Innervation Area Research Articles

A Novel Transverse Ultrasound-Guided Approach for Puncturing the Cervical Dorsal Root Ganglion at the Level of Articular Pillar for Radiofrequency Treatment.

Currently, minimally invasive intervention surgery for cervical spondylotic radiculopathy mostly involves the use of cervical dorsal root ganglion (DRG) block or radiofrequency modulation therapy. Here, we proposed a novel transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment. A retrospective analysis of the clinical data of 30 patients with cervical spondylotic radiculopathy admitted to the Pain Department of Taihe Hospital Affiliated with Hubei Medical University from January 2021 to March 2024 was performed. During surgery, motor electrical stimulation was used to induce movement in the nerve-innervated area, and the relationship between the puncture needle tip and the cervical DRG position was verified using a C-arm X-ray machine. The numerical rating scale (NRS) was used for preoperative and postoperative pain assessment, clinical treatment effectiveness was evaluated, surgical duration and the associated complications were also recorded. Thirty patients exhibited clear cervical DRG images under ultrasound guidance, and the punctures were successful in all patients. Motor electrical stimulation induced movement in the corresponding nerve innervation area in the range of 0.3-0.8 mv in all patients. No serious complications occurred during the procedure. The transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment is effective, convenient, and safe.

Innervation of thumb carpometacarpal joint: implications for diagnostic block and denervation procedures

IntroductionOsteoarthritis (OA) of the thumb carpometacarpal (CMC) joint is a common disorder that negatively impacts hand function. Denervation of the thumb CMC joint has emerged as a viable treatment option....

Age-related changes in olivocochlear efferent innervation in gerbils.

Age-related hearing difficulties have a complex etiology that includes degenerative processes in the sensory cochlea. The cochlea comprises the start of the afferent, ascending auditory pathway, but also receives efferent feedback innervation by two separate populations of brainstem neurons: the medial olivocochlear and lateral olivocochlear pathways, innervating the outer hair cells and auditory-nerve fibers synapsing on inner hair cells, respectively. Efferents are believed to improve hearing under difficult conditions, such as high background noise. Here, we compare olivocochlear efferent innervation density along the tonotopic axis in young-adult and aged gerbils (at ~50% of their maximum lifespan potential), a classic animal model for age-related hearing loss. Efferent synaptic terminals and sensory hair cells were labeled immunohistochemically with anti-synaptotagmin and anti-myosin VIIa, respectively. Numbers of hair cells, numbers of efferent terminals, and the efferent innervation area were quantified at seven tonotopic locations along the organ of Corti. The tonotopic distribution of olivocochlear innervation in the gerbil was similar to that previously shown for other species, with a slight apical cochlear bias in presumed lateral olivocochlear innervation (inner-hair-cell region), and a broad mid-cochlear peak for presumed medial olivocochlear innervation (outer-hair-cell region). We found significant, age-related declines in overall efferent innervation to both the inner-hair-cell and the outer-hair-cell region. However, when accounting for the age-related losses in efferent target structures, the innervation density of surviving elements proved unchanged in the inner-hair-cell region. For outer hair cells, a pronounced increase of orphaned outer hair cells, i.e., lacking efferent innervation, was observed. Surviving outer hair cells that were still efferently innervated retained a nearly normal innervation. A comparison across species suggests a basic aging scenario where outer hair cells, type-I afferents, and the efferents associated with them, steadily die away with advancing age, but leave the surviving cochlear circuitry largely intact until an advanced age, beyond 50% of a species' maximum lifespan potential. In the outer-hair-cell region, MOC degeneration may precede outer-hair-cell death, leaving a putatively transient population of orphaned outer hair cells that are no longer under efferent control.

Determining the Maximum Tolerable Concentration of Ropivacaine to Maintain Sensation of the Nerve Root in Percutaneous Endoscopic Transforaminal Lumbar Discectomy: Can Epidural Anaesthesia Achieve Pain-Tactile Separation Block to Avoid Nerve Injury?

Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC) of ropivacaine concentration for epidural anaesthesia, is defined as the concentration that minimises pain while preserving the sensation of the nerve roots. This distinct advantage allows the patient to provide feedback to the surgeon when the nerve roots are contacted. We used a biased-coin design to determine the MTC, which was estimated by the 10% effective concentration (EC10), ie, the concentration at which 10% of patients lost sensation in the nerve roots. The determinant for positive response was lack of sensory feedback upon contact with the nerve root, and the feedback from occurrence of sensations in the innervation area upon contact with the nerve root was defined as a negative response. Primary outcome was the response from contact nerve root. Secondary outcomes were the type and number of statements of negative response and each patient's pain score during surgery. Fifty-four patients were included in this study. The EC10 was 0.434% (95% CI: 0.410%, 0.440%) using isotonic regression in comparison with 0.431% (95% CI: 0.399%, 0.444%) using probit regression. Three type statements of negative response were reported including "tactile sensation", radiculalgia, and numbness. The MTC of ropivacaine used for epidural anaesthesia was 0.434% to avoid nerve injury in percutaneous endoscopic transforaminal lumbar discectomy.

The Anterior Branch of the Medial Femoral Cutaneous Nerve Innervates Cutaneous and Deep Surgical Incisions in Total Knee Arthroplasty.

Background/Objectives: The intermediate femoral cutaneous nerve (IFCN), the saphenous nerve, and the medial femoral cutaneous nerve (MFCN) innervate the skin of the anteromedial knee region. However, it is unknown whether the MFCN has a deeper innervation. This would be relevant for total knee arthroplasty (TKA) that intersects deeper anteromedial genicular tissue layers. Primary aim: to investigate deeper innervation of the anterior and posterior MFCN branches (MFCN-A and MFCN-P). Secondary aim: to investigate MFCN innervation of the skin covering the anteromedial knee area and medial parapatellar arthrotomy used for TKA. Methods: This study consists of (1) a dissection study and (2) unpublished data and post hoc analysis from a randomized controlled double-blinded volunteer trial (EudraCT number: 2020-004942-12). All volunteers received bilateral active IFCN blocks (nerve block round 1) and saphenous nerve blocks (nerve block round 2). In nerve block round 3, all volunteers were allocated to a selective MFCN-A block. Results: (1) The MFCN-A consistently innervated deeper structures in the anteromedial knee region in all dissected specimens. No deep innervation from the MFCN-P was observed. (2) Sixteen out of nineteen volunteers had an unanesthetized skin gap in the anteromedial knee area and eleven out of the nineteen volunteers had an unanesthetized gap on the skin covering the medial parapatellar arthrotomy before the active MFCN-A block. The anteromedial knee area and medial parapatellar arthrotomy was completely anesthetized after the MFCN-A block in 75% and 82% of cases, respectively. Conclusions: The MFCN-A shows consistent deep innervation in the anteromedial knee region and the area of MFCN-A innervation overlaps the skin area covering the medial parapatellar arthrotomy. Further trials are mandated to investigate whether an MFCN-A block translates into a clinical effect on postoperative pain after total knee arthroplasty or can be used for diagnosis and interventional pain management for chronic neuropathic pain due to damage to the MFCN-A during surgery.

Cause analysis and clinical intervention of C 5 palsy after cervical surgery

To review the research progress of C 5 palsy (C 5P) after cervical surgery, providing new clinical intervention ideas for the C 5P patients. The relevant literature domestically and abroad was extensively consulted and the latest developments in the incidence, risk factors, manifestations and diagnosis, prevention, and intervention measures of C 5P were systematically expounded. C 5P is characterized by weakness in the C 5 nerve innervation area after cervical decompression surgery, manifested as limited shoulder abduction and elbow flexion, with an incidence rate more than 5%, often caused by segmental spinal cord injury or mechanical injury to the nerve roots. For patients with risk factors, careful operation and preventive measures can reduce the incidence of C 5P. Most of the patients can recover with conservative treatment such as drug therapy and physical therapy, while those without significant improvement after 6 months of treatment may require surgical intervention such as foraminal decompression and nerve displacement. Currently, there has been some advancement in the etiology and intervention of C 5P. Nevertheless, further research is imperative to assess the timing of intervention and surgical protocol.

Atypical presentation of tight filum terminale with thoracic disc herniation: a case report

BackgroundTight filum terminale is a rare and challenging condition to diagnose because it presents with nonspecific symptoms and unclear imaging findings. This report documents an atypical case of tight filum terminale.Case presentationThe patient was a previously healthy Asian 18-year-old male presenting with recurrent upper extremity and back pain, initially treated as nonspecific musculoskeletal pain. Notably, the patient’s symptoms were inconsistent with the dermatome, showing no correlation with his skin’s sensory innervation areas. In contrast to typical tight filum terminale presentations focused on lower extremity and lumbar region disturbances, this patient experienced pain and weakness predominantly in the upper extremities and back, hypothesized to result from traction myelopathy exacerbated by thoracic disc herniation. Investigations including blood and nerve function tests were inconclusive. However, a magnetic resonance imaging scan revealed a combination of tight filum terminale and tiny thoracic disc herniation. A diagnosis of tethered spinal cord syndrome was confirmed following further tests and imaging. The filum terminale was surgically removed, resolving the symptoms at a 7-month follow-up.ConclusionsThis case underlines the importance of including tight filum terminale as a differential diagnosis in cases of unexplained upper or lower extremity pain. Primary care practitioners, particularly those managing undefined symptoms, should consider tight filum terminale in their diagnostic approach.

Barrier methods of prevention of epidural fibrosis at the lumbar level after microdiscectomy

The problem of cicatrical adhesion formation not only after microdiscectomies, but also after any spine surgery, remains unresolved to this day, being one of the main issues of spinal surgery. Several trigger mechanisms can be identified in the pathogenesis of epidural fibrosis formation: interaction of intervertebral cartilage components with surrounding tissues, disruption of vertebral canal integrity, dystrophy or complete absence of epidural fat, and presence of blood in the postoperative area. The pain syndrome associated with epidural fibrosis is persistent and increases after walking and prolonged being upright. There may be hyperaesthesia or hyperpathia in the innervation area of the affected roots and brisk tendon reflexes. Many authors are now trying to predict epidural fibrosis by analyzing immunological parameters and osteoprotegerin levels in blood serums, assessing anthropometric measures of patients, and examining the blood coagulation system. In modern neurosurgical society there is a clear view that epidural fibrosis should be prevented, but there are many prevention techniques. The following techniques have been identified: ligamentum flavum plasty and different variants of this operation, placement of an autograft from the inner flap of lumbar fascia into the intercostal space, use of autologous fat, use of fibrin glue, fibrous ring plasty, use of biodegradable membrane, application of anti-adhesion resorbable gel, insertion of wound drainage, use of amniotic sac, chitosan compounds in combination with L-glutamic acid, and many others.

Hand replantation surgery in regional anesthesia - report of two cases

Introduction. Hand replantation is a microsurgical operation on completely or incompletely amputated hand during which the soft tissue and bone structures are reanastomosed and reconstructed. Blockade of peripheral nerves provides anesthesia and analgesia, but also a sympatholytic effect, improving blood flow and offering better perfusion of the replanted tissue. The aim of this paper is to show the importance of regional anesthesia for hand replantation surgery. Case report. Two male patients sustained a traumatic amputation of the hands by working on industrial machines. The patients underwent a microsurgical hand replantation. An ultrasound-guided brachial plexus block was performed through an axillary approach. A 22G, 10 cm needle was used. Bupivacaine 0.25% 30 ml and lidocaine 1.3% 30 ml without adrenaline were injected perineurally. The medial side of the upper arm was infiltrated with lidocaine since it is the area of intercostobrachial nerve innervation that remains unaffected by the brachial plexus block, preventing the pain caused by the pressure from the tourniquet. During the operation, the patients were sedated with midazolam. Postoperatively, the patients were under observation at the Intensive Care Unit. Analgesia was maintained with intravenous nonsteroidal anti-inflammatory drugs and tramadol, and a single-shot blockade of brachial plexus, intramuscular groove approach. Laboratory tests were conducted, and every three hours, the skin color and turgor, capillary refill, and tactile temperature were monitored. Conclusion. Reducing peripheral vascular resistance, preventing vasospasm, and increasing blood flow through the anastomoses increase the chance of successful replantation and reduce postoperative pain and anxiety, which overall affect patients function and comfort.

Physical Medicine and Rehabilitation for Complex Regional Pain Syndromes

A common clinical constellation of pain, sensory, autonomic, motor, or trophic symptoms that can no longer be attributed to the initial trauma characterizes Complex Regional Pain Syndrome (CRPS). These signs and symptoms are not localized to the areas of innervation. Most of the diagnosis is clinical. Following that, mobility difficulties, fluctuating skin temperature, sensory loss and changes in body perception are the prominent symptoms. In acute phases, pharmaceutical treatment may be very beneficial. Empirically, common anti-neuropathic pain medications can be suggested. Physical and occupational therapy, as well as behavioral therapy, are crucial parts of the treatment.

AURICULOTEMPORAL NERVE AND FREY'S SYNDROME

Background: The auriculotemporal nerve is one of the main branches of the mandibular nerve. It provides sensory innervation to the auricle, the scalp in the temporal region, the temporomandibular joint and part of the dura mater, the parasympathetic innervation of the parotid salivary gland, as well as the external surface of the tympanic membrane, and the sympathetic innervation of the sweat glands and of the blood vessels passing through the parotid gland. Its interruption during surgical interventions or trauma can results in its most common disease - Frey's syndrome. This article is an overview and is based on 23 foreign scientific works - articles published in refereed and renowned scientific publications and anatomy atlases by world-renowned and proven specialists in their field. Review Results: The auriculotemporal nerve is a sensory nerve which includes secretory parasympathetic vasomotor sympathetic fibers coming from the otic ganglion. It is a branch of the mandibular nerve (V3). Its five terminal nerve branches are front auricular branches, branches for the external auditory canal, branches for the temporomandibular joint, branches for the parotid gland and superficial temporal branches. Frey's syndrome occurs when the auriculotemporal nerve is cut or injured proximal to the site of separation of the branches for the parotid gland or are severed themselves. The clinical picture characteristic of Frey's syndrome includes redness, sweating, warmth and itching in the area of innervation of the nerve and less often pain. Conclusion: Knowledge of the anatomy of the auriculotemporal nerve and Frey's syndrome are essential for understanding its nature and stand on the basis of its prevention.

Clinical Effects of the End-Love Technique in the Treatment of Recurrent Lumbar Disc Herniation 1 Year After Surgery.

The number of patients with lumbar disc herniation in China is increasing year by year. Percutaneous endoscopic lumbar discectomy (PELD) is currently the main surgical method for treating lumbar disc herniation (LDH). However, with the increase in the number of surgical cases, the number of patients with recurrent lumbar disc herniation (RLDH) is also increasing. Currently, the common method in China is lumbar fusion surgery, but this surgery would cause the loss of fusion segment mobility and considerable postoperative complications. In order to solve the problem above the following technique will be studied: the technique of posterior lumbar laminectomy and nucleus pulposus removal under fully visualized spinal endoscopy (ENDO-LOVE) to treat RLDH. Its clinical effects will be observed in this paper, too. This series includes RLDH patients treated with ENDO-LOVE technology between January 2017 and January 2021. All patients will undergo at least three follow-up visits one year after surgery. The modified MacNab standard, VAS, JOA, and ODI scores will be used to evaluate clinical efficacy, observe for cerebrospinal fluid leak, nerve root injury, and surgical site infection, and evaluate clinical safety. All 29 patients completed the surgery successfully. Three patients had postoperative pain and numbness in the area of nerve root innervation, and all patients had no serious complications. The VAS, JOA scores and ODI indices of back pain and leg pain 1-day, 3-months, and 1-year postoperatively differed statistically significantly from the preoperative scores (p < 0.05). Efficacy evaluated at 1-year postoperatively using the modified MacNab criteria showed an excellent rate of 89.7%. ENDO-LOVE technology has demonstrated good clinical efficacy and safety in the treatment of patients with RLDH. It should be considered for all patients with this condition.

Transcranial Magnetic and Transcutaneous Spinal Cord Electrical Stimulation a Stroke-Patients Walking Correction: Blinded Clinical Randomised Study

INTRODUCTION. The impairment of motor system function due to stroke often leads to patients’ dependence on external assistance. The technique of rhythmic transcranial magnetic stimulation (rTMS) is now widely used in the restoration of impaired central nervous system (CNS) function. In recent years, there has been information about the use of transcutaneous electrical spinal cord stimulation (TSCS) in the correction of motor functions in CNS disorders of various genesis. AIM. To evaluate the possibilities of combined use of transcranial magnetic and transcutaneous electrical stimulation of the spinal cord in the correction of locomotor functions in patients after ischemic stroke. MATERIALS AND METHODS. The conducted blind clinical randomized study involved patients who had an ischemic stroke. Study participants were randomly divided into control (n = 12) and experimental (n = 9) groups. Patients in the control group received standardized neurorehabilitation techniques. The participants of the experimental group were offered standardized neurorehabilitation techniques combined with rTMS and TSCS. High-frequency rTMS was performed in the projection of the sensory-motor cortex on the side of the lesion, in the area of innervation of the lower limb. During TSCS, a stimulating electrode was placed between Th11–Th12, indifferent electrodes were placed in the region of the iliac crests, and the lumbar enlargement of the spinal cord was stimulated. The dynamics of neurological deficit was assessed using the rehabilitation routing scale, the Rivermead mobility index, the Berg balance scale, and a six-point scale for assessing muscle strength. The excitability of the neural networks of the spinal cord was determined using TSCS at the T11–T12 level, with electromyographic recording of the evoked motor responses of the muscles of the lower extremities. RESULTS AND DISCUSSION. The combined use of rTMS and TSCS in the rehabilitation of patients in the acute period after ischemic stroke leads to an increase in the excitability of neuronal networks of the lumbar thickening of the spinal cord, a decrease in the activation thresholds of the RF, BF, TA and GM muscles of the affected limb (by 7.7 ma, 18.3 ma, 24.8 ma and 14.2 ma, respectively). Inclusion of rTMS and TSCS in the rehabilitation course leads to a significant improvement in the rehabilitation routing scale (by 2 points), Rivermead mobility index (by 5.8 points), statokinetic control functions (balance-Berg by 12 points) and an increase in lower limb muscle strength (flexors by 5.1 points, extensors by 6.2 points). CONCLUSION. The use of rTMS and TSCS can be used as an additional effect within the framework of rehabilitation measures in the acute period after ischemic stroke.

Efficacy of CT-guided partial radiofrequency ablation of bilateral responsible cranial nerves in the treatment of Meige syndrome

Objective: To evaluate the efficacy of CT-guided partial radiofrequency ablation of bilateral responsible cranial nerves in the treatment of Meige syndrome. Methods: The Clinical data of 56 patients with Meige syndrome in the Department of Pain Medicine, Affiliated Hospital of Jiaxing University from June 2019 to January 2023 were retrospectively analyzed [19 males and 37 females, aged 42-76 (58.6±8.3) years], including 51 cases of blepharospasm, 3 cases of oromandibular dystonia and 2 cases of blepharospasm concomitant with oromandibular dystonia. CT-guided partial radiofrequency ablation of bilateral responsible cranial nerves was performed on different types of Meige syndrome. And the efficacy and complications of the technique were observed. Results: Fifty-one patients with blepharospasm Meige syndrome underwent CT-guided radiofrequency of facial nerve through bilateral stylomastoid foramen punctures, the symptoms of blepharospasm disappeared completely, leaving bilateral mild and moderate facial paralysis symptoms. Three patients with oral-mandibular dystonia underwent CT-guided radiofrequency therapy by bilateral foramen ovale puncture of mandibular branches of trigeminal nerve, masticatory muscle spasm disappeared, the patients had no difficulty opening the mouth, and the skin numbness in bilateral mandibular nerve innervation area was left. Two cases of Meige syndrome with blepharospasm concomitant with oromandibular dystonia were treated by radiofrequency of facial nerve and mandibular branch of trigeminal nerve, and all symptoms disappeared. The patients were followed up for 1-44 months after the operation, and the symptoms of mild and moderate facial paralysis disappeared at (3.2±0.8) months after the operation, but the numbness did not disappear. Three patients with blepharospasm recurred at the 14, 18 and 22 months after the operation, respectively, while the rest cases did not recur. Conclusions: According to different types of Meige syndrome, CT-guided partial radiofrequency ablation of responsible cranial nerves can effectively treat the corresponding type of Meige syndrome. The complications are only mild and moderate facial paralysis which can be recovered, and/or skin numbness in the mandibular region.

High-resolution volumetric imaging constrains compartmental models to explore synaptic integration and temporal processing by cochlear nucleus globular bushy cells.

Globular bushy cells (GBCs) of the cochlear nucleus play central roles in the temporal processing of sound. Despite investigation over many decades, fundamental questions remain about their dendrite structure, afferent innervation, and integration of synaptic inputs. Here, we use volume electron microscopy (EM) of the mouse cochlear nucleus to construct synaptic maps that precisely specify convergence ratios and synaptic weights for auditory nerve innervation and accurate surface areas of all postsynaptic compartments. Detailed biophysically based compartmental models can help develop hypotheses regarding how GBCs integrate inputs to yield their recorded responses to sound. We established a pipeline to export a precise reconstruction of auditory nerve axons and their endbulb terminals together with high-resolution dendrite, soma, and axon reconstructions into biophysically detailed compartmental models that could be activated by a standard cochlear transduction model. With these constraints, the models predict auditory nerve input profiles whereby all endbulbs onto a GBC are subthreshold (coincidence detection mode), or one or two inputs are suprathreshold (mixed mode). The models also predict the relative importance of dendrite geometry, soma size, and axon initial segment length in setting action potential threshold and generating heterogeneity in sound-evoked responses, and thereby propose mechanisms by which GBCs may homeostatically adjust their excitability. Volume EM also reveals new dendritic structures and dendrites that lack innervation. This framework defines a pathway from subcellular morphology to synaptic connectivity, and facilitates investigation into the roles of specific cellular features in sound encoding. We also clarify the need for new experimental measurements to provide missing cellular parameters, and predict responses to sound for further in vivo studies, thereby serving as a template for investigation of other neuron classes.

Study on the Effect of Acupuncture, Massage, and Functional Exercise in the Treatment of Patients with Lumbar Disc Herniation

Lumbar intervertebral disc herniation is a common orthopedic disease, mainly manifested by low back pain, weakness, paralysis of lower extremity sarcomere, or abnormal distribution of dermatomes. Surgery is required in 10%-18% of patients. For lumbar disc herniation, the common ones include posterior small incision discectomy, percutaneous endoscopic lumbar discectomy, posterior microendoscopic discectomy, and foraminal endoscopic nucleus pulposus removal, Intervertebral fusion, etc. However, it is often accompanied by residual symptoms such as lumbar mobility disorder, lumbar swelling and pain, abdominal distension, constipation, lower limb strength, and hyperalgesia in the nerve root innervation area of the lower limb. Acupuncture has the characteristics of simple treatment, effective effect, and high acceptance. It can relieve postoperative pain and improve various physiological and biochemical functions by regulating qi, blood, yin, and yang. With the continuous development and change of acupuncture techniques, traditional acupuncture treatments and various innovative acupuncture treatments have achieved good clinical effects in rehabilitation.

First case-series of robot-assisted pudendal nerve release: technique and outcomes.

Pudendal Nerve Entrapment (PNE) may determine chronic pelvic pain associated with symptoms related to its innervation area. This study aimed to present the technique and report the outcomes of the first series of robot-assisted pudendal nerve release (RPNR). 32 patients, who were treated with RPNR in our centre between January 2016 and July 2021, were recruited. Following the medial umbilical ligament identification, the space between this ligament and the ipsilateral external iliac pedicle is progressively dissected to identify the obturator nerve. The dissection medial to this nerve identifies the obturator vein and the arcus tendinous of the levator ani, which is cranially inserted into the ischial spine. Following the cold incision of the coccygeous muscle at the level of the spine, the sacrospinous ligament is identified and incised. The pudendal trunk (vessels and nerve) is visualized, freed from the ischial spine and medially transposed. The Median duration of symptoms was 7 (5, 5-9) years. The median operative time was 74 (65-83) minutes. The median length of stay was 1 (1-2) days. There was only a minor complication. At 3 and 6months after surgery, a statistically significant pain reduction has been encountered. Furthermore, the Pearson correlation coefficient reported a negative relationship between the duration of pain and the improvement in NPRS score, -0.81 (p = 0.01). RPNR is a safe and effective approach for the pain resolution caused by PNE. Timely nerve decompression is suggested to enhance outcomes.

КЛИНИЧЕСКАЯ АНАТОМИЯ КРОВОСНАБЖЕНИЯ И ИННЕРВАЦИИ ПЕРЕДНЕБОКОВОЙ БРЮШНОЙ СТЕНКИ В ПРАКТИКЕ ХИРУРГА

The arterial blood supply of the anterior abdominal wall comes from the superior, inferior, and superficial suprailiac arteries, the superficial and deep arteries enveloping the iliac crest, the external genital artery, the lumbar and intercostal arteries. The innervation of the anterior abdominal wall is carried out by the intercostal nerves, branches of the iliopsoas and iliac-subiliac nerves. All of these structures may have different topography in each particular patient. Most variations will not be pathologic, but they are worth keeping surgeons in mind when performing surgical interventions. For example, in severe sclerosis of the distal arteries or aorta, or in the case of aortic coarctation, there is significant vessel dilation to provide blood supply to the lower extremities. Transection of the epigastric arteries in such cases can lead to more severe bleeding and ischemia of the lower extremities. Variation in the location of the branch of the deep inferior epigastric artery, the crown of death, occurs in 77% of patients and can cause life-threatening hemorrhagic shock. Also of clinical importance is the replacement of the areas of sensitive innervation of the iliopsoas and iliac-subiliac nerves during operations on inguinal hernia and during blockade anesthesia. Thus, surgeons need to be aware of variations in the blood supply and innervation of the anterolateral abdominal wall during surgical interventions, particularly during trocar insertion and other surgical manipulations. In order to improve surgical technique, it is suggested to introduce convenient and relatively inexpensive neuroimaging or neuromapping methods into routine practice.

Anteromedial coronoid facet fractures and associated ligament lesions: A case series

IntroductionVarus posteromedial rotational injury mechanisms lead to fractures of the coronoids process' anteromedial facet. As these fractures are often unstable, rapid fracture treatment is vital to prevent progressive osteoarthritis. Materials and methodsTwelve patients with a fracture of the anteromedial facet treated surgically were enrolled in the study. Computed tomography images were used to classify the fractures according to the system by O'Driscoll et al. Clinical follow-up included each patient's medical record, surgical treatment algorithm, all complications encountered during the follow-up period, Disabilities of the arm, shoulder, and hand score, subjective elbow value, and pain. ResultsA total of 8 men (66.7%) and 4 women (33.3%) were treated surgically and followed-up after a mean period of 45 ± 23 months. The mean DASH score was 11.9 ± 12.9 points. One patient complained of transient neuropathy in the innervation area of the ulnar nerve, however, this existed already pre-operatively and resolved after less than three months. ConclusionsThe presented patient cohort shows that AMF fracture of the coronoid process are unstable lesions according to the bony instability and the frequently ruptured collateral ligament complexes which need to be addressed. The MCL seems to be affected more frequently than previously appreciated. Level of evidenceLevel IV; Case Series; Treatment Study.

The language-related cerebro-cerebellar pathway in humans: a diffusion imaging-based tractographic study.

The cerebellum and cerebral cortex form the most important cortico-cerebellar system in the brain. However, diffusion magnetic resonance imaging (MRI)-based tractography of the connecting white matter between the cerebellum and cerebral cortex, which support language function, has not been extensively reported on. This work aims to serve as a guideline for facilitating the analysis of white matter tracts along the language-related cerebro-cerebellar pathway (LRCCP), which includes the corticopontine, pontocerebellar, corticorubral, rubroolivary, olivocerebellar, and dentatorubrothalamic tracts. The LRCCP templates were developed via processing the high-resolution, population-averaged atlas available in the Human Connectome Project (HCP)-1065 dataset (2017 Q4, 1,200-subject release) in DSI Studio. The deterministic tracking was performed with the manually selected regions of interest (ROIs) on this atlas according to prior anatomic knowledge. Templates were then applied to the MRI datasets of 30 health participants acquired from a single hospital to verify the practicability of the tracking. The diffusion tensor and shape analysis metrics were calculated for all LRCCP tracts. Differences in the tracking metrics between the left and right hemispheres were compared, and the related white matter asymmetry was discussed. The LRCCP templates were successfully created and applied to healthy participants for quantitative analysis. Significantly higher mean fractional anisotropy (FA) values were discovered on the left (L) corticorubral tract [L, 0.43±0.02 vs. right (R), 0.41±0.02; P<0.01] and left dentatorubrothalamic tract (L, 0.47±0.02 vs. R, 0.46±0.02; P<0.01). Significant differences in tract volume and streamline number were observed between the corticopontine, corticorubral, and dentatorubrothalamic tracts. The size of the right corticopontine and corticorubral tracts were smaller, and both had smaller streamline numbers and innervation areas when compared with the contralateral sides. The R dentatorubrothalamic tract showed a larger volume (R, 23,582.47±4,160.71 mm3 vs. L, 19,821.27±2,983.91 mm3; P<0.01) and innervation area (R, 2,117.37±433.98 mm2 vs. L, 1,610.00±356.19 mm2; P<0.01) than did the L side. No significant differences were observed in the rubroolivary tracts. This work suggests the feasibility of applying tractography templates of the LRCCP to quantitatively evaluate white matter properties associated with language function. Lateralized diffusion metrics were observed in preliminary experiments. LRCCP tractography-based research may provide a potential quantitative method to better understanding neuroplasticity.