summarizes previous classifications. It can be assumed that determining the risk of malignancy, and the level of reproductive potential based on location, vascularization, ductus deferens drainage, and environmental factors (e.g., temperature) affecting the SNTs, indicates the best approach to management. Therefore, we have created a new classification based on previous ones, addressing the aforementioned issues, which will guide the clinician to select the most appropriate treatment.

Testicular Metastasis from Renal Cell Carcinoma: A Systematic Review.

Approximately one-third of renal cell carcinoma (RCC) is recognized in its metastatic stage. This systematic review aimed to summarize knowledge on the occurrence and treatment of testicular RCC metastasis. The literature search was performed by two authors independently, with the use of main electronic medical databases (Science Direct, Web of Science, and PubMed) until March 2023 to identify relevant articles that could potentially contribute to this review. Neither language nor publication dates were set as limits. Although we found a total of 51 case reports, only 31 of them contained all the required information. Testicular metastasis in patients with RCC suggests a late stage of the disease. Moreover, it usually does not present typical systemic or specific symptoms except for swelling and enlargement of the affected testis. Knowledge of the possibility of such variants of RCC metastases will allow a clinician to make an appropriate diagnosis and implement adequate treatment without delay, which is crucial in the management of neoplastic disease.

Morphology of the Sella Turcica: A Meta-Analysis Based on the Results of 18,364 Patients.

BACKGROUND: This meta-analysis aimed to present data on the sella turcica (ST) morphology and variations. Furthermore, a detailed morphometric analysis of the ST was conducted. METHODS: Major online databases such as PubMed, Scopus, Embase, Web of Science, and the Cochrane Library were searched through. The overall search process was conducted in three stages. RESULTS: This meta-analysis was based on the results of 18,364 patients and demonstrates the most up-to-date and relevant data regarding the morphology of the ST in the available literature. Four classification methods of the ST shape can be distinguished, in which the most commonly occurring variants are the normal ST (55.56%), the U-shaped ST (73.58%), the circular type of ST (42.29%), and non-bridging ST (55.64%). The overall midpoint height of the ST was 6.59 mm (SE = 0.13). The overall length of the ST was 9.06 mm (SE = 0.15). The overall volume of the ST was 845.80 mm3 (SE = 288.92). Four main classification methods of ST morphology can be distinguished in the available literature. Various morphometric characteristics of the ST may be applied in clinical practice to evaluate its shape, dimensions, and normal or pathological variants.

Glomangioma in the hand: diagnosis, treatment, and challenges.

INTRODUCTION: In this paper, we have analysed all hand glomangioma cases referred to our clinic in the context of symptoms, time to diagnosis, and the role of surgical resection of the lesion. MATERIAL AND METHODS: We have collected the following data: the presence of risk factors, manifestation, time to diagnosis, the treatment applied, and follow-up of patients. RESULTS: We have collected medical records from six patients, three males and three females. The median age was 45 (IQR: 29.5-65.75). The main symptom in all patients was severe pain and tenderness. The first-choice physician(s) were: general practitioners, general surgeons, and neurologists. The median time to diagnosis was 7 (IQR: 5-10) years. The main complaint of our patients was severe pain - 9 (IQR: 9-10) on the VAS scale, which was significantly alleviated after surgical treatment - 0 (IQR: 0-0; p = 0.043). CONCLUSIONS: Extremely long times to final diagnosis, and excellent outcomes of surgical treatment, highlight the necessity of raising awareness of glomangiomas among clinicians.

Duplication of the Hypoglossal Nerve Branch to the Thyrohyoid Muscle: A Case Report.

The motor fibers to the thyrohyoid muscle are provided by the anterior ramus of C1 via the hypoglossal nerve rather than via the ansa cervicalis. Knowledge of possible variations in the branching patterns of the nerves attached to the hypoglossal nerve is necessary to minimize iatrogenic injury to these structures during surgical procedures. We describe a rare anatomical variant of the nerve branch to the thyrohyoid muscle. To our knowledge, this particular variant has not been previously reported.

Immunohistochemical analysis of the ligamentum mucosum is the key to understand its clinical usefulness.

Ligamentum Mucosum(LM) is a ligamentous structure within the synovial layer of the knee joint capsule. For a long time LM was perceived as the vestigial remnant from the embryological development of the knee. Being treated as an irrelevant structure LM was often the first victim of shaver during arthroscopy. However, last years have shown increased interest in this structure due to its potentially significant clinical role. Our aim was to classify LM based on its morphological characteristics and examine its microanatomy using immunohistochemical analysis to reveal the potential clinical value for surgeons. We have examined sixteen fresh frozen lower limbs, 6 females (mean age 83.1 ± 3.4 years) and 10 males (mean age 84.2 ± 6.8 years). Classical histological H+E stain was routinely conducted. Subsequently, CD31 antibody (DAKO, Monoclonal Mouse Anti-Human, Clone JC70A) was used to mark vascular epithelium. Monoclonal Mouse Anti-Human Neurofilament Protein (NFP) antibody (DAKO, Clone 2F11) was used to expose the nerves. Moreover, we have conducted arthroscopic visualizing and suturing LM to the torn ACL during routinely performed arthroscopic suturing of the ACL. The dissection process has revealed that LM was present only in 75% of cases. Histological examination confirmed the presence of longitudinal collagen fiber bundles in all samples. Tiny nerves were confirmed by NFP, along the subsynovial layer in all samples. CD-31 immunostain revealed the presence of many vascular vessels along the entire ligament, especially well developed at its distal end. Our study has revealed that LM contains rich vascular network. Thus, it may be a donor for the revascularization process after ACL tear or reconstruction which may improve the recovery. Another great advantage of the LM is the presence of nerves along the subsynovial layer, hopefully they may serve as the source of reinnervation and hence better clinical outcome. Based on our results we believe that seemingly irrelevant LM may be very useful during surgical procedures in the knee region. Suturing LM to the ACL may not only prevent the infrapatellar fat pad from subluxation but also improve the blood flow and reinnervation of the injured ACL. Until now there are only a few studies examining microanatomy of the LM. This basic knowledge may serve as the foundation for surgical procedures. Hopefully our findings may be useful for surgeons while planning surgical procedures or clinicians while diagnosing patients who suffer anterior knee pain.

Prevalence, Laterality, and Classification of Ossified Petroclival Ligaments: An Anatomical and Histological Study With Application to Skull Base Surgery.

Background The petroclival ligament (PL) forms the roof of Dorello's canal (DC). In humans, partial and complete ossification of this ligament have been reported. When completely ossified, DC is transformed into a bony foramen for the abducens nerve and accompanying vascular structures. As this osteological finding might have an impact on skull base surgery, this anatomical study was performed. Methodology Using 100 adult human skulls, the presence of an ossified PL was noted and classified. The diameter of the resultant bony foramen and laterality were documented. Additionally, PL was evaluated histologically in 10 heads. Results Overall, 8% of the sides were found to have partial or complete ossification of the PL. Partial ossification (type I) was noted on 3% of the sides. Completely ossified PL was identified on 5% of the sides. Some ossified ligaments (2.5%) were seen as an ossified bridge (type II), and others (2.5%) were converted into small foramina (type III). Three skulls (3%) were found to have a completely ossified ligament bilaterally. The mean diameter of the underlying DC was 0.8 mm. Partially ossified ligaments were statistically more likely to be on the right sides, and the diameter of the underlying DC was statistically smaller in type III. Histologically, the PL was found to have bone within it on three skull sides. Conclusions An ossified ligament can be found on imaging of the skull base. Moreover, during surgical approaches to the petroclival region and, specifically, DC, skull base surgeons should be cognizant of this anatomical variation.

The sphenopalatine vein: anatomical study of a rarely described structure.

Although in counterpart, the sphenopalatine artery (SPA), has been well described in the medical literature, the sphenopalatine vein (SPV) has received scant attention. Therefore, the present anatomical study was performed. Additionally, we discuss the variations, embryology, and clinical significance of the SPV. Adult cadaveric specimens underwent dissection of the SPV. In addition, some specimens were submitted for histological analysis of this structure. The SPV was found to drain from the sphenoidal sinus and nasal septum. Small tributaries traveled through the nasal septum with the posterior septal branches of the SPA and nasopalatine nerve. The SPA and SPV were found to travel through the sphenopalatine foramen and another tributary was found to perforate the medial plate of the pterygoid process and to connect to the pterygoid venous plexus which traveled lateral to the medial plate of the pterygoid process. The vein traveled through the posterior part of the lateral wall of the nasal cavity with the posterior lateral nasal branches of the SPA and the lateral superior posterior nasal branches of the maxillary nerve. To our knowledge, this is the first anatomical study on the SPV in humans. Data on the SPV provides an improved anatomical understanding of the vascular network of the nasal cavity. Developing a more complete picture of the nasal cavity and its venous supply might help surgeons and clinicians better manage clinical entities such as posterior epistaxis, cavernous sinus infections, and perform endoscopic surgery with fewer complications.

The Sphenoparietal Sinus Revisited: Anatomical and Histological Study With Application to Interventional Procedures and Skull Base Surgery.

Background The sphenoparietal sinus (SPS) is implicated in various clinical pathologies, specifically arteriovenous fistulas and venous sinus thrombosis. This study is aimed to better understand this venous structure of the skull base via histological examination. Methods Ten embalmed and latex-injected adult body donors' heads (20 sides) underwent microdissection of the SPS using a surgical microscope. The entire dura on the underside of the lesser wing of the sphenoid bone encompassing the region known as the groove for the SPS was harvested from each body donor and submitted for histological analysis (H&E, Periodic acid-Schiff [PAS], Masson's Trichrome). Five left and five right transverse sinuses were harvested and analyzed histologically as controls. Results A definitive SPS was identified in 14/20 (70%) of the latex-injected body donors. When present, the sinuses were classified as small, medium, or large. Tributaries included the middle meningeal veins, superficial Sylvian vein, and anterior temporal veins. All sinuses drained medially into the cavernous sinus. For the body donors analyzed histologically, 17 (85%) were consistent with a dural venous sinus and not a vein and were observed to have a rich nerve and arterial supply within their walls. The histological findings of the SPS were similar to those seen for the transverse sinus. The combined prevalence for the SPS in gross and histological body donors was 78%. Conclusions Our findings support the presence of SPS in the majority of body donors. To our knowledge, this is the first histological study of the SPS.

Microanatomical study of arachnoid granulations and meningeal architecture around Meckel's cave.

Although the microanatomy of Meckel's cave (MC) has been well studied, there are still controversies regarding the meningeal architecture of the space. Moreover, there are only general mentions of the arachnoid granulations near MC in just a few sources. This study is aimed at determining the frequency, location, and anatomical variability of the main clusters of arachnoid granulations around MC. The dissection involved 26 isolated specimens of MC fixed in formalin (neutral buffered, 10%). This number included five freshly harvested specimens examined histologically. Additional paraffin block with MC horizontal section was taken from our neuroanatomical collection. Carefully selected anatomical and histological techniques were applied to assess the complex relationships between the arachnoid granulations and adjacent structures. Arachnoid granulations were found around MC in all specimens with different anatomical variations. The main clusters of arachnoid granulations were close to the trigeminal ganglion and its divisions. The dorsolateral wall of MC was a thick layer formed by interweaving bundles of collagen fibers arranged in various directions. The entire MC was surrounded by a dural sleeve (envelope). This sleeve separated MC from the lateral sellar compartment. At its anterior (rostral) end, it formed a cribriform area pierced by individual fascicles of the trigeminal nerve's primary divisions. The connective tissue forming the sleeve was not only continuous with the epineurium but also shifted to the perineuria surrounding individual nerve fascicles. The meningeal architecture around MC has a complex and multilayer arrangement with a collagenous sleeve closely related to the trigeminal ganglion. Arachnoid granulations are typically found around MC.

The Morphology of the Pituitary Gland: A Meta-Analysis with Implications for Diagnostic Imaging.

The objective of this meta-analysis was to present transparent data on the morphology of the pituitary gland (PG) using the available data in the literature. The main online medical databases, such as PubMed, Embase, Scopus, and Web of Science, were searched to gather all relevant studies regarding PG morphology. The mean overall volume of the PG was found to be 597.23 mm3 (SE = 28.81). The mean overall height of the PG was established to be 5.64 mm (SE = 0.11). The mean overall length of the PG was found to be 9.98 mm (SE = 0.26). In the present study, the PG's overall morphology and morphometric features were analyzed. Our results showed that, on average, females from Asia have the highest volume of PG (706.69 mm3), and males from Europe have the lowest (456.42 mm3). These values are crucial to be aware of because they represent the normal average properties of the PG, which may be used as reference points when trying to diagnose potential pathologies of this gland. Furthermore, the present study's results prove how the PG's size decreases with age. The results of the present study may be helpful for physicians, especially surgeons, performing procedures on the PG.

Polyorchidism: An Up-to-Date Systematic Review.

Polyorchidism is a rare male urogenital tract anomaly characterized by at least one supernumerary testis in the scrotum or ectopically. According to data based on our systematic review, 76% of the supernumerary testes (SNTs) were located in the scrotum, and 24% were extra-scrotal (p < 0.001). Among testes located outside the scrotum, 87% were found in the inguinal canal and 13% in the abdominal cavity. In 80% of cases, the diagnosis of SNT was made based on imaging tests, and the remaining 20% of cases were detected incidentally during surgery. The imaging tests performed (US or MRI) resulted in a significantly higher rate of patients who qualified for observation vs. surgical treatment (45% vs. 35%, p < 0.001). The most common conditions associated with SNT were ipsilateral inguinal hernia (15% of cases) and cryptorchidism (15% of cases). Surgery (orchidopexy/orchidectomy) was performed on 54% of patients with SNT, and the decision to observe the SNT was made in a total of 46% of patients (p = 0.001). The therapeutic approach depends on the location of the SNT and the presence of factors that raise suspicion of neoplastic proliferation.

The ligamentum mucosum: A new classification.

The ligamentum mucosum (LM) is a ligamentous structure within the synovial layer of the knee joint capsule. For a long time LM was perceived as the vestigial remnant from the embryological development of the knee. However, last years have shown increased interest in this structure due to its potentially significant clinical role. Fifty-one, 12 females (mean age 83.1 ± 3.4 years) and 39 males (mean age 84.2 ± 6.8 years) fixed in 10% formalin were examined. Upon dissection, the following morphological features of the LM were assessed: the types of LM, morphometric measurement and histological analysis of each type. The LM was present in 66.7% of all examined specimens. Three different types were recognized: Type I (55.9%)-single band with attachment to the intercondylar notch, Type IIa-bifurcated ligament with attachment to the anterior cruciate ligament, Type IIb-bifurcated ligament with both attachments to the intercondylar notch, Type III-double ligament with two independent bands and attachments to the intercondylar notch and to the knee joint capsule. The LM is variable and probably evolutionary changes are the reason. In our study we propose the new clinically useful classification supported by its anatomical and histological characteristics. Type IIa seems to be the most important from the clinical point of view, as it may be responsible for clinical issues and should be paid attention while diagnosing patients suffering from anterior cruciate ligament torn or anterior knee pain.

Intramedullary Spinal Cord Abscess with Concomitant Spinal Degenerative Diseases: A Case Report and Systematic Literature Review.

Intramedullary spinal cord abscess (ISCA) is a rare clinical pathology of the central nervous system that usually accompanies other underlying comorbidities. Traditionally it has been associated with significant mortality and neurological morbidities because it is often difficult to diagnose promptly, owing to its nonspecific clinical and neuroimaging features. The mortality rate and the outcome of these infections have been improved by the introduction into clinical practice of antibiotics, advanced neuroimaging modalities, and immediate surgery. We report the case of a 65-year-old male patient who presented with a progressive spastic gait and lumbar pain, predominantly in the left leg. An MRI image revealed an expansile intramedullary cystic mass in the thoracic spinal cord, which was initially diagnosed as a spinal tumor. He underwent laminectomy and myelotomy, and eventually the pus was drained from the abscess. The follow-up MRI showed improvement, but the patient's paraplegia persisted. In light of his persistent hypoesthesia and paraplegic gait with developing neuropathic pain, he was readmitted, and an MRI of his lumbar spine revealed multilevel degenerative disease and tethered spinal cord syndrome with compression of the medulla at the L2-L3 level. The patient underwent central flavectomy with bilateral foraminotomy at the L2-L3 level, and the medulla was decompressed. Postoperatively, his neurological symptoms were significantly improved, and he was discharged from hospital on the third day after admission. In support of our case, we systematically reviewed the recent literature and analyzed cases published between 1949 and May 2022, including clinical features, mechanisms of infection, predisposing factors, radiological investigations, microbial etiologies, therapies and their duration, follow-ups, and outcomes. Initial clinical presentation can be misleading, and the diagnosis can be challenging, because this condition is rare and coexists with other spinal diseases. Hence, a high index of suspicion for making an accurate diagnosis and timely intervention is required to preclude mortality and unfavorable outcomes. Our case is a clear example thereof. Long-term follow-up is also essential to monitor for abscess recurrences.

What Is Currently Known about Intramedullary Spinal Cord Abscess among Children? A Concise Review.

Intramedullary spinal cord abscesses (ISCA) are rare. Typical symptoms include signs of infection and neurological deficits. Symptoms among (younger) children can be highly uncharacteristic. Therefore, prompt and proper diagnoses may be difficult. Typical therapeutic options include antibiotics and neurosurgical exploration and drainage. In this review, we analyze published cases of ISCA among children. Most pediatric cases were found to be under the age of 6 years. The typical symptoms included motor deficits in 89.06%, infection signs in 85.94%, and sensory deficits in 39.06%. Urinary dysfunction was observed in 43.75%, and bowel dysfunction in 17.19%. The predisposing factors included dermal sinuses, (epi)dermoid cysts, prior infection, iatrogenic disorder, and trauma. The most common pathogens were: Staphylococcus aureus, Mycobacterium tuberculosis, Escherichia coli, and Proteus mirabilis. The pediatric population has good outcomes as 45.93% of patients had complete neurological recovery and only 26.56% had residual neurological deficits. Fifteen (23.44%) had persistent neurological deficits. Only one (1.56%) patient died with an ISCA. In two (3.13%) cases, there were no details about follow-up examinations.

The costocervical trunk: A detailed review.

The number of studies on the anatomy of the costocervical trunk (CCT) is scarce, and the actual prevalence of this structure is unknown. Therefore, the authors of the present study would like to propose a set of four types of CCT, which were created based on observations of computed tomography angiographies (75 CCTs). A retrospective study was conducted to establish variations and the morphometric properties of the CCT. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography (CTA) were analyzed in March 2022. The analysis was performed on a total of 75 CCTs. Of these, 32 were from women (42.7%) and 43 were from men (57.3%). Branching variations of each CCT were thoroughly analyzed. A classification of the branching pattern of the CCTs was made and consisted of four types. In the present study, the variety of branching and morphology of CCT was analyzed, proposing its novel classification based on the four most frequently observed types. Type 1 was the most prevalent (76.1%), having a similar origin and branching pattern as described in the major anatomical books. CCT was found to be absent in 23.94% of the cases, making it a somewhat less consistent branch of the SA. Understanding the variability of the anatomy of the CCT can be a great tool for physicians performing endovascular procedures in the cervical region.