Descriptive Analysis of Sphenovomerine Suture and Its Importance in Neurosurgery.

PURPOSE: Articulation of rostrum of sphenoid bone with alae of vomer forms a schindylesis type of joint. The circumference of this joint, called sphenovomerine suture (SVS), is very important in establishing a reliable surgical field in the endoscopic transsphenoidal pituitary surgery. Because of its vital role in endoscopic transsphenoidal pituitary surgery, this radio-anatomical study was designed to establish the morphological properties of SVS. METHODS: In this study, the authors examined SVS in 235 patients (121 females and 114 males) on the computed tomography images of the paranasal sinus and made 4 measurements to describe SVS. RESULTS: The mean distance between superior margin of the upper labial philtrum and top of SVS was 6.66 ±â€Š0.43 cm for females and 7.44 ±â€Š0.54 cm for males. The distance between the top of SVS and dorsum sellae was 3.08 ±â€Š0.33 cm for females and 3.19 ±â€Š0.32 cm for males, the alae of vomer angle in the upper surface was 74.22 ±â€Š20.06° for females and 74.23 ±â€Š19.68° for males. The distance between the most lateral points of 2 alae of vomer was 0.99 ±â€Š0.17 and 1.01 ±â€Š0.19 cm for females and males, respectively. CONCLUSIONS: For an easy and successful operation, removal of the SVS is very important as it will provide a better view of the sellar base and make the management of the surgical instruments easier in the wider safe surgical field thus created.

Is preoperative paranasal sinus computed tomography necessary for every patient undergoing septoplasty?

BACKGROUND: The aim of this study was to determine whether anterior rhinoscopy (AR), nasal endoscopy (NE) and paranasal sinus computed tomography (PNS CT) can predict other sinonasal obstructive pathologies in the setting of nasal septal deviation (NSD), and to evaluate the impact of preoperative PNS CT on the decision for a surgical procedure in patients with NSD. METHODS: A total of 262 patients with NSD were evaluated using AR, NE, PNS CT, and the visual analogue scale (VAS) for nasal obstruction. The diagnostic values of AR, NE, and PNS CT for sinonasal obstructive pathologies, and the impact of preoperative PNS CT on the decision for a surgical procedure in patients with NSD were evaluated. RESULTS: PNS CT showed concomitant nasal pathologies in the 62 of 262 patients (23.6%) with NSD. Positive predictive value (PPV) and negative predictive value (NPV) of NE for concomitant nasal pathologies were 0.75 and 0.069, respectively. The sensitivity of NE for sinonasal pathologies was significantly higher in the patients with mild NSD than in the patients with moderate-severe NSD. The decision for a surgical procedure was changed in 22 of 262 (8.3%) patients after a PNS CT. CONCLUSION: We recommend performing preoperative PNS CTs on patients in whom septoplasty is planned, if they have obstructive middle turbinate hypertrophy, if one is unable to evaluate the middle meatus and posterior nasal cavity because of an anteriorly severe deviation or a nasal polyp, and in patients with chronic sinusitis based on clinical and endoscopic findings.

A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case.

During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. The superior trunk bifurcated into anterior and posterior divisions, the anterior division continued as the lateral cord forming the MCN. The posterior division gave off the subscapular branch. The inferior trunk trifurcated into radial, median, and ulnar nerves. The radial nerve gave off the axillary and thoracodorsal nerves. The ulnar nerve gave off the median cutaneous nerves of the arm and forearm. The median nerve received a small ascending branch from the MCN. On the right side, there was a communicating branch from the MCN to the MN in the lower third of the arm region. This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists.