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PubMed2003

Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches.

OBJECT: Meningiomas of the lower clivus and foramen magnum are among the most challenging of all neurosurgical lesions. Debate continues regarding the most appropriate approach to this eloquent anatomical region. This anatomical study was undertaken to measure and compare the area of surgical exposures of the lower clivus achieved using the retrosigmoid and the extreme-lateral transcondylar (ELT) approaches. METHODS: Thirteen embalmed cadaveric heads were dissected bilaterally via the retrosigmoid approach on one side and the ELT approach on the other. The circumference of the area of exposure was delineated using beaded pins placed into the dura. After removal of the brain, the longest longitudinal and transverse axes of the pinned areas were measured and surface area calculated. The area of surgical exposure was also expressed as a percentage of the total area of the lower clivus. Normalized and adjusted surface areas were calculated using the bimastoid diameter. The areas of exposure were compared using the two-tailed paired Student t-test. The mean area of exposure required using the retrosigmoid approach was 19.8 +/- 14.7 mm2 (range 6-49 mm2) and that using the ELT approach was 27.8 +/- 22.8 mm2 (range 10-90 mm2). The mean percentage of the lower clivus exposed by the retrosigmoid approach was 14.9 +/- 3.6% (range 10-22%) and that exposed by the ELT approach was 20.5 +/- 4.9% (range 10-25%). The ELT approach provided significantly greater area of operative exposure and allowed a significantly higher percentage of lower clivus and foramen magnum exposure than did the retrosigmoid approach (p < 0.05). Normalized and adjusted surface areas, taking into consideration the bimastoid diameter, were also statistically significant in favor of the ELT approach. CONCLUSIONS: The ELT approach provided a significantly greater area of exposure than did the retrosigmoid approach.

Cranial Fossa, Posterior↗
PubMed2000

Microanatomy of the pericallosal arterial complex.

OBJECT: The pericallosal arterial complex supplies the callosal and pericallosal regions, as well as the anterior two thirds of the medial and superomedial aspects of both hemispheres. It is composed of the pericallosal artery (that is, the segment of the anterior cerebral artery located distal to the anterior communicating artery [ACoA]) and the median callosal artery (or third pericallosal artery), which originates from the ACoA. This system was studied in 46 specimens (23 human cadaver heads) injected with colored latex. METHODS: After being injected with colored latex, embalmed, and bleached, the specimens were studied with the aid of optic magnification. The pericallosal artery was found to be divided into four segments (A2-A5 in the proximodistal direction). After giving rise to central, callosal, and cortical branches, it terminated near the splenium of the corpus callosum as the posterior pericallosal artery, or on the precuneus as the inferomedial parietal artery. CONCLUSIONS: The authors propose a logical classification of the different variations in the pericallosal arterial complex based on embryological development. This complex can be considered a hemodynamic solution to an abnormal regression of one of its parts, which is balanced by the development of supplemental channels from other parts.

Anterior Cerebral Artery↗
PubMed2001

Duplicated abducent nerve and its course: microanatomical study and surgery-related considerations.

OBJECT: The anatomy of the abducent nerve is well known; its duplication (ranging from 5 to 28.6%), however, has rarely been reported in the literature. The authors performed a microanatomical study in 100 cadaveric specimens (50 heads) to evaluate the prevalence of this phenomenon and to provide a clear anatomical description of the course and relationships of the nerve. The surgery-related implications of this rare anatomical variant will be highlighted. METHODS: The 50 human cadaveric heads (100 specimens) were embalmed in a 10% formalin solution for 3 weeks. Fifteen of them were injected with colored neoprene latex. A duplicated abducent nerve was found in eight specimens (8%). In two (25%) of these eight specimens the nerve originated at the pontomedullary sulcus as two independent trunks: in one case the superior trunk was thicker than the inferior and in the other it was thinner. In the other six cases (75%) the nerve originated as a single trunk, splitting in two trunks into the cisternal segment: in two of them the trunks ran below the Gruber ligament, whereas in four specimens one trunk ran below and one above it. In all the specimens, the duplicated nerves fused again into the cavernous sinus, just after the posterior genu of the internal carotid artery. CONCLUSIONS: Although the presence of a duplicated abducent nerve is a rare finding, preoperative magnetic resonance imaging should be performed to rule out this possibility, thus tailoring the operation to avoid postoperative deficits.

Abducens Nerve↗
PubMed2002

Comparison of different infratentorial-supracerebellar approaches to the posterior and middle incisural space: a cadaveric study.

OBJECT: The purpose of this investigation was to describe and compare through cadaveric dissection the microsurgical exposure afforded by the median, paramedian, and extreme-lateral infratentorial-supracerebellar approaches to the posterior and middle incisural space. METHODS: The median, paramedian, and extreme-lateral infratentorial-supracerebellar approaches were performed in 10 embalmed cadaveric heads by using standard microneurosurgical methods; each approach was executed a minimum of five times. The dissections were performed in a stepwise fashion, comparing the exposure afforded by each surgical route and highlighting the relationships among the targeted neurovascular structures. Exposure of the dural sinuses and transection of the tentorium were also evaluated in relation to the degree of exposure achieved. The median infratentorial-supracerebellar route provides direct exposure of the posterior incisural space, although the culmen represents a relative obstacle to exposure of the lower quadrigeminal plate. The paramedian variant allows a more lateral perspective on the posterolateral brainstem surface at the level of the middle incisural space, in addition to exposing the homolateral collicular plate. The extreme-lateral corridor widens the exposure of the paramedian approach to include the anterolateral brainstem surface, offering a complete view of the cisternal space surrounding the middle incisural space. Complete, constant exposure and retraction of the dural sinuses facilitated the surgical exposure. CONCLUSIONS: The infratentorial-supracerebellar approaches allow safe circumferential exposure of the posterior and middle incisural space. Choosing among different variants allows the surgeon to reach selected areas, with the midline variant being best for exposure of the posterior incisural space, and the paramedian and extreme-lateral variants being best for reaching the posterior and the anterior part of the middle incisural space, respectively. The more lateral the approach, the more anterior and multiangled the exposure gained. Complete, constant exposure and retraction of the dural sinuses improves the exposure. Accurate knowledge of the regional anatomy is mandatory.

Cadaver↗
PubMed2001

Use of a guide device to place pedicle screws in the thoracic spine: a cadaveric study. Technical note.

In this cadaveric study, the safety and accuracy of a specially designed guide device for the placement of thoracic pedicle screws was investigated in a normal anatomical situation. Five embalmed human cadaveric thoracic spines (T1-12) were used for the study of transpedicular screw placement in the thoracic spine. Overall 120 screws were placed at all thoracic levels. The screws were inserted bilaterally in the thoracic pedicles by using a specially designed guide device. No radiographs or other imaging studies were obtained. Following screw placement, computerized tomography scans were performed to evaluate the accuracy of the pedicle screw positioning. Seven (5.8%) of the screws penetrated the pedicle wall or the vertebral body (VB) cortex. Two screws (1.7%) penetrated the medial wall of the pedicle. Two screws (1.7%) penetrated the lateral wall of the pedicle, and one screw (0.8%) penetrated the lateral wall of the pedicle and the anterior VB cortex simultaneously. Two screws (1.7%) penetrated the anterior VB cortex. Compared with the results of other studies, the findings here indicate that using this device to guide the placement of thoracic pedicle screws can significantly reduce the incidence of pedicle penetration, particularly in the medial wall.

Bone Screws↗
PubMed2002

First appearance and sense of the term "spinal column" in ancient Egypt. Historical vignette.

In contemporary anatomical nomenclature terms have often been derived from an ancient perspective of the human body. The term "spinal column" was used in ancient Egypt, symbolized by the "djet column." The authors discuss the first appearance of the term "spinal column," taking the ancient Egyptian interaction between religion and daily life into consideration, and they describe the different segments of the spinal column known to the ancient Egyptians. Inspection of medical papyri provides insight into the knowledge held by ancient Egyptian physicians and embalmers. It is assumed that hieroglyphs were used to depict the different vertebral regions of the spinal column (cervical, thoracic, and lumbar). The knowledge was gleaned, in fact, in pursuit of religious goals. The djet might be an example of how anatomical knowledge can improve understanding of a symbol that was previously thought to have a primarily religious meaning. The authors maintain that modern medical knowledge is useful for making a more precise and anatomically correct interpretation of the presumed sense intended by the ancient Egyptians.

Anatomy↗
PubMed2006

Evaluation of registration techniques for spinal image guidance.

OBJECT: Paired point matching alone and paired point matching combined with surface matching are the two techniques used for the registration step in preoperative computerized tomography-based spinal image guidance. In the present study the authors sought to compare paired point-matching registration alone with paired point matching supplemented with surface matching to determine if the addition of surface matching improves navigational accuracy. METHODS: Pedicle screws were placed in three embalmed human cervicothoracic spinal specimens during image guidance to serve as a reference points. The specimens were then rescanned, and each level was registered using paired point matching alone and then by paired point supplemented with surface matching. Navigational accuracy was assessed by placing the stereotactic probe in the center of the screw head, and measuring the apparent distance between the screw head and probe on the computer monitor. Statistical analysis was used to compare the registration error and navigational error between the two techniques. Seventy-five screws were placed at 46 vertebral levels. The mean registration error for the paired point matching/surface matching technique (0.5 mm) was significantly lower (p < 0.001) than that of the paired point matching alone technique (1.2 mm); however, the intertechnique difference in navigational error was nearly equivalent (1.3 mm compared with 1.4 mm) and statistically insignificant (p > 0.05). CONCLUSIONS: Although the addition of surface matching to paired point registration significantly decreased the mean registration error, the actual navigational accuracy between the two techniques was equivalent when easily distinguishable points were meticulously selected. The use of paired point matching alone did not compromise the accuracy of navigation and is likely to result in decreased operating time.

Bone Screws↗
PubMed2006

[Palaeoparasitological study of atypical elements of the low and High Nile Valley].

Paleoparasitology in the Old World has mainly concerned the study of latrine sediments and coprolites collected from mummified bodies or archaeological strata, mostly preserved by natural conditions. For the first time, different unusual archaeological samples were studied to look for the eggs of helminths parasites (embalming reject jar, canopic package, shroud). Now, samples of organic matter have been successfully processed in order to extract helminths eggs, following the protocol of BOUCHET 2001 (4). Helminth eggs are frequently preserved in the late Quaternary archaeological contexts because of their hard-wearing chitin shell. Six types of eggs were revealed (Schistosoma mansoni, Schistosoma haematobium, Taenia, Enterobius vermicularis, Ascaris lumbricoides and Trichuris trichiura). This study allows to enlarge the Palaeoparasitological research with material never exploited. Moreover, if we take into account identified parasite and geography, it's possible to enlarge the debate to parasite spatio-temporal migration. Considering the particular context of samples preservation, it's interesting to observe an exceptional conservation of parasitological sign related to excellent taphonomic condition (aridity anaeroby, rapid interruption of thanatomorphosis, natural "mummification").

Animals↗
PubMed1992

Anatomical observation on draining patterns of saphenous tributaries in Korean adults.

This study was done to identify the normal and variants of saphenous tributaries in Korean adults. The pattern of confluence of saphenous tributaries, medial accessory saphenous, lateral accessory saphenous, superficial epigastric, superficial circumflex iliac and superficial external pudendal veins, was carefully examined in 249 lower limbs (right, 129; left, 120) of embalmed Korean cadavers (73 males & 56 females). The medial accessory saphenous vein drained into the great saphenous vein directly (in 82.3%) or by a common trunk (in 17.7%) with the superficial epigastric or superficial external pudendal vein. The lateral accessory saphenous vein entered the great saphenous (in 67.1%) or the femoral vein (in 32.9%) directly or, forming a common trunk with other saphenous tributaries. The superficial epigastric vein joined the great saphenous (in 77.1%) or the femoral vein (in 22.9%) directly or, by a common trunk with other saphenous tributaries. The superficial circumflex iliac vein reached the great saphenous (in 83.1%) or the femoral vein (in 16.9%) directly or, by a common trunk with other saphenous tributaries. The superficial external pudendal vein opened into the great saphenous (in 95.2%) or the femoral vein (in 4.8%) directly or by a common trunk with other saphenous tributaries. In Koreans, the incidence of the normal pattern of saphenous tributaries was 23.7% and in 76.3% any one of variant saphenous tributaries entered the femoral or the great saphenous vein by a common trunk with other saphenous tributaries.

Adult↗
PubMed1992

Prophylactic cerclage: a method of preventing femur fracture in uncemented total hip arthroplasty.

The incidence of femur fracture in non-cemented hip arthroplasty has been reported to be between 4.1% and 27.8%. To quantitate the hoop stress generated during insertion of a femoral broach in total hip arthroplasty and determine the effect of cerclage with both braided cable and wire, we harvested 14 pairs of embalmed cadaver femurs. These were reamed and broached to duplicate the surgical technique of inserting a straight non-cemented femoral component. Group one consisted of eight matched cadaver femurs which were tested using a single 2.0 mm chrome-cobalt cable placed around the calcar of one femur, with the other serving as a control. Group two consisted of five matched cadaver femurs which were tested using a single 18 gauge cerclage wire in the same manner. In group one, the femurs serving as controls were found to have a mean microstrain of (1425.00 +/- 1180.19). The eight femurs tested with a 2 mm cable were determined to have a mean microstrain of (4179 +/- 2853.89). In group two, the femurs serving as controls were found to have a mean microstrain of (962.60 +/- 956.78). The five femurs in group two tested with a cerclage wire were determined to have a mean microstrain of (1112.00 +/- 975.66). Using a paired t-test, statistical significance was achieved with a confidence level of P less than or equal to .01 in group one. Prophylactic wiring of the proximal femur with 2 mm cable increases the hoop stress resistance and, therefore, should decrease the incidence of intraoperative femur fractures in uncemented total hip arthroplasty.

Bone Cements↗
PubMed1996

The deep branch of the ulnar nerve in Guyon's canal: branching and innervation of the hypothenar muscles.

Thirty-seven embalmed, unpaired cadaver hands were dissected to delineate and classify the innervation of the hypothenar musculature. The deep branch of the ulnar nerve passed between the abductor digiti minimi and flexor digiti minimi and then pierced the opponens in all specimens. All branching occurred on the ulnar aspect of the deep branch of the ulnar nerve. A classification based on proximity of the different branches is prepared. Five different patterns have been noted.

Cadaver↗
PubMed1998

The location of the spinal nerve root on plain radiographs of the cervical spine.

Twelve cervical spines from C2 to T1 were harvested from embalmed cadavers to study the location of the nerve root on plain radiographs. After removal of the soft tissue, the spinal nerves just lateral to the transverse processes were exposed and injected with lead oxide. Plain radiographs including anteroposterior (AP) and left and right oblique views were taken. Angular and linear measurements were performed directly on the radiographs. Results showed that the average frontal angle of the nerve root for all levels was 155 degrees on the AP view, 108 degrees on the foraminal side of the oblique view, and 153 degrees on the opposite side of the oblique view. The nerve root height for all levels averaged 4.7 +/- 0.5 mm. The interpedicular space height increased consistently from 7.8 +/- 0.7 mm at C3-C4 to 9.0 +/- 1.3 mm at C6-C7 except at C2-C3. The nerve root height with respect to the interpedicular space height was 56.2% at C2-C3, 57.8% at C4-C5, and 53.7% at C6-C7. A knowledge of the location of the cervical nerve root related to plain radiographs may enhance the value of plain radiographs in the diagnosis and treatment of cervical spinal disorders.

Aged↗
PubMed1998

Femoral neck fracture fixation: a biomechanical study of two cannulated screw placement techniques.

This biomechanical study evaluated two different methods of femoral neck fracture fixation. Ten pairs of embalmed femora were used. A standardized midcervical osteotomy was performed. One side from each pair was fixed with either conventional (central) or calcar (cortical adjacent) screw placement. The femora pairs then were subjected to cyclic and load to failure biomechanical testing. The results demonstrated significant improved stability, load, stiffness, and displacement in all tested parameters for the group with calcar screw fixation. Grossly, the conventional fixation group tended to fail in an excessively varus position, while the calcar fixation group failed with impaction of the head on the calcar, a potentially stable position.

Aged↗
PubMed2001

Anatomic considerations of the posterolateral lumbar disk region.

Sixteen embalmed cadavers were dissected to determine the location of the lumbar nerve root and sympathetic trunk with reference to the superior border of transverse process. In the posterolateral lumbar disk region, a safe zone was found between the anterior limit of the lumbar nerve and the posterior limit of the sympathetic trunk. It has a transverse dimension of 22 mm at the T12-L1 disk region and 25 mm at the L4-L5 disk region. The only exception to this was the genitofemoral nerve running close to the lateral margin of the L2-L3 disk. The study provides an understanding of the posterolateral orientation of the lumbar nerves and sympathetic trunk.

Aged↗
PubMed2001

Magnetic resonance imaging of periarticular titanium screws.

Magnetic resonance imaging (MRI) may be the most sensitive modality for detecting post-traumatic degeneration of articular cartilage. Magnetic resonance imaging must accurately depict articular cartilage in the presence of periarticular fracture stabilization devices to be effective for postoperative imaging of articular fractures. This study examines how close titanium screws can be inserted to tibial articular surfaces and still allow accurate MRI of the overlying articular cartilage. Cannulated titanium screws were inserted at varying distances from subchondral bone in the proximal and distal tibiae of embalmed human cadaveric legs, which were then imaged using a standard nonfat-saturated fast low angle shot two-dimensional sequence (FLASH 2D). The distance from the center of the screw to the subchondral bone and the thickness of the articular cartilage directly overlying the screw was then determined by direct measurement and by measurement on the scanned images. To allow FLASH 2D MRI of the articular cartilage, 7.3-mm screws had to be at least 13 mm from the subchondral bone, and 4.5-mm screws had to be at least 12 mm from the subchondral bone. For MRI to be effective for the postoperative imaging of the articular surface following severe articular fractures of the tibia, titanium fracture hardware must be farther away from the articular surface than these minimum distances. Alternate materials for stabilizing articular fractures are available and may allow clearer and more accurate imaging of the articular cartilage when inserted close to the articular surface.

Bone Screws↗
PubMed2002

Variations in the origin of the medial calcaneal nerve.

Previous anatomic studies of the medial heel region were done on embalmed human cadavers. Here, the innervation of the medial heel region was studied by dissecting living tissue with the use of 3.5-power loupe magnification during decompression of the medial ankle for tarsal tunnel syndrome in 85 feet. The medial heel was found to be innervated by just one medial calcaneal nerve in 37% of the feet, by two medial calcaneal nerves in 41%, by three medial calcaneal nerves in 19%, and by four medial calcaneal nerves in 3%. An origin for a medial calcaneal nerve from the medial plantar nerve was found in 46% of the feet. This nerve most often innervates the skin of the posteromedial arch, where it is at risk for injury during calcaneal spur removal or plantar fasciotomy. Knowledge of the variations in location of the medial calcaneal nerves may prevent neuroma formation during surgery and provide insight into the variability of heel symptoms associated with tarsal tunnel syndrome.

Cadaver↗
PubMed1999

[Cadaver study of acetabular cup mobility in the healthy hip and prosthesis by monopodal pressure simulation ].

PURPOSE OF THIS STUDY: The purpose of this study was to quantify relative displacement of anterior and posterior horn of the acetabulum lunate surface using Omega strain gauges while increasing loads were applied to the hip joint. Measurement were performed on fresh cadaver bones in unipodal stance using experimental method before and after socket's implantation. MATERIAL AND METHODS: [corrected] Nine skeletons, from fresh non-embalmed cadavers, including pelvis, the three last lumbar vertebrae and both femurs were maintained in unipodal equilibrium using metallic cables for muscle passive simulation. Loads were applied up to 700 N. Specific extensometric Omega strain gauges were created and tested, with 5 mu of sensibility. Measurement of displacement between horns were studied on two sides of each pelvic before and after implantation of conventional and prototype cemented or press fit implants. RESULTS: Among 81 loads on 18 acetabulum healthy and implanted, displacement was significant in 58 cases with a spacing of horn of 7 to 140 mu with average 31.1 mu and non significant in 25 cases. On healthy acetabulum, spacing was variable from 12 to 140 mu (average 43.2 mu) in 18 of 26 loads. On implanted acetabulum by different sockets, spacing was variable from 7 to 100 mu (average 27.4 mu) in 40 of 55 loads. Displacement was function of rotation hip, smaller in internal rotation and larger in external rotation. Spacing of horns was reduced in oversize sockets. DISCUSSION: The data obtains by omega strain gauge suggest acetabular displacement is not univocal under load. There were a widening of the acetabular notch on load. This can be explained by the modification of primary incongruity of the two components of the hip joint because of acetabular deformation. Such results are in agreement with recently published data obtained about length of the transverse acetabular ligament.

Acetabulum↗
PubMed1999

[Experimental comparative study of 3 systems of osteosynthesis for proximal humeral fractures. Preliminary study of the mechanical properties of conserved trabecular bone].

PURPOSE OF THE STUDY: We have compared three systems for osteosynthesis of proximal humeral fractures on a four-fragment fracture model: Plate with tuberosity screwing (P), Kirschner wires with bone sutures (K) and an original implant, the "bilboquet" (Stryker) (B), composed of a hook for the head supported on a diaphyseal stem. MATERIAL AND METHODS: Because of the unavailability of fresh human material, we have turned to embalmed bones after having shown, on cancellous femoral head bone, the little influence of our method Vs freezing conservation. Settings were tested in compression. We measured their mechanical resistance judged on the ultimate strength and on the slope (displacement/load), to this limit. We similarly analyzed by video recording displacement of the different fragments according to four components (head slipping, its lateral displacement, its see-saw and the separation of tuberosities), to show the weak points of the three systems. RESULTS AND DISCUSSION: K was more deformable (p < 0.001) that P and B (average slopes in mm/100N to 0.67 for K, 0.42 for P and 0.43 for B). The ultimate strength differed but not significantly (average values in Newton to 1223 for K, 1601 for P and 1721 for B). We also showed for the three techniques, the significant correlation between slopes and bony densities. Video analysis showed that P opposed lateral displacement of the head and separation of tuberosities better, the resistance to slipping and see-saw seems to be improvable by greater divergence of screws or a modification of the plate (mini canon). B opposed slipping and see-saw better but its weak point was the risk of articular break-in of the hook, by defect of resistance to lateral displacement, that for us could be limited by a less peripheral position of teeth or a modification of their form. K is indeed the least effective of the four components but we think that it would be improvable by using, for example, a centro-medullary technique, allowing an internal cortical support.

Bone Density↗