Persistent jugulocephalic vein: case report including commentaries on distribution of valves, blood flow direction and embryology

This paper is a detailed case study of the persistent anastomotic channel between the cephalic vein and the external jugular vein, running anterior to the clavicle, corresponding to the jugulocephalic vein present at early stages of the ontogenesis in humans. This connection is not only a relic of early foetal development seldom occurring in adults, but it may also be of clinical significance, increasing the risk of complications during the cephalic vein catheterisation, clavicular fractures or head and neck surgery. The novelty in this paper was to determine the presence and distribution of valves within the persistent jugulocephalic vein. Three bicuspid venous valves were found that allowed the blood to flow only in one direction — from the cephalic vein to the external jugular vein. The anastomosis between the persistent jugulocephalic vein and the thoracoacromial veins was additionally present. Due to lack of similar data in the literature, further research should be performed on the presence and distribution of the venous valves in various types of the persistent jugulocephalic vein in humans

The report on the co-occurrence of two different rare anatomic variations of the plantaris muscle tendon on both sides of an individual

The plantaris muscle usually begins with a short and small muscle belly on the popliteal surface of the femur and on the knee joint capsule. It continues distally to form a long and thin tendon typically fixed to the calcaneal tuberosity. However, the course and the insertion of the plantaris muscle is variable, which may influence the development of Achilles tendinopathy. The plantaris tendon may also be used for reconstruction of tendons and ligaments, such as talofibular and calcaneofibular ligament. In literature review no data concerning the co-occurrence of anatomic variations of the plantaris muscle tendon in different individuals has been found. This report presents a rare variant of the plantaris muscle insertion into the deep crural fascia on the left leg and absence of the plantaris muscle on the right leg of the same individual

Circumaortic left renal vein (circumaortic renal collar) associated with the presence of vascular anomalies: a case series and review of literature

Renal vessels exhibit a high degree of anatomical variations in terms of their number, level of origin, diameter and topographical relationships. In particular, it applies to the left renal vein which can take retroaortic or even circumaortic placement. Anatomical variations of the left renal vein may be of great clinical significance, particularly in the case of renal transplantation, retroperitoneal surgery as well as vascular or diagnostic procedures. Thus, the aim of this report was to present a complete anatomical description of two cases of the circumaortic left renal vein (CLRV; circumaortic renal collar) co-existing with the presence of various vascular anomalies. In the first case, the circumaortic renal collar was connected via a large anastomosis with the hemiazygos vein and was associated with the presence of the supernumerary left renal artery located below the main left renal artery. In the second case, the circumaortic renal collar was accompanied by the renal artery dividing close to its origin. Moreover, in the latter case, the fusiform aneurysm of the abdominal aorta was observed. In both cases, the CLRV began as a single and short trunk. On its further course, the initial segment of the CLRV was divided into two limbs — anterior (anterior left renal vein) and posterior (posterior left renal vein). Both anterior and posterior limb of the CLRV opened into the inferior vena cava.

Klingler’s method of brain dissection: review of the technique including its usefulness in practical neuroanatomy teaching, neurosurgery and neuroimaging

Klingler’s technique was discovered in the 1930s. It is a modified method of brain fixation and dissection, based on freezing and thawing of the brain tissue, subsequent peeling away of white matter fibres and the gradual exposure of white matter tracts. The added value of this technique is that it is carried out in a stratigraphic manner. This fact makes it an invaluable tool for an in-depth understanding of the complex anatomical organisation of the cerebral hemispheres. The purpose of this paper is to provide a review of Klingler’s method while taking into account the original description of the technique and its value for medical training. The historical background, the concise outline of white matter organisation, as well as our own experience in using this procedure for research and teaching activities were also included. The fibre dissection technique may still be considered an excellent complementary research tool for neuroanatomical studies. Numerous detailed observations about the white matter topography and spatial organisation have been recently made by applying this method. Using this technique may also improve understanding of the three-dimensional intrinsic structure of the brain, which is particularly important both in under- and postgraduate training in the field of neuroanatomy

Types of coeliac trunk branching including accessory hepatic arteries: a new point of view based on cadaveric study

Background: The coeliac trunk (CT) is major visceral branch of the abdominal aorta. Familiarity with anatomic variations of the CT is relevant for planning radiological and surgical procedures. The aim of our research was determining variations of the CT, including the occurrence of accessory hepatic arteries (AHA). Materials and methods: Forty cadavers were studied. Six patterns of CT branching were observed in this study. AHA were observed in 7 (17.5%) specimens. The most prevalent variation was normal trifurcation, accounting for 62.5% of cases. The rarest variation was absence of the CT, with an incidence of 2.5%. In this variant the left gastric artery, the common hepatic artery, and the splenic artery branched directly off the abdominal aorta. Results: The study material allowed to distinguish two CT branching patterns which, to the best of our knowledge, have not been reported before. It was a type with four branches originating from the CT: the left gastric artery, the common hepatic artery, the splenic artery, and right AHA. The other previously unreported pattern variant was the CT which gave off three branches: the common hepatic artery, the splenic artery and right AHA. Conclusions: The average distance between the aortic hiatus and the coeliac trunk calculated for all the cadavers amounted to 54 ± 11.85 mm. The average distance between the CT and the superior mesenteric artery was 11.1 ± 7.7 mm

The abducens nerve: its topography and anatomical variations in intracranial course with clinical commentary

Background: The sixth cranial nerve (CN VI) — or the abducens nerve — in humans supplies only the lateral rectus muscle. Due to its topographic conditions, including angulations and fixation points along its course from the brainstem to the lateral rectus muscle, the CN VI is vulnerable to injury. Every case of CN VI palsy requires precise diagnostics, which is facilitated by an understanding of the anatomy. The present article’s aims include a detailed study of the intracranial course of the CN VI, determination of occurrence of its particular anatomical variations, as well as presentation of some essential anatomical conditions which may conduce to CN VI palsy. Special emphasis was put on the correlation between craniometric measurements and a particular variation of the CN VI, which complements the data that can be found in literature. Materials and methods: Twenty randomly selected specimens of cadaveric heads fixed in a 10% formalin solution were studied. The study used 40 specimens of the CN VI in order to examine its course variations within the section between the pontomedullary sulcus and the superior orbital fissure. Results: Detailed analysis of the CN VI topography and anatomy in its intracranial course revealed 3 anatomical variations of the nerve in the studied specimens. Variation I, found in 70% of cases, covers those cases in which the CN VI was found to be a single trunk. Those cases in which there was a branching of the CN VI exclusively inside the cavernous sinus were classified as variation II, occurring in 20% of cases. Cases of duplication of the CN VI were classified as variation III, found in 10% of the specimens. In 75% of cases of CN VI duplication one of the nerve trunks ran upwards from the petrosphenoidal ligament, outside Dorello’s canal. Conclusions: The CN VI throughout its intracranial course usually runs as a single trunk, however, common variations include also branching of the nerve in the cavernous sinus or duplication. Topographic relations of the CN VI with adjacent structures account for the risk of injuries which may be caused to the nerve as a result of a disease or surgical procedures.

Morphology and a proposed model of innervation of the human deltoid muscle: a pilot study

Background: The deltoid muscle (DM) plays an essential role in retaining the stability and correct function of the upper limb. The aims of the study were to perform a detailed morphological analysis of the DM including its innervation, structure, attachments and relationship with adjacent structures.Materials and methods: The study was carried out on 17 formalin-fixed cadavericupper limbs. After dissection of the shoulders, the DM was visualised and analysed.The following measurements of the muscle were performed for all cases: width of attachments (acromial, clavicular, spinal), entire width of origin, length of the component parts (acromial, clavicular, and spinal) and length of the arm.Results: In all specimens, a characteristic ‘segmented’ innervation scheme of the DM was observed. The axillary nerve (AN) was always divided into an anterior branch (abAN) and a posterior branch (pbAN). Two variations of the DM innervation were distinguished: variation I, where the clavicular and the acromial parts were innervated by the abAN, while the spinal part was supplied both by abAN (anterior fibres) and by pbAN (posterior fibres), and variation II, in which the spinal part did not have double innervation — the abAN innervation area covered only the acromial and clavicular parts, and the entire spinal part was supplied by pbAN. Both variations had a segmented arrangement of sub-branches reaching individual parts of the DM, which was particularly distinct in the clavicular and acromial parts. Correlations were found between the entire width of the DM originand the length of the arm (p = 0.001), between the length of the acromial part of the DM and the length of the arm (p = 0.003), between the width of the spinal attachment and the length of the spinal part (p = 0.002), and between the width of the spinal attachment and the length of the arm (p = 0.0008).Conclusions: The study confirmed the existence of a characteristic segmented innervation scheme of the DM which corresponds with the segmented morphology of its individual parts. An analysis of the internal structure of the muscle specific architectonics based on the tendon system was also presented

Infraorbital groove localisation for the endoscopic decompression of the orbit in Graves’ disease

Background: The aim of our study was to determine the localisation of the inferior margin of the optic canal in relation to the infraorbital canal/groove complex (IOC/G complex) and zygomaticoorbitale (ZO) as the potential useful landmarks for reducing dangerous complications following surgical and invasive procedures. Materials and methods: Sixty-four orbits of thirty-two human skulls were investigated. The distances between: the inferior margin of the optic canal and the posterior margin of the infraorbital groove measured at its medial border (OC-S); the inferior margin of the optic canal and the posterior margin of the roof of the infraorbital canal (OC-C); the inferior margin of the optic canal and the zygomaticoorbitale (OC-ZO) — were measured. The left/ /right symmetry ratio and the asymmetry index were counted. The symmetry between the contralateral measurements was analysed and statistical analysis was performed. Results: On the right side the mean distance from the inferior margin of the optic canal to: the posterior margin of the infraorbital groove measured at its medial border; to the posterior margin of the roof of the infraorbital canal; and to the zygomaticoorbitale were: 23.41 ± 3.10 mm; 34.44 ± 5.30 mm; and 47.53 ± 4.13 mm, respectively. On the left side the mean distance from the inferior margin of the optic canal to: the posterior margin of the infraorbital groove measured at its medial border; to the posterior margin of the roof of the infraorbital canal; to the zygomaticoorbitale were 23.69 ± 2.80 mm; 36.75 ± 5.10 mm; 46.84 ± 3.24 mm, respectively. Conclusions: The presented measurements may be particularly helpful for endoscopic decompression in patients with the thyroid ophthalmopathy to avoid the complications

A quantitative study of the arrangement of the suprascapular nerve and vessels in the suprascapular notch region: new findings based on parametric analysis

Background: When closed by the superior transverse scapular ligament (STSL), the suprascapular notch (SSN) creates an osseo-fibrous tunnel which acts as a pathway for the suprascapular nerve (SN). Anatomical variations are common in this region, and these can increase the risk of neuropathy by restricting the space for nerve passage. The aim of this study is to identify any correlation between the area reduction coefficient parameters and the SN and vessel arrangements in the SSN region. Material and methods: The SSN region was dissected in 88 formalin-fixed cadaveric shoulders (40 left and 48 right). During dissection, the topography of the SN, artery and vein was evaluated. Quantitative visual data analysis software was used to measure the areas of the STSL and the anterior coracoscapular ligament (ACSL), as well as the diameters of the SN and associated vessels, and to assign those structures to existing classifications. The area reduction coefficient (ARC) was calculated for each shoulder. Results: The area of the STSL (aSTSL) and ACSL (aACSL) were significantly larger in Type IV than Type I of the triad. Similarly, the aSTSL and area of the SSN (aSSN) were found to be significantly larger in Type IV than Type III. However, no significant differences were found in the ARC of the STSL (ARCSTSL), the ARC of the ACSL (ARCACSL) or the total ARC (ARCtotal). Conclusions: Although the aSTSL, aACSL and aSSN varied according to the type of SN and vessel arrangement, coefficient analysis (ARCSTSL, ARCACSL and ARCtotal) indicated that combined effect of these variations did not significantly affect SSN morphology.

Unusual formation of the musculocutaneous and median nerves: a case report refined by intraneural dissection and literature review

This report presents a detailed anatomical investigation of an upper limb specimen showing an atypical formation of the musculocutaneous nerve (MCN) and median nerve (MN). The study was refined by intraneural dissection, which supplements earlier descriptions of similar anatomical variations and allows for revision of the accepted classification.The case described in this report was an incidental finding during routine dissection of a fixed isolated upper limb. Intraneural dissection revealed partial fusion between the MCN and aberrant bundles of the MN. Those aberrant bundles joined the main steam of the MN at the level at which the MCN branched off as an independent nerve. The procedure allowed the aberrant fibres of the MN to be differentiated from the MCN. The presence of separate bundles in a territory corresponding to the MCN was confirmed, although those bundles and the aberrant MN bundles were covered by a common epineurium. The aberrant MN bundles running within the MCN did not contribute to innervation of the forearm muscles. They rejoined the main nerve trunk in the arm.A comprehensive understanding of the diverse anatomical variations of the upper limb nerves could be crucial for the safety and success of surgical procedures, especially procedures for reconstructing the brachial plexus or its branches