E. George Salter

Anatomic landmarks for nerves of the neck: a vade mecum for neurosurgeons.

Anatomic landmarks are often quite useful in localizing structures within the human body, especially in the surgical realm. We have reviewed the medical literature and multiple texts of surgery and anatomy and culled together many anatomic landmarks regarding important nerves of the neck. This region is complicated by formidable anatomy, and a single collection of the relationships of the nerves in this region is lacking in the literature. It is our hope that this collection will serve to assist the surgeon who operates in this region of the body.

The accessory atlantoaxial ligament.

OBJECTIVE:The stability of the joints connecting the cranium to the upper cervical spine is of vital importance. The ligaments of this region, for the most part, have been thoroughly investigated, with the exception of the accessory atlantoaxial ligament. METHODS:Ten cadaveric specimens were examined to observe the anatomy of this ligament. RESULTS:This ligament was found in all specimens, and in each, it not only connected the atlas to the axis but also continued cephalically to the occipital bone. The approximate dimensions of this structure were 3 cm ×5 mm. Functionally, this ligament became maximally taut with a rotation of the head of 5 to 8 degrees. Laxity was observed with cervical extension, and maximal tautness was seen at 5 to 10 degrees of cervical flexion. CONCLUSION:The accessory atlantoaxial ligament seems to participate in craniocervical stability and perhaps should be renamed the accessory alar ligament or accessory atlantoaxialoccipital ligament; both of these terms better denote its anatomic characteristics. Perhaps in the future, better magnetic resonance imaging techniques and machines will be able to identify this structure so as to appreciate its integrity after upper cervical spine trauma.

The petrosal nerves: Anatomy, pathology, and surgical considerations

The literature lacks a comprehensive review of the petrosal nerves, which often have a complicated course and nomenclature. The medical literature was reviewed comprehensively for information regarding the anatomy, pathology, and surgery of the petrosal nerves. The terminology and anatomy of the petrosal nerves are often complicated. Our review found multiple nomenclatures used in the description of these structures. Information regarding the petrosal nerves may assist those who observe or operate at or near the skull base. To our knowledge, this is the first comprehensive review of these structures. Clin. Anat. 22:537–544, 2009.

Additional vascular compression of the brachial plexus in a cadaver with a cervical rib: case illustration

Cervical ribs are uncommon and occur in approximately 0.5–1% of the population. The authors describe a cadaver found to have a cervical rib with further compression by the dorsal scapular artery. This vessel originated from the third portion of the subclavian artery. No other anomalies were found in this specimen. The authors speculate that some cases of symptomatic cervical rib may have an additional vector of compression from a dorsal scapular artery when it arises from the third portion of the subclavian artery. Additional studies aimed at the vascular system may be useful in diagnosis and operative planning for symptomatic patients.

Vidius Vidius (Guido Guidi): 1509-1569.

LITTLE IS KNOWN of the early physician/anatomist Vidius Vidius (Guido Guidi). Anatomic structures named after Vidius include the Vidian nerve, artery, and canal and are well known to neurosurgeons. His anatomic treatise was printed under the title Vidi Vidii: Florentini de anatome corporis humani libri VII in a posthumous edition (1626). We report what is known regarding this historical figure of both early anatomy and medicine.

The triangle of the vertebral artery.

OBJECTIVE: Neurosurgical procedures such as proximal brachial plexus repair, scalenotomy, and direct isolation of the proximal vertebral artery require a good working knowledge of the triangle of the vertebral artery. This deep triangle of the neck is bound by the subclavian artery and the anterior scalene and longus cervicis muscles. In addition to the vertebral artery, many important structures are found in this area, such as the ganglionated sympathetic chain and certain cervical spinal nerves. METHODS: Twenty formalin-fixed cadavers were used for this study. Dissection of this triangle was performed, and measurements were made not only of parts of its borders, but also distances from these borders to neurologically important structures within its confines, such as the C8 spinal nerve. RESULTS: In all specimens, the middle scalene muscle was noted to form part of the posterior wall of the triangle. The mean height of the triangle was found to be 3.2 cm, and the mean width of its base was 1.3 cm. We observed that the C8 spinal nerve had a mean distance of 1.2 cm inferior to the apex of the triangle and that the C7 spinal nerve was found inside the triangle in 5% of sides. If the phrenic nerve entered the triangle, it was never found more than 6 mm medial to the anterior scalene muscle. The vertebral artery always traveled intimately along the lateral border of the longus cervicis muscle, and its lateral edge ranged 5 to 8 mm medial to the medial edge of the anterior scalene muscle. CONCLUSION: The C7 spinal nerve was observed in the triangle of the vertebral artery. In addition, the posterior border of the triangle of the vertebral artery was clearly defined in this study, and the middle scalene muscle could be used as a landmark. These data, coupled with our quantitation of parts and structures within the triangle, may assist neurosurgeons who operate on this area of the neck.

The intriguing history of the human calvaria: sinister and religious

IntroductionA review of the ancient world finds multiple documentations describing the use of the human calvaria as a drinking implement.TerminologyThis term, which is frequently and incorrectly called the “calvarium,” has a unique history among multiple cultures of the world. For example, the purported site of Jesus’ crucifixion “Calvary” is derived from this term calvaria. The present report explores the derivation, misuse, and history of the human calvaria.

Gimbernat y Arbós, Antonio de (1734–1816)

Don Manuel Louise Antonio de Gimbernat y Arbós, Spanish anatomist and surgeon, was one of the pioneers during the “age of dissection” (late eighteenth century). A bright young mind, Gimbernat was confident and audacious, which allowed him to become a recognized surgeon with a famed reputation that influenced his colleagues internationally. The Spaniard was most widely recognized for his advancements in the treatment of strangulated femoral hernias, and the lacunar ligament was named “Gimbernat’s ligament” in his honor. In 1793, he published Nuevo Método de operar en la Hernia Crural dedicated to King Charles IV, which was translated into English by Thomas Beddoes 2 years later. Gimbernat’s daring procedures helped improve safety and efficiency of hernia surgery. A person of great determination, he was known as a brilliant, meticulous, and creative man who exemplified the importance of surgeons. His devoted study of anatomy, especially of inguinal anatomy, allowed him to devise a legendary surgical technique in repairing femoral hernias, influencing renowned surgeons of his time and thereafter.