Dural sinus septum as an underlying cause of intrinsic venous sinus stenosis: Anatomical, clinical, and stent placement considerations.

Recently, an interesting study regarding "Dural sinus septum: an underlying cause of cerebral venous sinus stenting failure and complications." was published, to our knowledge, being the launching point of the clinical/interventional applications of this intraluminal variation. Herein, we wish to highlight paramount anatomical, clinical, and stent placement considerations related to DSS located in the dural venous sinus at the posterior cranial fossa and the interventional complications caused by the presence of this variation during stenting procedures.

Anatomical characteristics and morphometric analyses of the internal carotid artery using retrospective angiographic images.

PURPOSE: Anatomical variations of the internal carotid artery (ICA) can cause complications during endovascular treatments. Therefore, the aim of this study was to investigate the features of the ICAs obtained from 2D digital subtraction angiography (2D DSA). METHODS: The morphometrics and angles of the ICA segments from 2D DSA images from a total of 100 patients (45 males and 55 females) were investigated. The lengths (L1-3), angles (A1-3), and diameters (D1-6) through the ICA measurement points (five segments: C2 [petrous], C3 [lacerum], C4 [cavernous], C5 [clinoid], C6 [ophthalmic]) were systemically recorded by two observers. All measured parameters were compared for both sexes and sides. RESULTS: The lengths (mm) and angles of the ICA were 7.20 ± 2.22 (L1), 15.71 ± 2.32 (L2), 10.99 ± 1.66 (L3) and 109.31 ± 17.77 (A1), 107.87 ± 20.51 (A2), 80.81 ± 16.33 (A3), respectively. There were no differences in the angulations of the A1-A3 segments between the sexes (p > 0.05). The L2 (C3-C4) was significantly longer in males, but only the left side of females showed a greater length (p < 0.05). The averaged mean diameters of the ICA (D1-6) in both sexes were 4.17 ± 0.55 mm. However, the diameters of the D1-D6 from left and right sides of males except the right D6 were significantly longer than those of females (p < 0.05). Also of significance was that the right diameters of females (D1) and males (D1 and D2) were shorter compared to left sides. CONCLUSION: This study demonstrates some differences in lengths, diameters, and angles in both sexes and sides of the normal ICA. Neurosurgeons and neurointerventionalists should be aware of such variations when operating, performing interventional procedures, and interpreting 2D DSA.

Clinical importance of variability in the branching pattern of the internal iliac artery - An updated and comprehensive review with a new classification proposal.

The main aim of this study is to present, describe and compare the most significant anatomical classifications of the internal iliac artery (IIA) and its branches, their pros and cons, to relate them to clinical practice and note their clinical importance, and to offer a new classification based on number of main vessels origins. Many classifications covering the detailed morphology of the IIA have been developed, focusing on the destination of vessels making it possible to determine the name and type of branching precisely. However, because the allocation criteria are overdetailed and of doubtful accuracy, these classifications have become impractical for clinical practice and advanced statistical calculations. The argument of this research paper is that highly variable vascularized regions should be classified from either an anatomical point of view to determine detailed morphology aspects or a clinical perspective. Presented classification proposes unification of many branching types presented among various classifications, which look identical when determining the origin pattern from the main vessel and differ only in the destination point of the vessel, what brings clarity and increases the statistical usefulness of the collected data. This should translate into better cooperation between scientists and clinicians and thus benefit patients. The paper proposes a new, clinically useful classification based on the model of vessel origins from the main stem. The IIA is the main vascular supply to the pelvic region, so precise knowledge of origin and its branching pattern is essential for all clinicians, especially for general and orthopaedic surgeons, gynecologists, obstetricians and urologists.

Morphological characteristics of the posterior neck muscles and anatomical landmarks for botulinum toxin injections.

PURPOSE: Cervical dystonia is a common movement disorder for which botulinum toxin (BoNT) is the first choice treatment. Injecting the specific neck muscles can be challenging because of their thin morphology and deep locations. We, therefore, designed a study to investigate the locations of the posterior neck muscles to help the physician predict the locations of the targeted neck muscles and to protect the vertebral vessels from injury during deep injections. METHODS: The posterior neck region was divided into four quadrants by imaginary lines passing vertically and transversely through the spinous process of C2 vertebra (C2sp). The thicknesses and depth of the posterior neck muscles were measured in ten formaldehyde-fixed adult male cadavers. These muscles were located and a projection of them was drawn on the neck. Using the measurements, colored latex in place of BoNT was injected into them in one cadaver. The cadaver was dissected to investigate whether the muscles were colored. RESULTS: 2 cm above the C2sp, trapezius, splenius capitis (SPC) and semispinalis capitis (SSC) were colored at depths of 10.70 mm, 11.88 mm and 15.91 mm, respectively. 2 cm below the C2sp, the trapezius, SPC and SSC were colored at depths of 20.89 mm, 23.25 mm and 27.63 mm, respectively. The posterior neck muscles were had taken up their assigned colors when they were injected according to the results obtained in this study. The vertebral vessels were not colored. CONCLUSIONS: Although BoNT injection into the posterior neck muscles is challenging, we think that it can be practically and safely applied using the measurements obtained in this study.

Case report of a bifurcated fibular (lateral) collateral ligament: which band is the dominant one?

BACKGROUND: The fibular collateral ligament is a permanent and extracapsular ligament of the knee joint. It is located on the lateral aspect of the knee and extends from the lateral epicondyle of the femur to the lateral surface of the head of the fibula. As one of the main knee joint ligaments it is a stabilizer of the posterolateral corner of the knee and resists varus stress. The case report displays the bifurcated variant of the fibular collateral ligament. The aim of this study is to determine which of those bands should be considered dominant. MATERIALS AND METHODS: Classical anatomical dissection was performed on the left knee joint. The fibular collateral ligament was thoroughly cleansed around its origin, distal attachments, and course. Appropriate morphometric measurements were collected. RESULTS: A bifurcated variant of the fibular collateral ligament with inverted proportions of its two bands (main and accessory one) constitutes our findings. It originated on the lateral epicondyle of the femur. Then it divided into two bands (A1 and A2). Band A1 inserted to the head of the fibula. A bony attachment of band A2 was located on the lateral aspect of the lateral condyle of the tibia. CONCLUSIONS: Although the fibular collateral ligament is a permanent structure it presents morphological variations. It is important to constantly extend morphological knowledge for all scientists concerned in anatomy.

Morphological variability of the extensor hallucis longus in human fetuses.

INTRODUCTION: The extensor hallucis longus originates from about the middle three fifths of the anterior surface of the fibula, medial to the origin of the extensor digitorum longus, and inserts into the distal phalanx of the great toe. The goal of this study was to examine the insertion of the extensor hallucis longus tendon and thus prepare its first classification in human fetuses. MATERIAL AND METHODS: Fifty spontaneously-aborted human fetuses (26 male, 24 female, 100 lower limbs), aged 18-38 weeks of gestation, were examined. RESULTS: The classification comprised three types of extensor hallucis longus insertion. The most common was type I (68%), which was characterized by a single tendon that ends as an extensor hood inserting into the dorsal aspect of the base of the distal phalanx of the great toe. The second most frequent was type II (27%), which was characterized by two distal tendons: the dominant one ends as an extensor hood inserting into the distal phalanx of the great toe, and the auxiliary inserts separately into the dorsal aspect of the proximal phalanx of the great toe, medial to the insertion of the extensor hallucis brevis tendon. Finally, type III (5%), the least frequent type, was characterized by two distal tendons: the dominant one ends as an extensor hood inserting into the distal phalanx of the great toe, and the auxiliary connects to the tendon of the extensor hallucis brevis. CONCLUSION: The extensor hallucis longus demonstrates great variability in the approach of its tendon to the foot, at least in fetuses, as indicated by this initial classification.

Untreated incomplete isolated cleft palate: cadaveric findings.

Isolated cleft palate without cleft lip is a rare deformity. Cleft lip and cleft palate can sometimes develop in combination with a syndrome due to genetic causes. Affected patients have morbidity through life from birth and experience comprehensive treatment for such clefts including surgery. It is extremely rare that the untreated clefts are found during routine cadaveric dissection, since many patients have treatment for clefts in developed countries. Herein, we present a case of an untreated incomplete isolated cleft palate on the right side of the maxilla. An oronasal fistula was found in the same location as the missing right maxillary lateral incisor, and the soft palate was considerably intruding into the hard palate but without penetration into the nasal cavity. The right incisivus labii superioris muscle forming the oral vestibule was incompletely torn with two fistulae. An incomplete bony defect was found on the right maxilla without oronasal or oroantral fistula. This paper may contribute to evaluating the disturbed site of the incomplete isolated cleft palate with no treatment.

Integration of anatomical and radiological analysis suggests more segments in the human kidney.

An increasing number of observations have called the general scheme of five renal segments into question: anatomists, radiologists, and surgeons have reported discrepancies between Graves's scheme and morphological observations. The aims of the present study are: (1) to assess the correspondence between a virtual and a real vascular cast of the kidney; (2) to analyze the arterial anatomy with reference to the renal segments. Fifteen kidneys were injected with acrylic resins to obtain vascular casts, which were also analyzed by computed tomography. A mean of 6.3 (range 4-8) avascular fissures was found, indicating a mean of 7.3 segments (range 5-9). In the superior and middle territories there was a single segment in 4 (26.7%) and 8 (53.3%) cases, respectively, and there were two segments in 11 (73.3%) and in 7 (46.7%) cases, respectively. In the inferior territory there was a single segment in two cases (13.3%), two segments in nine (60%), and three segments in four (26.7%). A mean segmental volume of 550.5 mm3 was calculated; the posterior (1,030.1 mm3 , 28.9%) and inferior (450.3 mm3 , 24.2%) segments were the largest. More third order branches were identified in the inferior segments than in the other segments (three branches of the inferior segmental artery in 26.6%). According to these data the inferior segment occupies the inferior pole, extending both anteriorly and posteriorly. In conclusion, the high correspondence between a virtual and a real vascular cast permits more segments to be identified than those described by Graves, and the volume of each segment can be calculated. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

Ventral and dorsal tethering bands of the spinal cord in the same patient: a case report.

Fibrous bands are one of the causes of tethered cord syndrome and these can be located on the dorsal or more rarely, ventral aspect of the dura mater. We report a case of dorsal and ventral tethering bands in the same patient found at surgery for tethered cord syndrome. Such fibrous bands restrict normal movement of the spinal cord and lead to a variety of neurological symptoms. To our knowledge, we report the first case of dorsal and ventral tethering bands of the spinal cord in the same patient. This case report aims to increase awareness of such anatomical variations and emphasize the importance of meticulous surgical dissection in order to identify such bands.

Pediatric glossopharyngeal neuralgia: a comprehensive review.

INTRODUCTION: Debilitating facial pain can seriously affect an individual's daily living. Given that the pathophysiology behind neuropathic and myofascial pain is not fully understood, when chronic facial pain goes undiagnosed, it has been proposed that one of the two is the likely cause. Since their discovery, glossopharyngeal neuralgia (GN) and Eagle's syndrome have been considered mostly conditions afflicting the adult population. However, when pediatric patients present with symptoms resembling GN or Eagle's syndrome, physicians are less apt to include these as a differential diagnosis simply due to the low prevalence and incidence in the pediatric population. MATERIALS AND METHODS: A literature review was performed with the aim to better understand the history of reported cases and to provide a comprehensive report of the anatomical variations that lead to these two conditions as well as the way these variations dictated medical and surgical management. Articles were obtained through Google Scholar and PubMed. Search criteria included key phrases such as pediatric glossopharyngeal neuralgia and pediatric Eagle syndrome. These key phrases were searched independently. PubMed was searched primarily then cross-referenced articles were found via Google Scholar. Results from non-English articles were excluded. RESULTS: A total of 58 articles were reviewed. Most of the articles focused on adult glossopharyngeal neuralgia, and the majority was comprised of case reports. When searched via PubMed, a total of 16 articles and 2 articles returned for glossopharyngeal neuralgia and Eagle's syndrome, respectively. After criteria selection and cross-referencing, a total of seven articles were found with respect to pediatric glossopharyngeal neuralgia. CONCLUSIONS: While they are rare conditions, there are multiple etiologies that lead to the debilitating symptoms of GN and Eagle's syndrome. The clinical anatomy proved notable as multiple causes of GN and Eagle's syndrome are due to variation in the anatomy of the neurovascular structures surrounding the glossopharyngeal nerve, an elongated styloid process, a calcified stylohyoid ligament as well as a calcified stylomandibular ligament. Due to the success of different treatment modalities, the treatment of choice is dependent on clinical judgment.

Spanish Translation of the Anatomical Quality Assurance (AQUA) Checklist: new guidelines for reporting in original anatomical studies

Clear reporting of original studies is an integral part of evidence-based principles, which the basic sciences, including anatomy, have only recently begun to adapt to. Evidence-based anatomy (EBA), is a developing field of anatomical research which employs evidence-based methods such as meta-analyses, systematic reviews, and high-quality original studies. However, there is a lack of standardized reporting checklist within anatomical research, and the Anatomical Quality Assurance (AQUA) Checklist was developed to account for this deficit. The AQUA Checklist serves to guide authors in clear reporting of original anatomical studies and is endorsed by the Federative International Committee for Scientific Publications (FICSP). To assure high quality, comprehensive and unambiguous description of methodology and results, the checklist consists of 29 reporting items that should be addressed by authors of original anatomical studies. The AQUA Checklist has been translated into the Spanish language to remove any language barriers and to allow utilization and reproducibility of Spanish anatomical research. Conforming to the reporting items of the AQUA Checklist will help elevate the standards of future original anatomical research and raise the quality of anatomical studies published in Spanish journals

No disponible

A comprehensive review of the anterior fontanelle: embryology, anatomy, and clinical considerations.

PURPOSE: Fontanelles are a regular feature of infant development in which two segments of bone remain separated, leaving an area of fibrous membrane or a "soft spot" that acts to accommodate growth of the brain without compression by the skull. Of the six fontanelles in the human skull, the anterior fontanelle, located between the frontal and parietal bones, serves as an important anatomical diagnostic tool in the assessment of impairments of the skull and brain and allows access to the brain and ventricles in the infant. METHODS: Using a standard database search, we conducted a review of the anterior fontanelle, including its embryology, anatomy, pathology, and related surgical implications. CONCLUSIONS: The diagnostic value of the anterior fontanelle, through observation of its shape, size, and palpability, makes the area of significant clinical value. It is important that clinicians are aware of the features and associated pathologies of this area in their everyday practice.

Nasal Myiasis in Hinduism and Contemporary Otorhinolaryngology.

Various case reports on nasal myiasis written during the 1990s and 2000s state that nasal myiasis, which is known as peenash among South Asian natives, is a form of divine punishment in Hindu mythology, but do not provide citations from Hindu scriptures that would suggest this interpretation. This paper aims to discuss the phenomenon of peenash in a historical context by examining medical literature written during the nineteenth and early twentieth centuries, to identify Hindu texts contributing to the belief of some Hindus that nasal myiasis is a form of divine punishment, and to provide an overview of contemporary treatment for and management of nasal myiasis.

Neural connections between the nervus intermedius and the facial and vestibulocochlear nerves in the cerebellopontine angle: an anatomic study.

PURPOSE: Unexpected clinical outcomes following transection of single nerves of the internal acoustic meatus have been reported. Therefore, this study aimed to investigate interneural connections between the nervus intermedius and the adjacent nerves in the cerebellopontine angle. METHODS: On 100 cadaveric sides, dissections were made of the facial/vestibulocochlear complex in the cerebellopontine angle with special attention to the nervus intermedius and potential connections between this nerve and the adjacent facial or vestibulocochlear nerves. RESULTS: A nervus intermedius was identified on all but ten sides. Histologically confirmed neural connections were found between the nervus intermedius and either the facial or vestibulocochlear nerves on 34 % of sides. The mean diameter of these small interconnecting nerves was 0.1 mm. The fiber orientation of these nerves was usually oblique (anteromedial or posterolateral) in nature, but 13 connections traveled anteroposteriorly. Connecting fibers were single on 81 % of sides, doubled on 16 %, and tripled on 3 %, six sides had connections both with the facial nerve anteriorly and the vestibular nerves posteriorly. On 6.5 % of sides, a connection was between the nervus intermedius and cochlear nerve. For vestibular nerve connections with the nervus intermedius, 76 % were with the superior vestibular nerve and 24 % with the inferior vestibular nerve. CONCLUSIONS: Knowledge of the possible neural interconnections found between the nervus intermedius and surrounding nerves may prove useful to surgeons who operate in these regions so that inadvertent traction or transection is avoided. Additionally, unanticipated clinical presentations and exams following surgery may be due to such neural interconnections.

Is the decline of human anatomy hazardous to medical education/profession?--A review.

PURPOSE: The continuous decrease in teaching time, the artificially created scarcity of competent anatomical faculties and a reduced allocation of resources have brought about the decline of anatomy in medical education. As a result of this, anatomical knowledge and the standard of medical education have fallen with consequences including safety in clinical practice. The aim of the present study is to analyze this declining phase of anatomy and its impact on medical education and to consider corrective measures. METHODS: This article expresses comparative viewpoints based on a review of the literature. RESULTS: Anatomy enables doctors to master the language of medical science so they can communicate with patients, the public and fellow doctors and diagnose and treat diseases successfully in all medical fields. No medical specialist or expert can master their field without adequate knowledge of human anatomy. The shrinkage of anatomical schedules, inadequate faculties and declining allocation of resources is therefore unfortunate. These factors produce stress in both student and faculty creating gaps in anatomical knowledge that means insufficient skill is developed to practice medicine safely. CONCLUSION: This decline is hazardous not only to the medical profession but also to society. Reforms consisting of balanced rescheduling of medical curricula and optimum resource allocation have been proposed to improve the standard of education of doctors.

The surgical anatomy of the inguinal lymphatics.

Knowledge of the lymphatic system plays critical importance in surgical oncology. The study of the lymphatic system and its role in tumor metastasis continues to advance with new anatomical and surgical studies, and with a new study, we can gain a better understanding on how aggressive surgeons need to be with nodal dissection while balancing the complications with overly aggressive approaches. The lymphatics of the inguinal region represent a network of lymph nodes and vessels, which act as the bridge among the lower extremities, pelvis, perineum, and rest of the body. These lymph nodes are of particular importance in the metastatic spread of genitourinary and lower gastrointestinal epithelial cancer to the inguinal nodes. The aim of this article is to reveal the literature with regard to the inguinal lymph nodes and their relation in various carcinomas.

Characterization of the discrepancies between four-dimensional phase-contrast magnetic resonance imaging and in-silico simulations of cerebrospinal fluid dynamics.

The purpose of the present study was to compare subject-specific magnetic resonance imaging (MRI)-based computational fluid dynamics (CFD) simulations with time-resolved three-directional (3D) velocity-encoded phase-contrast MRI (4D PCMRI) measurements of the cerebrospinal fluid (CSF) velocity field in the cervical spinal subarachnoid space (SSS). Three-dimensional models of the cervical SSS were constructed based on MRI image segmentation and anatomical measurements for a healthy subject and patient with Chiari I malformation. CFD was used to simulate the CSF motion and compared to the 4D PCMRI measurements. Four-dimensional PCMRI measurements had much greater CSF velocities compared to CFD simulations (1.4 to 5.6× greater). Four-dimensional PCMRI and CFD both showed anterior and anterolateral dominance of CSF velocities, although this flow feature was more pronounced in 4D PCMRI measurements compared to CFD. CSF flow jets were present near the nerve rootlets and denticulate ligaments (NRDL) in the CFD simulation. Flow jets were visible in the 4D PCMRI measurements, although they were not clearly attributable to nerve rootlets. Inclusion of spinal cord NRDL in the cervical SSS does not fully explain the differences between velocities obtained from 4D PCMRI measurements and CFD simulations.