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Anatomic Variability

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Albert L. Rhoton – One of the best experts on this subject based on the ideXlab platform.

  • Microvascular anatomy of the medial temporal region: part 1: its application to arteriovenous malformation surgery.
    Neurosurgery, 2010
    Co-Authors: Juan C. Fernandez-miranda, Evandro De Oliveira, Pablo Rubino, Hung Tzu Wen, Albert L. Rhoton

    Abstract:

    Background The medial temporal region (also called the temporomesial or mediobasal temporal region) is the site of the most complex cortical anatomy. Objective To investigate the Anatomic Variability of the arterial supply and venous drainage of each segment of the medial temporal region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR. Methods Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected. Results The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%. Conclusion An understanding of the vascular Variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.

  • Microvascular anatomy of the medial temporal region: part 1: its application to arteriovenous malformation surgery.
    Neurosurgery, 2010
    Co-Authors: Juan C. Fernandez-miranda, Evandro De Oliveira, Hung Tzu Wen, Pablo A Rubino, Albert L. Rhoton

    Abstract:

    The medial temporal region (also called the temporomesial or mediobasal temporal region) is the site of the most complex cortical anatomy.
    To investigate the Anatomic Variability of the arterial supply and venous drainage of each segment of the medial temporal region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR.
    Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected.
    The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a predominant inferior drainage in 16%.
    An understanding of the vascular Variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.

A. Lee Dellon – One of the best experts on this subject based on the ideXlab platform.

  • Superficial Peroneal Nerve (Superficial Fibularis Nerve): The Clinical Implications of Anatomic Variability
    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2006
    Co-Authors: Stephen L. Barrett, A. Lee Dellon, Gedge D. Rosson, Linda Walters

    Abstract:

    The purpose of this study is to refine further the knowledge about the Anatomic Variability of the superficial peroneal nerve in the middle third of the leg. Approaching the superficial peroneal nerve in this location is required: 1) when either the deep or the superficial peroneal nerve must be resected for the treatment of dorsal foot pain; 2) when a neurolysis of the superficial peroneal nerve is required; 3) when a fasciotomy must be performed either for trauma or for exertional compartment syndrome surgery; and 4) during elevation of a fasciocutaneous or fibular flaps. Because of the Variability encountered during these procedures, a prospective study was carried out via lower extremity cadaver dissection with fresh, frozen specimens. A total of 35 nonpaired lower extremities and 40 paired lower extremities were dissected with 3.5 loupe magnification. The superficial peroneal nerve was identified in the lateral compartment immediately adjacent to the fascial septum in 72% of the specimens (54 of 75), with a branch in both the anterior and the lateral compartment in 5% of the specimens (4 of 75), and located in the anterior compartment in only 23% of the specimens (17 of 75). The clinical implications of these Anatomic findings are that the surgeon operating in the anterior and lateral compartments of the leg should be aware that the superficial peroneal nerve may be located in the lateral compartment and may also exhibit branches in both the anterior and lateral compartments.

  • Superficial peroneal nerve Anatomic Variability changes surgical technique.
    Clinical orthopaedics and related research, 2005
    Co-Authors: Gedge D. Rosson, A. Lee Dellon

    Abstract:

    Entrapment of the superficial peroneal nerve is an uncommon entrapment that occurs in sports trauma or fracture and dislocation as the nerve comes under pressure between the underlying muscles and the overlying fascia. Although the superficial peroneal nerve traditionally is depicted as being in the

Ketan M. Patel – One of the best experts on this subject based on the ideXlab platform.

  • A prospective clinical assessment of Anatomic Variability of the submental vascularized lymph node flap.
    Journal of surgical oncology, 2017
    Co-Authors: Ming-huei Cheng, Chia-yu Lin, Ketan M. Patel

    Abstract:

    INTRODUCTION The vascularized submental lymph node (VSLN) flap has become a popular choice for the treatment of lymphedema. Despite its favorable characteristics, Anatomic Variability exists, making the harvest of this flap challenging. Knowledge and characterization of Anatomic Variability can aid the surgeon in safe and effective flap harvest. METHODS A prospective analysis of all patients who underwent VSLN flap transfer for lymphedema was performed. Demographics, operative details, and post-operative recovery were analyzed for included patients. Intraoperative videography and detailed Anatomic drawings of each case were reviewed to accurately account for Anatomic Variability and details. RESULTS Forty-two patients were identified during the study period. Arteriovenous Anatomic Variability (A1-A2 and V1-V4) existed, with most patients having the artery and vein present superior to the submandibular gland (A1V1; 31%), with other combinations occurring less frequently. Flap harvest time was found to be significantly increased with an intraglandular arterial course (P 

  • a prospective clinical assessment of Anatomic Variability of the submental vascularized lymph node flap
    Journal of Surgical Oncology, 2017
    Co-Authors: Ming-huei Cheng, Chia-yu Lin, Ketan M. Patel

    Abstract:

    INTRODUCTION The vascularized submental lymph node (VSLN) flap has become a popular choice for the treatment of lymphedema. Despite its favorable characteristics, Anatomic Variability exists, making the harvest of this flap challenging. Knowledge and characterization of Anatomic Variability can aid the surgeon in safe and effective flap harvest. METHODS A prospective analysis of all patients who underwent VSLN flap transfer for lymphedema was performed. Demographics, operative details, and post-operative recovery were analyzed for included patients. Intraoperative videography and detailed Anatomic drawings of each case were reviewed to accurately account for Anatomic Variability and details. RESULTS Forty-two patients were identified during the study period. Arteriovenous Anatomic Variability (A1-A2 and V1-V4) existed, with most patients having the artery and vein present superior to the submandibular gland (A1V1; 31%), with other combinations occurring less frequently. Flap harvest time was found to be significantly increased with an intraglandular arterial course (P < 0.01). CONCLUSIONS The VSLN flap can be safely and effectively harvested with knowledge of arteriovenous Anatomic Variability. Most commonly, the artery and vein travel together superior to the submandibular gland, but other variations exist, which may add time to surgical flap harvest and increased need for dissection. J. Surg. Oncol. 2017;115:43-47. © 2017 Wiley Periodicals, Inc.