Length Of Nerve Research Articles

An endoscope-assisted craniometric cadaveric study for the brain stem and the cisternal segment of the trochlear nerve.

This study analyzed the relationship of trochlear nerve with neurovascular structures using craniometric measurements. The study was aimed to understand the course of trochlear nerve and minimize the risk of injury during surgical procedures. Twenty trochlear nerves of 10 fresh cadavers were studied bilaterally using endoscopic assistance through the view afforded by the lateral infratentorial-supracerebellar, and the combined presigmoid-subtemporal transtentorial approaches. Trochlear nerves were exposed bilaterally taking seven parameters into consideration: the distance between the cisternal segment of trochlear nerve and vascular structures (superior cerebellar artery/SCA; posterior cerebral artery/PCA), the origin of the trochlear nerve in the brain stem, the angle in the level of tentorial junction, length, diameter, and length of nerve in the cisternal segment. We identified the brain stem and cisternal segments of the trochlear nerve. The lateral infratentorial supracerebellar approach allowed the exposure of the cisternal segments (crural and ambient cisterns), including the origin of the nerve in the brain stem. The combined presigmoid-subtemporal transtentorial approaches provided visualization of the cisternal segment of the nerve and the free edge of the tentorium. In this study, the mean length and width of the trochlear nerve in the cisternal segment were 30.3 and 0.74 mm, respectively. Length of the trochlear nerve from its origin to its dural entrance was 37.2 mm, tentorial dural entrance angle of the trochlear nerve and exit angle of the trochlear nerve from the brain stem were 127.0 degrees and 54 degrees, PCA to trochlear nerve in mid ambient cistern and SCA to trochlear nerve in mid ambient cistern were 7.3 mm and 6.8mm. Trochlear nerve is vulnerable to injury during the surgical procedures. Therefore, it is necessary to have a sufficient knowledge of the anatomy of cisternal segment and its relationship with adjacent neurovascular structures. The anatomical and craniometric data can be helpful in middle and posterior fossa surgery in minimizing the potential injury of the trochlear nerve.

Morphometric examination of trigeminal nerve and its adjacent structures in patients with trigeminal neuralgia: a case-control study.

Morphological differences that can lead the trigeminal nerve to neurovascular conflict and a new solitary pontine lesion are associated with the pathogenesis of trigeminal neuralgia (TN). In this case-control study, we aimed to contribute to the current discussions about the pathogenesis of TN by investigating the anatomical structures that may have an effect on the morphometric parameters of the trigeminal nerve. This study included 25 patients with TN followed up for pain in the Department of Algology, Faculty of Medicine, and 25 age- and gender-matched controls. We performed morphometric measurements including the length and volume of the trigeminal nerve, cerebellopontine cistern, pons, and posterior fossa in the MRIs of these individuals. Comparative analyses were performed for the mean of the affected and unaffected sides of the TN patients and the right, left, and both sides of the control group. In patients with TN, on the affected side, length and volume of the trigeminal nerve and cerebellopontine cistern volume were found smaller than controls (p < 0.05). Pons volume was higher in patients with TN compared to controls (p < 0.05). The length of the affected nerve was significantly related to prepontine cistern length and cerebellopontine cistern volume (p < 0.05). The cerebellopontine cistern volume has a significant impact on the morphometric characteristics of the trigeminal nerve. Especially, whether the increase in the volume of pons causes a decrease in the volume of cerebellopontine cistern should be clarified with further research.

Surgical anatomy of the femoral nerve in formalin prefixed cadavers in an adult Kenya population

Background: Ethnic variations involving femoral nerve have been described in literature. This nerve is the largest branch of the lumbar plexus. It innervates the hip flexors, knee extensors, and sensory function to medial and anterior aspects of the thigh. Risks of insults to nerve can be non-iatrogenic (trauma), and iatrogenic (approaches to the acetabulum, pelvis and proximal femur). The study aimed at providing precise description of variant anatomy of nerve, hence will help surgeons avoid iatrogenic insults.Methods: An anatomic descriptive cross-sectional study design involving fifty six (56), formalin prefixed adult cadaveric specimens. The length of the femoral nerve in relation to the inguinal ligament and its bony attachments, and the patterns of distribution of main branches in the regions were defined. Results: Males- 35 (Left=17, Right=18); Females- 21(Left=7, Right=14). Femoral nerve location: 53.02 mm (SD 14.59) from the ipsilateral anterior superior iliac spine (ASIS). Nerve trunk in relation to inguinal ligament measured: 47.85mm (SD 13.719) from the psoas muscle proximally and branched 29.32 mm (SD 14.239) distally. Innervations and branches: quadriceps in all specimens (Posterior); Sartorius muscles (Anterior), with noted variability in individual muscles. Branching pattern variations: 6 limbs (10.71%) at ligament level, 2(3.57%) limbs more proximal, while one nerve was split by a slip from the psoas muscle and then united 25.88mm proximal to ligament. The variations in sex were not statistically significant (p> 0.05).Conclusion: The anatomical course, length and branches of the femoral nerve in relation to inguinal ligament concur to great extent with described anatomic studies with some noted variability. Surgeons should be aware of the anatomic variations of femoral nerve and be cautious when operating in the zones traversed by the nerve.

Assessment of Anterior Loop of Inferior Alveolar Nerve – A Cone Beam Computed Tomography Study

Introduction: The anterior loop (AL) of the inferior alveolar nerve (IAN) and the mental foramen (MF) are important anatomical structures that should be taken into consideration during preoperative planning in the anterior mandibular region. This study aims to assess the prevalence, length, and type of the AL of the IAN in males and females in a South Indian population. Additionally, the distance from the MF to the lower border of the mandible is assessed. Materials and Methods: A total of 115 cone-beam computed tomography (CBCT) scans of 230 sides of mandibles were taken using a Carestream Select CS9300 CBCT machine (Carestream Dental LLC, Atlanta, USA). The scans were selected from archives and divided into three different age groups (<40, 41–60, >61 years). The scans were analyzed to detect the canal of the AL of the inferior alveolar nerve canal (IANC). The IANC, along with the AL canal and part of the incisive nerve canal, was traced using the CS 9300 software. The length of the mandibular nerve was measured for each patient in cross-sectional and panoramic views. Results: The AL was present in 92.6% of the 115 participants. Overall anterior loop length ranged between 0.9 and 15.2 mm. The mean length of AL in panoramic view on the right side was 3.284 ± 2.314 mm and it was 3.015 ± 2151 mm on the left side. Y-shaped AL was more predominant when compared to T-shaped AL in the sample. Conclusion: The prevalence of AL was relatively higher in subjects ranging from 41 to 60 years with a slight increase in female predominance.

Subbasal corneal nerve damage in patients with bacterial keratitis: in vivo confocal microscopy study.

To examine subbasal corneal nerve changes in patients with bacterial infectious keratitis using in vivo confocal microscopy. Thirteen patients (13 eyes) with unilateral bacterial keratitis and 12 healthy controls were prospectively enrolled in the study. In vivo confocal microscopy was performed in all the patients at 2 time points, in the acute phase of infectious keratitis and at 28 ± 0.6 months after resolution of the infection. The subbasal nerve length was 5.15 ± 1.03 mm/mm2 during the acute phase of bacterial keratitis (compared with that of the controls: 19.02 ± 1.78 mm/mm2, p<0.05). Despite the significant corneal nerve regeneration over the interval of 28 months after the resolution of the infection, the nerve density was still significantly reduced as compared with that of the controls (9.73 ± 0.93 mm/mm2, p<0.05). Moreover, in vivo confocal microscopy images showed diffuse high-reflecting areas referring to the scar tissue areas with thin and tortuous nerve branches regenerating toward these areas. A partial corneal nerve regeneration of subbasal nerve plexus during the first 28 months after the acute phase of infectious keratitis was observed. Moreover, the regenerated nerves of the patients remained morphologically altered as compared with those of the healthy controls. These results may be relevant to the clinical follow-up and surgical planning for these patients.

Morfometrijske karakteristiki listova vrsta Paulownia elongata S. Y. Hu. i Paulownia fortunei Seem. Hemsl. u odnosu na prihranjivanje na različitim staništima

The paper presents the results of the analysis dealing with the impact of plant fertilisation in the first year after planting on the leaf morphological characteristics. The analysis was conducted within the research into the potential introduction and adaptation of paulownia to different sites in Serbia. The results related to the effects of fertilisation on the quality of plant leaves are useful for the cultivation of certain types of soil where the morphometric analysis of leaves reveals structure-function relationships, i.e., more detailed indicators of the species' adaptability. The research was conducted in two localities. Sample plots with Paulownia elongata S. Y. Hu. and Paulownia fortunei Seem. Hemsl. were established in Obrenovac and Pambukovica, where leaf material was collected for laboratory analysis. The following morphometric leaf characteristics were measured: leaf area, leaf perimeter, leaf lamina length, central nerve length, maximum leaf width, leaf width at 1 cm from the base of the leaf, petiole length, distance between the 3rd and 4th nerve, the number of nerves to the left side of the midrib, and the number of veins to the right side of the midrib. The obtained results of leaf morphometric measurements were statistically processed in the Statgraphics software. Based on the results of measuring the leaf morphometric characteristics, fertilisation has a positive effect on the size of the leaves of the studied paulownia species.

Tauopathy induces degeneration and impairs regeneration of sensory nerves in the cornea

The cornea is transparent and innervated by a dense collection of sensory nerves originating from the ocular branch of the trigeminal nerve. This study was designed to comprehensively analyze alterations of corneal sub-basal nerve plexus in a mouse model of tauopathy (P301L transgenic mice) to test the possibility of using corneal nerves as a biomarker for tauopathy. Corneal sensitivity, thickness and epithelial wound healing were measured non-invasively by aeshesiometer, optical coherence tomography and fluorescein staining, respectively. Tau, corneal nerves and immune cells were examined by immunohistochemistry or Western blot. At the early stage of tauopathy, although corneal sensitivity, thickness and nerve fiber density were not greatly altered, corneal nerve abnormalities were observed in the peripheral region of young P301L mice. With aging, the density of abnormal nerves increased, while corneal sensitivity, epithelial thickness, nerve fiber density and length decreased in middle-aged P301L mice compared with WT mice. After corneal epithelial injury in young mice, no difference in reepithelialization was observed between two groups of mice, however, the regeneration of corneal nerves in P301L mice lagged behind WT mice, which was reflected by delayed recovery of corneal sensitivity, decreased corneal nerve density and length and density of CD45+ dendriform cells in P301L mice. In conclusion, our data provide compelling evidence that corneal nerves were changed in a mouse model of tauopathy in an age-dependent manner. Moreover, tau overexpression impairs corneal nerve regeneration. These results suggest that cornea may serve as a promising ocular site for the early diagnosis of tauopathy.

Hamstring branches of the sciatic nerve as donors for neurotization of the superior gluteal nerve: A cadaveric feasibility study.

Although superior gluteal nerve (SGN) injury can have significant morbidity, to date, surgical strategies for its repair are scant in the literature. Specifically, neurotization options have not been explored. To address this deficiency in the literature, the current cadaveric feasibility study was performed. Via a transgluteal approach on 16 cadaveric sides, the proximal sciatic nerve and the entrance of the SGN into the gluteus medius and minimus were identified. Additionally, branches from the sciatic nerve to the hamstring muscles were traced proximally to confirm their position in relation to the sciatic nerve as a whole. These branches were cut at the level of the ischial tuberosity and teased away from the sciatic nerve proximally to the greater sciatic foramen and transferred superolateral to the SGN. The diameter of each nerve branch was measured as well as its available length for reaching the SGN. All branches of the sciatic nerve to the hamstring muscles arose from the anteromedial part of the nerve. The mean diameters of the branches to the semimembranosus, semitendinosus, and biceps femoris muscles were 2.1, 1.9, and 1.5 mm, respectively. The mean diameter of the SGN was 3.1 mm and the mean distance from this entrance point to the ischial spine was 7.2cm. The mean length of the donor nerve was 8.5cm. Based on our study, use of a tibial-innervated hamstring branch as a donor for nerve transfer to the SGN is feasible.

Endoscopic Anatomy of the Zygomatic Nerve: Implications for the Endoscopic Transmaxillary Approach.

Introduction Understanding the anatomic features of the zygomatic nerve is critical for performing the endoscopic transmaxillary approach properly. Injury to the zygomatic nerve can result in facial numbness and corneal problems. Objective To evaluate the surgical anatomy of the zygomatic nerve and its segments from an endoscopic endonasal perspective for clinical implications of performing the endoscopic transmaxillary approach. Methods The origin, course, length, and segments of the zygomatic nerve were studied in four specimens from an endonasal perspective. Results The zygomatic nerve arises 4.1 ± 1.7 mm from the foramen rotundum of the maxillary nerve in the superolateral pterygopalatine fossa (PPF). According to its anatomic region in endonasal endoscopic surgery, we divided the zygomatic nerve into two segments: the PPF segment, from origin to the point of entry under Muller's muscle, which runs superolaterally to the inferior orbital fissure (IOF) (length, 4.6 ± 1.3 mm), and the IOF segment, starting at the entry point in Muller's muscle and terminating at the exit point in the IOF, which travels between Muller's muscle and the great wing of the sphenoid bone (length, 19.6 ± 3.6 mm). In the transmaxillary approach, the zygomatic nerve is a critical landmark in the superolateral PPF. Conclusion The zygomatic nerve travels in the PPF and the IOF; better visualization and preservation of this nerve during endonasal endoscopic surgery are crucial for successful outcomes.

Change patterns in the corneal sub-basal nerve and corneal aberrations in patients with dry eye disease: An artificial intelligence analysis

We aimed to investigate the change patterns in corneal sub-basal nerve morphology and corneal intrinsic aberrations in dry eye disease (DED). Our study included 229 eyes of 155 patients with DED and 40 eyes of 20 healthy control. We used the Oculus keratograph and the ocular surface disease index questionnaire to assess their signs and symptoms. In vivo confocal microscopy was used to observe the corneal sub-basal nerves, corneal endothelial cells, and Langerhans cells (LCs). An artificial intelligence (AI) technique run by the deep learning model generated the sub-basal nerve fibre parameters. Furthermore, we used the Pentacam HR system to measure the corneal intrinsic aberrations and corneal surface regularity indices. DED patients more frequently had increased anterior and total corneal aberrations than controls (P < 0.05). In addition, DED had decreased average density and maximum length of corneal nerve. (Both P < 0.01) The LC number was significantly correlated with maximum length (CC = −0.19, P = 0.01) of the sub-basal nerve fibre. Furthermore, the corneal nerve average density was negatively correlated with IHD, and anterior, posterior, and total corneal aberrations (All P < 0.05) especially the higher-order aberrations. Significant correlations were seen between corneal nerve morphology changes, analysed by AI and corneal intrinsic aberrations, particularly higher-order aberrations.

Prenatal development of sympathetic innervation of the human pancreas

BackgroundThe sympathetic nervous system plays an important role in the regulation of pancreatic exocrine and endocrine secretion. The results of experimental studies also demonstrate the involvement of the sympathetic nervous system in the regulation of endocrine cell differentiation and islet formation during the development of the pancreas. However, the prenatal development of sympathetic innervation of the human pancreas has not yet been studied. Material and methodsPancreatic autopsy samples from 24 human fetuses were examined using immunohistochemistry with antibodies to tyrosine hydroxylase (TH). The density, concentration, and size (width, length, perimeter and area) of the TH-positive sympathetic nerves were compared in four developmental periods: pre-fetal (8–11 weeks post conception (w.p.c.), n = 6), early fetal (13–20 gestational weeks (g.w.), n = 7), middle fetal (21–28 g.w., n = 6) and late fetal (29–40 g.w., n = 5) using morphometric methods and statistical analysis (Multiple Comparisons p values). Double immunofluorescence with antibodies to TH and either insulin or glucagon and confocal microscopy were applied to analyze the interaction between the sympathetic nerves and endocrine cells, and the co-localization of TH with hormones. ResultsTH-positive sympathetic nerves were detected in the fetal pancreas starting from the early stages (8 w.p.c.). The developmental dynamics of sympathetic nerves was follows: from the pre-fetal period, the amount of TH-positive nerves gradually increased and their branching occurred reaching the highest density and concentration in the middle fetal period, followed by a decrease in these parameters in the late fetal period. From the 14th g.w. onwards, thin TH-positive nerve fibers were mainly distributed in the vicinity of blood vessels and around the neurons of intrapancreatic ganglia, which is similar in adults. There were only rare TH-positive nerve fibers adjacent to acini or located at the periphery of some islets. The close interactions between the TH-positive nerve fibers and endocrine cells were observed in the neuro-insular complexes. Additionally, non-neuronal TH-containing cells were found in the pancreas of fetuses from the pre-fetal and early fetal periods. Some of these cells simultaneously contained glucagon. ConclusionsThe results demonstrate that sympathetic innervation of the human pancreas, including the formation of perivascular and intraganglionic nerve plexuses, extensively develops during prenatal period, while some processes, such as the formation of sympathetic innervation of islet capillaries, may occur postnatally. Non-neuronal TH-containing cells, as well as the interactions between the sympathetic terminals and endocrine cells observed in the fetal pancreas may be necessary for endocrine pancreas development in humans.

An Anatomical Feasibility Study on the Use of the Hypoglossal and Hemihypoglossal Nerve as a Donor Motor Nerve for Free Functioning Muscle Transfer in Upper Extremity Reconstruction

Brachial plexus injuries (BPI) with complete root avulsions remains a clinical challenge due to a paucity of nerves available for nerve transfer and innervation of free functioning muscle transfers (FFMT). The hypoglossal and hemihypoglossal nerve has not been studied as a donor nerve option for FFMTs in brachial plexus reconstruction, despite successful outcomes of hypoglossal nerve transfers in facial reanimation surgery. We hypothesized that the hypoglossal nerve could be an appropriate candidate for surgical repair of BPI using FFMT. A cadaveric study was performed to determine the anatomic feasibility of using the hypoglossal and hemihypoglossal nerves as donor nerves to neurotize the gracilis or latissimus dorsi muscle in an FFMT to restore elbow flexion. Twelve cadavers (6 males and 6 females) were studied. The hypoglossal nerve, thoracodorsal nerve, and obturator nerve branches to the gracilis muscle were dissected, measured, and analyzed. The average length of the hypoglossal nerve was 6.3 ± 0.5 cm in both sexes. The average distance between the lowest point of the hypoglossal nerve and the lateral clavicle was 8.4 ± 1.3 cm in males and 7.7 ± 0.8 cm in females. When the hypoglossal nerve was transected distally, the average distance to the clavicle was 4.5 ± 1.6 cm in males and 3.8±1.5 cm in females. The maximum theoretical length of the donor nerve required to perform an adequate FFMT using the hypoglossal nerve was 8.9 ± 1.2 cm, which was well exceeded by the lengths of the thoracodorsal nerve (14.5 ± 1.3 cm) and nerve to the gracilis muscle (12.7± 1.7 cm). This cadaveric study demonstrated that the hypoglossal or hemihypoglossal nerves may be used as potential motor donor nerves to innervate a free gracilis or latissimus dorsi muscle transfer for the restoration of elbow flexion via a direct nerve transfer without the need for nerve grafting.

Measurement of the Radial Nerve Danger Zone in Filipino Adults: A Cadaveric Study.

Introduction:The radial nerve danger zone (RNDZ) is an important anatomic consideration to anticipate or prevent injury in trauma assessment or surgical fixation. No published estimate currently exists for Filipinos. In this study, we sought to provide a local estimate and explore potential predictors of this anatomic region in Filipino adult cadavers.Materials and methods:Posterior dissection to expose and measure the radial nerve, from the lateral epicondyle to the lateral intermuscular septum, was performed in 60 upper limbs from 30 formalin-preserved cadavers in the laboratory of the Department of Anatomy, College of Medicine, University of the Philippines Manila. Univariate and multivariate linear regression modelling was performed with RNDZ as the dependent variable and age, sex, height and humeral length as potential independent variables individually and in combinations.Results:The mean radial nerve length from the lateral epicondyle to the lateral intermuscular septum was estimated at 10.6 cm (95% confidence interval: 10.3 cm, 10.9cm). Height and humeral length were statistically significant univariate predictors in female cadavers, while only height was significant in male cadavers. In addition, all multivariate regression models were statistically significant and accounted for more than 57% of the variability in female RNDZ estimates. In comparison, only models that included height and age were statistically significant predictors of RNDZ and accounted for at most 22% of the variability of the estimate in males.Conclusion:The estimated length of the radial nerve danger zone generated in this study should be strongly considered over other published estimates in surgical fixation procedures performed in adult Filipinos.

A novel dual nerve transfer for restoration of shoulder function and sensory recovery of the hand, in patients with C567 traumatic root avulsion of the brachial plexus

ObjectiveThe objective of our study is to determine the anatomical viability in cadavers of a novel doble nerve transfer technique for simultaneous reanimation of shoulder abduction and sensory recovery of the hand, in patients with brachial plexus injuries sustaining a C5-C6-C7 roots avulsion. These new transfers should be complemented in the clinical setting with other classic nerve transfers, i.e.: (1) a spinal accessory to suprascapular for shoulder abduction and stability, (2) ulnar nerve fascicles to the biceps branches of the musculocutaneous for elbow flexion, and (3) intercostal to triceps branches for elbow extension. MethodsThe proposed surgical technique includes (1) transferring motor fascicles of the median nerve (MNF), as donors to the axillary nerve (AN), and (2) the whole medial antebrachial cutaneous nerve (MACN) to the lateral contribution (sensory) of the median nerve (LCMN), both without the use of interposed nerve grafts. These techniques were performed in eight cadaveric upper extremities. Analyzed variables were: donor and receptor nerves diameter, length and distance of donor and receptors nerves, and axonal count. ResultsThe mean distance between the MNF and its point of coaptation to the AN was 19 mm. The average length of each one of the MNF, after distal dissection, was 46.5 mm. The average diameter of each fascicle of the median nerve at its coaptation point with the axillary nerve was 0.8 mm, while the average diameter of the latter was 3.9 mm.The average distance between the MACN and its point of coaptation to the LCMN, was 16.5 mm. The average diameter of the MACN and the LCMN at their point of coaptation, were 2.7 mm and 3.5 mm, respectively. ConclusionThese nerve transfers are anatomically viable and could be a complement for other currently used techniques that can be employed in severely injured C567 brachial plexus patients.

Meta-analysis of the normal diffusion tensor imaging values of the median nerve and how they change in carpal tunnel syndrome

Carpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve ‘health’ which are sensitive to myelination, axon diameter, fiber density and organisation. This meta-analysis summarises the normal DTI values of the median nerve, and how they change in CTS. This systematic review included studies reporting DTI of the median nerve at the level of the wrist in adults. The primary outcome was to determine the normal fractional anisotropy (FA) and mean diffusivity (MD) of the median nerve. Secondarily, we show how the FA and MD differ between asymptomatic adults and patients with CTS, and how these differences are independent of the acquisition methods. We included 32 studies of 2643 wrists, belonging to 1575 asymptomatic adults and 1068 patients with CTS. The normal FA was 0.58 (95% CI 0.56, 0.59) and the normal MD was 1.138 × 10–3 mm2/s (95% CI 1.101, 1.174). Patients with CTS had a significantly lower FA than controls (mean difference 0.12 [95% CI 0.09, 0.16]). Similarly, the median nerve of patients with CTS had a significantly higher mean diffusivity (mean difference 0.16 × 10–3 mm2/s [95% CI 0.05, 0.27]). The differences were independent of experimental factors. We provide summary estimates of the normal FA and MD of the median nerve in asymptomatic adults. Furthermore, we show that diffusion throughout the length of the median nerve becomes more isotropic in patients with CTS.

Long Term Clinical Outcomes With Dedicated Proton Ocular Beam and Helium Ion Radiation for Uveal Melanoma Patients Aged 45 and Younger

<h3>Purpose/Objective(s)</h3> Uveal melanoma (UM) is particularly rare and potentially devastating for patients ≤ 45 years old (yo). Limited long term data exist post-particle beam radiation (RT) for this age group and hence an in-depth analysis of clinical outcomes is presented. <h3>Materials/Methods</h3> Patients were identified in a single institution's prospectively maintained database (n = 2558) of eye treatment with proton beam radiation (PBRT, 1994-2020) and helium ion RT (1979-1992). All included patients were treated for UM. Post-local eyewall resection or salvage RT patients were excluded. Patients were aged ≤ 45 yo at radiation (PBRT, n = 247 and helium, n = 80). PBRT patients undergoing 56 GyE in 4 fractions (n = 240) were further analyzed for local control (LC), eye preservation, distant metastasis (DM), and overall survival (OS). Univariate analysis using the Kaplan-Meier method (log rank test) and multivariate regression analysis using Cox's proportional hazard model (likelihood ratio test) were performed. <h3>Results</h3> Median follow-up for PBRT pts was 85.7 months (3.0-317.5). Median age at RT was 38.3 years (13.3-45.9); tumor location was 87% choroidal, 11% ciliary body (CB), and 2% iris only; tumor height 4.4 mm (0.8-15.8), largest tumor diameter (LTD) 10.5 mm (2.1-25.1), distance to disc/fovea 3.1/1.9 mm. 5-year (y) LC was 95% and 10y 94%. Ciliary body (CB) tumors showed lower LC (<i>P</i> = 0.02). LTD was the one independent multivariate predictor of LC (<i>P</i> = 0.04). Three patients had very late local failures (LF), all showed spindle-cell features [time-to-LF 13.2, 16.1, 17.5 years]. 10y overall eye preservation was 83%. Enucleation risk decreased with greater tumor-disc distance (<i>P</i> = 0.0001). Improved eye preservation was noted with ≤ 50% dose to lens (<i>P</i> = 0.01), ≤ 20% CB (<i>P</i> = 0.02), disc (<i>P</i> = 0.004), macula (<i>P</i> = 0.03), and nerve (<i>P</i> = 0.009). Multivariate analysis identified nerve length receiving 50% dose (<i>P</i> = 0.0003) and tumor height (<i>P</i> = 0.0008) as significant independent predictors of enucleation. 10y DM-free rate was 81% and 10y OS was 83%. LTD was the most significant predictor of DM (<i>P</i> = 0.0001) followed by age > 30 vs ≤ 30 (<i>P</i> = 0.03). The age ≤ 30 subgroup (n = 44) had a 5y DM-free of 100%, and had only 2% CB tumors. Two of seven early (1994-1995) proton patients receiving 48 GyE in 4 fx, had LF. The helium cohort median follow-up was 160.9 months (23.9-292.8). Median age at RT was 37.2 (18.1-45.9), tumor height 6.2 mm (2.9-14), LTD 10.5 mm (5-25), distance to disc/fovea 3.8/3.0 mm, and 24% had tumors with ciliary body involvement. Median (range) for helium RT dose was 70 GyE (48-80). Helium cohort 10y LC was 99%, 10y eye preservation was 82%. <h3>Conclusion</h3> Excellent long-term local control (10y 94% PBRT and 99% Helium cohorts) and eye preservation is seen in UM patients aged ≤ 45 treated with proton and helium ion radiation. Specific clinical and dose-volume parameters may be utilized to assess patient prognosis.

Neurovascular variations in the proximal plantar metatarsal region of the horse.

Neurovascular variation may be relevant when performing surgical techniques to the proximal plantar metatarsal region. To document variations in the neurovascular anatomy of the proximal plantar metatarsal region and study the relationship of the neurovascular components to each other and other structures located in this area. Descriptive anatomical study. Paired cadaver hind limbs from 15 horses were dissected from the distal tibia to the metatarsophalangeal joint. Deep branch of the lateral plantar nerve (DBLPN) length, location of its origin from the lateral plantar nerve (LPN), individual DBLPN ramifications into the suspensory ligament (SL) and relationship of the DBLPN to the plantar arch and accessory ligament of the deep digital flexor tendon (ALDDFT) were recorded. Mean DBLPN length was 5.8±1.7cm with the nerve arising 3.7±1.5cm proximal to the head of the fourth metatarsal bone (MTIV). There was a median of three individual DBLPN ramifications (range 2-6) entering the SL. There were no significant left/right differences. In 57% (CI 39%-74%; n=17) limbs, the deep plantar arch was superficial to the DBLPN, whereas in 33% (CI 16%-50%; n=10) limbs, the DBLPN passed between the venous and arterial components of the arch. In 10% (CI 1%-20%; n=3) limbs, the deep plantar arch was deep to the DBLPN. In 67% (CI 50%-84%; n=20) limbs, the DBLPN was superficial to the ALDDFT, whereas in 33% (CI 16%-50%; n=10) limbs, the nerve ran deep to the ALDDFT. An additional branch from the LPN was noted in one limb. Limbs were used from horses with unknown clinical history. Anatomical variation, in particular the relationship of the DBLPN and deep metatarsal fascia to the deep plantar arch and the ALDDFT is an important consideration when undertaking surgical approaches to the proximal plantar metatarsal region.

ANATOMICAL CHARACTERISTICS OF THE TEMPOROFACIAL NERVE BRANCH WITHIN THE PAROTID GLAND IN VIETNAMESE ADULTS

Objectives: Describe anatomical characteristics of the temporal branch of the facial nerve within the parotid gland in Vietnamese adults. Study population: The study was conducted in 12 hemifaces (right: 7; left: 5) of Vietnamese adult cadavers (5 cadavers with both hemifaces and 2 cadavers with only hemiface). Gender: 4 male (57.1%) and 3 female (42.9%). The average age was 73.0 ± 13.39 years (52-88 years). Method: Descriptive cross-sectional with analysis. Result and Conclusion: Most of the temporofacial trunks were located within the parotid gland (81.8%); 18.2% were located behind the parotid gland. The length of the facial nerve within the parotid gland was 8.88 ± 3.55 mm (4.62 - 16.96mm). The distance from the division point of the temporofacial trunk into the temporofrontal branch and the orbital nerve branch to the line (d) [crossing through the lateral canthus (A) and the point that root of the helix intersecting with the face] and (d2) [crossing the lateral canthus and the upper point of the tragus, just above the upper edge of external auditory canal] was 36.06 ± 7.50mm (19.26- 45.34 mm) và 21.94 ± 6.28 mm (11.52- 37.20 mm).

Haemostatic devices in parotid surgery: a systematic review.

The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

QS1: Pre-implanted Nerve Grafts (PING) to Improve Functional Outcomes in VCA

Purpose:Improved graft reinnervation and functional recovery would greatly enhance the utility of vascularized composite allotransplantation (VCA). Pre-implantation of nerve grafts in a limb transplant recipient prior to transplantation to increase the length of the severed nerves in the amputation stump offers a novel, readily translatable approach to this problem. At the time of transplantation a pre-implanted nerve graft (PING) would be elevated from its wound bed in the amputated stump and unfurled distally into the transplanted limb, allowing for a more distal nerve coaptation.Methods:We used a reversed sciatic-tibial nerve isograft coapted end-to-end to a median nerve in a rat to: (1) determine viability of distal axons after elevating PINGs; and (2) assess for ischemic injury to axons in the distal PING following elevation from the wound bed. For axonal viability, grafts of varying lengths (2cm,3cm,4cm, n≥5/group) were left to regenerate for 8 weeks. The distal ends were then biopsied prior to elevation, and again one week after elevation. For ischemia assessment, blood flow along 4cm long PINGs was measured with laser doppler at multiple timepoints: baseline (at time of grafting), 8 weeks after grafting (before elevation), immediately after elevation, and 3 and 7 days post-elevation (n=8/timepoint). Means were compared with t-tests and ANOVA. A pig forelimb model was used to assess the functional impact of PINGs. A 6cm long reversed ulnar-PING was coapted to the proximally transected ulnar nerve. After 12 weeks of regeneration, the distal PING was transferred end-to-end to the median nerve just proximal to the elbow. A control group underwent ulnar-to-median nerve transfer 6cm proximal to the elbow (n=4 limbs/group). Hoof flexion force was measured every three weeks.Results Axonal viability:after 8 weeks, axons had regenerated into the distal grafts in all lengths: mean myelinated axon counts (±SD): 7043 (±790), 6066 (±1838), 6491 (±983) in 2cm,3cm,4cm grafts, with no differences between graft lengths (p=0.48). One week after elevation and unfurling, the number of myelinated axons was significantly decreased in all groups (p<0.006): 3821 (±567), 2953 (±1107), 2894 (±1761) in 2cm,3cm,4cm grafts, with no differences between lengths (p=0.91). Ischemic injury: immediately after elevating a PING, blood flow within the distal half of the graft fell to baseline levels (i.e. no blood flow). 3 days after elevation, blood flow throughout the graft was significantly above baseline (p≤0.04) and matched/exceeded flow measured immediately prior to elevation. Functional impact: preliminary results suggest PINGs can deliver rapid functional recovery.Conclusions:Axons remain present in clinically relevant numbers at the distal ends of PINGs after elevation and unfurling. A decrease in axon counts after elevation may relate to ischemia in the distal PING immediately after elevation. Preliminary functional results show PINGs are capable of delivering early functional recovery.