R. Shane Tubbs

Seattle Science Foundation

Observing anomalies in the origin of the coronary arteries is a rare but recognised scenario during coronarography. All the major coronary arteries originating from the right sinus of Valsalva is an extremely rare anomaly, its reported incidence being 0.008% in angiographic studies. Most coronary artery variations are benign and are therefore found...

From a topographical standpoint, the digastric muscle is key to the formation of several triangles of the neck, which are of the utmost clinical significance. Herein, we present a previously unrecognized variation of the digastric muscle: a quadrigastric muscle with two accessory bellies originating from the body and angle of the mandible and inser...

In general, when a particular term in medicine is used, it should be correct and precise. Human anatomy is an old science and has developed over the years with various and numerous terms and classifications being used. Their role is to present and summarize the described findings, simply and understandably, not only to the anatomist but also to the...

Acting in medial rotation of the arm, the subscapularis (SM) is the most powerful and largest muscle of the rotator cuff. It is morphologically variable, especially in the number of tendons, place of insertion, and number of bellies, and it is sometimes fused with another muscle. An accessory subscapularis muscle (ASM) is among the morphological va...

Detailed knowledge of the anatomy and different variations of the saphenous nerve could be of great importance not only to anatomists but also to clinicians. There are very few studies of saphenous nerve morphology in thigh. Most of the reported variations of this nerve concern the infrapatellar branch. In contrast, a saphenous plexus has been desc...

The ophthalmic artery arises from the supraclinoid segment of the internal carotid artery (ICA) and enters the orbit through the optic canal. It perfuses the orbit and the orbit apparatus. Ophthalmic artery aneurysms (OAA) account for 0.5% to 11% of all intracerebral aneurysms. Patients are usually asymptomatic but, in some cases, patients can pres...

Most muscular structures in the human body are named based on their function, origin/insertion, or shape. During routine dissection of the back, an unusual muscle was found deep to the rhomboid muscles. The details of this case and a review of the extant literature are provided.

Purpose: The following research aimed to investigate the prevalence and anatomical features of the axillary arch (AA) – a muscular, tendinous or musculotendinous slip arising from the latissimus dorsi and that terminates in various structures around the shoulder girdle. The AA may complicate axillary lymph node biopsy or breast reconstruction surge...

Unambiguous reporting of a study's compliance with ethical guidelines in anatomical research is imperative. As such, clear, universal, and uniform reporting guidelines for study ethics are essential. In 2016, the International Evidence-Based Anatomy Working group in collaboration with international partners established reporting guidelines for anat...

Purpose The extensor indicis proprius (EIP) is a muscle of the forearm that originates from the posterior surface of the ulna and the adjacent interosseous membrane and attaches to the index finger. Many anatomical variations of this muscle have been reported in the literature. The extensor digitorum brevis manus (EDBM) is a variant muscle found on...

Introduction: Children with malignancies show a significantly higher incidence of morphological anomalies (head, eye, nose, ear, trunk, rib and spine anomalies and defects) than “their” healthy counterparts. Cervical ribs (CR) are supernumerary ribs that emerge from seventh cervical vertebra. Aim: This meta-analysis aimed to investigate the preval...

Compression of the radial nerve is most commonly described at the supinator muscle (i.e., arcade of Frohse). However, radial nerve compression can occur in the arm. Therefore, the purpose of this article is to review both etiologies of radial nerve entrapment and the sites at which this can occur in the arm. The clinical presentation of radial nerv...

Mimetic muscles contract and pull the overlying skin toward the muscle’s bony attachment. Numerous books and articles have shown the mimetic muscles via cadaveric dissection. However, for dentistry and oral surgery, the mimetic muscles have not been detailed from intraoral dissection. Recently, several papers have addressed various mimetic muscles...

Background: The course of the nerves along the nasal septum has not been clearly studied, and surgical procedures such as rhinoplasty require a more detailed topography of the nerve supply inside the septum. Therefore, we aimed to investigate the distribution of the internal nasal branch of the infraorbital nerve inside the nasal septum and to def...

Introduction: Cardiac abnormalities are observed frequently after aneurysmal subarachnoid hemorrhage (aSAH). A subset of aSAH patients develops neurogenic cardiomyopathy, likely induced by catecholamine excess. Genetic polymorphisms of the endothelial nitric oxide synthase (eNOS) gene have been linked to decreased nitric oxide (NO) levels, coronar...

This rare case report describes the diagnosis and treatment of an isolated left-sided orbital floor fracture with a complete dislocation of the globe into the maxillary sinus and briefly discusses the indications of surgery and recovery for orbital floor fractures in general. Complete herniation of the globe through an orbital blow-out fracture is...

The location of the opening of the zygomaticotemporal branch (ZTb) of the zygomatic nerve inside the orbit (ZTFIN) has significant surgical implications. This study was conducted to locate the ZTFIN and investigate the variations of the ZTb inside the orbit. A total of 20 sides from 10 fresh frozen cadaveric Caucasian heads were used in this study....

Penetrating injuries to the orbit represent a small but very complicated portion of head injuries. Because of the close proximity to many vital structures, any penetrating orbital injury requires a multidisciplinary follow-up. Cases of penetrating injuries have flooded the literature, but no one has presented a systematic approach to the complicati...

The mentalis (MT) and the incisivus labii inferioris (ILI), which are accessory muscles of the orbicularis oris (OO) muscle, form an intertwined and three-dimensionally related complex. The purpose of this study is to clarify the relationship between the MT, ILI, and OO muscles via intraoral dissection. Twenty-two sides from 11 fresh adult Caucasia...

Leg pain from lumbar disc herniation is a common presentation. However, certain muscular and peripheral nerve variants may present similarly and represent an unrecognized etiology of femoral nerve dysfunction. Such cases might affect the outcome of specific treatment regimes. Therefore, recognition of these variations in anatomy may be useful to th...

Os odontoideum (OO) is a rare anomaly of the odontoid process first described by Giacomini in 1886. There is considerable debate about the origin of this anomaly, whether congenital or acquired, though a growing body of evidence favors the latter. Using PubMed, we reviewed the literature on OO with regards to its etiology, clinical presentations, d...

Background: The first description of the voluntary motor function of the facial nerve and separate sensory-motor contributions of the trigeminal nerve is most commonly attributed to Charles Bell. However, a review of the original scientific accounts and subsequent historical publications question the validity of this credit. The objective of the p...

Background Various surgical techniques have been described for treating odontoid instability and achieving effective stabilization. The earliest technique to be described proposed a C1 lateral mass entry point including neurectomy of the C2 nerve roots to ensure hemostasis. Because C2 neurectomy remains controversial, preservation of the C2 nerve r...

Objective: Various authors have described the morphology of the alar ligaments, however, there are no reports of a cadaveric study that focuses on their attachments onto the dens. The purpose of this study is to use fresh cadaveric specimens to describe in detail the different attachment patterns of the alar ligaments onto the dens. Methods: Twe...

The posterior cerebral artery (PCA) has been noted in literature to have anatomical variations, specifically fenestration. Cerebral arteries with fenestrations are uncommon, especially when associated with other vascular pathologies. We report a case here of fenestrations within the P1 segment of the right PCA associated with a right middle cerebra...

Abstract During a routine anatomical dissection in the right brachium of a 75-year-old male cadaver, a novel variation of the coracobrachialis muscle (CB) was discovered. It consisted of three parts: proximal, starting from the upper border of the scapula; medial, presenting the well-accessed CB; and distal, formed by a proximal tendinous part that...

INTRODUCTION Chronic dry eye (keratitis sicca) is a significant problem that in certain populations can result in corneal desiccation and the potential for blindness. Therefore, novel treatments for such disorders might decrease patient morbidity. The present study aimed to investigate a potential treatment for chronic dry eye via a cadaveric feasi...

Introduction The accessory foramina could not be identified on some imaging modalities such as surface-rendered images. The purpose of this study was to investigate the ability of surface-rendered images in detecting these foramina. Materials and methods We analyzed 20 accessory mental foramina (AMF) in nine mandibles removed from cadavers with co...

Introduction: Osteochondromas are common benign tumors of bone and spinal involvement is uncommon. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to adjacent neural structures. Case presentation: Herein, we present a case of solitary osteochondroma arising from the posterior ar...

Study design: Retrospective cohort study. Objective: The objective of this study is to compare the incidence of infection in patients who do and do not receive blood transfusions in major deformity surgery (>8 levels). Summary of background data: Postoperative infections increase morbidity and mortality rates in spine surgery and generate addi...

Introduction The median and radial nerves are two important neural structures found in the cubital fossa. The trajectory and landmarks used to identify their location are important when procedures are done in this area. Methods and materials Ten fresh-frozen cadavers were dissected (20 upper limbs) and measurements were taken from the medial epico...

This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an effective free radical scavenger an...

Spinal?hematomas are a rare but?serious?complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space.?Spinal subdural hematomas?likely exist within a traumatically induced?space within?the?dural?border cell layer, rather than an anatomical?subdural space.?Spinal?su...

Permissions and Reprints Abstract This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an...

Introduction: Recently, placement of a ventriculoperitoneal shunt via a transumbilical approach has been reported. Patients and methods: Herein, we report the repair of an umbilical hernia via the same incision and introduction of the distal end of a ventricultoperitoneal shunt into the peritoneal cavity in 3 patients. A case illustration is inc...

The purpose of this paper is to survey the literature on Gerbode defect and provide an overview of its history, anatomy, development, pathophysiology, diagnosis, and treatment options. The available literature on this topic, including case reports, was thoroughly reviewed. Gerbode defect is defined as abnormal shunting between the left ventricle an...

Objects: Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) requiring permanent cerebrospinal fluid (CSF) diversion in up to two thirds of patients. Factors that predict permanent CSF diversion are not well established. Methods: An exploratory analysis of 149 patients enrolled in the Cerebral Aneurysm Renin Angio...

We compare, on left and right side of human skulls, the length of Whitnall's tubercle as a relevant landmark and anchor point for the lateral retinaculum. Twenty human skulls were used in this study. A caliper was used to measure the length of Whitnall's tubercle, the distance from Whitnall's tubercle to the frontozygomatic suture and the height of...

Background: Intraventricular schwannoma remains a rare entity in the literature. Controversy exists on the possible pathogenesis of such a tumor within cerebral ventricles. Literature is sparse on tumor characteristics and differences between pediatric and adult patients. Case report: We present a case of intraventricular schwannoma in a 9-year-...

This chapter describes a meningeal branch of the C1 spinal nerve as well as an articular branch to the atlanto-occipital joint. It discusses C1 dorsal roots, C1 dorsal root ganglion, and C1 dorsal ramus. In 50% specimens, the spinal accessory nerve joined with dorsal rootlets of C1 spinal nerve. Dorsal root ganglion of C1 gives rise to the motor ne...

To accommodate the natural curvature of the spine, cervical lordosis, thoracic kyphosis, and lumbosacral lordosis, the spinal cord follows similar curvatures. The three meningeal layers protect the spinal cord. They are pia, arachnoid, and dura mater. The dentate ligaments (DL) bridge the pia and dura and support the spinal cord vertically and hori...

This chapter discusses the branches of the autonomic nervous system, including sympathetic ganglia, superior cervical ganglion, splanchnic nerves, ansa subclavia and cardiac plexus. The superior cervical ganglion may be fused with the middle cervical ganglion. Inferior cervical ganglion is frequently combined with the first thoracic and is named th...

Background and Purpose: Delayed cerebral ischemia (DCI) is a recognized complication of aneurysmal subarachnoid hemorrhage (aSAH) that contributes to poor outcome. This study seeks to determine the effect of nosocomial infection on the incidence of DCI and patient outcome. Methods and Subjects: An exploratory analysis was performed on 156 aSAH pati...

This case report describes a patient with an anatomic variant of the foramen ovale that was encountered during an attempted glycerol rhizolysis for trigeminal neuralgia. Various complications have been reported during transcutaneous trigeminal neuralgia treatment. We report an adult female on whom transcutaneous cannulation of the foramen ovale was...

Background: Vagus nerve stimulation (VNS) is an adjunctive neurophysiological treatment for those patients who have pharmacoresistant or surgically resistant partial onset epilepsy. Objective: The aim of this study is to determine the effects of high and low stimulation paradigms on a responder rate of ≥50 and ≥75 % reduction in seizure frequenc...

Introduction: Approaches for proximal sciatic nerve decompression use a transgluteal route, but are associated with morbidity and complications. An alternative anterior approach to the sciatic nerve was designed. Methods: Five adult human cadavers (10 sides) were used. In the supine position and with lower limbs abducted, an incision was made 3-cm...

A number of criteria are used in the literature to describe high take-off coronary arteries which can, in part, explain the divide in the literature on the pathological significance of this anomaly. This study presents the anatomical variations of high take-off coronary arteries to draw attention to the possible clinical implications they may cause...

Objectives The roof of the porus trigeminus, composed of the posterior petroclinoid dural fold, is an important landmark to the skull base surgeon. Ossification of the posterior petroclinoid dural fold is an anatomical variation rarely mentioned in the literature. Such ossification results in the trigeminal nerve traversing a bony foramen as it ent...

Current understanding of the hindbrain hernias known as Chiari I malformations is based on more than 100 years of pathologic and clinical experience. Over time, the definition of this finding has been analyzed and altered. The term Chiari I malformation is currently used to describe tonsillar ectopia in a wide range of patients with varying embryon...

Masses of the cavernous sinus and Meckel's cave are uncommon. We report a patient who presented with facial pain. His exam at the most recent presentation was normal other than a diminished corneal reflex on the right side and hyperreflexia throughout. Imaging demonstrated an enhancing lesion of the left occipital lobe, left gyrus rectus, right ven...

We have previously described a technique for the partial bisection of the corpus callosum in the cadaver in order to increase the minimally invasiveness of this procedure. We now present our experience with this procedure in an animal model. Following a 1.0 cm midline skin incision, cranial trephinations (approximately 0.5 cm) were performed in fiv...

We present two clinical cases of infants with hydrocephalus requiring multiple cerebrospinal fluid (CSF) shunt revisions and diagnostic computerized tomography (CT) scans that developed head and neck malignancies during their late teen years. These represent the first reported cases of possible diagnostic imaging-induced malignancy in children. The...

Midline cysts of the anterior brain are common in infants e.g. cavum septum pellucidum et vergae. We report twin brothers with midline intracranial cysts, mildly increased ventricular size, and macrocephaly. One brother had a cavum septum pellucidum and vergae and the other a cavum septum pellucidum. With the obliteration of each brother’s midline...

The ankle joint is important in human balance and gait, being responsible for transferring the body weight to the foot and performing motions which are essential to gait. Owing to its rigidity, it maintains body balance, and owing to its flexibility, it provides a comfortable, smooth, and nearly effortless human gait. The ankle joint is a synovial...

Introduction: Solitary fibrous tumors are mesenchymally derived masses most commonly originating from the lung pleura. Case report: Herein, we report a 6-month-old presenting with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and a suprasellar mass. The mass proved to be a solitary fibrous tumor. This case and salient literatu...

External to internal carotid artery anastomoses are normally found in man. However, such connections at the skull base between the cavernous internal carotid artery and middle meningeal artery are rarely discussed in the literature and when present, are difficult, if not impossible, to see with imaging studies unless pathologically enlarged. Theref...

The aim of this study was to determine the in-depth anatomical location of the neurovascular structures important for nerve block. Forty fresh specimens from 22 adult Korean cadavers were used for this study. The average angle and depth of the bifurcation point of the sciatic nerve (BC) was 18.7-3.6 and 20.6-7.1 mm, respectively. The point where t...

The authors present a unique and unreported variation of the ansa cervicalis, which was found during upper neck microdissection on an isolated cadaveric neck. The C1 contribution to the hypoglossal nerve was found to take its origin from the suboccipital nerve. This branch pierced the dura along with the vertebral artery to enter the intradural spa...

Introduction Preserving cranial nerve (CN) function during tumor removal at the jugular foramen is challenging. No anatomical study has better defined the relevant dural septations on the inner surface of the jugular foramen. This study was undertaken to elucidate this anatomy. Methods Fourteen cadaveric heads (28 sides) were dissected, and relatio...

The pathophysiology underlying Chiari I malformations (CIMs) provides room for debate with several theories attempting to address this issue. We retrospectively reviewed many of our past patients with pediatric CIMs (specifically, those with peri-odontoid pannus), and present a hypothesis for the development of the malformation in some of said pati...

Cross-sectional sonographic measurements are considered first-line confirmatory tests in diagnosing peripheral nerve entrapment syndromes. Our aim is to establish normal values of cross-sectional area of the posterior interosseous nerve (PIN) at the arcade of Frohse, the most common site of compression of this nerve. The PIN was identified with ult...

In accord with the notions of humoralism that prevailed in medieval medicine, therapeutic interventions, including diuretics, were used to restore the disturbed balance among the four humors of the human body: blood, phlegm, yellow bile, and black bile. Most diuretics were derived from plants. The primary textual reference on herbal diuretics was D...

As important as the vertebral ligaments are in maintaining the integrity of the spinal column and protecting the contents of the spinal canal, a single detailed review of their histology and embryology is missing in the literature. A literature search using online search engines was conducted. Single comprehensive reviews of the histology and embry...

The thoracoabdominal diaphragm is a composite musculotendinous structure, separating the thoracic and abdominal cavities. Reemphasis of the already well-delineated variations of the muscular and tendinous portions, and blood and nerve supply of the diaphragm is becoming apparent. Scientific reports concerning reconstruction of the pericardium, acti...

As important as the vertebral ligaments are in maintaining the integrity of the spinal column and protecting the contents of the spinal canal, a single detailed review of their anatomy and function is missing in the literature. A literature search using online search engines was conducted. Single comprehensive reviews of the spinal ligaments are no...

Localization of nerves during surgery or for minimally invasive procedures is important in avoiding complications. Therefore, landmarks for more easily identifying these structures can be useful to clinicians and surgeons. The present chapter reviews the literature regarding various superficial and regional anatomic landmarks for nerves found in th...

Knowledge of the lymphatic system plays critical importance in surgical oncology. The study of the lymphatic system and its role in tumor metastasis continues to advance with new anatomical and surgical studies, and with a new study, we can gain a better understanding on how aggressive surgeons need to be with nodal dissection while balancing the c...