Latex vascular injection as method for enhanced neurosurgical training and skills.

Background: Tridimensional medical knowledge of human anatomy is a key step in the undergraduate and postgraduate medical education, especially in surgical fields. Training simulation before real surgical procedures is necessary to develop clinical competences and to minimize surgical complications. Methods: Latex injection of vascular system in brain and in head-neck segment is made after washing out of the vascular system and fixation of the specimen before and after latex injection. Results: Using this latex injection technique, the vascular system of 90% of brains and 80% of head-neck segments are well-perfused. Latex-injected vessels maintain real appearance compared to silicone, and more flexible vessels compared to resins. Besides, latex makes possible a better perfusion of small vessels. Conclusions: Latex vascular injection technique of the brain and head-neck segment is a simulation model for neurosurgical training based on real experiencing to improve surgical skills and surgical results.

The Vertebrobasilar Trunk and Its Anatomical Variants: A Microsurgical Anatomical Study.

BACKGROUND: The trunk of the basilar artery has not been included in microanatomy studies. Anatomical variants of the perforant branches of the vertebrobasilar trunk and their relationship with neural structures are very important in surgical approaches. Surgical dissection for the treatment of vascular lesions requires a perfect knowledge of the microsurgical anatomy. METHODS: We conducted a descriptive analysis of 50 brains, which were fixed with formalin at 10% for 2 weeks, and the arterial system was injected with colored latex. After microsurgical dissection, it was divided into three segments: the lower portion went from the anterior spinal artery to the anteroinferior cerebellar artery, the middle segment was raised from the upper limit of the lower portion to the origin of the superior cerebellar artery, and the upper segment ranged from the previous portion until the origin of the posterior cerebral artery. RESULTS: The basilar artery had an average length of 30 mm. The average diameter at its junction with the vertebral arteries was 4.05 mm. The average middle segment was 3.4 mm in diameter and 15.2 mm in length. The diameter of the upper segment was 4.2 mm, and its average length was 3.6 mm. The average number of bulbar arteries was three, and their average diameter was 0. 66 mm. The number of caudal perforator arteries were five on average, with a diameter of 0.32 mm. We found three rare cases of anatomical variants in the vertebra-basilar junction. CONCLUSIONS: The basilar artery emits penetrating branches in its lower, middle, and upper portions. The origin of penetrating branches was single or divided after forming a trunk. However, we observed long branches from perforant arteries.

Seno cavernoso: anatomía, histología y terminología.

BACKGROUND: Although the cavernous sinus (CS) has been studied since 1695, its anatomy and name are still under discussion. METHOD: Anatomy and histology of 40 CS from human cadavers were studied, included both from a newborn specimen. RESULTS: Two walls limit the CS, an inferior medial one composed only of the dura's outer layer and a superior lateral one consisting of both dura's layers. Sinusoidal veins pass through the lateral wall of the CS as a transition between venous tributaries and the CS. An endothelial layer covers the inner surface of the CS and the outer surface of the internal carotid artery. The space within the CS shows trabeculae, which are rarer in adults compared to the newborn. The loss of trabeculae in the CS may be a natural process along with life. CONCLUSIONS: In conclusion, the CS is a real sinus, and the term "cavernous sinus" is appropriately applied.

ANTECEDENTES: Si bien el seno cavernoso (SC) ha sido estudiado desde 1695, su anatomía y nombre aún están bajo discusión. MÉTODOS: Se estudiaron la anatomía y la histología de 40 SC de cadáveres humanos, incluyendo los dos de un recién nacido. RESULTADOS: El SC está limitado por dos paredes, una inferomedial compuesta solo por la capa más externa de la duramadre y otra superolateral compuesta por ambas capas de la duramadre. Hay venas sinusoidales que atraviesan la pared lateral del SC formando una transición entre venas tributarias y el SC. Una capa endotelial recubre la superficie interna del SC y la superficie externa de la arteria carótida interna. El espacio dentro del SC presenta trabéculas, las cuales son escasas en el adulto en comparación con el recién nacido. La pérdida de trabéculas en el SC puede ser un proceso natural a lo largo de la vida. CONCLUSIONES: En conclusión, el SC es un verdadero seno, por lo que el término «seno cavernoso¼ se aplica de forma correcta.

Neuroanatomical basis of Wallenberg syndrome.

Wallenberg syndrome, or lateral medullar syndrome, is the clinical presentation of the infarct in the territory of posterior inferior cerebellar artery. Its signs and symptoms include vertigo, nystagmus, diplopia, ipsilateral Horner syndrome, facial ruddiness and dry skin, dysphonia, dysphagia, dysarthria, ipsilateral loss of gag reflex, ipsilateral ataxia, ipsilateral impaired taste, ipsilateral facial pain and paresthesia, decreased ipsilateral blink reflex, contralateral hypoalgesia and thermoanaesthesia in the trunk and limbs; and ipsilateral facial hypoalgesia and thermoanaesthesia. Neuroanatomical knowledge is essential to its comprehension, study and diagnosis, because the classic neurological manifestations are easy to explain and understand if function and localization of affected anatomical structures are known as if the posterior cerebral circulation is.

El síndrome de Wallenberg, o síndrome bulbar lateral, es la manifestación clínica del infarto en el territorio de irrigación de la arteria cerebelosa posteroinferior. Su presentación incluye vértigo, nistagmo, diplopía, síndrome de Horner, rubicundez y anhidrosis facial homolateral, disfonía, disfagia, disartria, pérdida homolateral del reflejo nauseoso, ataxia homolateral, disgeusia homolateral, dolor y parestesia faciales homolaterales, pérdida o disminución homolateral del reflejo corneal, hipoalgesia y termoanestesia de tronco y extremidades contralaterales, hipoalgesia y termoanestesia facial homolateral. El conocimiento neuroanatómico es imprescindible para su comprensión, estudio y diagnóstico, ya que sus manifestaciones neurológicas clásicas son fácilmente explicables y entendibles si se conocen la función y la localización de las estructuras anatómicas afectadas, así como la irrigación cerebral posterior.

White Matter Topographic Anatomy Applied to Temporal Lobe Surgery.

BACKGROUND: The temporal lobe is an important and complex anatomic region of the brain. Accurate knowledge of anatomic relationships becomes extremely relevant when deciding surgical strategy, such as epilepsy or oncologic surgery, involving this lobe. To our knowledge, there is no strong literature highlighting the relationship between white matter tracts and craniometric landmarks applied to temporal lobe surgery. We aim to describe the topographic relationship between the craniometric points and white matter tracts of the temporal lobe through dissection of cadaveric specimens and describe the potential preoperative usefulness of diffusion tensor imaging in relation to the anatomic features found during the dissections. METHODS: Fifteen formalin-fixed whole cadaveric heads were dissected by the Klingler technique in a stepwise manner across the temporal and sphenoid bone windows. The white matter pathways were identified in their different planes and their position was described in relation to craniometric landmarks. Diffusion tensor studies were performed in 2 healthy volunteers to analyze the temporal fasciculi in vivo. RESULTS: We identified the topographic relationships between craniometric points and relevant association tracts that lie within the cranial corridors (superior and inferior frontal, parietal, occipital, sphenoidal, and temporal). Important landmarks were defined in correspondence to these different fasciculi. CONCLUSIONS: Through this kind of microsurgical anatomic study, a better understanding of the different anatomic layers of the temporal region might be achieved. This factor is essential in planning adequate surgery and strategies to operate in the temporal lobe, improving surgical results and minimizing functional deficits.

Microsurgical Anatomy and Approaches to the Cerebral Central Core.

OBJECTIVE: Through a cadaveric study, we divided the cerebral central core (CCC) into different areas and have proposed a corresponding neurosurgical approach for each sector. As a secondary objective, we analyzed the cortical and subcortical microsurgical anatomy of the CCC. The CCC includes the insula, extreme capsule, claustrum, external capsule, lenticular nucleus, internal capsule, caudate nucleus, and thalamus. METHODS: Twelve adult human brain hemispheres and one cadaveric head specimen were dissected and studied at the Laboratory of Neuroanatomic Microsurgical of the University of Buenos Aires. Nine cases of CCC neurosurgical pathologies were included in the present study and analyzed. Digital drawings were created of the approaches proposed for each sector of the CCC showing the most relevant surgical details. Photographs of each dissection and measurements obtained were taken. RESULTS: We divided the CCC into a medial, intermediate, and lateral sector, with specific subdivisions for the lateral and medial sectors. The lateral projection of the foramen of Monro was found deep to the third short gyri of the insula with the following distances: anterior insular limen margin, 23.95 mm; posterior insular limen margin, 22.92 mm; superior limiting sulcus, 14.99 mm, and inferior limiting sulcus, 13.76 mm. We have proposed the following approaches: an ipsilateral transcallosal approach, a contralateral transcallosal approach, a choroidal transfissure approach, a trans-splenial approach, transparietal access entering the intraparietal sulcus, and trans-sylvian approach. The preoperative imaging studies should be analyzed using our method to select the most accurate and safe approach. CONCLUSIONS: We have provided a description of the limits and anatomy of the CCC using brain dissection, an analysis of operated cases, and useful measurements for the neurosurgeon.

Anatomia Microquirúrgica y Abordajes al Central Core Cerebral / Microsurgical Anatomy and Approaches to the Central Core Cerebral

Objetivos: A través del estudio cadavérico dividir al central core cerebral (CCC) en diferentes áreas y proponer para cada sector el abordaje neuroquirurgico correspondiente. Como objetivo secundario analizaremos la anatomía neuroquirúrgico cortical y subcortical del CCC. Introducción : El CCC es descripto como un bloque que descansa sobre el tronco del encéfalo. Incluye la ínsula, capsula extrema, claustro, capsula externa, núcleo lenticular, capsula interna, núcleo caudado y el tálamo. Material y Métodos: Se estudiaron 12 hemisferios cerebrales humanos adultos y una cabeza en el ­LaNeMic- de la Universidad de Buenos Aires, analizamos 9 casos de patologías neuroquirúrgicas del CCC y dibujos digitales de los abordajes propuestos para cada sector del CCC. Se tomaron fotografías de cada disección y las mediciones obtenidas con calibre digital. Resultados: Dividimos al CCC en un sector medial, intermedio y lateral; con subdivisiones específicas para el lateral y medial. La proyección lateral del foramen de Monro se encontró en el tercer giro corto de la ínsula con las distancias: MILA: 23,95 mm; MILP: 22,92 mm; SLS: 14,99 mm y SLI: 13,76 mm. Proponemos los siguientes abordajes: abordaje transcalloso homolateral, abordaje transcalloso contralateral, abordaje trans-fisura coroidea, abordaje trans-esplenial, acceso trans-parietal ingresando al surco intraparietal y abordaje trans-silviano. Discusión: Se deben analizar los estudios preoperatorios del paciente, comprendiendo las lesiones según la ubicación y de ese modo seleccionar el abordaje más preciso y seguro. Conclusiones: Se provee a través de este trabajo una descripción de los límites y anatomía del CCC, empleando disecciones cerebrales, análisis de casos operados y de medidas útiles para el neurocirujano.

Objectives: Through the cadaveric study, we divide the cerebral central core (CCC) in different areas and propose the corresponding neurosurgical approach for each sector. As a secondary objective, we will analyze the cortical and subcortical microsurgical anatomy of the CCC. Introduction: The CCC is described as a block that rests on the trunk of the brain. It includes the insula, extreme capsule, claustro, external capsule, lenticular nucleus, internal capsule, caudate nucleusand thalamus. Material and Methods: We studied 12 adult human brain hemispheres and one head in the -LaNeMic- of the University of Buenos Aires, analyzed 9 cases of CCC neurosurgical pathologies and digital drawings of the approaches proposed for each sector of the CCC. Photographs of each dissection and measurements obtained with digital caliber were taken. Results: We divide the CCC into a medial, intermediate and lateral sector; with specific subdivisions for the lateral and medial. The lateral projection of the foramen of Monro was found in the third short gyri of the insula with the distances: MILA: 23.95mm; MILP: 22.92mm; SLS: 14.99mm and SLI: 13.76mm. We propose the following approaches: ipsilateral transcallosal approach, contralateral transcallosal approach, choroidal trans-fissure approach, trans-splennial approach, trans-parietal access entering the intraparietal sulcus, and trans-silvian approach. Discussion: The preoperative studies of the patient should be analyzed, understanding the lesions according to the location and in this way selecting the most accurate and safe approach. Conclusions: A description of the limits and anatomy of the CCC is provided through this work, using brain dissections, analysis of operated cases and useful measurements for the neurosurgeon.

El tratamiento de la cervicalgia con la terapia Su-Jok / Su-Jok therapy for cervicalgia treatment

Introducción: alrededor del 10% de la población adulta sufre, en algún momento de su vida, de cervicalgia. La columna cervical mantiene el equilibrio de la cabeza, lo que explica el aumento de la incidencia de cervicalgias, como consecuencia de posturas incorrectas, obligadas y mantenidas por un largo tiempo. Objetivo: determinar, según variables sociodemográficas y biomédicas, la eficacia de la terapia Su-Jok en el tratamiento de la cervicalgia. Métodos: se realizó un estudio cuasi experimental en la Sala de Rehabilitación del Policlínico Mario Gutiérrez Ardaya, del municipio de Holguín, en el período septiembre de 2015 a febrero de 2016. Remitidos por diferentes consultorios médicos, la muestra estuvo constituida por 30 pacientes. Se les aplicó la terapia Su-Jok, con el objetivo de eliminar los síntomas y las sensaciones dolorosas. Resultados: el sexo femenino resultó el más afectado con un 66,67% y los pacientes de 30 a 39 años alcanzaron un 50%. La actividad laboral que más pacientes afectó fue la de los cuentapropistas, con el 40%. Antes de la intervención, en el 63,33% predominaba el dolor severo. Luego de esta, el 76,67% presentó dolor ligero. El 53,33% de los pacientes mejoraron de la 5ta a la 8va sesión. Conclusiones: para la cervicalgia, la terapia Su-Jok es efectiva. En el futuro se requieren ensayos clínicos aleatorios controlados, que validen definitivamente la terapia utilizada.

Introduction: nearly 10% of adult population has a cervicalgia episode. Cervical spine keeps head balance; without it, muscular structure is forced to work harder. Cervicalgias raise is the result of long hours forced body positions. Objective: determining the effectiveness of Su-Jok therapy on cervicalgia treatment, according to biomedical and demographical variables. Methods: a quasi-experimental survey was carried out at the rehabilitation ward of "Mario Gutierrez Ardaya" clinic, at Holguín municipality, from September 2015 to February 2016. Sample was composed by 30 patients, referred to our center by their family doctors. Therapy was applied and the technique used was Su-Jok, to diminish symptoms and pain. Results: patients were 30-39 years old with 50%. Female were the most affected up to 66.67%. Self-employed patients were the most affected with 40%. Before the intervention, severe pain lead numbers with 63.33% and later, 76.67% showed light pain. The 53.33% of patients showed positive reactions from the 5th till 8th sessions. Conclusions: Su-Jok therapy is effective in cervicalgia. Controlled clinical trials are required therapy validation and usage.

Fractal anatomy of the hippocampal formation.

PURPOSE: We believed that the hippocampal complex is a fractal, and we try to demonstrate it. METHODS: We selected 12 magnetic resonance (MR) studies from healthy brains. Five women and 7 men without neurological or psychiatric disease were analyzed. The age range was 50-71 years old, with a mean 57.1 ± 7.6 years. Image series of MR were obtained through 3D SPGR in scanner GE Singa 3.0 T (general Electric, USA), matrix acquisition 512 Å-512 Å-120, field size 240 mm, voxel size 0.47 mm Å-0.47 mm Å-1.2 mm, repetition time of 13 ms and eco time of 5.6 ms. The MRI were imported in DICOM format in the OsiriXsoftware where they were contoured. Post processing was done with ImageJ software; Box Counting method for fractal analysis and we also used the Box Counting method of the BoneJ plugin. RESULTS: All of the hippocampus analyzed were a fractal. The fractal dimension analysis distribution of the measurements had a central tendency. The mean of hippocampal fractal dimension was 1.32635, the range was from 1.3373 to 1.5344. We found a short interval of variability in the hippocampal fractal number. CONCLUSIONS: The hippocampal complex is a fractal. The fractal analysis must be an objective measurement that can help us as a descriptive tool in hippocampal anatomy and maybe in a close future in the diagnosis of anatomical alterations.

Estudio fitoquímico de Tridax procumbens L. (romerillo) / Phytochemical Study of Tridax procumbens L. (romerillo)

Se realizó el estudio fitoquímico de Tridax procumbens L. (romerillo), en laboratorio provincial de control y calidad de la provincia de Holguín, se realizó la maceración del follaje de la planta con solventes de polaridad creciente por 24 horas en frascos de vidrio; para determinar los metabolitos secundarios de la planta. Las características macromorfológicas se correspondieron con las que se reportan para esta especie. Se logró determinar la presencia de metabolitos secundarios de esta planta siendo recolectada en estación de verano. El tamizaje fitoquímico evidenció la presencia de esteroides, flavonoides, aminoácidos y azúcares reductores. A esta especie medicinal se le reporta un gran número de propiedades terapéuticas que se corresponden con los metabolitos encontrados.

A phytochemical study of Tridax procumbens L. (romerillo) was carried out at provincial laboratory of control and quality of Holguín province, to determine the presence of secondary metabolites this plant by maceration of the foliage, being recollected in summer season with solvents of increasing polarity 24 hours in glass flasks. Macromorphological characteristics corresponded with those reported for this species. The phytochemical study evidenced the presence of steroids, flavonoides, amino acids and reducing sugars. To this medicinal sort has been attached a large number of therapeutic properties that correspond with metabolites found.

Estudio fitoquímico de Tridax procumbens L. (romerillo) / Phytochemical Study of Tridax procumbens L. (romerillo)

Se realizó el estudio fitoquímico de Tridax procumbens L. (romerillo), en laboratorio provincial de control y calidad de la provincia de Holguín, se realizó la maceración del follaje de la planta con solventes de polaridad creciente por 24 horas en frascos de vidrio; para determinar los metabolitos secundarios de la planta. Las características macromorfológicas se correspondieron con las que se reportan para esta especie. Se logró determinar la presencia de metabolitos secundarios de esta planta siendo recolectada en estación de verano. El tamizaje fitoquímico evidenció la presencia de esteroides, flavonoides, aminoácidos y azúcares reductores. A esta especie medicinal se le reporta un gran número de propiedades terapéuticas que se corresponden con los metabolitos encontrados.(AU)

A phytochemical study of Tridax procumbens L. (romerillo) was carried out at provincial laboratory of control and quality of Holguín province, to determine the presence of secondary metabolites this plant by maceration of the foliage, being recollected in summer season with solvents of increasing polarity 24 hours in glass flasks. Macromorphological characteristics corresponded with those reported for this species. The phytochemical study evidenced the presence of steroids, flavonoides, amino acids and reducing sugars. To this medicinal sort has been attached a large number of therapeutic properties that correspond with metabolites found.(AU)

[Microsurgical anatomy importance of A1-anterior communicating artery complex]. / Importancia de la anatomía microquirúrgica del complejo A1-arteria comunicante anterior.

BACKGROUND: The anterior cerebral artery originates from the bifurcation of the internal carotid artery lateral to the optic chiasm, then joins with its contralateral counterpart via the anterior communicating artery. A1-anterior communicating artery complex is the most frequent anatomical variants and is the major site of aneurysms between 30 to 37%. OBJECTIVE: Know the anatomy microsurgical, variants anatomical and importance of complex precommunicating segment-artery anterior communicating in surgery neurological of the pathology vascular, mainly aneurysms, in Mexican population. METHODS: The study was performed in 30 brains injected. Microanatomy was studied (length and diameter) of A1-anterior communicating artery complex and its variants. RESULTS: 60 segments A1, the average length of left side was 11.35 mm and 11.84 mm was right. The average diameter of left was 1.67 mm and the right was 1.64 mm. The average number of perforators on the left side was 7.9 and the right side was 7.5. Anterior communicating artery was found in 29 brains of the optic chiasm, its course depended on the length of the A1 segment. The average length of the segment was 2.84 mm, the average diameter was 1.41 mm and the average number of perforators was 3.27. A1-anterior communicating artery complex variants were found in 18 (60%) and the presence of two blister-like aneurysms. CONCLUSION: It is necessary to understand the A1-anterior communicating artery complex microanatomy of its variants to have a three-dimensional vision during aneurysm surgery.

Antecedentes: la arteria cerebral anterior se origina de la bifurcación de la arteria carótida interna lateral al quiasma óptico, posteriormente se une con su homóloga contralateral mediante la arteria comunicante anterior. El complejo precomunicante(A1)-arteria comunicante anterior es el lugar más frecuente de variantes anatómicas y el sitio con mayor cantidad de aneurismas (30 a 37%). Objetivo: conocer la anatomía microquirúrgica, las variantes anatómicas y la importancia del complejo segmento precomunicante-arteria comunicante anterior en cirugía neurológica de la patología vascular, principalmente aneurismas, en población mexicana. Material y métodos: estudio prospectivo y descriptivo efectuado en el Departamento de Anatomía de la Facultad de Medicina (UNAM) en 30 encéfalos inyectados. Se estudió la anatomía microquirúrgica (longitud y calibre) del complejo segmento precomunicante-arteria comunicante anterior de la arteria cerebral anterior y sus variantes. Resultados: se encontraron 60 segmentos precomunicantes. La longitud promedio del lado izquierdo fue de 11.35 mm y del derecho de 11.84 mm. El calibre medio en el lado izquierdo fue de 1.67 mm y en el derecho de 1.64 mm. El número promedio de perforantes en el lado izquierdo fue de 7.9 y en el derecho de 7.5. La arteria comunicante anterior se encontró en 29 encéfalos sobre el quiasma óptico, su trayecto dependió de la longitud del segmento A1. La longitud media del segmento fue de 2.84 mm, el calibre fue de 1.41 mm y el número promedio de perforantes de 3.27. En 18 encéfalos (60%) se encontraron variantes del complejo A1-arteria comunicante anterior y dos aneurismas tipo blíster. Conclusión: es necesario entender la anatomía microquirúrgica del complejo segmento precomunicante-arteria comunicante anterior y conocer las variantes para tener una visión en tercera dimensión durante la cirugía de aneurismas.

[Association of three anatomical variants of the anterior cerebral circulation]. / Asociación de tres variantes anatómicas de circulación cerebral anterior.

BACKGROUND: As part of a study of the microsurgical anatomy of the pericallosal artery, we describe one brain with three unusual anatomical variants. METHODS: From the autopsy of a 45 year-old female, we extracted the brain and all the arterial blood vessels were washed off with saline solution to be injected afterwards with red latex. The brain was then immersed in 10% formalin for two months. Finally, we dissected and measured the internal carotid artery segments, using a digital Vernier caliper under a Carl Zeiss OPMI surgical microscope with magnification of 6x up to 40x. RESULTS: The brain's weight was 1250 grams and three rare anatomical variants were found: 1) right accessory middle cerebral artery (ACMA-d), 2) right bihemispheric anterior cerebral artery (ACABihem-d), 3) median artery of the corpus callosum (AMCC). CONCLUSION: The association of the anatomical variations described previously is inconstant; furthermore, their appearance in a single case is rare.

Microsurgical anatomy of the extracerebral segment of recurrent artery of Heubner in the Mexican population.

BACKGROUND: The recurrent artery of Heubner (RAH) is originated commonly from the anterior cerebral artery. Its extracerebral segment is directed toward the anterior perforate substance where it penetrates the cortex. METHODS: The RAH was dissected from 15 human brains from Mexican population, and the presence, length, branches, course and either RHAs or anterior communicating artery complex variants were reported. RESULTS: The RAH was found in 93% of the hemispheres and duplicated in 39% of the hemispheres. The RAH was duplicated in at least a hemisphere in 46.6% of the brains; 40% of the brains had a RAH in every hemisphere. It was duplicated in every hemisphere in 20%. A single artery at a hemisphere was found in 26.6% and double at the other hemisphere. With a length between 13.6 and 36.7 mm (mean: 24.2 mm) and giving rise to 1-9 branches (mean: 3.9 branches), the RAH originated from the juxtacommunicating segment in 44% of the cases, from A2 in 41%, from A1 in 5% and as a branch of the frontopolar artery in 10%. It had an oblique course in 38%, an L in 31%, sinuous in 18% and an inverted L in 13%. In 53.3% of the brains, some variant of the anterior communicating artery complex was found. CONCLUSIONS: Because of the common anatomy of the RAH and its variants, we must consider the probability of finding it duplicated; therefore, it is necessary to make minute dissections of the region to locate or to secure the absence of the RAH.