Discovery of a trans-sellar vascular supply for the pituitary gland.

The vasculature of the pituitary gland is discussed briefly and the details of an anatomical discovery of the vessels supplying the pituitary gland provided. Twenty latex injected cadaveric heads were dissected. Any vessels that were found to penetrate the sella turcica and travel to the pituitary gland were documented and measured. Additionally, 25 adult skulls were evaluated for the presence, size, and sites of bony foramina in the floor of sella turcica. Trans-sellar vessels were identified in 65% of specimens. There was a mean of 1.5 vessels per specimen consisting usually of a mixture of veins and arteries. The mean diameter of these vessels was 0.3 mm and the mean length from the sella turcica to the pituitary gland was 2.3 mm. These vessels were concentrated in the most concave part of the sella turcica. In bony specimens, the mean number of trans-sellar foramina was four. The diameter of these foramina ranged from 0.3 to 0.6 mm in size. The trans-sellar foramina were concentrated near the center part of the sella turcica and had no regular pattern. The pituitary gland receives at least some blood supply and drainage via vessels traveling along the septum of the sphenoidal sinuses and through the sella turcica. Knowledge of such vessels might lead to a better understanding of the vascular supply and drainage of the pituitary gland and would be useful during skull base approaches such as trans-nasal approaches to the pituitary gland.

Novel Use of Nerve Branch to Sartorius as Donor for Intrapelvic Neurotization of the Sciatic Nerve and Its Contributions.

BACKGROUND: Sciatic nerve injuries are relatively infrequent but extremely disabling for the patient. As injury to this nerve is relatively infrequent, there is little about its repair in the literature, especially within the pelvis. METHODS: Twelve adult embalmed cadavers (24 sides) underwent exposure of the anteromedial thigh, inguinal region, and pelvic cavity. The sartorius muscle was identified in the anterior thigh, and its nerve branches from the femoral nerve were isolated and traced proximally to the femoral nerve trunk. The isolated sartorius nerve branches were further traced to the pelvic part of the femoral nerve. Next, the lumbosacral plexus was dissected on the posterior aspect of the pelvis so that its constituent parts were seen and followed distally to also visualize the most proximal part of the sciatic nerve. The previously dissected nerve branches to sartorius were then transposed to these constituent parts, and the ability for a tension-free anastomosis between these 2 nerves was evaluated. RESULTS: The branches ranged in diameter from 1.89 to 3.1 mm (2.88 mm). The average length of the nerves was 17.3 cm. Transposition of these branches to all ventral rami of the lumbosacral plexus in the pelvis and proximal sciatic (intrapelvic) nerve was possible on all cadaveric sides. CONCLUSIONS: Our cadaveric study found that nerve branches to the sartorius muscle can be transposed intrapelvically to the lumbosacral plexus and could provide tension-free anastomoses for neurotization procedures in patients with nerve injury.

A case series of penetrating spinal trauma: comparisons to blunt trauma, surgical indications, and outcomes.

OBJECTIVEWhile blunt spinal trauma accounts for the majority of spine trauma, penetrating injuries affect a substantial number of patients. The goal of this study was to examine the epidemiology of penetrating spine injuries compared with blunt injuries and review the operative interventions and outcomes in the penetrating spine injury group.METHODSThe prospectively maintained trauma database was queried for spinal fractures from 2012 to 2018. Charts from patients with penetrating spine trauma were reviewed.RESULTSA total of 1130 patients were evaluated for traumatic spinal fractures; 154 injuries (13.6%) were secondary to penetrating injuries. Patients with penetrating injuries were significantly younger (29.2 years vs 44.1 years, p < 0.001), more likely male (87.7% vs 69.2%, p < 0.001), and more commonly African American (80.5% vs 33.3%, p < 0.05). When comparing primary insurers, the penetrating group had a significantly higher percentage of patients covered by Medicaid (60.4% vs 32.6%, p < 0.05) or prison (3.9% vs 0.1%, p < 0.05) or being uninsured (17.5% vs 10.3%, p < 0.05). The penetrating group had a higher Injury Severity Score on admission (20.2 vs 15.6, p < 0.001) and longer hospital length of stay (20.1 days vs 10.3 days, p < 0.001) and were less likely to be discharged home (51.3% vs 65.1%, p < 0.05). Of the penetrating injuries, 142 (92.2%) were due to firearms. Sixty-three patients (40.9%) with penetrating injuries had a concomitant spinal cord or cauda equina injury. Of those, 44 (69.8%) had an American Spinal Injury Association Impairment Scale (AIS) grade of A. Ten patients (15.9%) improved at least 1 AIS grade, while 2 patients (3.2%) declined at least 1 AIS grade. Nine patients with penetrating injuries underwent neurosurgical intervention: 5 for spinal instability, 4 for compressive lesions with declining neurological examination results, and 2 for infectious concerns, with some patients having multiple indications. Patients undergoing neurosurgical intervention did not show a significantly greater change in AIS grade than those who did not. No patient experienced a complication directly related to neurosurgical intervention.CONCLUSIONSPenetrating spinal trauma affects a younger, more publicly funded cohort than blunt spinal trauma. These patients utilize more healthcare resources and are more severely injured. Surgery is undertaken for limiting progression of neurological deficit, stabilization, or infection control.