Incidence Of Anatomical Variations Research Articles

Pulmonary Vein Remodeling Between Atrial Fibrillation Subtypes: A Matched Comparison Cardiac Computed Tomography-Based Study Between Patients With Paroxysmal and Persistent Atrial Fibrillation

Although pulmonary vein (PV) isolation is the cornerstone for atrial fibrillation (AF) ablation; no data exist comparing the PV anatomy between the AF subtypes directly. We aimed to compare the PV anatomic characteristics between paroxysmal AF (PAF) and persistent AF (PeAF) in a matched population using cardiac computed tomography. A total of 58 patients with PeAF (with cardiac computed tomography before the first AF ablation procedure, absence of valvular disease/previous cardiac intervention), and 58 age-, gender-, and body surface area-matched patients with PAF were evaluated for left atrial (LA) and PV anatomy: ostial area, ovality index, and transverse/frontal angles. In the PeAF versus PAF group, other than a higher LA volume index; the PV ostial areas were significantly larger (between 64 and 101mm2, p <0.001 for all PVs; remaining valid after LA volume index adjustment for left superior PV [LSPV], left inferior PV [LIPV], and right superior PV); the left PVs were less oval (0.7 to 0.11 ovality index decrease, p=0.039 for LSPV; p=0.012 for LIPV); and the LSPV (p=0.019), LIPV (p <0.001), and right inferior PV (p=0.029) were more posteriorly directed; whereas the LSPV (p=0.002) and right superior PV (p=0.043) were more superiorly directed. The incidence of anatomic variations or early branching was not different. This study showed significant anatomic PV differences between patients with PeAF and PAF in terms of PV orientation, ostial size, and ovality. Anticipating such anatomic differences may aid in choosing the adequate catheter design and technology for PeAF ablation.

Assessment of Congenital Anomalies Encountered During Laparoscopic Cholecystectomy

Objective: To determine the congenital anomalies encountered during laparoscopic cholecystectomy.&#x0D; Methodology: The study was conducted in the Department of Surgery from February 2021 to July 2021 following ethical approval, included patients scheduled for cholecystectomy due to gallstone disease. Both male and female participants aged 18 to 60 years who consented to participate were encompassed. Laparoscopic techniques under general anesthesia were employed, and anomalies observed during surgery were meticulously documented using a predefined proforma. Subsequently, all collected data were entered and subjected to analysis using SPSS version 26.&#x0D; Results: A total of 143 patients were included in the analysis. The average age of the patients was 41.34 years, and the average duration of hospital stay was 6.28 days. The overall incidence of congenital anomalies among patients who underwent laparoscopic cholecystectomy was 18.88%. The most common anomaly observed was cystic artery anomalies, affecting 8.39% of patients, followed by cystic duct anomalies (3.49%), right hepatic duct anomaly (2.79%), gall bladder anomalies (2.9%), and the least common being the presence of a common hepatic artery (1.39%).&#x0D; Conclusion: In summary, the study revealed an overall incidence of anatomical variations during laparoscopic cholecystectomy of 18.88%, with cystic artery anomalies emerging as the most common variation. It is essential to consider these anomalies during the procedure to mitigate potential complications.

Morphological study of the anatomical variations of anterior belly of digastric muscle in Brazilian cadavers.

Cases of variations in anterior belly of the digastric muscle must be carefully identified to avoid misinterpretations and assist in the correct surgical or aesthetic procedure and help in the teaching of anatomy. The aim of this study was to describe the anatomical variations of anterior belly of digastric muscle in Brazilian cadavers. Thirty-one human heads were selected, from adult cadavers (18-80 years, 29 males and 2 females). The morphology of the anterior belly of the digastric muscle was observed, identifying the possible anatomical variations that were characterised and classified according to the amount of muscle bellies, fibre direction and place of origin and insertion. The morphometric measurements were performed using a digital calliper. To analyse the data obtained, photographic documentation, anatomical description and individual morphometric description of each muscle belly were performed. The incidence of anatomical variation was obtained in percentage (%). The anatomical variation of the anterior belly of the digastric muscle was present in 6 cadavers (19.31%; 1 female and 5 male). All anatomical variations presented an accessory belly to the anterior belly. However, these accessory bellies were configured differently in the location, direction of muscle fibres and in their dimensions (length and width). The gross anatomy of the anterior belly of the digastric muscle and their variations is important to assist in surgical procedures, pathological or diagnostic function. In addition, asymmetrical variations in the submental region must be carefully identified to avoid misinterpretations.

Prevalence of anatomical variations in children with congenital lung malformations investigated by video recordings of thoracoscopic lobectomy

Background: Sufficient knowledge of anatomy including normal patterns and aberrant variations is crucial in thoracoscopic lobectomy for congenital lung malformations (CLMs). This study aimed to investigate the prevalence of anatomical variations and their correlations with surgical outcome. Methods: Video-recordings of thoracoscopic lobectomy performed for CLMs between 2009 and 2021 were reviewed. The incidences of surgically relevant variations, including abnormal branches of pulmonary arteries and veins, aberrant systemic arteries, and incomplete fissures (as classified by Craig) were assessed in comparison with the previously published reports. Moreover, multiple univariate analyses were performed to seek correlations between surgical finding and prolonged operative times and postoperative drainage. Results: Fifty-six lobectomies were reviewed. Variations of pulmonary arteries were more commonly seen in the left lung (29.6%) compared to right (10.7%). The prevalence of atypical pulmonary venous branches was similar between the right (13.8%) and left (18.5%). The right upper oblique fissure was frequently associated with Grade 2 incomplete fissure (44.8%). Grade 3 incomplete fissure was rare (3.4%) in the right lower oblique fissure but relatively common (14.3 – 18.5%) in other locations. Grade 4 incomplete fissure was limited to the right horizontal fissure (1.7%). Multiple univariate analyses demonstrated a significant correlation between any degree of incomplete fissure and prolonged operative time (p < 0.05), whereas no factor was identified to affect need for postoperative drainage. Conclusions: The incidence of anatomical variations in CLM patients was similar to that reported in adults. Review of intra-operative video footage was useful to closely evaluate and understand anatomical variations.

Mid-term Outcomes of Endovascular and Hybrid Procedures to Treat Complex Aortic Arch Pathologies

Purpose: To compare the mid-term outcomes of endovascular and hybrid procedures in treating aortic arch pathologies with an unfavorable proximal landing zone, and analyze the different indications of the 2 methods. Methods: We collected the clinical data from 59 patients with complex aortic arch pathologies who underwent endovascular or hybrid surgery from March 2018 to April 2020 at a single center. Among the patients, 45 were treated by branched or fenestrated surgery and 14 by hybrid surgery. The clinical data of preoperative, perioperative, and postoperative results were retrospectively analyzed and compared. The main study indexes were the branch patency rate and endoleakage rate during the follow-up period. The secondary study indexes included the operation success rate, operative time, hospital expenses, complication incidence, freedom from reintervention rate, mortality, etc. Results: The operation success rate of all the groups was 100%. The hospital expenses of the hybrid group were lower than those of the endovascular group (p<0.05). The operative time of the hybrid group was longer than that of the endovascular group (p<0.05). The incidence of anatomic variants in the hybrid group was 28.6%, which was significantly higher than that in the endovascular group (2.2%, p=0.011). However, there were no significant differences in operative bleeding, ventilator use duration, and treatment time in intensive care units between the 2 groups (p>0.05). Follow-up was conducted for a period of 12 to 34 months. Four patients of the hybrid group experienced numbness of the upper limb (28.57%); the proportion was higher than the endovascular group (0%, p=0.002). There were no significant differences in the occurrence of endoleaks, retrograde aortic dissection, target lesion, secondary operation, branch patency rate, paraplegia, cerebral apoplexy, renal failure, or other complications in either group (p>0.05). The mortality of the endovascular group was 6.67% (3/45). Overall cumulative survival at 1 year was 100% in the hybrid group and 93.3% in the endovascular group. There was no statistical difference in the increase of the true lumen between the 2 groups for vascular remodeling (p>0.05). Conclusion: The hybrid surgery costs less and proves more suitable for treating variants of the aortic arch. The endovascular treatment still has limitations due to anatomical conditions.

PDA (Posterior Descending Artery) &amp; Coronary Dominance-A MDCT Coronary Angiographic Analysis of Anatomic Variations and Clinical Importance

Introduction: There is considerable variation in the arterial supply of diaphragmatic surface of the heart. Diaphragmatic myocardial infarction is one of the more common consequences of coronary artery disease. The aim of this study was to assess the incidence of anatomic variants of origin and termination of Posterior Descending Artery (PDA) and to determine the type of coronary dominance in North Indian population. Subjects and Methods: This prospective study was carried out on 50 routine subjects of different age groups who came to the Department of Radiodiagnosis, King George’s Medical University UP, Lucknow in the year 2010- 2011 with known or suspected coronary artery disease. All the cases were investigated on a 64 slice Multidetector Computed Tomographic (MDCT) scanner, using retrospective Electrocardiographic gating. Endeavour was made to determine the incidence of sites of origin and termination of PDA as well as to determine the type of coronary dominance. Results: PDA arose from Right Coronary Artery (RCA) in 39 (78%) cases and from Left Circumflex (LCx) artery in 11(22%) cases. The PDA was found to terminate in the upper 1/4 of Posterior Inter-Ventricular Groove (PIVG) in 18 (36%) cases, in upper 1/2 of PIVG in 19 (38%) cases, in upper 3/4 of PIVG in 10 (20%) cases and at the apex of the heart in 1 (2%) case. None of the female had termination of PDA at the apex. Termination of PDA could not be determined in 2 (4%) cases. Right dominance was seen in 36 (72%) cases, Left dominance in 11 (22%) cases. and Co-dominance in 3 (6%) cases. Conclusion: Posterior descending artery most commonly terminated after traversing the upper half of posterior inter-ventricular groove. The incidence of left coronary dominance was more in females, it was approximately twice the incidence found in males. Co-dominance was observed only in male subjects.

Variações anatômicas do nervo isquiático associadas ao músculo piriforme em fetos e crianças de até 1 ano de vida pós-natal

The sciatic nerve and the piriformis muscle are closely related structures due to their anatomy, in which the nerve passes below the muscle in its normal path. For this reason, any anatomical changes can cause sciatic pain. Considering the importance of knowing the variations of these two structures, we aim to evaluate and describe the relationship of the sciatic nerve with the piriformis muscle in cadavers of human fetuses and of children up to one year of postnatal life. Eighty-seven individuals preserved by the Giacomini method, all belonging to the didactic collection of the Department of Anatomy of the Institute of Biomedical Sciences of the University of Sao Paulo (DA / ICB-USP), were dissected. Of the individuals studied, 70 had fetal ages ranging from 18 to 28 weeks of intrauterine life (IU) and 17 individuals from stillbirth to one year of postnatal life. Of the total, 40 were male and 47 female. 19 individuals presented variations: 14 with the sciatic nerve dividing before their arrival in the region of the piriformis muscle and 5 with a variation in the path of the sciatic nerve. No statistical correlations were found for the incidence of anatomical variations of the sciatic nerve with age, gender or antimere.

Evaluation of the rabbit liver by direct portography and contrast-enhanced computed tomography: anatomical variations of the portal system and hepatic volume quantification

BackgroundThe study was aimed at: (1) describing the incidence of anatomic variations of the portal system in the rabbit using direct portography; and (2) estimating the liver volume and caudate lobe volume by using contrast-enhanced computed tomography (CECT) in the same animal model.MethodsForty-six New Zealand white rabbits were included. All of them underwent direct portography and unenhanced CECT. Conventional liver rabbit portal system anatomy (type 1) consisted of the bifurcation of the main portal vein (MPV) into the right portal vein (RPV) and left portal vein (LPV), which subsequently divided into medial left portal vein and lateral left portal vein. Trifurcation of the LPV was considered type 2. The LPV that divides into four smaller branches was classified as type 3. Other configurations of the portal system, including particular cases of MPV branching, were grouped as type 4. Liver lobes were manually segmented.ResultsThe incidence of each type of portal system anatomy was: type 1, 67.4%; type 2, 15.2%; type 3, 13.0%); and type 4, 4.3%. The mean volume of the caudate lobe was 19.1 ml ± 5.7 ml and of the cranial lobes it was 66.7 ml ± 13.7 ml, and the total liver volume was 85.7 ml ± 16.7 ml.ConclusionsIn New Zealand white rabbits, type 1 is the prevalent type of portal system, liver volume is about 86 ml, and the caudate and cranial lobes are separated. This information could be important when planning experimental rabbit liver procedures.

Anatomical variations in dorsal metatarsal arteries with surgical significance: A cadaveric study

Introduction: Based on angiosome concept to revascularize a particular artery, the microvascular and reconstructive surgeons must know the anatomy and variations in the arteries in that specific region of the body to achieve better results. Nowadays, dorsal metatarsal artery (DMTA) perforator flaps and toe grafts are becoming popular which also demand adequate information about normal anatomy and variants in these arteries for fruitful results. Materials and Methods: The authors studied normal anatomy and variations in the origin of DMTAs in 50 lower extremities of 25 embalmed cadavers. Results: The authors found many variations as the absence of DMTAs, origin of the DMTA from the deep plantar arch. The places wherever the arcuate artery was absent the lateral tarsal artery gave rise to dorsal metatarsal arteries. Conclusion: Being familiar with the incidence of anatomical variations in the origin of the DMTAs can increase vigilance in vascular and reconstructive surgeries leading to better prognosis. surgeries leading to better prognosis.

Anatomic Variations in Paranasal Sinuses of Patients With Sinonasal Polyposis

Although sinonasal anatomic variations have been postulated as a risk factor for sinus disease, the role of anatomic abnormalities in the pathogenesis of nasal polyps is still unclear. This study was conducted to examine the association of sinonasal polyposis with anatomic variations. The paranasal sinus computerized tomography scans of 155 patients with sinonasal polyposis were examined retrospectively from January 2012 to 2014 in a tertiary care hospital. Paranasal sinus computerized tomography of 100 patients without complaints and signs of sinus disease were also included to serve as control group. The incidence of anatomic variations was evaluated. The sinonasal polyposis and control group data was compared statistically. The incidence of the septal deviation, concha bullosa, Agger nasi, frontal sinus hypoplasiaand accessory sinus ostium in healthy subjects, and sinonasal polyposis patients revealed statistically significant difference. The mentioned variations were found significantly higher in sinonasal polyposis patients (P = 0.000, P = 0.000, P = 0.001, P = 0.002, and P = 0.035 respectively) and may be predisposing for this pathology. Considering the results obtained, the presence of septal deviation, concha bullosa, Agger nasi cell, frontal sinus hypoplasiaand accessory sinus ostium may play role in pathogenesis of sinonasal polyposis.

Anatomical Variations of the Transverse-Sigmoid Sinus Junction: Implications for Endovascular Treatment of Idiopathic Intracranial Hypertension.

Venous sinus pathology can result in multiple pathological diseases, including idiopathic intracranial hypertension (IIH). There remains a paucity of information on anatomical luminal variations of the major venous sinuses which may contribute to the etiology of certain disease states. Thirty-six transverse and sigmoid sinuses were removed following dissection of 19 unfixed cadaveric heads. Sinuses were opened longitudinally to study luminal variations. A semiquantitative classification system was developed to assess septations and blind pouches. Seventy-nine percent of cadavers had a luminal anatomical variation. Forty-four percent and 42% of sinuses dissected had occurrence of a septations or blind pouches, respectively. Thirty percent of septations and 25% of pouches were classified as large. Incidence of anatomical variations was not statistically significant between cadaver gender or sinus laterality. Luminal variations are present in the transverse and sigmoid sinuses at rates higher than expected. This study is the first to report the presence of blind pouches in the luminal wall of transverse and sigmoid sinuses. These variations can have clinical importance to the endovascular surgeon and may also contribute to the pathophysiological etiology of venous sinus diseases. Anat Rec, 299:1037-1042, 2016. © 2016 Wiley Periodicals, Inc.

Imaging study of the anatomical variations and the maxillary sinus pathology in patients with missing lateral teeth for the application of dental implants

Preoperative evaluation of maxillary sinus anatomy is very important to avoid surgical complications due to close anatomical relations between the sinus and the posterior maxillary teeth and/or edentulous alveolar ridge. Posterior superior alveolar artery is a branch of the maxillary artery and provides the vascularization of the lateral sinus wall and underlying mucosa. Maxillary artery branches should be taken into consideration during sinus lifting procedures and bone augmentation due to increased risk of bleeding by damaging the artery during the osteotomy. Computed tomography (CT) explores three-dimensional anatomic structures and provides complex and accurate information about them. Cone Beam Computed Tomography (CBCT) offers an accurate view of the teeth and surrounding structures at high resolution, despite low-dose radiation used. In this study, the incidence of anatomical variations and sinus pathology were assessed using CBCT. The aim is to evaluate the presence of sinus pathology (sinus mucosal thickening, oro-antral communications, sinus tumors, cysts, polyps), presence and position of the posterior superior alveolar artery. These issues are important because they are about the limits of the dental implants in the posterior maxillary area. The presence of sinus pathology and anatomical variations may predispose to complications and even failures of implantation therapy.

Anatomical structure and topographic anatomy of sciatic nerve in human fetuses

IntroductionSciatic nerve is the longest and thickest nerve of the human body which divides into two branches in popliteal fossa. Variations of sciatic nerve can be observed during the course of the nerve. These anatomical variations contribute to some clinical manifestations such as piriformis syndrome, sciatalgia. MethodsThis study was conducted on 60 aborted fetuses aged between 9 and 40 gestational weeks and with no gross anomalies. Morphometrical measurements related to the nerve and the neighboring structures were performed and also incidence of anatomical variations was determined. ResultsAll parametric data were seen increased with gestational age (p<0.05). Also, no statistical differences between the parameters from right and left were found (p>0.05). The sciatic nerve division was observed in 99 (82.5%) lower extremities in the popliteal fossa, 19 (15.83%) at a level above the popliteal fossa, and in 2 lower extremities (1.67%), high division was observed. Also, the status of sciatic nerve was assessed in regard to piriformis muscle. In 118 of the lower extremities (98.3%), sciatic nerve was observed leaving from underneath the piriformis muscle as one piece and the remaining 2 (1.67%) were observed as giving division at higher levels. In one of these lower extremities of the right side, tibial nerve branch was observed following a path under piriformis muscle and common peroneal nerve was observed passing through the piriformis nerve. DiscussionWe believe that our study will provide data regarding the development of sciatic nerve in fetal period and that data will contribute to related clinical studies and applications.

A study of sacral anthropometry to determine S1 screw placement for spinal lumbosacral fixation in the Korean population.

1. To investigate the incidence of closed-type PSIS in the Korean population. 2. To categorize the morphological features of Korean sacrum. 3. To measure the safe marginal length and angle for screw fixation considering the PSIS and course of the external iliac vein, using a Korean sacrum model. We performed our study in 160 sacra including the pelvic ring obtained from 80 Korean cadavers. The bony measurements were obtained by performing 1-mm computed tomography cuts from the L5 lumbar vertebra to the pelvic ring and excluding other structures. We evaluated the incidence of anatomic variation of the PSIS and measured the safe marginal length and angle for screw fixation considering the PSIS and course of the external iliac vein, using a Korean sacrum model. Our study showed that the closed type of PSIS is more frequent in males than in females. The optimal angle for screw fixation is 16.91 ± 6.85 (°), while the left side S1 pedicle insertion angle is 16.00 ± 6.20 (°). The average Korean optimal screw length is 58.35 ± 14.90 (cm) for the right side and 55.89 ± 16.16 (cm) for the left side. With reference to these parameters, the optimal screw length and angle can be chosen and bicortical anteromedial screw fixation can be easily and safely performed.

Incidence of anatomical variations and disease of the maxillary sinuses as identified by cone beam computed tomography: a systematic review.

To analyze available evidence on the incidence of anatomical variations or disease of the maxillary sinuses as identified by cone beam computed tomography (CBCT) in dentistry. A focused question was developed to search the electronic databases MEDLINE, EMBASE, the Cochrane Oral Health Group Trials Register, and CENTRAL and identify all relevant papers published between 1980 and January 19, 2013. Unpublished literature at ClinicalTrials.gov, in the National Research Register, and in the Pro-Quest Dissertation Abstracts and Thesis database was also included. Studies were included irrespective of language. These results were supplemented by hand and gray literature searches. Twenty-two studies were identified. Twenty were retrospective cohort studies, one was a prospective cohort study, and one was a case control study. The main indication for CBCT was dental implant treatment planning, and the majority of studies used a small field of view for imaging. The most common anatomical variations included increased thickness of the sinus membrane, the presence of sinus septa, and pneumatization. Reported sinus disease frequency varied widely, ranging from 14.3% to 82%. There was a wide range in the reported prevalence of mucosal thickening related to apical pathology, the degree of lumenal opacification, features of sinusitis, and the presence of retention cysts and polyps. More pathologic findings in the maxillary sinus were reported in men than in women, and the medial wall and sinus floor were most frequently affected. CBCT is used primarily to evaluate bony anatomy and to screen for overt pathology of the maxillary sinuses prior to dental implant treatment. Differences in the classification of mucosal findings are problematic in the consistent and valid assessment of health and disease of the maxillary sinus.

Pattern of variations in superficial palmar arch in 134 Negro cadaveric hands.

To investigate the incidence of anatomical variations of superficial palmar arch in Negro population. A total of 134 upper limbs comprising 74 right and 60 left specimens embalmed with formaldehyde were used for the investigation. The hand was dissected with palmar aponeurosis identified and removed to expose the ulnar and radial arteries. A complete superficial arch was observed in 73.9% specimens. In 70.1% cases the superficial branch of the ulnar artery communicated with its radial arterial counterpart. In 3.0% cases the arch was formed entirely by the ulnar artery while in a single case (0.8%), a rare pattern was observed in which the superficial palmar branch of the ulnar artery gave rise to the princeps pollicis artery as its terminal branch with the exclusion of radialis indicis that had its origin from deep palmar branch of radial artery. The incomplete arch constituted 26.1% of the entire palmar arch formation. In our Negro population study, deviation from normal anatomical pattern was common. Therefore, a review of vascular pattern prior to invasive or intervention surgery is strongly recommended to be able to detect anomalies likely to necessitate modification of surgical procedures.

Comparative analysis of mandibular anatomical variations between panoramic radiography and cone beam computed tomography

The objective of this study is to compare the ability of panoramic radiography and cone beam computed tomography (CBCT) in detecting anatomical variations of the mandibular canal and mental foramen. One hundred twenty-seven preoperative panoramic and CBCT images were evaluated. Two oral and maxillofacial radiologists investigated the presence of bifid mandibular canals and/or additional mental foramina on the right, left, or both sides of the mandible. Intra- and interobserver reliability was determined using Cohen's kappa coefficient. McNemar's test compared the prevalence of mandibular anatomical variations between panoramic radiography and CBCT. The significance level was set at 0.05. Additional mental foramen and bifid mandibular canal were detected in 1.2 and 7.4 % of the panoramic radiographs and 7.4 and 9.8 % of the CBCT images, respectively. The incidence of anatomical variations on the mandibular canal was not significantly different between both imaging modalities (P > 0.05). Although CBCT provides better viewing of anatomical structures, including location, shape, and relationship with the surrounding area, panoramic radiography is a conventional imaging modality that can be used in the study of the bifid mandibular canals.

Variações da artéria hepática: estudo anatômico em cadáveres

to demonstrate the minutiae of hepatic arterial system, the incidence of anatomical variations and to compare data obtained from the literature, thus contributing with students and professionals working in this area. We prepared 45 corpses at the Department of Anatomy of the Pontifical Catholic University of Paraná, between July 2010 and April 2011, of which group 30 displayed integrity of structures. We analyzed the anatomical variations of the hepatic arteries, their main characteristics, such as origin, course, length and diameter. The overall result was expressed as frequency and percentage of cadavers with anatomic variations of the hepatic arterial system. The estimative of this percentage was done by constructing a confidence interval of 95%. There was some kind of anatomical variation in 40% (n = 12) of cadavers. We found 02 variations in the common hepatic artery, 03 in the gastroduodenal artery, 03 in the right hepatic artery, 01 in the left hepatic artery, 01 in the right gastric artery, and 02 in cystic artery. As for the celiac artery, there were variations in length, diameter and height in its origin, which was common on the aorta. The variation of right hepatic artery originating from the superior mesenteric artery was found in 10% (n = 3) of the specimens studied and it was considered the most prevalent type of variation in this study. Changes in hepatic arteries are frequently found and in this study their incidence was 40%, similar to the literature. The most significant change, observed in 10% (3 cases), was the right hepatic artery with its origin in the superior mesenteric artery.

The medial loop of the V2 segment of the vertebral artery and the importance of this variation in correlation with the resection safe zone and technical characteristics of spinal cages during anterior cervical approaches

Dear Editor, Reviewing the literature, the incidence of anatomic variations of the V2 segment of the vertebral artery (VA), is relatively high. Furthermore, ignoring a medial loop of the V2 segment can potentially lead to severe complications during anterior approaches to the cervical spine. We studied the course of 400 vertebral arteries on 190 magnetic resonance imaging and ten contrast-enhanced computed tomography scans from our archive between May 2011 and June 2012. In our study, patients with MRI or CT axial sections from C3 to C7 were included regardless of the underlying pathology. In nine patients (4, 5 %), the V2 segment of the vertebral artery formed a medial loop with distance to the midline 8 mm and 8 mm except in one level (one in 360 cervical levels) [4]. Furthermore, anterior cervical diskectomy 8–10 mm from the midline and width of cervical corpectomy 16–18 mm centered on the midline have been suggested in the literature as safe resection zones [3]. The width and adequacy of cervical corpectomy remains a controversial topic, especially in cases of an unusual medial loop of the V2 segment. It could be technically challenging to avoid the injury of VA and achieve an adequate anterior decompression. Careful choice of cages regarding their width is a prerequisite for anterior cervical diskectomy and corpectomy procedures. According to our study, during drilling for anterior cervical approaches, this variation is likely to be encountered at 7–11 mm depth of vertebral body or intervertebral disk space. In such cases, the application of intraoperative Doppler could be invaluable. Knowledge of the aforementioned anatomic variation of the V2 segment is important for the avoidance of inadvertent injury of the vertebral artery during anterior cervical spine approaches [2], with potentially catastrophic complications for the patient. Given the relatively high incidence of a V2 N. Gkekas (*) :N. Georgakoulias Department of Neurosurgery, Athens General Hospital, G. Gennimatas, Mesogeion 154, Athens, Greece 11526 e-mail: nikolaosgkekasdr@yahoo.gr

Ultrasound-guided Injections for de Quervain’s Tenosynovitis

Nonsurgical management of de Quervain's tenosynovitis often includes corticosteroid injections. If the injection does not enter the compartment, or all subcompartments, response to the injection is variable. To ensure proper location of injections we evaluated the role of ultrasound. We determined (1) the incidence of two or more subcompartments, (2) the incidence of anatomic variations during surgical release after failed injections, and (3) the relief of pain after ultrasound-guided injections. A prospective series of 40 consecutive patients (42 wrists) diagnosed with de Quervain's tenosynovitis by clinical examination were referred to a radiologist for an ultrasound-guided injection. The radiologist injected the first dorsal compartment and noted any septations. Patients returned for followup where outcomes, DASH, and VAS scores were calculated. The treating surgeon was blinded to any anatomic variations. Followup was at 6 weeks and a minimum of 6 months (mean, 6 weeks, range, 3-17 months; mean, 11 months, range, 7-18 months). Four patients were lost to followup. Multiple subcompartments were noted in 22 of 42 (52%) wrists. At the 6-week followup, 36 of the 37 wrists examined in 36 patients (97%) had at least partial resolution of symptoms. Multiple subcompartments were identified in 52% of cases. At last followup, the mean DASH and VAS scores were 18.4 and 2.2, respectively. However 14% of wrists had recurrence of symptoms, all of which had subcompartments on ultrasound. No adverse effects from the injections were noted. We found ultrasound-guided injections to be useful for treatment of de Quervain's tenosynovitis. Our success with ultrasound-guided injections was slightly better than that reported in the literature and without adverse reactions.