Sladjana Petrovic

Similarities and dissimilarities of the blood supplies of the human sciatic, tibial, and common peroneal nerves

The aim was to investigate the arterial supply of the sciatic, tibial, and common peroneal nerves. Thirty‐six lower limbs of 18 human fetuses were studied. The fetuses had been fixed in buffered formalin and the blood vessels injected with barium sulfate. Fetal age ranged from 12 to 28 weeks of gestation. Microdissection of the fetal lower extremities was done under ×5 magnifying lenses. The sciatic nerves of 10 lower extremities were dissected and excised and radiographs taken. The extraneural arterial chain of the sciatic nerve was composed of 2–6 arterial branches of the inferior gluteal artery, the medial circumflex femoral artery, the perforating arteries, and the popliteal artery. The extraneural arterial chain of tibial nerve was composed of 2–5 arteries, which were branches of the popliteal, the peroneal, and the posterior tibial arteries. Radiographs showed the presence of complete intraneural arterial chains in the sciatic and tibial nerves, formed from anastomosing vessels. Dissection showed that, in 97.2% of the specimens, the common peroneal nerve was supplied only by one popliteal artery branch, the presence of which was confirmed radiologically. The sciatic and tibial nerves are supplied by numerous arterial branches of different origins, which provide for collateral circulation. In contrast, the common peroneal nerve is most frequently supplied only by one elongated longitudinal blood vessel, a branch of the popliteal artery. Such a vascular arrangement may make the common peroneal nerve less resistant to stretching and compression. Clin. Anat. 26:875–882, 2013.

The Parametric Model of the Human Mandible Coronoid Process Created by Method of Anatomical Features.

Geometrically accurate and anatomically correct 3D models of the human bones are of great importance for medical research and practice in orthopedics and surgery. These geometrical models can be created by the use of techniques which can be based on input geometrical data acquired from volumetric methods of scanning (e.g., Computed Tomography (CT)) or on the 2D images (e.g., X-ray). Geometrical models of human bones created in such way can be applied for education of medical practitioners, preoperative planning, etc. In cases when geometrical data about the human bone is incomplete (e.g., fractures), it may be necessary to create its complete geometrical model. The possible solution for this problem is the application of parametric models. The geometry of these models can be changed and adapted to the specific patient based on the values of parameters acquired from medical images (e.g., X-ray). In this paper, Method of Anatomical Features (MAF) which enables creation of geometrically precise and anatomically accurate geometrical models of the human bones is implemented for the creation of the parametric model of the Human Mandible Coronoid Process (HMCP). The obtained results about geometrical accuracy of the model are quite satisfactory, as it is stated by the medical practitioners and confirmed in the literature.

ADC is not reliable in determinating subtypes of meningiomas

ObjectiveTo verify the reliability of apparent diffusion coefficient (ADC) measurements in determining subtypes of meningiomas.Material and methodsThirty patients (20 women and 10 men; average age, 53±15 years) with meningiomas were prospectively studied using DWI with b values of 0 and 1000. ADC values of the neoplastic tissue were obtained as the mean of measurements from three regions of interests within the mass and compared with histologic subtypes using ANOVA test (SPSS16).ResultsThe meningothelial subtype was found in 15 (50%) patients, fibroblastic in 10 (33.33%) patients and cystic in 5 (16.67%) patients. All meningiomas belonged to the WHO Grade 1 — benign meningiomas. There was no significant statistical difference between meningothelial, fibroblastic and cystic meningiomas when considering mean ADC values (0.000411+/−0.000066 mm2/s vs. 0.000750+/−0.001045 mm2/s vs. 0.000688+/−0.000063 mm2/s (p>0.05). Perifocal edema was present only with fibroblastic meningioma with mean ADC 0.000683 mm2/s. The ADC of the cystic component was statistically significantly higher in cystic meningeomas (0.001283 mm2/s) compared with fibroblastic (0.000224 mm2/s) and meningothelial meningiomas (0.000088 mm2/s) (p<0.001). The ADC of meningiomas was higher compared with contralateral healthy brain tissue (0.000642 mm2/s vs. 0.000404 mm2/s; n.s).ConclusionADC measurement do not seem reliable in identifying histological subtypes of Grade I meningiomas.

Multichannel fenestration of the petrous and cavernous segments of the internal carotid artery associated with two small carotid canals.

A fenestration is defined as a division of the arterial lumen into distinctly separate channels, each with its own endothelial and muscularis layers, while the adventitia may be shared. Duplication, by contrast, is defined as two distinct arteries with separate origins and no distal arterial convergence. Fenestrations can range from a small focus of divided tissue to long segment duplications. They are the result of partial failure of fusion of paired primitive embryologic vessels or incomplete obliteration of different anastomosis in a primitive vascular network [1]. Fenestration, or duplication, of the internal carotid artery (ICA) is considered as an extremely rare anatomic variant. The prescens of greater than two channels in a long segment of the ICA has not been previously described. We report a case of multichannel fenestrations of the petrous and cavernous segments of the ICA associated with two small carotid canals. A 58-year-old man with no remarkable medical history was admitted to the Department of Neurology for transient ischemic attack involving the right upper extremity. At admission, his general and neurologic examinations were normal. Brain CT findings were unremarkable expect for narrow right carotid canal (Fig. 1). The inferior part of the carotid canal was divided by a bony septum into two smaller canals. CT angiography revealed hypoplastic cervical segment of the right ICA and multiple vessels in the petrous canal, and parasellar area converging to the intradural paraclinoid segment of the ICA (Fig. 2). Digital subtraction angiography (DSA) was performed. Right carotid angiogram (Fig. 3a, b) demonstrated small caliber of ICA, including the first (cervical) and second (ascending petrous) segment. Distally, four tortuous vessels with a diameter of 1–2 mm were found along the course of the third (horizontal intrapetrous), fourth (ascending intrapetrous and in foramen lacerum) and fifth (horizontal segment of the carotid siphon) segments. These vessels converged to the sixth (clinoid) segment. The seventh (supraclinoid) segment of ICA and medial cerebral artery were normal. There was hypoplasia of the A1 segment of the anterior cerebral artery. Selective right external carotid artery showed no abnormalities. Angiograms of the left carotid and both vertebral arteries were normal. Our case describes developmental abnormalities of the petrous and cavernous portion of the ICA, consisted of four channel fenestrations associated with two small carotid canals. Fenestration or segmental duplication of the petrous and the cavernous segment of the ICA is considered an extremely rare anatomic variant. To the best of our knowledge, this is the first report of long-segment multichannel fenestration involving petrous and cavernous segments of the ICA. There is only one case of multichannel fenestrations of the petrous segment of the ICA reported by Mangla and Teitelbaum [2]. They described the shortsegment division of the petrous segment into four channels on DSA. The fenestration was approximately 1-cm long. Uchino et al. [3] have published the only case of intracavernous fenestration diagnosed by MR angiography and DSA. They described duplicate arterial lumens just proximal to the supraclinoid segment. Fenestrations in the supraclinoid and cervical segments are more common. D. Stojanov P. Bosnjakovic D. Benedeto-Stojanov S. Petrovic Faculty of Medicine, University of Nis, Nis, Serbia

Morphometric analysis of the stylohyoid complex

PurposeStylohyoid complex is anatomical structure predisposed to numerous individual variations. These may result in its extreme elongation, medial deviation and finally Eagle’s syndrome occurrence. The aim of this study was to measure the length, angulation, evaluate morphological variations of stylohyoid complex by computed tomography and, subsequently, relate obtained data to the gender and the age of the evaluated cases.Materials and methodsThe material included CT scans of stylohyoid complexes of 282 individuals. The entire length, maximal thickness, and angulation of the stylohyoid complexes in the coronal, transverse, and sagittal planes were measured.ResultsAccording to their morphology, orientation and length, stylohyoid complexes were classified into six morphological types. Elongated, bent, segmented, and segmented with attached stylohyoid ligament for the lesser horns of the hyoid bone stylohyoid complex types were characterized by significantly greater length, while pseudoarticulated type was characterized by significantly lower length in relation to normal stylohyoid complex type. The elongated type was additionally significantly thicker and with significantly lower value of medial angle in transverse plain than the normal stylohyoid complex type. Elongated, bent, and segmented types were significantly more frequent in males than in females. Furthermore, the frequency of the elongated stylohyoid complex type increased, whereas normal and pseudoarticulated types decreased with age.ConclusionsIn conclusion, elongated and more medially deviated stylohyoid complexes are more frequent in males than in females. Their more frequent presence in the older age groups indirectly connects this phenomenon with the aging process.

Imaging in Clinical and Preclinical Practice

Over the years, medical imaging has become an inherent part of modern medicine and biomedical engineering. Various imaging methods, which provide the detailed insight into human body interior, are widely used in clinical and preclinical practice. They enable the accurate diagnosis of complex pathological states, planning and performing of challenging surgical operations, tissue engineering, design of medical devices and much more. The area of medical imaging is very complex, as it is comprised of different imaging modalities and it keeps expanding due to rapid development of modern technologies. An overview of most important imaging techniques, containing references that describe various applications of each of the methods, is given first. More detail is given on the following methods: radiography, computed tomography (CT), ultrasound imaging, magnetic resonance imaging (MRI), mammography and positron emission tomography (PET). Two detailed examples accompany the overview, which are related to monitoring of osteogenesis in large animals using CT and application of imaging techniques in diagnosis and management of osteoporosis.

Customized anatomically adjusted plate for fixation of mandible internal fractures

Mandible internal fractures are a common injury because of the mandibles lack of structural support. For the treatment of such injuries various fixation elements are used. In order to improve quality of the orthodontists interventions anatomically correct and geometrically accurate customized implants are necessary. In this paper an example of accurate geometrical model of the customized plate implant for the fixation of mandible fracture is presented. For the creation of such model new method has been developed. This method is based on reverse engineering techniques applied on the CT scan of the specific patient mandible. With the application of this method it is possible to create geometrical model of the customized plate implant which geometry and topology conforms to the shape of the mandible of the specific patient. The side of the implant, which is in contact with a periosteum outer layer of the mandible, is fully aligned with the shape of the mandible outer surface near the fracture. The obtained model(s) can be used for production of plate implants, and/or for simulation of orthodontist interventions.