Aysin Kale

The termination of superior sagittal sinus and drainage patterns of the lateral, occipital at confluens sinuum in newborns: clinical and embryological implications

Drainage patterns of dural venous sinuses at confluens sinuum are variable and clinically significant. It has been generally investigated in adults; however, we thought that neonatal cadaver study might be more informative in views of embryological and clinical. A total of 33 skull bases of neonatal cadavers were resected to identify termination patterns of lateral sinus (LS), superior sagittal sinus (SSS) and occipital sinus (OS) at the confluens sinuum. Termination patterns of these sinuses were classified into six types: the SSS showed continuity with right transverse sinus (TS) (with OSs) (30.3%) (Type I); or multiple OSs (21.2%) (Type II). The SSS continued with left TS (with OSs) (12.1% (Type III); or with multiple OSs (6.1%) (Type IV). The SSS shows continuity with both TS (9.1%) (Type V). SSS symmetrically bifurcated, the confluens sinuum has a large OS (21.2%) (Type VI). Understanding of the cerebral venous drainage and large variation of the posterior fossa dural sinuses is crucially important for planning surgical intervention to some tumors in the neck which may require ligation of the internal jugular vein.

Anatomic Course of the Superficial Branch of the Radial Nerve in the Wrist and Its Location in Relation to Wrist Arthroscopy Portals: A Cadaveric Study

PURPOSE The aim of this study was to assess the course of the superficial branch of the radial nerve (SBRN) at the level of the wrist and its branches in relation to wrist arthroscopy portals. METHODS Dissections were performed on 11 hands from 6 cadavers in the section starting from the point where the SBRN begins to emerge and ending at the terminal branches of the dorsal hand. The distribution of the SBRN, the distance from the superficial branch to the dorsal portals used in wrist arthroscopy, and the distance from the superficial branch to the anatomic determinants (styloid process of the radius, Lister tubercle) were studied. RESULTS At the level of the wrist, the nerve bifurcated into 2 branches in 8 of 11 wrists (73%) and into 3 branches in 3 of 11 wrists (27%). The mean distance from the SBRN where it was first detected proximal to the Lister tubercle was 73 mm. The mean distance between the styloids was 52 mm; the distance between the Lister tubercle and styloid process of the radius was 23 mm. At the wrist level, the distance from the branch closest to the radial side to the Lister tubercle was 28 mm (L-D1), 21 mm (L-D2/3), and 7 mm (RS-D1). The distance of the closest nerve branch to the 3-4 portal was 9 mm. The distances of the other portals were 5 mm (1-2RMC-D1), 8 mm (1-2RMC-D2/3), 8 mm (1-2P-D1), and 9 mm (1-2P-D2/3). CONCLUSIONS The limited size of the area where portals can be positioned and the anatomic variations between individuals are major obstacles in developing a guideline for reducing the risk of SBRN injury in wrist arthroscopy. CLINICAL RELEVANCE Great care must be taken when using the 1-2 portal. We suggest making a skin-only incision for this portal and then using blunt dissection to help prevent injury to the SBRN.

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.

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.

The localization and morphology of pterion in adult West Anatolian skulls.

Abstract The pterion is an important skull landmark because it is located where the frontal, the great wing of sphenoid, parietal, and squamous parts of the temporal bone junction. The objectives of this study were to determine the localization and the shape of pterion on skulls and to find out the distances between the pterion and some certain anatomic landmarks on neighboring structures. The study was performed on the skulls of 128 (256 sides) adult West Anatolian people. All of the morphometric measurements of the distances between the pterion and the anatomic landmarks were performed using a Vernier caliper with an accuracy of 0.1 mm. The pterion was classified into 4 types: the sphenoparietal, frontotemporal, stellate, or epipteric types. The incidences of types of pterion in the skulls were also found as the sphenoparietal type (85.2%), the epipteric type (8.2%), the stellate type (5.5%), and the frontotemporal type (1.1%). The mean (SD) distances from the center of the pterion to the zygomatic arch were measured as 40.02 (4.06) mm and 39.88 (4.01) mm; to the frontozygomatic suture, 31.80 (4.51) mm and 31.44 (4.73) mm; to the zygomatic angle, 41.54 (4.95) mm and 41.35 (5.14) mm; to the mastoid process, 82.48 (5.45) mm and 81.81 (5.50) mm; and to the external acoustic meatus, 53.29 (4.55) mm and 56.22 (4.60) mm, on the right and left sides, respectively. The mean (SD) distances between the foremost point of pterion and the anterior edge of the lateral wall of the orbit were 31.02 (5.78) mm and 32.31 (5.79) mm on the right and left sides, respectively. The localization and the shape of pterion are of importance because it is an anatomic landmark and should be of use in surgical approaches and interventions via the pterion.

Classification and Localization of the Adductor Hiatus: A Cadaver Study

OBJECTIVE To determine not only the vertical but also horizontal localization of the adductor hiatus (AH) and classify its shape and structure macroscopically. MATERIAL AND METHODS Forty lower extremities were dissected to expose the AH. Its shape and structure were macroscopically noted, and the AH was classified into four types. For determining the localization, measurements were made with digital calipers. RESULTS Twenty-four oval fibrous types, 12 oval muscular types, 2 bridging fibrous types and 2 bridging muscular types of AH were determined. For the horizontal localization of AH, the apex of the AH was determined to be located medial to the vertical line between the midpoint of the interepicondylar distance and the line which was drawn transversely from the apex of the AH, in all of the cadavers. For the vertical one, the apex of the AH was located in the middle third of the femur length in 14 thighs, and in the remaining 26 ones, the apex of the AH was located in the distal third of the femur length. CONCLUSION Adductor hiatus was classified according to its shape and structure for the first time. Moreover, the localization of the AH was practically defined, in order not to harm the popliteal artery and vein.

Pre-Operative Measurement of the Morphometry and Angles of the Anterior Clinoid Process (ACP) for Aneurysm Surgery

El proceso clinoide anterior (PCA) esta proximo a estructuras vitales, como el nervio optico, la arteria carotida interna y la arteria oftalmica, por tanto el estudio de su anatomia es importante en la orientacion y la definicion de la cirugia de base de craneo. Se estudio la estructura anatomica de la PCA, incluyendo el angulo formado por el vertice del triangulo PCA, y su orientacion, para proporcionar informacion para una cirugia mas facil y mas segura. La medicion se realizo en los planos axiales de 242 exploraciones craneales de tomografia computarizada (TC) y 27 craneos de individuos adultos turcos de ambos sexos. Se examino la longitud del PCA, el ancho del PCA en su base, el angulo formado por el angulo apical del triangulo PCA y la orientacion del PCA definido de acuerdo con la linea mediana sagital. En craneos turcos, la longitud y el ancho del PCA fueron similares a estudios anteriores. Nuestro estudio fue el primero en medir el angulo y la orientacion del PCA. El angulo promedio fue de 39,67 ± 12,64 (16,6 a 89,5) y, la orientacion fue posterior en 135 craneos (55 %) y medial en 107 craneos (45 %). Las complicaciones quirurgicas pueden evitarse mediante la planificacion radiologica preoperatoria atraves de cortes axiales de tomografia computarizada y determinando si la morfologia del PCA es de tipo 2 (larga, estrecha y aguda en angulo recto), lo que requiere la reseccion total.

M. SOLEUS'TA AKSESUAR KEMİK VEYA MYOSİTİS OSSIFICANS?

Istanbul Tip Fakultesi Anatomi Anabilim Dali’ndaki rutin disseksiyonlar sirasinda, 78 yasindaki bir erkek kadavranin sag m. soleus’unda kemiksi bir yapi ile karsilasildi. Bu kemiksi yapinin hicbir kemik, kapsuler ya da ligamentoz yapi ile iliskisi yoktu. Bu yapinin gercek bir kemik oldugunu ve bacagin kemiklerinden kopan bir kemik segment olmadigini ispatlamak icin bu bolgenin radyografisi cekildi. Radyografide bacak kemiklerinin kirilmis olduguna dair bir bulguya rastlanmadi. Ayrica bu kemik yapida normal trabekuler kemik goruntusu saptandi. Ikinci olarak bu yapi cikarilarak, uygun bir kesiti alinarak mikroskopik olarak incelendi. Mikroskopik olarak matur kemik lamelleri gozlendigi icin, bu yapinin gercek bir kemik oldugundan emin olundu. Bu alisilmadik yapi icin iki olasilik vardi. M. gastrocnemius’ta bulunabilen fabella gibi bir aksesuar kemigin m. soleus’ta bulunmasi veya bu kadavrada yasarken bu bolgede bir myositis ossificans gelismis olmasiydi. Kesin ayirici tani makroskopik, mikroskopik veya radyografik tetkiklere ragmen yapilamadi. Bugune kadar kadavralarda bildirilmis olan myositis ossificans vakasina literaturde rastlamadigimiz icin, bildirdigimiz olgunun, Anatomik calismalar sirasinda yumusak dokularda saptanan kemik kitlelerin ayirici tanisi acisindan yararli olacagi dusuncesindeyiz.