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Charbonneau L, Watanabe K, Chaalala C, Bojanowski MW, Lavigne P, Labidi M. Anatomy of the craniocervical junction - A review. Neurochirurgie 2024; 70:101511. [PMID: 38277861 DOI: 10.1016/j.neuchi.2023.101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/31/2023] [Indexed: 01/28/2024]
Abstract
An in-depth understanding of the anatomy of the craniocervical junction (CCJ) is indispensable in skull base neurosurgery. In this paper, we discuss the osteology of the occipital bone, the atlas (C1) and axis (C2), the ligaments and the muscle anatomy of the CCJ region and their relationships with the vertebral artery. We will also discuss the trajectory of the vertebral artery and review the anatomy of the jugular foramen and lower cranial nerves (IX to XII). The most important surgical approaches to the CCJ, including the far lateral approach, the anterolateral approach of Bernard George and the endoscopic endonasal approach, will be discussed to review the surgical anatomy.
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Affiliation(s)
- Laurence Charbonneau
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada.
| | - Kentaro Watanabe
- Department of Neurosurgery, Tokyo Jikei University School of Medicine, Tokyo, Japan
| | - Chiraz Chaalala
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada
| | - Philippe Lavigne
- Division of Oto-rhino-laryngology, Department of Surgery, University of Montreal, Quebec, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada
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Kunieda K, Makihara K, Yamada S, Yamaguchi M, Nakamura T, Terada Y. Brain Structures in a Human Embryo Imaged with MR Microscopy. Magn Reson Med Sci 2024:mp.2023-0110. [PMID: 38369336 DOI: 10.2463/mrms.mp.2023-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
PURPOSE To delineate brain microstructures in human embryos during the formation of the various major primordia by MR microscopy, with different contrasts appropriate for each target. METHODS We focused mainly on the internal structures in the cerebral cortex and the accessory nerves of the brain. To find appropriate sequence parameters, we measured nuclear magnetic resonance (NMR) parameters and created kernel density plots of T1 and T2 values. We performed T1-weighted gradient echo imaging with parameters similar to those used in the previous studies. We performed T2*-weighted gradient echo imaging to delineate the target structures with the appropriate sequence parameters according to the NMR parameter and flip angle measurements. We also performed high-resolution imaging with both T1- and T2*-weighted sequences. RESULTS T1, T2, and T2* values of the target tissues were positively correlated and shorter than those of the surrounding tissues. In T1-weighted images with a voxel size of (30 µm)3 and (20 µm)3, various organs and tissues and the agarose gel were differentiated as in previous studies, and the structure of approximately 40 µm in size was depicted, but the detailed structures within the cerebral cortex and the accessory nerves were not delineated. In T2*-weighted images with a voxel size of (30 µm)3, the layered structure within the cerebral cortex and the accessory nerves were clearly visualized. Overall, T1-weighted images provided more information than T2*-weighted images, but important internal brain structures of interest were visible only in T2*-weighted images. Therefore, it is essential to perform MR microscopy with different contrasts. CONCLUSION We have visualized brain structures in a human embryo that had not previously been delineated by MR microscopy. We discussed pulse sequences appropriate for the structures of interest. This methodology would provide a way to visualize crucial embryological information about the anatomical structure of human embryos.
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Affiliation(s)
- Kazuki Kunieda
- Institute of Pure and Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazuyuki Makihara
- Institute of Pure and Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shigehito Yamada
- Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Masayuki Yamaguchi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Division of Functional Imaging, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Takashi Nakamura
- Molecular Characterization Unit, Center for Sustainable Resource Research, RIKEN, Wako, Saitama, Japan
| | - Yasuhiko Terada
- Institute of Pure and Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Simão DT, Heise CO, Rodrigues JC, Yamauti LS, Villegas RI, Cho AB, Mattar Junior R. Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves. Microsurgery 2024; 44:e31152. [PMID: 38363113 DOI: 10.1002/micr.31152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/05/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION The main innervation of the trapezius muscle is provided by the spinal accessory nerve. Several studies describe the contributions of cervical plexus roots to the trapezius muscle innervation, either directly or through connections with the spinal accessory nerve. There is no adequate understanding of how the trapezius muscle is affected after using the spinal accessory nerve in nerve transfer procedures with the usual technique, preserving at least 1 branch for the upper trapezius. METHODS We evaluated 20 patients with sequelae of traumatic brachial plexus injury who underwent surgical procedures for brachial plexus repair or free muscle transfer, which included the spinal accessory nerve transfer technique and were followed for a minimum of 1 year. The three portions trapezius muscle were evaluated by physical examination, magnetic resonance imaging (analysis of fatty degeneration) and electromyography. RESULTS In all evaluation methods, the middle and lower portions of the trapezius muscle showed more significant morphological and/or functional impairment than the upper portion, in most cases. There was a statistically significant difference in all the complementary exams results, between the affected side (with sacrifice of the nerve) versus the normal side, in the middle and lower portions of the trapezius muscle. CONCLUSIONS Physical examination alone is not sufficient to determine the residual functionality of the trapezius muscle. Magnetic resonance imaging and electromyography are useful tools to assess both morphological involvement of the trapezius muscle and nerve conduction impairment of the trapezius muscle, respectively. The results suggest that the middle and lower portions of the trapezius muscle are affected by previous SAN transfer and should be considered with caution for further muscle transfer procedures.
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Affiliation(s)
- Danielle Tiemi Simão
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Carlos O Heise
- Division of Neurology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - João C Rodrigues
- Department of Imaging Diagnostic, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Radiology Department, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Lucas S Yamauti
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Robin I Villegas
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Alvaro B Cho
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
- Division of Hand Surgery and Microsurgery, Coordinator of the Hand Surgery and Microsurgery Fellowship Program, ABC Medical School, Santo André, Brazil
| | - Rames Mattar Junior
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
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Koliarakis I, Manatakis DK, Tsitsipanis C, Drakonaki E, Tsamandouras I, Tsiaoussis J. Spinal accessory nerve anatomy in the posterior cervical triangle: A systematic review with meta-analysis. Clin Anat 2024; 37:130-139. [PMID: 37767816 DOI: 10.1002/ca.24119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/10/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
This study aimed to investigate the anatomy of the spinal accessory nerve (SAN) in the posterior cervical triangle, especially in relation to adjacent anatomical landmarks, along with a systematic review of the current literature with a meta-analysis of the data. Overall, 22 cadaveric and three prospective intraoperative studies, with a total of 1346 heminecks, were included in the analysis. The major landmarks relevant to the entry of the SAN at the posterior border of the SCM muscle (PBSCM) were found to be the mastoid apex, the great auricular point (GAP), the nerve point (NP), and the point where the PBSCM meets the upper border of the clavicle. The SAN was reported to enter the posterior cervical triangle above GAP in 100% of cases and above NP in most cases (97.5%). The mean length of the SAN along its course from the entry point to its exit point from the posterior triangle of the neck was 4.07 ± 1.13 cm. The SAN mainly gave off 1 or 2 branches (32.5% and 31%, respectively) and received either no branches or one branch in most cases (58% and 23%, respectively) from the cervical plexus during its course in the posterior cervical triangle. The major landmarks relevant to the entry of the SAN at the anterior border of the TPZ muscle (ABTPZ) were found to be the point where the ABTPZ meets the upper border of the clavicle and the midpoint of the clavicle, along with the mastoid apex, the acromion, and the transverse distance of the SAN exit point to the PBSCM. The results of the present meta-analysis will be helpful to surgeons operating in the posterior cervical triangle, aiding the avoidance of the iatrogenic injury of the SAN.
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Affiliation(s)
- Ioannis Koliarakis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Christos Tsitsipanis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Elena Drakonaki
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Ioannis Tsamandouras
- Department of Otorhinolaryngology - Head and Neck Surgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - John Tsiaoussis
- Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Mark IT, Black D, Benson JC, Campeau NG, Johnson DR, Messina SA, Giannini C, Parney I, Morris PP. Benign Enhancing Foramen Magnum Lesions. AJNR Am J Neuroradiol 2023; 44:999-1001. [PMID: 37536735 PMCID: PMC10494948 DOI: 10.3174/ajnr.a7955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
Benign enhancing foramen magnum lesions have been previously described as T2-hyperintense small, enhancing lesions located posterior to the intradural vertebral artery. We present the first case with pathologic correlation. These lesions are fibrotic nodules adhering to the spinal accessory nerve. While they can enlarge with time on subsequent examinations, on the basis of the imaging characteristics and location, they do not necessitate surgical resection.
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Affiliation(s)
- I T Mark
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - D Black
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - J C Benson
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - N G Campeau
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - D R Johnson
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - S A Messina
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - C Giannini
- Department of Laboratory Medicine and Pathology (C.G.), Mayo Clinic, Rochester, Minnesota
| | - I Parney
- Department of Neurosurgery (I.P.), Mayo Clinic, Rochester, Minnesota
| | - P P Morris
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
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Melo ASC, Taylor JL, Ferreira R, Cunha B, Ascenção M, Fernandes M, Sousa V, Cruz EB, Vilas-Boas JP, Sousa ASP. Differences in Trapezius Muscle H-Reflex between Asymptomatic Subjects and Symptomatic Shoulder Pain Subjects. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094217. [PMID: 37177422 PMCID: PMC10180810 DOI: 10.3390/s23094217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58-75% or in 42-58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals' rehabilitation.
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Affiliation(s)
- Ana S C Melo
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Center for Interdisciplinary Applied Research in Health, School of Health, Setubal Polytechnic Institute, Campus do IPS Estefanilha, 2914-503 Setubal, Portugal
| | - Janet L Taylor
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia
- Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Ricardo Ferreira
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Bruno Cunha
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Manuel Ascenção
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Mathieu Fernandes
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Vítor Sousa
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Eduardo B Cruz
- Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Campus do IPS Estefanilha, 2914-503 Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - J Paulo Vilas-Boas
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
| | - Andreia S P Sousa
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
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Han J, Xu Y, Shan Y, Xie Y, Wang A, Gu C. Could C3, 4, and 5 Nerve Root Block be a Better Alternative to Interscalene Block Plus Intermediate Cervical Plexus Block for Patients Undergoing Surgery for Midshaft and Medial Clavicle Fractures? A Randomized Controlled Trial. Clin Orthop Relat Res 2023; 481:798-807. [PMID: 36730478 PMCID: PMC10013610 DOI: 10.1097/corr.0000000000002479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Variable innervation of the clavicle is a major challenge in surgery of clavicle fractures with patients under regional anesthesia. An interscalene block (ISB) combined with an intermediate cervical plexus block (ICPB) provides analgesia in clavicle fracture surgery, but this combination does not completely block sensation in the midshaft or medial clavicle. Cervical nerve root block is an alternative to deep cervical plexus block and has recently been used as an analgesic method in the neck and shoulder. Whether it should be used as an alternative for midshaft and medial clavicle fractures is unknown. QUESTIONS/PURPOSES In this randomized controlled trial, we compared a C3, 4, and 5 nerve root block to ISB combined with ICPB in surgery of midshaft and medial clavicle fractures in terms of the (1) proportion of patients achieving a sensory block that is sufficient for surgery, (2) onset time and duration of the block, and (3) effectiveness of postoperative analgesia, as measured by pain scores and consumption of analgesics. METHODS Between November 2021 and December 2021, we treated 154 patients for clavicle fractures. A total of 122 were potentially eligible, 91 of whom agreed to participate in this study. Twenty-nine patients were excluded because the patients chose general anesthesia or declined to undergo surgery. Ultimately, 62 patients were randomly allocated into the C3, 4, and 5 group or ISB + ICPB group, with 31 patients in each group; there were no dropouts. All patients were analyzed in the group they were randomized to under intention-to-treat principles. The assessor and patients were blinded to randomization throughout the trial. The two groups did not differ in any important ways, including age, gender, BMI, American Society of Anesthesiologists classification, and type of clavicle fracture. The two groups received either an ultrasound-guided C3, 4, and 5 nerve root block with 2, 3, and 5 mL of 0.5% ropivacaine or ultrasound-guided ISB with ICPB with 20 mL of 0.5% ropivacaine. The primary outcome was the proportion of patients in each group with a successful nerveba block who did not receive general anesthesia; this was defined as nerve block success. Secondary outcomes included the onset time and duration of the sensory block, defined as the onset to the moment when the patients felt pain and sought rescue analgesia; pain assessment in terms of the numeric rating scale (NRS) score (range 0 to 10) for pain after nerve block before and during surgery; and the median amount of sufentanil consumed intraoperatively and postoperatively in the recovery room. The dosing of sufentanil was determined by the assessor when the NRS score was 1 to 3 points. If the NRS score was more than 3 points, general anesthesia was administered as a rescue method. Complications after the two inventions such as toxic reaction, dyspnea, hoarseness, pneumothorax, and Horner syndrome were also recorded in this study. RESULTS A higher proportion of patients in the C3, 4, and 5 group had a successful nerve block than in the ISB + ICPB group (97% [30 of 31] versus 68% [21 of 31], risk ratio 6 [95% CI 1.5 to 37]; p < 0.01). The median onset time was 2.5 minutes (range 2.0 to 3.0 minutes) in the C3, 4, and 5 group and 12 minutes (range 9 to 16 minutes) in the ISB + ICPB group (difference of medians 10 minutes; p < 0.001). The sensory block duration was 10 ± 2 hours in the C3, 4, and 5 group and 8 ± 2 hours in the ISB + ICPB group (mean difference 2 hours [95% CI 1 to 3 hours]; p < 0.001). The median sufentanil consumption was lower in the C3, 4, 5 group than in the ISB + ICPB (median 5 µg [range 0.0 to 5.0 µg] versus median 0 µg [range 0.0 to 0.0 µg]; difference of medians 5.0 µg; p < 0.001). There were no differences between the two groups regarding NRS scores after nerve blocks and NRS score for incision and periosteum separation, with the minimum clinically important difference set at a 2-point difference (of 10). There were no severe complications in this study. CONCLUSION Based on our analysis of the data, a C3, 4, and 5 nerve root block was better than ISB combined with ICPB for surgery to treat medial shaft and medial clavicle fractures. When choosing the anesthesia method, however, the patient's basic physiologic condition and possible complications should be considered. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Junde Han
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yang Xu
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yu Shan
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yaming Xie
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Aizhong Wang
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chentao Gu
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Fidancı H, Buturak Ş, Öztürk İ, Arlıer Z. Needle electromyography abnormalities in the upper trapezius muscle in neuromuscular disorders. Turk J Med Sci 2023; 53:233-242. [PMID: 36945948 PMCID: PMC10387837 DOI: 10.55730/1300-0144.5578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/22/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : Needle electromyography (EMG) abnormalities in the trapezius muscle (TM) can be seen in neuromuscular disorders. The aim was to determine the characteristics of needle EMG abnormalities observed in the TM in neuromuscular disorders. METHODS The data of patients who applied to the Clinical Neurophysiology Laboratory of University of Health Sciences Adana City Training and Research Hospital between December 2018 and October 2021 were reviewed. Polio survivors, amyotrophic lateral sclerosis (ALS) patients, patients with sensorimotor polyneuropathy, patients with spinal cord lesions involving C2/C3/C4 segments, patients with spinal accessory nerve (SAN) lesions, neuralgic amyotrophy (NA) patients, and patients with myopathy were included. Needle EMG findings of the upper TM of the patients were analyzed. Positive sharp waves, fibrillation potentials, fasciculation potentials, myotonic discharges, and motor unit action potential (MUAP) changes were considered needle EMG abnormalities. RESULTS Eighty-one polio survivors, 23 ALS patients, 39 patients with sensorimotor polyneuropathy, 10 patients with cervical spinal lesions, eight NA patients, seven patients with SAN lesions, and three patients with myopathy were included in the study. Fifteen (65.2%) ALS patients, 18 (22.2%) polio survivors, three (30%) patients with cervical spinal lesions, two (5.1%) patients with sensorimotor neuropathy, one (12.5%) NA patient, seven (100%) patients with SAN lesions, and two (66.7%) patients with myopathies had at least one needle EMG abnormality in the TM. Fasciculation potentials in the TM were seen in 10 (43.5%) ALS patients. In four patients with SAN lesions and one polio survivor, MUAP could not be obtained from the TM. DISCUSSION There may be more frequent needle EMG abnormalities, particularly in ALS patients and patients with SAN lesions. Since the number of patients with myopathy included in this study was low, it is difficult to comment on the needle EMG features of the TM for these patients. In addition, this study indicated that fasciculation potentials in the TM are typical in ALS patients and that MUAP may not be obtained from the TM in patients with SAN lesions.
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Affiliation(s)
- Halit Fidancı
- Division of Clinical Neurophysiology, Department of Neurology,University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Şencan Buturak
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - İlker Öztürk
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Zülfikar Arlıer
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Salzano G, Bagnato A, Calabrìa F, Maglitto F, Perri F, Califano L, Ionna F. An unusual case of a radical neck dissection without the development of a shoulder syndrome. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Smit JA, Jacobs K, Bais B, Meijer B, Seinen MN, de Bree K, Veldhuis T, Hagoort J, de Jong KH, Breugem CC, Oostra RJ, de Bakker BS. A three-dimensional analysis of cranial nerve development in human embryos. Clin Anat 2022; 35:666-672. [PMID: 35445445 PMCID: PMC9320974 DOI: 10.1002/ca.23889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
Abstract
To increase our understanding of the etiology of specific neurological disorders (e.g., Duane syndrome, glossoptosis in Pierre Robin sequence), proper knowledge of anatomy and embryology of cranial nerves is necessary. We investigated cranial nerve development, studied histological sections of human embryos, and quantitatively analyzed the 3D reconstructions. A total of 28 sectioned and histologically stained human embryos (Carnegie stage [CS] 10 to 23 [21–60 days of development]) were completely digitalized by manual annotation using Amira software. Two specimens per stage were analyzed. Moreover, quantitative volume measurements were performed to assess relative growth of the cranial nerves. A chronologic overview of the morphologic development of each of the 12 cranial nerves, from neural tube to target organ, was provided. Most cranial nerves start developing at CS 12 to 13 (26–32 days of development) and will reach their target organ in stage 17 to 18 (41–46 days). In comparison to the rest of the developing brain, a trend could be identified in which relative growth of the cranial nerves increases at early stages, peaks at CS 17 and slowly decreases afterwards. The development of cranial nerves in human embryos is presented in a comprehensive 3D fashion. An interactive 3D‐PDF is provided to illuminate the development of the cranial nerves in human embryos for educational purposes. This is the first time that volume measurements of cranial nerves in the human embryonic period have been presented.
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Affiliation(s)
- Johannes A Smit
- Amsterdam UMC, location University of Amsterdam, Dept. of Plastic Surgery, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Karl Jacobs
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Oral Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Babette Bais
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Berrie Meijer
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marjolein N Seinen
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Karel de Bree
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tyas Veldhuis
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaco Hagoort
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Kees H de Jong
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Corstiaan C Breugem
- Amsterdam UMC, location University of Amsterdam, Dept. of Plastic Surgery, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bernadette S de Bakker
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Dept. of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, The Netherlands
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11
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Anatomical Variant of Spinal Accessory Nerve Passing through Fenestrated Internal Jugular Vein. Case Rep Dent 2022; 2022:7087970. [PMID: 35378842 PMCID: PMC8976659 DOI: 10.1155/2022/7087970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
Neck dissection (ND) is a major surgery for head and neck cancer. Currently, some or all of the spinal accessory nerve (SAN), sternocleidomastoid muscle, and internal jugular vein (IJV) are aggressively preserved during ND to reduce postoperative complications. Since the anatomical relationship between the SAN and IJV has several variations, knowledge of these variations is necessary to avoid iatrogenic damage. In the present case, the SAN was observed to pass through the fenestrated IJV at the level of the posterior belly of the digastric muscle during ND in a patient with squamous cell carcinoma of the mandible. Although the anatomical structure of the SAN and IJV is rare, surgeons must be aware of this anatomical variation.
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da Silva Correia A, Alves J, da Mota Santos S, Guerra D, Garção D. Anatomical variations in the relationship between the spinal accessory nerve and internal jugular vein: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2022; 52:13-18. [DOI: 10.1016/j.ijom.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/03/2022] [Accepted: 03/11/2022] [Indexed: 12/01/2022]
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13
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Patel A, Watson C, Olewnik Ł, Iwanaga J, Tubbs RS. Cutaneous Branch of the Spinal Accessory Nerve: Case Report With Potential Relevance to Occipital Neuralgia. Cureus 2021; 13:e17666. [PMID: 34646706 PMCID: PMC8487268 DOI: 10.7759/cureus.17666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/05/2022] Open
Abstract
We describe a case in which a cutaneous branch was found arising from the spinal accessory nerve, a nerve typically characterized as a purely motor nerve. Although reported anatomical variations of the lesser occipital and spinal accessory nerves are uncommon, rare variants have been reported. Such anatomy might result in unexpected patient presentations or rare complications following spinal accessory nerve injury.
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Affiliation(s)
- Aditi Patel
- Anatomy, Ross University School of Medicine, Two Mile Hill, BRB
| | - Caroline Watson
- Department of Ophthalmology, Tulane University School of Medicine, New Orleans, USA
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, POL
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA.,Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA.,Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
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14
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Van der Cruyssen F, Croonenborghs TM, Renton T, Hermans R, Politis C, Jacobs R, Casselman J. Magnetic resonance neurography of the head and neck: state of the art, anatomy, pathology and future perspectives. Br J Radiol 2021; 94:20200798. [PMID: 33513024 PMCID: PMC8011265 DOI: 10.1259/bjr.20200798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance neurography allows for the selective visualization of peripheral nerves and is increasingly being investigated. Whereas in the past, the imaging of the extracranial cranial and occipital nerve branches was inadequate, more and more techniques are now available that do allow nerve imaging. This basic review provides an overview of the literature with current state of the art, anatomical landmarks and future perspectives. Furthermore, we illustrate the possibilities of the three-dimensional CRAnial Nerve Imaging (3D CRANI) MR-sequence by means of a few case studies.
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Affiliation(s)
- Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Tomas-Marijn Croonenborghs
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University Leuven, Leuven, Belgium.,Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Casselman
- Department of Radiology, AZ St-Jan Brugge-Oostende, Bruges, Belgium.,Department of Radiology, AZ St-Augustinus, Antwerp, Belgium.,Department of Radiology, UZ Gent, Gent, Belgium
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15
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Abakay MA, Güneş S, Küçük C, Yazıcı ZM, Gülüstan F, Arslan MN, Sayın İ. Accessory Nerve Anatomy in Anterior and Posterior Cervical Triangle: A Fresh Cadaveric Study. Turk Arch Otorhinolaryngol 2020; 58:149-154. [PMID: 33145498 DOI: 10.5152/tao.2020.5263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To understand the variations and normal course of the accessory nerve (CNXI) to help more accurate and confident neck dissection. Methods The course of the CNXI in the neck, its relationship to the surrounding anatomic structures and the factors affecting its course were investigated. Results A total of 100 neck dissections were performed on 50 fresh cadavers. Eleven division variations were observed at the anterior triangle. The location of CNXI at the posterior border of the sternocleidomastoid muscle (PBSCM) was investigated and the ratio between the distance from the mastoid apex (MAA) to CNXI at the PBSCM and the distance from MAA to the posterior border where the PBSCM is attached to the clavicle increased as height of the subject increased (p<0.05). Conclusion It must be kept in mind that it is better to search for CNXI in taller subjects more inferiorly at the posterior border of the sternocleidomastoid muscle.
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Affiliation(s)
- Mehmet Akif Abakay
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Güneş
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Ceyhun Küçük
- Department of Forensic Science, İstanbul Forensic Medicine Institution, İstanbul, Turkey
| | - Zahide Mine Yazıcı
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Filiz Gülüstan
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Murat Nihat Arslan
- Department of Forensic Science, İstanbul Forensic Medicine Institution, İstanbul, Turkey
| | - İbrahim Sayın
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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16
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In-Depth Look at the Anatomical Relationship of the Lesser Occipital Nerve, Great Auricular Nerve, and Spinal Accessory Nerve and Their Implication in Safety of Operations in the Posterior Triangle of the Neck. Plast Reconstr Surg 2020; 146:509-514. [PMID: 32453270 DOI: 10.1097/prs.0000000000007049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Migraine surgery is an increasingly popular treatment option for migraine patients. The lesser occipital nerve is a common trigger point for headache abnormalities, but there is a paucity of research regarding the lesser occipital nerve and its intimate association with the spinal accessory nerve. METHODS Six cadaver necks were dissected. The lesser occipital, great auricular, and spinal accessory nerves were identified and systematically measured and recorded. These landmarks included the longitudinal axis (vertical line drawn in the posterior), the horizontal axis (defined as a line between the most anterosuperior points of the external auditory canals) and the earlobe. Mean distances and standard deviations were calculated to delineate the relationship between the spinal accessory, lesser occipital, and great auricular nerves. RESULTS The point of emergence of the spinal accessory nerve was determined to be 7.17 ± 1.15 cm lateral to the y axis and 7.77 ± 1.10 caudal to the x axis. The lesser occipital nerve emerges 7.5 ± 1.31 cm lateral to the y axis and 8.47 ± 1.11 cm caudal to the x axis. The great auricular nerve emerges 8.33 ± 1.31 cm lateral to the y axis and 9.4 ±1.07 cm caudal to the x axis. The decussation of the spinal accessory and the lesser occipital nerves was found to be 7.70 ± 1.16 cm caudal to the x axis and 7.17 ± 1.15 lateral to the y axis. CONCLUSION Understanding the close relationship between the lesser occipital nerve and spinal accessory nerve in the posterior, lateral neck area is crucial for a safer approach to occipital migraine headaches, occipital neuralgia, and new daily persistent headaches and other reconstructive or cosmetic operations.
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Martínez-Marcos A, Sañudo JR. Cranial Nerves: Morphology and Clinical Relevance. Anat Rec (Hoboken) 2020; 302:555-557. [PMID: 30810281 DOI: 10.1002/ar.24106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/24/2019] [Indexed: 01/13/2023]
Abstract
This Special Issue entitled "Cranial Nerves: phylogeny, ontogeny, morphology and clinical significance" has been divided into two consecutive volumes. This second volume is devoted to morphology and clinical relevance. Articles in this volume examine these topics from a macroscopic point of view and with a surgical interest. This volume includes articles on oculomotor nerves III, IV, and VI and their course in the orbit; intracranial and extracranial views of the V and VII pairs; and branching patterns of IX, X, XI, and XII pairs with medical significance. Together, these articles provide a general overview of cranial nerves' gross anatomical organization, as well as improving on the knowledge necessary for clinical approaches. Anat Rec, 302:555-557, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Alino Martínez-Marcos
- Laboratorio de Neuroplasticidad y Neurodegeneración, Facultad de Medicina de Ciudad Real, Centro Regional de Investigaciones Biomédicas, Universidad de Castilla-La Mancha, 13071, Ciudad Real, Spain
| | - José Ramón Sañudo
- Departamento de Anatomía y Embriología, Facultad de Medicina, Universidad Complutense de Madrid, 28040, Madrid, Spain
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18
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Marles H, Chisholm F, Varsou O. A contextual thematic analysis of the accessory nerve in Scottish historical medical collections of the Royal Colleges of Edinburgh and Glasgow. Clin Anat 2020; 34:170-177. [PMID: 32239537 DOI: 10.1002/ca.23593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The classification of the accessory nerve (CN XI) remains a source of debate; its exact function has not been fully elucidated having also an atypical morphology for a cranial nerve. A better insight into its anatomical and physiological features is of clinical relevance. The aim was to conduct a review of 18th and 19th century books from the Royal Medical/Surgical Colleges in Scotland, United Kingdom. A contextual historical analysis of the depictions and descriptions of the accessory nerve could provide insight into the disparity in the current descriptions. MATERIALS AND METHODS Online archive catalogues were systematically searched and, during site visits, resources were formally and contextually analyzed, with the information then thematically analyzed. The themes were discussed against a widely known reference textbook of the era. RESULTS Based on the thematic analysis, the resources were categorized either as practical anatomy books or field-specific anatomy books including neuroanatomy atlases. This intended use, along with the target audience, influenced the scope and detail of information, typically with general anatomy for students in the practical resources, and specialist information in the field-specific resources. The authors' professional background also influenced the way the accessory nerve was described and/or depicted, with surgeons/physicians placing emphasis on the clinical aspects. Content variations could also be attributed to communication restrictions of the era, and associated purchasing costs. CONCLUSIONS Although scientific advances are nowadays disseminated at a faster pace, actively bridging the gap between anatomical sciences and clinical research is still needed when considering the accessory nerve to further elucidate the mysteries of this structure.
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Affiliation(s)
- Henry Marles
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Fraser Chisholm
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Ourania Varsou
- School of Life Science, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
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Trejo JL. A Toast to the Cranial Nerves. Anat Rec (Hoboken) 2019; 302:552-554. [DOI: 10.1002/ar.24074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 12/11/2022]
Affiliation(s)
- José Luis Trejo
- Department of Translational Neuroscience, CSICCajal Institute Madrid Spain
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