48 research outputs found
Klippel-Feil anomaly with associated rudimentary cervical ribs in a human skeleton: case report and review of the literature
Anomalies of the cervical spine are intriguing anatomically and often come to
clinical attention. Fusion of one or more cervical vertebral segments, the Klippel-
Feil anomaly (KFA), often causes increased motion at the vertebral segments
superior to and inferior to the fused level with a resultant premature wear of
these joints. We report an adult male skeleton with fusion of his C6 and C7
vertebral bodies (Type II KFA). A remnant of the intervertebral disc space was
noted and bilateral rudimentary cervical ribs were observed emanating from the
C7 vertebrae. Excessive joint degeneration was noted between the vertebral
bodies of C5 and C6. Following our review of the literature and case report, it
appears that there is an increased incidence of the presence of cervical ribs in
KFA. We review the literature for coexistent KFA and cervical ribs and discuss
their dysembryology
The subanconeus muscle
There is a paucity of information in the extant literature regarding the detailed
anatomy of the subanconeus (articularis cubiti) muscle. Our current study seeks
to elucidate further the presence, morphology, and potential function of this
muscle. Eighteen cadaveric upper extremities underwent dissection of their posterior
elbow joint capsule with special attention to any fibres attaching to it from
the triceps brachii muscle. We found that all specimens had various amounts of
muscular attachment of the medial head of the triceps into the posterior joint
capsule. It was noted that the highest concentration of fibres was into the joint
capsule near the groove for the ulnar nerve. No specimen was found to have
a distinct muscle belly associated with these connections to the joint capsule.
On all sides these fibres were simply deeper attachments of the medial head of
the triceps brachii muscle. Following tension on these deeper fibres retraction of
the joint capsule was not noted but rather compression of the capsule. We
would speculate on the basis of our study that these fibres of the medial head of
the triceps brachii muscle do not represent a separate muscle per se and do not
retract the posterior elbow joint capsule with extension of the forearm as has
been theorised. It is possible that compression of the posterior elbow joint capsule
from these deeply placed fibres of the triceps brachii restricts the elbow fat
pad from being displaced and allows it to cushion the contact made between
the olecranon process and the olecranon fossa
Accessory venous sinus of Hyrtl
Variations of the intracranial venous sinuses are important to the surgeon during intraoperative procedures and to the clinician during imaging interpretation. We report a male cadaver found to have a rare venous sinus variation. In all likelihood, this sinus corresponded to the rarely reported accessory venous sinus
of Hyrtl. The sinus was approximately 5 mm in width and traveled from the
sphenoparietal sinus anteriorly to the veins, draining into the foramen spinosum (i.e. the middle meningeal veins) posteriorly. No other variations or obvious pathology were identified intracranially or extracranially. Knowledge of such a venous variation may be of use to the clinician
A complex dural-venous variation in the posterior cranial fossa: a triplicate falx cerebelli and an aberrant venous sinus
Variations of the dural folds and the dural venous sinuses are seldom reported in the extant medical literature. Such variations in the posterior cranial fossa may be problematic in various diagnostic and operative procedures of this region. We report our observation of an extremely rare variation of the falx cerebelli and posterior cranial fossa venous sinuses encountered upon dissection of a young male cadaver. In this specimen the falx cerebelli was duplicated with dimensions of 45.3 × 5.1 mm and 49.8 × 5.3 mm for the right and left falces respectively. The distance between the two falces was 3.2, 4.5 and 7.8 mm at their proximal, middle and distal thirds. An accessory small falx (31.8 × 2 mm) was also found approximately 3.4 mm lateral to the right falx cerebelli and blended with the lateral surface of the right falx cerebelli. There was only one occipital venous sinus (diameter, 2.5 mm) and no marginal sinus was detected. At the right floor of the posterior cranial fossa (posterolateral to the foramen magnum) an additional dural venous sinus was found, which connected the terminal portion of the right sigmoid sinus to the occipital and right transverse sinuses via one medial and two lateral branches respectively. We believe that such a complex dural-venous variation in the posterior cranial fossa has not previously been reported. Neurosurgeons and neuroradiologists should be aware of such variations, as these could be potential sources of haemorrhage during suboccipital approaches or may lead to erroneous interpretations of imaging of the posterior cranial fossa
Aortic bifurcation angle as an independent risk factor for aortoiliac occlusive disease
Recently, there has been interest in potential geometric risk factors that might result in or exaggerate atherosclerosis. The aortic bifurcation is a complex anatomical area dividing the high pressure blood of the descending abdominal aorta into the lower limbs and pelvis. The distribution of the bifurcation angle and any asymmetry, its relation with age and its possible contribution to the risk of aortoiliac atherosclerosis are presented here. Statistical analysis was performed by SPSS version 11.0 using, Fisher`s exact test, the Pearson and Spearman correlation
tests and logistic regression analysis. The p value was set at 0.05. No correlations were found between age, bifurcation angle and angle asymmetry
in the Pearson test (p > 0.05). Logistic regression analysis revealed that the bifurcation angle, but not its asymmetry, gender or age, was a significant and independent risk factor for aortoiliac atherosclerosis (model r2 = 0.662, p = 0.027). With additional study these results may have implications regarding risk factors for aortoiliac atherosclerosis. To our knowledge, this study is the first
of its kind to indicate the potential of such an important geometric risk factor for atherosclerosis at the aortic bifurcation
Intraluminal septation of the basilar artery: incidence and potential clinical significance
Variations in the cerebrovascular tree can increase surgical or interventional
morbidity. To date, only scant comments are to be found in the literature regarding
intraluminal variations of the basilar artery. To further elucidate such
anatomy, a cadaveric study was performed.
One hundred and fifty human brains were evaluated for the present study. The
basilar artery was identified in each and sectioned longitudinally to observe for
the presence of intraluminal septa.
One specimen (0.67%) was identified that harbored an intraluminal septum of
the basilar artery. This wall was within the proximal basilar artery and measured
3 mm by 1.5 mm. No specimen was found to have other anomalies of
the basilar artery and in the single specimen with an intraluminal septum no
signs of intracranial pathology were seen.
Although seemingly rare, septation of the basilar artery can be found. Knowledge
of such an intraluminal vascular variation may be important during invasive
and minimally invasive procedures
An unusual muscular variation of the infratemporal fossa
The infratemporal fossa is often the site of pathology or surgical intervention. We describe an unusual muscle found during the routine dissection of the right infratemporal fossa. The literature germane to this variable muscle, best described
as a variant of the pterygoideus proprius, is reviewed. The clinician may
contemplate the wide array of muscular anomalies within the infratemporal fossa
when considering unexplained neurological symptoms attributed to branches of V3 and pursue appropriate diagnostic testing
Bilateral accessory middle cerebral arteries associated with an aneurysm of the anterior circulation
An accessory middle cerebral artery is one variation of the intracranial vasculature
that may be a source of misinterpretation by clinicians dealing with cerebrovascular
diseases. We report a case of an elderly female found to have bilateral
accessory middle cerebral arteries, who presented with the rupture of an
aneurysm of the anterior part of the circle of Willis. Accessory middle cerebral
arteries are rare anatomical findings and the bilateral occurrence is exceedingly
rare. We believe this to be the first report of bilateral accessory middle cerebral
arteries associated with an aneurysm of the anterior cerebral-anterior communicating
arteries. The anatomical and clinical relevance of this variation is described
An unreported variation of the cervical vagus nerve: anatomical and histological observations
Variations involving the cervical portion of the vagus nerve are seemingly
very rare. We report an adult male found to harbour a right cervical vagus
nerve that crossed anterior to the right common carotid artery to terminate
in the lateral aspect of the thyroid gland. A very small continuation of this
nerve was found to continue distally into the thorax. Histologically, this part of the vagus nerve did not contain ganglion or other cell bodies. There were no heterologous inclusions (thyroid, parathyroid, thymus, salivary gland or branchial cleft remnants) present. Although grossly there was a connection into the thyroid gland, this was not observed histologically. No signs of trauma were found to the ipsilateral neck region. We hypothesise that this variation is due to entanglement between the thyroid gland and cervical vagus nerve during development. This rare variation might be considered by the clinician who operates in the cervical region or interprets imaging of the neck. To our knowledge, a vagus nerve with the above described morphology has not been described
The morphology and function of the quadrate ligament
There is a paucity of information in the literature regarding the quadrate ligament
and the information that does exist is extremely conflicting. We dissected 30 cadavers
(60 sides) to determine the morphology and function of this enigmatic
ligament. A quadrate ligament (thickening of the elbow joint capsule) was found
in all specimens. In all specimens this band was distinct from the circumferential
fibres of the annular ligament. The length, width, and thickness of the quadrate
ligament were found to be 11 mm, 8 mm, and 1 mm respectively. This ligament
not only aided in securing the neck of the radius to the ulna but also resisted
excessive supination and, to a lesser degree, pronation of the forearm. Following
transection of the quadrate ligament, the head of the radius was secured to the
ulna considerably less firmly and supination and pronation increased by 10 to 20
degrees and 5 to 8 degrees respectively. The quadrate ligament contributes to
proximal radioulnar stability, limits the "spin" of this joint, and should be considered
in manipulation, surgery, or imaging of the proximal forearm