Standardization of Strategies to Perform a Parafascicular Tubular Approach for the Resection of Brain Tumors in Eloquent Areas.

OBJECTIVE: The aim of this work is to define a methodological strategy for the minimally invasive tubular retractor (MITR) parafascicular transulcal approach (PTA) for the management of brain tumors sited in eloquent areas. METHODS: An observational prospective study was designed to evaluate the benefits of PTA associated with MITRs, tractography and intraoperative cortical stimulation. They study was conducted from June 2018 to June 2021. Information regarding white matter tracts was processed, preventing a potential damage during the approach and/or resection. All patients older than 18 years who had a single brain tumor lesion were included in the study. Patients with a preoperative Karnofsky Performance Scale (KPS) score greater than 70% and a Glasgow Coma Scale (GCS) score > 14 points were included. RESULTS: 72 patients were included in the study, the mean age was 49.6, the most affected gender was male, 12.5% presented aphasia, 11.1% presented paraphasia, 41.6% had motor deficit, 9.7% had an affection in the optic pathway, the most frequently affected region was the frontal lobe (26.3%), the most frequent lesions were high-grade gliomas (34.7%) and the measurement of the incisions was on average 5.58 cm. Of the patients, 94.4% underwent a total macroscopic resection and 90.2% did not present new postoperative neurological deficits. In all cases, a PTA was used. CONCLUSION: Tubular minimally invasive approaches (MIAs) allow one to perform maximal safe resection of brain tumors in eloquent areas, through small surgical corridors. Future comparative studies between traditional and minimally invasive techniques are required to further investigate the potential of these surgical nuances.

The Quality and Readability of English Wikipedia Anatomy Articles.

Forty anatomy articles were sampled from English Wikipedia and assessed quantitatively and qualitatively. Quantitatively, each article's edit history was analyzed by Wikipedia X-tools, references and media were counted manually, and two readability indices were used to evaluate article readability. This analysis revealed that each article was updated 8.3 ± 6.8 times per month, and referenced with 33.5 ± 24.3 sources, such as journal articles and textbooks. Each article contained on average 14.0 ± 7.6 media items. The readability indices including: (1) Flesch-Kincaid Grade Level Readability Test and (2) Flesch Reading Ease Readability Formula demonstrated that the articles had low readability and were more appropriate for college students and above. Qualitatively, the sampled articles were evaluated by experts using a modified DISCERN survey. According to the modified DISCERN, 13 articles (32.5%), 24 articles (60%), 3 articles (7.5%), were rated as "good," "moderate," and "poor," respectively. There were positive correlations between the DISCERN score and the number of edits (r = 0.537), number of editors (r = 0.560), and article length (r = 0.536). Strengths reported by the panel included completeness and coverage in 11 articles (27.5%), anatomical details in 10 articles (25%), and clinical details in 5 articles (12.5%). The panel also noted areas which could be improved, such as providing missing information in 28 articles (70%), inaccuracies in 10 articles (25%), and lack or poor use of images in 17 articles (42.5%). In conclusion, this study revealed that many Wikipedia anatomy articles were difficult to read. Each article's quality was dependent on edit frequency and article length. Learners and students should be cautious when using Wikipedia articles for anatomy education due to these limitations.

[Rethinking Sciatica In View of a Bilateral Anatomical Variation of the Sciatic Nerve, with Low Origin and High Division: Historical, Anatomical and Clinical Approach]. / Repensar a Ciatalgia Perante Variação Anatómica Bilateral do Nervo Isquiático, com Origem Baixa e Divisão Alta: Importância Histórica, Anatómica e Clínica.

INTRODUCTION: The aim of the present study is to report an original, unusual, case of bilateral anatomical variation of the sciatic nerve, with low origin and high division. MATERIAL AND METHODS: Anatomical dissection was performed on a 66 year-old female cadaver. The corpse was embalmed and conserved through our original embalming techniques. RESULTS: The particular anatomical variation was first detected during routine dissection classes for undergraduate students. The study was completed with contralateral dissection to unveil bilateral variation. In both hind limbs, the sciatic nerve had a low origin, deep below the mid-gluteal region, and suffered high division, near the lower margin of the gluteal region, after a short length of circa 8 cm, to divide into the common fibular and tibial nerves. DISCUSSION: We detect several cases of sciatic nerve high division, in the reports of the earliest anatomists, such as Leonardo da Vinci, Vesalius, Da Cortona, or Eustachius. Such ancestral interest for these anatomical variations demonstrates the importance of their knowledge for health professionals of different areas. CONCLUSION: The accurate study of sciatic nerve anatomical variations bears evident surgical, anaesthesiology and clinical applications. As more meticulous as our anatomical studies may get, one will never reach the state of perfection to consider such studies as definitive.

Introdução: O objectivo do presente estudo é o relato de um caso de variação anatómica do nervo isquiático, por origem baixa e divisão alta bilateral.Material e Métodos: Foi dissecado um cadáver feminino de 66 anos, conservado pelas técnicas originais desenvolvidas no nosso departamento.Resultados: No trabalho regular de dissecção cadavérica da disciplina de Anatomia Regional II detectou-se nervo isquiático, em ambos os membros, com pequeno trajecto, de aproximadamente, 8 - 10 cm, dividido em nervos fibular comum e tibial, ao nível da margem inferior do músculo glúteo máximo.Discussão: Casos semelhantes aos do presente estudo, foram descritos por alguns autores desde Leonardo da Vinci, Da Cortona, ou Eustachius, demonstrando a importância desse conhecimento, tanto em termos clínicos, como cirúrgicos ou anestesiológicos. Diversas ilações são possíveis, por revisão do presente caso, infrequente.Conclusão: Para além de proporcionar conhecimento prévio da anatomia loco-regional, o estudo das variações do nervo isquiático orienta o melhor seguimento de patologias, bem como acessos cirúrgicos e/ou anestésicos. Por mais meticulosos que sejam os nossos estudos anatómicos, jamais poderemos considerar terminada ou definitiva a investigação em anatomia humana.

Anatomy of the triceps surae: a pictorial essay.

Gastrocnemius contracture has recently gained relevance owing to its suggested relationship with foot disorders such as metatarsalgia, plantar fasciopathy, hallux valgus, and others. Consequently this has induced a renewed interest in surgical lengthening techniques, including proximal gastrocnemius release, to resolve gastrocnemius contracture in patients with foot disorders. This article describes and discusses the general anatomy of the triceps surae and the surgical anatomy of the gastrocnemius.

Extensor pollicis et indicis communis with triple slips in a bilateral case of accessory muscles of the hand.

The presence and disposition of supernumerary tendons in the fourth extensor compartment of the wrist have been described by several authors. The aim of this communication was to describe a finding in a study of an anatomical dissection of an adult cadaver that presents a rare disposition of extensor tendons in the fourth extensor compartment of both wrists. In the right wrist, we found an extensor pollicis et indicis communis with three slips: two toward the index finger and one toward the thumb. We found no similar reports in a review of the literature. Additionally, we found an extensor indicis radialis in the left wrist. In both hands, the course of accessory slips was modified by fiber derived from intertendinous fascia. Although this represents a small percentage of the distribution of tendons of the dorsal hand, knowledge of these anatomical variations and their relationships to intertendinous fascia is critical for clinical decisions because this area is used frequently in treatments related to tendon graft, transfer, and transplantation.

Extensor pollicis et indicis communis or extensor indicis radialis muscle.

Anatomical variations of the fingers extensor tendons are not uncommon and have been described by several authors. Participation of intertendinous band of fascia in this kind of variation can change muscle functionality. However, this element is scarcely described in the literature. In this case report, we describe the finding of an accessory tendon located between the extensor digitorum communis muscle tendon, destined for the index finger, and the extensor pollicis longus tendon. In an anatomical analysis, we observed a connection between the radial portion of the accessory tendon and the ulnar portion of the extensor pollicis longus tendon by intertendinous fascia. This finding corresponds anatomically to the supernumerary muscle denominated extensor indicis radialis, but due to the fascial connections observed with the extensor pollicis longus, this muscle would behave functionally as a supernumerary muscle denominated extensor pollicis et indicis communis. This report suggests that participation of fascia in muscular variation in this anatomical segment is essential to establish the correct morpho-functional denomination of muscular variants.