A prefix brachial plexus with two trunks and one anterior cord

The brachial plexus presents a great variability in formation, division and branching pattern. Its variants are of immense importance during axillary and arm surgery and nerve blockade. The current case highlights a unilateral atypical formation of brachial plexus, the so called prefix, in which the C4 root contributed a large branch to the superior trunk and further anastomosis with the inferior trunk. Thus, the prefix or high brachial plexus consisted of a superior and inferior trunk and one anterior cord. Coexisting neural and arterial variations are also discussed in relation to the data literature

An atypical biceps brachii and coracobrachialis muscles associated with multiple neurovascular aberrations: a case report with clinical significance

Neural and vascular variations in the axilla and upper limb area are usually paired, but coexistence of muscular aberration on top of this is uncommon. The current case report emphasizes on the unilateral coexistence of a three-headed (tricipital) biceps brachii muscle, a two-headed coracobrachialis with an accessory muscle bundle joining the superficial and deep heads of coracobrachialis muscle. On the ipsilateral side of the 72-year-old male cadaver, a connecting branch originated from the musculocutaneous nerve and joined the median nerve after surpassing the accessory muscle bundle. A large diameter subscapular trunk originated from the 2nd part of the axillary artery and after giving off the 1st lateral thoracic artery trifurcated into a common stem which gave off the 2nd and 3rd lateral thoracic arteries, the circumflex scapular artery and a common branch that gave off the 4th and 5th lateral thoracic arteries and the thoracodorsal artery, as the ultimate branch. All lateral thoracic arteries were accompanied by multiple intercostobra- chial nerves. Documentation of such muscular and neurovascular variants and their embryologic origin increases awareness of their potential impact on diagnosis and treatment of upper limb pathology. To the best of our knowledge, the currently reported cadaveric observations seem to constitute a unique finding.

Transtendinous course of the infrapatellar branch of saphenous nerve. A contribution to the aetiology of entrapment neuropathy and modification of the existing classification

Background: The course of the infrapatellar branch of saphenous nerve (IPBSN) in relation to the Sartorius muscle has been classified into presartorial, transsartorial and retrosartorial types. Mechanical compression of the IPBSN within the Sartorius tendon has been surgically recognised as a cause of entrapment neuropathy. Purpose of the present study was to differentiate the IPBSNs penetrating the Sartorius tendon from those penetrating the Sartorius muscle, from an anatomical and clinical point of views and thus modifying the existing classification. Materials and methods: The IPBSN was bilaterally dissected in 27 cadavers. The cases of the IPBSNs penetrating the Sartorius tendon were recorded separately from those penetrating the Sartorius muscle belly. Results: In 11 out of 54 limbs (20.4%) the IPBSN ran through the Sartorius muscle belly. In 3 out of 54 (5.6%) limbs, the IPBSN penetrated the Sartorius tendon. Conclusions: The penetrating type of IPBSN includes two distinct subtypes: the muscle-penetrating type and the tendon-penetrating type. These subtypes are also distinct from a clinical point of view, since only the tendon-penetrating type has been associated with the IPBSN entrapment neuropathy. According to these findings we suggest a modification of the current classification. Further clinical studies are necessary to fully demonstrate whether the tendon-penetrating type should be considered as a predisposing factor for the IPBSN entrapment neuropathy. Distinguishing the two subtypes might be helpful for that purpose

High origin of a superficial ulnar artery arising from the axillary artery: anatomy, embryology, cinical significance and a review of the literature

The superficial ulnar artery (SUA) is an ulnar artery of high origin that lies superficially in the forearm. Its reported frequency ranges from 0.17% to 2%. During anatomical dissection in our department we observed a unilateral case of SUA in a 75-year-old white male human cadaver. It originated from the right axillary artery at the level of the junction of the two median nerve roots and followed a looping course, crossing over the lateral root of the median nerve and running lateral to it in the upper and middle thirds of the arm, whereas in the inferior third of the arm the SUA crossed over the median nerve and ran medially to it. In the cubital fossa, it passed superficially over the medial side of the ulnar aponeurosis and coursed subcutaneously in the ulnar side of the forearm superficially to the forearm flexor muscles. In the hand the SUA anastomosed with the superficial palmar branch of the radial artery, creating the superficial palmar arch. Additionally, it participated in the development of the deep palmar arch. The axillary artery, after the origin of the SUA, continued as the brachial artery and divided into the radial and common interosseous arteries in the cubital fossa. The normal ulnar artery was absent. No muscular or other arterial variations were observed in this cadaver. The embryological interpretation of this variation is difficult and it may arise as a result of modifications to the normal pattern of capillary vessel maintenance and regression. The existence of a SUA is undoubtedly of interest to the clinician as well as to the anatomist. This report presents a case of unilateral SUA along with a review of the literature, embryological explanation and analysis of its clinical significance

Axial transformation of the profunda femoris vein: formation, relations and course in a cadaveric specimen

When the superficial femoral vein is obstructed by thrombosis, the profunda femoris vein provides an important collateral pathway, transforming into the axial vein of the lower limb. When operating on a transformed axial vein, a surgeon should be aware of the formation, the relations and the course of the vein. A precise description of these anatomical features is not feasible on the basis of ultrasound, venographic or surgical study but only from anatomical studies. We present a case of axial transformation of the profunda femoris vein found in a cadaver, focusing on the anatomical features of the transformed axial vein

Bilateral accessory thoracodorsal artery

The subscapular artery arises from the third part of the axillary artery and gives off the circumflex scapular and the thoracodorsal arteries. Although anatomical variations of the axillary artery are very common, the existence of a unilateral accessory thoracodorsal artery has been described in the literature only once. There are no reports of bilateral accessory thoracodorsal artery, in the literature. In the present study, a bilateral accessory thoracodorsal artery, originating on either side of the third part of the axillary artery, is described in a 68-year-old female cadaver. All the other branches of the axillary artery had a typical origin, course, distribution and termination. This extremely rare anatomical variation apart from the anatomical importance also has clinical significance for surgeons in this area. Especially, during the dissection or mobilization of the latissimus dorsi that is partly used for coverage problems in many regions of the body and also in dynamic cardiomyoplasty, any iatrogenic injury of this accessory artery may result in ischemia and functional loss of the graft. © 2006 Elsevier GmbH. All rights reserved

A prefix brachial plexus with two trunks and one anterior cord

The brachial plexus presents a great variability in formation, division and branching pattern. Its variants are of immense importance during axillary and arm surgery and nerve blockade. The current case highlights a unilateral atypical formation of brachial plexus, the so called prefix, in which the C4 root contributed a large branch to the superior trunk and further anastomosis with the inferior trunk. Thus, the prefix or high brachial plexus consisted of a superior and inferior trunk and one anterior cord. Coexisting neural and arterial variations are also discussed in relation to the data literature. Copyright © 2020 Via Medica

A morphometric study of the atlas occipitalization and coexisted congenital anomalies of the vertebrae and posterior cranial fossa with neurological importance

Purpose: Our study highlights the morphometry of the partial and complete atlas occipitalization (AOZ), its coexistence with fusions of the 2nd and 3rd cervical vertebrae and morphological and morphometric abnormalities of the posterior cranial fossa that are of paramount neurological importance. Methods: One hundred and eighty adult dry skulls, the atlas and axis vertebrae were examined. Results: Four skulls (2.2 %) showed AOZ. Two of them (1.1 %) presented a partial AOZ, one male skull (0.6 %) a complete AOZ and a female skull (0.6 %) had a fused left hemiatlas with the occipital bone and a fusion of the 2nd and 3rd cervical vertebrae. The inner anteroposterior and transverse diameters of the foramen magnum (FM) in the control group were 34.6 ± 3.46 and 29.3 ± 3.47 mm. Only the skull with the complete AOZ had a reduced outer anteroposterior diameter of the FM (29.8 mm), while no specimen was found with a reduced transverse diameter. A wide total decrease (range 13.1–50.9 %) in the surface area of the FM in skulls with AOZ was detected. Extracranial, the clivus length in two skulls with AOZ was smaller than the normal range. No skull was detected with a reduction in the intracranial length of the clivus. All skulls with the AOZ had a vermian fossa. Conclusions: The study adds important morphometric details about the partial and complete AOZ and correlates the phenomenon of synostosis with the narrowing of the FM, particularly in the case of complete AOZ. Awareness of the AOZ and other fusions of the upper cervical vertebrae and their topographical relations and attendant problems are of paramount importance to surgeons, when operate to the craniocervical junction, or interpret imaging studies to plan a safe surgery for nerve or spinal tissue decompression. © 2016, Springer-Verlag France

Online educational methods vs. traditional teaching of anatomy during the COVID-19 pandemic

Aim of the present study was to determine the impact of the COVID-19 outbreak on anatomy teaching to medical and dental students comparing the traditional anatomy teaching with three remote teaching modalities. A cross-sectional study was conducted among undergraduate medical and dental students of the Aristotle University of Thessaloniki. Four hundred and twenty students who attended anatomy classes during COVID-19 outbreak in Greece, were asked to fill in a questionnaire of 22 questions evaluating the formats of the different courses provided. Each student was asked to complete the questionnaire anonymously via the Google Forms® platform. A total of 200 students participated. During the lockdown, 59.5% of students attended all online anatomy lectures compared to 44.5% in the pre-pandemic year. Overall, the higher percentage of 73.5% was satisfied with the traditional anatomy teaching, instead of 56% which were satisfied with the effectiveness of online anatomy lectures. Asking whether any remote educational method can partially or completely replace the traditional anatomy teaching, the majority of students replied “no” for all the three remote modalities. The traditional anatomy teaching remains the most preferred and effective teaching modality. The students ranked online anatomy lectures and pre-recorded anatomy lectures in second place in terms of effectiveness and preference. The development of remote learning methods has increased students' active participation in anatomy lessons, but significantly negatively affected the students' performance at exams. Remote learning cannot replace the traditional anatomy teaching method, but online lectures could be incorporated into anatomy curricula as an additional tool. © 2021 Anatomy & Cell Biology. All Rights Reserved