The Relative Contributions of the Medial Sural and Peroneal Communicating Nerves to the Sural Nerve

The medial sural cutaneous nerve (MSCN) and peroneal communicating nerve (PCN) conjoin in the calf area to form the sural nerve (SN). In previous anatomic studies, there was unresolved debate as to the main contributor to the sural nerve, and the relative contributions of MSCN and PCN had not been studied. The purpose of this study is to determine their relative neurophysiologic contributions to the SN by nerve conduction study (NCS). A total of 47 healthy subjects (25 males and 22 females, mean age 29.6 ± 10.4 yrs, range 20-59 yrs) participated in the study. This study employed the orthodromic nerve conduction technique: stimulation at the ankle and recording at the mid calf (SN); specifically, we preformed stimulation at the mid calf (MSCN, PCN) and recording at 14 cm proximal to the middle of the popliteal fossa (MSCN) and fibular head (PCN). The onset and peak latencies (ms) were SN 2.3 ± 0.2 and 3.0 ± 0.2; MSCN 2.1 ± 0.2 and 2.8 ± 0.2; and PCN 2.1 ± 0.2 and 2.8 ± 0.2. The peak-to-peak amplitudes (µV) and areas (nVsec) of the SN, MSCN, and PCN were 9.7 ± 3.9, 7.0 ± 4.7, and 5.0 ± 3.2; and 7.2 ± 2.9, 5.7 ± 3.4, and 4.0 ± 2.4, respectively. The side-to-side difference was not statistically significant. The main contributor to the SN was found to be the MSCN. The relative contribution ratio of the MSCN to the PCN was 1.37:1 by amplitude and 1.42:1 by area. However, in 32.9% of the subjects, the contribution of the PCN was greater than that of the MSCN

Endothelin-1 as a neuropeptide: neurotransmitter or neurovascular effects?

Endothelin-1 (ET-1) is an endothelium-derived peptide that also possesses potent mitogenic activity. There is also a suggestion the ET-1 is a neuropeptide, based mainly on its histological identification in both the central and peripheral nervous system in a number of species, including man. A neuropeptide role for ET-1 is supported by studies showing a variety of effects caused following its administration into different regions of the brain and by application to peripheral nerves. In addition there are studies proposing that ET-1 is implicated in a number of neural circuits where its transmitter affects range from a role in pain and temperature control to its action on the hypothalamo-neurosecretory system. While the effect of ET-1 on nerve tissue is beyond doubt, its action on nerve blood flow is often ignored. Here, we review data generated in a number of species and using a variety of experimental models. Studies range from those showing the distribution of ET-1 and its receptors in nerve tissue to those describing numerous neurally-mediated effects of ET-1

Anatomical insight into the normal and abnormal branching pattern of the popliteal artery Reply

WOS: 00026871290001

Human left atrial appendage anatomy and overview of its clinical significance [İnsanda sol aurikula açi{dotless}kli{dotless}gi{dotless}ni{dotless}n anatomisi ve klinik önemine genel bir baki{dotless}ş]

PubMed ID: 23886901Objective: The left atrial appendage (LAA) is an important anatomic region since it is a source of thromboembolism in patients with atrial fibrillation. Although this anatomic and clinical relation it has received little attention until recent years. Methods: This descriptive laboratory study was performed in 56 hearts of adult formalin fixed cadavers. The morphological characteristics of LAA were recorded. The distances between the orifices of left superior pulmonary veins (LSPV), circumflex artery, left anterior descending (LAD) artery, mitral valve and LAA were also measured in this study. Results: The morphological appearance of the LAA was classified into two different ways. There were two types according to the first classification: slender like a crooked finger (in 73.2%) and stump-like (in 26.8%). The lobe number of LAA was two in 64.3% specimens and three in 35.7%. The types of LAA were Cactus (24%), Chicken Wing (12%), Windsock (38%) and Cauliflower (26%) according to the second classification. The LAA orifice was oval-shaped in 37.5% and round-shaped in 62.5%. The bridge on the orifice was determined in one specimen. The longest diameter of LAA orifice was 16.5±4 mm. The presence of accessory left atrial appendage was observed in one specimen. The distance between LAA orifice and oval fossa was 27.5±5.5 mm. Conclusion: We highlighted the anatomic features of LAA and LAA orifice. LAA diameters, shape and the relation between neighboring structures in relation to atrial fibrillation and surgical approaches were discussed. © 2013 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd

Anatomic feature of fossa navicularis at the skull base and its clinical importance [Kafa iskeletinde fossa navicularis'in anatomik özellikleri ve klinik önemi]

The basilar (basiooccipital) part of the occipital bone is the quadrilateral part of this bone in front of the foramen magnum. The inferior surface of the basilar part has a small pharyngeal tubercle for attachment of the fibrous pharyngeal raphe about 1 cm anterior to foramen magnum. The fossa navicularis is a rare anatomic variation of the skull base and it is located anterior to the pharyngeal tubercle. The purpose of present study was to determine the incidence and morphometric features of the fossa navicularis. The study was carried out on 95 specimens. The fossa navicularis was investigated in 6.3 % of the specimens. The depth of fossa navicularis was 1.58±0.84 mm. The transverse diameter was 4.66±1.43 mm. The sagittal diameter was 6.50±1.73 mm. The distances between fossa navicularis and other anatomic landmarks such as most anterior point of pharyngeal tubercle (4.36±2.14 mm) and vomer (6.53±3.77 mm) were also measured to define the position of the fossa. An awareness of the existence of this variation will be especially helpful during surgical approaches to the skull base. It will also keep the clinicians misinvestigations during the observations of radiological images

Dimensions of the anterior tarsal tunnel and features of the deep peroneal nerve in relation to clinical application

WOS: 000249409400001PubMed ID: 17607504Background The aim of this study was to demonstrate anatomical features of the anterior tarsal tunnel and the deep peroneal nerve and to discuss the importance of these structures for the anterior tarsal tunnel syndrome and some other surgical approaches to minimize the injury risk. Methods Lower limbs of 18 formalin fixed cadavers were examined. The limbs showed no evidence of pathology or trauma. Results The lateral length of the tunnel was 21.7 +/- 4.3 mm and the medial length of the tunnel was 55.0 +/- 9.0 mm. The width of the tunnel at the inferior border between the extensor hallucis longus and extensor digitorum longus tendons was 12.6 +/- 2.1 mm. The location of the deep peroneal nerve bifurcation was in the anterior tarsal tunnel in 31 specimens (86.1%) and distal to the tunnel in two specimens (5.6%). In three specimens (8.3%) there was no bifurcation because of the absence of the medial terminal branch of the deep peroneal nerve. In these three specimens, the superficial peroneal nerve distributed to the adjacent sides of the great and second toes. Bifurcation above the tunnel was not observed in our specimens. There was connection between the deep peroneal nerve and the superficial peroneal nerve in 10 specimens (27.8%) in the first interdigital space. During the observations, the presence of a fibrous band over the nerve and vessel was noted in 22 specimens (61.1%). conclusions We believe that a detailed anatomic knowledge of the anterior tarsal tunnel and the deep peroneal nerve will be of help during surgical approaches to this area and the diagnosis of the problems related to the peripheral nerves on the dorsum of the foot

A cadaver study on preserving peroneal nerves during ankle Arthroscopy

WOS: 000250660200008PubMed ID: 18021586Background: Ankle arthroscopy is an important diagnostic and therapeutic procedure, but neurovascular injury remains a disadvantage. By understanding the anatomy of the superficial peroneal nerve (SPN) and deep peroneal nerve (DPN) the risk of nerve injury can be minimized. Methods: Thirty-four lower limbs from 17 cadavers were dissected to find the safest anatomical points easily during arthroscopy. Results: There was a single branch of the SPN in eight of 34 specimens (23.5%); type 1), two branches in 18 (52.9%; type 2), three branches in six (17.7%; type 3) and four branches in two specimens (5.9%; type 5) at the level of the talocrural (TC) joint. The closest SPN branch to lateral border of the TC joint was 14 +/- 8.4 mm. There was no branch of the SPN or DPN medial to the extensor hallucis longus tendon in any specimen. The DPN bifurcation was 6.5 nun proximal to the TC joint in a single specimen (2.9 %) and 14.5 +/- 5.5 mm distal to TC joint in 26 specimens (76.5%). In four specimens (11.8%), the DPN bifurcation was at the same level with the TC joint. In three specimens (8.8%), there was no bifurcation of the DPN. Conclusions: From this study the anatomic landmarks defining the medial midline portal are safely away from the SPN and DPN and their respective branches. Clinical studies are needed to define its safety during ankle arthroscopy. Clinical Relevance: This study proves that the medial midline portal is the best portal for the anterior arthroscopic procedures

The clinical importance of the relationship between the deep peroneal nerve and the dorsalis pedis artery on the dorsum of the foot

4th Asian-Pacific-International-Congress of Anatomists (APICA 2005) -- SEP 07, 2005 -- Kusadasi, TURKEYWOS: 000248900100014PubMed ID: 17700120Background: The aim of this study was to describe the relationship between the deep peroneal nerve and the dorsalis pedis artery to help ensure a safer surgical approach in flap surgery. Methods: The dissection of 36 cadaver lower limbs was undertaken to describe the relationship of the deep peroneal nerve to the dorsalis pedis artery in the anterior tarsal tunnel and on the dorsum of the foot. Results: Four distinct relationships of the deep peroneal nerve to the dorsalis pedis artery were determined. In type 1 (36.1 percent), the artery was medial to the deep peroneal nerve in the tunnel and medial to the medial terminal branch below the tunnel on the dorsum of the foot. In type 2 (25.0 percent), the artery was medial to the deep peroneal nerve in the tunnel and lateral to the medial terminal branch below the tunnel on the dorsum of the foot. In type 3 (30.6 percent), the deep peroneal nerve and the artery were crossing over each other at multiple levels. In type 4 (8.3 percent), no medial terminal branch was observed. The artery was medial to the lateral terminal branch. Conclusions: The dorsalis pedis neurovascular island flap contains both the dorsalis pedis artery and the deep peroneal nerve. Because the design of a neurovascular free flap requires detailed knowledge of the nerve and vascular supply, the data presented here will help surgeons during the surgical approaches to the foot and ankle