Lateral Nerve Research Articles

Utility of diffusion tensor imaging for guiding the treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy

The purpose of this study was to evaluate the utility of diffusion tensor imaging (DTI) for guiding the treatment of lumbar disc herniation (LDH) by percutaneous transforaminal endoscopic discectomy (PTED). We collected the clinical data of a total of 19 patients: 10 with unilateral S1 nerve root injury, 6 with unilateral L5 nerve root injury, and 3 with unilateral L5 and S1 nerve root injury. All patients underwent DTI before surgery, 3 days post-surgery, 30 days post-surgery, and 90 days post-surgery. The comparison of the fractional anisotropy (FA) values of compressed lateral nerve roots before surgery and 3, 30, and 90 days post-surgery demonstrated the recovery of nerve roots to be a dynamic process. A significant difference was found in the FA values between compressed lateral nerve roots preoperatively and normal lateral nerve roots before surgery, 3 days post-surgery and 30 days post-surgery (p < 0.05). There was no significant difference in FA values between compressed lateral nerve roots and normal ones 90 days post-surgery (p > 0.05). DTI can be used for the accurate diagnosis of LDH, as well as for postoperative evaluation and prognosis, and it is thus useful for the selection of surgical timing.

The Existence Of the Betel Leaf (Piper betle L.) is in the Tasawuf Prespective

Plants are one of the richest natural resources in Indonesia and contain active chemicals.These plants have the potential to become raw materials for traditional medicine. One of them isbetel plant. The use of Betel leaves, especially in Java, is generally accompanied by specialconditions or criteria, namely: betel leaf which 'meets ros-e'. 'Ros' comes from the Javanese languagewhich means vein, in this case it is a vein of leaves. 'Temu' comes from the Javanese language whichmeans to meet, meet. Betel rose meeting is betel which leaves veins (lateral nerves) meet theposition of the segment; so that the shape is symmetrical. Meanwhile, phytochemical laboratory testresults for total flavonoid content of betel leaves and non-temurose leaves were 53,522 and 43,041ppm. These values include high levels (&gt; 50 ppm) and moderate levels (between&gt; 10 - 50 ppm). Thehigher the level of flavonoids, the more likely the antioxidant potential will be. In theimplementation of riyadhoh, making betel leaves meet rose as a medium as a form of philosophy thatis betel or tell me means ngangsu kaweruh (studying), whereas meet rose can be interpretedas meeting taste.

Restoring the High-Frequency Dynamic Visual Acuity with a Vestibular Implant Prototype in Humans

Introduction: The vestibular implant could become a clinically useful device in the near future. This study investigated the feasibility of restoring the high-frequency dynamic visual acuity (DVA) with a vestibular implant, using the functional Head Impulse Test (fHIT). Methods: A 72-year-old female, with bilateral vestibulopathy and fitted with a modified cochlear implant incorporating three vestibular electrodes (MED-EL, Innsbruck, Austria), was available for this study. Electrical stimulation was delivered with the electrode close to the lateral ampullary nerve in the left ear. The high-frequency DVA in the horizontal plane was tested with the fHIT. After training, the patient underwent six trials of fHIT, each with a different setting of the vestibular implant: (1) System OFF before stimulation; (2) System ON, baseline stimulation; (3) System ON, reversed stimulation; (4) System ON, positive stimulation; (5) System OFF, without delay after stimulation offset; and (6) System OFF, 25 min delay after stimulation offset. The percentage of correct fHIT scores for right and left head impulses were compared between trials. Results: Vestibular implant stimulation improved the high-frequency DVA compared to no stimulation. This improvement was significant for “System ON, baseline stimulation” (p = 0.02) and “System ON, positive stimulation” (p < 0.001). fHIT scores changed from 19 to 44% (no stimulation) to maximum 75–94% (System ON, positive stimulation). Conclusion: The vestibular implant seems capable of improving the high-frequency DVA. This functional benefit of the vestibular implant illustrates again the feasibility of this device for clinical use in the near future.

New taxa of Rhododendron tschonoskii alliance (Ericaceae) from East Asia.

Three new taxa, Rhododendron sohayakiense Y.Watan. & T.Yukawa (Ericaceae), and its two varieties, var. kiusianum Y.Watan., T.Yukawa & T.Minamitani and var. koreanum Y.Watan. & T.Yukawa are described and illustrated from Japan and South Korea. They can be distinguished from each other and from the other members of the R. tschonoskii alliance, i.e. R. tschonoskii, R. tetramerum, R. trinerve and R. tsusiophyllum, through their combination of leaf size, leaf morphologies including lateral nerves on abaxial leaf surface, corolla morphologies including number of corolla lobes, style length and anther form. Phylogenetic inferences based on chloroplast DNA and genome-wide sequences revealed that each of the three new taxa is monophyletic and they further form a clade. Distributions of the three taxa are also clearly separated from each other and also from the other members of the R. tschonoskii alliance.

Fixation of intracapsular fracture of the femoral neck using combined peripheral nerve blocks and transthoracic echocardiography in a patient with severe obstructive hypertrophic cardiomyopathy: a case report

BackgroundHypertrophic obstructive cardiomyopathy (HOCM) is a type of hypertrophic cardiomyopathy associated with left ventricular outflow tract stenosis. The increased pressure gradients across the left ventricular outflow tract in patients with HOCM could lead to circulatory collapse. We describe our experience with perioperative management under femoral nerve block (FNB), lateral femoral cutaneous nerve block (LFCNB), and transthoracic echocardiography (TTE) monitoring during open reduction and internal fixation of a femoral neck fracture in a patient with severe HOCM.Case presentationA 72-year-old man, who was indicated to undergo open reduction and internal fixation of an intracapsular femoral neck fracture, had a history of treatment for hypertension and HOCM. He had heart failure for 4 years and was hospitalized several times. He was resuscitated after ventricular fibrillation and received an implantable cardioverter-defibrillator at that time. He also had severe physical limitations (New York Heart Association class III). We selected FNB and LFCNB as the methods for anesthesia and injected 0.25% levobupivacaine (20 mL) around the femoral nerve and 0.25% levobupivacaine (10 mL) into the lateral femoral nerve region. He underwent TTE during the perioperative period, which enabled us to perform hemodynamic and morphological evaluations of the heart. The intraoperative TTE findings remained stable from before the induction of anesthesia to the patient’s exit from the operating room. Postoperatively, his hemodynamic parameters continued to remain stable.ConclusionsIn this case, FNB and LFCNB contributed to hemodynamic stability during non-cardiac surgery. Additionally, TTE was useful for the perioperative evaluation of cardiac hemodynamics and morphology in our patient with severe HOCM.

Stereotactic Ablative Radiosurgery (SABR) of Dorsal Sacral Lateral Nerve Branches for Treatment of Sacroiliac Pain – a Dosimetric Feasibility Study Exploring the Role of Noninvasive SABR in Place of Bipolar Radiofrequency Ablation

Sacroiliac (SI) joint dysfunction can be the underlying cause of low back pain in up to 15 to 25% cases. Bipolar RFA lesioning of the lateral branches of the S1 to S3 dorsal rami, which innervate the SI joint, can provide clinical relief of pain in patients. Due to the irregular paths of the nerves travelling to the SI joint and the many small nerve branches, it can be technically difficult to ablate the entire area at risk with RFA, which may make relief less effective. Ablative therapies such as SABR can be used for nerve ablation in settings such as trigeminal neuralgia. We hypothesize that LINAC-based SABR may be a noninvasive option for delivering ablative radiation dose to the branching dorsal lateral nerves while maintaining low doses to the surrounding organs at risk (OARs). The ultimate goal being equivalent or improved pain relief when compared to RFA. CT images of the lumbosacral spine in 1.25mm slices were obtained from 5 anonymized patients with standard immobilization who were treated at our facility for issues unrelated to back pain. An interventional radiologist who regularly performs injections and RFA contoured the dorsal nerves of the SI joint for the targeted strips of the dorsal sacral surface bilaterally. PTV volumes included a 1mm expansion. Four VMAT beams targeting the PTV were used to optimize the dose distribution and spare the OARs. The following table shows the relevant treatment volumes, PTV coverage, and OAR doses. We avoided excessive doses to the surrounding OAR structures in the plans for all 5 patients bilaterally. A thin 1mm strip of bone was included in the PTV. Excessive bone doses and volumes were minimized in an attempt to lower risks for osteoradionecrosis. Coverage was acceptable with an average of 49Gy covering the 95% IDL. This study demonstrates the feasibility of delivering ablative doses to the lateral branches of the dorsal sacral nerves that innervate the SI joint. Due to its posterior location all OARs received acceptable doses, other than the portion of bone immediately deep to the treated strip of tissue. By minimizing the treated bone volume while covering the pathways of the traveling nerves, we hope to minimize risk of osteoradionecrosis. This unique approach requires further study but has the potential to replace invasive interventions and allow for decrease in opiate requirement and consumption.Abstract 3601; Table 1Structure and parameterMean ± SDPTV volume (cm3)4.45±1.20Spinal canal Dmax (cGy)218±172Bladder mean (cGy)34±17Bowel mean (cGy)147±60Bone mean (cGy)535±147Bone volume over 30 Gy (cc)21±15 Open table in a new tab

Neurectomy of the deep branch of the lateral palmar nerve as a treatment for chronic equine forelimb proximal suspensory desmitis: 26 cases

Neurectomy of the deep branch of the lateral palmar nerve as a treatment for chronic equine forelimb proximal suspensory desmitis: 26 cases

The Simplicity of the Brachial Plexus: Common Nerve Roots for Synergistic Function.

The upper extremity moves in coordinated motions to accomplish complex tasks.1,2 This requires contraction of multiple muscles in unison for actions to occur in a natural, seamless fashion.2 For example, as one brings one's hand to his or her mouth, the shoulder externally rotates, extends and adducts, while the hand supinates and the elbow flexes. The muscles required to perform this movement are innervated by various terminal nerve branches (eg, suprascapular, axillary, lateral pectoral nerve, musculocutaneous, radial nerve), but fibers all originate from the same C5-6 nerve roots. Less natural motions require more intentional action of the thorax, shoulder, and elbow. The purpose of this article is to examine the organization of the brachial plexus in one simple, unifying theme: muscles involved in synergistic function share a common nerve root, despite their terminal branch. The brachial plexus originates as 5 ventral roots from C5 to T1 and terminates as 5 motor branches that power the upper extremity. Between the roots and branches, the plexus becomes 3 trunks, 6 divisions, and 3 cords. Along this course, the plexus gives off 12 other terminal branches. The intervening convolution between the roots and branches, at first glance, would seem unnecessary. The crossing divisions and contributions from each cord provide complexity in anatomy that cannot be explained by redundancy, as loss of a single nerve can lead to devastating loss of function. The anatomical intricacies, however, can be explained as a highway system for nerve roots to arrive at target muscles, with multiple muscles working together to perform 1 coordinated motion. The intervening trunks, divisions, and cords can be thought of as simply a system to deliver axons from a similar nerve root to terminal branches that reach the end target muscle of interest. Each of these motions occurs as a result of various muscles contracting together and are all innervated by similar nerve roots, despite variations in branches. Cadaveric dissections demonstrate variations in innervation patterns. The triceps receives nerve fibers from the radial nerve, axillary nerve, and/or even branches off the ulnar nerve.3,4 Anatomic discrepancies can also been seen for the extensor carpi radialis brevis between the superficial branch of the radial nerve (55%), posterior interosseous nerve (2nd most common), and radial nerve.5 Despite the variability in terminal nerve branch, the derivative nerve root remains consistent. The more proximal and distal muscles are primarily innervated by the higher and lower nerve roots, respectively. However, this is not uniformly true. For example, the pectoralis major is the only muscle with 2 nerves directly off the brachial plexus and innervation from every nerve root (lateral pectoral nerve C5, C6, C7 and medial pectoral nerve C8, T1). The lack of innervation order can also be seen for the finger extensors. The brachial plexus is a complex network of structure and function whose layout can be simplified into axons going from point A (nerve root) to point B (synergistic muscle) with the intervening trunks, cords and divisions being a system to deliver these axons to synergistic muscles that co-contract in unison. As the philosophical principle, Occam's razor, states, the simplest solution tends to be correct. This may very well also be the case for the brachial plexus.

How to Use Pectoral Nerve Blocks Effectively—An Evidence-Based Update

Since the original description in 2011, the array of pectoral nerve blocks has evolved. The pectoral nerve (PECS) block in conjunction with general anesthesia can decrease an additional analgesic in perioperative period for breast cancer surgeries. Current literature on the PECS block has reported 3 several types (PECS I, PECS II, and serratus plane blocks). The PECS I block is the same as to the fi rst injection in the PECS II block. The second injection in the PECS II block and the serratus plane block blocks intercostal nerves (Th2–6) and provides an analgesic for the breast cancer surgery. However, the PECS I block (or fi rst injection in the PECS II block) has no analgesic, because both lateral and medial pectralis nerve blocks are motor nerves. PECS block in previous reports, when added to opioid-based general anesthesia, may improve analgesia and decrease narcotic use for breast cancer surgery. Moreover, PECS block compares favorably with other regional techniques for selected types of surgery. A major limitation of the PECS block is that it cannot block the internal mammary region. Therefore, some studies have reported its ability to block the anterior branches of the intercostal nerve. PECS block is an effective analgesic tool for the anterolateral chest. In particular, the PECS block can provide more effective analgesia for breast cancer surgery.

Proximal neuropathies in patients with poststroke shoulder pain

BackgroundPoststroke shoulder pain (PSSP) could be due to proximal neuropathy or upper trunk brachial plexus lesion.AimThe aim was to detect any electrophysiological abnormality in the proximal nerves supplying shoulder structures that could contribute to PSSP.Settings and designCross-sectional study at institution: a university hospital, tertiary level of clinical care.Materials and methodsNerve conduction studies of the axillary, musculocutaneous, suprascapular, and lateral antebrachial nerves were done on both sides. In addition, electromyography of the deltoid, biceps brachii and infraspinatus on the hemiplegic side was performed on 30 stroke survivors with PSSP.Statistical analysis usedStatistical Package for the Social Sciences (SPSS ver.20). Description and analysis of the obtained data were done using appropriate tests.ResultsAxillary and musculocutaneous motor nerve latencies on the hemiplegic side were significantly prolonged compared with the normal side (P=0.012, 0.029, respectively). Moreover, axillary and suprascapular nerve amplitudes on the hemiplegic side were significantly lower than those on the normal side (P=0.008, 0.002, respectively). Twelve (40%) patients had electrophysiological abnormalities. Upper trunk brachial plexopathy was the most common abnormality which occurred in six (20%) patients. In addition, isolated axillary or suprascapular nerve lesion occurred at a similar frequency (10%).ConclusionProximal nerve lesions are not uncommon in PSSP patients.

Nerve Preservation and Allografting for Sensory Innervation Following Immediate Implant Breast Reconstruction.

While newer breast reconstruction approaches utilizing nipple-sparing mastectomy (NSM) techniques and immediate reconstruction can provide excellent aesthetic outcomes, absent postoperative sensation remains a major limitation. Here, we present a novel technique for implant reconstruction combining the latest advances in breast oncologic, reconstructive, and peripheral nerve surgery to improve sensory outcomes. Sixteen women (31 breasts) underwent NSM and prepectoral, direct-to-implant reconstruction. During NSM, careful dissection was performed along the lateral aspect of the breast to preserve any visible intercostal nerves. When nerves could be preserved without compromising oncologic safety, they were left intact within the subcutaneous tissue of the lateral mastectomy skin flap. Nipple/areolar complex (NAC) neurotization was also performed utilizing allograft coapted from transected T4 or T5 lateral intercostal nerves to subareolar nerves identified at the completion of the mastectomy. Of the 12 women (23 breasts) with at least 3 months' follow-up, NAC 2-point discrimination was preserved in 20 breasts (87%), was worse in 2 breasts (9%), and had actually improved in 1 breast (4%). All patients had intact sensation to light touch throughout the majority of, if not their entire, reconstructed breasts. None of the women developed dysesthesias or neuromas. Nerve grafting in conjunction with careful nerve preservation at the time of NSM and implant-based breast reconstruction is safe and effective with a 90% rate of preserved sensation. With longer follow-up, continued return of sensation or possibly improved sensation from baseline can be reasonably anticipated.

Evaluation of the iPACK block injectate spread: a cadaveric study

Background and objectivesUltrasound-guided infiltration of the interspace between the popliteal artery and capsule of the knee (iPACK) block, a new regional analgesic technique, is believed to relieve posterior knee pain,...

Anatomic Variation of the Phrenic Nerve and Brachial Plexus Encountered during 100 Supraclavicular Decompressions for Neurogenic Thoracic Outlet Syndrome with Associated Postoperative Neurologic Complications

The objective of this study was to characterize phrenic nerve and brachial plexus variation encountered during supraclavicular decompression for neurogenic thoracic outlet syndrome and to identify associated postoperative neurologic complications. A multicenter retrospective review was performed to evaluate anatomic variation of the phrenic nerve and brachial plexus from November 2010 to July 2018. After initial characterization, the following two groups were identified: variant anatomy (VA) group and standard anatomy (SA) group. Complications were analyzed and compared between the two groups. In total, 105 patients were identified, and 100 patients met inclusion criteria. Any anatomic variation of the standard course or configuration of the phrenic nerve and/or brachial plexus was encountered in 47 (47%) patients. Phrenic nerve anatomic variations were identified in 28 (28%) patients. These included 9 duplicated nerves, 6 lateral accessory nerves, 8 medial displacement, and 5 lateral displacement. Brachial plexus anatomic variation was found in 34 (34%) patients. The most common variant configuration of a fused middle and inferior trunk was identified in 25 (25%) patients. Combined phrenic nerve and brachial plexus anatomic variation was demonstrated in 15 (15%) patients. The VA and SA groups consisted of 47 and 53 patients, respectively. Transient phrenic nerve injury with postoperative elevation of the ipsilateral hemidiaphragm was documented in 3 (6.4%) patients in the VA group and 6 (11.3%) patients in the SA group (P=0.49). Permanent phrenic nerve injury was identified in 1 (2.1%) patient in the VA group (P=0.47) and none in the SA group. Transient brachial plexopathy was encountered in 1 (1.9%) patient in the SA group (P=1.0) with full recovery to normal function. Anatomic variability of the phrenic nerve and brachial plexus are encountered more frequently than previously reported. While the incidence of nerve injury is low, surgeons operating within the thoracic aperture should be familiar with variant anatomy to reduce postoperative complications.

Multicenter Efficacy Trial of a Percutaneous Radiofrequency System for the Reduction of Glabellar Lines.

Bipolar percutaneous radiofrequency (RF) is an established method for ablation of distal peripheral branches of the facial nerve to produce weakness of the corrugator muscle. Recent developments to the Serene RF system (Serene Medical, Inc., Pleasanton, CA) allowing for safer and more predictable results highlighted a need for prospective clinical data. The authors sought to assess the ability of percutaneous RF to safely improve the appearance of dynamic glabellar lines for a minimum of 3 months and up to 1 year. This prospective study enrolled 78 patients across 5 centers in the United States. The most distal branches of the medial and lateral facial nerve innervation to the brow depressor/corrugator complex were treated. Follow-up was at 3 days by telephone and in-office at 7 days and 3, 6, 9, and 12 months posttreatment. Patients were evaluated employing the Merz scale for dynamic glabellar lines. At 3 months, 93.6% of patients had a ≥1-point Merz scale improvement in dynamic glabellar lines based on independent, blinded review. Sustained ≥2-point improvement was present in 60% and 20% of patients at 3 and 12 months, respectively. Overall satisfaction remained >60% through 6 months and >50% at 12 months. All device- or procedure-related adverse events were mild (90%) or moderate (10%) and resolved without medical intervention. Bipolar percutaneous RF may be adopted in conjunction with surgery or as an office-based procedure where it can serve as a minimally invasive alternative to, or in concert with, Botulinum Toxin A therapy.

Sites of Anesthetic Block of the Lateral and Medial Palmar Metacarpal Nerves in Equines of Indeterminate Breed

Background: Local anesthesia blockage at equines claudication diagnosis besides favoring the beginning of the therapy and relieving patient’s pain, it allows the identification of the specific affected region and its origin, however, if it is done incorrectly (by improper volume of anesthetics application and/or mistakenly nerve identification due to the lack of anatomic referential) it may cause inflammation, infection or even tissue necrosis. The aim was describing anatomically lateral and medial palmar metacarpal nerves in equines to improve diagnostic anesthetic block techniques on four metacarpophalangeal articulation joints of the specie.Materials, Methods &amp; Results: A number of 20 thoracic limbs from 10 equines of indeterminate breed were used to be fixated in 10% phormaldehyde and with a marked arterial system by water solution of red dyed latex. The structures were identified by dissection, and their denomination bases on Nomina Anatomica Veterinaria (N.A.V.) by the International Committee on Veterinary Gross Anatomical Nomenclature. The study had been approved by the Board of Ethics in Animal Use of the University Center of Patos de Minas (UNIPAM), protocol n° 18/17. The lateral and medial palmar metacarpal nerves have been observed in all of the specimens originated from the deep branch of lateral palmar nerve, immediately distal to the intercarpal articulation. After its origin, the first nerve stretched ipsilaterally from the common trunk, whilst the second nerve positioned counter-lateral manner after superficially crossing the interosseus muscle. Both penetrated at the level of the mid third of the referred muscle and the metacarpal bone III and, assumed respectively a parallel medial position to the metacarpal bone IV and lateral to the metacarpal II, being intimately associated to the palmar face of the metacarpal bone III. Distally, those nerves emerged from a palmar position to a lateral and medial to the distal extremity of the metacarpal bones, corresponding and adjacent to the metacarpophalangeal articulation palmar recession, where they had finally ramified to partially innervate the associated articular capsule and the subcutaneous tissue of the region.Discussion: The lateral and medial palmar metacarpal nerves present similar origin and disposition to the above described, however, besides largely mentioned in literature, we point out here as recommended by N.A.V., no use of terms like axial and abaxial as position indicators for equine. As a part of block anesthetic diagnosis of four metacarpophalangeal articulation points, it is hereby suggested for the studied nerves desensitization, should be palpated the distal extremities of the metacarpal bones IV and II. After the identification, using thumb located from the extremity at proximal direction way, introduce the needle bilaterally for 1.5 cm downright between the above mentioned metacarpal bones and the interosseus muscle, being these latter and the flexor muscle tendons drawn in the palmar direction. Thus, it becomes valid to affirm that the technique of four-point diagnostic anesthetic block of the metacarpophalangeal articulation has been perfected for equines, and that it will limit the chances of false results on account of misplaced puncturing of nearby structures, such as, for example, the synovial recesses, mentioned as the location of the utmost gravity, hence septic synovitis may come in play.

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

Background and objectivesRefractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain....

Ossification of the pterygoalar and pterygospinous ligaments: a computed tomography analysis of infratemporal fossa anatomical variants relevant to percutaneous trigeminal rhizotomy.

Ossification of pterygoalar and pterygospinous ligaments traversing the superior aspect of the infratemporal fossa results in formation of osseous bars that can obstruct percutaneous needle access to the trigeminal ganglion through the foramen ovale (FO), interfere with lateral mandibular nerve block, and impede transzygomatic surgical approaches. Presence of these ligaments has been studied on dry skulls, but description of their radiological anatomy is scarce, in particular on cross-sectional imaging. The aim of this study was to describe visualization of pterygoalar and pterygospinous bars on computed tomography (CT) and to review their prevalence and clinical significance. The authors retrospectively reviewed 200 helical sinonasal CT scans by analyzing 0.75- to 1.0-mm axial images, maximum intensity projection (MIP) reconstructions, and volume rendered (VR) images, including views along the anticipated axis of the needle in percutaneous Hartel and submandibular approaches to the FO. Ossified pterygoalar and pterygospinous ligaments were readily identifiable on CT scans. An ossified pterygoalar ligament was demonstrated in 10 patients, including 1 individual with bilateral complete ossification (0.5%), 4 patients with unilateral complete ossification (2.0%), and 5 with incomplete unilateral ossification (2.5%). Nearly all patients with pterygoalar bars were male (90%, p < 0.01). An ossified pterygospinous ligament was seen in 35 patients, including 2 individuals with bilateral complete (1.0%), 8 with unilateral complete (4%), 8 with bilateral incomplete (4.0%), 12 with bilateral incomplete (6.0%) ossification, and 5 (2.5%) with mixed ossification (complete on one side and incomplete on the contralateral side). All pterygoalar bars interfered with a hypothetical needle access to the FO using the Hartel approach but not the submandibular approach. In contrast, 54% of complete and 24% of incomplete pterygospinous bars impeded the submandibular approach to the FO, without affecting the Hartel approach. This study provides the first detailed description of cross-sectional radiological and applied surgical anatomy of pterygoalar and pterygospinous bars. Our data are clinically useful during skull base imaging to predict potential obstacles to percutaneous cannulation of the FO and assist in the choice of approach, as these two variants differentially impede the Hartel and submandibular access routes. Our results can also be useful in planning surgical approaches to the skull base through the infratemporal fossa.

Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance.

Background The presented study attempts to classify individual anatomical variants of the pectoralis major muscle (PM), including rare and unusual findings. Rare cases of muscular anomalies involving the PM or its tendon have been presented. An attempt has also been made to determine whether anatomical variations of the PM may affect the innervation pattern of the lateral and medial pectoral nerves. Material and Methods The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. Results Typical PM structure was observed in 63.75% of specimens. The most frequently observed variation was a separate clavicular portion of the PM. In one female cadaver (2.5% of specimens) the hypotrophy of the clavicular portion of the PM was noticed. In two male cadavers (5% of specimens) the fusion between the clavicular portion of the PM and the deltoid muscle was observed. In one of those cadavers, small sub-branches of the lateral pectoral nerve bilaterally joined the clavicular portion of the deltoid muscle. The detailed intramuscular distribution of certain nerve sub-branches was visualized by Sihler's stain. PM is mainly innervated by the lateral pectoral nerve. In all specimens stained by Sihler's technique, the contribution of the intercostal nerves in PM innervation was confirmed. Conclusions Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region.

The neuroanatomy of Barentsia discreta (Entoprocta, Coloniales) reveals significant differences between bryozoan and entoproct nervous systems

BackgroundEntoprocta affinities within Lophotrochozoa remain unclear. In different studies, entoprocts are considered to be related to different groups, including Cycliophora, Bryozoa, Annelida, and Mollusca. The use of modern methods to study the neuroanatomy of Entoprocta should provide new information that may be useful for phylogenetic analysis.ResultsThe anatomy of the nervous system in the colonial Barentsia discreta was studied using immunocytochemistry and transmission electron microscopy. The ganglion gives rise to several main nerves: paired lateral, aboral, and arcuate nerves, and three pairs of tentacular cords that branch out into tentacular nerves. The serotonergic nervous system includes paired esophageal perikarya and two large peripheral perikarya, each with a complex net of neurites. Each tentacle is innervated by one abfrontal and two laterofrontal neurite bundles. Sensory cells occur regularly along the abfrontal side of each tentacle. Star-like nerve cells are scattered in the epidermis of the calyx. The stalk is innervated by paired stalk nerves.ConclusionsThe neuroanatomy of the colonial Barentsia discreta is generally similar to that of solitary entoprocts but differs in the anatomy and ultrastructure of the ganglion, the number of neurite bundles in the calyx, and the distribution of serotonin in the nerve elements. A comparison of the organization of the nervous system in the Entoprocta and Bryozoa reveals many differences in tentacle innervations, which may indicate that these groups may not be closely related. Our results can not support with any certainty the homology of nervous system elements in adult entoprocts and adult “basal mollusks”.

Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention

Background and objectivesIn 2011, chronic shoulder joint pain was reported by 18.7 million Americans. Image-guided radiofrequency ablation has emerged as an alternative intervention to manage chronic shoulder joint pain. To...