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ABSTRACT: The aim of this study was to show morphological sulcal variations of the pars triangularis of the inferior frontal gyrus and to provide a clearer description of the anterior sylvian point. Thirty-six hemispheres of 18 adult cadavers were studied. The hemispheres were harvested by the classical autopsy method and fixed in 10% formalin solution for three weeks. In six hemispheres, the arteries and veins were filled with colored silicone. The proximal and distal segments of the sylvian fissure, the perpendicular distance of both the anterior sylvian point and inferior rolandic point to the insular cortex and the distances between the anterior ascending ramus and the precentral, central, and postcentral sulcus were measured. The anterior horizontal and ascending rami were exposed. The sulcus located on the pars triangularis was appraised. The relationship between the anterior sylvian point and the vascular structure around the sylvian fissure was examined. The rising of the anterior horizontal and ascending ramus from the sylvian fissure defines the shape of the pars triangularis. The pars triangularis has three shapes: V, U, and Y. In V- and Y-shaped pars triangularis both rami merge but in U-shaped pars triangularis the rami do not merge. The pars triangularis was Y-shaped in 30.76% (4/13) of the right hemispheres and in 50% (7/14) of the left hemispheres; U-shaped in 20.3% (3/13) of the right hemispheres and in 35.71% (5/14) of the left hemispheres; V-shaped in 40.61% (6/13) of the right hemispheres and in 14.29% (2/14) of the left hemispheres. Minimally invasive procedures use basic anatomic landmarks intracranially to reach the targeted area; therefore, exact and detailed knowledge of the anatomy of the sylvian fissure and pars triangularis is of great importance.
Clinical Anatomy 05/2012; 25(4):429-36. · 1.29 Impact Factor
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ABSTRACT: IntroductionMention of the ligament of Barkow at the proximal tibiofibular joint is rarely found in the literature and it is not represented
in most anatomical atlases. To our knowledge, quantitation of this structure has not been performed. As injury to the knee
region is so common, a comprehensive knowledge of this regional anatomy is important to the clinician and surgeon alike.
Materials and methodsForty lower limbs from embalmed cadavers underwent dissection of the proximal leg with special attention toward the presence
or absence of ligament of Barkow. When identified, measurements of this structure were made.
ResultsThe ligament of Barkow was identified in 95% of specimens. For right sides, the mean width was 1.5cm and the mean length
was 1.2cm. For left sides, the mean width of this ligament was 1.2cm and the mean length was 1.5cm. The mean thickness
of ligament of Barkow was 1.2mm (range 0.9–1.4mm). The upper edge of this ligament was on average 3cm inferior to the inferior
most aspect of the proximal tibiofibular joint. The lower edge of ligament of Barkow was a mean distance of 7mm from the
anterior tibial artery at its entrance into the anterior compartment of the leg. One ligament was found to be fully ossified;
thereby, creating a bony bar superior to the anterior tibial vessels.
ConclusionsOur hopes are these data will help further elucidate the ligament of Barkow. Imaging studies are now necessary to further
elucidate functional and pathological involvement of this structure.
Surgical and Radiologic Anatomy 04/2012; 31(3):161-163. · 1.06 Impact Factor
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ABSTRACT: The tibial nerve has been reported to be often iatrogenically injured during fibular graft harvest, high tibial osteotomy
and fascial release procedures. Despite this complication, there are limited data available in the literature concerning the
surgical anatomy of tibial nerve branches in the deep posterior compartment of the leg. The aim of the present study was to
quantitative and localize the motor nerve points for the flexor hallucis longus (FHL), tibialis posterior (TP) and flexor
digitorum longus muscles (FDL) in relation to a regional bony landmark. The range for the number of branches of the tibial
nerve and the terminal motor points of each muscle were identified and measurements were made with a digital caliper from
these points to the apex of the head of fibula. Three particular types in the branching of tibial nerve were determined. In
55.6% of the cases there were separate branches to each of the muscles in the deep posterior compartment of the leg (Type
I). In 30.6% of the cases there were two main branches of the tibial nerve that provided motor branches (Type II). Finally,
the tibial nerve had one main branch, which gave rise to separate motor branches to each of the muscles in 13.8% (Type III).
In 61.1% of the cases the FHL was innervated by proximal and distal branches of the tibial nerve. In 38.9% of the cases, it
was innervated only by one proximal branch. In all of our cases, the TP was innervated by both proximal and distal branches
and the FDL innervated only distally. This provided a detailed anatomical description of the tibial nerve in the deep posterior
compartment of the leg. Knowledge of the variable peripheral course of the tibial nerve, as well as the detailed anatomy of
its motor branches may decrease iatrogenic injuries and motor loss of the foot during surgical procedures.
Surgical and Radiologic Anatomy 04/2012; 30(4):291-295. · 1.06 Impact Factor
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ABSTRACT: Smiling causes a deformity in some rhinoplasty patients that includes drooping of the nasal tip, elevation and shortening of the upper lip, and increased maxillary gingival show. The depressor septi muscle leads this deformity. The dermocartilaginous ligament originates from the fascia of the upper third of the nose and extends down to the medial crus, merging into the depressor septi muscle.
In this study, 100 primary rhinoplasty patients were studied for hyperdynamic nasal tip ptosis. Of these patients, 36 had hyperdynamic nasal tip ptosis due to hyperactive depressor septi nasi muscle. The dermocartilaginous ligament was used as a guide to reach the depressor septi muscle in open rhinoplasty. Muscle excision was performed just below the footplates of the medial crura. A strong columellar strut graft was placed between the medial crura to avoid narrowing of the columellar width resulting from tissue excision and to withstand activation of depressor septi muscle remnants.
No complications such as infection or hematoma occurred in the early postoperative period. The technique corrected the hyperdynamic nasal tip ptosis, increased upper lip length, and decreased gingival show when patients smiled. There was no narrowing of the columellar width. No depression in the columellar-labial junction due to distal resection of the depressor septi muscle was observed.
The dermocartilaginous ligament can be used as a reliable guide to reach the depressor septi muscle in open rhinoplasty. Therefore, the hyperactive depressor septi muscle can be definitively identified and treated without an intraoral approach. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
Aesthetic Plastic Surgery 04/2012; 36(4):819-26. · 1.41 Impact Factor
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ABSTRACT: The branching structure of the middle cerebral artery (MCA) remains a debated issue. In this study the authors aimed to describe this branching structure in detail.
Twenty-seven fresh, human brains (54 hemispheres) obtained from routine autopsies were used. The cerebral arteries were first filled with colored latex and contrast agent, followed by fixation with formaldehyde. All dissections were done under a microscope. During examination, the trunk structures of the MCA and their relations with cortical branches were demonstrated. Lateral radiographs of the same hemispheres were then obtained and comparisons were made. Angles between the MCA trunks were measured on 3D CT cerebral angiography images in 25 patients (50 hemispheres), and their correlations with the angles obtained in the cadaver brains were evaluated.
A new classification was made in relation to the terminology of the intermediate trunk, which is still a subject of debate. The intermediate trunk was present in 61% of cadavers and originated from a superior trunk in 55% and from an inferior trunk in 45%. Cortical branches supplying the motor cortex (precentral, central, and postcentral arteries) significantly originated from the intermediate trunk, and the diameter of the intermediate trunk significantly increased when it originated from the superior trunk. In measurements of the angles between the superior and intermediate trunks, it was found that the intermediate trunk had significant dominance in supplying the motor cortex as the angle increased. The intermediate trunk was classified into 3 types based on the angle values and the distance to the bifurcation point as Group A (pseudotrifurcation type), Group B (proximal type), and Group C (distal type). Group A trunks were seemingly closer to the trifurcation structure that has been reported on in the literature and was seen in 15%. Group B trunks were the most common type (55%), and Group C trunks were characterized as the farthest from the bifurcation point. Group C trunks also had the smallest diameter and fewest cortical branches. Similarities were found between the angles in cadaver specimens and on 3D CT cerebral angiography images. Beyond the separation point of the MCA, trunk structures always included the superior trunk and inferior trunk, and sometimes the intermediate trunk.
Interrelations of these vascular structures and their influences on the cortical branches originating from them are clinically important. The information presented in this study will ensure reliable diagnostic approaches and safer surgical interventions, particularly with MCA selective angiography.
Journal of Neurosurgery 02/2012; 116(5):1024-34. · 2.96 Impact Factor
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ABSTRACT: Surgical approaches to Meckel's cave (MC) are often technically difficult and sometimes associated with postoperative morbidity. The relationship of surgical landmarks to relevant anatomy is important. Therefore, we attempted to delineate quantitatively their anatomy and the relationships between MC and surrounding structures.
With the aid of a surgical microscope, MC and its contents were studied in 15 formalin-fixed cadaver head specimens. Measurements were made and their relationships were observed.
The distance from the zygomatic arch and the lateral end of the petrous ridge to MC was 26.5 and 34.4 mm, respectively. The distance from the arcuate eminence, the facial nerve hiatus, and the foramen spinosum to MC was 16.6, 12.8 and 7.46 mm respectively. The TG lay 5.81 mm posterior to the foramen ovale. The distance from the abducens, trochlear and oculomotor nerves to the trigeminal ganglion was 1.87, 5.53 and 6.57 mm respectively. The distance from the posterior and the anterior walls of the sigmoid sinus to the trigeminal porus was 43.6 and 33.1 mm respectively. The trigeminal porus was on average 7.19 mm from the anterior wall of the internal acoustic meatus.
The anatomical landmarks as presented herein regarding MC may be used for a safer skull base approach to the region.
Turkish neurosurgery 01/2012; 22(3):317-23. · 0.62 Impact Factor
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ABSTRACT: The purpose of this study is to determine the lengths of motor nerves in the upper extremity. Motor nerves of 27 muscles in 10 cadavers (16 extremities) were dissected from their roots at the level of intervertebral foramen to the entry point of the nerves to the corresponding muscles. Distance between acromion and the lateral epicondyle of the humerus was also measured in all cadavers. Nerve length of the coracobrachialis muscle was the shortest (18.26 ± 1.64 cm), while the longest was the nerve of the extensor indicis (59.51 ± 4.80 cm). The biceps brachii, the extensor digitorum communis, and the brachialis muscles showed highest coefficient of variation that makes these nerve lengths of muscles inconsistent about their lengths. This study also offers quotients using division of the lengths of each nerve to acromion-the lateral epicondyle distance. Knowledge of the nerve lengths in the upper extremity may provide a better understanding the reinnervation sequence and the recovery time in the multilevel injuries such as brachial plexus lesions. Quotients may be used to estimate average lengths of nerves of upper extremity in infants and children. Moreover, reliability of the biceps brachii as a determinant factor for surgery in obstetrical brachial plexus lesions should be reconsidered due to its highest variation coefficient.
Clinical Anatomy 08/2011; 25(3):373-8. · 1.29 Impact Factor
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ABSTRACT: The objective of this study was to analyze relationship of the intervertebral disc to the nerve root in the intervertebral foramen. Fourteen formalin-fixed cadavers were studied and measurements were performed. At the medial line of the neural foramen, the disc-root distance gradually increased from L1-L2 to L5-S1. The shortest distance between the disc to nerve root was L1-L2 (mean, 8.2 mm) and the greatest distance was found at L3-L4 (mean, 10.5 mm). In the mid-foramen, the disc-root distance decreased from L1-2 to L5-S1. The shortest distance from the disc to nerve root was found at L5-S1 (mean, 0.4 mm); and the greatest distance, at L1-L2 (mean, 3.8 mm). For the lateral line, the distance between an intersection point between the medial edge of the nerve root and the superior edge of the disc and lateral line of the foramen consistently increased from L1-L2 to L5-S1. The shortest distance from nerve root to the lateral border of the foramen, at the point where the nerve root crosses disc was at level L1-L2 (mean, 2.6 mm), the greatest distance, L5-S1 (mean, 8.8 mm). The width of the foramina progressively increased in a craniocaudal direction (mean, 8.3-17.8 mm from L1-2 to L5-S1, respectively). The mean height of the foramina was more or less the same for disc levels (range, 19.3-21.5). The results showed that nerve roots at lower levels traveled closer to the midline of the foramen. This morphometric information may be helpful in minimizing the incidence of injury to the lumbar nerve root during foraminal and extraforaminal approaches.
Clinical Anatomy 06/2011; 25(2):218-23. · 1.29 Impact Factor
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ABSTRACT: Damage to the olfactory bulb and tract is a frequently described complication of brain surgery in the frontal region, and it seems to be influenced by the surgical approaches. Eighty cerebral hemispheres and 5 formalin-fixed cadavers filled with colored latex were used. Parameters were directly measured, and after olfactory bulb and tract were mobilized with careful dissections, retraction of the frontal lobe was noted. The anterior border of the olfactory bulb is 22.21 (SD, 5.45) mm posterior to the frontomarginal sulcus, and arachnoidal dissection should be performed parallel to olfactory structures using sharp instruments to allow early visualization. Overall mobilization of the olfactory bulb and tract as 29.3 (SD, 6.4) mm in length is possible without disrupting the structures and enables a greater degree of the frontal-lobe elevation window up to 13.1 (SD, 3.2) mm. Using the morphometric data and anatomic knowledge may prevent unwanted anosmia complication during surgical approaches.
The Journal of craniofacial surgery 05/2011; 22(3):1080-2. · 0.81 Impact Factor
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ABSTRACT: The surgical anatomy of the dorsal branch of the ulnar nerve and artery on the dorsal aspect of the hand is important in design of neurocutaneous flaps for reconstructive surgery and serves as a donor site for nerve grafts. In this study, the course, location, and diameter of the dorsal branches of the ulnar nerve and artery were studied from anatomical and reconstructive perspectives.
Upper limbs of 14 (7 left and 7 right) and 22 formalin-preserved adult cadavers (15 left and 7 right) were dissected in two different centers.
The diameters of the ulnar nerve, artery, and their dorsal branches were measured at selected reference points. The distances to specific anatomical landmarks were also measured, during their courses from the proximal forearm towards the middle phalanges of the 4th and 5th fingers.
Our data may facilitate the design of neurocutaneous flaps nourished from the dorsal branches of the ulnar nerve and artery, and may aid in the harvesting of nerve grafts from the dorsal branch of the ulnar nerve, and provide a safe surgical approach to the dorsum of the hand.
Anatomia Clinica 04/2011; 33(3):229-33. · 0.93 Impact Factor
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ABSTRACT: Although injury to the lumbar arteries during anterior spinal approaches is often encountered, there are few published articles regarding the relationship between the lumbar arteries and spinal cord ischemia.
To examine the morphology of the lumbar arteries and to emphasize their clinical importance.
With the aid of a surgical microscope, 80 lumbar arteries in 10 formalin-fixed male cadavers were studied. Measurements of these structures were made and relationships observed.
The spinal artery was usually the first branch of the lumbar artery. The greatest lumbar artery diameter was at L4 and had a mean diameter of 3.25 mm; the smallest diameter was identified at L2 and had a mean diameter of 2.05 mm. The largest spinal artery diameter was at L3 (mean, 0.56 mm) and the smallest at L1 (mean, 0.42 mm). The largest anastomotic artery diameter was at L4 (mean, 0.42 mm) and the smallest at L1 (mean, 0.32 mm). For the right and left sides, the mean greatest distance between the origin of the lumbar artery and the tendinous arch was at L4 (mean, 40.9 and 31.8 mm, respectively) and the least at L1 (mean, 31.8 and 22.5 mm, respectively). The mean of the greatest distance between the anastomotic branch and the base of the transverse process of the lumbar vertebrae was at L4 (mean, 4.41 and 4.35 mm, respectively) and the smallest at L1 (mean, 4.04 and 4.08 mm, respectively).
These anatomic findings of the lumbar segmental arteries would be useful for emphasizing their surgical importance.
Neurosurgery 03/2011; 68(1 Suppl Operative):16-22; discussion 22. · 2.79 Impact Factor
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ABSTRACT: Deviated cartilages structures of the nose can be affected by nasal muscles, and deviation becomes conspicuous when the patient smiles. This condition depends on activity of nasal muscles, particularly the levator labii alaeque nasi muscle. A total of 124 septorhinoplasty operations were performed to correct dorsal concave septal deviation between 2005 and 2009 years. The 70 women and 54 men included in the study had an average age of 28 years. The average follow-up period was 12 months. Open septorhinoplasty was preferred in all cases. The medial part of the levator labii alaeque nasi muscle was extensively dissected from the lateral crus and surrounding tissues. The lateral crura of the alar cartilages were separated from the upper lateral cartilages in the scroll area. The dorsal septal deviation was corrected by combination of bilateral spreader grafts, which reinforced cartilage with horizontal control sutures. Early postoperative period was uneventful. Nasal obstruction was reduced after surgery, and significant subjective postoperative improvements were observed in all patients. Comparison of preoperative and postoperative photographs demonstrated improved dorsal nasal contour. Revision operation was performed in 3 cases. The corrected septal cartilage was in a good position in all revised cases; therefore, septal surgery was not performed in the revision operations. In conclusion, surgical disruption of the anatomic relationship between the muscle with the dorsal septal cartilage and reinforcement of the dorsal septal cartilage with spreader grafts and horizontal control sutures can decrease risk of recurrence.
The Journal of craniofacial surgery 03/2011; 22(2):446-9. · 0.81 Impact Factor
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ABSTRACT: The lumbosacral intrathecal anatomy is complex because of the density of nerve roots in the cauda equina. Space-occupying lesions, including disc herniation, trauma and tumor, within the spinal canal may compromise the nerve roots, causing severe clinical syndromes. The goal of this study is to provide spinal surgeons with a detailed anatomical description of the intrathecal nerve roots and to emphasize their clinical importance.
Ten formalin-fixed male cadavers were studied. They were dissected with the aid of a surgical microscope, and measurements were performed.
The number of dorsal and ventral roots ranged from one to three. The average diameter of roots increased from L1 to S1 (0.80 mm for L1 and 4.16 for S1), respectively. Then their diameter decreased from S1 to S5 (4.16 mm for S1, 0.46 mm for S5). The largest diameter was found at S1 and the smallest at S5. The average number of rootlets per nerve root increased from L1 to S1, then decreased (3.25 for L1, 12.6 for S1, and 1.2 for S5), respectively. The greatest rootlet number was seen at S1, and the fewest were observed at S5. The average diameter of the lateral recess gradually decreased from L1 to L4 (9.1 mm for L1; 5.96 mm for L4) and then increased at L5 level (6.06 mm); however, the diameter of the nerve root increased from L1 to L5. The midpoint of distance between the superior and inferior edge of the intradural exit nerve root was 3.47 mm below the inferior edge of the superior articular process at the L1 level, while the origin of the L5 exit root was 5.75 mm above the inferior edge. The root origin gradually ascended from L1 to L5.
The findings of this study may be valuable for understanding lesions compressing intradural nerve roots and may be useful for intradural spinal procedures.
Acta Neurochirurgica 03/2011; 153(7):1435-42. · 1.52 Impact Factor
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ABSTRACT: Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications.
Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated.
For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1-2 to L4-5 (range 2.7-3.8 mm and 2.9-4.5 mm for right and left side, respectively) and slightly decreased at L5-S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3-11.6 mm and 8.2-10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3-4 to L5-S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root-to-disc angle gradually decreased from L-3 to S-1 (range 105°-110.6° and 99°-108°). Disc heights gradually increased from L1-2 to L5-S1 (range 11.3-17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels.
To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.
Journal of neurosurgery. Spine 02/2011; 14(5):630-8. · 1.61 Impact Factor
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ABSTRACT: We aimed to show the significance of the anterior pontine membrane as a determining structure between the subdural and subarachnoid space in the clival region. MATERIAL and
Five adult cadaver heads and five cerebral hemispheres were used. The skull vault and hemipheres were removed by sectioning through the pontomesencephalic junction. Five other heads hemispheres were removed but the arachnoid membrane was protected and the cerebral side of the clival dura mater was dissected. In another specimen, the dural porus of the abducens nerve was sectioned for histological evaluation. Three cases of hematoma at the clivus were presented to support our findings.
The anterior pontine membrane is the arachnoid membrane forming the anterior wall of the prepontine cistern with its lateral extension at the skull base. This membrane forms the subdural and subarachnoid spaces by forming a barrier between the clival dura mater and neurovascular structures of the brainstem. There were rigid fibrous trabeculations between both cerebral and periosteal dural layers forming the basilar plexus as the interdural space in the clivus.
The anterior pontine membrane separates the subdural and subarachnoid spaces at the clival region. The hematomas of the clival region require to be evaluated with consideration given to the existance of the subdural space.
Turkish neurosurgery 01/2011; 21(3):372-7. · 0.62 Impact Factor
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ABSTRACT: The anatomy of the lateral complex of the ankle joint comprises multiple ligaments and muscles. This study aims to demonstrate the complexity of the lateral ankle structures in detail.
The study was performed on 11 cadavers (22 ankles) fixed in 10% formaldehyde, and 24 free talus specimens. The detailed course and attachments of each ligament was observed and noted with the ankle in neutral position. Talar measurements were applied to 46 specimens including the dissected cadavers and free talus ones. This study also investigated the relationships between these ligaments and gross morphologic pattern of lateral complex and talus, including the morphological pattern of the peroneal groove and the relationship between the peroneal tendons before and after the peroneal groove.
The whole relationship of lateral ankle structures including anatomic and morphologic patterns and talus were evaluated. No morphologic variation was found concerning peroneus brevis and longus muscles. Although the existence of peroneus quartus muscle has been reported to be 6.6%, we detected it in two of our dissections (9%). We found a peroneus quinti in four of our dissections. We also found an extraordinary ligamentous structure that runs between the distal lateral process of the calcaneus and the inferior peroneal retinaculum in 12 of our dissections. A single form of the anterior talofibular ligament (ATFL) was observed in 23%, a bifurcate ATFL in 59% and the trifurcate ATFL in 18% of the dissected ankles in this study.
Understanding the detailed anatomy of lateral ligament complex of the ankle joint with their relationships to the osseous structures and biomechanics of the ankle can help increase the success of treatment on ankle pathologies.
Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery. 12/2010; 21(3):153-8.
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ABSTRACT: Because the skin of anteromedial thigh region usually is thinner, pliable, hairless it can be preferred based on the requirements of the recipient site. In this way more information is necessary about the perforators of anteromedial thigh region. The aim of this cadaveric study was described to provide useful knowledge about localizations and number of anteromedial thigh perforators.
Study was carried out on 16 lower extremities of 9 cadavers. The area in anteromedial aspect of the thigh searched for perforators was defined between the anterolateral border of sartorius and the posterior border of gracilis. The diameters of the dissected perforators were measured and the locations were documented.
A total of 204 perforators were dissected in 16 lower extremities. The majority of musculocutaneous perforators were from gracilis (24 of 37) and there were at most 3 musculocutaneous perforators arising from gracilis muscle. 167 septocutaneous perforators were identified. Origin of all perforators was determined as 52 from deep femoral artery, 25 from proximal part of femoral artery and 127 from distal part of femoral artery and their branches. Perforators with the largest diameter were the ones arising from the intermuscular septa between the adductor (longus and magnus) and sartorius muscles. The mean diameter of the perforators was 0.75 ± 0.11 mm and ranged between 0.61 and 0.96 mm.
The septocutaneous perforators of the anteromedial aspect of the thigh are as much important as the musculocutaneous perforators and all they are with adequate to perform anteromedial thigh flap. This study provides numerical overview, useful perception about the localization of the perforators of the anteromedial aspect of the thigh and detailed anatomical basis for anteromedial thigh flap to be an important alternative.
Anatomia Clinica 10/2010; 33(3):241-7. · 0.93 Impact Factor
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ABSTRACT: Surgical approach to the upper thoracic spine diseases is challenging since anterior interventions to this region are quite complicated with the presence of major vascular elements or important visceral and soft-tissue structures. MATERIAL and
Operative technique was performed initially on eight cadavers and then on three consecutive patients. Costotransvesectomy was performed on the left side and pediculectomy were added on the contralateral side to achieve wide visual angle during corpectomy. A cage was implanted into the field of corpectomy from the left side and the stabilization procedure was completed with posterior instrumentation.
Anterior low cervical approach is less invasive than posterior approach for T2 level and above.The area below T3 level includes the heart, aorta, common carotid or brachiocephalic artery and thoracic duct favoring the safety of posterior approach which provides a sufficient surgical window for corpectomy and circumferential stabilization at a single operation.
The corpectomy procedure could be clearly performed under bilateral visualization of healthy bony margins with this technique. Although preserved laminae and spinous process lose the connection to the involved segment and hanged to adjacent levels only with posterior ligamentous complex, we propose that a chance of interlaminar fusion could further contribute to spinal stabilization rather than posterior instrumentation only.
Turkish neurosurgery 04/2010; 20(2):231-40. · 0.62 Impact Factor
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ABSTRACT: Epidural fibrosis is the scar tissue formed over the dura mater after a laminectomy. Extensive epidural fibrosis may be an important underlying cause of failed back syndrome. Pimecrolimus, an ascomycin derivative, is one of the new classes of immunomodulating macrolactams and was specifically developed for the treatment of inflammatory diseases. This study examined the preventive effects of the local application of pimecrolimus in minimizing spinal epidural fibrosis in a rat laminectomy model.
Thirty Wistar rats were divided into 3 equal groups: control, mitomycin C (MMC), and pimecrolimus groups. Each rat underwent a laminectomy at the L-3 lumbar level. In the experimental groups, a cotton pad soaked with MMC (0.5 mg/ml) or 5 mg pimecrolimus was placed on the exposed dura mater. No treatment was performed in the control group rats. Thirty days after surgery, the rats were killed and the dura mater thickness, epidural fibrosis, and arachnoidal involvement were quantified.
The mean dura thickness was measured at 9.28 +/- 3.39 microm in the MMC group and at 8.69 +/- 2.32 microm in the pimecrolimus group, compared with 14.70 +/- 4.14 microm in the control group. In addition, the epidural fibrosis and arachnoidal involvement were reduced significantly in the treatment groups compared with the control group.
In this animal model, it was shown that locally applied pimecrolimus effectively reduces epidural fibrosis and dural adherence in rats that underwent lumbar laminectomy. Mitomycin C was equally effective as pimecrolimus in reducing epidural fibrosis and dural adherence in this study.
Journal of neurosurgery. Spine 12/2009; 11(6):758-63. · 1.61 Impact Factor
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ABSTRACT: To evaluate the possible complications of overpenetrated C1 lateral mass screws and to identify and define a "safe zone" area anterior to the C1 vertebra.
The study was performed on 10 cadavers and 50 random patients who had undergone computed tomographic scanning with contrast medium of the neck for other purposes. Atlas lateral mass screw trajectories were plotted, and the safe zone for screw placement anterior to the atlas vertebra was determined for each trajectory.
The trajectory of the internal carotid artery was measured from its medial wall. The trajectory of the internal carotid artery according to the ideal entrance point of the screw was 11.55 +/- 4.55 degrees (range, 2-22 degrees) in the cadavers and 9.78 +/- 4.55 degrees (range, -5 to 22 degrees) bilaterally in the patients. At 15 degrees (ideal screw trajectory), the thickness of the rectus capitis anterior muscle and longus capitis muscle was 6.69 +/- 0.83 mm (range, 5.32-7.92 mm) in the cadavers and 7.29 +/- 1.90 mm (range, 0.50-13.63 mm) bilaterally in the patients. The smallest distance from the internal carotid artery to the anterior cortex of the C1 vertebra was calculated as 4.33 +/- 2.03 mm (range, 1.15-8.40 mm) bilaterally in the cadavers and 5.07 +/- 1.72 mm (range, 2.15-8.91 mm) bilaterally in radiological specimens.
The internal carotid artery trajectory is lateral to the ideal entrance point of C1 lateral mass screws. The medial angulation of a screw placed in the lateral mass of C1 seemed to increase the margin of safety for the internal carotid artery. The rectus capitis anterior and longus capitis muscles may be thought of as a safe zone area for C1 lateral mass screws. At more than 25 degrees of medial angulation, the risk of perforation of the oropharyngeal wall increases.
Neurosurgery 12/2009; 65(6):1154-60; discussion 1160. · 2.79 Impact Factor
