Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine

1995 ◽  
Vol 82 (6) ◽  
pp. 1011-1014 ◽  
Author(s):  
T. Glenn Pait ◽  
Phillip V. McAllister ◽  
Howard H. Kaufman
Keyword(s):  
Anatomical Landmarks ◽  
Cervical Mass ◽  
Content Type ◽  
Bony Landmarks ◽  
Fixation Devices ◽  
Human Cadavers ◽  
Lateral Mass Screws ◽  
Neurovascular Structures ◽  
Lateral Facet ◽  
Fine Print

✓ Knowledge of the relevant anatomy is important when developing a strategy for introducing screws into the lateral masses to secure internal fixation devices. This paper defines key bony landmarks and their relationship to critical neurovascular structures and identifies a location for safe placement of cervical articular pillar (lateral mass) screws. Measurements of anatomical landmarks in 10 spines from human cadavers aged 61 to 85 years were made by caliper and a metric ruler. Landmarks were the lateral facet line, rostrocaudal line, medial facet line, intrafacet line, and medial facet line—vertebral artery line. The average distances and ranges were recorded. Such great variance existed in measurements from spine to spine and within the same spine as to render averages clinically unreliable. Dissection revealed that division of the articular pillar into four quadrants leaves one, the superior lateral quadrant, under which there are no neurovascular structures; this may be considered the “safe quadrant” for placement of posterior screws and plates.

The straight sinus

1974 ◽  
Vol 41 (6) ◽  
pp. 724-727 ◽  
Author(s):  
R. C. Saxena ◽  
M. A. Q. Beg ◽  
A. C. Das
Keyword(s):  
Dura Mater ◽  
Posterior Cranial Fossa ◽  
Cerebral Vein ◽  
Content Type ◽  
Straight Sinus ◽  
Sagittal Sinus ◽  
India Ink ◽  
Human Cadavers ◽  
Cranial Fossa ◽  
Fine Print

✓ The dura mater of the posterior cranial fossa of 86 adult human cadavers has been examined grossly after the injection of India ink through the confluence of sinuses in order to visualize the extent, communications, and tributaries of the straight sinus. Variations from the textbook description of formation by the union of the inferior sagittal sinus and the great cerebral vein are described and discussed.

Individual variations in the sulcal anatomy of the basal temporal lobe and its relevance for epilepsy surgery: an anatomical study performed using magnetic resonance imaging

2002 ◽  
Vol 96 (3) ◽  
pp. 464-473 ◽  
Author(s):  
Klaus Novak ◽  
Thomas Czech ◽  
Daniela Prayer ◽  
Wolfgang Dietrich ◽  
Wolfgang Serles ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Temporal Lobe ◽  
Anatomical Landmarks ◽  
Resonance Imaging ◽  
Mr Images ◽  
Hippocampal Region ◽  
Content Type ◽  
Individual Variations ◽  
Fine Print

Object. The concept of selective amygdalohippocampectomy is based on pathophysiological insights into the epileptogenicity of the hippocampal region and the definition of the clinical syndrome of mesial temporal lobe epilepsy (TLE). High-resolution magnetic resonance (MR) imaging allows correlation of the site of histologically conspicuous tissue with anatomical structure. The highly variable sulcal pattern of the basal temporal lobe, however, definitely complicates the morphometric analysis of histomorphologically defined subdivisions of the hippocampal region. The goal of this study was to define individual variations in the sulcal anatomy on the basis of preoperative MR images obtained in patients suffering from TLE. Methods. The authors analyzed coronal MR images obtained in 50 patients for the presence of and intrinsic relationships among the rhinal, collateral, and occipitotemporal sulci. The surface relief of consecutive sections of 100 temporal lobes was graphically outlined and the resulting maps were used for visual analysis. The sulci were characterized by measurement of their depth, distance to the temporal horn, and laterality. The anatomical measurements and frequencies of sulcal patterns were assessed for statistical correlation with patients' histories and the lateralization of the seizure focus. Conclusions. Statistical assessment shows that patient sex is a significant factor in sulcal patterns. Anatomical measurements are significantly decreased on the side of the seizure origin, which relates to loss of white matter, a known morphological abnormality associated with TLE. Magnetic resonance imaging allows for accurate preoperative knowledge of individual sulcal patterns and facilitates intraoperative orientation to anatomical landmarks.

Endoscopy of the posterior fossa and dissection of acoustic neuroma

1999 ◽  
Vol 91 (5) ◽  
pp. 776-780 ◽  
Author(s):  
Nebil Göksu ◽  
Yıldırım Bayazıt ◽  
Yusuf Kemaloğlu
Keyword(s):  
Posterior Fossa ◽  
Acoustic Neuroma ◽  
Residual Tumor ◽  
Lateral Aspect ◽  
Content Type ◽  
Retrolabyrinthine Approach ◽  
The Relationship ◽  
Neurovascular Structures ◽  
Internal Acoustic Canal ◽  
Fine Print

Object. The authors evaluated the importance of endoscopes in eliminating the disadvantages of the posterior fossa approach, such as the lack of adequate visualization of the lateral aspect of the internal acoustic canal (IAC).Methods. Between 1989 and 1998, 32 patients underwent removal of acoustic neuroma (AN) via a combined retrosigmoid—retrolabyrinthine approach. Endoscopes were used at different stages of the operation, and their use was evaluated with regard to elimination of the disadvantages of the posterior fossa approach. All patients in whom AN had been diagnosed underwent surgery in which a standard retrosigmoid—retrolabyrinthine approach was used. Standard sinus endoscopes of 0°, 30°, and 70° were introduced into the cerebellopontine angle before debulking the tumor, and the IAC was inspected at the end of the operation. Neurovascular integrity as well as the relationship between the AN and surrounding structures were evaluated. The IAC was inspected for residual tumor, and if any was found, endoscopically guided tumor dissection was performed.Conclusions. Endoscopes have facilitated an understanding of the anatomy between an AN and neighboring neurovascular structures. For surgery in which the posterior fossa approach is used, endoscopes can make operations safer by eliminating the disadvantages of the approach. In addition to allowing inspection of the fundus, it is possible to perform endoscopically guided tumor dissection within the IAC.

Mandibular subluxation as an adjunct to exposure of the distal internal carotid artery in endarterectomy surgery

1995 ◽  
Vol 83 (5) ◽  
pp. 926-928 ◽  
Author(s):  
David M. Frim ◽  
Bonnie Padwa ◽  
Deidre Buckley ◽  
Robert M. Crowell ◽  
Christopher S. Ogilvy
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Anatomical Landmarks ◽  
Simple Method ◽  
Content Type ◽  
Anterior Nasal Spine ◽  
Edentulous Patients ◽  
Fine Print

✓ The location of the carotid artery bifurcation and the distance atherosclerotic disease extends distally in the internal carotid artery (ICA) are two factors that contribute to the technical difficulty of carotid endarterectomy. When the bifurcation is high (above C-3) or the disease extends distally, standard approaches may not provide adequate exposure for dissection of plaque or for arteriotomy repair. A simple method of mandibular subluxation is described for added exposure of the distal carotid artery. The criteria for use of this method include: a carotid bifurcation at or above C-2; disease extending to within 2 cm of the skull base; and a small-caliber distal ICA lumen with the expectation of a patch graft extending close to the skull base. In dentulous patients, the mandible is subluxed by attaching an intradental wire from the ipsilateral mandibular bicuspid to an intradental wire around the contralateral maxillary bicuspid. In edentulous patients, a wire is placed around the ipsilateral mandible and secured to a wire placed through the anterior nasal spine. The entire preoperative subluxation requires 10 to 15 minutes under anesthesia and an additional 1 to 2 minutes postoperatively to remove the wires. A single skin suture and an absorbable intraoral suture were placed in some edentulous patients. This technique has been evaluated over a 15-month reference period during which 115 carotid endarterectomies were performed. The criteria stated above were met in seven cases (six patients, 6%) and jaw subluxation was performed preoperatively. An additional 1 to 2 cm of distal exposure was obtained by using this technique and endarterectomy proceeded without complication. A slight “shift” of the standard anatomical landmarks occurred due to the movement of the mandible, which was easily recognized. There were no significant postoperative complaints related to the subluxation; specifically, no temporomandibular joint pain, no other postoperative pain, and no tooth damage were encountered. It is concluded that this relatively simple approach to mandibular subluxation provided significant added exposure to the distal ICA without notably increasing operative time. In addition, there was no morbidity and little additional care was needed when compared with other more radical approaches to high carotid artery exposure.

Surgical anatomy of the dorsal scapular nerve

2005 ◽  
Vol 102 (5) ◽  
pp. 910-911 ◽  
Author(s):  
R. Shane Tubbs ◽  
Elizabeth C. Tyler-Kabara ◽  
Alan C. Aikens ◽  
Justin P. Martin ◽  
Leslie L. Weed ◽  
...  
Keyword(s):  
Trapezius Muscle ◽  
Spinal Nerve ◽  
Surgical Anatomy ◽  
Anterior Border ◽  
Content Type ◽  
Levator Scapulae ◽  
Human Cadavers ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

Object. There is a paucity of literature regarding the surgical anatomy of the dorsal scapular nerve (DSN). The aim of this study was to elucidate the relationship of this nerve to surrounding anatomical structures. Methods. Ten formalin-fixed human cadavers (20 sides) were dissected, and measurements made between the DSN and related structures. The nerve pierced the middle scalene muscle at a mean distance of 3 cm from its origin from the cervical spine and was more or less centrally located at this exit site. It lay a mean distance of 1.5 cm medial to the vertebral border of the scapula between the serratus posterior superior, posterior scalene, and levator scapulae muscles. It was found to have a mean distance of 2.5 cm medial to the spinal accessory nerve as it traveled on the anterior border of the trapezius muscle. The nerve intertwined the dorsal scapular artery in all specimens and was found along the anterior border of the rhomboid muscles. On 19 sides the DSN originated solely from the C-5 spinal nerve, and on one side it arose from the C-5 and C-6 spinal nerves. Conclusions. Knowledge of the anatomy of the DSN will aid the surgeon who wishes to explore and decompress this structure.

Endoscopic anatomy of the chordae willisii in the superior sagittal sinus

2004 ◽  
Vol 101 (5) ◽  
pp. 832-835 ◽  
Author(s):  
Mansoor Sharifi ◽  
Jacek Kunicki ◽  
Pawel Krajewski ◽  
Bogdan Ciszek
Keyword(s):  
Superior Sagittal Sinus ◽  
Tap Water ◽  
Digital Camera ◽  
Content Type ◽  
Sagittal Sinus ◽  
Structural Relationships ◽  
Human Cadavers ◽  
Bridging Veins ◽  
Different Diameters ◽  
Fine Print

Object. Chordae willisii are structures located in the lumen of the superior sagittal sinus (SSS). It is thought that they act as flow-improving structures within the sinuses. There are few anatomical descriptions of chordae willisii, and all previous observations were performed through standard anatomical dissections. The purpose of this study was to visualize and describe structural and topographical features of the chordae willisii with the aid of rigid endoscopy. Methods. Twenty-five SSSs obtained from fresh human cadavers during autopsies were the material for this study. Specimens were flushed with tap water to remove clots. Bridging veins emptying into the sinus were ligated, and continuous flow of a saline solution through the sinus in a physiological direction was achieved by connecting the sinus to an irrigating system. Rigid endoscopes of different diameters (2.7–4.5 mm) and optic (0 and 30°) were inserted into the lumen of the sinus. The endoscope was connected to a digital camera and a video system to allow for recording of the observed structures. Finally, the sinuses were opened and the chordae willisii were dissected using standard anatomical methods. The chordae willisii were observed in all examined specimens. Three different types of the cords were found: lamellar, trabecular, and valvelike types. The most common type was the valvelike (mixed) one, which comprised 45.1% of all cords. The chordae willisii were most commonly observed in the parietooccipital region of the SSS. Conclusions. Witout disturbing any structural relationships, the use of endoscopy allowed visualization and description of intraluminal structures as they behaved physiologically.

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

2002 ◽  
Vol 97 (4) ◽  
pp. 922-928 ◽  
Author(s):  
Mario Ammirati ◽  
Antonio Bernardo ◽  
Angelo Musumeci ◽  
Albino Bricolo
Keyword(s):  
Anterior Part ◽  
Content Type ◽  
Regional Anatomy ◽  
Cadaveric Dissection ◽  
Dural Sinuses ◽  
Accurate Knowledge ◽  
Direct Exposure ◽  
Quadrigeminal Plate ◽  
Neurovascular Structures ◽  
Fine Print

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.

The apical ligament: anatomy and functional significance

2000 ◽  
Vol 92 (2) ◽  
pp. 197-200 ◽  
Author(s):  
R. Shane Tubbs ◽  
Paul Grabb ◽  
Alan Spooner ◽  
Wally Wilson ◽  
W. Jerry Oakes
Keyword(s):  
Functional Significance ◽  
Craniocervical Junction ◽  
Content Type ◽  
Adult Human ◽  
Significant Contributor ◽  
Human Cadavers ◽  
Study Support ◽  
Clinical Problems ◽  
Fine Print

Object. The authors conducted a study to describe the detailed anatomy of the apical ligament and to acknowledge or refute its historical description as a functionally significant contributor to craniocervical stability. Methods. In 20 adult human cadavers measurements of the apical ligament were obtained, and its detailed anatomy was observed. Ranges of motion were also assessed to discern the function of the apical ligament. Conclusions. Results of the study support the concept that the apical ligament is best described as a vestigial structure that offers no significant added stability to the craniocervical junction. In fact, this ligament was absent in 20% of the specimens examined. These data will aid physicians who frequently view images or manage clinical problems of the craniocervical junction because they may focus on other ligaments of this area and not the apical ligament.

Double straight sinus

1973 ◽  
Vol 39 (4) ◽  
pp. 540-542 ◽  
Author(s):  
R. C. Saxena ◽  
M. A. Q. Beg ◽  
A. C. Das
Keyword(s):  
The Other ◽  
Falx Cerebri ◽  
Content Type ◽  
Tentorium Cerebelli ◽  
Straight Sinus ◽  
Human Cadavers ◽  
Fine Print

✓ The straight sinus was examined in 43 human cadavers. In 13.95% of the cadavers the straight sinus was double, being either median in position, that is, one was superior and the other inferior (9.3%), or paramedian, that is, both lay side by side on either side of the midline at the junction of the falx cerebri with the tentorium cerebelli (4.65%).

Flexibility of lumbar spinal motion segments correlated to type of tears in the annulus fibrosus

2000 ◽  
Vol 92 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Victor M. Haughton ◽  
Timothy A. Schmidt ◽  
Kevin Keele ◽  
Howard S. An ◽  
Tae-Hong Lim
Keyword(s):  
Annulus Fibrosus ◽  
Lateral Bending ◽  
Spinal Motion ◽  
Content Type ◽  
Kinematic System ◽  
Flexion Extension ◽  
Human Cadavers ◽  
The Difference ◽  
Lumbar Spinal ◽  
Fine Print

Object. The authors conducted a study in which their objective was to measure the effect of tears in the annulus fibrosus on the motions of lumbar spinal motion segments. Methods. Lumbar spinal motion segments were harvested from human cadavers and studied using a 1.5-tesla magnetic resonance imager. The motion segments were subjected to incremental flexion, extension, rotation, and lateral bending torques. Displacements and rotations were measured using a kinematic system. The segments were sectioned on a cryomicrotome to verify the presence of tears in the annulus fibrosus. Conclusions. Tears in the annulus fibrosus increase the amount of motion that results from a torque applied to the motion segment. Radial and transverse tears of the annulus fibrosus have a greater effect on motions produced by an axial rotatory torque than on those produced by flexion, extension, or lateral bending torques. The difference between normal discs and discs with annular tears is more marked during moments of axial rotational than during those of flexion, extension, or lateral bending.

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