Arteriovenous Anastomosis in Human Hand Digital Skin.

While a digital arteriovenous anastomosis (Hoyer-Grosser's organ, Masson's glomus) is a well-known structure, photographic evidence of communication between arterial and venous lumens might not be demonstrated in routine histological or immunohistochemical analysis. Abundant clusters of so-called glomera were found in semi-serial sections of the distal aspect of 14 fingers obtained from 7 donated elderly cadavers. Two to six round or oval clusters were observed in each longitudinal section (over 0.3-0.6 mm in maximum diameter) in subcutaneous tissue 0.5-1.5 mm below the basal layer of the skin, whereas none were often observed in transverse sections. Lumen-to-lumen communication between arteriole and venule at 8 sites in 2 cadavers was identified in these clusters of glomera. The opening in the arteriole was large (50 µm in diameter) at 3 sites in specimens from an 80-year-old man, whereas it was small (10-30 µm) at 5 sites in those from a 91-year-old man. The arterial aspect was tightly surrounded by abundant nerve fibers expressing tyrosine hydroxylase immunoreactivity, whereas the venous part was not. No or little expression of S100 protein immunoreactivity suggested that these nerve fibers were unmyelinated. The morphology at the lumen-to-lumen communication was simple - possibly an end-to-end anastomosis - rather than a sinuous curve of arteriole opening on to a short funnel-shaped venule as seen in the standard textbooks.

Development and growth of the craniocervical junction with special reference to topographical relationship between the occipital basion, the anterior arch of atlas, and the odontoid process of axis: A study using human fetuses.

The embryonic occipital bone and odontoid process of the axis are attached and connected by the notochord, but become separated in later development and growth. With special attention to the process of separation, we examined sagittal sections of the craniocervical junction in 18 human fetuses at 8-16 weeks and 22 fetuses at 31-37 weeks. At 8-9 weeks, the anterior arch of atlas was always seen overriding the occipital basal part. The odontoid process was close to the occipital with or without a transient joint cavity until 16 weeks. Near term, the top of the odontoid process was usually higher than the anterior arch, but the former was sometimes (7 of 22) at a level almost equal to or lower than the latter. The apical ligament was evident in a few specimens (5 of 22). A distance between the occipital basion and odontoid process was sometimes less than 1.5 mm (8 of 22) or less than half the thickness of the arch (10 of 22). A transient joint cavity between the basion and odontoid process was often (10 of 22). In three fetuses near term, the atlanto-occipital joint cavity was continuous with the median atlanto-axial joint cavity, and the anterior arch was overriding the occipital basal part. Therefore, rather than stage or age, individual differences were evident in the topographical relationship between the three bony elements at the craniocervical junction. An understanding of the embryology and normal development will aid in the correct interpretation of radiologic images of the pediatric cervical spine.

Topographical anatomy of the tentorium cerebelli and venous confluences in human midterm fetuses.

Early development of veins and sinuses at and around the posterior cranial fossa seemed not to be shown by photographs except for our recent study (Ann Anat, 2020). Examination of histological sections of 38 fetuses at 10-16 weeks gestational age (GA) demonstrated that: (1) the superior petrosal sinus passed posterosuperiorly through the tentorium cerebelli and, distant and lateral to both the cerebellum and internal ear, drained into the transverse sinus; (2) the superior sagittal sinus was underdeveloped, and the inferior sagittal sinus was not yet evident; (3) the straight sinus (STS) originated from a joining of the bilateral pial veins from the lateral ventricular choroid plexus, passed through the inferoposterior part of the falx cerebri, reached the initial confluens sinuum, and then divided into the bilateral transverse sinuses. The STS origin was immediately behind the pineal body, and near the inferoposterior end of the third ventricle. The falx had a thick attachment to the tentorium below the entire course of the STS and was behind other parts of the brain. Therefore, the development and growth of the posterior dural system seemed to be independent from brain growth, and occurred well before the cerebellum grew to fill the posterior cranial fossa. A basic configuration of intracranial veins and sinuses, including embryonic transient veins (such as the vena capitis prima) seemed to be established by venous return from the choroid plexus and cranial wall, without greatly increasing the abundance of neuronal or glial cells in the brain.

Suboccipital myodural bridges revisited: Application to cervicogenic headaches.

There seems to be no complete demonstration of the suboccipital fascial configuration. In 30 human fetuses near term, we found two types of candidate myodural bridge: (1) a thick connective tissue band running between the rectus capitis posterior major and minor muscles (rectus capitis posterior major [Rma], rectus capitis posterior minori [Rmi]; Type 1 bridge; 27 fetuses); and (2) a thin fascia extending from the upper margin of the Rmi (Type 2 bridge; 20 fetuses). Neither of these bridge candidates contained elastic fibers. The Type 1 bridge originated from: (1) fatty tissue located beneath the semispinalis capitis (four fetuses); (2) a fascia covering the multifidus (nine); (3) a fascia bordering between the Rma and Rmi or lining the Rma (13); (4) a fascia covering the inferior aspect of the Rmi (three); and (5) a common fascia covering the Rma and obliquus capitis inferior muscle (nine). Multiple origins usually coexisted in the 27 fetuses. In the minor Type 2 bridge, composite fibers were aligned in the same direction as striated muscle fibers. Thus, force transmission via the thin fascia seemed to be effective along a straight line. However, in the major Type 1 bridges, striated muscle fibers almost always did not insert into or originate from the covering fascia. Moreover, at and near the dural attachment, most composite fibers of Type 1 bridges were interrupted by subdural veins and dispersed around the veins. In newborns, force transmission via myodural bridges was likely to be limited or ineffective. The postnatal growth might determine a likely connection between the bridge and headache. Clin. Anat. 32:914-928, 2019. © 2019 Wiley Periodicals, Inc.