The position of a duodenal diverticulum in the area of the major duodenal papilla and its potential clinical implications.

BACKGROUND: Although duodenal diverticula are associated with less frequent pathology than the colonic diverticula in the large intestine, their periampullary position may have significant clinical implications. The aim of the study was to identify any possible correlation between the type of localisation of the major duodenal papilla, duodenal diverticula, and some particular clinical issues. MATERIALS AND METHODS: In total, 628 patients (408 females and 220 males; aged 21-91 years), who underwent endoscopic retrograde cholangiopancreatography were included in this study. The patients were divided into two groups: a study group comprising 66 (10.5%) patients with periampullary position of diverticula (group A), and a control group comprising 562 (89.5%) patients without diverticula (group B). RESULTS: A duodenal diverticulum was diagnosed in the periampullary position in 66/628 (10.5%) patients: 41 women (aged 52-91 years) and 25 men (aged 54-83 years). CONCLUSIONS: Three types of localisation were observed for the major duodenal papilla with regard to the diverticula, with the most common type being next to each other (type III). In patients with diverticula, similar frequencies of gallstone occurrence are observed in men and women. Patients with papilla in the diverticulum who underwent cholecystectomy are more prone to develop lithiasis.

Anatomical variations of the abductor pollicis longus: a pilot study.

BACKGROUND: The abductor pollicis longus (APL) originates from the lateral part of the dorsal surface of the body of the ulna below the insertion of the anconeus muscle, from the interosseous membrane, and from the middle third of the dorsal surface of the body of the radius. However, the number of its accessory bands and their insertion vary considerably. MATERIALS AND METHODS: Fifty upper limbs (2 paired, 31 male, 19 female) were obtained from adult Caucasian cadavers, and fixed in 10% formalin solution before examination. RESULTS: The APL muscle was present in all specimens. The muscles were divided into three main categories, with type II and III being dived into subtypes. Type I was characterised by a single distal attachment, with the tendon inserting to the base of the I metacarpal bone. Type II was characterised by a bifurcated distal attachment, with the main tendon inserting to the base of the first metacarpal bone; this type was divided into three subtypes (a-c). Type III was characterised by the main tendons inserting to the base of the first metacarpal bone, while the accessory band was characterised by mergers (fusion) with other tendons. This type was divided into two subtypes (a, b). CONCLUSIONS: The abductor pollicis longus is characterised by high morphological variability.

A morphological study of the medial and lateral femoral circumflex arteries: a proposed new classification.

BACKGROUND: Confirming the branching pattern of the deep femoral artery (DFA) is vital in planning radiological and surgical procedures involving the medial circumflex femoral artery (MFCA) and the lateral circumflex artery (LFCA). The aim of this study was to characterise the course and morphology of branches of the DFA. MATERIALS AND METHODS: The anatomical dissection included 80 lower limbs which were fixed in 10% formalin solution. A dissection of the femoral region was carried out according to a pre-established protocol, using traditional techniques. Morphometric measurements were obtained twice by two researchers. RESULTS: Six types of medial and lateral femoral circumflex artery variations were distinguished. In type I, the DFA divides into the MFCA and the LFCA (observed in 45% of cases). In type II, the MFCA is absent and the LFCA origin normally from the DFA (18.75%). In type III, the MFCA arises from the femoral artery above the origin of the DFA, while the LFCA starts from the DFA (15%). Finally, in type IV, the LFCA arises from the femoral artery above the origin of the DFA, while the MFCA starts from the DFA (10%). In type V, the LFCA origin alone from the femoral artery below the origin of the DFA, while the MFCA origin from the DFA (7.5%), while in type VI (3.75%), both the MFCA and the LFCA origin from the femoral artery. The mean diameter of the femoral artery at the level of the DFA origin was greatest in type 2 (10.62 ± 2.07 mm) and the least in type 6 (7.90 ± 1.72 mm; p = 0.0317). The distance from inguinal ligament to where the DFA arose was the greatest in type 6 (78.24 ± 29.74 mm) and least in type 5 (28.85 ± 11.72 mm; p = 0.0529). CONCLUSIONS: The medial and lateral femoral circumflex arteries were characterised by high morphological variations. The diameter of the femoral artery at the level of inguinal ligament correlated with the diameter of the DFA and distance to where the DFA arises from femoral artery.

Quality and quantity comparison study of corrosion casts of bovine testis made using two synthetic kits: Plastogen G and Batson no. 17.

BACKGROUND: Although corrosion casting has been implemented for almost five centuries, the choice of resin has a strong influence on the effectiveness of casting vessel formations. Our aim was to compare quality and quantity features of two groups of corrosion casts made using two kits: Plastogen G resin and Batson no. 17 resin. MATERIALS AND METHODS: Thirty corrosion casts were made of testicular arterial vessels (15 made using Plastogen G and 15 made using Batson no. 17) and their shape, colour, fragility and flexibility were evaluated. The following parameters were measured: maximal width of corrosion cast of testis, maximal length of centripetal and centrifugal arteries, diameter of testicular artery and its terminal branches. Based on these measurements, five indexes were calculated (Iq1-Iq5). RESULTS: Generally both groups of corrosion casts demonstrated similar attributes. Only the rami tunicales minores displayed higher fragility and lower flexibility in the Plastogen G group than the Batson no. 17 group. The only observed quantitative difference was that Iq3 was significantly lower in the Plastogen G group (0.71 ± 0.01) than in Batson no. 17 group (0.79 ± 0.01; p = 0.0092). CONCLUSIONS: The two corrosion cast groups displayed similar qualitative and quantitative attributes. Batson no. 17 appears to be a good resin for three-dimensional visualisation of extra- and intratesticular arterial vessels.

Circumaortic left renal vein (circumaortic renal collar) associated with the presence of vascular anomalies: a case series and review of literature.

Renal vessels exhibit a high degree of anatomical variations in terms of their number, level of origin, diameter and topographical relationships. In particular, it applies to the left renal vein which can take retroaortic or even circumaortic placement. Anatomical variations of the left renal vein may be of great clinical significance, particularly in the case of renal transplantation, retroperitoneal surgery as well as vascular or diagnostic procedures. Thus, the aim of this report was to present a complete anatomical description of two cases of the circumaortic left renal vein (CLRV; circumaortic renal collar) co-existing with the presence of various vascular anomalies. In the first case, the circumaortic renal collar was connected via a large anastomosis with the hemiazygos vein and was associated with the presence of the supernumerary left renal artery located below the main left renal artery. In the second case, the circumaortic renal collar was accompanied by the renal artery dividing close to its origin. Moreover, in the latter case, the fusiform aneurysm of the abdominal aorta was observed. In both cases, the CLRV began as a single and short trunk. On its further course, the initial segment of the CLRV was divided into two limbs - anterior (anterior left renal vein) and posterior (posterior left renal vein). Both anterior and posterior limb of the CLRV opened into the inferior vena cava.

Klingler's method of brain dissection: review of the technique including its usefulness in practical neuroanatomy teaching, neurosurgery and neuroimaging.

Klingler's technique was discovered in the 1930s. It is a modified method of brain fixation and dissection, based on freezing and thawing of the brain tissue, subsequent peeling away of white matter fibres and the gradual exposure of white matter tracts. The added value of this technique is that it is carried out in a stratigraphic manner. This fact makes it an invaluable tool for an in-depth understanding of the complex anatomical organisation of the cerebral hemispheres. The purpose of this paper is to provide a review of Klingler's method while taking into account the original description of the technique and its value for medical training. The historical background, the concise outline of white matter organisation, as well as our own experience in using this procedure for research and teaching activities were also included. The fibre dissection technique may still be considered an excellent complementary research tool for neuroanatomical studies. Numerous detailed observations about the white matter topography and spatial organisation have been recently made by applying this method. Using this technique may also improve understanding of the three-dimensional intrinsic structure of the brain, which is particularly important both in under- and postgraduate training in the field of neuroanatomy.

The Plantaris Muscle Tendon and Its Relationship with the Achilles Tendinopathy.

PURPOSE: Although the plantaris muscle (PM) is vestigial in humans, it has a significant clinical role in procedures such as grafting. However, recent reports suggest its potential involvement in the tendinopathy of the midportion of the Achilles tendon. The aim of the study is therefore to evaluate morphological variation of the PM with regard to its potential conflict with the Achilles tendon. MATERIAL AND METHODS: Classical anatomical dissection was performed on 130 lower limbs (71 right, 59 left) fixed in 10% formalin solution. The morphology of the PM was assessed regarding the relationship between the course of the plantaris tendon and the calcaneal tendon. RESULTS: The PM was present in 89.2% of cases. The findings indicate the presence of a new type of PM tendon insertion in which the tendon is inserted into the tarsal canal flexor retinaculum, potentially affecting the tendinopathy of the tibialis posterior muscle. In 26 cases (22.4%), insertion blended with the Achilles tendon (Type II), which may increase the risk of Achilles tendinopathy. CONCLUSION: The anatomical variation of PM tendon morphology may create a potential conflict with the Achilles tendon and the tibialis posterior tendon, thus increasing the possibility of tendinopathy.

The plantaris muscle - rare relations to the neurovascular bundle in the popliteal fossa.

The plantaris muscle is characterised by morphological variability, both for origin and insertion, and may sometimes be absent. Its strength allows the ligament to be used for reconstruction of other tendons and ligaments. This report presents the rare placements and course of the plantaris muscle in relation to the neurovascular bundle. In this case, the hypertrophy of this muscle might cause pressure on the tibial nerve and produce symptoms similar to sciatica.

Suprascapular notch morphology in the pediatric population: a computed tomography study.

Suprascapular notch is characterized by variable morphology. However, its development is not well studied. We hypothesize that it proceeds postnatally. Thus, the aim of this research was to characterize the morphology of the suprascapular notch in a pediatric population based on computed tomography. A retrospective analysis was performed of 291 chest computed tomography examinations of patients under 18 years old taken following other clinical indications. The inclusion criteria were as follows: both scapulae encompassed in a field of view; no artifacts; no pathologies concerning the scapulae. Based on visual assessment and measurements, the suprascapular notch was classified according to a fivefold classification (type I, deeper than wider; type II, equally deep and wide; type III, wider than deeper; type IV, bony foramen; type V, discreet notch). In all, 173 examinations were included (60 females and 113 males). The most common suprascapular notch types were discreet notch (type V, 225 scapulae; 65.0 %) and type III (114 scapulae; 32.9 %). Children with type V suprascapular notch were significantly younger than children with other types (26.1 ± 42.4 months vs. 111.2 ± 66.7 months; p < 0.05). In types I-III, a positive correlation was found between age and dimensions of the suprascapular notch (p < 0.05). This study provides the first description of the suprascapular notch in a pediatric population based on computed tomography. It confirms that morphology of the suprascapular notch undergoes postnatal development.

Types of coeliac trunk branching including accessory hepatic arteries: a new point of view based on cadaveric study.

BACKGROUND: The coeliac trunk (CT) is major visceral branch of the abdominal aorta. Familiarity with anatomic variations of the CT is relevant for planning radiological and surgical procedures. The aim of our research was determining variations of the CT, including the occurrence of accessory hepatic arteries (AHA). MATERIALS AND METHODS: Forty cadavers were studied. Six patterns of CT branching were observed in this study. AHA were observed in 7 (17.5%) specimens. The most prevalent variation was normal trifurcation, accounting for 62.5% of cases. The rarest variation was absence of the CT, with an incidence of 2.5%. In this variant the left gastric artery, the common hepatic artery, and the splenic artery branched directly off the abdominal aorta. RESULTS: The study material allowed to distinguish two CT branching patterns which, to the best of our knowledge, have not been reported before. It was a type with four branches originating from the CT: the left gastric artery, the common hepatic artery, the splenic artery, and right AHA. The other previously unreported pattern variant was the CT which gave off three branches: the common hepatic artery, the splenic artery and right AHA. CONCLUSIONS: The average distance between the aortic hiatus and the coeliac trunk calculated for all the cadavers amounted to 54 ± 11.85 mm. The average distance between the CT and the superior mesenteric artery was 11.1 ± 7.7 mm.

The report on the co-occurrence of two different rare anatomic variations of the plantaris muscle tendon on both sides of an individual.

The plantaris muscle usually begins with a short and small muscle belly on the popliteal surface of the femur and on the knee joint capsule. It continues distally to form a long and thin tendon typically fixed to the calcaneal tuberosity. However, the course and the insertion of the plantaris muscle is variable, which may influence the development of Achilles tendinopathy. The plantaris tendon may also be used for reconstruction of tendons and ligaments, such as talofibular and calcaneofibular ligament. In literature review no data concerning the co-occurrence of anatomic variations of the plantaris muscle tendon in different individuals has been found. This report presents a rare variant of the plantaris muscle insertion into the deep crural fascia on the left leg and absence of the plantaris muscle on the right leg of the same individual.

Renal artery entrapment - anatomical risk factors rating.

BACKGROUND: Cases of renal artery entrapment (RAE) by extrinsic compression have been infrequently reported in the literature. We aimed to describe RAE and elucidate anatomical factors that may be related to renal artery stenosis. MATERIALS AND METHODS: Two hundred and four patients' computed tomography scans made for various reasons in Radiology Department from 2011 to 2015 were retrospectively analysed and 7 cases of RAE were found. Authors studied the level of origin of renal arteries vs. coeliac trunk (CT), superior mesenteric artery (SMA) and vertebrae. Diameter of renal arteries, distance between main left renal artery (LRA) and right renal artery (RRA) as well as renal arterial patterns were also investigated. RESULTS: The origin of main renal arteries off the aorta was between the upper margin of L1 and lower margin of L2 vertebra, with the predominant lower 1/3 of L1 vertebra and L1 intervertebral disc. However, in patients with highest range of stenosis of renal artery the origin was most commonly located at the level of Th12 intervertebral disc and upper part of L1. Statistically significant relationships were proven between range of stenosis and level of origin of stenotic renal artery vs. vertebrae (Pearson's correlation coefficient: -0.393, p < 0.01), distance between main LRA and RRA (Pearson's correlation coefficient: 0.398, p < 0.0001), renal artery-CT distance (Pearson's correlation coefficient: -0.263, p < 0.0001), renal artery-SMA distance (Pearson's correlation coefficient: -0.149, p < 0.033). CONCLUSIONS: Analysis of RAE allowed finding anatomical factors of renal artery stenosis and classifying them regarding to their importance. Relationship of renal artery origin vs. vertebrae and distance between main LRA and RRA were proven the most important. However, distances between higher originated renal artery and CT, higher originated renal artery and SMA should also be taken into consideration.

A quantitative study of the arrangement of the suprascapular nerve and vessels in the suprascapular notch region: new findings based on parametric analysis.

BACKGROUND: When closed by the superior transverse scapular ligament (STSL), the suprascapular notch (SSN) creates an osseo-fibrous tunnel which acts as a pathway for the suprascapular nerve (SN). Anatomical variations are common in this region, and these can increase the risk of neuropathy by restricting the space for nerve passage. The aim of this study is to identify any correlation between the area reduction coefficient parameters and the SN and vessel arrangements in the SSN region. MATERIAL AND METHODS: The SSN region was dissected in 88 formalin-fixed cadaveric shoulders (40 left and 48 right). During dissection, the topography of the SN, artery and vein was evaluated. Quantitative visual data analysis software was used to measure the areas of the STSL and the anterior coracoscapular ligament (ACSL), as well as the diameters of the SN and associated vessels, and to assign those structures to existing classifications. The area reduction coefficient (ARC) was calculated for each shoulder. RESULTS: The area of the STSL (aSTSL) and ACSL (aACSL) were significantly larger in Type IV than Type I of the triad. Similarly, the aSTSL and area of the SSN (aSSN) were found to be significantly larger in Type IV than Type III. However, no significant differences were found in the ARC of the STSL (ARCSTSL), the ARC of the ACSL (ARCACSL) or the total ARC (ARCtotal). CONCLUSIONS: Although the aSTSL, aACSL and aSSN varied according to the type of SN and vessel arrangement, coefficient analysis (ARCSTSL, ARCACSL and ARCtotal) indicated that combined effect of these variations did not significantly affect SSN morphology.

Persistent jugulocephalic vein: case report including commentaries on distribution of valves, blood flow direction and embryology.

This paper is a detailed case study of the persistent anastomotic channel between the cephalic vein and the external jugular vein, running anterior to the clavicle, corresponding to the jugulocephalic vein present at early stages of the ontogenesis in humans. This connection is not only a relic of early foetal development seldom occurring in adults, but it may also be of clinical significance, increasing the risk of complications during the cephalic vein catheterisation, clavicular fractures or head and neck surgery. The novelty in this paper was to determine the presence and distribution of valves within the persistent jugulocephalic vein. Three bicuspid venous valves were found that allowed the blood to flow only in one direction - from the cephalic vein to the external jugular vein. The anastomosis between the persistent jugulocephalic vein and the thoracoacromial veins was additionally present. Due to lack of similar data in the literature, further research should be performed on the presence and distribution of the venous valves in various types of the persistent jugulocephalic vein in humans.

A computed tomography study on the correlation between the morphometry of the suprascapular notch and anthropometric measurements of the scapula.

BACKGROUND: The suprascapular notch is a clinically important site because it is the main site of injury and compression of the suprascapular nerve. Its shape and size are the most important factors in the aetiopathology of suprascapular nerve neuropathy. This article reports the first computed topography (CT) study on the correlation between the diameters of the suprascapular notch and anthropometric measurements of the human scapula. MATERIALS AND METHODS: A total of 130 scans of shoulders by a helical 32-row multidetector CT scanner were retrospectively analysed. The following scapular measurements were performed: morphological length, morphological width, projection length of the scapular spine, maximal width of the scapular spine, length of the acromion, maximal length of the coracoid process, length of the superior border of the scapula, morphological height of the supraspinous fossa, length of the lateral border of the scapula, and morphological height of infraspinous fossa. The following suprascapular notch dimensions were measured: maximal depth, superior transverse diameter, middle transverse diameter. RESULTS: The maximum depth of the suprascapular notch correlates with the morphological length of the scapula, the length of the lateral border of the scapula and the morphological width of the scapula. The superior transverse diameter of the suprascapular notch correlates with the length of the superior border of the scapula and negatively with the length of the lateral border of the scapula. In addition it has been shown that the length of the superior border of the scapula correlates more closely with the superior transverse diameter of the suprascapular notch than the middle transverse diameter of the suprascapular notch. CONCLUSIONS: It could be supposed that humans with longer scapulae have deeper notches. It may be also concluded that scapulae with a wider superior border have a shallower suprascapular notch.

The abducens nerve: its topography and anatomical variations in intracranial course with clinical commentary.

BACKGROUND: The sixth cranial nerve (CN VI) - or the abducens nerve - in humans supplies only the lateral rectus muscle. Due to its topographic conditions, including angulations and fixation points along its course from the brainstem to the lateral rectus muscle, the CN VI is vulnerable to injury. Every case of CN VI palsy requires precise diagnostics, which is facilitated by an understanding of the anatomy. The present article's aims include a detailed study of the intracranial course of the CN VI, determination of occurrence of its particular anatomical variations, as well as presentation of some essential anatomical conditions which may conduce to CN VI palsy. Special emphasis was put on the correlation between craniometric measurements and a particular variation of the CN VI, which complements the data that can be found in literature. MATERIALS AND METHODS: Twenty randomly selected specimens of cadaveric heads fixed in a 10% formalin solution were studied. The study used 40 specimens of the CN VI in order to examine its course variations within the section between the pontomedullary sulcus and the superior orbital fissure. RESULTS: Detailed analysis of the CN VI topography and anatomy in its intracranial course revealed 3 anatomical variations of the nerve in the studied specimens. Variation I, found in 70% of cases, covers those cases in which the CN VI was found to be a single trunk. Those cases in which there was a branching of the CN VI exclusively inside the cavernous sinus were classified as variation II, occurring in 20% of cases. Cases of duplication of the CN VI were classified as variation III, found in 10% of the specimens. In 75% of cases of CN VI duplication one of the nerve trunks ran upwards from the petrosphenoidal ligament, outside Dorello's canal. CONCLUSIONS: The CN VI throughout its intracranial course usually runs as a single trunk, however, common variations include also branching of the nerve in the cavernous sinus or duplication. Topographic relations of the CN VI with adjacent structures account for the risk of injuries which may be caused to the nerve as a result of a disease or surgical procedures.

Intermediate veins in swine (Sus scrofa domestica) kidney: authors' own anatomical classification.

BACKGROUND: The use of domestic swine as an experimental animal is increasing steadily. Swine organs are the best animal model for urological experiments. The aim of the study was to evaluate the course and size of intermediate veins in a swine kidney. The research results were compared with the results obtained from studies on venous vascularisation of human kidneys. The knowledge of the above-mentioned vessels is important both in human and veterinary medicine and will enable researchers to compare and notice differences between human and swine organs. MATERIALS AND METHODS: The study was conducted on 94 kidneys, 47 right ones and 47 left ones, taken from adult domestic swines (Sus scrofa domestica). The kidneys were prepared and corrosion casts were made. RESULTS: The average lumen diameter of secondary intermediate veins was 7.96 mm. The average diameter of the primary intermediate veins directly inserted in the renal vein (type A) and primary intermediate veins inserted in the secondary intermediate veins (type B) amounted to 6.7 mm and 4.75 mm, respectively. The average length of primary intermediate veins of type A was 21.91 mm. Secondary intermediate veins were shorter - on average 19.83 mm. Primary intermediate veins of type B were on average 12.91 mm long. CONCLUSIONS: Intermediate veins are formed in the area of vascular anastomoses on the level of renal papillae. The following veins can be distinguished: primary intermediate veins of type A and type B, as well as secondary intermediate veins. Secondary intermediate veins and primary intermediate veins of type A run only on the ventral side of the renal pelvis. Only the primary intermediate veins of type B can run on the dorsal side. From the anatomy point of view, intermediate veins of swine kidneys are very similar to equivalent vessels in human kidneys as regards their run and anastomoses.

Infraorbital groove localisation for the endoscopic decompression of the orbit in Graves' disease.

BACKGROUND: The aim of our study was to determine the localisation of the inferior margin of the optic canal in relation to the infraorbital canal/groove complex (IOC/G complex) and zygomaticoorbitale (ZO) as the potential useful landmarks for reducing dangerous complications following surgical and invasive procedures. MATERIALS AND METHODS: Sixty-four orbits of thirty-two human skulls were investigated. The distances between: the inferior margin of the optic canal and the posterior margin of the infraorbital groove measured at its medial border (OC-S); the inferior margin of the optic canal and the posterior margin of the roof of the infraorbital canal (OC-C); the inferior margin of the optic canal and the zygomaticoorbitale (OC-ZO) - were measured. The left/ /right symmetry ratio and the asymmetry index were counted. The symmetry between the contralateral measurements was analysed and statistical analysis was performed. RESULTS: On the right side the mean distance from the inferior margin of the optic canal to: the posterior margin of the infraorbital groove measured at its medial border; to the posterior margin of the roof of the infraorbital canal; and to the zygomaticoorbitale were: 23.41 ± 3.10 mm; 34.44 ± 5.30 mm; and 47.53 ± 4.13 mm, respectively. On the left side the mean distance from the inferior margin of the optic canal to: the posterior margin of the infraorbital groove measured at its medial border; to the posterior margin of the roof of the infraorbital canal; to the zygomaticoorbitale were 23.69 ± 2.80 mm; 36.75 ± 5.10 mm; 46.84 ± 3.24 mm, respectively. CONCLUSIONS: The presented measurements may be particularly helpful for endoscopic decompression in patients with the thyroid ophthalmopathy to avoid the complications.

The influence of atherosclerotic abdominal aorta on the shape of duplicated inferior vena cava: its potential clinical implications and vascular complications.

Duplication of the inferior vena cava (IVC) is a congenital condition where there are 2 large vessels: right IVC (RIVC) and left IVC (LIVC) on both sides of the abdominal aorta. Here, we present 2 cases of duplicated inferior cava coexisting with rare morphology of left gonadal (ovarian/testicular) vein. Both were observed during multidetector 64-row computer tomography. In first case atherosclerotic, tortuous abdominal aorta models both inferior venae cavae. The shape of veins were more- (RIVC) and less-arcuate (LIVC). Two years ago, the patient had been diagnosed with pulmonary thromboembolism. In second case abdominal aortic aneurysm models both large veins. The RIVC has a highly right-arcuate shape, while the LIVC has a less left-arcade shape. Our observation would seem to be especially important, because the tortuous abdominal aorta changes the shape of both IVC, and may predispose them for thrombosis formation. The presented report precisely describes the topography and measurements of the vessels in the retroperitoneal area. The literature concerning this anomaly, potential clinical implications and vascular complications are reviewed and the possible practical aspects are discussed. A familiarity with the anatomy of the most common types of venous anomalies is crucial for all surgeons, urologists and oncologists to reduce the risk of severe haemorrhage during all abdominal procedures.

The suprascapular vein: a possible etiology for suprascapular nerve entrapment and risk of complication during procedures around the suprascapular foramen region.

INTRODUCTION: Nerve can be compressed when traveling through any osteo-fibrous tunnel. Any eventual anatomic structure limiting this passage increases the risk of neuropathy. During dissection of the shoulder region we recognized a vein travelling on the inferior border of the suprascapular notch together with the suprascapular nerve. The aim of this work was to evaluate the morphological characteristics of this vein in cadaveric material. MATERIALS AND METHODS: The suprascapular notch (SSN) region was dissected in 60 cadaveric shoulders. The course, number and diameter of nerve and vessels in the suprascapluar notch region were evaluated. Length, proximal and distal width of the superior transverse scapular ligament were measured. Photographic documentation was taken to evaluate the suprascapular nerve passage area. RESULTS: The vein identified was named as the suprascapular notch vein. It was present in 58.3% of shoulders. In 11 specimens, it was double. Its mean diameter was 1.7 mm (SD 0.7 mm) and did not correlate with the suprascapular nerve passage area. A suprascapular notch vein co-occurred more often with the anterior coracoscapular ligament (ACSL). In comparison with the SSN without the ACSL, it has a significantly greater diameter (2 mm; SD 0.7 mm vs 1.5 mm; SD 0.6 mm, respectively; P=0.021). CONCLUSIONS: The suprascapular notch vein was a common structure that did not replace the suprascapular vein. Its presence correlated with the occurrence of the ACSL and was independent of body side, STSL type and SSN type. TYPE OF STUDY: Observational anatomic study.