1
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Lohmeier SJ, Heidel RE, Hechler BL. Does three-dimensional intraglandular location predict malignancy in parotid tumors? Int J Oral Maxillofac Surg 2023; 52:296-303. [PMID: 35791993 DOI: 10.1016/j.ijom.2022.06.012] [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: 01/03/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
Tumors arising within the parotid encompass a heterogeneous mix of benign and malignant neoplasms and other tissue growths. The purpose of this study was to determine the association between the location of intraparotid masses and the risk of malignancy. A retrospective cohort study was performed of patients diagnosed with parotid tumors following open tumor excision. The primary predictor variable was the location of the epicenter of the tumor in three-dimensional space, as determined from preoperative imaging. Other variables were patient demographics and clinical parameters. The primary outcome variable was the final histopathologic diagnosis of a benign or malignant process. A χ2 analysis was performed to test for any significant associations between demographic, clinical, and radiographic factors in relation to the outcome, and backwards stepwise logistic regression analysis was used to control for variables. Both increasing age (P = 0.002) and the presence of local pain (P = 0.020) were associated with malignancy. Tumors located anterior to the posterior border of the retromandibular vein had 2.18 times higher odds of malignancy (95% confidence interval 1.13-4.21; P = 0.020). Multivariate regression analysis suggested that patient age, the presence of pain, and tumor location anterosuperiorly and superoinferiorly could all assist in determining the odds of malignancy.
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Affiliation(s)
- S J Lohmeier
- Department of Oral and Maxillofacial Surgery, San Antonio Military Health System, San Antonio, TX, USA
| | - R E Heidel
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - B L Hechler
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA.
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2
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Farooq J, Lee JY. Vascular tortuosity in endovascular mechanical thrombectomy. Brain Circ 2021; 7:3-7. [PMID: 34084969 PMCID: PMC8057096 DOI: 10.4103/bc.bc_5_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022] Open
Abstract
Endovascular mechanical thrombectomy effectively removes occlusive thrombi from the arterial lumen; however, there is little literature supporting the relevance of vascular geometry on surgical outcomes. Critical vessel characteristics including the degree of angulation and tortuosity influence the ability to advance stent retriever devices toward the site of occlusion. Therefore, it is crucial to evaluate the impact of carotid artery catheter pathway accessibility on the thrombectomy outcomes in acute ischemic stroke (AIS) patients. Traditional imaging modalities generate incomplete pictures of the vascular tortuosity and are prone to clinical judgment errors. Recent three-dimensional computed tomography angiography image analysis techniques circumvent these limitations to calculate accurate tortuosity and angulation measurements. These novel images facilitate classifying common anatomical variant patients into groups that may be treated with specially designed catheter devices. Importantly, this image analysis method reveals significant angulation in the common carotid artery and extracranial internal carotid artery that correlates with delays in reaching the occlusion site. Increased age, which is associated with increased risk of stroke, also increases the incidence of severe tortuosity. The semi-automated measurements technique also demonstrate that full 360° arterial loops are present in nearly 3% of catheter pathways and that the overall degree of angulation differs bilaterally. In this review, we examine the utility of this novel image analysis procedure and evaluate the recent literature relevant to neuroendovascular thrombectomy in AIS patients. Three literature databases – PubMed, Embase, and Web of Science were queried for original articles investigating both preclinical and clinical thrombectomy applications.
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Affiliation(s)
- Jeffrey Farooq
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jea Young Lee
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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3
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Wongsuriyanan S, Sriamornrattanakul K. Preoperative Localization of the Carotid Bifurcation for Cervical Carotid Exposure Using the Mastoid-Hyoid Line. Asian J Neurosurg 2020; 15:913-918. [PMID: 33708662 PMCID: PMC7869270 DOI: 10.4103/ajns.ajns_285_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/13/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Importance: The location of the carotid bifurcation (CB) is highly variable, which makes precise exposure of the cervical carotid artery difficult, especially in transverse incisions. The method for preoperative localization of the CB is not well established. We used the distance from the mastoid-hyoid (M-H) line to the CB, measured preoperatively with computed tomography angiography, to localize the location of the transverse skin incision. We describe and evaluate the accuracy of a method for preoperative localization of the CB for cervical carotid exposure. Methods: The researchers retrospectively evaluated 16 patients with aneurysms arising from the internal carotid artery (ICA) who had received cervical carotid exposure using the localization method of incision and were retrospectively evaluated from February 2018 to November 2019. The method of measurement and localization of the skin incision are described, and two illustrative cases are demonstrated. Results: Saccular aneurysms of the ophthalmic (C2) segment and communicating (C1) segment of the ICA were found in 8 and 8 patients, respectively. Nine patients had left-sided exposure, and 7 patients had right-sided exposure. The mean distance from the M-H line to the CB was 2.1 cm (range 0.5–3.5 cm). The accuracy of this method was 93.8%. No paralysis of the depressor anguli oris or the depressor labii inferioris was found postoperatively. Conclusion: The distance from the M-H line to the CB can be used to estimate transverse skin incisions for cervical carotid exposure.
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Affiliation(s)
- Somkiat Wongsuriyanan
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kitiporn Sriamornrattanakul
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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4
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Mokin M, Waqas M, Chin F, Rai H, Senko J, Sparks A, Ducharme RW, Springer M, Borlongan CV, Levy EI, Ionita C, Siddiqui AH. Semi-automated measurement of vascular tortuosity and its implications for mechanical thrombectomy performance. Neuroradiology 2020; 63:381-389. [PMID: 32816090 DOI: 10.1007/s00234-020-02525-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Few studies have examined the geometry of endovascular mechanical thrombectomy pathways. Here we examine the tortuosity and angulations of catheter pathways from the aortic arch to the termination of the internal carotid artery (ICA) and its association with thrombectomy performance. METHODS We included 100 consecutive anterior circulation large vessel occlusion thrombectomy patients over 12 months. Computed tomography angiograms (CTA) were used for 3D segmentation of catheter pathway from the aortic arch to ICA termination. Tortuosity index (TI) and angulations of the catheter pathway were measured in a semi-automated fashion. TI and angulation degree were compared between sides and correlated with age and procedural measures. RESULTS We analyzed 188 catheter pathways in 100 patients. Severe angulation (≤ 30°) was present in 5.8% and 39.4% of common carotid artery (CCA) and extracranial ICA segments, respectively. Five pathways (2.6%) had 360° loop. CCA and extracranial ICA tortuosity had a weak but significant correlation with age (r = 0.17, 0.21, p value = 0.05, 0.02 respectively), time from groin puncture to the site of occlusion (r = 0.29, 0.25, p values = 0.008, 0.026 respectively), and fluoroscopy time (r = 0.022, 0.31, p values = 0.016, 0.001 respectively). There was a significant difference in the pattern of angulation (p value = 0.04) and tortuosity between right and left side in CCA segment (TI = 0.20 ± 0.086 vs. 0.15 ± 0.82, p value < 0.001). CONCLUSIONS There was a significant difference in CCA angulation between right and left sides. TI of extracranial CCA and ICA correlated with age and influenced time from groin puncture to the occlusion site and total fluoroscopy time.
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Affiliation(s)
- Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Felix Chin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Hamid Rai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | | | | | | | | | - Cesario V Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Ciprian Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA. .,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.
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5
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Eyenga VC, Esene IN, Bikono EA, Eloundou NJ. Treatment of Cervical Spine Fractures and Subluxations without the Use of Intraoperative Fluoroscopy in Resource-Limited Settings. J Neurosci Rural Pract 2020; 11:160-163. [PMID: 32140021 PMCID: PMC7055626 DOI: 10.1055/s-0040-1701369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background
Surgical management of subaxial cervical spine injuries remains challenging. Although intraoperative fluoroscopy is usually used for intraoperative spinal level localization (SLL), it is unavailable in most developing countries. The surgeon therefore has to rely on anatomic landmarks. In our setting, in the absence of intraoperative fluoroscopy, we used the carotid tubercle for SLL. Herein we evaluate the accuracy and reliability of the carotid tubercle as a landmark during surgery for traumatic cervical spine injury.
Methods
This was a retrospective cohort study on 34 patients undergoing anterior cervical surgery for subaxial cervical spine fractures and/or subluxation between January 2005 and February 2011. From their medical records, the patients’ sociodemographic, clinical, radiological, and operative data were retrieved and analyzed.
Results
Thirty-four patients were included in the study. The mean age was 36.2 years. Thirty patients were males. The mean duration between the trauma and surgical intervention was 9.6 days. Six patients were completely tetraplegic. Fourteen patients had fractures and 20 patients had subluxation. The carotid tubercle was palpable in all the 34 cases. Twenty-two (68.8%) patients had partial or complete neurologic recovery. Complete anatomic reduction was achieved in 30 cases. One case of slight malalignment of the plate was observed. No case of significant deviation nor penetration of the screw into the vertebral canal was found. One patient died.
Conclusions
Carotid tubercle, a palpable intrinsic marker, is an attractive anatomic landmark for SLL during surgeries for traumatic spine injuries in resource-limited settings.
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Affiliation(s)
- Victor-Claude Eyenga
- Division of Neurosurgery, Department of Surgery, Yaoundé General Hospital, Yaounde, Cameroon
| | - Ignatius N Esene
- Division of Neurosurgery, Department of Surgery, Yaoundé General Hospital, Yaounde, Cameroon.,Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Cameroon.,Neurosurgery Unit, Garoua Regional Hospital, Cameroon
| | - Ernestine A Bikono
- Division of Neurosurgery, Department of Surgery, Yaoundé General Hospital, Yaounde, Cameroon
| | - Ngah J Eloundou
- Division of Neurosurgery, Department of Surgery, Yaoundé General Hospital, Yaounde, Cameroon
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6
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Abstract
Exact localization of the bifurcation of the common carotid artery using skin surface landmarks is important for various diagnostic and therapeutic purposes, including emergency cases. Traditional methods have confirmed their accuracy in only a certain percentage of cases and there are inconsistencies among various publications. The cervical computed tomography-angiographic examinations for any diagnostic purpose between June 2017 and December, 2017 in the authors' hospital were examined. Measurements were performed for (MT-CB) and (MT-SE) distances and the results were recorded [MT = The tip of the mastoid process; CB = common carotid artery bifurcation; SE = sternal extremity of the clavicle]. Cervical computed tomography angiography was found in the records of 91 patients in the 6-month period between June 2017 and December 2017. After exclusion criteria were applied, a total of 116 carotid bifurcation levels on the right and left sides were measured in 58 patients. The mean MT-CB distance was 6.29 ± 0.9 cm (range: 2.9-8.4 cm). The mean distance between MT and SE was 15.3 ± 1.7 cm (range: 9.9-19.0 cm). The (MT-CB): (MT-SE) ratios ranged from 29% to 51% with a mean of 41 ± 4.2% (95% CI: 39.88%-42.10%) and a median of 41.1% (P < 0.05) (Kolmogorov-Smirnov test). The distance ratio values did not change significantly according to age and gender (respectively P = 0.341, P = 0.093). These results show that the CB is usually located at two-fifths of the distance from the mastoid tip to the sternal extremity of the clavicle and closer to the mastoid tip.
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7
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Iwanaga J, Ishak B, Saga T, Singla A, Impastato D, Chapman JR, Oskouian RJ, David G, Porzionato A, Reina MA, Macchi V, Caro R, Tubbs RS. The Lumbar Ligamentum Flavum Does Not Have Two Layers and Is Confluent with the Interspinous Ligament: Anatomical Study with Application to Surgical and Interventional Pain Procedures. Clin Anat 2019; 33:34-40. [DOI: 10.1002/ca.23437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/14/2019] [Accepted: 07/14/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation Seattle Washington
- Division of Gross and Clinical Anatomy, Department of Anatomy Kurume University School of Medicine Kurume Japan
| | - Basem Ishak
- Seattle Science Foundation Seattle Washington
- Swedish Medical Center Swedish Neuroscience Institute Seattle Washington
- Department of Neurosurgery Heidelberg University Hospital Heidelberg Germany
| | - Tsuyoshi Saga
- Division of Gross and Clinical Anatomy, Department of Anatomy Kurume University School of Medicine Kurume Japan
| | - Amit Singla
- Swedish Medical Center Swedish Neuroscience Institute Seattle Washington
| | - David Impastato
- Swedish Medical Center Swedish Neuroscience Institute Seattle Washington
| | - Jens R. Chapman
- Swedish Medical Center Swedish Neuroscience Institute Seattle Washington
| | - Rod J. Oskouian
- Seattle Science Foundation Seattle Washington
- Swedish Medical Center Swedish Neuroscience Institute Seattle Washington
| | - Glen David
- Swedish Medical Center Swedish Neuroscience Institute Seattle Washington
| | - Andrea Porzionato
- Institute of Human Anatomy, Department of Neurosciences University of Padova Padova Italy
| | - Miguel Angel Reina
- School of Medicine CEU San Pablo University Madrid Spain
- Department of Anesthesiology Madrid‐Montepríncipe University Hospital Madrid Spain
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Neurosciences University of Padova Padova Italy
| | - Raffaele Caro
- Institute of Human Anatomy, Department of Neurosciences University of Padova Padova Italy
| | - R. Shane Tubbs
- Seattle Science Foundation Seattle Washington
- Department of Anatomical Sciences St. George's University St. George's, Grenada West Indies
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8
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Kikuta S, Iwanaga J, Kusukawa J, Tubbs RS. Triangles of the neck: a review with clinical/surgical applications. Anat Cell Biol 2019; 52:120-127. [PMID: 31338227 PMCID: PMC6624334 DOI: 10.5115/acb.2019.52.2.120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 11/27/2022] Open
Abstract
The neck is a geometric region that can be studied and operated using anatomical triangles. There are many triangles of the neck, which can be useful landmarks for the surgeon. A better understanding of these triangles make surgery more efficient and avoid intraoperative complications. Herein, we provide a comprehensive review of the triangles of the neck and their clinical and surgical applications.
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Affiliation(s)
- Shogo Kikuta
- Seattle Science Foundation, Seattle, WA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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9
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Fisahn C, Yilmaz E, Iwanaga J, Schmidt C, Benca E, Chapman JR, Oskouian RJ, Tubbs RS. Avoiding the Esophageal Branches of the Recurrent Laryngeal Nerve During Retractor Placement: Precluding Postoperative Dysphagia During Anterior Approaches to the Cervical Spine. Global Spine J 2019; 9:383-387. [PMID: 31218195 PMCID: PMC6562208 DOI: 10.1177/2192568218810198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Anatomical cadaver study. OBJECTIVES Postoperative dysphagia is a significant complication following anterior approaches to the cervical spine and the etiology of this complication is poorly understood. Herein, we studied the esophageal branches of the recurrent laryngeal nerves to improve understanding of their anatomy and potential involvement in dysphagia. METHODS Ten fresh frozen cadaveric human specimens were dissected (20 sides). All specimens were adults with no evidence of prior surgery of the anterior neck. The recurrent laryngeal nerves were identified under a surgical microscope and observations and measurements of their esophageal branches made. RESULTS For each recurrent laryngeal nerve, 5-7 (mean 6.2) esophageal branches were identified. These branches ranged from 0.8 to 2.1 cm (mean 1.5 cm) in length and 0.5 to 2 mm (mean 1 mm) in diameter. They arose from the recurrent laryngeal nerves between vertebral levels T1 and C6. They all traveled to the anterior aspect of the esophagus. No statistical differences were seen between left and right sides or between sexes. CONCLUSION The esophageal branches of the recurrent laryngeal nerve have been poorly described and could contribute to complications such as swallowing dysfunction following anterior cervical discectomy and fusion procedures. Therefore, a better understanding of their anatomy is important for spine surgeons. Our study revealed that these branches are always present on both sides and the anterior surface of the esophagus should be avoided while retracting it in order to minimize the risk of postoperative dysphagia.
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Affiliation(s)
- Christian Fisahn
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
- Seattle Science Foundation, Seattle, WA, USA
- BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Emre Yilmaz
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
- Seattle Science Foundation, Seattle, WA, USA
- BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
- Emre Yilmaz, Swedish Neuroscience Institute, Swedish
Medical Center, 550 17th Avenue, Seattle, WA 98122, USA.
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA
| | - Cameron Schmidt
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
- Seattle Science Foundation, Seattle, WA, USA
| | - Eric Benca
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
- Seattle Science Foundation, Seattle, WA, USA
| | - Jens R. Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
| | - Rod J. Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
| | - R. Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA
- St George’s University, Grenada
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10
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Jenkins S, Bordes S, Aly I, Jeyamohan S, Ishak B, Iwanaga J, Loukas M, Tubbs RS. Internal Morphology of the Odontoid Process: Anatomic and Imaging Study with Application to C2 Fractures. World Neurosurg 2019; 127:e1120-e1126. [PMID: 30980977 DOI: 10.1016/j.wneu.2019.04.052] [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: 02/23/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Fracture of the odontoid process is a critical injury to diagnose and often treat. The aim of this anatomic study was to present a comprehensive understanding of this part of the C2 vertebra. METHODS We used 20 C2 vertebrae. Samples underwent imaging (computed tomography [CT] with and without three-dimensional reconstruction, micro-CT, 1.5T magnetic resonance imaging) and sagittal and coronal sectioning using a bone saw. Sectioned specimens were imaged under a digital handheld microscope, and transillumination of the bone was used to highlight its internal trabecular pattern. Three samples underwent infusion of the odontoid process with a hardening substance and were then decalcified. RESULTS Internal trabecular patterns of the odontoid process of all specimens were discernible. In sagittal and coronal sections, trabecular patterns were highlighted with transillumination, but the patterns were much clearer using the digital microscope. Magnetic resonance imaging and CT provided the least detail of the imaging methods, but the trabecular patterns could be identified. Three-dimensional reconstruction of CT data was the preferred imaging method over magnetic resonance imaging and CT without three-dimensional reconstruction. The most distinct trabecular and cortical patterns were seen using micro-CT. Osteoporosis was seen in 2 specimens (10%). Five specimens (25%) were found to have a subdental synchondrosis. For most specimens, the trabeculae were found throughout the odontoid process. CONCLUSIONS Improved knowledge of the anatomy, structural composition, and variations within the C2 vertebra may allow for better treatment options and patient care.
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Affiliation(s)
- Skyler Jenkins
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Stephen Bordes
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Islam Aly
- Seattle Science Foundation, Seattle, Washington, USA
| | | | - Basem Ishak
- Seattle Science Foundation, Seattle, Washington, USA
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
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11
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Altafulla J, Iwanaga J, Lachkar S, Prickett J, Dupont G, Yilmaz E, Ishak B, Litvack Z, Tubbs RS. The Great Auricular Nerve: Anatomical Study with Application to Nerve Grafting Procedures. World Neurosurg 2019; 125:e403-e407. [PMID: 30703599 DOI: 10.1016/j.wneu.2019.01.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND When it comes to autogenous nerve grafting, the sural and great auricular nerve (GAN) are the 2 nerves predominately used for trigeminal and facial nerve repair. Arising from the second and third cervical ventral rami, the GAN emerges from the posterior border of the sternocleidomastoid coursing superiorly and anteriorly toward the ear. METHODS Eleven sides from 5 Caucasian and 1 Asian cadaveric heads (all fresh-frozen) were used. One man and 5 women were used with an age at death ranging from 57 to 91 years, with a mean of 80.3 years. Measurements were made from the inferior border of the ear to the GAN, the GAN to the external jugular vein, and the inferior border of the mastoid process to the GAN; the proximal, medial, and distal diameters of the GAN and the length of the GAN that was obtained from this exposure were also measured. RESULTS The mean distance from the inferior border of the mastoid process to the GAN, inferior border of the ear to the GAN, and GAN to the external jugular vein was 27.71, 31.03, and 13.28 mm, respectively. The mean length of the GAN was 74.86 mm. The mean diameter of its distal, middle, and proximal portions was 1.51, 1.38, and 1.58 mm, respectively. CONCLUSIONS The GAN is an excellent option for use in nerve grafting for repair of, for example, facial dysfunction. In this study, we review our measurements, techniques for identification, and dissecting techniques for the GAN. The proximity to the operative area and minimal complications associated with GAN grafting might contribute to improved patient satisfaction and better outcomes regarding functional restoration.
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Affiliation(s)
- Juan Altafulla
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Neurosurgery Department, Hospital Santo Tomas, Panama
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan.
| | | | - Joshua Prickett
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Graham Dupont
- Seattle Science Foundation, Seattle, Washington, USA
| | - Emre Yilmaz
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Basem Ishak
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Zachary Litvack
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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12
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Ishak B, Gnanadev R, Dupont G, Kikuta S, Altafulla J, Iwanaga J, Tubbs RS. Gerber's Ligament-A Forgotten Structure of the Craniocervical Junction. World Neurosurg 2019; 124:e707-e709. [PMID: 30660889 DOI: 10.1016/j.wneu.2018.12.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ligaments of the craniocervical junction play a critical role in stabilizing this region. Gerber's ligament has more or less been forgotten and, to our knowledge, never studied. METHODS Dissection of the craniocervical junction was performed in 15 fresh frozen cadavers. In the prone position, the posterior elements of the upper cervical vertebrae and occiput were removed. After removing the contents of the spinal canal and posterior cranial fossa, the dura mater and tectorial membrane were reflected. The superior band of the cruciform ligament was reflected. When Gerber's ligament was identified, its attachments and morphometry were recorded. Lastly, Gerber's ligament was observed while range of motion of the craniocervical junction was performed. RESULTS Gerber's ligament was identified in 7 specimens (46.7%). This structure arose anteriorly from the junction of the superior band and transverse part of the cruciform ligament. Gerber's ligament was always found to be just deep to the superior band of the cruciform ligament but traveled more anteriorly to attach onto the posterior aspect of the dens approaching, but not attaching onto, its apex. Mean length was 11 mm, and mean width was 7 mm. Thickness of the ligament was 0.5-1.1 mm. The ligament was found to become taut with minimal rotation of the atlantoaxial joint and extension of the craniocervical junction. CONCLUSIONS A good understanding of all ligaments of the craniocervical junction is important to surgeons and physicians treating patients with injury to the upper cervical spine.
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Affiliation(s)
- Basem Ishak
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Raja Gnanadev
- Seattle Science Foundation, Seattle, Washington, USA
| | - Graham Dupont
- Seattle Science Foundation, Seattle, Washington, USA
| | - Shogo Kikuta
- Seattle Science Foundation, Seattle, Washington, USA
| | | | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA.
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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13
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Dupont G, Iwanaga J, Altafulla JJ, Lachkar S, Oskouian RJ, Tubbs RS. Bilateral sternocleidomastoid variant with six distinct insertions along the superior nuchal line. Anat Cell Biol 2019; 51:305-308. [PMID: 30637167 PMCID: PMC6318458 DOI: 10.5115/acb.2018.51.4.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 11/27/2022] Open
Abstract
Anatomical variations of the sternocleidomastoid muscle (SCM) have been observed to occupy multiple origins and insertion points and have supernumerary heads, sometimes varying in thickness. During routine dissection, a SCM was observed to have six distinct insertions that interface with the course of the superior nuchal line, ending at the midline, bilaterally. This variation was also seen to receive innervation from the accessory nerve as well as the great auricular nerve. To our knowledge, this variant of supernumerary insertions and nerve innervations has not yet been reported. These variants may pose as problematic during surgical approaches to the upper neck and occiput, and should thus be appreciated by the clinician. Herein we discuss the case report, possible embryological origins, and the clinical significance of the observed variant SCM.
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Affiliation(s)
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA
| | - Juan J Altafulla
- Seattle Science Foundation, Seattle, WA, USA.,Swedish Neuroscience Institute, Seattle, WA, USA
| | | | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA.,Department of Anatomical Sciences, St. George's University, St. Geroge's, Grenada, West Indies
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14
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Kikuta S, Iwanaga J, Watanabe K, Tubbs RS. Superficial anterior atlanto-occipital ligament: Anatomy of a forgotten structure with relevance to craniocervical stability. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:42-45. [PMID: 31000980 PMCID: PMC6469323 DOI: 10.4103/jcvjs.jcvjs_110_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction The superficial anterior atlanto-occipital ligament (SAAOL) is a narrowband located anterior to the anterior atlanto-occipital membrane. Nearly forgotten, it has not been well described in older anatomical textbooks and is missing in the current anatomical literature. As all of the binding structures of the craniocervical junction (CCJ) are important in maintaining stability, this study aims to clarify the anatomy and potential function of the SAAOL. Materials and Methods The CCJ from ten fresh-frozen cadavers was studied. These specimens were derived from three males and seven females, and the age at death ranged from 57 to 91 years (mean, 79.8 years). The length, width, and thickness of the SAAOL were measured. In five specimens, the force to failure was recorded. Results The SAAOL was found between the anterior tubercle of the atlas and the occiput and located as central thick fibers in front of the anterior atlanto-occipital membrane in 9 (90%) specimens. In one specimen, the vertical band to the occipital bone did not attach to the anterior tubercle of the atlas, but extended to the anterior aspect of the axis. The mean length, width, and thickness of the SAAOL were 19.8, 6.2, and 0.6 mm, respectively. The force to failure for the ligament was 38.8 N. Conclusion The SAAOL was a constant structure of the anterior atlanto-occipital joint. This ligament seems to be a secondary stabilizer of the CCJ by limiting the extension of CCJ. Knowledge of this ligament may help in further understanding of craniocervical stability.
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Affiliation(s)
- Shogo Kikuta
- Seattle Science Foundation, Seattle, WA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Department of Anatomy, Division of Gross and Clinical Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Koichi Watanabe
- Department of Anatomy, Division of Gross and Clinical Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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15
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Ahn J, Duran M, Syldort S, Rizvi A, D'Antoni AV, Johal J, Iwanaga J, Oskouian RJ, Tubbs RS. Arcuate Foramen: Anatomy, Embryology, Nomenclature, Pathology, and Surgical Considerations. World Neurosurg 2018; 118:197-202. [DOI: 10.1016/j.wneu.2018.07.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/25/2022]
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16
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Gnanadev R, Iwanaga J, Loukas M, Tubbs RS. An Unusual Finding of the Hyoid Bone. Cureus 2018; 10:e3365. [PMID: 30510875 PMCID: PMC6257470 DOI: 10.7759/cureus.3365] [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] [Indexed: 11/20/2022] Open
Abstract
The hyoid contributes to many biomechanical processes including swallowing. Additionally, the hyoid bone has been studied for over a century in an effort to catalog and categorize many observed biometric differences. This has led to the hyoid being a major structure involved in forensic pathology. In this paper, we discuss a very unusual finding of an adult female hyoid bone.
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Affiliation(s)
- Raja Gnanadev
- Miscellaneous, Seattle Science Foundation, Seattle, USA
| | - Joe Iwanaga
- Medical Education and Simulation, Seattle Science Foundation, Seattle, USA
| | | | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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17
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Dalip D, Iwanaga J, Loukas M, Oskouian RJ, Tubbs RS. Review of the Variations of the Superficial Veins of the Neck. Cureus 2018; 10:e2826. [PMID: 30131919 PMCID: PMC6101467 DOI: 10.7759/cureus.2826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The venous drainage of the neck can be characterized into superficial or deep. Superficial drainage refers to the venous drainage of the subcutaneous tissues, which are drained by the anterior and external jugular veins (EJVs). The brain, face, and neck structures are mainly drained by the internal jugular vein (IJV). The superficial veins are found deep to the platysma muscle while the deep veins are found encased in the carotid sheath. The junction of the retromandibular vein and the posterior auricular vein usually form the EJV, which continues along to drain into the subclavian vein. The anterior jugular vein is usually formed by the submandibular veins, travels downward anterior to the sternocleidomastoid muscle (SCM), and drains either into the EJV or the subclavian vein. Other superficial veins of the neck to consider are the superior, middle, and inferior thyroid veins. The superior thyroid and middle thyroid veins drain into the IJV whereas the inferior thyroid vein usually drains into the brachiocephalic veins.
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Affiliation(s)
| | | | - Marios Loukas
- Anatomical Sciences, St. George's University, St. George's, GRD
| | - Rod J Oskouian
- Neurosurgery, Swedish Neuroscience Institute, Seattle, USA
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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18
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Altafulla JJ, Patel M, Tubbs RS, Iwanaga J, Litvack Z. An Unusual Back Muscle Identified Bilaterally: Case Report. Cureus 2018; 10:e2816. [PMID: 30128220 PMCID: PMC6093753 DOI: 10.7759/cureus.2816] [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] [Indexed: 11/05/2022] Open
Abstract
Most muscular structures in the human body are named based on their function, origin/insertion, or shape. During routine dissection of the back, an unusual muscle was found deep to the rhomboid muscles. The details of this case and a review of the extant literature are provided.
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Affiliation(s)
| | - Mayank Patel
- Clinical Anatomy Research, Seattle Science Foundation, Seattle, USA
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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