Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery

CONTEXT: The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP), which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP) by a ligament known as the caroticoclinoid ligament (CCL), which may be ossified, forming the caroticoclinoid foramen (CCF). Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons. CASE REPORT: We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.

CONTEXTO Y OBJETIVO: El extremo intermedio de la frontera posterior del hueso del sphenoid presenta el proceso anterior del clinoid (ACP), que está alcanzado generalmente para las operaciones que implican el espacio clinoidal y el sino cavernoso. El ACP es conectado a menudo con el proceso medio del clinoid (MCP) por un ligamento conocido como el ligamento del carotico-clinoid (CCL), que puede ser osificado, formando el agujero del clinoid del carotico (CCF). Las variaciones del ACP con excepción de la osificación, son raras. El CCL osificado puede tener efectos compresivos en la arteria carótida interna. El conocimiento así anatómico y radiológico del ACP y del espacio clinoidal es también importante mientras que funciona en la arteria carótida interna. La supresión del ACP se puede requerir para muchos cirugía basada cráneo y la presencia de cualquier anomalía tal como CCL osificado, puede plantear un problema para el neurocirujano. INFORME DEL CASO: Observamos la presencia de CCL osificado en un hueso del cráneo. Un estudio radiológico detallado del CCL y del CCF fue conducido. Las medidas morphometric fueron registradas y las fotografías fueron tomadas. El ACP fue conectado con el MCP y convertido en un CCF. En vista del hecho, los libros de textos de esa anatomía del estándar no proporcionan la descripción morfológica y la evaluación radiológica de CCL, el actual estudio puede ser importante para los neurocirujanos que funcionan en la región del ACP.

Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery.

CONTEXT: The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP), which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP) by a ligament known as the caroticoclinoid ligament (CCL), which may be ossified, forming the caroticoclinoid foramen (CCF). Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons. CASE REPORT: We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.

Ossification of superior transverse scapular ligament and its clinical implications.

The superior transverse scapular ligament (STSL) bridges the suprascapular notch, converting it into a suprascapular foramen. The suprascapular nerves and the vessels traverse through the suprascapular foramen of the scapula. Often the STSL is ossified to produce compression of the suprascapular nerves producing resultant symptoms. The entrapment of the suprascapular nerve by the ossified STSL may result in symptoms like pain in the shoulder region and also result in wasting and weakness of the supraspinatus and infraspinatus muscles. Such a condition has to be differentiated from other conditions like rotator cuff tears. Often asymptomatic cases make the diagnosis difficult. The present study reports the anomalous ossified STSL detected in a bone specimen, discusses its anatomical and radiological aspects and describes its clinical implications.

Unusual occipital condyles of the skull: an osteological study with clinical implications

CONTEXT: The occipital condyles of the skull articulate with the superior articular facets of the atlas vertebra and form an important junction between the cranium and the vertebral column. The morphological features of occipital condyles are relevant in biomechanical, anatomical and clinical studies. OBJECTIVE: To describe the anatomical profile of unusual occipital condyles detected in a bone specimen. CASE REPORT: The present osteological study provides a detailed morphological description of unusual occipital condyles showing uneven and serrated surfaces and also displaying longitudinal and transverse grooves on the left and right sides respectively. The case study also discusses the clinical importance of such anomalies. Precise anatomical knowledge of the occipital condyles is important for any craniovertebral operative procedures such as resection of the occipital condyles.

CONTEXTO: Os côndilos occipitais do crânio se articulam com as facetas superiores da vértebra atlas e formam uma importante junção entre o crânio e a coluna vertebral. As características morfológicas dos côndilos occipitais são relevantes em estudos biomecânicos, anatômicos e clínicos. OBJETIVO: Descrever o perfil anatômico de côndilos occipitais incomuns observados em uma amostra óssea cadavérica. RELATO DE CASO: O estudo osteológico aqui apresentado mostra a detalhada descrição morfológica de côndilos occipitais incomuns com superfícies desproporcionais e serradas, e também com sulcos longitudinais e transversais à esquerda e à direita, respectivamente. O estudo do caso também discute a importância clínica dessas anomalias. O conhecimento anatômico preciso dos côndilos occipitais é importante para qualquer procedimento cirúrgico como, por exemplo, a ressecção de côndilos occipitais.

Unusual occipital condyles of the skull: an osteological study with clinical implications.

CONTEXT: The occipital condyles of the skull articulate with the superior articular facets of the atlas vertebra and form an important junction between the cranium and the vertebral column. The morphological features of occipital condyles are relevant in biomechanical, anatomical and clinical studies. OBJECTIVE: To describe the anatomical profile of unusual occipital condyles detected in a bone specimen. CASE REPORT: The present osteological study provides a detailed morphological description of unusual occipital condyles showing uneven and serrated surfaces and also displaying longitudinal and transverse grooves on the left and right sides respectively. The case study also discusses the clinical importance of such anomalies. Precise anatomical knowledge of the occipital condyles is important for any craniovertebral operative procedures such as resection of the occipital condyles.

A duplicated spinous process of the C7 vertebra.

Normally the 7th cervical vertebra (C7) has a long non-bifid spine. A bifid spine is a feature of typical cervical vertebrae such as C3--C6. In contrast to past studies, which have described a bifid spine in the C3--C6 cervical vertebrae, this study is a report on the presence of a duplicated spinous process in the C7 vertebra with an intervening space. The presence of such anomalies may be associated with other congenital anomalies and needs a careful and thorough clinical approach. This is an extremely rare finding which may be of clinical interest to radiologists, neurologists, orthopaedic surgeons, anthropologists and forensic personnel. The present case report describes the anatomical details in the bone specimen along with its radiological picture in a case of a duplicated spinous process of the C7 vertebra.

Anatomical observations on os inca and associated cranial deformities.

The present study describes the presence of os inca, incomplete metopic suture with asymmetrical frontal sinuses and multiple sutural deformities in a skull bone. Os inca has been reported to be associated with other cranial deformities. However, the present study, besides reporting os inca and associated sutural abnormalities, also highlights the presence of an unusual pterion in such cases. The aim is to provide anatomical insight into the morphology of sutures, frontal sinuses and associated cranial abnormalities. These are important findings which may be relevant for surgeons and radiologists in clinical practice.

A supernumerary maxillary tooth: its topographical anatomy and its clinical implications.

A supernumerary tooth was detected in the left maxilla during an osteology teaching session with undergraduate medical students. Supernumerary teeth have previously been detected in individuals who have approached a dental surgeon with a complaint and who have then been diagnosed by X-ray. Asymptomatic cases are frequently not diagnosed in time and it is only the malalignment or delayed eruption of the tooth which raises the suspicion that this type of dental anomaly is present. The present paper highlights the anatomico-radiological study of a supernumerary maxillary tooth in a bone specimen and describes its clinical implications. Precise anatomical details of the supernumerary maxillary tooth might be of significant clinical interest to dental and maxillofacial surgeons in drawing up a plan for orthodontic treatment and may thus minimise the possible complications involved.

Clinical importance of unusual patterns of tendinous intersections of rectus abdominis muscle.

The objective of the present study was to note the different patterns of tendinous intersections of rectus abdominis muscle and its surgical importance. The tendinous intersections of rectus abdominis muscle were studied in dissected 46 human cadavers dissected over a span of 3 years. Only two unusual patterns of intersections; one with tendinous intersections arched, and the other with the intersections at different levels on the right and left sides of the same cadaver, were observed, in two different cadavers. The tendinous intersections are the sites of anastomosis of numerous blood vessels. Surgeons using the the Transverse Rectus Abdominis (TRAM) flap in autogenous breast constructive surgeries should be aware of such unusual patterns so as to design the TRAM flap accordingly. Biomechanics of rectus abdominis muscle may also be influenced by arched pattern of tendinous intersections instead of normal transverse pattern.