Internal carotid artery-persistent primitive anterior choroidal artery aneurysms: report of two cases and literature review

PURPOSE

Persistent primitive anterior choroidal artery (PPAChA) is a rare vascular anomaly. The clinical course of internal carotid artery (ICA)-PPAChA aneurysms has not been well described.

CASE REPORTS

We report two patients with an ICA-PPChA aneurysm and summarize previously reported cases.

RESULTS

Including our two, a total of 10 patients with an ICA-PPAChA aneurysm have been reported. Data were not described for one. Among the remaining nine, five patients (56%) experienced aneurysmal rupture. Five patients underwent surgical clipping and four underwent endovascular coiling. The procedure was completed in all but one patient who had a tiny branch artery adherent to the aneurysm; this patient was converted from clipping to aneurysm coating with a cotton sheet. Among the other eight patients, one who underwent coiling experienced an internal capsule infarction. The remaining seven had a satisfactory postoperative course; however, an asymptomatic occlusion of the PPAChA at its origin was noted on postoperative angiography in one.

CONCLUSION

PPChA is associated with a high incidence of aneurysm formation and rupture. During treatment of ICA-PPAChA aneurysms, obstruction of the PPAChA and any surrounding perforating arteries should be avoided to prevent ischemic stroke.

Locally invasive cholangiocarcinoma causing gastric outlet obstruction in heterotaxy syndrome: A case report and review of literature

Heterotaxy syndrome is a disease of embryo development resulting in abnormal distribution of thoracic and abdominal organs across the left-right axis. In this case, A 77-year-old gentleman was admitted with gastric outlet obstruction secondary to cholangiocarcinoma. This is on a background of heterotaxy syndrome, specifically situs ambiguus. The patient's anatomical variations included a right-sided stomach, midline liver, and asplenia. Due to variant anatomy and risk of aspiration; endoscopy was abandoned in favor of surgical bypass via a gastrojejunostomy. Although technically challenging, complex upper abdominal surgery in heterotaxy syndrome has been described in the literature. Variations in anatomy observed in heterotaxy syndrome may render patients ineligible for resection of cholangiocarcinoma and increase the risk of complications. Careful preoperative planning with imaging and meticulous intraoperative dissection is required.

Facial nerve communication with ansa cervicalis - An unusual anatomical variation

Neural connections of the seventh cranial nerve with its neighboring nerves are common and well documented; however, communication with ansa cervicalis is as yet unknown. We present a case with such a connection found during cadaveric dissection, with hitherto unknown consequences. In this specimen, after giving the marginal mandibular and cervical branches, the cervicofacial division continued distally to communicate with the distal loop of ansa cervicalis. Presence of such connection may result in facial muscle paralysis on injury to the ansa or strap muscle paralysis on injury to the facial nerve, depending on the direction of nerve fibers. Such unusual connections bring to light the need for extreme care during surgeries in the neck to safeguard any such connections and when using the ansa as donor.

A Rare Variant of Zuckerkandl Tubercle: Thyroid Ring

Zuckerkandl tubercles are posteromedial projections of normal thyroid gland with relations with important neck structures. In our case, we reported "Thyroid ring", that is a ring configuration of the thyroid gland encasing the trachea and esophagus, without compression symptoms. Ring was formed by the elongated zuckerkandl tubercles, passing through the column between the esophagus and vertebral body and abutting each other at left posterolateral border of esophagus. Reporting of these relations and variations is important as it helps the operating surgeon in planning the approach to the procedure.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04079-4.

Anconeus epitrochlearis muscle resulting in cubital nerve compressive neuropathy: Two case reports

Background

The anconeus epitrochlearis muscle is an anatomical variant prevalent in amphibians but unusual in humans. In favorable cases, this muscle provides protection to the cubital nerve but can result in neuropathy due to compression of the cubital nerve.

Case Description

We present two cases with different clinical manifestations but both did not respond to conservative treatment. We opted for a surgical decompression where the anconeus epitrochlearis muscle was found intraoperatively, and the muscle fibers were dissected.

Conclusion

Considering the presence of the muscle variant is the key point to intraoperatively achieve a complete dissection of the muscle fibers of the anconeus epitrochlearis muscle variant and obtain the decompression of the cubital nerve with satisfactory postoperative results.

Posterior inferior cerebellar artery originating from the posterior meningeal artery mimicking dural arteriovenous fistula

PURPOSE

Many variations in the origin of the posterior inferior cerebellar artery (PICA) have been reported. To our knowledge, only one case of a PICA originating from the posterior meningeal artery (PMA) has been reported.

METHODS

We describe a case with a PICA that was supplied retrograde from the distal segment of the PMA, mimicking a dural arteriovenous fistula on magnetic resonance angiography (MRA).

RESULTS

A 31-year-old man was admitted to our hospital with a sudden occipital headache and nausea. MRA showed a hyperplastic left PMA, continuing to an abnormal vessel that was suspicious for venous drainage. Digital subtraction angiography revealed the left PMA originated from the extradural segment of the vertebral artery and then connected to the left PICA near the torcula. The cortical segment of the PICA flowed retrograde, which appeared as venous reflux on MRA. A second PICA originated from the extradural segment of the left vertebral artery and perfused the tonsillomedullary and televelotonsillar segment of the left PICA territory.

CONCLUSION

We present an anatomical variant of the PICA mimicking a dural arteriovenous fistula. Digital subtraction angiography is useful for diagnosis of the cortical segment of the PICA flowing retrograde from the distal segment of the PMA because signal intensity in MRA of retrograde flow tends to decrease and diagnosis may be difficult. During endovascular treatment and open surgery, we should note that ischemic complications may occur due to the potential anastomosing channels between cerebral and dural arteries.

Symptomatic bifid insertion of the Flexor Carpi Radialis Brevis

A 35 year-old right-handed female presented with persistent wrist pain lasting two years. Imaging disclosed an accessory tendon-shaped structure, identified as a Flexor Carpi Radialis Brevis, strangling the Flexor Carpi Radialis tendon at the wrist during effort. Surgical exploration found the insertion of the Flexor Carpi Radialis Brevis to be bifid. Resection of the stenosing branch and the fibrotic tendon sheath restored strength in the right wrist and painless symmetrical motion compared to the left wrist ten weeks postoperatively.

Persistent sciatic artery with peripheral arterial disease: A case report

BACKGROUND

Persistent sciatic artery (PSA) is a congenital malformation due to incomplete involution during the embryonic period. Its etiology is unknown, with an estimated incidence of 0.02 - 0.04% in the whole population and a mean age of 60-65 years. Its presentation can be bilateral. It is asymptomatic in most cases and is usually detected accidentally; however, some symptoms may appear, such as claudication, sciatic neuralgia, and pain in the affected limb. It can also manifest as an aneurysmal dilatation or thrombosis that can generate distal embolism with ischemia. <P> </P> Case Report: In this case study, a patient in her 90s with a suspected peripheral arterial disease, which required an angiotomography of the lower limb, showing a superficial femoral artery running to the middle and distal third of the thigh and a vascular structure running in the sciatic neurovascular bundle corresponding to a persistent sciatic artery presenting atherosclerotic changes and extensive occlusion, was presented. The patient&s treatment was clinical with dual antiplatelet therapy and prophylactic anticoagulation. This was due to comorbidities and age. Moreover, the PSA occlusion was not critical and did not significantly impact the patient&#039;s quality of life. <P> </P> Conclusion: Most patients with this anatomical variant are asymptomatic all their lives, but some of them may present symptoms with serious consequences. It is important to suspect it by clinical presentation and perform diagnostic confirmation by angiotomography. Treatment has yielded excellent results with endovascular techniques. Certain patients only require conservative treatment with anticoagulants and antiplatelet agents.

Aberrant left gastric vein: what should surgeons know?

PURPOSE

Aberrant left gastric vein is a rare variant and hardly known by surgeons. Its misidentification may lead to accidental bleeding. More importantly, it can also be the root of hypertensive gastropathy in cirrhotic patients and tumor spread in patients with gastric cancer. Here, we describe and provide imaging data of the three patterns of aberrant left gastric veins.

METHODS

Over the past 5 years, three cases were noted, each one corresponding to one of the three variants.

RESULTS

Aberrant left gastric vein is a rare anatomical entity and has rarely been reported. Its normal anatomy and variants, embryological origins, radiological analysis, and clinical implications are all discussed, bringing light to what surgeons should know when encountering an aberrant left gastric vein.

CONCLUSION

Surgeons should be aware of the types of ALGV, its associated arterial variations, the presence of pseudolesion or not, and the potential atrophy of liver segment.

The first reported case of left renal vein fenestration

PURPOSE

Vascular fenestrations are mostly seen in the arterial system and cerebral vessels, but they can be seen rarely in the venous system. In this article, we aimed to present the first case of left renal vein fenestration, which has not been previously reported in the English literature to the best our knowledge.

METHODS

Computed tomography angiography (CTA) examination was performed on a 40-year-old male patient who presented with rectal bleeding, and iron deficiency anemia, detected hemorrhoids in colonoscopy, and was planned for superior rectal artery embolization.

RESULTS

In CTA examination, a fenestration in the middle part of the left renal vein was detected. The fenestrated segment length was measured approximately 3 cm. The diameter of anterior and posterior channels were 7.66 and 6.01 mm, respectively. The 2.85 mm diameter inferior segmental artery of the left renal artery was passing between the anterior and posterior channels of the fenestrated segment, and there was a slight indentation of this artery to the posterior canal.

CONCLUSION

Although venous fenestrations are rare, they can also be seen in the renal venous system, and can be detected with CTA. It is important for radiologists to be aware of this situation, to increase its detectability and to prevent iatrogenic injury in possible surgical procedures. And also as in our case, left renal vein fenestration may be one of the causes of microscopic hematuria.

A novel meniscofemoral ligament variant intra-substance to the PCL

While much detail is known about each anatomic structure of the knee and its contributory effect on biomechanics, our understanding is still evolving. In particular, the function of the meniscofemoral ligaments and their anatomical variants have yet to be fully described. In this report, a never-before-described anatomical meniscofemoral ligament variant intra-substance to the PCL is presented. Arthroscopists should be aware of the novel variant as a growing number of studies have demonstrated the biomechanical importance of the meniscofemoral ligaments in protecting the lateral meniscus and supporting the function of the PCL.Level of Evidence: IV.

Free gracilis end-to-side microanastomosis to a peronea arteria magna: a case report

BACKGROUND

Complex orthoplastic lower limb trauma in individuals with multiple injuries requires considerable resources and interdisciplinary collaboration for good outcomes. We present the first reported end-to-side free flap microanastomosis for lower limb trauma reconstruction involving a peronea arteria magna without radiographic collaterals.

CASE PRESENTATION

A 55-year-old Caucasian gentleman involved in road traffic collision sustained an open tibial fracture on the anteromedial distal third of the left lower leg with local degloving and a subtotal right foot and ankle degloving. Both injuries were reconstructed with free tissue transfer. A left lower limb peronea arteria magna successfully received a free gracilis muscle flap by end-to-side microanastomosis and perfusion of the foot was preserved. This rare anatomical variant and its anatomy is reviewed, as well as a description of the suggested preoperative planning and technique for reconstruction.

CONCLUSIONS

Successful free flap reconstruction may be performed to a lower limb with a peronea arteria magna recipient as the lone vessel supplying the foot in trauma, although preoperative counseling of the risks, benefits, and options are essential.

LEVEL OF EVIDENCE

Level V, case report.

An accessory iliotibial band insertion: a unique anatomical variant

The iliotibial band (ITB) is considered an important anterolateral knee joint stabiliser. Its exact anatomy remains unclear with inconsistency owing to relative paucity of detailed cadaveric studies. Multiple ITB distal insertional sites have been reported, the most common and well known being a direct attachment onto Gerdy's tubercle of the anterolateral tibia. We report a rare distal insertional site not previously documented. A 50-year-old man presented with anterior knee pain. MRI showed an accessory band deep to the ITB, partially blending in with its superficial fibres. It inserted onto the anterolateral tibial tuberosity, deep to the patellar tendon insertion and inferomedial to Gerdy's tubercle. This was asymptomatic but the patient did have an underlying median patella ridge osteochondral defect successfully treated with stem cell grafting, completely unrelated to the mentioned variant. This case highlights the importance of detecting rare anatomical variants which can potentially be a source of lateral knee pain.

Rare anastomosis between a replaced right hepatic artery and left branch of the proper hepatic artery

Appreciation of the potential anatomical variation of the hepatic arterial supply and branches of the abdominal aorta is of paramount importance in pancreatic and hepatobiliary surgery. Here we describe a hitherto un-reported coelio-mesenteric anastomotic connection between a replaced right hepatic artery, originating from the superior mesenteric artery, and the left hepatic branch of the proper hepatic artery. The embryological origins of the variant anatomy as well as its potential surgical implications are discussed with a view to encourage thorough pre-operative interrogation of available imaging by radiologists and surgeons to successfully identify such variants and take advantage of their potentially useful functionality.

The Medial Metaphyseal Periosteal Artery (MMPA): An Alternate Pedicle for the Medial Femoral Trochlea Flap

We report a case of medial femoral trochlea flap used for scaphoid proximal pole reconstruction, in which the transverse branch of the descending genicular artery was vestigial. The medial metaphyseal periosteal artery was clearly the dominant pedicle supplying the trochlear region. The flap was safely raised on the medial metaphyseal periosteal artery pedicle. The incidence of this uncommon presentation remains unknown and this anatomical variant is newly described.

Crossed doubled patellar tendon: A rare anatomical variant with potential clinical significance

The patellar tendon is an integral part of the knee extensor mechanism and has been historically described as a single tendon. A doubled patellar tendon is an exceedingly rare finding. We present a case of a crossed doubled patellar tendon in a 70-year-old male with a history of right knee pain, which to our knowledge has only been reported once before in the literature. The presence of a doubled patellar tendon has a potential influence on surgical planning and in the etiology of anterior knee pain.

Anterior cervical discectomy and fusion in the setting of kissing carotids: A technical report and literature review

BACKGROUND

The "kissing carotids" (KCS) phenomenon refers to bilateral retropharyngeal displacement of the internal carotid arteries (ICA). This anomalous anatomy can impose a significant surgical challenge to spine surgeons.

OBJECTIVE

In this report, we describe our approach for an anterior cervical discectomy and fusion in the setting of kissing carotids.

METHODS

We discuss our case, surgical technique, rationale, and outcome. Additionally, we conducted a systematic review of the literature.

CASE DESCRIPTION

An 82-year-old female presented to our service with progressive myelopathy. Cervical spinal imaging revealed a large disc herniation at C3-C4 and severe spinal canal stenosis. Vascular imaging showed anomalous ICAs bilaterally overlying the prevertebral fascia at the midline. The patient received aspirin preoperatively and underwent a multidisciplinary approach with neurosurgery and otolaryngology. A standard transcervical approach centered on the C5-C6 disc space, where the carotid arteries splayed most from midline, allowed for facilitated visualization and mobilization of the vessels. Prevertebral dissection was then performed rostrally to the C3-C4 disc space. The patient was put into burst suppression prior to retraction and underwent uncomplicated anterior discectomy and fusion.

CONCLUSIONS

KCS is a rare but critical presentation of extreme medial displacement of bilateral ICAs. Few cases have been reported in the spinal surgery literature. Knowledge of this rare variant is important to avoid iatrogenic injury and complications.

Unusual variant of choledochal cyst in a child: A case report, in Tertiary Specialized Hospital, Ethiopia

•

In the hepatobiliary system anatomical variations can happen.

•

Though type II choledochal cyst has great outcome after surgery, it has differentials to think about before exploration.

•

The anatomic variation in choledochal cyst will cause diagnostic and management challenges.

Introduction

Choledochal cyst (CC) is an uncommon congenital disease of the biliary tract. There are five main types of CC with several recognized sub-types. However, occasional variants with a difficulty in diagnosis and management do occur.

Presentation of the case

We report a case of a nine years old female child diagnosed with CC who presented with right quadrant abdominal pain with unremarkable physical findings. Investigation using abdominal CT scan suggested type II choledochal cyst. The intraoperative finding revealed an unusual site of the cyst that is at the confluence of common hepatic duct (CHD) posteriorly. The cyst was successfully excised and the child is doing well on her follow ups.

Discussion

In the management of choledochal cyst the anatomy should be clearly defined with detailed investigations like Abdominal CT Scan or cholangiography before surgical excision as abnormal variants which usually do not fit into the known classification types and subtypes. This might confuse with other differentials like gall bladder duplication. Surgical excision is the gold standard management option.

Conclusion

This case report will alert surgeons that there are different anatomic variant of choledochal cysts out of the known classifications and with meticulous dissection will help proper excision and avoid unnecessary complications.

Innominate variant artery in the first web space

INTRODUCTION

Numerous variations are characteristic for hand anatomy. Although a lot of work has been done in the field, a detailed description of the branches of the radial artery is still missing. The aim of this study is to determine the incidence and diameter of the accessory artery, which can be found running on the dorsal surface of the interosseus dorsalis primus muscle, to deliver the detailed description of this arterial variation and based on that to suggest a systematic name of the artery which would be in line with Terminologia Anatomica.

METHODS

We used 133 complete donor bodies and 237 cadaverous hands in our study, giving us a total sample size of 503 samples. When possible, we determined the age of the donors which was between 62 and 90 years. We performed detailed anatomical dissection to determine the individual branching. We also measured the diameter of selected arteries. When relevant we performed statistical comparisons. To do that we first applied Shapiro-Wilk test to determine the normality of distribution and after that we used Mann-Whitney U test and One-way ANOVA.

RESULTS

The variation of interest was found in 11.93% of cases. Based on the anatomical differences we determined four types of branching, type 1-3 forming the anastomosis with superficial palmar arch (being considered as positive findings) and type 4 which did not form this anastomosis (thus considered to be a negative finding).

DISCUSSION

We successfully determined the incidence of this arterial variation on a sufficient sample size. We also described the anatomy of this branching in detail and were able to determine four types of this branching. After careful consideration of these findings we proposed the new name for this artery and suggest to use the name superficial dorsal branch of radial artery. This could contribute to a better understanding of this branching and potential use in clinical practice.

Successful management of unilateral congenital patellar tendon aplasia: case report

Anatomical variation is discovered frequently in humans, and much such variation in the musculoskeletal system has been reported. We present a rare case of unilateral congenital patellar tendon aplasia with concomitant apparent shortness of the bilateral halluces as a result of shortened first metatarsals as an anatomical variant.

A Serpiginous Pericallosal Anterior Cerebral Artery

The anterior cerebral artery (ACA) is a unique artery with many important variations with substantial clinical significance. Tortuous intracranial arteries usually occur in basilar, communicating, anterior, posterior cerebral arteries and in the white matter arterioles. This could happen for many reasons including but not limited to ageing, hypertension, patients with Moyamoya disease, congenital malformation, or increased flow associated with elastin degradation. While dolichoectasia of the ACA has been described even in children, to our knowledge, a serpiginous ACA without ectasia has not been reported, especially in the pediatric population.

Accessory Articulation of the Cervical Transverse Process: A Very Rare Anatomic Variant

We present a very unusual case of an accessory articulation of the transverse processes of C6 and C7. Only four previous cases have been described in English literature. Our case stresses the importance of computed tomography (CT) and post-processing images to discriminate this variant from posttraumatic or degenerative lesions. Multiplanar reformations and volume-rendered images should be added to the cervical spine CT protocol.

Buckled Thyroid Cartilage: An Anatomic Variant

OBJECTIVE

Anatomic abnormalities in the larynx can cause significant and bothersome symptoms. Identified here is an anatomical variant of the thyroid cartilage.

STUDY DESIGN

This study is a retrospective case series of 11 subjects diagnosed with an anatomic variant of the thyroid cartilage.

METHODS

Patients with an anatomic inward buckling of the thyroid cartilage, termed here as buckled thyroid cartilage, were identified through a 20-year retrospective chart review of a tertiary care laryngology practice.

RESULTS

We describe 11 patients with fullness or asymmetry in the area of the false vocal fold and an associated inward buckling of the thyroid cartilage on computed tomography scan. All patients presented with a bothersome voice-related complaint. The most common presenting complaints were hoarseness (54%), globus sensation (45%), or vocal fatigue (27%). One patient was found to have a history of known laryngeal trauma. Surgical correction through an external approach on one patient was successfully performed with subsequent resolution of symptoms.

CONCLUSION

We postulate that deformity and protrusion of the false vocal fold can result in a dampening effect on the vibratory capacity of the vocal fold that can lead to symptomatic hoarseness and vocal fatigue. Buckled thyroid cartilage is, therefore, an important anatomical variant to be aware of and be able to recognize.

A case of crossed-doubled patellar tendon: an atavistic variant, simple mutation or pathologic finding?

Anatomical variants can be found throughout the whole body. Especially in the knee region, some variability has been reported concerning the osseous, tendinous, and muscular system. Beside a few cases of patellar tendon aplasia, no anatomical variations of this tendon are known. We present a rare case of a doubled patellar tendon as an anatomical variant, which to our knowledge, has not been described previously.

Accessory articulation of elongated anterior transverse process: a rare anatomical variant of the cervical spine depicted with CT and post-processing techniques

There are several described anatomical variants of the cervical spine, ranging from common to extremely rare, which may have different clinical implications. We present the case of an extremely rare anatomical variant of the cervical spine, in a symptomatic patient, consisting of a unilateral accessory articulation between the 5th and 6th cervical vertebrae, due to elongated anterior transverse processes. Our search found only three cases in the English literature describing similar findings to the case here reported. Our case is, to our knowledge, the first report of this anatomical variant imaged with computed tomography including post-processing images (volume rendering technology and multiplanar reformations), which contribute greatly to a better understanding and depiction of the anatomical variant.

Pre-procedural evaluation of the left atrial anatomy in patients referred for catheter ablation of atrial fibrillation

BACKGROUND

Cardiac computed tomography (CT) provides accurate imaging of the pulmonary vein (PV) and left atrial (LA) anatomy. This study aimed to evaluate the prevalence and morphological characteristics of anatomical variants that could influence atrial fibrillation (AF) ablation procedures.

METHODS AND RESULTS

One thousand forty consecutive patients (62±10 years, 243 female, 644 paroxysmal AF) undergoing pre-procedural imaging with a 320-row CT and their first AF ablation procedure were analyzed. A total of 194 (18.7%) patients had anatomical variants. Left, right, and inferior common PVs were observed in 118, 5, and 6 patients, respectively. Three right and left PVs were observed in 44 and 4 patients, respectively. Three patients had remnants of PVs after lobectomies, and significant PV stenosis was observed in one. Supernumerary PVs that drained into the LA and diverticula were observed in eight patients. One patient had a string-like structure connecting the LA septum and posterior LA, and the others had membranous structures incompletely compartmentalizing the LA. Three patients had persistent left superior vena cavae, two strong deviations of the LA and PVs, and one dexiocardia. All patients underwent successful PV isolation during the index procedure.

CONCLUSIONS

Patients referred for AF ablation often have anatomical variants, which could influence the procedure. This information might aid in planning procedural strategies, and reducing unexpected procedural complications in AF ablation.

Unusual course of the aberrant right hepatic artery running through the pancreatic parenchyma during modified Frey's procedure

We report a variation of an aberrant right hepatic artery arising from the superior mesenteric artery and crossing into pancreatic head without other hepatic artery substitution. The variant was discovered during radiological examinations in a patient with symptomatic chronic pancreatitis requiring Frey's procedure with reinsertion of the common bile duct into the pancreatic head. An aberrant right hepatic artery arising from the superior mesenteric artery is present in 10 to 20% of case and its course is usually retro-pancreatic. The course of this artery into the pancreatic head is uncommon and can be present up to 10% in case of ARHA. Knowledge of an aberrant right hepatic artery crossing into the pancreatic head is important before pancreatic surgery in order to avoid surgical complications, especially for liver necrosis.

High division of the spinal accessory nerve and communication with a C2 branch of the cervical plexus: a previously unreported anatomical variant

Anatomical variations of the spinal accessory nerve are well known. We describe a previously unreported variant in which the nerve divided high in level II after crossing the internal jugular vein and before entering the sternomastoid muscle. Both branches were joined by a communication from the C2 cervical root. We discuss the clinical implications of this finding.

Musculocutaneous nerve substituting for the distal part of radial nerve: A case report and its embryological basis

In the present case, we have reported a unilateral variation of the radial and musculocutaneous nerves on the left side in a 64-year-old male cadaver. The radial nerve supplied all the heads of the triceps brachii muscle and gave cutaneous branches such as lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of forearm. The radial nerve ended without continuing further. The musculocutaneous nerve supplied the brachioradialis, extensor carpi radialis longus and extensor carpi radialis brevis muscles. The musculocutaneous nerve divided terminally into two branches, superficial and deep. The deep branch of musculocutaneous nerve corresponded to usual deep branch of the radial nerve while the superficial branch of musculocutaneous nerve corresponded to usual superficial branch of the radial nerve. The dissection was continued to expose the entire brachial plexus from its origin and it was found to be normal. The structures on the right upper limb were found to be normal. Surgeons should keep such variations in mind while performing the surgeries of the upper limb.

Unilateral variant motor innervations of flexure muscles of arm

The musculocutaneous nerve usually branches out from the lateral cord of brachial plexus. It innervates the corcobrachialis, biceps brachii and brachialis muscles and continues as the lateral cutaneous nerve of forearm without exhibiting any communication with the median nerve or any other nerve. We report unilateral variation in motor innervations of the left arm in a 58-year-old male cadaver. The musculocutaneous nerve was found to be absent. A muscular branch of the median nerve was supplying the coracobrachialis muscle. In the middle of arm, the median nerve was found to be branching out, bifurcating and supplying the long and short head of biceps. The median nerve was found to be giving a separate branch, which supplied the brachialis muscle and continued as the lateral cutaneous nerve of forearm. The right sided structures were found to be normal. Surgeons should keep such variations in mind while performing arm surgeries.