1
|
Ni J, Pei Y, Xu Z, Zhang B, Sun Z, Wu X, Liang L. Three-Dimensional Anatomy of the Hypoglossal Canal: A Plastinated Histologic Study. World Neurosurg 2023; 178:e362-e370. [PMID: 37482084 DOI: 10.1016/j.wneu.2023.07.075] [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: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To provide a precise description of the morphology and morphometry of the hypoglossal canal (HC) and its relationship with surrounding structures by using the epoxy sheet plastination technique. METHODS Thirty human cadaveric heads were plastinated into 5 sets of gross transparent plastination slices and 43 sets of ultrathin plastination sections. The HC were examined at both macro- and micro levels in these plastination sections and the reconstructed 3-dimensional visualization model. RESULTS The HC was an upward arched bony canal with a dumbbell-shaped lumen. According to the arched trajectory of its bottom wall, the HC could be divided into a medial ascending segment and a lateral descending segment. The thickness of the compact bone in the middle part of the HC was thinner than that at the intracranial and extracranial orifices. In 14 of 43 sides (32.6%), the posterior wall or the roof of the HC were disturbed by passing venous channels which communicated the posterior condylar emissary vein and the inferior petroclival vein. The trajectory of hypoglossal nerve in HC is mainly from anterosuperior to posteroinferior. The meningeal dura and the arachnoid extended into the HC along the hypoglossal nerve to form the dural and arachnoid sleeves and then fused with the nerve near the extracranial orifice of the HC. CONCLUSIONS Knowledge of the detailed anatomy of the HC can be helpful in avoiding surgical complications when performing surgery for lesions and the occipital condylar screw placement in this complex area.
Collapse
Affiliation(s)
- Jingyi Ni
- Grade 2020, School of Nursing, Anhui Medical University, Hefei, China
| | - Yazhi Pei
- Department of Anatomy, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Zhaoyang Xu
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Bo Zhang
- Department of Anatomy, School of Basic Medical Sciences, Anhui Medical University, Hefei, China; Human Brain Tissue Resource Center, Anhui Medical University, Hefei, China
| | - Zhengzheng Sun
- Department of Anatomy, School of Basic Medical Sciences, Anhui Medical University, Hefei, China; Human Brain Tissue Resource Center, Anhui Medical University, Hefei, China
| | - Xiao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liang Liang
- Department of Anatomy, School of Basic Medical Sciences, Anhui Medical University, Hefei, China.
| |
Collapse
|
2
|
Kim J, Seo C, Yoo JH, Choi SH, Ko KY, Choi HJ, Lee KH, Choi H, Shin D, Kim H, Lee MC. Objective analysis of facial bone fracture CT images using curvature measurement in a surface mesh model. Sci Rep 2023; 13:1932. [PMID: 36732582 PMCID: PMC9894972 DOI: 10.1038/s41598-023-28056-7] [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] [Received: 07/03/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
The human facial skeleton consists of multiple segments and causes difficulty during analytic processes. We developed image analysis software to quantify the amount of injury and validate the smooth curvature of the surface after facial bone reduction surgery. Three-dimensional computed tomography images of facial bone were obtained from 40 patients who had undergone open reduction surgery to treat unilateral zygomaticomaxillary fractures. Analytic software was developed based on the discrete curvature of a triangular mesh model. The discrete curvature values were compared before and after surgery using two regions of interest. For the inferior orbital rim, the weighted average of curvature changed from 0.543 ± 0.034 to 0.458 ± 0.042. For the anterior maxilla, the weighted average of curvature changed from 0.596 ± 0.02 to 0.481 ± 0.031, showing a significant decrement (P < 0.05). The curvature was further compared with the unaffected side using the Bray-Curtis similarity index (BCSI). The BCSI of the inferior orbital rim changed from 0.802 ± 0.041 to 0.904 ± 0.015, and that for the anterior maxilla changed from 0.797 ± 0.029 to 0.84 ± 0.025, demonstrating increased similarity (P < 0.05). In computational biology, adequate analytic software is crucial. The newly developed software demonstrated significant differentiation between pre- and postoperative curvature values. Modification of formulas and software will lead to further advancements.
Collapse
Affiliation(s)
- Jeenam Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Konkuk University, Seoul, Korea
| | - Chaneol Seo
- Department of Plastic and Reconstructive Surgery, School of Medicine, Konkuk University, Seoul, Korea
| | - Jung Hwan Yoo
- Department of Plastic and Reconstructive Surgery, School of Medicine, Konkuk University, Seoul, Korea
| | - Seung Hoon Choi
- Department of Computer Science and Engineering, Konkuk University, 120 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea
| | - Kwang Yeon Ko
- Department of Computer Science and Engineering, Konkuk University, 120 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea
| | - Hyung Jin Choi
- Department of Computer Science and Engineering, Konkuk University, 120 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea
| | - Ki Hyun Lee
- Department of Computer Science and Engineering, Konkuk University, 120 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea
| | - Hyungon Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Konkuk University, Seoul, Korea
| | - Donghyeok Shin
- Department of Plastic and Reconstructive Surgery, School of Medicine, Konkuk University, Seoul, Korea
| | - HyungSeok Kim
- Department of Computer Science and Engineering, Konkuk University, 120 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea.
| | - Myung Chul Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Konkuk University, Seoul, Korea
| |
Collapse
|
3
|
Labuda R, Nwotchouang BST, Ibrahimy A, Allen PA, Oshinski JN, Klinge P, Loth F. A new hypothesis for the pathophysiology of symptomatic adult Chiari malformation Type I. Med Hypotheses 2022; 158. [PMID: 34992329 PMCID: PMC8730378 DOI: 10.1016/j.mehy.2021.110740] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chiari malformation Type I (CMI) is characterized by herniation of the cerebellar tonsils through the foramen magnum. The pathophysiology of CMI is not well elucidated; however, the prevailing theory focuses on the underdevelopment of the posterior cranial fossa which results in tonsillar herniation. Symptoms are believed to be due to the herniation causing resistance to the natural flow of cerebrospinal fluid (CSF) and exerting a mass effect on nearby neural tissue. However, asymptomatic cases vastly outnumber symptomatic ones and it is not known why some people become symptomatic. Recently, it has been proposed that CMI symptoms are primarily due to instability of either the atlanto-axial (AA) or the atlanto-occipital (AO) joint and the cerebellar tonsils herniate to prevent mechanical pinching. However, only a small percentage of patients exhibit clinical instability and these theories do not account for asymptomatic herniations. We propose that the pathophysiology of adult CMI involves a combination of craniocervical abnormalities which leads to tonsillar herniation and reduced compliance of the cervical spinal canal. Specifically, abnormal AO and/or AA joint morphology leads to chronic cervical instability, often subclinical, in a large portion of CMI patients. This in turn causes overwork of the suboccipital muscles as they try to compensate for the instability. Over time, the repeated, involuntary activation of these muscles leads to mechanical overload of the myodural bridge complex, altering the mechanical properties of the dura it merges with. As a result, the dura becomes stiffer, reducing the overall compliance of the cervical region. This lower compliance, combined with CSF resistance at the same level, leads to intracranial pressure peaks during the cardiac cycle (pulse pressure) that are amplified during activities such as coughing, sneezing, and physical exertion. This increase in pulse pressure reduces the compliance of the cervical subarachnoid space which increases the CSF wave speed in the spinal canal, and further increases pulse pressure in a feedback loop. Finally, the abnormal pressure environment induces greater neural tissue motion and strain, causing microstructural damage to the cerebellum, brainstem, and cervical spinal cord, and leading to symptoms. This hypothesis explains how the combination of craniocervical bony abnormalities, anatomic CSF restriction, and reduced compliance leads to symptoms in adult CMI.
Collapse
Affiliation(s)
- Rick Labuda
- Conquer Chiari, 320 Osprey Ct., Wexford, PA 15090, United States
| | - Blaise Simplice Talla Nwotchouang
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, 264 Wolf Ledges Pkwy Rm 211b, Akron, OH 44325, United States
| | - Alaaddin Ibrahimy
- Department of Biomedical Engineering, Yale University, 17 Hillhouse Avenue, New Haven, CT 06520, United States
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, 302 Buchtel Hall, Akron, OH 44325, United States
| | - John N Oshinski
- Department of Radiology & Imaging Sciences, Emory University School of Medcinece, Atlanta, GA 30322, United States
| | - Petra Klinge
- The Warren Alpert Medical School of Brown University, United States
| | - Francis Loth
- Department of Mechanical & Industrial Engineering, Department of Bioengineering, Northeastern University, 334 Snell Engineering, 360 Huntington Ave, Boston, MA 02115, United States
| |
Collapse
|