Amac Kiray

The human sacrum and safe approaches for screw placement

The human sacrum is the target of lumbosacral instrumentation and decompression procedures. Such surgical interventions require detailed knowledge of the anatomy of the human sacrum. The aim of this study was to measure surgically relevant parameters. Several factors, including the one-piece composition of the sacrum, the angles of the sacral pedicles and the anteroposterior diameter of the sacral vertebral bodies distinguish the sacrum from other parts of spine. Thirty-two measurements of shape, angles and distances between parts were taken of the sacra of 100 adult West Anatolian people using a Vernier caliper accurate to 0.1 mm and goniometer. According to this morphometric study, when measured from the sagittal, the S1 facet angle was measured as 35.71 degrees +/-9.59 and 34.70 degrees +/-9.66, the sacral pedicle anteromedial screw trajectory angle was 35.65 degrees +/-4.73 and 31.95 degrees +/-3.95 and the anterolaterally oriented sacral wing screw trajectory angle was 32.65 degrees +/-3.51 and 29.10 degrees +/-3.14, on the right and left sides, respectively. The distance of the midline oriented S1 pedicle screw was 51.12 mm and 51.26 mm on the right and left side, respectively. The distance for sacral wing oriented screw placement was 50.13 mm and 50.46 mm on the right and left side, respectively. The anteroposterior and transverse diameter of the sacral spinal canal were 21.81 mm and 31.31 mm, respectively. Thus, this study describes anatomical specifications of the sacrum. These defined morphometric details should be taken into consideration during surgical procedures. This study also describes anatomical landmarks which will allow injury of the sacrum during surgery to be avoided.

Thoracic duct variations may complicate the anterior spine procedures

The aim of this study is to localize and document the anatomic features of the thoracic duct and its tributaries with special emphasis on the spinal surgery point of view. The thoracic ducts were dissected from nine formaldehyde-preserved male cadavers. The drainage patterns, diameter of the thoracic duct in upper, middle and lower thoracic segments, localization of main tributaries and morphologic features of cisterna chyli were determined. The thoracic duct was detected in all cadavers. The main tributaries were concentrated at upper thoracic (between third and fifth thoracic vertebrae) and lower thoracic segments (below the level of ninth thoracic vertebra) at the right side. However, the main lymphatic tributaries were drained into the thoracic duct only in the lower thoracic area (below the level of the tenth thoracic vertebra) at the left side. Two major anatomic variations were detected in the thoracic duct. In the first case, there were two different lymphatic drainage systems. In the second case, the thoracic duct was found as bifid at two different levels. In formaldehyde preservation, the dimensions of the soft tissues may change. For that reason, the dimensions were not discussed and they may not be a guide in surgery. Additionally, our study group is quite small. Larger series may be needed to define the anatomic variations. As a conclusion, anatomic variations of the thoracic duct are numerous and must be considered to avoid complications when doing surgery.

The V2 segment of the vertebral artery in anterior and anterolateral cervical spinal surgery: A cadaver angiographic study

OBJECTIVE The second segment of the vertebral artery is under the risk of injury during anterior and anterolateral cervical spine procedures. To avoid such a risk, one needs to be familiar with the regional anatomy. The aim of this study was to measure the distance between the vertebral artery and the uncinate process, midline, and the medial side of the longus colli muscle using vertebral artery angiograms at the level of C6, C5, C4, and C3 vertebrae. MATERIALS AND METHODS In 12 human cadavers, the vertebral arteries were first irrigated with water. Then the arteries were filled with silicon and barium, and finally their angiographic images were obtained. RESULTS The transverse diameter of the vertebral artery was measured at C6, C5, C4, C3, and C2 level. The values on the left were bigger than the values on the right (p>0.05). The distance between the vertebral artery and the midline decreased from C6 (17.2+/-5.6mm on the right, 17.2+/-2.3mm on the left) to C3 (15.8+/-5.3mm on the right, 13.8+/-2.1mm on the left) (p>0.05). The distance between the apex of the uncinate process and the medial side of the vertebral artery was found to be longer at C4 (2.7+/-1.0 mm on the right, 2.2+/-1.0mm on the left) and C5 (2.5+/-1.1mm on the right, 2.5+/-1.0mm on the left) vertebra levels on the right side (p=0.339 at C4, p=0.862 at C5). The distance between the medial side of the longus colli muscle and the medial side of the vertebral artery was measured as 9.7+/-2.7 mm (9.5+/-2.9 mm on the right, 9.8+/-2.6mm on the left) at C6 level, 9.2+/-2.6mm (8.6+/-2.4mm on the right, 9.8+/-3.1mm on the left) at C5, 9.4+/-1.9 mm (9.2+/-2.1mm on the right, 9.5+/-2.0mm on the left) at C4, and 10.4+/-2.7 mm (10.5+/-3.0mm on the right, 10.1+/-2.6mm on the left) at C3 vertebra level. No significant difference was found between the right and the left (p>0.05). The angle between the vertebral artery and the midline was measured as 4.0+/-1.9 degrees on the right and 2.2+/-1.4 degrees on the left side (p=0.030). CONCLUSION It was considered that the values obtained could be useful in anterolateral and anterior cervical approaches in terms of evaluating the position of the vertebral artery and its relation to vertebral structures. It is also concluded that the risk of injury in upper subaxial cervical spine is higher than in the lower part of the subaxial cervical spine.

Arterial anatomy of the lower lip: A cadaveric study

The aim of the study was to investigate the arterial anatomy of the lower lip. The location, course, length, and diameter of the inferior labial artery and the sublabial artery were revealed by bilateral meticulous anatomic dissections in 14 adult male preserved cadaver heads. Another cadaver head was used for silicone rubber injection to fill the regional arterial tree. The inferior labial artery was the main artery of the lower lip and in all cases branched off the facial artery. The mean length of the inferior labial artery was found to be 52.3 mm (range, 16 to 98 mm). The mean distance of the origin of the inferior labial artery from the labial commissura was 23.9 mm. The mean external diameter of the inferior labial artery at the origin was 1.2 mm. The sublabial artery was present in 10 (71 percent) of the cadavers. Mean measurements of this artery were 1 mm for diameter, 23.4 mm for length, and 27.6 mm for distance from the labial commissura. The sublabial artery may originate from the facial artery or the inferior labial artery. This study found that this region does not have a constant arterial distribution, the inferior labial artery and the sublabial artery (if it exists) can be in different locations unilaterally or bilaterally, and the diameter and the length may vary.

The effects of exposure to electromagnetic field on rat myocardium

Exposure to electromagnetic fields (EMFs) causes increased adverse effects on biological systems. The aim of this study was to investigate the effects of EMF on heart tissue by biochemical and histomorphological evaluations in EMF-exposed adult rats. In this study, 28 male Wistar rats weighing 200–250 g were used. The rats were divided into two groups: sham group (n = 14) and EMF group (n = 14). Rats in sham group were exposed to same conditions as the EMF group except the exposure to EMF. Rats in EMF group were exposed to a 50-Hz EMF of 3 mT for 4 h/day and 7 days/week for 2 months. After 2 months of exposure, rats were killed; the hearts were excised and evaluated. Determination of oxidative stress parameters was performed spectrophotometrically. To detect apoptotic cells, terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling (TUNEL) staining and caspase-3 immunohistochemistry were performed. In EMF-exposed group, levels of lipid peroxidation significantly increased and activities of superoxide dismutase and glutathione peroxidase decreased compared with sham group. The number of TUNEL-positive cells and caspase-3 immunoreactivity increased in EMF-exposed rats compared with sham. Under electron microscopy, there were mitochondrial degeneration, reduction in myofibrils, dilated sarcoplasmic reticulum and perinuclear vacuolization in EMF-exposed rats. In conclusion, the results show that the exposure to EMF causes oxidative stress, apoptosis and morphologic damage in myocardium of adult rats. The results of our study indicate that EMF-related changes in rat myocardium could be the result of increased oxidative stress. Further studies are needed to demonstrate whether the exposure to EMF can induce adverse effects on myocardium.

Iliolumbar veins have a high frequency of variations.

The spectrum of individual anatomic variations of the vascular structures are broad, however, the exact incidence of variations of the lumbosacral vein is obscure. In the current study, 38 iliolumbar veins were dissected from 19 formaldehyde-preserved male cadavers. The drainage pattern of the iliolumbar vein was determined. The diameter and the length of the iliolumbar vein were measured, and the relationships of the iliolumbar vein with the lumbosacral trunk, obturator nerve, and iliolumbar artery were ascertained. Means and standard deviations were used as descriptive measures to define variations among the cases. The iliolumbar vein or veins were detected in both sides of all 19 cadavers. Five drainage patterns were seen between the iliolumbar vein and the lumbosacral major veins. In only five cadavers, symmetric drainage patterns were seen on the left and the right sides. In our study, two drainage patterns were seen that were not previously reported. Anatomic variations of the iliolumbar vein are numerous and should be considered to avoid complications when doing surgery.

The effects of prenatal and neonatal exposure to electromagnetic fields on infant rat myocardium.

Introduction Electromagnetic fields (EMF) have adverse effects as a result of widespread use of electromagnetic energy on biological systems. The aim of this study was to investigate the effects of prenatal exposure to EMF on rat myocardium by biochemical and histopathological evaluations. Material and methods In this study, 10 pregnant Wistar rats were used. Half of the pregnant rats were exposed to EMF of 3 mT, and the other half to sham conditions during gestation. After parturition, rat pups in the 5 EMF-exposed litters from birth until postnatal day 20 were exposed to EMF of 3 mT for 4 h/day (EMF-exposed group, n = 30). Rat pups in sham litters from birth until postnatal day 20 were exposed to sham conditions (sham group, n= 20). Results In the EMF-exposed group, lipid peroxidation levels significantly increased compared to sham. Superoxide dismutase activities decreased significantly in the EMF-exposed group compared to sham. TUNEL staining showed that the number of TUNEL-positive cells increased significantly in EMF-exposed rats compared with sham. Under electron microscopy, there were mitochondrial degeneration, reduction in myofibrils, dilated sarcoplasmic reticulum and perinuclear vacuolization in EMF-exposed rats. Conclusions In conclusion, the results show that prenatal exposure to EMF causes oxidative stress, apoptosis and morphological pathology in myocardium of rat pups. The results of our study indicate a probable role of free radicals in the adverse effects of prenatal exposure to EMF. Further studies are needed to demonstrate whether the EMF exposure can induce adverse effects on the myocardium.

Anatomy of the Dorsal Nerve of the Penis, Clinical Implications

OBJECTIVE To show the branching patterns and the anatomic variations of the dorsal nerve of the penis (DNP) along the penile shaft, particularly the relation with the tunica albuginea. METHODS The penises of 22 adult cadavers were dissected. The number and the diameters of the branches, the presence of anastomoses between the main trunks, the positioning of the nerves before entering the glans penis, and the presence of branches emerging from the body of the DNP and perforating the tunica albuginea were noted and photographed. The compartments where the anatomic findings were located were noted. RESULTS The DNP was composed of 2, 3, 4, 5, and 6 main branches in 6 (27.3%), 6 (27.3%), 6 (27.3%), 1 (4.5%), and 3 (13.6%) of 22 dissections, respectively. We could trace 2, 3, 4, and 5 terminal branches of the DNP going into the glans penis in 4 (18.2%), 8 (36.4%), 7 (31.8%), and 3 (13.6%) dissections, respectively. In 2 dissections (9.1%), fine branches were present between the main trunks crossing the midline. Anastomosing branches between ipsilateral main trunks of the DNP were identified in 5 dissections (22.7%). In 16 (72.7%) dissections, branches emerging from the inferior aspect of the body of the DNP, which perforated the tunica albuginea, could be identified. CONCLUSION The exact anatomic knowledge of the DNP is mandatory during penile reconstructive surgeries. The presence of branches perforating the tunica albuginea is the most important finding of this cadaveric study, together with the other documented variations, which must be taken into consideration during penile reconstructive surgeries.

Anatomical variations of iliolumbar artery and its relation with surgical landmarks

OBJECTIVES The aim of this study was to reveal the variations of origin of iliolumbar artery, and its relations with the surrounding surgically important anatomical structures. METHODS The origin, diameter, and tract of iliolumbar artery were determined bilaterally in 21 formalin-fixed adult male cadavers (21 right and 21 left arteries) in the Laboratory of Department of Anatomy. RESULTS Iliolumbar artery was originating from common iliac artery in 4.8% (2 arteries), internal iliac artery in 71.4% (30 arteries), posterior trunk of internal iliac artery in 19% (8 arteries), and as two different arteries from internal iliac artery in 4.8% (2 arteries) of the cases. The mean diameter of the iliolumbar artery was 3.7 mm. CONCLUSION The anatomical properties of iliolumbar artery and its relation with anatomical landmarks, which were presented here, would be helpful in decreasing iatrogenic trauma to iliolumbar artery during surgery.

The relation between the lumbar vertebrae and the spinal nerves for far lateral lumbar spinal approaches

The far lateral approaches to the lumbar spine require accurate knowledge of regional anatomy. The aim of this study is to evaluate the course of the lumbar nerve roots and their relation to important bony landmarks. Seven adult male cadavers fixed with formaldehyde were used. Morphometric parameters, including the lumbar nerve root diameters, the angle between the nerve roots and the midline, the transverse process length, the inter-transverse process height and width, and the relation between the nerve roots and the transverse processes of the caudal vertebrae were measured. It was observed that the diameter of the nerve roots, and the angle between the nerve roots and the midline, and the distance between the nerve roots and the lateral edge of the superior articular process increased gradually from L1 to L5. The diameter of the nerve root was 4.9+/-0.5mm for L1 and 7.5+/-1.0mm for L5. The midline nerve root angle was 36.1+/-1.6 degrees mm for L1 and 40.4+/-1.4 degrees mm for L5. The distance between the nerve root and the lateral edge of the superior articular process was 6.5+/-1.0mm for L1 and 11.4+/-1.6mm for L5. The nerve roots crossed the transverse processes of the caudal lumbar vertebrae. The nerve roots of L1 and L2 crossed the transverse processes in their first two quarters, the L3 nerve root crossed the transverse process in its second, third or fourth quarters, and the L4 nerve roots crossed the L5 transverse process in its third and fourth quarter or even external to it. Descending toward the lower lumbar vertebrae, the diameter of the lumbar nerve root increases and the nerve roots exit the intervertebral foramen with a larger angle. The special relation between the nerve roots and the caudal vertebra transverse process should be remembered during far lateral lumbar spine approaches.