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Jumah A, Alsaif A, Fana M, Aboul Nour H, Zoghoul S, Eltous L, Miller D. Spinal procedures, pneumocephalus, and cranial nerve palsies: A review of the literature. Neuroradiol J 2024; 37:17-22. [PMID: 36628447 PMCID: PMC10863573 DOI: 10.1177/19714009221150851] [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] [Indexed: 01/12/2023] Open
Abstract
Purpose: Minimally invasive and surgical spine procedures are commonplace with various risks and complications. Cranial nerve palsies, however, are infrequently encountered, particularly after procedures such as lumbar punctures, epidural anesthesia, or intrathecal injections, and are understandably worrisome for clinicians and patients as they may be interpreted as secondary to a sinister etiology. However, a less commonly considered source is a pneumocephalus which may, in rare cases, abut cranial nerves and cause a palsy as a benign and often self-resolving complication. Here, we present the case of a patient who underwent an intrathecal methotrexate infusion for newly diagnosed non-Hodgkin's T-cell lymphoma and subsequently developed an abducens nerve palsy due to pneumocephalus. We highlight the utility of various imaging modalities, treatment options, and review current literature on spinal procedures resulting in cranial nerve palsies attributable to pneumocephalus presenting as malignant etiologies.
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Affiliation(s)
- Ammar Jumah
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Ali Alsaif
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Fana
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Hassan Aboul Nour
- Department of Vascular Neurology, Emory University Hospital, Atlanta, GA, USA
| | - Sohaib Zoghoul
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Lara Eltous
- Jordan University of Science and Technology, Irbid, Jordan
| | - Daniel Miller
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
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Żytkowski A, Clarke E, Musiał A, Dubrowski A, Mazur M, Iwanaga J, Tubbs RS, Wysiadecki G. Atypical attachment of the petrosphenoidal (petroclival) ligament to the posterior genu of the cavernous internal carotid artery – Case report. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Wysiadecki G, Radek M, Tubbs RS, Iwanaga J, Walocha J, Brzeziński P, Polguj M. Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery. Brain Sci 2021; 11:brainsci11050649. [PMID: 34065668 PMCID: PMC8156379 DOI: 10.3390/brainsci11050649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
The present study aims to provide detailed observations on the cavernous segment of the abducens nerve (AN), emphasizing anatomical variations and the relationships between the nerve and the internal carotid plexus. A total of 60 sides underwent gross-anatomical study. Five specimens of the AN were stained using Sihler’s method. An additional five specimens were subjected to histological examination. Four types of AN course were observed: a single nerve along its entire course, duplication of the nerve, division into separate rootlets at the point of contact with the cavernous part of the internal carotid artery (ICA), and early-branching before entering the orbit. Due to the relationships between the ICA and internal carotid plexus, the cavernous segment of the AN can be subdivided into a carotid portion located at the point of contact with the posterior vertical segment of the cavernous ICA and a prefissural portion. The carotid portion of the cavernous AN segment is a place of angulation, where the nerve always directly adheres to the ICA. The prefissural portion of the AN, in turn, is the primary site of fiber exchange between the internal carotid plexus and either the AN or the lateral wall of the cavernous sinus.
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Affiliation(s)
- Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland;
- Correspondence:
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, University Hospital WAM-CSW, 90-549 Łódź, Poland;
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA; (R.S.T.); (J.I.)
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA 70433, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Anatomical Sciences, St. George’s University, Grenada FZ 818, West Indies
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA; (R.S.T.); (J.I.)
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland;
| | - Piotr Brzeziński
- Department of Histology and Embryology, Chair of Anatomy and Histology, Medical University of Lodz, 90-752 Łódź, Poland;
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland;
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Comparison of lateral and medial rectus muscle in human: an anatomical study with particular emphasis on morphology, intramuscular innervation pattern variations and discussion on clinical significance. Surg Radiol Anat 2020; 42:607-616. [PMID: 31897658 DOI: 10.1007/s00276-019-02400-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
This paper aims to present various aspects of the anatomy of horizontal (i.e., lateral and medial) rectus muscles. It mainly compares morphology and detailed patterns of intramuscular innervation of those muscles. It is also one of the first reports that uses the Sihler's stain to examine human extraocular muscles. The study was conducted on 80 isolated cadaveric hemi-heads. Sihler technique of nerves staining served to expose the course of intramuscular branches of the oculomotor and abducens nerves. The lateral rectus was longer (48 mm versus 46.5 mm) and more distant from the limbus (6.8 mm versus 5.7 mm) than the medial rectus muscle. Three variants of the abducens nerve primary division were observed in the lateral rectus muscle. In the medial rectus muscle, the motor branch from the oculomotor nerve was more evenly divided into sub-branches. In both examined horizontal rectus muscles, primary muscular branches split into secondary sub-branches, which undergo numerous further divisions. The most numerous terminal sub-branches formed the terminal plexus. The distance between the insertion and the anterior-most end of the terminal plexus referenced to the total length of the muscle ranged from 35.4 to 48.5% for the lateral rectus muscle and from 36.3 to 50.5% for medial rectus muscle. Both horizontal rectus muscles share similar general pattern of distribution of intramuscular nerves, with characteristic root-like arborizations of sub-branches. The terminal nerve plexus was observed near half of both muscles' length. Knowledge of variations and innervation pattern of the extraocular muscles may be relevant during ophthalmology surgeries.
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Haładaj R, Wysiadecki G, Tubbs RS. Intramuscular innervation of the lateral rectus muscle evaluated using sihler's staining technique: Potential application to strabismus surgery. Clin Anat 2019; 33:585-591. [PMID: 31429984 DOI: 10.1002/ca.23452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 12/20/2022]
Abstract
The latest research suggests that the abducens nerve may be divided into subbranches that reach functionally distinct zones of the lateral rectus muscle. The goal of the study was to examine this muscle's innervation, including the detailed distribution of the intramuscular subbranches of the abducens nerve. Twenty-five lateral rectus muscle specimens were harvested (with the orbital segment of the abducens nerve), fixed in 10% formalin solution, and stained with Sihler's whole mount nerve staining technique. Subbranches running to the lateral rectus divided into two main groups: superior and inferior. Both groups of subbranches are distributed in a fan-shaped manner, show a characteristic "tree-like" branching pattern and form terminal plexus near the proximal half of the lateral rectus muscle. However, some smaller subbranches run as far as the muscle's insertion, and recurrent subbranches also reach its origin. With respect to their course to the muscle's origin or insertion, the smallest subbranches running within the muscle may be associated with innervation of the tendon. In the majority of cases (88%), superior and inferior subbranches of the abducens nerve overlapped in the central one-third of the lateral rectus muscle's width so that any clearly distinct anatomical segments of the muscle could be observed based on Sihler's technique. In the remaining 12% of specimens, superior and inferior groups of subbranches innervated two distinct compartments of the lateral rectus muscle with no overlapping. Dense, fan-shaped distribution of abducens nerve intramuscular subbranches can be observed within the lateral rectus muscle. Clin. Anat. 33:585-591, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Robert Haładaj
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Łódź, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Łódź, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Seattle Science Foundation, Seattle, Washington
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Dupont G, Altafulla J, Iwanaga J, Watanabe K, Tubbs RS. Ossification of the roof of the porus trigeminus with duplicated abducens nerve. Anat Cell Biol 2019; 52:211-213. [PMID: 31338240 PMCID: PMC6624332 DOI: 10.5115/acb.2019.52.2.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/27/2022] Open
Abstract
Ossification of parts of the intracranial dura mater is common and is generally accepted as an age-related finding. Additionally, duplication of the abducens nerve along its course to the lateral rectus muscle is a known, although uncommon anatomical variant. During routine cadaveric dissection, an ossified portion of dura mater traveling over the trigeminal nerve's entrance (porus trigeminus) into the middle cranial fossa was observed unilaterally. Ipsilaterally, a duplicated abducens nerve was also observed, with a unique foramen superolateral to the entrance of Dorello's canal. To our knowledge, there has been no existing report of a simultaneous ossified roof of the porus trigeminus with an ipsilateral duplicated abducens nerve. Herein, we discuss this case and the potential clinical and surgical applications. We believe this case report will be informative for the skull base surgeon in the diagnosis of neuralgic pain in the frontomaxillary, andibular, orbital, and external and middle ear regions.
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Affiliation(s)
| | - Juan Altafulla
- Seattle Science Foundation, Seattle, WA, USA.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA.,Seattle Science Foundation, Seattle, WA, USA
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, 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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