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Korkmaz AC, Gungor Y, Tuncay İ, Bozkurt M, Acar Hİ. Protection of the innervation of the tensor fasciae latae in hip direct anterior and anterolateral approaches: a cadaver study. Hip Int 2023; 33:649-654. [PMID: 35959716 DOI: 10.1177/11207000221118551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to reveal the exact course of the superior gluteal nerve (SGN) branch innervating the tensor fascia lata (TFL) and show how it can be protected in the direct anterior approach (DAA) and anterolateral approach (ALA). METHODS The anterolateral regions of 22 thighs from formalin-fixed cadavers were dissected. 3 anatomical points were determined. Point A, B, C indicates where the SGN enters the gluteus minimus (GMin) fibres, the SGN leaves the gluteal muscles, the SGN enters the TFL, respectively. Measurements were made on 3 separate lines. RESULTS On the anterior superior iliac spine (ASIS) and the head of the fibula line (Line 1), the horizontal-vertical distances from point B and C to the ASIS were 7.99 ± 3.65 mm-40.40 ± 11.50 mm and 11.74 ± 6.61 mm-70.35 ± 14.11 mm respectively. The horizontal-vertical distances from point A, B, C to the greater trochanter (GT) were 32.41 ± 9.97 mm-55.28 ± 12.25 mm; 67.70 ± 8.54 mm-17.76 ± 13.57 mm; 63.92 ± 9.96 mm-13.00 ± 7.92 mm on the GT and the head of the fibula line (Line 2), respectively. The horizontal-vertical distances from point A, B, C to the GT were 24.58 ± 9.83 mm-42.54 ± 12.86 mm; 9.45 ± 7.92 mm-36.25 ± 9.06 mm; 26.18 ± 11.12 mm-64.05 ± 11.67 mm on the ASIS and the GT line (Line 3). CONCLUSIONS In the DAA, the increased risk of damaging the branch of the SGN that innervates the TFL must be kept in mind. The protection of this branch can be ensured with easy and applicable rules.
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Affiliation(s)
- Ali Can Korkmaz
- Gulhane Training and Research Hospital, Ministry of Health University, Ankara, Turkey
| | - Yigit Gungor
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| | - İbrahim Tuncay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Murat Bozkurt
- Department of Orthopedics and Traumatology, Acibadem Hospital Ankara, Ankara, Turkey
| | - Halil İbrahim Acar
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
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Guner YE, Comert A, Sayaci EY, Korkmaz AC, Gungor Y, Morali Guler T, Kahilogullari G, Savas A. Microsurgical anatomy of the anterior cerebral artery and the arterial supply of the cingulate gyrus. Surg Radiol Anat 2023; 45:351-358. [PMID: 36840818 DOI: 10.1007/s00276-023-03083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/07/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The cingulate gyrus is a potential surgical area to treat tumours, psychiatric diseases, intractable pain and vascular malformations. The aim of the study was to define the topographic anatomy and arterial supply of the cingulate gyrus located on the medial surface of the cerebral hemisphere. METHODS We studied thirty-six hemispheres, each hemisected in the midsagittal plane. The vertical thickness of the cingulate gyrus was measured at the anterior commissure (AC), posterior commissure (PC), and genu levels of the corpus callosum. The branches of the anterior and posterior cerebral arteries supplying each zone were noted separately. The arterial pathways were transformed to digital data in AutoCAD to identify the condensation and reduction areas. RESULTS The mean AC-PC distance was 27.17 ± 1.63 mm. The thinnest region was the genu level of the corpus callosum (10.29 mm). The superior internal parietal artery (SIPA), inferior internal parietal artery (IIPA) and pericallosal artery (PrCA) supplied all zones of the cingulate gyrus. The anterior zone received the greatest supply. The arterial condensation and reduction areas on both sides of cingulate gyrus and its x, y, and z coordinates specified. CONCLUSIONS The target cingulotomy (TC) area was determined for anterior cingulotomy. The properties of the TC area are that the thinnest region of the cingulate gyrus is supplied relatively less than other areas and is close to the anterior cingulotomy areas in the literature. The arterial reduction area (ARA) was found to be suitable for corpus callosotomy in terms of avoiding haemorrhage.
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Affiliation(s)
- Yahya Efe Guner
- Department of Neurosurgery, School of Medicine, Yuksek Ihtisas University, Ankara, Turkey
| | - Ayhan Comert
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey.
| | - Emre Yagiz Sayaci
- Department of Neurosurgery, Memorial Ankara Hospital, Ankara, Turkey
| | - Ali Can Korkmaz
- Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yigit Gungor
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| | - Tugba Morali Guler
- Department of Neurosurgery, School of Medicine, Karabuk University, Karabuk, Turkey
| | - Gokmen Kahilogullari
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Ali Savas
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
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Guler TM, Comert A, Gungor Y, Guner E, Sayaci YE, Korkmaz AC, Ela C, Gokmen K. Topographical Anatomy of the Superficial Temporal Artery. Turk Neurosurg 2022; 33:302-307. [PMID: 36622194 DOI: 10.5137/1019-5149.jtn.41572-22.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM This study was conducted to describe in detail the gross anatomy of the superficial temporal artery (STA), its course and branches, its relationships with the branches of the facial nerve, and certain anatomical and surgical landmarks to preserve these structures in daily neurosurgical practice and use the STA during revascularization surgery. MATERIAL AND METHODS This cadaveric study was conducted on 16 cadaver heads bilaterally, in which 32 silicon/latex-injected STAs were dissected using a microdissection technique in a neuroanatomy laboratory. The distances between the facial nerve, tragus, STA, superficial temporal vein (STV), and imaginary lines created between important anatomical landmarks were measured. The curvilinear lengths of STA and STV were also measured. RESULTS The average distances of the most posteriorly located branch of the facial nerve to the frontal region and the tragus at the midpoint of zygoma in the horizontal plane, at the superior border of the zygoma and at the level of the superior border of the parotid gland, were measured as 25.39, 29.84, and 15.56 mm, respectively. The average distance directly measured between the tragus and STA was 39.29 mm, and that between the tragus and STV was 20.26 mm. The average curvilinear lengths of the frontal and parietal branches of STA were 97.63 and 96.45 mm, respectively. CONCLUSION Understanding the clinical anatomy of the STA and its branches and its relationships with other structures is of critical importance for a successful and noncomplicated surgery. Our findings will be useful not only for surgical approaches such as pterional craniotomy and orbitozygomatic approaches but also for cerebral revascularization.
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Affiliation(s)
- Tugba Morali Guler
- Karabuk University, School of Medicine, Department of Neurosurgery, Karabuk, Turkey
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Sayaci EY, Kahilogullari G, Comert A, Morali Guler T, Guner YE, Korkmaz AC, Gungor Y, Cansiz Ersoz C, Okcu Heper A, Savas A. Morphology of the trigeminal ganglion: anatomical structures related to trigeminal radiofrequency rhizotomy. Acta Neurochir (Wien) 2022; 164:1551-1566. [PMID: 35235035 DOI: 10.1007/s00701-022-05160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trigeminal neuralgia is the most common example of craniofacial neuralgia. Its etiology is unknown and is characterized by severe episodes of paroxysmal pain. The trigeminal ganglion and its adjacent anatomical structures have a complex anatomy. The foramen ovale is of great importance during surgical procedures such as percutaneous trigeminal rhizotomy for trigeminal neuralgia. OBJECTIVE We aimed to identify the anatomical structures associated with the trigeminal ganglion and radiofrequency rhizotomy on cadavers and investigate their relationship with the electrodes used during rhizotomy to determine the contribution of the electrode diameter and length to the effectiveness of the lesion formation on the ganglion. METHODS Five fresh-frozen cadaver heads injected with red silicone/latex were used. A percutaneous puncture was made by inserting of a cannula through the foramen ovale to create a pathway for electrodes. The relationships between the electrodes, Meckel's cave, trigeminal ganglion, and neurovascular structures were observed and morphometric measurements were obtained using a digital caliper. RESULTS Trigeminal ganglion, therefore the electrode in its final position, shows proximity with important anatomical structures. The electrode was inserted posteriorly into the foramen ovale in all of the specimens and was located on the retrogasserian fibers. This study revealed that the electrodes targeting the ganglion and passing through the foramen ovale may cause a radiofrequency lesion due to the contact effect of the dura itself pressing on the electrode. Pushing the cannula beyond the petroclival angle may result in puncturing of the dura propria and moving further away from the target area. CONCLUSION The success of radiofrequency rhizotomy is directly related to the area affected by the lesion. Understanding the mechanism of action underlying this procedure will ensure the effectiveness, success, and sustainability of the treatment.
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Affiliation(s)
- Emre Yagiz Sayaci
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, 06230, Turkey.
| | - Gokmen Kahilogullari
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, 06230, Turkey
| | - Ayhan Comert
- Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey
| | - Tugba Morali Guler
- Department of Neurosurgery, Karabuk University School of Medicine, Karabuk, Turkey
| | - Yahya Efe Guner
- Department of Neurosurgery, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Ali Can Korkmaz
- Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey
| | - Yigit Gungor
- Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey
| | | | - Aylin Okcu Heper
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Savas
- Department of Neurosurgery, Ankara University School of Medicine, Ankara, 06230, Turkey
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Uz A, Korkmaz AC, Filgueira L, Guner MA, Tubbs RS, Demirciler AK. Anatomic Analysis of the Internal and External Aspects of the Pterion. World Neurosurg 2020; 137:84-88. [PMID: 32028010 DOI: 10.1016/j.wneu.2020.01.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The pterion is an H-shaped suture complex. This study's goal was to determine the location of its external and internal surfaces and extension and emphasize and discuss its surgical importance. METHODS Fifty dried adult human skulls were obtained from the Department of Anatomy. A 2-mm drill bit was placed externally over the pterion, and the pterion was drilled through the bone perpendicular to the skull's surface. RESULTS The midpoint of the H shape in the pterion area was not at the same level on the skull's external and internal pterion surfaces. According to these measurements, the external pterion lay above the internal pterion when the skull was viewed externally. Furthermore, the internal pterion was on average longer than the external pterion. The internal and external pterions were schematized such that the skull was viewed from the outside. These areas were divided into 4 quadrants (anterior-superior, anterior-inferior, posterior-superior, and posterior-inferior) by a vertical and horizontal line. In 30 cases (60%), sulci of the middle meningeal artery's parietal branches entered the posterior-superior quadrant on the bone, whereas the artery's frontal branches were located in the anterior-superior and anterior-inferior quadrants, and the Sylvian fissure's origin was in the posterior-inferior quadrant. CONCLUSIONS By using a subdivision into 4 quadrants, and considering our anatomic findings, we determined the way surgical procedures can be performed more easily and reliably. Even with modern localization technologies, anatomic landmarks can be useful to the neurosurgeon.
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Affiliation(s)
- Aysun Uz
- Department of Anatomy, Ankara University School of Medicine, Morfoloji, Sihhiye, Ankara, Turkey; Department of Anatomy, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; Department of Neuroscience, Ankara University Graduate School of Health Science, Ankara, Turkey.
| | - Ali Can Korkmaz
- Department of Anatomy, Ankara University School of Medicine, Morfoloji, Sihhiye, Ankara, Turkey
| | - Luis Filgueira
- Department of Anatomy, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Mehmet Ali Guner
- Department of Anatomy, Ankara University School of Medicine, Morfoloji, Sihhiye, Ankara, Turkey; Department of Anatomy, University of Health Sciences Faculty of Medicine, Etlik, Ankara, Turkey
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Ayse Karatas Demirciler
- Department of Neurosurgery, Ankara University School of Medicine, Morfoloji, Sihhiye, Ankara, Turkey; Department of Neurosurgery, Izmir Katip Celebi University, Ataturk Education and Research Hospital, Izmir, Turkey
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