Sophia Anagnostopoulou

Eagle's syndrome: A review of the literature

Eagles syndrome represents symptoms brought on by compression of regional structures by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. Watt Eagle described it for the first time in 1937, dividing it into two subtypes: the “classic syndrome” and the “stylo‐carotid artery syndrome.” Many theories have been put forth regarding its pathogenesis. Depending on the underlying pathogenetic mechanism and the anatomical structures compressed or irritated by the styloid process, symptoms vary greatly, ranging from cervicofacial pain to cerebral ischemia. The syndrome generally follows tonsillectomy or trauma. Diagnosis is confirmed by radiological findings. Palpation of the styloid process in the tonsillar fossa and infiltration with anesthesia are also used in making the diagnosis. The treatment is primarily surgical; however, some conservative treatments have also been used. The current literature on Eagles syndrome is reviewed, highlighting its often underestimated frequency and its clinical importance. Clin. Anat. 22:545–558, 2009.

An anatomical study of the pterygospinous and pterygoalar bars and foramina – their clinical relevance

AIM To describe the incidence and the detailed anatomy of the pterygospinous and pterygoalar bony bridges, their variations, and their clinical relevance. These bony structures are ossified ligaments extending from distinct points of the lateral surface of the lateral pterygoid lamina to the undersurface of the greater wing of the sphenoid bone, and located close to the foramen ovale. By means of the completely ossified ligaments two individual foramens are formed, respectively: the pterygospinous (Cinivinis) foramen and the pterygoalar foramen (porus crotaphitico-buccinatorius). MATERIAL AND METHODS The existence of the pterygospinous and pterygoalar bony bridges and foramina was studied in 50 Greek dry skulls. RESULTS In this study, complete ossified pterygospinous ligaments were found in only one skull bilaterally (two out of 100 observations) and incomplete ossification in 25 out of the 100 cases. Complete and incompletely ossified pterygoalar ligaments were found unilaterally in one and in seven out of the 100 observations, respectively. CONCLUSION Bearing in mind the relatively small sample of the study the incidence of the pterygospinous bony bridges seems to be higher than the pterygoalar bridges. Also, complete ossification of both foramina may appear less frequently than the incomplete ossification. The knowledge of the detailed anatomy of these structures can increase the success of diagnostic evaluation and approaches to the region.

Thoracic paravertebral spread using two different ultrasound‐guided intercostal injection techniques in human cadavers

The continuity between the intercostal and paravertebral space has been established by several studies. In this study, the paravertebral spread of a colored dye was attempted with two different ultrasound‐guided techniques. The posterior area of the trunk was scanned with a linear probe between the level of the fifth and the seventh thoracic vertebrae in eleven embalmed human cadavers. In the first technique, the probe was placed transversely below the inferior margin of the rib, and a needle was inserted between the internal intercostal membrane and the pleura. In the second technique, the probe was placed longitudinally at the intercostal space 5 cm lateral to the spinous processes, and the needle was inserted between the internal intercostal membrane and the pleura. In both techniques, 1 ml of methylene blue was injected, and both the intercostal and paravertebral spaces were prepared. In total, 33 injections were performed: 19 with the transverse technique and 14 with the longitudinal technique. Successful spread of the dye to the thoracic paravertebral space was recorded in 89.5% cases using the transverse technique and 92.8% cases using the longitudinal technique. No intrapleural spread of the dye was recorded in either technique. Ultrasound‐guided injection into the intercostal space may offer an alternative approach to the thoracic paravertebral space. Clin. Anat. 23:840–847, 2010.

Polymorphous low-grade adenocarcinoma of the palate: Report of a case with electron microscopy

A case of polymorphous, low-grade adenocarcinoma of the palate is presented with special emphasis on the histologic and ultrastructural features of this recently described entity.

Anatomical variation and morphology in the position of the palatine foramina in adult human skulls from Greece

OBJECTIVE To investigate the anatomical variability of the palatine structures in Greek population. MATERIAL AND METHODS 71 Greek adult dry human skulls were examined to detect the position of the greater palatine (GPF) and lesser palatine foramina (LPF) related to adjacent anatomical landmarks. RESULTS The perpendicular distance of the GPF to the midline sagittal suture was 1.53 cm and 0.3 cm from the inner border of the alveolar ridge. The mean distance from the posterior palatal border was consistent 0.46 cm on the right and 0.47 cm on the left side of the skulls. In the greater majority of the skulls (76.2%), the GPF were between proximal-distal surfaces of the 3rd maxillary molar. A single LPF was observed in 53.45% of the skulls, two LPF were observed in 31% of the skulls bilaterally and five LPF were rare (2.1%). The commonest position of LPF was at the junction of the palatine bone and the inner lamella of the pterygoid plate (71.9%). CONCLUSION Our results can help clinicians localize the palatine foramina in patients with and without maxillary molars and to predict the depth of a needle to anaesthetise the maxillary nerve with greater success when performing surgical procedures in the hard and soft palate.

Anatomy of the human nucleus accumbens: a combined morphometric study

PurposeThe human nucleus accumbens (NA), which belongs to the basal ganglia of the brain, is the main part of the ventral striatum. The purpose of our clinically oriented anatomical-radiologic study was to provide anatomical and imaging data of the human NA, primarily useful to neurosurgeons.MethodsFor our imaging study, we used cerebral magnetic resonance images (MRIs) from 26 neurosurgical patients (52 NAs). The material for our anatomic study consisted of 32 cerebral hemispheres (32 NAs) from 18 normal human brains which we have in our department (Department of Anatomy) from cadaver donors. We measured and analyzed the dimensions of the NA at specific clinically important transverse, coronal and sagittal levels.ResultsThe human NA suffers from age-related but no side- or sex-related morphometric changes. In surgically important stereotactic levels this nucleus is easily identifiable on MRIs.ConclusionsWe present an anatomic guide of the NA from carefully measured data of our extensive and combined study and we hope that our work will be really helpful to neuroscientists interested in the NA.

The human nucleus accumbens suffers parkinsonism-related shrinkage: a novel finding

PurposeThe human nucleus accumbens (NA) plays an important role in motivation and emotional processes and is involved in some of the most disabling neuropsychiatric disorders such as Parkinson’s disease (PD). The purpose of our study was to check out the potential existence of a statistically significant difference in NA size between parkinsonian and non-parkinsonian individuals, through studying brain magnetic resonance images (MRIs).MethodsFor our study we used 52 NAs from 26 cerebral MRIs from neurosurgical patients. Of these MRIs, 15 were preoperative from patients with advanced PD who underwent bilateral deep brain stimulation of the subthalamic nucleus. The group of non-parkinsonian MRIs came from the rest 11 individuals. We measured the absolute and relative NA maximum transverse diameter (Dmax), and absolute and relative NA width at a specific transverse plane.ResultsWe found a statistically significant difference of the mean value of the Dmax (absolute and relative) between the two groups. The mean percentage reduction of the NA size was 11.77% represented by the relative Dmax.ConclusionsTo our knowledge, this is the first report of parkinsonism-related shrinkage of the human NA. Further research is needed to identify whether a respective shrinkage is also observed in patients with early PD and whether this atrophy is correlated with dopaminergic neuropsychiatric symptoms (perhaps mediated by a malfunctioning NA) that occur in PD.

Verruciform xanthoma of the palate: Case report with electron microscopy

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Topographic relationship between the cochlea and the middle fossa floor: the anatomical basis for an alternative approach to the cochlear turns

The cochlea has attained extreme surgical interest since cochlear implantation has been recognized as an established method for the management of certain types of bilateral profound hearing loss. Traditionally access to the cochlear turns is achieved through the middle ear. Extremely limited references exist in the literature regarding alternative surgical approaches to the cochlea. In the present study we tried to highlight the anatomic relationships of the superior aspect of the bony cochlea to the adjacent superficial structures of the petrous bone, as there have been suggestions that the cochlea is surgically accessible through the floor of the middle cranial fossa (MCF). A total of 58 dry human adult skulls (116 temporal bones) were studied. The groove for the greater superficial petrosal nerve (GGSPN) and the facial hiatus were used as landmarks in order to expose the superior aspect of the cochlea. Measurements were made of the following distances: a) between the MCF floor and the superficial part of the basal turn (SPBT), b) between the MCF floor and the apex of the cochlea, c) between the SPBT and the GGSPN and d) between the SPBT medially and the first genu of the facial canal laterally. Our results indicate that adequate and reliable surgical access to the bony cochlea could be achieved through the MCF floor.

Ketamine-induced changes in metabolic and endocrine parameters of normal and 2-kidney 1-clip rats.

Background and objective: The aim of this study was to investigate the effect of ketamine on the endocrine and lipid metabolic status of the renal‐banded animals. Methods: Forty male rats were randomly divided into four groups. Group A served as control, Group B animals received ketamine intraperitoneally at a dose of 100 mg kg−1, Group C was submitted to 2‐kidney 1‐clip experimental hypertension and Group D received ketamine as above, as well as being submitted to renal artery clipping. Atrial natriuretic peptide, angiotensin II and free fatty acid concentrations were measured in serum. In addition, adipose tissue lipoprotein lipase activity and angiotensin II content were determined, while the left ventricular weight relative to body weight was used as a cardiac hypertrophy index. Results: In renal‐banded rats (Groups C and D) serum atrial natriuretic peptide, free fatty acid and angiotensin II concentrations as well as ventricular weight were increased, while adipose tissue lipoprotein lipase activity was lower than in control animals (Groups A and B). Ketamine administration did not influence angiotensin II concentrations either in normal (Group B) or banded rats (Group D). Ketamine increased serum atrial natriuretic peptide and free fatty acid concentrations only in normal animals (Group B). It had no influence on adipose tissue lipoprotein lipase activity either in normal (Group B) or banded animals (Group D). Adipose angiotensin II content did not differ between the four groups. Conclusion: Ketamine increased the atrial natriuretic peptide and free fatty acid concentration in normal rats. In 2‐kidney 1‐clip animals, ketamine did not elicit an additional response of serum atrial natriuretic peptide or free fatty acids levels. Its contribution to these factors was not significant.