Ahmet Salbacak

The origin of gonadal arteries in human fetuses: Anatomical variations

Testicular arterial anatomy has been well studied because of its importance in testicular physiology, as well as testicular and renal surgery. In contrast to classical anatomical descriptions, it may originate from the suprarenal or lumbar arteries or a high-positioned origin, course behind the inferior vena cava or be doubled or arise from an inferior polar renal artery. Different developmental patterns as variations in relation to origin, course and number of the renal and gonadal arteries have been reported and discussed. This study was performed on 90 spontaneously aborted fetuses obtained from two different hospitals in Konya. The study was carried out on the testicular or ovarian arteries of fetuses fixed by immersion in 10% formalin. In all, 180 gonadal arteries were studied and 16 of them were found to have variations in their origin (8.8%). The variations of the gonadal artery origins could be classified into four types. The gonadal artery variations were more commonly found in male than the female fetuses and on the right side rather than the left. In the present study, it is clear that these variations are important not only from the developmental point of view or research interest, but they also may explain some pathological conditions. Knowledge of these variations may help to avoid the clinical complications especially during radiological examinations and/or surgical approaches in this region.

Selective restoration of motor function in the ulnar nerve by transfer of the anterior interosseous nerve. An anatomical feasibility study.

Background: Proximal ulnar-nerve lesions have an unfavorable prognosis. The goal of the present study was to evaluate the feasibility of selective restoration of motor function of the ulnar nerve by the transfer of the anterior interosseous nerve or one of its branches to the motor branch of the ulnar nerve. Methods: Ten cadaveric arms were used in the present study. The ulnar nerve and its motor and sensory branches as well as the anterior interosseous nerve and its branches were dissected. The widths of the motor branch of the ulnar nerve and the anterior interosseous nerve and its motor branches as well as the relevant distances from the points of divergence were measured. The axons were counted, and the distances from the end of the main anterior interosseous nerve, its motor branches, and the motor branch of the ulnar nerve to the level of the dorsal sensory branch of the ulnar nerve were measured. Results: Our results indicate that the length, width, and number of axons of the branch of the anterior interosseous nerve to the pronator quadratus make it suitable for transfer to the motor branch of the ulnar nerve. The use of the main anterior interosseous nerve or its motor branches to the flexor pollicis longus and the flexor digitorum profundus is less feasible because of the need to graft a long segment and the longer distance from the level of transfer to the motor end points. Conclusions: The findings of the present study confirm the feasibility of motor-nerve transfer for reconstruction after an injury of the ulnar nerve. Nerve-grafting would be needed for injuries distal to the level of the dorsal sensory branch of the ulnar nerve.

The relationship between the lumbosacral enlargement and the conus medullaris during the period of fetal development and adulthood

The spinal cord is situated within the vertebral canal by the third month of intrauterine life. The spinal cord possesses two symmetrical enlargements, which constitute the segments of the plexuses the cervical enlargement for the brachial plexus and the lumbosacral enlargement for the lumbar and sacral plexus. In our study, we aimed to investigate the relationship between the termination level of the lumbosacral enlargement (TLLE) and that of the conus medullaris (TLCM) during the period of fetal development and adulthood. We used a total of 75 cases 25 fetuses (male 16, female 9) whose crown-rump length ranged between 90–190 mm, 25 premature and full-term neonates (male 17, female 8) whose post-menstrual ages ranged between 33–55 weeks, and 25 adults (male 12, female 13) aged between 22–72 years. The dissection technique for fetuses, ultrasonography for premature and full-term newborns, and magnetic resonance imaging (MRI) for adults were used to determine lumbosacral enlargement and TLCM. The differences between the TLCM and the termination level of the largest part of the transverse diameter of the lumbosacral enlargement were investigated. The differences between the TLLE and TLCM were found in different ratios from the period of fetal development to adulthood. Therefore, during medical treatment and surgical procedures this should be taken into account to avoid complications.

The course and variations of the branches of the musculocutaneous nerve in human fetuses

The course and branches of the musculocutaneous nerve (MCN) were dissected in 140 human fetal arms. The MCN entered the superior, middle, and inferior part of coracobrachialis in 43%, 37%, and 17% of arms, respectively, and the remaining 3% did not pierce coracobrachialis. The motor branches to biceps were classified as follows: Type 1 (83.6%): a single branch that bifurcated to supply the two heads of biceps; Type 2 (14.3%): two separate branches each innervating one head of biceps; Type 3 (2.1%): a single branch that bifurcated to supply each head of biceps plus an additional branch that innervated the distal part of biceps. The motor branches to brachialis were classified as follows: Type 1 (93.6%): a single branch to brachialis; Type 2 (6.4%): a single branch that bifurcated into two branches both supplying brachialis. Communications between the MCN and the median nerve (MN) were observed in 10% of specimens, of which three types (A, B, C) could be identified depending on their origin and union. In the most frequently observed type (B, 50% of cases) the communicating branch arose from the proximal part of the MCN and joined the MN in the middle or distal part of arm. The data presented here will be of use to surgeons, especially pediatric surgeons who undertake surgical procedures in the axilla and arm. Clin. Anat. 22:337–345, 2009.

An investigation of the conus medullaris and filum terminale variations in human fetuses.

The morphologic structure of the conus medullaris and filum terminale was investigated by dissection in 123 human fetuses, obtained from Selçuk University, Faculty of Medicine and Maternity hospital of Konya between 1992–1995. In 78 fetuses, the conus medullaris and filum terminale had a normal morphologic aspect, whereas there was a slight depression or groove formation in the closure region of the caudal neuropore in 45 fetuses. In 15 fetuses, important malformations of the cranium and vertebral column were observed. The morphologic aspects of the conus medullaris in 30 fetuses were abnormal in shape and position, among them 24 fetuses had an abnormal filum terminale (grooved, depressed, thickened or duplicated) whereas it was normal in 6. Deficiency of closure of the caudal neuropore was considered to have a negative effect on the fetal development of the filum terminale.

Morphometric analyses of the development of nasal cavity in human fetuses: An anatomical and radiological study

OBJECTIVE It was aimed to research the morphometric development of the nasal cavity with dissection and radiological scanning methods and to detect anatomical variations. DESIGN Retrospective study. SETTING Departments of Anatomy and Radiology, Meram Medical Faculty, Selcuk University. PATIENTS Dissection stage was performed on 80 spontaneously aborted fetuses (40 males and 40 females) (63 second trimesters and 17 third trimesters) between 13 and 40 weeks of gestation. Radiological scanning stage was carried out on 40 spontaneously aborted fetuses (19 males and 21 females) (12 second trimesters and 28 third trimesters) with multi-detector computed tomography. METHODOLOGY One hundred and sixty nasal cavities and related structures were examined by means of bilateral dissection. Reference images were obtained in the axial plane with 3-mm collimation using multi-detector computed tomography (MDCT; Sensation 64, Siemens, Erlangen, Germany). These reference images were sent to the workstation (Leonardo, Siemens, Germany) and three-dimensional (axial, sagittal, and coronal) reformatted images with 1mm thickness were obtained via multiplanar imaging method. RESULTS In the dissected fetuses 16 suprema nasal conchae were determined. Six (15%) NSDs (four towards the left and two towards the right) were detected on radiological sections. The angle between the virtual line from sphenoidal sinus ostium through limen nasi and the horizontal plane was 32.72+/-3.3 degrees on average. CONCLUSION It was thought that some anatomic variations (e.g. suprema nasal concha, nasal septum deviation) occur in the fetal period; however, other certain differences (e.g. Onodi, Haller, and Agger nasi cells, concha bullosa) might be with effects of environmental factors (trauma and chronic infections) in postnatal period.

Unilateral Variations of Vessels and Nerves in the Neck

Durante una diseccion de rutina, fue obserada en el lado izquierdo del cuello de un cadaver de sexo masculino de 65 anos de edad variaciones anatomicas vasculares y nerviosas. Se observo que el tronco linguofacial se originaba de la arteria carotida externa y que la arteria faringea ascendente se origina en la arteria occipital. Se determino que los ramos laringofaringeos originadas desde el ganglio cervical superior, giraban en torno al origen de la arteria tiroidea superior. Como una variacion adicional, la vena jugular interna se encontro dividida. El asa cervical y el vientre inferior del musculo omohioideo pasaban a traves de las partes de la dividion de la vena. Creemos que este tipo de variaciones supone dificultades importantes durante procedimientos radiologicos y quirurgicos de la region del cuello, y por tanto, es importante que los cirujanos conozcan estas variaciones.

A modified technique for bypass of the external carotid artery to the proximal posterior cerebral artery: an anatomical and technical study.

Conclusions. Our results support the proposition that bypass between the external carotid artery (ECA) and proximal posterior cerebral artery (PCA) can be achieved by using a short saphenous venous graft. The diameters of the ECA and vein graft may provide an increased blood flow with a straighter course. This technique may be helpful for management of patients with vertebrobasilar insufficiency or those requiring a high volume blood flow to the posterior circulation. Objectives. We aimed to describe a modified technique using a short saphenous vein graft for bypass between the ECA and the PCA in order to use a small length of graft material and increase the patency of the anastomosis. Materials and methods. Ten sides of five cadavers were dissected bilaterally. After a frontotemporal craniotomy and zygomatic arch osteotomy, the middle cranial fossa was exposed. A hole located approximately 2–3 cm posterolateral to the foramen rotundum was created extradurally. The sylvian fissure and the interpedincular and ambient cisterns were opened. The proximal P2 segment of the PCA was identified. The ECA was found through a cervical incision. A short interposition saphenous vein graft was conducted to pass just behind the ramus mandible to the infratemporal fossa. The bypass between the ECA and P2 segment of the PCA was performed by using a short saphenous vein graft. The diameters of the ECA, P2 segment of PCA and both ends of the saphenous vein graft and its length were measured using an electronic micrometer. Results. The mean cross-clamping time of the PCA was 10.4±1.8 min. The mean diameters of the P2 segment of the PCA and ECA were 2.2±0.15 mm and 3.83±0.28 mm, respectively. The mean length of the saphenous vein graft was 88.8±3.8 mm.

The growth of the upper and lower extremities of Turkish fetuses during the fetal period

Prenatal analysis of the fetal structures gives us information about fetal growth and gestational age. The aim of this study was to investigate the morphologic structure of the upper and lower extremities of Turkish fetuses during the fetal period, to measure the morphometric values, and to determine the relationship between CRL (crown-rump length) and growth of the foot. In this study, 106 human fetuses (56 males, 50 females) without external anomalies and aged between 10–40 post-menstrual weeks (PMW) were studied. In the upper extremity, the width of shoulder and the length of the arms, forearms and hands were measured. In the lower extremity, the width of the iliac crest, knee condyles, feet, and heels and the length of the thighs, legs and feet were measured. A significant correlation was found between all parameters taken within the fetal period and PMW (p < 0.001). Statistically significant correlations found between foot-growth measurements and fetal parameters indicate that foot length may be a good predictor of age. The measurements of the upper and lower extremities during fetal period are a reliable parameter for use in the assessment of gestational age. These measurements are particularly useful when other parameters do not accurately predict gestational age in some cases such as hydrocephalus, anencephaly, short-limb dysplasia. Our opinion is that the measurements can be useful to assess gestational age in several fields such as anatomy, pathologic anatomy (fetopathology), forensic medicine, medical imaging, obstetrics and pediatrics.

The Morphometrical Analysis of the External Carotid Artery and its Branches with Multidetector Computerized Tomography Angiography Technique

La arteria carotida externa (ACE) es la principal arteria de la cabeza y de la region del cuello. La bifurcacion carotidea (BC) es uno de los lugares donde las placas ateroscleroticas son mas frecuentes. El procedimiento quirurgico para tratar estas placas que causan el accidente vascular cerebral (AVC) es la endarterectomia carotidea. En este procedimiento quirurgico, el conocimiento de los cursos anatomicos y variaciones de la arteria carotida aumenta el rendimiento de la cirugia. El objetivo de nuestro estudio fue presentar el trayecto, localizacion y variacion de la ACE y sus ramas. El estudio se realizo mediante angiografia multidetector por tomografia computarizada de la ACE de 50 hombres y 50 mujeres, totalizando 200 ACE (100 derechas y 100 izquierdas). Se evaluaron el diametro interior de la arteria carotida comun (ACC) y la ACE. Se determino la ubicacion de la BC y se midio la distancia vertical hasta el gonion. Se observo que la arteria tiroidea superior (ATS) se origino desde la ACC, la BC y la ACA. Las distancias verticales entre la BC, y las arterias tiroidea superior, lingual (AL), facial (AF) y occipital (AO) fueron medidas. La ACE y sus ramas se registraron. Creemos que la evaluacion morfometrica de la ACE puede comprender grupos de control de las enfermedades relacionadas con el diametro de los vasos, y estos datos pueden ser utilizados como referencia clinica y quirurgica. El conocimiento de los detalles anatomicos y variaciones es de vital importancia para evitar complicaciones imprevisibles en la cirugia.