1/51. Posterior interosseous nerve palsy following placement of the compass elbow hinge for acute instability: a case report.We describe a case of posterior interosseous nerve palsy that developed after application of a hinged elbow external fixation device. Our hypothesis that forearm pronation during ulnar half pin insertion may have been causative is supported by anatomic findings noted during subsequent cadaveric dissection. Based on our observations we recommend that the ulnar half pins required with this device be inserted with the forearm in supination.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/51. Clinicopathological study of an autopsy case with sensory-dominant polyradiculoneuropathy with antiganglioside antibodies.A previously reported patient presenting sensory-dominant neuropathy with antiganglioside antibodies, bound preferentially to polysialogangliosides including GD1b, was autopsied. While axonal degeneration was predominant in the sural nerve, many demyelinated fibers were present in the spinal roots. Dorsal roots had undergone significant damage. These pathological findings were well correlated with the electrophysiological results showing decreased F-wave conduction velocities and conduction blocks in motor nerves and decreased or absent sensory action potentials in sensory nerves, with distribution of GD1b in nerve tissues such as dorsal root ganglia and paranodal myelin in the ventral and dorsal roots.- - - - - - - - - - ranking = 0.8keywords = nerve (Clic here for more details about this article) |
3/51. A keyhole approach for endoscopically assisted pedicle screw fixation in lumbar spine instability.OBJECTIVE: The standard approach for dorsal transpedicular fixation in lumbar spine instability requires extensive exposure of the vertebral column. This increases the risk of potential complications and possibly destabilizes healthy neighboring segments because of the dissection and denervation of paravertebral muscles. The majority of spinal disorders are currently treated successfully via limited and tailored approaches. Accordingly, a keyhole approach for dorsal fusion of the lumbar spine was developed on the basis of an anatomic study. methods: The new endoscopic technique entails the transmuscular insertion of a pedicle screw-rod fixation device via a rigid operating sheath. As a prerequisite, the endoscopic microanatomy of the target area, as visible through the operating sheath, was first evaluated on lumbar bone specimens. To localize the exact screw entry point into the pedicle, we identified the bony and ligamentous landmarks on partly macerated specimens. To determine the course of the pedicle screws, we deduced the corresponding angles of convergence from transparent polyester casting models of average vertebrae from T12 to S1. These angles were transferred into the operative situation and measured on-line with an inclinometer. The approach was finally tested on 12 cadavers for clinical feasibility and accuracy of screw placement and then successfully implemented in patients. RESULTS: After extracutaneous localization of the pedicles at lateral fluoroscopy, paramedian skin incisions were made above the pedicles of the motion segment to be stabilized. The operative windows were exposed by use of a rigid operating sheath (length, 50 mm; diameter, 15 mm), which was inserted transmuscularly in the pedicle axis. The screw entry point into the pedicles was localized by endoscopic dissection of the mamilloaccessory ligament, bridging the mamilloaccessory notch. The pilot holes were created via insertion of a blunt-tipped pedicle probe. The adequate angles of convergence were constantly controlled during hollowing of the pedicles by an inclinometer mounted to the pedicle probe handle. The pedicle screws were then inserted through the operating sheaths. After removal of the operating sheaths, the connecting rods were inserted transmuscularly and anchored in the pedicle screw heads. Posterior bone grafting was performed after completion of the dorsal instrumentation. The dorsal fusion site was exposed by reinserting the operating sheath and tilting it medially. CONCLUSION: This new approach significantly reduces surgical traumatization and destabilization of adjacent motion segments. An endoscopic operating sheath, adopted from thoracoscopic surgery, creates space for visualization and surgical manipulations. The newly defined anatomic landmarks provide guidance to the screw entry point into the pedicle in the center of the exposure. observation of the exact corresponding angles of convergence during screw insertion by an inclinometer facilitates correct screw placement. In accordance with the initial anatomic studies, this approach was successfully performed on 12 cadavers and then used in six patients. Two illustrative cases are presented.- - - - - - - - - - ranking = 0.061540181967767keywords = median (Clic here for more details about this article) |
4/51. Sonography and MR imaging of bifid median nerve with anatomic and histologic correlation.OBJECTIVE: Imaging of a bifid median nerve has not been previously described in the radiology literature. We present three cases of bifid median nerve. The first is a patient with carpal tunnel syndrome seen on sonography and confirmed at surgery. The other two were found among 10 cadaveric specimens and were imaged with sonography and MR imaging. Confirmation of bifid median nerve in these two specimens was obtained using anatomic and histologic correlation. CONCLUSION: Sonography and MR imaging can allow effective diagnosis and delineation of a bifid median nerve in the wrist. This diagnosis is important to make before carpal tunnel release or other wrist surgeries are performed to avoid nerve injury. Furthermore, the sonographic size criteria for diagnosing carpal tunnel syndrome in nonbifid median nerves may not be accurate in evaluating bifid median nerves.- - - - - - - - - - ranking = 69.163778391783keywords = median nerve, nerve, median (Clic here for more details about this article) |
5/51. Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome.During routine dissection a subclavius posticus muscle was found on the left side of a male cadaver. This muscle arose from the upper margin of the scapula and transverse scapular ligament, inserted in the superior side of the first rib cartilage, and was innervated by a small branch from the suprascapular nerve. The anatomical relationships of the supernumerary muscle with the brachial plexus and the subclavian artery is suggestive of a possible cause of the thoracic outlet syndrome and therefore of clinical significance.- - - - - - - - - - ranking = 0.2keywords = nerve (Clic here for more details about this article) |
6/51. Flexor digitorum superficialis nerve transfer to restore pronation: two case reports and anatomic study.Loss of pronation affects most activities of daily living. We report 2 cases of traumatic loss of pronator teres function and successful reconstruction by transfer of a redundant motor branch to the flexor digitorum superficialis to the pronator teres branch(es). Follow-up period was 2 years and pronation strength was restored to 4/5 and 5/5 in the 2 patients. The anatomy of the median nerve in the proximal forearm was examined by dissecting 31 cadaver specimens. A branching scheme was formulated. The histomorphometric properties of the individual muscular branches were studied in 15 fresh specimens to evaluate their suitability and size match for nerve transfer.- - - - - - - - - - ranking = 7.8963778391783keywords = median nerve, nerve, median (Clic here for more details about this article) |
7/51. A trigeminal neuralgia-like paroxysmal pain condition presumably due to buccal nerve compression in the temporalis muscle.We encountered three patients with trigeminal neuralgia-like paroxysmal pain in the buccal nerve region. In all cases, paroxysmal pain was felt spreading to the receptive field of the ipsilateral buccal nerve, and clear tenderness was observed during intraoral palpation at the inner side of the mandibular ramus where the temporalis muscle runs and attaches. It was assumed that the paroxysmal pain might be caused by nerve compression related to temporalis muscle hyperactivity. To lend support to this hypothesis, we also studied the anatomical relationship between the buccal nerve and the masticatory muscles. In this autopsy study, the buccal nerve pierced the temporalis muscle in six (12%) of 52 specimens from 26 cadavers. These findings support the hypothesis that peripheral buccal nerve compression could be an etiology of paroxysmal neuropathic pain in the unilateral orofacial region.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
8/51. recurrent laryngeal nerve palsy and endotracheal intubation.voice changes developing after endotracheal intubation have been found to be due to a recurrent laryngeal nerve palsy in four patients. In none of these patients was there any obvious cause and this posed the question whether endotracheal intubation itself could result in a paralysis of the nerve. cadaver dissection has suggested a way in which which paralysis could occur and this and other possible aetiologies are discussed.- - - - - - - - - - ranking = 1.2keywords = nerve (Clic here for more details about this article) |
9/51. Extraforaminal entrapment of the fifth lumbar spinal nerve by osteophytes of the lumbosacral spine: anatomic study and a report of four cases.STUDY DESIGN: An anatomic study of the associations between the fifth lumbar spinal nerve (L5 spinal nerve) and a lumbosacral tunnel, consisting of the fifth lumbar vertebral body (L5 vertebral body), the lumbosacral ligament, and sacral ala, and clinical case reports of four patients with lumbar radiculopathy secondary to entrapment of the L5 spinal nerve in the lumbosacral tunnel. OBJECTIVES: To delineate the anatomic, clinical, and radiologic features and surgical outcome of patients with entrapment of the L5 spinal nerve in the lumbosacral tunnel. SUMMARY OF BACKGROUND DATA: Although several cadaveric studies on a lumbosacral tunnel as a possible cause of L5 radiculopathy have been reported, few studies had focused on osteophytes of the L5-S1 vertebral bodies as the major component of this compressive lesion, and clinical reports on patients with this disease have been rare. methods: Lumbosacral spines from 29 geriatric cadavers were examined with special attention to the associations between osteophytes of the L5-S1 vertebral bodies and the L5 spinal nerve. Four patients with a diagnosis of the entrapment of the L5 spinal nerve by osteophytes at the lumbosacral tunnel were treated surgically, and their clinical manifestations and surgical results were reviewed retrospectively. RESULTS: The anatomic study demonstrated osteophytes of the L5-S1 vertebral bodies in seven of the 29 cadavers. Entrapment of the L5 spinal nerve in the lumbosacral tunnel was observed in six of the seven cadavers with L5-S1 osteophytes but in only one of the 22 cadavers without such osteophytes (P < 0.05, chi2 test). All four patients had neurologic deficits in the L5 nerve root distribution. MRI and myelography showed no abnormal findings in the spinal canal, but CAT scans demonstrated prominent osteophytes on the lateral margins of L5-S1 vertebral bodies in all four. Selective L5 nerve block completely relieved all patients of pain but only temporarily. Three patients were treated via a posterior approach by resecting the sacral ala along the L5 spinal nerve, and the other patient was treated by laparoscopic anterior resection of the osteophytes. pain relief was obtained in the four patients immediately after surgery, but one patient experienced recurrence of pain 1 year after the first surgery and was successfully treated by additional posterior decompression and fusion. CONCLUSIONS: Extraforaminal entrapment of L5 spinal nerve in the lumbosacral tunnel can cause L5 radiculopathy, and osteophytes of L5-S1 vertebral bodies are a major cause of the entrapment.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
10/51. Limited macular translocation with scleral retraction suture.BACKGROUND/AIMS: Macular translocation with scleral imbrication is a new technique for treating subfoveal choroidal neovascular membranes (CNV). This procedure shortens the sclera but may result in a minimal decrease in the internal circumference of the globe and limits the amount of foveal displacement. The authors propose a new scleral retraction suture aimed at decreasing the internal circumference of the globe in an effort to increase foveal displacement. methods: Using a cadaver model, they compared the amount of scleral shortening using a standard scleral imbrication technique and a modified three suture scleral retraction technique. Sections of the globes were digitised and specialised software was used to estimate the amount of scleral shortening. Three patients with subfoveal choroidal neovascularisation underwent limited macular translocation using pars plana vitrectomy and macular detachment with the modified scleral suture technique. The main outcome measures were visual acuity, foveal displacement, and complications. RESULTS: In the cadaver model, the scleral retraction suture resulted in a flatter internal scleral fold compared to the standard suture technique and created approximately 890 microm of effective scleral shortening. In the patients who underwent macular translocation and laser photocoagulation of the CNV, visual acuity improved in two patients and worsened in one patient. The range of foveal displacement was 1400-2400 microm. CONCLUSION: The foveal displacements achieved in this limited study compared to median displacement previously published using standard suture techniques demonstrates that the scleral retraction suture technique may be a useful adjunct to limited macular translocation. The advantage of this type of suture in conjunction with translocation may depend on the effective scleral shortening offered by this retraction suture.- - - - - - - - - - ranking = 0.061540181967767keywords = median (Clic here for more details about this article) |
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