Maria Tzika

Sternalis muscle: an underestimated anterior chest wall anatomical variant

Over the recent years, an increased alertness for thorough knowledge of anatomical variants with clinical significance has been recorded in order to minimize the risks of surgical complications. We report a rare case of bilateral strap-like sternalis muscle of the anterior chest wall in a female cadaver. Its presence may evoke alterations in the electrocardiogram or confuse a routine mammography. The incidental finding of a sternalis muscle in mammography, CT, and MRI studies must be documented in a patients medical records as it can be used as a pedicle flap or flap microvascular anastomosis during reconstructive surgery of the anterior chest wall, head and neck, and breast. Moreover, its presence may be misdiagnosed as a wide range of benign and malignant anterior chest wall lesions and tumors.

Entrapment of the superficial peroneal nerve: an anatomical insight.

Entrapment of the superficial peroneal nerve is an uncommon neuropathy that may occur because of mechanical compression of the nerve, usually at its exit from the crural fascia. The symptoms include sensory alterations over the distribution area of the superficial peroneal nerve. Clinical examination, electrophysiologic findings, and imaging techniques can establish the diagnosis. Variations in the superficial peroneal sensory innervation over the dorsum of the foot may lead to variable results during neurologic examination and variable symptomatology in patients with nerve entrapment or lesions. Knowledge of the nerves anatomy at the lower leg, foot, and ankle is of essential significance for the neurologist and surgeon intervening in the area.

The accessory deep peroneal nerve: A review of the literature

The accessory deep peroneal nerve (ADPN) is a common variant branch of the superficial peroneal nerve. It unrarely participates in the innervation of the extensor digitorum brevis muscle and interferes with the differential diagnosis of peroneal nerve lesions. Several electrophysiological and anatomical studies have been conducted in order to document the topography, characteristics and prevalence of ADPN, presenting significantly different results. ADPN existence is of great clinical and surgical importance, thus the aim of this study is to select and present all the relevant data available in the literature.

Fascial entrapment of the sural nerve and its clinical relevance

Sural nerve presents great topographic variability and it is responsible for sensory innervation of the posterolateral side of the distal third of the leg and lateral aspect of the foot. Entrapment of the nerve could be caused by compression due to fascial thickening, while the symptomatology includes sensory alterations and deficits at the nerve distribution area. We report a cadaveric case of a variant sural nerve that presented a distinct entrapment site. A supernumerary sensory branch was encountered originating from the common peroneal nerve, while the peroneal component of the sural nerve was observed to take a course within a fibrous fascial tunnel 3.1 cm in length that caused nerve fixation and flattening. The tension applied to the aforementioned branch was shown to worsen during passive forcible foot plantaflexion and inversion. The etiology, diagnosis and the treatment options are discussed comprehensively.

Abnormal origin of internal thoracic artery from the thyrocervical trunk: surgical considerations

An unusual case of left internal thoracic artery (ITA) origin from the thyrocervical trunk (TCT) was detected during routine cadaver dissection. The variability of origin and course of ITA has less or more frequently been documented in the literature. However, the ITA origin from the TCT on the left side has been detected less commonly, making its dissection and preparation during coronary artery bypass grafting surgery more difficult. We discuss the ITA origin and course variability as well as clinical significance of the present variant, reviewing the relative literature. The objective of our study is to exhibit a rare ITA origin in order to provide a more accurate knowledge of such variations.

FIVE ROOTS PATTERN OF MEDIAN NERVE FORMATION

An unusual combination of median nerves variations has been encountered in a male cadaver during routine educational dissection. In particular, the median nerve was formed by five roots; three roots originated from the lateral cord of the brachial plexus joined individually the median nerves medial root. The latter (fourth) root was united with the lateral (fifth) root of the median nerve forming the median nerve distally in the upper arm and not the axilla as usually. In addition, the median nerve was situated medial to the brachial artery. We review comprehensively the relevant variants, their embryologic development and their potential clinical applications.

Potential Entrapment of an Accessory Superficial Peroneal Sensory Nerve at the Lateral Malleolus: A Cadaveric Case Report and Review of the Literature

The superficial peroneal nerve presents great anatomic variability regarding its emergence from the crural fascia, course, branching pattern, and distribution area. Entrapment neuropathy of the superficial peroneal nerve has been documented in the published data, resulting in pain and paresthesia over the dorsum of the foot. We report a case of a female cadaver in which an accessory superficial peroneal sensory nerve was encountered. The nerve originated from the main superficial peroneal nerve trunk, proximal to the superficial peroneal nerve emergence from the crural fascia, and followed a subfascial course. After fascial penetration, the supernumerary nerve was distributed to the skin of the proximal dorsum of the foot and lateral malleolar area. A potential entrapment site of the nerve was observed at the lateral malleolar area, because the accessory nerve traveled through a fascial tunnel while perforating the crural fascia, and presented with distinct post-stenotic enlargement at its exit point. The likely presence of such a very rare variant and its potential entrapment is essential for the physician and surgeon to establish a correct diagnosis and avoid complications during procedures to the foot and ankle region.

Human body exhibitions: Public opinion of young individuals and contemporary bioethics

PurposeThe exhibitions of plastinated cadavers and organs have attracted millions of visitors globally, while raising serious controversy about their content and purpose of implementation.MethodsWe performed a survey based study on 500 randomly chosen individuals, aged 18- to 35-year old, in order to access their opinion regarding the conduction of such shows as well as body donation for scientific purposes.ResultsWe found that 46.3% of the participants had moral concerns, and 46.1% did not. Religious and philosophical beliefs concerned 21.8% of the sample, while 28% believed that the exhibits may affect visitors’ mental health. Human dignity violation was stressed by 21.6%, whereas 26.6% disagreed with body donation to science.ConclusionsThe desire for qualitative-guided anatomy education is evident from the highly popular plastinated body and specimen exhibitions. Hence, additional focused effort could be provided to educate the public about normal and pathological anatomy in order to amend their life-style. This could be effected by certified anatomy demonstrators in graduated steps according to the cohort’s age, education, occupation, and health status.

Double sternal foramina in a dried sternum: a rare normal variant and its radiologic assessment

Sternal foramina (SF) constitute developmental defects of the sternum and are usually radiologic or postmortem accidental findings. A rare case is presented, concerning the dried sternum of Greek origin and unknown age. The manubrium, sternal body and xiphoid process were fused and ossified, while two SF of undocumented size were present. The proximal SF was located at the sternal body extending between the fourth and fifth intercostal spaces, whereas the distal SF was located at the xiphoid process being surrounded by a thin “ring-like” osseous rim. Computed tomography was utilized for further investigation. Awareness of this variation is essential for the radiologist to avoid misdiagnosis and interpret with accuracy the current combination of normal anatomic variants. Moreover, SF existence is associated with clinical and forensic implications that are shortly discussed.

Multibranch anastomotic variant of the lateral femoral cutaneous nerve: possible implications in neurosurgical practice.

Dear Editor, The anatomy and topography of the lateral femoral cutaneous (LFCN) and genitofemoral (GFN) nerves is known to have some variability [6]. Their formation and distribution may complicate the outcome of several surgical procedures, such as extraperitoneal approaches to the anterior and lateral lumbar spine [1, 2], rendering these nerves more vulnerable to iatrogenic injury. During a routine dissection of a formalin-fixed, 78-yearold male cadaver, a variant left LFCN was encountered. In the pelvis, the LFCN originated from the L2/L3 roots and emerged typically from the lateral border of the psoas major (PM) muscle. The nerve gave off a lateral accessory LFCN and a medial accessory anterior femoral cutaneous nerve branch, at 5.6 cm and 7.2 cm from the lateral border of the PM muscle, respectively. The GFN, after penetrating the PM muscle, branched off at 3.4 cm prior to the inguinal ligament (IL), providing a lateral nerve that anastomosed with the two LFCN branches below the IL level (Fig. 1a). The three nerve branches passed separately behind the IL and anastomosed 1.1 cm below the IL level, creating a multibranch octopus-like formation that eventually gave off six terminal nerve branches providing sensory supply to the anterolateral thigh (Fig. 1b). Both GFN and LFCN constitute branches of the lumbar plexus [6]. In GFN neuropathy, the symptomatology includes sensory loss and paresthesia over the GFN distribution area. In our case, the GFN anastomosed with the LFCN below the IL level; thus GFN neuralgia may present with sensory abnormalities such as numbness in the anterolateral and lateral thigh. LFCN injury leads to “meralgia paresthetica”, a disorder presenting with paresthesia and numbness over the LFCN supplied area [4]. The IL constitutes a potential entrapment site; in our case, three nerve branches passed behind the IL, jeopardizing nerve traction and neuropathy, leading to increased risk of producing such symptoms. Surgical treatment of “meralgia paresthetica” mainly includes nerve decompression or neurolysis and transposition of the trapped nerve branch [5]. Neurectomy can be also done in cases where other surgical treatments have failed [3]. The presence of multiple nerve branches passing behind the IL may provoke recurrence of symptoms if the surgeon does not identify the responsible nerve branch, although this multinerval supply may be useful in preserving sensation in the affected area after resection of the injured branch. Both LFCN and GFN can be injured during a lateral retroperitoneal approach to the lumbar spine [1, 2]. It is also challenging to recognize possible variants in surgery. Due to the fact that their activity is difficult if not impossible to be monitored reliably with neurophysiology intraoperatively, this type of injury usually remains unnoticed during surgery, with patients complaining for thigh numbness postoperatively [2]. Fortunately, the symptoms tend to resolve within weeks. G. K. Paraskevas :K. Natsis :M. Tzika Department of Anatomy, Faculty of Medicine, Aristotle University, Thessaloniki, Greece