Adnan Ozturk

Morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screw fixation.

Study Design. A morphometric evaluation of pedicle projections in 29 cervical spinal columns (C3–C7) for three-dimensional surgical anatomy for safe surgery was proposed. Objective. In this study, pedicles and intimate structures of the subaxial vertebrae from C3 to C7 were evaluated to provide some morphometric data for cervical transpedicular screw fixation. Summary of Background Data. Detailed knowledge of surgical anatomy and variation of the subaxial vertebrae is a must for safe and effective surgery of the region. Although there are several clinical studies of transpedicular fixation, few studies have been performed on cervical pedicle measurements and their projection. Methods. In 29 dried bone cervical spinal columns (C3–C7), pedicle dimensions (pedicle height, width, length), measurements of lateral mass and pedicle length distance and pedicle axis length, investigation of distances of superior facet-midpedicle axis and inferior facet-midpedicle axis, and transverse and sagittal angles of the pedicles were performed in linear and angular measurements. Results. The obtained data from the series revealed that the mean values were approximately ranging from 6.7 to 7.2 mm for pedicle height, 4.4 to 4.9 mm for pedicle width, 5.3 to 6.2 mm for pedicle length, 15.3 to 16.0 mm for lateral mass and pedicle length, 22.2 to 27.7 mm for pedicle axis length, 3.8 to 5.3 mm for superior facet-midpedicle axis distance, 9.9 to 12.0 mm for inferior facet-midpedicle axis distance, 42.3° to 51.5° for transverse angle, and 5.2° to 14.1° for sagittal angle. Conclusions. Linear measurements of pedicle dimensions and also axial angles from horizontal and vertical planes may provide some anatomic limitations for subaxial cervical transpedicular screw fixation, and also contribute to the safety of the surgical procedure. One should also rely on tomographic data and computer-assisted guidance systems.

Evaluation of the bony landmarks in transcondylar approach

Background. The aim of this study is to define the anatomic landmarks which are necessary for transcondylar approach and to determine the importance of these structures during surgical resection. Methods. 56 dry skulls were included in this study. Landmarks were detected. Some distances and angles, which were determined before, were measured and the anatomical structures were observed. 21 parameters were examined and analysed in totally 56 dry skulls using 56 foramen magnum, 112 hypoglossal canal and 112 occipital condyles. The landmarks which were used were the anterior and posterior borders of the occipital condyle, the medial and lateral margin of the occipital condyle, basion, opisthion, hypoglossal canal and posterior condylar canal. The measurements were made separately for the right and left sides. Results. The mean length of the occipital condyle was found as 23.1 mm. The distance betweeen the intracranial edge of the hypoglossal canal and anterior margin of the occipital condyle was measured as 11.2 mm in both sides. The distance betweeen the intracranial edge of the hypoglossal canal and posterior margin of the occipital condyle was measured as 12.5 mm at the right side and 12.6 mm at the left one. The mean length of the hypoglossal canal was measured as 10.5 mm at the right side and 10.6 mm at the left one. 14 hypoglossal canals were divided into two compartments by a septum. Conclusions. In transcondylar approach, the anatomical landmarks should be well known in order to make a safe occipital condyle resection. The distance betweeen the intracranial edge of the hypoglossal canal and posterior margin of the occipital condyle is important for a safe occipital condyle resection, and it was found to be 12.55 ±0.05 mm in our study. Approximately 12 mm occipital condyle resection can be made without giving damage to the neural tissue. This value is appropriate to the ½ of the occipital condyle.

The Relationship of the Superficial Radial Nerve and Its Branch to the Thumb to the First Extensor Compartment

PURPOSE The superficial radial nerve and its branches are vulnerable during surgery for de Quervain tenovaginitis. We studied the proximity of the nerve branches to the first extensor compartment. METHODS We dissected 20 forearms of 11 cadavers and measured the branching point of the superficial radial nerve relative to the radial styloid. We defined the midline of the first extensor compartment and measured distances of nerves adjacent to it. RESULTS The superficial radial nerve gave the lateral dorsal digital branch to the thumb at 50 ± 13 mm (minimum, 26 mm; maximum, 72 mm) proximal to the radial styloid. Average distances of the lateral dorsal digital branch to the thumb to the midline of first extensor compartment from proximal to distal were 2, 2, and 2 mm, respectively. In 8 forearms, the lateral dorsal digital branch to the thumb passed directly over the first extensor compartment along its entire length. We found that as the superficial radial nerve diverged from the first extensor compartment, its lateral dorsal digital branch to the thumb coursed parallel and in close relation to it. CONCLUSIONS Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury. CLINICAL RELEVANCE The close relation of the superficial radial nerve and its lateral dorsal digital branch to the thumb with the first extensor compartment may guide surgeons during surgery for de Quervain tenovaginitis.

Inferior Phrenic Arteries and Their Branches, Their Anatomy and Possible Clinical Importance: An Experimental Cadaver Study

BACKGROUND Transcatheter arterial chemoembolization is a common treatment for patients with inoperable hepatocellular carcinoma. If the carcinoma is advanced or the main arterial supply, the hepatic artery, is occluded, extrahepatic collateral arteries may develop. Both, right and left inferior phrenic arteries (RIPA and LIPA) are the most frequent and important among these collaterals. However, the topographic anatomy of these arteries has not been described in detail in anatomy textbooks, atlases and most previous reports. AIMS To investigate the anatomy and branching patterns of RIPA and LIPA on cadavers and compare our results with the literature. STUDY DESIGN Descriptive study. METHODS We bilaterally dissected 24 male and 2 female cadavers aged between 49 and 88 years for this study. RESULTS The RIPA and LIPA originated as a common trunk in 5 cadavers. The RIPA originated from the abdominal aorta in 13 sides, the renal artery in 2 sides, the coeliac trunk in 1 side and the left gastric artery in 1 side. The LIPA originated from the abdominal aorta in 9 sides and the coeliac trunk in 6 sides. In 6 cadavers, the ascending and posterior branches of the LIPA had different sources of origin. CONCLUSION As both the RIPA and LIPA represent the half of all extrahepatic arterial collaterals to hepatocellular carcinomas, their anatomy gains importance not only for anatomists but interventional radiologists as well.

The mendosal suture

Purpose. The knowledge regarding the mendosal suture is still on debate in the literature. Though reports of the closure of this childhood suture are variable, a few reports show the presence of the suture in the adults. This study was conducted to determine the occurrence and a better topographic location of the mendosal suture. Methods. We used 129 dry skulls for this study. In the specimens, which were determined to have a mendosal suture, the morphometric traits of the mendosal suture and the angle between the mendosal suture line and lambdoidal suture line (α angle) were measured. Results. We found mendosal suture on 18 specimens, 11 of them were bilateral and 7 were unilateral. The length of these sutures ranged from 10.4 to 23.8 mm on the right side and 10.8 to 31.6 mm on the left side, respectively. The angle between two suture lines ranged from 36 to 68° on the right side and 32 to 75° on the left side. Conclusions. We believe that, these data will be of use to clinicians in order to avoid any misinterpretation of the mendosal suture with cranial fractures.

A multipurpose landmark for skull-base surgery: Henle’s spine

OBJECTIVE To determine whether Henles spine could be used as a reliable and multipurpose landmark for the other important structures of the skull base. MATERIALS AND METHODS Ninety-two specimens from 46 cadaveric adult dry skulls were studied. Two imaginary lines and a triangle were defined: a spinopterygoidal line extending from Henles spine to the root of the medial pterygoid plate, a bispinal line extending from one Henles spine to the contralateral one, and a parapetrosal triangle lying between the spinopterygoidal line, the bispinal line and the sagittal midline. The parapetrosal triangle encompasses nearly all the main structures of the skull base, including the petrosal internal carotid artery. RESULTS Along the spinopterygoidal line the distance from Henles spine to the spine of the sphenoid was found to be about 3 cm, to the foramen spinosum 3.5 cm, to the posterior and anterior margins of the foramen ovale 4 and 4.5 cm, to the root of the lateral pterygoid plate 5 cm, to the root of the medial pterygoid plate 5.5 cm, and to the vomer 6.5-7 cm. Along the bispinal line, the distance from Henles spine to the stylomastoid foramen was found to be about 1.5 cm, to the lateral and medial margins of the jugular foramen 2.5 and 3.5 cm, to the external orifice of the hypoglossal canal 4 cm, and to the foramen magnum 5 cm. CONCLUSION Henles spine with its superficial and central position can be used to localize important anatomical structures during skull-base surgery.

Anatomical relations between anterior coracoscapular ligament and suprascapular neurovascular structures and a proposal for classification

OBJECTIVE Although suprascapular nerve entrapment is rare, the most common site of compression is the suprascapular notch. The anterior coracoscapular ligament (ACSL), which lies inferior to the superior transverse scapular ligament (STSL), may also be a cause of entrapment. We aimed to investigate the presence of ACSL and its relations to the suprascapular nerve and vessels. METHODS We dissected 50 shoulders of 26 cadavers. We excluded 2 shoulders due to previous shoulder surgery. We observed the course of the suprascapular nerve, artery, and vein(s), and examined whether they passed between STSL and ACSL or under ACSL. We classified the anatomical relations between neurovascular structures, STSL, and ACSL. In Type I, the suprascapular nerve passed between STSL and ACSL; in Type Iıa, the suprascapular nerve and a single suprascapular vein passed between STSL and ACSL; in Type Iıb, a suprascapular vein passed under ACSL and the suprascapular nerve passed between STSL and ACSL; in Type III, the suprascapular artery, vein, and nerve passed between STSL and ACSL. RESULTS ACSL was present in 16 shoulders (32%). The suprascapular nerve passed between STSL and ACSL in all cases. We observed Type I, Type Iıa, Type Iıb, and Type III anatomical relations in 14%, 12%, 2%, and 4% of cases, respectively. CONCLUSION Vascular structures that pass under STSL may cause suprascapular nerve entrapment. Presence of ACSL with vessel(s) passing under it and/or between it and STSL may increase the risk of nerve entrapment.

Current status of cadaver sources in Turkey and a wake-up call for Turkish anatomists

Persisting difficulties in body procurement in Turkey led to the acquisition of donated, unclaimed, autopsied, and imported bodies regulated under current legislature. Yet, no study had investigated the extent of the on‐going cadaver problem. This study was aimed to outline cadaver sources in anatomy departments and their effectiveness by means of an online survey. Additionally, official websites of each department were investigated regarding any information on body donation. Unclaimed cadavers (84.8%) were the major source for anatomy departments, followed by donated (50%) and imported cadavers (39.1%). Foundation‐based medical faculties were more likely to import cadavers (P = 0.008). There was a moderate increase (rs = 0.567; P = 0.018) in donation registrations to our department after 2000. The departments in cities with significantly higher City‐Based Gross Domestic Product measures (US

Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study

9,900 vs. US

Classification and Localization of the Adductor Hiatus: A Cadaver Study

16,772, P = 0.041), frequencies for mid‐ or high‐school graduates (30.4% vs. 31.3%, P = 0.041), and frequencies for under‐ or post‐graduates (13.1% vs. 15.8%, P = 0.24) had managed to use donated cadavers. Anatomy departments’ major reasons for using unclaimed cadavers were education (45.9%), unclaimed cadavers being the only source (24.3%), and receiving inadequate donations (21.6%). Nine out of seventy‐four departments (12.2%) provided information regarding body donation on their websites. Body procurement remains as a serious problem in Turkey and it is apparent that current legislature does not provide a sufficient cadaver inflow. Similarly, anatomy departments’ effectiveness in public awareness of body donation and support in the National Body Donation Campaign seems questionable. Anat Sci Educ 11: 155–165.