Deniz Uzmansel

Posterior cranial fossa morphometry in symptomatic adult Chiari I malformation patients: comparative clinical and anatomical study.

BACKGROUND AND OBJECTIVES The cerebellar tonsillar herniation occurring in Chiari malformation Type I (CMI) mainly results from overcrowding of a normally developing hindbrain within a primary small posterior cranial fossa (PCF) due to an anomaly in the embryological development of the occipital bone. In the present study, the lengths of PCF parameters were studied in adult CMI patients. PATIENTS AND METHODS The authors retrospectively examined 15 adult patients with CMI. Multiple measurements were made on magnetic resonance images (MRIs). The results were compared with the findings in 25 controls and 30 dry skulls. RESULTS Length of the neural structures did not significantly differ between the CMI and the control groups. The average length of the basiocciput was significantly shorter in the CMI group as compared with the control group. The mean length of the supraocciput was significantly shorter and the average diameter of the foramen magnum was significantly longer in the CMI group when compared to the control group and dry skulls. CONCLUSIONS The morphometric data suggest that, in CMI, a hypoplastic occipital bone, possibly due to the paraxial mesodermal defect of the parachordal plate, causes overcrowding in PCF, which contains the normally developed neural structures.

An unreported pattern of musculocutaneous and median nerve communication with multiple variations of biceps brachii: a case report

An unreported pattern of communication between musculocutaneous (Mcn) and median nerve (Mn) with multiple variations of biceps brachii (Bb) was observed during the dissection of a male cadaver. The first branch of the Mcn ended in coracobrachialis (Cb). The second was the main Mcn piercing the Cb and giving its motor branches to the muscles of the anterior compartment of the arm. It then continued as the lateral cutaneous nerve of the forearm. The largest third branch also pierced the Cb distal to the main Mcn and communicated with the Mn which was classically formed by relevant roots of the medial and lateral cords. Additionally, a third head of Bb was observed bilaterally. Slips from the pectoralis major were inserted on the tendon of the third head on both sides. The origin of the third head was the greater tubercle to the left and the joint capsule to the right. These extremely rare patterns of both variations which were seen concomitantly in the same subject do not exist in the literature. Lack of awareness of such variations with different patterns of communications between Mcn and Mn might complicate surgical repair of the nerves. Knowing different patterns of Bb variations also have clinical importance as they also may cause compression of neurovascular structures or confuse a surgeon during surgical procedures.

Examination of the Accessory Tendons of Extensor Hallucis Longus Muscle in Fetuses

There are various data about the incidence of accessory tendons (AT) of extensor hallucis longus (EHL) muscle; however, their function is unknown. This study aimed to determine the incidence and morphometric features of the AT of EHL muscle in fetuses in order to provide more information to discuss its possible function. Forty‐five fetuses (26 female and 19 male) were used in this study. Fetuses were grouped as Group A (16–21weeks), Group B (22–27 weeks), and Group C (28–34 weeks) according to their age. In 23 (51%) out of 45 fetuses, there were AT. These were bilateral in 15 fetuses (65%) and unilateral in eight fetuses (35%). Fifty‐two percent of the fetuses in group A, 43% in group B, and 67% in group C had AT. AT were observed in 14 female (54%) and 9 male (47%) fetuses. In all cases, the AT were always diverging to the medial side of the main EHL tendons and attached to the metatarsophalangeal joint capsule distal to the joint space. Significant correlations were observed in this study between EHL and AT widths as well as between EHL width and EHL‐AT distance on both sides. The present study is the first to provide morphometric data about the AT of EHL muscle in fetuses which will be of use in understanding their function, particularly in biomechanics of the great toe. Clin. Anat. 21:713–717, 2008.

Microsurgical anatomy and variations of the anterior clinoid process.

AIM The aim of this study was to better define the microsurgical anatomy of the supra/parasellar region and describe variations of the anterior clinoid process (ACP). MATERIAL AND METHODS Fifteen formalin-fixed cadaver heads and 25 dry skulls were used to define the microsurgical anatomy of the ACP and related structures. The presence of the caroticoclinoid foramen (CaCF) as well as other relevant measurements were all noted. Radiological examination of the CaCF was also demonstrated on dry skulls. RESULTS Interosseous bridges, which form between the anterior and middle clinoid processes or connect all three (anterior, middle and posterior) clinoid processes, were found in 30% of the specimens. The average basal width, length and thickness of the ACP were 7.3 mm, 9.7 mm and 5.4 mm, respectively. Length of the optic nerve (ON) up to the falciform ligament (FL) was 10.9 mm; length of the ON under the FL was 2.7 mm; length of ON after removal of the ACP and unroofing the optic canal was 21.1 mm. CONCLUSION This study contributes to the relationship of important vascular, neural, bone and dural layers of this region and also demonstrates the variations of ACP by means of microsurgical dissections and radiological examinations.

An unusual case of a tortuous abdominal aorta with a common celiacomesenteric trunk: demonstrated by angiography

The abdominal aorta (AA) begins at the aortic hiatus of the diaphragm, in front of the lower border of the body of the last thoracic vertebra and descending in front of the vertebral column and ends on the body of the fourth lumbar vertebra, commonly a little to the left of the middle line by dividing into the two common iliac arteries. The celiac trunk (CeT) and superior mesenteric artery (SMA) are the two widest vessels arising from the ventral aorta. The celiac trunk divides into the left gastric, common hepatic and splenic arteries. SMA and the coeliac trunk can arise from the ventral aorta as a common origin.1 The unusual embryologic development of the ventral splanchnic arteries can lead to considerable variations.2 Many variational patterns of the CeT have been described. A review by Yi et al.3 summarized that only 87.7% of CeTs exhibited classic trifurcation. An incomplete CeT, namely bifurcation, accounted for 5.8–24.1%. Aside from these variations, the CeT itself may be absent and its branches can arise directly from the aorta. Moreover, in rare cases, the CeT and SMA may be fused into a common celiacomesenteric trunk (CMT), of which the incidence was mentioned as 0–11% (average, 1.5%).3 Many different types of catheter or intra‐aortic balloon pumping are commonly used either to diagnose vascular diseases or treat them via the AA. In abnormalities like a tortuous AA, use of catheters is advised with great caution; straight‐tipped catheters are discouraged.4-7

A rare combination of vascular variations of both kidneys.

Bilateral variations of renal vessels were encountered during the dissection of a 54-year-old male cadaver. There were triple renal arteries bilaterally, double renal veins on the right, and an unusual formation of renal vein on the left side. A bilateral occurrence of triple renal arteries has not been encountered in the literature, so does an incidence. Additional renal vessels have the potential to cause clinical complications such as hydronephrosis. Their existence has utmost importance in surgical and radiological interventions and radiological examinations.

Morphometric properties of the levator scapulae, rhomboid major, and rhomboid minor in human fetuses

PurposeThe main objective of this study is to showcase the growth dynamics of levator scapulae, rhomboid major, and rhomboid minor algebraically, to help plan surgeries on newborns and young infants.MethodsTwenty-five formalin-fixed fetuses (11 male–14 female) with a mean gestational age of 21.80 ± 2.61 (range 18–27) weeks present in the inventory of Mersin University Faculty of Medicine Anatomy Department were dissected. Surface area of levator scapulae, rhomboid major, and rhomboid minor was calculated using digital image analysis software; width and length parameters were measured using digital calipers.ResultsNeither sex nor side significant differences were observed in relation with the numerical data of levator scapulae, rhomboid major, and rhomboid minor (p > 0.05). Algebraic parameters such as surface area, width and length were detected to exhibit a linear growth from 18th to 27th week. Linear functions for levator scapulae, rhomboid major and rhomboid minor surface areas were obtained as y = − 136.871 + 10.598 × age (weeks), y = − 480.567 + 33.147 × age (weeks) and y = − 128.090 + 8.843 × age (weeks), respectively.ConclusionThe results and data of this study can potentially be beneficial in planning of surgeries for many infancy diseases such as trapezius paralysis, obstetrical brachial plexus palsy, Sprengel’s disease, or winged scapula. Linear functions calculated in this study are expected to provide a better understanding of the growth dynamics of levator scapulae, rhomboid major, and rhomboid minor in fetal term and more precise estimation of muscle sizes.

The effect of anatomic differences on the relationship between renal artery and diaphragmatic crus

BACKGROUND The aim of this study is to investigate the effect of anatomic differences on the relationship between renal artery and diaphragmatic crus via the touch of two structures. MATERIALS AND METHODS The study included dynamic computed tomography (CT) scans of 308 patients performed mainly for characterisation of liver and renal masses. Anatomic differences including the thickness of the diaphragmatic crus, the localisation of renal artery ostium at the wall of aorta, the level of renal artery origin with respect to superior mesenteric artery were evaluated. Statistical relationships between renal artery-diaphragmatic crus contact and the anatomic differences were assessed. RESULTS Thickness of the diaphragmatic crus at the level of renal artery origin exhibited a statistically significant relationship to renal artery-diaphragmatic crus contact at the left (p < 0.001) and right side (p < 0.001). There was a statistically significant relationship between high renal artery origin and renal artery- -diaphragmatic crus contact at the left (p < 0.001) and right side (p = 0.01). The localisation of renal artery ostium at the wall of aorta (right side, p = 0.436, left side, p = 0.681) did not demonstrate a relationship to renal artery-diaphragmatic crus contact. CONCLUSIONS Thickness of the diaphragmatic crus and high renal artery origin with respect to superior mesenteric artery are crucial anatomic differences determining the relationship of renal artery and diaphragmatic crus. (Folia Morphol 2018; 77, 1: 22-28).

Morphometric properties of the tensor fascia lata muscle in human fetuses

BACKGROUND In neonatal and early childhood surgeries such as meningomyelocele repairs, closing deep wounds and oncological treatment, tensor fasciae lata (TFL) flaps are used. However, there are not enough data about structural properties of TFL in foetuses, which can be considered as the closest to neonates in terms of sampling. This studys main objective is to gather data about morphological structures of TFL in human foetuses to be used in newborn surgery. MATERIALS AND METHODS Fifty formalin-fixed foetuses (24 male, 26 female) with gestational age ranging from 18 to 30 weeks (mean 22.94 ± 3.23 weeks) were included in the study. TFL samples were obtained by bilateral dissection and then surface area, width and length parameters were recorded. Digital callipers were used for length and width measurements whereas surface area was calculated using digital image analysis software. RESULTS No statistically significant differences were found in terms of numerical value of parameters between sides and sexes (p > 0.05). Linear functions for TFL surface area, width, anterior and posterior margin lengths were calculated as y = -225.652 + 14.417 × age (weeks), y = -5.571 + 0.595 × age (weeks), y = -4.276 + 0.909 × age (weeks), and y = -4.468 + 0.779 × age (weeks), respectively. CONCLUSIONS Linear functions for TFL surface area, width and lengths can be used in designing TFL flap dimensions in newborn surgery. In addition, using those described linear functions can also be beneficial in prediction of TFL flap dimensions in autopsy studies.

Variation in the position, relation and vasculature of left suprarenal gland: a case report

A malposition of the left suprarenal gland with varied relations and vasculature was observed in a 50-year-old male cadaver during the routine dissection of the abdominal region. The gland was partly situated over the hilum of the left kidney. Its posterior surface was related to the left crus of the diaphragm and to the hilum of the left kidney extending some distance above on the medial margin of the kidney. Its anterior surface was totally covered by the body of the pancreas and the splenic artery and vein. There were only two suprarenal arteries. A left lateral branch of the aorta divided into three branches of which the middle and inferior branches entered the gland as seperate suprarenal arteries. There were the two suprarenal veins of the gland which were draining into the left renal vein. Such a malposition with varied relations and vasculature is of utmost importance from the surgical point of view because it can affect the orientation of the surgeon in laparoscopic adrenalectomy.