The topographical features and variations of nervus ischiadicus in human fetuses

BACKGROUND

We aimed to investigate the topographical features and variations of ischiadic nerve during prenatal period in human.

METHODS

Our study was conducted on lower extremities of 34 human fetal cadavers who were free of any anomalies and were obtained from the department of pathology of our faculty.

RESULTS

When the development of topographical features of ischiadic nerve is considered according to the gestational weeks, it was shown that the distances increased in accordance with the age and there was a positive correlation between the two (p < 0.01), however the width of the ischiadic nerve did not increase similarly and there was no significant correlation between its width and the age (p > 0.01).

CONCLUSIONS

Understanding the structure and course of ischiadic nerve in both gluteal and femoral regions is important during all interventions to these regions due to the potential damage on the nerve itself. The knowledge of topographical features of ischiadic nerve in the prenatal period and its relations with reference points that are used especially in childhood and adults will help to follow up the variations during postnatal and grow up periods (Tab. 2, Fig. 4, Ref. 13).

C-2 anterior plate-screw fixation: a quantitative anatomical and morphometric evaluation

OBJECTIVES

Discectomy and inter-vertebral body fusion combined with the anterior plate-screw fixa tion is the common procedure in cervical spine surgery. But the anterior plate-screw fixation of the C2 spine has been the uncommon surgical procedure. In this study, we analyze the anatomy of the C2 body relevant to C2 anterior plate-screw fixation.

MATERIAL AND METHODS

Eighty-six dried C2 spines were evaluated directly for this study. Measurements were made on the C2 body width and midsagittal anteroposterior (AP) depth and the anteroposterior parasagittal depth 5 mm lateral to midline on the inferior endplates, in addition to on the middle body. Measurements also were made of anteroposterior parasagittal vertebral depth with both medial and lateral inclination of 10 degrees, with respect to the parasagittal plane of the vertebral body.

RESULTS

The ideal maximum screw length and trajectory was found to be AP medial parasagittal depth of inferior surface of the C2 body [Right: 13.7 +/- 1.4 mm (11.0-17.9), Left: 13.6 +/- 1.5 mm (10.7-17.8)].

CONCLUSIONS

We report the measurements of the vertebral body of the C2. We think these measurements provide guidelines for operating on the anterior C2 spine, and enhance the confidence interval for the surgeon (Tab. 3, Fig. 1, Ref. 24).

The anterior extraperitoneal approach to the rare presacral/ retroperitoneal schwannoma

Presacral/retroperitoneal schwannomas are extremely unusual and their surgical approach is challenging. Various surgical approaches have been proposed. Here we describe our experience with the anterior extraperitoneal approach for the Type 3 presacral/retroperitoneal schwannoma. A 33-year-old woman presented with a history of infertility and a presacral/retroperitoneal mass. The patient underwent abdominal/pelvic CT and MRI that demonstrated presence of a solid, well circumscribed Type 3 presacral/retroperitoneal schwannoma. The anterior extraperitoneal approach was successfully used to remove the presacral/retroperitoneal schwannoma. The histopathological evaluation confirmed the preoperative diagnosis. The anterior extraperitoneal approach is helpful as an alternative approach in the surgical management of benign Type 3 presacral/retroperitoneal schwannomas (Fig. 4, Ref. 15).

Brucellar spondylo-discitis with rapidly progressive spinal epidural abscess presenting with sciatica

STUDY DESIGN

Case report.

OBJECTIVE

To present a patient with spinal brucellosis, which was initially presented with sciatica and misdiagnosed as a lumbar disc herniation owing to nonspecific neurological and radiological findings. The delay in diagnosis led to rapid progression of the disease and complications.

SETTING

Department of Neurosurgery at a tertiary university teaching hospital (Sutcu Imam University Medical Center in Turkey).

CASE REPORT

A 57-year-old woman with a history of low-back pain for 6 months, fatigue, and severe left-sided sciatica for the last 3 months presented to our hospital. Three months earlier, at another hospital, she had had a negative Rose-Bengal test for brucellosis and a lumbar computed tomography performed at that time showed only minimal L4-5 annular bulging. For 2 months, she was treated with analgesics for 'lumbar disc herniation' without relief of pain. On presentation to our department, her magnetic resonance imaging (MRI) examination showed edema and minimal annular bulging at L3-4 and L4-5. When her Rose-Bengal test returned positive, she was started on triple antibiotics for presumed Brucella infection. When symptoms and neurologic signs worsened while taking antibiotics, repeat MRI scan showed a spinal epidural abscess at the L4-5 level. Emergent surgery and 8 weeks of antibiotics resulted in cure.

CONCLUSION

In areas endemic for brucellosis, subtle historical and exam features should be sought to exclude an infection such as brucellar sponylo-discitis. Appropriate serological tests should be readily available to confirm or exclude this diagnosis in selected patients, to avoid delays in antibiotic treatment.

Hydrocele of the canal of Nuck as a result of a rare ventriculoperitoneal shunt complication

Patients with ventriculoperitoneal (VP) shunts may have multiple complications. Migration of the peritoneal catheter into some anatomical or congenitally open cavities can cause inguinal or genitourinary manifestations such as hernia, hydrocele or acute scrotum, and these are common in male infants. We report a very rare complication of VP shunt encountered in a female infant, manifesting as hydrocele of the canal of Nuck, the female counterpart of hydrocele of the spermatic cord. It is emphasized that VP shunts may also cause clinical inguinal manifestations in female infants, and groin or external genital organ swelling in these patients may be an important sign of shunt malfunction.

Landmarks of the sacral hiatus for caudal epidural block: an anatomical study

BACKGROUND

This study determined the landmarks for caudal epidural block (CEB) after morphometric measurements of the sacral hiatus on dry sacral bones. Anatomical features of the sacral hiatus of clinical importance during CEB, along with distances and angles of use in detecting the apex, were measured. This provides detailed knowledge of the anatomy of the sacral hiatus and practical landmarks.

METHODS

Ninety-six dry sacral bones were used. Anatomical measurements were made with a Vernier caliper accurate to 0.1 mm.

RESULTS

Two sacral bones were excluded since they had total posterior closure defect. Agenesis of the sacral hiatus was detected in six sacral bones. As the posterior superior iliac spines impose on the superolateral sacral crests of the sacrum, the latter were accepted as forming the base of a triangle. The distance between the two superolateral sacral crests and the distances between the sacral apex and the right and left superolateral sacral crest were 66.5 (SD 53.5), 67.1 (10.0) and 67.5 (9.5) mm respectively, on average.

CONCLUSION

The triangle formed between the apex of the sacral hiatus and the superolateral sacral crests was found to have the features of an equilateral triangle. The sacrum and sacral hiatus are variable anatomical structures. However, the equilateral triangle located between the apex of the sacral hiatus and superolateral sacral crests will certainly be of use in determining the location of the sacral hiatus during CEB.

Lumbosacral neurenteric cyst with associated tethered cord in an adult

Spinal neurenteric cysts are rare congenital lesions of endodermal origin that lead to spinal cord compression or tethering. These cysts are usually lined by mucus-secreting epithelium resembling that of the gastrointestinal tract. A 31-year-old man presented with low back and bilateral limb pain of three-year duration. Magnetic resonance imaging (MRI) revealed an intradural extramedullary heterogeneous mass lesion at L4 - L5 disc level causing severe compression and displacement of terminal portion of conus medullaris to the left side. Additionally, tethered cord, syringohydromyelia and spina bifida were present. He had also polysyndactyly on the left foot. The patient underwent laminoplasty and partial excision of the lesion through a posterior approach. Neurosurgical exploration revealed a large intradural, extramedullary solid lesion with cystic component, compressing the spinal cord. Histopathology confirmed a neurenteric cyst with mucin-producing cuboidal or columnar epithelium lining the cystic cavity. Clinical suspicion is important for an early diagnosis, and their early preplanned surgical removal should be the goal of treatment, which leads to a better outcome. This case is reported in view of rare congenital abnormality in an adult with peculiar presentation.