Sural nerve harvest for infants: integrated with information based on anatomical dissections

Background/aim: The aim of the present study was to determine the course and possible variations of the sural nerve with all anatomical details in human fetal cadavers. Materials and methods: This study was performed on 60 fetal cadavers. Formation type and level of the sural nerve was detected. Results: According to trimesters, it was determined that the mean transverse and vertical distance between the lowest point of the LM and the SN varied between 1.1 and 2.9 mm and 1.54 and 3.58 mm, respectively. Type 2 was the most common seen type of sural nerve (35.83%). It was determined that the sural nerve was mostly formed at the middle third of the leg (42.5%). Conclusion: Sural nerve graft with the knowledge of the anatomical details may be used for peripheral nerve reconstruction is required in congenital lesions, such as facial paralysis, obstetric brachial paralysis, and posttraumatic lesions in infants and children.

Morphological structure and variations of fetal lateral meniscus: the significance in convenient diagnosis and treatment.

PURPOSE: The aim of this study is to evaluate of morphometry of the lateral meniscus (LM) and determine incidence of the LM shapes. METHODS: This study was performed on fetal cadaver collection of Anatomy Department of Necmettin Erbakan University. Fifty human fetal cadavers (25 female, 25 male human fetal cadavers) were used in this study. Microdissection was performed. Morphometric measurements were performed. LM were classified into four types and five subtypes. RESULTS: In this study, it was identified that all parameters which were measured were found to be increased with gestational ages. Four morphological types and five morphological subtypes were determined. It was found that 12% of the LM were crescent-shaped, 66% of the LM were C-shaped, 14% of the LM were incomplete-disc-shaped, 2% of the LM were disc-shaped, 6% of the LM were variant C-shaped. CONCLUSIONS: A few studies on fetal meniscal anatomy and its development were performed. Each new study is important for having detailed anatomy and development of the fetal menisci which will have both clinical and anatomical impacts during childhood and adulthood for orthopedic surgeons and anatomists, respectively. The most important results of this study were the detailed objective analysis of the macroscopic fetal growth of LM. It was significantly observed that four morphological types and five morphological subtypes of LM. The results of the present study related with both the observation of morphological development of the fetal meniscal anatomy, and its morphological variants, are important in terms of improving our knowledge, and clinical approach on the description, and the management of the symptomatic lateral discoid meniscus tears in children, adolescents, and adults. The clinical relevance of this study was that this classification of fetal menisci could ameliorate our current understanding of the morphology of lateral meniscus in adult, further.

Transfer of the Fifth Finger to Replace an Amputated Thumb: A Preliminary Study.

Amputation of the thumb causes not only loss of significant functional use of the hand but also psychological and social problems. The procedures of toe-to-thumb transfer, pollicization, or metacarpal extension are recognized and well-documented options in thumb reconstruction. Although these techniques have been successfully applied, they have some disadvantages. This study aims to test the feasibility of the fifth finger for thumb reconstruction. The fifth finger was released following exploration of the digital artery, vein, nerve, and flexor and extensor tendons, including the flexor retinaculum. The digital vein and the extensor tendon of the fifth finger were separated at the level of the metacarpophalangeal joint. The proximal phalanx of the fifth finger was cut smoothly at the level of the metacarpophalangeal joint with a saw. The deep flexor tendons, digital arteries, and nerves were preserved. The proximal phalanx of the released fifth finger was fixed to the first metacarpal bone. The digital vein of the first finger was anastomosed to the digital vein of the fifth finger by microsurgery. Angiography was done after the transfer. Exploration till the flexor retinaculum enabled thumb transfer without any restriction of movement in all 10 cadaver fingers. The average total surgical time was 135 ± 12 minutes. Flow from both radial and ulnar arteries was demonstrated in the transferred fifth finger by angiography. The technique appears to be feasible for thumb reconstruction by preserving digital arteries and nerves in a relatively short time, but further important aspects have to be assessed in further clinical studies.

Modified medial Stoppa approach for acetabular fractures: an anatomic study.

BACKGROUND: The modified medial Stoppa approach is an alternative and new surgical approach to access to the internal pelvis and medial wall of the acetabulum. There is little information about the clinical anatomic specifications of exposure in the literature. In this study, the pertinent surgical anatomy that involved the modified medial Stoppa approach was further defined and the anatomic positions and variations of the structures seen in the surgical site were analyzed. METHODS: We dissected five formalized cadavers to present structures at risk in a standard modified medial Stoppa approach. The internal iliac artery and branches were colored with latex injection in formalized cadavers. Morphometrical measurements of the neurovascular structures adjacent to quadrilateral surface and their anatomic variations were noted. RESULTS: It was detected that the obturator vessels and nerve and the iliolumbar vessels were primarily the structures at risk. Obturator vessels and nerve were the most important structures to pay attention because of their direct contact to quadrilateral surface. There was communication (corona mortis) between obturator and inferior epigastric veins in 4 (40%) of 10 hemipelvises. CONCLUSIONS: Before clinical applications, performing cadaver dissection is important to minimize intraoperative complications. This study was the first anatomic study in the literature that reveals the structures that are at risk during surgical treatment of acetabular fractures, which was treated with the modified medial Stoppa approach.

Effects of long-term 50 Hz magnetic field exposure on the micro nucleated polychromatic erythrocyte and blood lymphocyte frequency and argyrophilic nucleolar organizer regions in lymphocytes of mice.

OBJECTIVES: We aimed to investigate the effects of weak extremely low frequency electromagnetic fields (ELF-EMFs) on the nucleus size, the silver staining nucleolar organizer regions (AgNORs), the frequency of micro nucleated peripheral blood lymphocytes (MPBLs) and the micro nucleated polychromatic erythrocytes (MPCEs). METHODS: One hundred and twenty Swiss albino mice were equally divided into 6 groups. The study groups were exposed to 1, 2, 3, 4 and 5 microT 50 Hz-EMFs for 40 days. Micronucleus number (MN) per PBL was determined.. RESULTS: ELF-EMF exposure caused a nonlinear decline of nucleus area. A sharp drop occurred in AgNOR area of 1 microT group, and following it gained an insignificantly higher level than that of the control group. The field did not change mean AgNOR numbers per nucleus of the groups. Relative AgNOR area had the highest level in 1 microT-exposure group, and the level was quite similar to that of the 5 microT-exposure group. The remaining groups had significantly lower values quite similar to that of the control level. The field exposure at any intensity did not affect significantly the frequency of either MPBLs or MPCEs. The number of MN per PBL in the 4 and 5 microT-exposure groups were significantly higher than those of the lower intensity exposure groups. The males in 4 microT-exposure group displayed the highest MN number per PBL, whereas values changed in a nonlinear manner. CONCLUSIONS: The results of the present study suggest that

Reconstruction of large nasal septal perforations with a three layer galeal pericranial flap: an anatomical and technical study.

OBJECTIVES: In this study, a modified surgical method was carried out to repair large nasal septal perforations with a galeal pericranial flap using endoscopic technique. MATERIALS AND METHODS: Six adult human cadavers were dissected by applying the classic open rhinoplasty technique. Large perforations were created in the septal cartilages. To repair the perforations, we prepared galeal pericranial flaps with supraorbital neurovascular pedicles and calvarial bone grafts under endoscopic visualization. The flaps were inserted between the upper lateral cartilages and folded into three layers. The flaps were sutured to the nasal mucosa with absorbable sutures. The length, the width, the size of the flaps and the perforations were measured using an electronic caliper and a flexible ruler. RESULTS: The mean length and width of the flap pedicles were measured as 26.8±5.1 mm (range 20 to 32 mm) and 19.3±2.6 mm (range 15 to 23 mm), respectively. In addition, the mean length and the width of the flaps were 54.1±4.9 mm (range 50 to 60 mm) and 51.6±7.8 mm (range 45 to 63 mm), respectively. All of the nasal septal perforations were repaired with a galeal pericranial flap. CONCLUSION: The galeal-pericranial flap is well-vascularized and similar to the nasal mucosa for tissue thickness. Therefore, reconstruction with galeal-pericranial flaps can be an alternative surgical technique for repair of large nasal septal perforations.

Anatomic and radiologic analysis of the atlantal part of the vertebral artery.

The horizontal third segment (V3h) of the vertebral artery (VA) in 7 cadavers (14 sides) was dissected and the anatomical measurements recorded. Measurements from 24 healthy individuals (48 sides) were taken for comparison using multislice CT scanning. The distance between the medial tip of the VA V3h and the line passing through the mid point of the posterior tuberculum of the atlas was marked as length A. The distance between the medial tip of the VA V3h and the point penetrating the dura mater was classified as length B. The angle between these lines was the alpha (alpha) angle. Measurements were taken when the head was in a neutral position, as well as in maximum right and left rotation, extension and flexion. In cadavers, the mean alpha angle (+/-S.D.) was 82.42+/-10.34 degrees and 83.21+/-10.81 degrees on the right and left side, respectively. On multislice CT scanning, the mean alpha angle was 81.64+/-10.15 degrees on the right and 83.77+/-10.65 degrees on the left. These angles varied with the position of the head.

The course and variations of the branches of the musculocutaneous nerve in human fetuses.

The course and branches of the musculocutaneous nerve (MCN) were dissected in 140 human fetal arms. The MCN entered the superior, middle, and inferior part of coracobrachialis in 43%, 37%, and 17% of arms, respectively, and the remaining 3% did not pierce coracobrachialis. The motor branches to biceps were classified as follows: Type 1 (83.6%): a single branch that bifurcated to supply the two heads of biceps; Type 2 (14.3%): two separate branches each innervating one head of biceps; Type 3 (2.1%): a single branch that bifurcated to supply each head of biceps plus an additional branch that innervated the distal part of biceps. The motor branches to brachialis were classified as follows: Type 1 (93.6%): a single branch to brachialis; Type 2 (6.4%): a single branch that bifurcated into two branches both supplying brachialis. Communications between the MCN and the median nerve (MN) were observed in 10% of specimens, of which three types (A, B, C) could be identified depending on their origin and union. In the most frequently observed type (B, 50% of cases) the communicating branch arose from the proximal part of the MCN and joined the MN in the middle or distal part of arm. The data presented here will be of use to surgeons, especially pediatric surgeons who undertake surgical procedures in the axilla and arm.

Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches.

INTRODUCTION: Radiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit. OBJECTIVE: The goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry. METHODS: This retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations. RESULTS: Lamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14mm, 147.88° and 9.6mm, 152.72°, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3mm, 7.2cm2, 6.89cm2, 4.51cm2 and 12.46cm2 respectively. The orbital height and width were measured as 35.9mm and 39.2mm respectively. The mean orbital cavity depth was 46.3mm from optic foramen to the orbital entrance and the orbital volume was 19.29cm3. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types. CONCLUSION: Precise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.

The lumbar roots and pedicles: a morphometric analysis and anatomical features.

The objective of this study was to conduct a morphometric analysis of the lumbar nerve roots and surrounding structures. In this investigation, the lumbar roots were studied in 14 cadavers (70 lumbar vertebrae). Lumbar pedicle heights and widths were measured at every level of the lumbar vertebrae. The largest mean root diameter was 5.6 mm (L5 root) and the smallest 3.5 mm (L1 root). With regard to the root-dura exit angle, the widest was measured at L1 as 26.2+/-1.6 degrees and the narrowest at L5 as 16.3+/-2.4 degrees. The widest lumbar pedicle was measured at L5 as 17.1+/-4.2 mm and the narrowest at L1 as 8.4+/-1.8 mm. The longest lumbar pedicle was measured at L2 as 15.3+/-2.2 mm and the shortest at L4 as 13.8+/-2.3 mm. Quantitative measurements of lumbar root diameters, their exit angles from the dura, and lumbar pedicle heights and widths in anatomical dissection models may help us to gain a deeper understanding of the pathologies of this region and positively influence the success of surgical interventions.

Determination of the effects of extremely low frequency electromagnetic fields on the percentages of peripheral blood leukocytes and histology of lymphoid organs of the mouse.

OBJECTIVE: To determine the effects of very weak, extremely low frequency (50 Hz) electromagnetic field (ELF-EMF) on the relative spleen weight, lymphoid organ histology, peripheral blood leukocyte and alpha-naphthyl acetate esterase positive (ANAE- positive) lymphocyte percentages of the mouse. METHODS: The study was carried out in Scientific Research and Application Center of Selcuk University, Konya, Turkey in 2005. A total of 120 Swiss albino mice were divided into 6 groups (20 in each group). The experimental animals were exposed to 1, 2, 3, 4 and 5 microT flux intensities (rms) of EMF at 50 Hz for 40 days. RESULTS: In the exposure groups with 20 animals, the body weight (BW) increased gradually in higher field intensities and reached at peak level in the 4 microT, and then slightly decreased. The relative spleen weight (% of the BW) was not affected. The ELF-EMF treatment did not cause any significant change in lymphocyte, monocyte and ANAE-positive lymphocyte ratios, whereas percentages of neutrophils and basophiles changed non-linearly. Any change in the lymphoid organ histology, which is attributable to the field effect, was not observed in the exposure groups. CONCLUSION: Extremely low frequency-EMF exposure with the flux intensities between 1-5 microT for 40 days did not cause any effect on the relative spleen weight, lymphoid organ histology, leukocyte and ANAE-positive lymphocyte percentages of the mouse.

Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery.

INTRODUCTION: The course of the infraorbital canal may leave the infraorbital nerve susceptible to injury during reconstructive and endoscopic surgery, particularly when surgically manipulating the roof of the maxillary sinus. OBJECTIVE: We investigated both the morphometry and variations of the infraorbital canal with the aim to show the relationship between them relative to endoscopic approaches. METHODS: This retrospective study was performed on paranasal multidetector computed tomography images of 200 patients. RESULTS: The infraorbital canal corpus types were categorized as Type 1: within the maxillary bony roof (55.3%), Type 2: partially protruding into maxillary sinus (26.7%), Type 3: within the maxillary sinus (9.5%), Type 4: located anatomically at the outer limit of the zygomatic recess of the maxillary bone (8.5%). The internal angulation and the length of the infraorbital canal, the infraorbital foramen entry angles and the distances related to the infraorbital foramen localization were measured and their relationships with the infraorbital canal variations were analyzed. We reported that the internal angulations in both sagittal and axial sections were mostly found in infraorbital canal Type 1 and 4 (69.2%, 64.7%) but, there were commonly no angulation in Type 3 (68.4%) (p<0.001). The length of the infraorbital canal and the distances from the infraorbital foramen to the infraorbital rim and piriform aperture was measured as the longest in Type 3 and the smallest in Type 1 (p<0.001). The sagittal infraorbital foramen entry angles were detected significantly smaller in Type 3 and larger in Type 1 than that in other types (p=0.003). The maxillary sinus septa and the Haller cell were observed in 28% and 16% of the images, respectively. CONCLUSION: Precise knowledge of the infraorbital canal corpus types and relationship with the morphometry allow surgeons to choose an appropriate surgical approach to avoid iatrogenic infraorbital nerve injury.

Developmental variations and clinical importance of the fetal thyroid gland. A morphometric study.

OBJECTIVE: To investigate the morphologic structures and developmental anomalies of the thyroid gland in human fetuses. METHODS: This study performed in the Department of Anatomy, Meram Faculty of Medicine between February and April in 2002. Fetuses were obtained from the Gynecology Department of the Meram Faculty of Medicine, Selcuk University, and Dr. Faruk Sukan Maternity Hospital (Konya, Turkey). Sixty spontaneously aborted fetuses (30 boys and 30 girls) between the ages of 13.5th and 32.5th weeks, which had no detectable anomalies, were evaluated. The gland was dissected under the microscope. The location of the gland was determined according to the tracheal ring levels and laryngeal cartilage levels. The length, width and thickness of both lobes and isthmus of the gland were measured and then, the developmental anomalies were noted. The obtained data were statistically analyzed by Least Squares in variant analysis. RESULTS: Although there was no significant difference regarding to the gender for all parameters except in width of the right lobe (p<0.05), difference in the length and width of lobes and the length of isthmus between trimesters was significant (p<0.05). All measured parameters were increasing with advancing gestational age. The pyramidal lobe was observed in 18.3% of the cases. CONCLUSION: Normal dimensions and developmental anomalies of the fetal thyroid, which was shown in this study, may provide useful information for the prenatal diagnosis and in-utero treatment of thyroid dysfunctions.

A guideline for femoral nerve block with the age-related formulas obtained from the distances between the femoral nerve and surface anatomical landmarks in fetal cadavers / Una guía para el bloqueo del nervio femoral con fórmulas relacionadas con la edad obtenidas a partir de las distancias entre el nervio femoral y los puntos de referencia anatómicos superficiales en cadáveres fetales

SUMMARY: The femoral nerve (FN) is used for nerve block in many surgeries and provides effective postoperative analgesics in the pediatric population. However, although there are sufficient anatomical maps and signs for femoral nerve blockades in adults, there is not enough information for the pediatric group. Therefore, in our study, we tried to determine an effective area for safe block blocking with the help of bone structures in order to perform effective blockade in younger age groups. The study was conducted on 60 lower limbs. The exit point of the FN was identified. The measurements were examined in two regards, namely the level of the FN and the relationship of the FN with the surrounding structures. For the right and left sides, all the parameters showed increases with age. A significant relationship was found between all the parameters of the fetal cadavers (p<0.01). It was determined that there was a strong correlation between all parameters related to FN and surrounding bone structures (p<0.01). Sex was not found to be significantly related to the other parameters (p<0.05 Among all the fetal cadavers, high-level division was observed in six limbs (10 %), mid-level division in 33 limbs (55 %), and lower-level division in 21 limbs (35 %). Gestational age-based regression equations from my study showed that the site of the blockage could be effectively performed with the aid of palpable bone structures from the outside without the need for technical assistance.

RESUMEN: El nervio femoral (NF) se utiliza para el bloqueo nervioso en muchas cirugías y proporciona analgesia posoperatoria eficaz en la población pediátrica. Sin embargo, aunque existen suficientes mapas anatómicos y signos de bloqueo del NF en los individuos adultos, no hay suficiente información para el grupo pediátrico. Se intentó determinar una área exacta para el bloqueo del NF junto con estructuras óseas para realizar un bloqueo efectivo. El estudio se realizó en 60 miembros inferiores. Se identificó el punto de salida del NF. Las mediciones se realizaron en dos puntos, nivel del NF y la relación de éste con las estructuras circundantes. Para los lados derecho e izquierdo, todos los parámetros mostraron incrementos con la edad. Se encontró una relación significativa entre todos los parámetros de los cadáveres fetales (p<0,01). Se determinó que existía una fuerte correlación entre todos los parámetros relacionados con el NF y las estructuras óseas circundantes (p <0,01). No se encontró que el sexo se relacionara significativamente con los otros parámetros (p<0,05 Entre todos los cadáveres fetales se observó un alto nivel de división en seis miembros (10 %), una división de nivel medio en 33 miembros (55 %) y división de nivel inferior en 21 miembros (35 %). Las ecuaciones de regresión basadas en la edad gestacional del estudio mostraron que el sitio de bloqueo se podría realizar eficazmente con la ayuda de estructuras óseas palpables desde el exterior sin necesidad de asistencia técnica.

A modified technique for bypass of the external carotid artery to the proximal posterior cerebral artery: an anatomical and technical study.

CONCLUSIONS: Our results support the proposition that bypass between the external carotid artery (ECA) and proximal posterior cerebral artery (PCA) can be achieved by using a short saphenous venous graft. The diameters of the ECA and vein graft may provide an increased blood flow with a straighter course. This technique may be helpful for management of patients with vertebrobasilar insufficiency or those requiring a high volume blood flow to the posterior circulation. OBJECTIVES: We aimed to describe a modified technique using a short saphenous vein graft for bypass between the ECA and the PCA in order to use a small length of graft material and increase the patency of the anastomosis. MATERIALS AND METHODS: Ten sides of five cadavers were dissected bilaterally. After a frontotemporal craniotomy and zygomatic arch osteotomy, the middle cranial fossa was exposed. A hole located approximately 2-3 cm posterolateral to the foramen rotunda was created extradurally. The sylvian fissure and the interpeduncular and ambient cisterns were opened. The proximal P2 segment of the PCA was identified. The ECA was found through a cervical incision. A short interposition saphenous vein graft was conducted to pass just behind the ramus mandible to the infratemporal fossa. The bypass between the ECA and P2 segment of the PCA was performed by using a short saphenous vein graft. The diameters of the ECA, P2 segment of PCA and both ends of the saphenous vein graft and its length were measured using an electronic micrometer. RESULTS: The mean cross-clamping time of the PCA was 10.4+/-1.8 min. The mean diameters of the P2 segment of the PCA and ECA were 2.2+/-0.15 mm and 3.83+/-0.28 mm, respectively. The mean length of the saphenous vein graft was 88.8+/-3.8 mm.

Transzygomatic-Subtemporal Approach for Middle Meningeal-to-P2 Segment of the Posterior Cerebral Artery Bypass: An Anatomical and Technical Study.

We evaluated the use of a bypass between the middle meningeal artery (MMA) and P2 segment of the posterior cerebral artery (PCA) as an alternative to an external carotid artery (ECA-to-PCA) anastomosis. Five adult cadaveric heads (10 sides) were used. After a temporal craniotomy and zygomatic arch osteotomy were performed, the dura of the floor of the middle cranial fossa was separated and elevated. The MMA was dissected away from the dura until the foramen spinosum was reached. Intradurally, the carotid and sylvian cisterns were opened. After the temporal lobe was retracted, the interpeduncular and ambient cisterns were opened and the P2 segment of the PCA was exposed. The MMA trunk was transsected just before the bifurcation of its anterior and posterior branches where it passes inside the dura and over the foramen spinosum. It was anastomosed end to side with the P2 segment of the PCA. The mean caliber of the MMA trunk before its bifurcation was 2.1 +/- 0.25 mm, and the mean caliber of the P2 was 2.2 +/- 0.2 mm. The mean length of the MMA used to perform the bypass was 32 +/- 4.1 mm, and the mean length of the MMA trunk was 39.5 +/- 4.4 mm. This bypass procedure is simpler to perform than an ECA-to-P2 revascularization using long grafts. The caliber and length of the MMA trunk are suitable to provide sufficient blood flow. Furthermore, the course of the bypass is straight.

A rare variation of the coeliac trunk.

The hepatic, splenic and Left gastric arteries are considered as the "main classic branches" of the coeliac trunk. During the routine dissections in the laboratory of the Anatomy Department in a 62-year-old male cadaver, a rare variation, a coeliacomesenteric trunk was observed. This trunk gave rise to the left gastric, the common hepatic, the splenic, the left gastro-epiploic, the right and left inferior phrenic arteries. The developmental and clinical significance of this anomalous vessel is discussed.

An investigation of the origin, location and variations of the renal arteries in human fetuses and their clinical relevance.

We investigated the origin, localizations and anatomic variations of the renal artery (RA) in human fetuses with the aim of determining the distribution of these variations according to lateralization and gender. In total, 90 fetuses of spontaneous abortion (45 males, 45 females) with no congenital malformations were included to the study. The abdominal aorta and its branches were dissected after latex solution colored with red ink had been injected into the vessels from the thoracic aorta. In all, 180 RA dissections were performed bilaterally in 90 cases and the anatomic variations were photographed. Right and left RAs were found to originate from the following levels according to the columna vertebralis, respectively: 3.8% and 1.9% lower T12, 67.3% and 25.0% upper L1, 9.6% and 28.8% mid L1, 15.3% and 40.3 lower L1, 3.8% and 3.8% upper 1/3 part of L2 vertebra. The right RA originated from the lateral part and anterolateral wall of the abdominal aorta in 73.0% and 26.9% of cases while the lateral and anterolateral wall origin percentages of left RA were 90.3% and 9.6%, respectively. The origin site of the right RA from the abdominal aorta was superior to, at the same level with, and inferior to that of the left RA in 53.8%, 34.6% and 11.5% of the cases, respectively. There were no variations in 75% of the cases whereas the remaining 25% had several variation patterns. The presented morphological results are as follows: A single hilar artery in 75% of the cases, double hilar arteries in 11.1%, an inferior polar artery in 10.5%, and a superior polar artery in 3.3% of specimens studied. Anatomical variations were observed more frequently among male fetuses and on the right side. Knowledge of RA variations is important for surgeons in performing many procedures and may help to avoid clinical complications, especially, during radiological examination and/or surgical approaches in the abdominal region.

Superficial temporal artery graft for bypass of the maxillary to proximal middle cerebral artery using a transantral approach: an anatomical and technical study.

CONCLUSION: Using a transantral approach, we examined a new bypass of the maxillary artery (MA) to proximal middle cerebral artery (MCA). The caliber of the MA was suitable to provide sufficient blood flow. The length of the graft was shorter and it had a straighter course in the new technique than in previously described techniques. OBJECTIVE: To examine a new bypass of the MA to proximal MCA using a transantral approach as an alternative to other forms of anterior circulation bypass surgery. MATERIAL AND METHODS: The method was applied to five adult cadavers bilaterally. The MA and its branches were easily found after removal of the posterior sinus wall using a transantral approach. Then, a hole was created in the sphenoid bone 5-6 mm lateral to the posteroinferior edge of the superior orbital fissure extradurally. After the carotid and sylvian cisternae had been opened, the M2 segment of the MCA was exposed. The MA was transected just before the origin of the descending palatine artery branch. After opening the dura over the hole, the MA was passed through the hole to reach the intracranial cavity. The proximal side of the superficial temporal artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the M2 segment of the MCA. RESULTS: The mean caliber of the MA was 2.4+/-0.3 mm before the origin of the descending palatine artery branch. The mean caliber of the largest trunk of the M2 segment of the MCA was 2.3+/-0.3 mm. The average length of the graft was 24+/-3 mm.

A modified technique to bypass the maxillary artery to supraclinoid internal carotid artery by using radial artery graft: an anatomical study.

OBJECTIVE: This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to the supraclinoid internal carotid artery (ICA) in treating ICA occlusions. STUDY DESIGN AND SETTING: This method was carried out on five adult cadaver sides. The MA was reached 1-2 cm inferior to the crista infratemporalis, following a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2-3 cm lateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4 mm tipped drill. A radial artery graft was passed through the hole to the inside of the dura. Before giving the infraorbital artery branch, the MA was dissected from the surrounding tissue and transected. The proximal end of the graft was anastomosed end-to-end with the MA and the distal end of the graft end-to-side with the supraclinoid ICA. RESULTS: The mean calibre of the MA was 2.6 +/- 0.3 mm. The mean calibre of the proximal end of the radial artery graft was 2.5 +/- 0.25 mm and the distal end was 2.35 +/- 0.2 mm. The mean length of the radial artery graft was 4.0 +/- 0.5cm. CONCLUSION: This study suggested that the cases with ICA occlusion, which require high blood flow, may be treated as an alternative to current bypass methods requiring long vein grafts.