The recurrent artery of Heubner (RAH) is the largest vessel of the medial lenticulostriate arteries. It supplies many deep structures, mainly the corpus striatum, the globus pallidus, and the anterior crus of the internal capsule. The aim of the present paper was studying the morphological variations of the RAH and its diameter in relation to different areas of origin. The series contained the records from 183 formalin-fixed adult human brains. The calibrated digital images of the studied brains were evaluated and measured by Image J, which can calculate the number of pixels and convert them to metric measures. The RAH arose most often from the postcommunicating part of the anterior cerebral artery (47.81%). It originated from the precommunicating part of the anterior cerebral artery in 3.55% and at the level of the anterior communicating artery in 43.4% of cases. The RAH was missing in 5.19% and doubled in 6.28% of cases. The mean outer diameter of the RAH was 0.6 mm. The maximal measured diameter was 1.34 mm, and the minimal diameter was 0.19 mm. The awareness of the various anatomical and morphometric variations of the RAH is essential in planning the neurosurgical procedures to avoid unexpected neurological complications.
Abstract:Background: The course of the brachial plexus, its relations with surrounding structures and unique primary and secondary divisions result in its wide range of anatomical variations. Most of these variations were detected during anatomical dissections and studies. It has been found that 53% of studied brachial plexuses contained variations. The communication between musculocutaneous and median nerves is the most common variation of infraclavicular part of brachial plexus. Methods: During gross anatomical dissections of peripheral nerves, we observed neuronatomical variations in upper limbs of four formalin embalmed adult cadavers. Musculocutaneous and median nerves were connected by a communicating branch at distinct level in each cadaver. The formation and relations of both nerves were noted in each case to exclude the existence of other anatomical variations. The connections were measured and documented by digital camera. Results: The communicating fi bers of variations 1 and 2 were located in the upper third of arm and proximally to musculocutaneous nerve penetration through coracobrachialis muscle. In variations 3 and 4, the communicating branch was situated in the lower third of arm and distal to the nerve penetration point. Conclusion: Variable interconnections between musculocutaneous and median nerve have to be considered in diagnosis of nerve lesions in axillary and arm regions. Compound musculocutaneous and median nerve neuropathy would occur in lesions of the interconnecting branches. Injuries of musculocutaneous nerve proximal to these branches can cause particular and unexpected symptoms, such as weakness of forearm fl exors and thenar muscles (Fig. 6 The brachial plexus is formed by the anterior rami of the cervical nerves C5-C8. It receives variable connections from the anterior rami of the fourth cervical nerve (C4) and the fi rst thoracic nerve (T1). The prefi xed type of the plexus is characterized by thick contributive nerve fi bers from C4 and thin or absent fi bers from T1. In the constitution of the postfi xed brachial plexus the fi rst two thoracic nerves (T1-T2) with absence of the nerve connection from C4 take part. The prefi xation of the plexus is more common than its postfi xation (1, 2).The roots of the plexus lie in the posterior cervical triangle between the anterior and middle scalene muscles. The nerve roots unite to form complex nerve network, from which the three primary trunks of the brachial plexus are branching: superior middle and inferior trunks. These are passing together with the subclavian artery under the clavicle and through the scalene gap. Each trunk is divided into anterior and posterior divisions. The lateral, medial and posterior cords of the plexus are formed by these divisions in the axillary fossa. The cords are named according to their relative position around the axillary artery (3, 4).From the topographical point of view the plexus is divided into supraclavicular and infraclavicular parts. The supraclavicular part gives off branches to innervate th...
Vermiform appendix is an anatomical structure, which due to its topographical relations usually causes many complications, especially in infl ammation such as appendicitis. One of the manifestations of the infl ammatory processes is pain, which may have different location. It could be probably a result of the neuron stimulation. The nerve formation and distribution of the vermiform appendix is still unknown in fi ne details and is a subject of further studies (Fig. 8, Ref.12).
Abstract:Background: Congenital anomalies of the abdominal wall are classifi ed as anomalies with the abdominal wall defect (omphalocele, gastroschisis) and without the defect (umbilical hernia, persistent ductus omphaloentericus or urachus). Clinical presentations of these conditions are different, and so is the timing of surgical intervention and approach with or without the exploration of the peritoneal cavity. Case: The presented case report refers to a rare fi nding of ectopic liver forming mesodermal cyst within the umbilical region. Full term neonate girl with 5 cm spheroid tumor in umbilicus was otherwise without problems. Ultrasonography (USG) of the lesion detected a tissue with good vascularization and a cystic cavity. There was no fl ow in the umbilical vessels and no evidence of intestinal loop in the sac. USG of the liver was normal. During surgery an additional narrow canaliculus was identifi ed connecting the spheroid along with umbilical vessels to the liver. The whole spheroid together with the canaliculus was surgically removed without exploration of the abdominal cavity. Histological evaluation of the surgical specimen discovered liver tissue with a mesodermal cyst in the center. The sphere was connected to the liver by a bile duct. Six months after the operation the child is in a good clinical condition. Conclusion: In conclusion omphalocele may contain liver. Ectopic liver is an extremely rare condition. Surgical treatment in the presented case focused only on umbilicus without exploration of the abdominal cavity and appeared to be suffi cient. Long-term postoperative follow up typical in pediatrics will be applied also in this patient (Fig. 3, Ref. 25). Full Text in PDF www.elis.sk.
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