The Vertebral Artery Convergence to the Cervical Spine in Elders.

BACKGROUND: In the older population, tortuosity of the vertebral artery (VA), uncovertebral joint (UVJ) osteoarthritis, and abnormal vertebral alignment may alter the normal anatomy. AIM: We aimed to determine the anatomical variations and relationships between the cervical segment of the VA and the cervical spine with regard to ageing. MATERIALS AND METHODS: In this retrospective cross-sectional study, the computed tomography angiography scans of 110 subjects were reviewed. Any variations in the VA, UVJ degeneration were identified. The distance between the VA and uncinate process (UP) was measured electronically. The distance between the VA and UP were compared according to the age group (group A < 45, group B = 45-65, and group C > 65 years-old). RESULTS: With regard to the transverse foramen, 7.2% of the cases had entering abnormalities of the VA, while in one case (0.83%), the right VA had an exiting abnormality (exiting from the C2 instead of the C1). UVJ degeneration was found to be significantly higher in the older age group (p < 0.05). Furthermore, at the C4-C7 levels, the distances between the VA and UP were significantly smaller in the older age group (p < 0.01). CONCLUSIONS: The VA-UP distance has been shown to decrease due to increasing UVJ osteoarthritis in the elderly. The convergence of the VA toward the spine occurs at the most mobile segment of the cervical spine, and this anatomical alteration may predispose temporary and/or permanent vertebral artery occlusion clinically, and be dangerous during cervical spine surgery.

Age-related morphologic changes of the vertebral artery in the transverse process. Analysis by multidetector computed tomography angiography.

BACKGROUND CONTEXT: The V2 segment of the vertebral artery (VA) ascends and passes through the transverse foramen (TF) of the C6-C1 vertebrae. Atherosclerosis of the VA and degenerative changes in the cervical spine are likely to occur with aging, and subsequent morphologic changes may alter the normal anatomy. PURPOSE: The aim was to determine the morphologic changes of TF and VA in relation to aging. STUDY DESIGN/SETTING: This was a retrospective cross-sectional study. PATIENT SAMPLE: One hundred ten consecutive patients who had undergone computed tomography angiography were included. METHODS: The subjects were then divided into three groups according to age: Group A, less than 45 years; Group B, from 45 to 65 years; and Group C, older than 65 years. Cases with stenosis and dissection of the VA were excluded from the quantitative analysis. The areas of the VA and TF were measured, and the VA/TF occupation ratio (OR) was calculated accordingly. The presence of VAs tortuosity within the TF was also noted. RESULTS: The TF was larger in the oldest group, but the difference was not statistically significant. There was also no significant statistical difference among the age groups in terms of the VA and VA/TF ORs (p>.05). In the Group C, the rate of overall tortuosity of the VA was 73%, and arterial tortuosity in the TF was 28.6%. In cases with tortuous VA, C6 and C4 TFs were found to be significantly larger. CONCLUSIONS: Tortuous VAs tend to be associated with enlargement of C6 and C4 TFs. Knowledge of such changes in the anatomy is crucial during instrumentation used for cervical spine surgeries, to prevent serious complications in patients aged older than 65 years.

Investigation of the nerve distribution pattern of leg muscles in rat.

Information about the distribution of intramuscular nerve fibres within the skeletal muscles will enhance the understanding of their morphological structure and functions. This study was designed to examine the entire intramuscular nerve distribution pattern in rat leg muscles. The tibialis cranialis, tibialis caudalis, extensor digitorum longus, flexor digitorum longus, gastrocnemius, peroneus longus and brevis muscles were dissected from origo and insertion points under a surgical microscope in seven rats. These skeletal muscles from right hindlimbs were stained with Sihler's stain. The diameter of extramuscular and major nerve branches, number of major and minor nerve branches and anastomoses were measured and photographed under a stereomicroscope. In addition, serial sections were obtained from the left hindlimb muscles with S100 immunohistochemical staining and transferred to the computer to reconstruct images. A significant difference was found between the gastrocnemius and tibialis caudalis (p < 0.001), flexor digitorum longus and tibialis caudalis (p < 0.003), and peroneus longus and tibialis caudalis (p < 0.049) with regard to the diameter of major branches. The gastrocnemius was significantly different from the flexor digitorum longus, peroneus longus, extensor digitorum longus, tibialis caudalis and tibialis cranialis with regard to the number of minor nerve branches (p < 0.001). Knowledge of the branching pattern and some key landmarks, such as the number and diameter of major and minor nerve branches and the number of anastomoses between the nerve branches of skeletal muscles, is helpful in surgical or therapeutic interventions and botulinum toxin injections in areas of high extramuscular and intramuscular nerve density.

Anatomical, radiological and histological investigation of the great and small saphenous veins.

OBJECTIVE: To provide information on superficial veins of the lower limb such as anatomic variations, valve distribution, termination forms, and histological properties of vein walls. METHODS: Two hundred greater saphenous veins in 200 patients and 10 cadavers were investigated. Ultrasound examinations were performed in the Department of Radiology, Ataturk Hospital between December 2004 and October 2005. RESULTS: The lateral accessory branch of the great saphenous vein was found in 75 persons while in 48 persons no major branch was encountered. In addition, medial accessory branch of the great saphenous vein was observed in 17 (8.5%) on both sides. The popliteal type of termination was found in 211 cases. The small saphenous vein gave off perforating branches to the popliteal vein in 29 persons. The diameters of such veins were all measured on both sides of the cadavers and ultrasonographically on patients. Statistical analyses revealed no significant difference. One hundred and fifty-six valves were classified according to their position and type. The maximum number of valves was found in the first interval and the minimum number was in the second interval. The valves were mostly in Type III format. CONCLUSION: Knowledge on the anatomic variations and characteristics of the valves of the superficial veins of the lower limbs can be helpful in clinical practice and surgical operations concerning the lower extremity.

Qualitative comparison of anatomical microdissection, Sihler's staining and computerized reconstruction methods for visualizing intramuscular nerve branches.

UNLABELLED: STATING BACKGROUND: This study was designed to examine the entire intramuscular nerve distribution pattern of various human skeletal muscles in fetuses. METHODS: In the present study rhomboid major, trapezius, long head of the biceps femoris and masseter muscles were investigated in five 18 weeks old fetal cadavers. Anatomical microdissection was applied to one fetal cadaver. In two fetuses, the extramuscular (main), major and minor nerve branches, and anastomosis were examined using Sihler's staining and labeling. In the remaining two fetuses, consecutive slices with 0.5 mm interval and 5 microm thickness were obtained from each skeletal muscle. These slices were stained with S100 for the demonstration of the nerve fibers and thereafter 3D reconstruction images were constituted using PC software. RESULTS: Anatomical microdissection, Sihler's staining and computerized reconstruction methods were compared to demonstrate the intramuscular nerve distribution pattern. Demonstration of the intramuscular minor nerve branches and anastomosis showed difficulties in anatomical dissected specimens when compared with three-dimensionally reconstructed images and specimens obtained with Sihler's staining technique. Nevertheless, anatomical dissection is a simple method whereas Sihler's technique and computer aided 3D reconstruction are complex methods and take a long time to complete. CONCLUSION: The obtained information exposed that staining technique and the 3D reconstructions appeared to provide better results than did anatomical dissection.

Numerical variation of the celiac trunk and anatomical variation in origin and course of the dorsal pancreatic artery.

A numerical anomaly of the celiac trunk and anatomical variation in origin, and course of the dorsal pancreatic artery were encountered during a routine upper abdomen dissection of a 62-year-old male cadaver. The aim of this study was to describe a rare celiac trunk and dorsal pancreatic artery variation in detail, which can be a guide and precaution during operative procedures in this region. The abdominal aorta, its branches and the pancreas were cut and removed just above the celiac trunk and below the superior mesenteric artery to investigate the vascular distribution of the pancreas in detail. The celiac trunk divided into the left gastric, hepatic, splenic, and dorsal pancreatic arteries. The anatomical variation of the celiac trunk and splenic artery makes it vulnerable to iatrogenic surgery. Knowledge of the existing aberrations is important in planning and conducting surgical procedures.

Observation of the relationship between the shape of skeletal muscles and their nerve distribution patterns: a transparent and microanatomic study.

BACKGROUND: There are many gaps in the understanding of the neuroanatomy of skeletal muscles with regards to the nerve distribution pattern and shape of the muscles. This study was designed to examine the entire intramuscular nerve-distribution patterns of various human skeletal muscles. METHODS: The relationships among nine skeletal muscles with various architecture (rhomboid major, biceps brachii, flexor pollicis longus, rectus femoris, sternohyoid, trapezius, masseter, digastric muscles) and their nerve-distribution patterns were investigated in four fetal cadavers using the Sihler staining method. The diameter and number of extramuscular (main) and major nerve branches, the number of minor nerve branches, and anastomoses were examined and evaluated statistically. RESULTS: With regards to the number of extramuscular (main) nerve branches, the rhomboid major muscle resembled the flexor pollicis longus, trapezius, masseter, and sternohyoid muscles, and the anterior belly of the digastricus muscle (p > 0.05), whereas it was significantly different from the rectus femoris, the posterior belly of digastricus, and the long and short heads of the biceps brachii (p < 0.05). Trapezius and masseter muscles were different from all of the skeletal muscles that were studied with regards to the diameter of main branches (p < 0.05). The masseter muscle had the largest diameter (p < 0.05). With regards to the number of minor nerve branches, the sternohyoid muscle was significantly different from all the skeletal muscles that were studied (p < 0.05) except the short head of the biceps brachii, rectus femoris, and the posterior belly of digastricus (p > 0.05). As for the number of neural anastomoses, the sternohyoid muscle was statistically different from all skeletal muscles that were studied (p < 0.05) except the masseter and trapezius muscles (p > 0.005). CONCLUSIONS: A surgeon's thorough knowledge of the relationship between the shape and nerve distribution pattern of skeletal muscles is important in successful reinnervation and regeneration of these muscles. It might also be useful in the field of muscle transplantation.

Rare variation of the celiac trunk and related review.

In this study, we report a rare variation of the branching of the celiac trunk. During a routine abdominal dissection on a female cadaver, we found the celiac trunk to emerge from the abdominal aorta as 2 roots named hepatogastric trunk and hepatosplenic trunk. The hepatogastric trunk arises from the anterior surface of the abdominal aorta and divides into an aberrant branch to the right lobe of the liver, a branch to the right hemi diaphragm, the left hepatic and the left gastric arteries. The hepatosplenic trunk, which arises 1.5 cm below the hepatogastric trunk, gave off the common hepatic and splenic arteries. The common hepatic artery divided into the gastroduodenal, the right branch to the hepatic and the cystic arteries. It is important to know the variations of hepatogastric trunk and hepatosplenic trunk for the success of surgical operations to the liver and radiological investigations of those regions.

Axillopectoral muscle (Langer's muscle).

In a routine dissection of the axillary fossa, a muscle originating from the coracoid process of the scapula and extending to the long head of triceps brachii muscle was observed. The mentioned muscle was adhering to both the triceps brachii muscle and the tendinous part of the latissimus dorsi muscle. This anatomical variation is referred to as axillary arch (Langer's muscle or axillopectoral muscle). The muscle mass was measured 9.6 cm in length and 1.4 cm in width. The accessory muscle can be a reason of an axillary mass and can exert pressure on the neighboring neurovascular bundle or lymph routes; thus, exposing a wide range of symptoms. Therefore, variations of this area should be kept in mind in surgical interventions.

Variations in the anatomy of the auriculotemporal nerve.

The common representation of the auriculotemporal nerve is either that of a single posterior branch of the mandibular nerve or of two roots that envelope the middle meningeal artery. Our observation in the anatomy of the auriculotemporal nerve on 32 dissections (16 cadaveric heads) of the infratemporal fossa included: one specimen with four roots (3.1%), three specimens with three roots (9.4%), 12 specimens with two roots (37.5%), and 16 specimens with one root (50%). Furthermore, a connecting nerve branch was observed between auriculotemporal and inferior alveolar nerves in four specimens, and in another auriculotemporal nerve case, between the upper and lower roots. In the cadaver of a 70-year-old male, a four-rooted auriculotemporal nerve variation was found. These four branches lay to the posterior, combined at the posterosuperior of the maxillary and superficial temporal arteries and formed a ganglion-like knot. From this knot, four branches stemmed and ran to the temporomandibular joint, external acoustic meatus, zygoma, and parotid gland. The knot was larger and thicker than expected; thus, it was removed and stained with haematoxylin-eosin (H&E) and S100 for histological studies. This structure was not a true ganglion but a structure formed by fusion of nerve fibers.

Intrauterine structure of foot muscles in talipes equinovarus due to high-level myelomeningocele: a light microscopic study in fetal cadavers.

The purpose of this study was to investigate the light microscopic structure of extrinsic foot muscles in talipes equinovarus (TEV) deformity that developed during intrauterine life due to high-level myelomeningocele. Ten feet of five fetal cadavers ranging in age from 18 to 20 weeks were dissected. Five feet had typical TEV deformity and the other five feet did not have any deformity (control group). Under light microscopic examination quantitative measurement of both muscle fiber sizes and fibrosis in the muscle tissue were performed to investigate the denervation muscle atrophy. Mean muscle fiber size of the TEV group was found to be significantly lower than that of the control group in all foot muscles except the gastrocnemius muscle. The proportion of fibrosis due to denervation atrophy was significantly higher in the TEV group than in the control group in all muscles. This situation was most evident in the peroneus longus muscle. It was concluded that muscular imbalance due to significant muscular atrophy might be the cause of TEV deformity that developed during intrauterine life due to high-level myelomeningocele.

Demonstration of the nerve distribution of the extraocular muscles in rabbits (Oryctolagus cuniculus).

PURPOSE: The intramuscular nerve distribution of the extraocular muscles may be of utmost importance for better understanding of their physiologic and pathologic reactions. The aim of this study was to determine the entire intramuscular nerve distribution pattern of rabbit extraocular muscles by utilizing Sihler's staining technique. METHODS: Six New Zealand rabbits were used in order to demonstrate the intramuscular nerve distribution of the extraocular muscles by using Sihler's staining method. RESULTS: The number of extramuscular and intramuscular major nerve branches were higher in the inferior oblique muscle while the number of intramuscular minor nerve branches were higher in the superior oblique muscle when compared with the other extraocular muscles. The smallest number of extramuscular branch and intramuscular both major and minor branches were found in the medial rectus muscle. More complex anastomoses and a branching pattern were observed in the superior oblique and superior rectus muscle. The anastomosing nerve branches were observed to run in a "Y", "I" or "U"-shaped pattern in all of the extraocular muscles. Of all the extraocular muscles, the longest major nerve branches were observed in the retractor bulbi muscles. However, these branches had the smallest diameter. No morphological difference was observed between the two sides with regard to all the characteristics of the extraocular muscles. CONCLUSION: Sihler's neural staining technique could be quite useful in the demonstration of the intramuscular nerve distribution of extraocular muscles.