Spinal accessory nerve meningioma in a paediatric patient: case report

Accessory nerve meningiomas are exceedingly rare. We present a case of a nine-year-old patient with neurofibromatosis type 2 who had radiologic evidence of spinal cord compression from an upper cervical/foramen magnum lesion. He was asymptomatic from this lesion, but it progressed in size. The tumor was resected and histologic investigation revealed frequent tight whorls and psammoma bodies consistent with meningioma. To the authors' knowledge, this is the first reported spinal accessory nerve meningioma in a pediatric patient.     

The surgical anatomy of ulnar and median nerve communications in the palmar surface of the hand

OBJECT: Sensation in the palmar surface of the digits is supplied by the median and ulnar nerves, with the boundary classically being the midline of the ring finger. Overlap and variations of this division exist, and a communicating branch between the ulnar and median nerve could potentially explain further variations in digital sensory innervations. The aim of this study was to examine the origin and distribution of the communicating branch between the ulnar and median nerves and to apply such findings to the risk involved in surgical procedures in the hand. METHODS: The authors grossly and endoscopically examined 200 formalin-fixed adult human hands obtained in 100 cadavers, and a communicating branch was found to be present in 170 hands (85%). Of the specimens with communicating branches, the authors were able to identify four notable types representing different points of connections of the branches. The most common, Type I (143 hands, 84.1%), featured a communicating branch that originated proximally from the ulnar nerve and proceeded distally to join the median nerve. Type II (12 hands, 7.1%) designated a communicating branch that originated proximally from the median nerve and proceeded distally to join the ulnar nerve. Type III (six hands, 3.5%) designated a communicating branch that traversed perpendicularly between the median and ulnar nerves in such a way that it was not possible to determine which nerve served as the point of origin. Type IV (nine hands, 5.3%) designated a mixed type in which multiple communicating branches existed, arising from both ulnar and median nerves. CONCLUSIONS: According to the origin and distribution of these branching patterns, the investigators were able to define a risk area in which the communicating branch(es) may be subject to iatrogenic injury during common hand procedures.     

An endoscopic and anatomical approach to the septal papillary muscle of the conus

Many authors have questioned the gross anatomy of the septal papillary muscle of the conus known as the papillary muscle complex (PMC) during the past century. An anatomical investigation was conducted to identify the morphology and the topography of the PMC. Our study involved 200 formalin fixed adult human hearts. The PMC was present in 82% of the hearts, while in the remaining 18% of specimens, it was replaced by tendinous chords. The PMC was connected with the septal (59.7%), anterior (20.7%), or both septal and anterior leaflets (19.5%) with single (29.8%) or multiple chordae tendinae (70.1%). The PMC was also found to be present as a single papilla (51.8%), double papilla (32.9%) or triple papilla (15.2%). In addition to the PMC, we observed accessory single septal papillary muscles 42 specimens, double septal papillary muscles 32 specimens and triple septal papillary muscles 26 specimens. In the right ventricular inflow tract, the location of the PMC was consistently found to be in a position below the junction of the anterior and septal leaflets of the tricuspid valve. In the right ventricular outflow tract, we were able to identify 73 specimens in which the PMC was located at the junction formed superiorly by the inferior border of the subpulmonary infundibulum and inferiorly by the superior-lateral border of the septal band, extending into the region of the subpulmonary infundibulum. In the remaining 27%, the PMC was located primarily at the area occupied by the superiolateral border of the septal band without extending to the subpulmonary infundibulum. The present study describes the topography of the PMC according to its surrounding anatomical structures such as the tricuspid valve, subpulmonary infundibulum and septal band of the right ventricle. This anatomical data could have important clinical significance for cardiac surgeons operating in this area.     

Ibn Jazlah and his 11th century accounts (Taqwim al-abdan fi tadbir al-insan) of disease of the brain and spinal cord. Historical vignette

The 11th century was culturally and medicinally one of the most exciting periods in the history of Islam. Medicine of this day was influenced by the Greeks, Indians, Persians, Coptics, and Syriacs. One of the most prolific writers of this period was Ibn Jazlah, who resided in Baghdad in the district of Karkh. Ibn Jazlah made many important observations regarding diseases of the brain and spinal cord. These contributions and a review of the life and times of this early Muslim physician are presented.     

Use of the clavicle in anterior cervical discectomy/corpectomy fusion procedures: cadaveric feasibility study

Introduction Graft sources for cervical fusion procedures include synthetic materials, donor grafts, and autologous bones such as the iliac crest. Considering the data that autologous bone grafts seem to generate the best results for fusion, the next logical step is to seek alternative donor sites so as to attempt to reduce the morbidity associated with these procedures. To our knowledge, autologous clavicle has not been explored as a potential source for cervical fusion. Therefore, the following study was performed to verify the utility of this bone for these procedures. Materials and methods Seven adult cadavers were used for this study. In the supine position, a standard surgical approach and dissection to the anterior cervical spine were performed. Specimens underwent a standard discectomy or corpectomy with placement of harvested ipsilateral clavicle previously dissected. An anterior cervical plating system was next placed over these sites using standard techniques. Measurements of the harvested clavicle were made. Results The results of our morphometric analysis were as follows: An average of 5 cm of bone was easily removed from the middle one third of the clavicle. No gross injury was found to vicinal neurovascular structures. The middle one third of the clavicle offered sufficient bone for the one to two segments fused in our study with remaining bone for at least two additional segments. The mean diameter of this part of the clavicle was 1.2 cm. Conclusions Based on our cadaveric study, such a bony substitute as autologous clavicle might be a reasonable alternative to the iliac crest for use in anterior cervical fusion procedures.     

Do mechanical fluid laws dictate the branching pattern of the renal artery?

INTRODUCTION: Anatomy of the renal artery is an important issue in the renal transplantation era. Multi-detector computed tomography angiography (MDCTA) is an accurate modality for the preoperative assessment of live renal donors, and it provides excellent details of donor arterial anatomy. We studied the relationship between the angle of emergence of the renal artery from the aorta and its branching pattern. METHODS: In this study, the MDCTA images obtained from the 138 kidneys of 77 potential renal transplant donors were studied. The courses of the right and left renal arteries from the aorta to the kidney hilus were delineated. The branching angle of the renal artery from the aorta (beta, angle) and the length of the renal artery from the aorta until its first division were measured (Delta, distance). The renal artery deviation from the perpendicular plane of the aorta (D, factor of deviation) was calculated by the following formula: D = (1 - sin [beta]). The cosine of this angle (cos [beta]) was also calculated. Statistical analyses were performed with Pearson correlation tests. The P value was set at .05. RESULTS: The mean age of patients was 28.7 +/- 4.3 with a male to female ratio of 63:14. The mean Delta distance and small de, Cyrillic diameter were 34.37 +/- 10.68 mm (range, 10-58) and 6.13 +/- 1.37 mm (range, 2.8-9.9), respectively. The mean beta angle, factor of deviation, and cos (beta) were 62.19 degrees +/- 16.44, 0.15 +/- 0.14, and 0.45 +/- 0.25, respectively. Significant negative correlations were found between the beta angle, and Delta distance (r = -0.308; P < .001), and small de, Cyrillic diameter (r = -0.303; P = .003). Factor of deviation and cos (beta) were directly associated Delta distance and small de, Cyrillic diameter. CONCLUSION: These findings indicated that with the main renal artery axis deviating from the perpendicular plane of the aorta or with a smaller branching angle, this artery had a greater diameter and underwent late branching. This study suggested that the renal artery diameter and branching pattern might be determined by the mechanical fluid laws.