Anatomy of the sphenopalatine artery and its implications for transnasal neurosurgery.

BACKGROUND: The knowledge of sinonasal vasculature is inevitable in transnasal neurosurgery. We performed an anatomical study on the sphenopalatine artery from the perspective of skull base procedures. METHODOLOGY: To analyse the anatomical landmarks of the sphenopalatine artery, arterial skull corrosion casts (26 head halves) underwent endoscopic transnasal phantom surgery. Furthermore, we performed microsurgical dissection on formaldehyde-fixated cadavers with arterial perfusion (14 head halves) as well as studied Cone Beam CT-scans of anonymised patients and cadavers (115 head sides). RESULTS: In our cadaveric material, the sphenopalatine foramen is located at the transition of the superior and middle nasal meatus (95.0%) or in the superior nasal meatus (5.0%). It is the main entry point of the branches of the sphenopalatine artery into the nasal cavity. In most cadaveric cases (25.0%), at this level there are 2 branches superiorly and 1 vessel inferiorly to the ethmoid crest. An average of 2.4 vessels leave the sphenopalatine foramen superiorly to the ethmoid crest, 97.8% of them belong to the sphenopalatine arterys posterior septal branches. An average of 2.1 branches leave the sphenopalatine foramen inferiorly to the ethmoid crest; all of them belong to the posterior lateral nasal branches. There are no cases with a single artery at the plane of the sphenopalatine foramen. We describe a triangular bony structure bordering the sphenopalatine foramen anteriorly which is built up by the palatine and ethmoid bone as well as the maxilla. According to the radiographic studies, this triangular prominence is surrounded superiorly by a posterior ethmoid cell (57.4%), the sphenoid sinus (41.7%) or the orbit (0.9%) with a varying contribution of the superior nasal meatus; inferolaterally by the maxillary sinus (98.3%) or the pterygopalatine and infratemporal fossa (1.7%) and inferomedially by the middle nasal meatus. The medial vertex of the bony triangle corresponds to the ethmoid crest of the palatine bone. In transnasal endoscopic surgery, the posterior lateral nasal branches of the sphenopalatine artery appear at the triangle's inferomedial edge, the posterior septal branches emerge at its superior edge. CONCLUSIONS: The triangular bony structure is a landmark to find and differentiate the posterior lateral nasal and posterior septal branches of the sphenopalatine artery and to identify the sphenoid sinus.

Vascularization of the trapeziometacarpal joint and its clinical importance: anatomical study.

Few studies have investigated the vascular anatomy of the trapeziometacarpal (TM) joint of the thumb. The aim of our study was to describe the supplying arteries of the trapezium and the TM joint since this knowledge is essential for trapezium osteotomies. Ten anatomical dissections in ten different cadavers using two different techniques (four macerations, six classic dissections) were performed. The arteries of the TM joint originated from the radial artery and the princeps pollicis artery. Four important branches were identified. The arteries formed a vascular network around the joint. The dorsoradial surface of the joint contained the richest arterial network. These findings present an important consideration when performing an osteotomy of the trapezium.

Perisynaptic aggrecan-based extracellular matrix coats in the human lateral geniculate body devoid of perineuronal nets.

The extracellular matrix surrounds different neuronal compartments in the mature nervous system. In a variety of vertebrates, most brain regions are loaded with a distinct type of extracellular matrix around the somatodendritic part of neurons, termed perineuronal nets. The present study reports that chondrotin sulfate proteoglycan-based matrix is structured differently in the human lateral geniculate body. Using various chondrotin sulfate proteoglycan-based extracellular matrix antibodies, we show that perisomatic matrix labeling is rather weak or absent, whereas dendrites are contacted by axonal coats appearing as small, oval structures. Confocal laser scanning microscopy and electron microscopy demonstrated that these typical structures are associated with synaptic loci on dendrites. Using multiple labelings, we show that different chondrotin sulfate proteoglycan components of the extracellular matrix do not associate exclusively with neuronal structures but possibly associate with glial structures as well. Finally, we confirm and extend previous findings in primates that intensity differences of various extracellular matrix markers between magno- and parvocellular layers reflect functional segregation between these layers in the human lateral geniculate body.

Donor face reconstruction in a case of facial allotransplantation: technical note.

Families of organ donors are much more reluctant to approve donation of the corneas, face, and hands than of internal organs. The idea to "sacrifice" the face of a dead loved one is shocking to many. Moreover, most national laws, including Belgian laws, demand respect for the corpse. When mourners view an open coffin, visible parts such as the hands and face should appear normal. Hence, careful donor face reconstruction is required in a case of facial allotransplantation. We present a technique for donor face reconstruction that is both expedient and cost-effective. Instead of laboratory-cured silicone or acrylic polymers with internal and external coloration, an A-silicone impression material with a 2-minute set time and external colouring is used.

Surgical anatomy of the cribriform plate and adjacent areas.

Continuous improvement of surgical techniques is needed in skull base surgery in order to decrease intraoperative complications during various operations. However, the basis of minimizing damage in the operative field is a comprehensive knowledge of microsurgical anatomy. This article provides a detailed description of the cribriform plate and adjacent areas, based on investigations of over one thousand dried skulls and 225 computerized tomography scans of the anterior skull base. The main anatomic structures and the different types of the cribriform plate are demonstrated on color photographs and identified on CT scans as well. The variations important in anterior skull base approaches are also discussed and compared with the data found in the literature. The surface anatomy and development of the cribriform plate is described.

Real-time endoarticular ultrasound imaging of the TMJ--a new diagnostic possibility? A cadaver study.

Recent advances in ultrasound imaging suggested endoarticular ultrasound imaging of the temporomandibular joint (TMJ) in combination with TMJ-arthroscopy as a new diagnostic method. Our investigations were performed on human cadavers, in combination with traditional TMJ-arthroscopy. During our investigations, the main articular structures were identified: the glenoid fossa of the temporal bone, articular disc, condyle of the mandible, and retrodiscal tissue. The combination of arthroscopy and ultrasound imaging provides more information on position, movement, and pathological changes in joint structures. Although all of the advantages, disadvantages, indications, and complications of this new diagnostic procedure are not yet clear, the authors consider this new method a useful diagnostic procedure for TMJ imaging.

[Endoscopic anatomy of the tympanic cavity]. / A dobüreg endoszkópos anatómiája.

Development of modern diagnostic procedure requires inframacroscopic description of tympanic cavity. This description has to suit the special requirements of diagnostic endoscopy, too. The authors made an attempt to describe clinical anatomy of the tympanic cavity. For endoscopic investigation transtympanic, transtubal and transmastoidal approaches were used, out of which the transmastoidal has the least clinical importance. Using the transtympanic approach, detailed anatomical description of the medial wall, the auditory ossicles and the stapedius muscle can be given. Using the transtubal approach, the epitympanic region, stapedius and tensor tympani muscle and two major nerves, chorda tympani and tympanic nerve can be also investigated. Using transmastoidal approach, auditory ossicles were seen, but it was possible to identify lateral part of epitympanic recess, as well.

The "rete mirabile" of the clivus and the dorsum sellae. A microanatomical study.

The osteofibrous space underneath the dura mater of the dorsoclival area was studied with respect to the arterial branches arising from the internal carotid artery at this level. Special attention was given to the main variations of branching and anastomosing patterns found in this area. Our results indicate that the meningohypophyseal trunk is the main supplier of the dorsoclival area. The dorsal meningeal artery was present in all cases. In the course of this vessel three main variations were observed. The inferior hypophyseal and the tentorial artery also contributed to the arterial supply of this region. A large number of anastomoses between the internal and external carotid artery was present as well. Because of the refinement of microsurgical and interventional techniques pathological lesions like tumors and vascular malformations of the dorsoclival area are frequently accessible. The knowledge of the microvascular anatomy of the clivus and the dorsum sellae is important as the rich collateral network found in this area may contribute to the arterial supply of pathological lesions arising here.

The meningohypophyseal trunk and its blood supply to different intracranial structures. An anatomical study.

50 meningohypophyseal trunks of the intracavernous internal carotid artery were studied in 25 human cadavers. Special attention was given to the main variations of branching patterns of this trunk. The dorsal meningeal arteries were found in all cases and three typical variations were observed in their origins and courses: a prominent medial branch (52%), a bifurcating type (38%) or a single lateral branch was present (10%). The tentorial artery of Bernasconi-Cassinari arised as a single branch in 64% of the cases, while in 36% two or more branches took a direct origin from the main trunk. The inferior hypophyseal artery was prominent in 82% of the cases. The inferolateral trunk had a common origin with the meningohypophyseal trunk in 8% of our dissections. A large number of anastomoses between these vessels was observed. As a number of tumorous and vascular pathologies, which can be treated with microsurgical techniques, take their origin from the cavernous sinus, the knowledge of the smaller vessels arising from the intracavernous internal carotid artery as well as their main variations is important.

[Additional roentgen-anatomical examination of OP (orthopantomography) pictures]. / OP-felvételek kiegészítö röntgenanatómiai vizsgálata.

The authors examined various anatomical details which appeared in the OP pictures with varying frequency and in various recognisable forms. They sought to help to a more perfect implementation and evaluation of techniques which are considered to be relatively new in our country.