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Singh S, Chopra P, Necker F, Scholz M, Liphardt AM, Schuster L, Paulsen F, Bräuer L. Internal vascular anatomy of the human lacrimal gland: A protocol based on cadaver dissection and three-dimensional micro-computed tomography. Ann Anat 2024; 252:152207. [PMID: 38159615 DOI: 10.1016/j.aanat.2023.152207] [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: 10/28/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To evaluate the feasibility of studying the vascular supply of the orbital and palpebral lobes of the human lacrimal gland using micro-computed tomography (micro-CT) and microscopic dissection. METHODS The lacrimal gland artery of a fresh parasagittalized cadaver head (male, aged 76 years) was infused with a lead oxide-latex mixture near the occipital pole of the gland. The entire lacrimal gland was imaged using micro-CT and 3D cinematic rendering (CR) and then dissected under a surgical microscope. RESULTS Micro-CT and CR images showed well-demarcated internal vascular branches of the lacrimal artery and their distribution within the orbital and palpebral lobes. The entire course of the artery and its branches could be visualized by CR and microscopic dissection, with the former showing better spatial orientation and finer branching. The main artery runs along the free edge of the aponeurosis of the levator palpebrae superior muscle and lies in the isthmus portion of the gland (between the orbital and palpebral lobes). The branches of the main lacrimal artery include one branch to the orbital adipose tissue just before entering the gland, two branches to the orbital lobe (medial and lateral), and two branches to the palpebral lobe (medial and lateral). The main artery terminates as palpebral and orbital lobe branches in the lateral half of the lacrimal gland. CONCLUSION Latex and contrast-enhanced micro-CT is very well suited to visualize the vascular anatomy of the lacrimal artery within the gland. A large number of lacrimal gland examinations using the method presented here are required to demonstrate and understand the variability of the vascular anatomy of the human lacrimal gland.
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Affiliation(s)
- Swati Singh
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India.
| | | | - Fabian Necker
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Scholz
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna-Maria Liphardt
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Louis Schuster
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lars Bräuer
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Singh S, Winter Z, Necker F, Bäuerle T, Scholz M, Bräuer L, Paulsen F. New insights into lacrimal gland anatomy using 7T MRI and electron microscopy: Relevance for lacrimal gland targeted therapies and bioengineering. Ocul Surf 2023; 30:204-212. [PMID: 37774917 DOI: 10.1016/j.jtos.2023.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To study the tissue architecture, isthmus (connection between two lobes) of the lacrimal gland using preclinical 7T MRI in combination with histology and electron microscopy. METHODS Ten lacrimal glands from Caucasian body donors (mean age 78.7 years) were studied using 7T-MRI (N = 5; scanned at 75-μm intervals), histology, and electron microscopy (N = 5) and 3D cinematic rendering (CR) techniques. RESULTS 3D CR images showed uniform-sized lobules (widest lobule diameter, 1.68 ± 0.19 mm in orbital lobe, 1.68 ± 0.17 mm in palpebral lobe) in both lobes, separated by septae (size, 0.29 ± 0.09 mm). The internal framework of the gland resembled a honeycoomb pattern. In CR and histology, the isthmus contained glandular acini, large blood vessels, nerves, and no more than two ducts having a tortuous course towards the conjunctival surface. On assigning a color display to the rendered lacrimal gland, all glands showed a blood vessel originating from the main lacrimal artery just 5 mm beyond the hilum and making it course to the palpebral lobe via isthmus. The distance between the conjunctiva and the central substance of the orbital and palpebral lobe was 9.4 ± 0.2 mm and 2.8 ± 0.7 mm, respectively. Electron microscopy of the palpebral lobe revealed compact subepithelial layer in the overlying conjunctiva, followed by loosely scattered collagen bundles that contained the gland lobules. CONCLUSION 3D-CR can be used to study the lacrimal gland microstructure, help fabricate a 3D scaffold for lacrimal gland bioprinting, and serve as guide for transconjunctival lacrimal gland targeted therapies i.e., 2.9 & 9 mm long needle to reach the orbital and palpebral lobe center, respectively in normal-size glands.
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Affiliation(s)
- Swati Singh
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Zoltan Winter
- Preclinical Imaging Platform Erlangen (PIPE), Institute of Radiology, University Hospital Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Fabian Necker
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Tobias Bäuerle
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Scholz
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lars Bräuer
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Holtmann C, Roth M, Filler T, Bergmann AK, Hänggi D, Muhammad S, Borrelli M, Geerling G. Microvascular anastomosis of the human lacrimal gland: a concept study towards transplantation of the human lacrimal gland. Graefes Arch Clin Exp Ophthalmol 2022; 261:1443-1450. [PMID: 36477647 PMCID: PMC10148775 DOI: 10.1007/s00417-022-05933-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Introduction
Severe aqueous tear deficiency is caused by primary or secondary main lacrimal gland insufficiency. The transplantation of a human lacrimal gland could become a potential treatment option to provide physiological tears with optimal properties. To this end, we performed an ex vivo study to develop a surgical strategy that would ensure a vascular supply for a lacrimal gland transplant using microvascular techniques.
Material and methods
Five cadaver heads were used to perform a lateral orbitotomy in order to identify the vascular pedicle and the lacrimal gland itself. The principal feasibility and the time of the required surgical steps for an intraorbital microvascular re-anastomosis of the human lacrimal gland were documented. Patency and potential leakage of the anastomosis were tested with hematoxylin intraoperatively. Postoperatively, routine histological, as well as scanning electron microscopy (SEM) of the gland and vascular anastomosis, were performed.
Results
The vascular pedicle of all five glands could be isolated over a minimum stretch of at least 1 cm, severed, and successfully reanastmosed microsurgically. Time for arterial anatomization (n = 4) was 23 ± 7 min and 22 ± 3 min for the vein (p = 0.62). The total time for the entire microvascular anastomosis was 46 ± 9 min. All anastomosis were patent upon testing. SEM revealed well-aligned edges of the anastomosis with tight sutures in place.
Conclusion
Our study demonstrates as proof of principle the feasibility of intraorbital microvascular re-anastomosis of a human lacrimal gland within the presumed window of ischemia of this tissue. This should encourage orbital surgeons to attempt lacrimal gland transplantation in humans in vivo.
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Affiliation(s)
- Christoph Holtmann
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - Mathias Roth
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Timm Filler
- Institute of Anatomy I, Heinrich-Heine-University Duesseldorf, Universitaetsstr. 1, 40225, Duesseldorf, Germany
| | - Ann Kathrin Bergmann
- Core Facility Elektronenmikroskopie (CFEM), Heinrich-Heine-Universität Duesseldorf, Universitaetsstr. 1, 40225, Duesseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Sajjad Muhammad
- Department of Neurosurgery, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Maria Borrelli
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
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Akdemir Aktaş H, Mine Ergun K, Tatar İ, Arat A, Mutlu Hayran K. Investigation into the ophthalmic artery and its branches by superselective angiography. Interv Neuroradiol 2022; 28:737-745. [PMID: 35317633 PMCID: PMC9706266 DOI: 10.1177/15910199221067664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The vascular anatomy of orbit is highly complex, and the main blood supply to the orbit is via the ophthalmic artery, which is a branch of the internal carotid artery. The purpose of this study was to determine the morphometry of the ophthalmic artery and its branches by superselective angiography in a large series of pediatric patients. METHODS We evaluated 134 angiographies performed on children with intraocular retinoblastoma undergoing intra-arterial chemotherapy. The origin, diameter, and angiographic visibility percentages of the ophthalmic artery and its branches were examined according to age group and sex. RESULTS The ophthalmic artery originated 97.8% from the internal carotid artery and 2.2% from the middle meningeal artery. The mean diameter of ophthalmic artery was measured 0.76 ± 0.14 mm in girls, 0.80 ± 0.15 mm in boys and 0.79 ± 0.15 mm in general. The posterior ciliary, lacrimal, inferior muscular, and anterior ethmoidal arteries had a higher angiographic visibility percentages (> 85%) than the other OA branches. Only the diameter of the dorsal nasal artery showed a significant correlation with age. The supratrochlear and posterior ciliary arteries showed statistically significant relationship with sex. CONCLUSIONS Present study will make a substantial contribution to the pediatric literature about the ophthalmic artery and its branches. A better understanding of ophthalmic artery morphology can help surgeons and neurointerventional radiologists to avoid possible severe complications during embolization, intra-arterial chemotherapy, cosmetic procedures, endonasal and orbital surgeries.
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Affiliation(s)
- Hilal Akdemir Aktaş
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
| | - Kadriye Mine Ergun
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
| | - İlkan Tatar
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
| | - Anıl Arat
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
| | - Kadir Mutlu Hayran
- Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 06100
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