Muzaffer Seker

The relationship between the lumbosacral enlargement and the conus medullaris during the period of fetal development and adulthood

The spinal cord is situated within the vertebral canal by the third month of intrauterine life. The spinal cord possesses two symmetrical enlargements, which constitute the segments of the plexuses the cervical enlargement for the brachial plexus and the lumbosacral enlargement for the lumbar and sacral plexus. In our study, we aimed to investigate the relationship between the termination level of the lumbosacral enlargement (TLLE) and that of the conus medullaris (TLCM) during the period of fetal development and adulthood. We used a total of 75 cases 25 fetuses (male 16, female 9) whose crown-rump length ranged between 90–190 mm, 25 premature and full-term neonates (male 17, female 8) whose post-menstrual ages ranged between 33–55 weeks, and 25 adults (male 12, female 13) aged between 22–72 years. The dissection technique for fetuses, ultrasonography for premature and full-term newborns, and magnetic resonance imaging (MRI) for adults were used to determine lumbosacral enlargement and TLCM. The differences between the TLCM and the termination level of the largest part of the transverse diameter of the lumbosacral enlargement were investigated. The differences between the TLLE and TLCM were found in different ratios from the period of fetal development to adulthood. Therefore, during medical treatment and surgical procedures this should be taken into account to avoid complications.

An investigation of the conus medullaris and filum terminale variations in human fetuses.

The morphologic structure of the conus medullaris and filum terminale was investigated by dissection in 123 human fetuses, obtained from Selçuk University, Faculty of Medicine and Maternity hospital of Konya between 1992–1995. In 78 fetuses, the conus medullaris and filum terminale had a normal morphologic aspect, whereas there was a slight depression or groove formation in the closure region of the caudal neuropore in 45 fetuses. In 15 fetuses, important malformations of the cranium and vertebral column were observed. The morphologic aspects of the conus medullaris in 30 fetuses were abnormal in shape and position, among them 24 fetuses had an abnormal filum terminale (grooved, depressed, thickened or duplicated) whereas it was normal in 6. Deficiency of closure of the caudal neuropore was considered to have a negative effect on the fetal development of the filum terminale.

Communications between the palmar digital branches of the median and ulnar nerves: A study in human fetuses and a review of the literature†

In this study, median nerves (MNs) and ulnar nerves (UNs) were dissected in 200 palmar sides of hands (left and right) of 100 (50 male, 50 female) spontaneously aborted fetuses with no detectable malformations. The fetuses, whose gestational ages ranged from 13 to 40 weeks, were dissected under an operating microscope. The MN divided first into a lateral ramus and a medial ramus and then formed a common digital nerve. The first common digital nerve trifurcated in all of the studied cases. The branching patterns were classified into two types (Type 1 and Type 2) based on the relationship with the flexor retinaculum (behind/distal of it). A communication branch between the UNs and MNs in the palmar surface of the hand was found in 59 hands (29.5%). The proper palmar digital nerves were numbered from p1 to p10, starting from the radial half of the thumb to the ulnar half of the little finger, and these nerves exhibited six types of variations. The present data obtained from human fetuses will aid in elucidating the developmental anatomy of the nervous system and provide hand surgeons with a more complete anatomical picture to help them to avoid iatrogenic injuries. Clin. Anat. 23:234–241, 2010.

The Mandibular Landmarks about the Facial Artery and Vein with Multidetector Computed Tomography Angiography (MDCTA): an Anatomical and Radiological Morphometric Study

El objetivo de este estudio fue investigar el curso de los vasos faciales de acuerdo con varios puntos de referencias mandibulares en sujetos vivos mediante angiografia por tomografia computarizada multidetector (ATCM) para determinar si estos estan relacionados con el sexo y el lado. El estudio se llevo a cabo en el Departamento de Radiologia, Facultad de Medicina de Meram en Necmettin Erbakan (Konya, Turkey). En total, sesenta caras de 30 sujetos (15 hombres y 15 mujeres), que presentaban sintomas y signos de la enfermedad vascular fueron evaluados para explorar los vasos faciales por ATCM. Los parametros sobre los vasos faciales se midieron en relacion a puntos de referencia (angulo de la mandibula, proceso mental, foramen mental y linea mediana facial). La distancia desde el punto en el que la arteria facial aparece por primera vez en el margen inferior de la mandibula hasta el angulo mandibular de la arteria facial derecha y izquierda fueron 3,53±0,66 cm y 3,31±0,73 cm en hombres, respectivamente. En mujeres fueron 2,91±0,52 cm y 3,35± 0,48 cm. La ATCM es un examen nuevo, poderoso, seguro y no invasivo para demostrar la vascularizacion de la cabeza. Las estructuras oseas y la morfologia de los vasos vecinos pueden ser evaluados por esta tecnica en casos de trauma con sospecha de lesiones de los vasos y se puede considerar de seleccion en pacientes para realizar cirugias de colgajo.

Anatomical Examination of the Foramens of the Middle Cranial Fossa

Tres foramenes pueden ser identificados en el ala mayor del esfenoides: El foramen redondo (FR), foramen oval (FO) y el foramen espinoso (FS). Puede ademas existir otro foramen llamado foramen oval accesorio o foramen de Vesalio (FV), que conecta la fosa craneal media a la fosa pterigoidea. Se describe como una abertura con paredes lisas por anterior y medial al foramen oval, que conduce a un canal oblicuo dirigido hacia la fosa pterigoidea. FV estuvo presente entre FO y FR en 14 (31,8%) de 44 craneos secos y 6 (33,3%), en 18 lados en la base de craneos de cadaveres (total 20 (32,3%) de 62). El diametro de los foramenes en los lados derecho e izquierdo se observo casi simetricos. Las distancias de FR desde la linea mediana en el lado izquierdo fue mayor que en el lado derecho. Ademas, la distancia entre FO y el vertice de la porcion petrosa y la distancia entre el FS y el vertice porcion petrosa fueron mayores en el lado izquierdo. En el lado derecho la distancia entre A y FR, asi como la distancia entre A y FS fueron mayores. Por otra parte, la distancia entre los FR y el vertice del porcion petrosa fue mayor en el lado derecho. Las variaciones anatomicas en el tamano de la apariencia y la distancia de FR, DE, FS y FV son de gran importancia quirurgica. Podemos inferir que la informacion proporcionada en este estudio puede ayudar al neurocirujano y anatomista para aumentar el conocimiento sobre la anatomia de la fosa craneal media.

The evaluation of morphometry of the mastoid process using multidetector computed tomography in a living population.

AbstractThe aim of this study was to examine the relationships of the bony landmarks on the lateral surface of the mastoid process (MP). It was also the target of this study to reveal the importance of sexual dimorphism in terms of the mastoid triangle. Our study was performed on 140 (70 women, 70 men) multidetector computed tomography images obtained from patients who underwent radiologic examination at the Department of Radiology of Meram Medical Faculty, Necmettin Erbakan University. The height of the MP was measured using 2 different ways. The distance between the mastoid apex and the midpoint of the distance of the porion and the mastoid notch was measured (mastoid height 1). Then, the distance between the Frankfurt horizontal plane and the mastoid apex was measured (mastoid height 2). The distances between porion–mastoid notch, porion–mastoid apex, porion-asterion, asterion–mastoid apex, articular tubercle–asterion, articular tubercle–mastoid apex, as well as the right and the left MP were also measured. Finally, the angles between porion–mastoid apex–asterion, mastoid apex–asterion– porion, and asterion–porion–mastoid apex were measured. All data were analyzed statistically using the Student’s t-test. According to the results of the measurements, all right and left parameters of the men were higher than the women’s right and left sides except for the angle between asterion–porion–mastoid apex. In addition, all right and left parameters were almost the same in both sexes. Having the knowledge of measurements of the distances between the major landmarks of the temporal bone is essential to avoid possible complications during facial, mastoid, and especially sigmoid sinus surgeries.

Morphometric Analysis of Styloid Process Using Multidetector Computed Tomography.

AbstractStyloid process (SP) is a cylindrical anatomical structure located at the anterior side of stylomastoid foramen. Normally, it is 20 to 25 mm in length and can vary with ageand sex. An elongated SP is an unusual source of craniofacial and cervical pain. In this study, the clinical role of morphometric data of SP was discussed.In this study, 64-slice multidetector computed tomography images (Somatom Sensation 64, Siemens, Germany) from Radiology Departments archive of Necmettin Erbakan University were used. The examined images were collected from 100 patients (31 female and 69 male). Length of SP (SPL), SP width (SPW), distance between SP rooths (DBR), SPs angulation, and the distance between SP and internal carotid artery (SP-ICA) were measured.Statistical differences were found regarding to the data of SPL, SPW, DBR, and SP-ICA left between sexes. No statistical significance was detected between right and left side SPL (paired t test; P = 0.989, P > 0.05). SP was observed as mostly type A1 (right %55, left %52). These parameters were also compared with those of previous studies.The present study showed side and sex differences and types of SP. We believe that it was necessary to determine the normal range of values for different populations, and this knowledge will provide guidance to surgeons in the examination of this area.

Complete Ossification of the Superior Transverse Scapular Ligament in an Turkish Male Adult

La escapula tiene tres margenes y tres angulos, y se encuentra en la region posterolateral del torax. Una de las estructuras anatomicas de la escapula es la incisura supraescapular situada medial a la base del proceso coracoides. La incisura supraescapular puede tener diferentes formas y profundidad. Esta rodeada por el ligamento escapular transverso, un ligamento corto y fuerte. Con esta estructura, crea un pasaje osteofibroso por el cual pasa el nervio supraescapular. Se ha reportado que esta estructura osteofibrosa se puede osificar completa o parcialmente. Todas las lesiones de los nervios ocurren en su trayecto como resultado de la exposicion a compresion, tension y flexion, lo que se denomina neuropatia por atrapamiento. El nervio supraescapular puede estar expuesto a compresion al pasar por la incisura supraescapular, generando neuropatia por atrapamiento. Su etiologia puede ser por traumatismo directo, microtraumatismo repetitivo y lesiones compresivas progresivas. Una incisura supraescapular de forma oval puede ser un factor predisponente para la neuropatia por atrapamiento. En un estudio retrospectivo realizado en la Universidad Necmettin Erbakan, Facultad de Medicina de Meram, Departamento de archivo de Radiologia, se observo la imagen de un varon de 68 anos con variacion en la incisura supraescapular derecha, la cual se transformo en un foramen por un puente oseo. Los diametros del foramen fueron 5,27 mm transversales y 6,48 mm verticales. Creemos que el conocimiento detallado de la incisura supraescapular es necesario en el diagnostico y posible curso de dolor del hombro, debido al atrapamiento del nervio supraescapular en la incisura y la posible paralisis nerviosa, dando una guia a los clinicos en las practicas quirurgicas.