Publications by authors named "Joe Iwanaga"

402 Publications

Giant dural arteriovenous fistula in an infant.

Anat Cell Biol 2021 10 18. Epub 2021 Oct 18.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.

Dural arteriovenous fistulas (dAVFs) are commonly encountered by the neurosurgeon. Herein, we present a case illustration of an infant presenting with an extremely large fistula that took up a significant part of the intracranial volume. A one-month-old female presented with irritability and failure to thrive. She was the product of a 35-week pregnancy and was delivered vaginally without complications or a difficult labor. Based on the findings of magnetic resonance imaging, the diagnosis of a giant dAVF involving the transerve-sigmoid sinuses was made. The patient was scheduled for an arteriogram but died before the procedure could be performed. Such a case illustrates how large some dAVF can become and at a very early age. As in the present case, the patient was minimally symptomatic. Therefore, the time to intervention after diagnosis is thus, sometimes, critical.
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http://dx.doi.org/10.5115/acb.21.083DOI Listing
October 2021

Cutaneous Branch of the Spinal Accessory Nerve: Case Report With Potential Relevance to Occipital Neuralgia.

Cureus 2021 Sep 2;13(9):e17666. Epub 2021 Sep 2.

Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA.

We describe a case in which a cutaneous branch was found arising from the spinal accessory nerve, a nerve typically characterized as a purely motor nerve. Although reported anatomical variations of the lesser occipital and spinal accessory nerves are uncommon, rare variants have been reported. Such anatomy might result in unexpected patient presentations or rare complications following spinal accessory nerve injury.
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http://dx.doi.org/10.7759/cureus.17666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8487268PMC
September 2021

Comprehensive review of the incisive branch of the inferior alveolar nerve.

Anat Cell Biol 2021 Oct 8. Epub 2021 Oct 8.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.

The incisive branch of the inferior alveolar nerve is a vital anatomical structure within the anterior mandible that has not been thoroughly defined and outlined in reports in the literature until recent years. Advances in radiological imaging, particularly the widespread use of cone-beam computed tomography has allowed for accurate visualization of the mandibular incisive canal (MIC) and its associated incisive branch of the inferior alveolar nerve. Surgical damage to the MIC, which could result in hemorrhage and sensory disturbance, may occur in commonly practiced oral and maxillofacial procedures, such as chin bone harvesting, implant placement, fracture repair and removal of pathologic entities of the anterior mandible. Knowledge of both the presence, dimensions and location of the incisive branch is a vital component to pre and peri-operative planning of oral and maxillofacial surgeries performed within the mandible, particularly within the interforaminal zone. In this article, the terminology, anatomy, imaging, surgical consideration, and pathology of the incisive branch will be discussed.
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http://dx.doi.org/10.5115/acb.21.113DOI Listing
October 2021

Displacement of lower third molar into floor of mouth: a single institutional experience.

Oral Maxillofac Surg 2021 Oct 1. Epub 2021 Oct 1.

Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1Shikata-cho, Kita-ku, Okayama-shi, 700-8525, Japan.

Purpose: The displacement of the tooth/tooth fragment into the floor of mouth sometimes happens during the lower third molar surgery and the patients are usually referred to oral and maxillofacial surgeons. To date, however, there is no consensus how to manage the displaced tooth due to the lack of available data.

Methods: In this study, we have retrospectively analyzed the management of the displaced lower third molar into the floor of mouth. Our institute experienced seven cases during 2010 to 2020.

Results: Incidence rate of the lingual nerve injury caused by displacement of the lower third molar was 1/7. Six patients out of seven underwent surgical removal of the displaced fragment. The direct approach was used when the fragment was palpable superficially and the fragment was horizontally located away from the lingual plate (2 cases), while when the fragment was not palpable, or was palpable and adjacent to the lingual plate, the lingual mucoperiosteal flap was selected (4 cases).

Conclusion: We conclude that the palpation and preoperative diagnosis with computed tomographic images are significantly important to decide a better and most effective surgical approach.
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http://dx.doi.org/10.1007/s10006-021-01012-3DOI Listing
October 2021

A comprehensive review of the "supracondylar process" with translation of Adachi.

Clin Anat 2021 Sep 28. Epub 2021 Sep 28.

Department of Anatomical Sciences, St. George's University, St. George's, Grenada.

The supracondylar process is a nonpathological projection from the distal humerus that in some patients, can result in compression of regional neurovascular structures, for example, median nerve. Since the first description of the supracondylar process in 1818, it has also been a focus of anthropological study because of its possible relevance to human origins and relationships to other species. Although its overall incidence is low, it is more common in races of European descent. It is particularly interesting for anatomists and anthropologists, but knowledge of its anatomical relationships and effect on pathological processes helps in the diagnosis and treatment of supracondylar process syndrome. One of the most detailed descriptions of this variant process stems from the work of Buntaro Adachi. Herein, a translation of his findings is provided and a review of the supracondylar process and its potential pathological presentations presented.
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http://dx.doi.org/10.1002/ca.23794DOI Listing
September 2021

Detethering the superficial temporal artery: Application to tension free superficial temporal artery-middle cerebral artery bypasses.

Clin Anat 2021 Sep 25. Epub 2021 Sep 25.

Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA.

Extracranial-intracranial bypass has been shown to be effective in the surgical treatment of moyamoya disease, complex aneurysms, and tumors that involve proximal vasculature in carefully selected patients. Branches of the superficial temporal artery (STA) are used commonly for the bypass surgery; however, an appropriate length of the donor vessel must be harvested to avoid failure secondary to anastomotic tension. The goal of this cadaveric study was to investigate quantitatively operative techniques that can increase the STA length available to facilitate tension-free STA-middle cerebral artery (MCA) bypass. We conducted a cadaveric study using a total of 16 sides in eight cadavers. Measurements of the STA trunk with its frontal branch (STAfb) were taken before and after skeletonization and detethering of the STA with the STAfb and mobilization of the parietal branch of the STA. A final measurement of the STA with the STAfb was taken for the free length gained toward visible proximal cortical branches of the MCA. Paired student's t-tests were used to compare the mean length before and after mobilization and unpaired t-tests to analyze according to laterality. The mean length of the STA with the STAfb was 9.0 cm prior to modification. After skeletonization and mobilization, the mean lengths increased significantly to 10.5 and 11.3 cm, respectively (p < 0.05). Especially in the cases that had the coiled and tortuous STA, skeletonization was considerably effective to increase the length of the STA with the STAfb. After simulating a bypass by bringing the STAfb to the recipient MCA site, the mean extended length of the STA with the STAfb was 3.0 cm. There were no statistically significant differences between sides in all measurements. We report a significant increase in the mean STA length available (3.0 cm) following skeletonization and mobilization. Clinical applications of the extended length of the STA with the STAfb may facilitate tension-free STA-MCA bypasses and improve outcomes. Further studies are needed in a clinical context.
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http://dx.doi.org/10.1002/ca.23789DOI Listing
September 2021

A narrative review and clinical anatomy of herpes zoster infection following COVID-19 vaccination.

Clin Anat 2021 Sep 23. Epub 2021 Sep 23.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.

Introduction: In this review, cases of herpes zoster (HZ) infection following receipt of COVID-19 vaccines will be analyzed. We also present two cases of oral HZ following the COVID-19 vaccine and discuss this clinical anatomy.

Materials And Methods: A database search using PubMed was conducted in August 2021 and 20 articles were found to be eligible for review. Patient data and vaccine information were analyzed. In addition, two cases of oral HZ infection following the receipt of COVID-19 vaccines are presented.

Results: A total of 399 cases were identified. The affected dermatomes mimicked the regular distribution of HZ. For the dermatomes of the face, the various reports used different ways to describe the areas involved; CNV, CNV1, CNV2, CNV3, lower jaw, forehead, and under the eyebrow (CNV, 2 cases; CNV1, 4 cases; CNV2, 3 cases; and CNV3, 3 cases). Some patients who had a history of varicella zoster virus vaccination had HZ following the COVID-19 vaccination. Two patients with oral HZ following vaccination were found to have involvement of the greater palatine nerve.

Conclusions: Vaccine-related HZ cases have been reported worldwide. Although many studies with a larger number of cases are ongoing, detailed information can be obtained from case reviews as reported herein.
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http://dx.doi.org/10.1002/ca.23790DOI Listing
September 2021

An anatomical study of the pharyngeal plexus: Application to avoiding postoperative dysphagia following anterior approaches to the cervical spine.

Clin Anat 2021 Sep 18. Epub 2021 Sep 18.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.

We aimed to localize the pharyngeal branches of the pharyngeal plexus to preclude postoperative complications such as dysphagia resulting from injury to those branches. Cranial nerves IX and X and the sympathetic trunk were dissected on 10 sides in the necks of embalmed adult cadavers of European descent to identify the pharyngeal branches so that anatomical landmarks could be identified and injury thereby avoided. In all sides, the pharyngeal branches originated from the glossopharyngeal and vagus nerves and the superior cervical ganglion and entered the posterior pharyngeal wall at the C2-C4 levels within 10 mm medial to the greater horn of the hyoid bone. All pharyngeal branches were anterior to the alar fascia. Based on our anatomical study, vagus nerve branches to the pharyngeal muscles enter at the C3/C4 vertebral levels. Such knowledge might help decrease or allow surgeons to predict which patients are more likely to develop dysphagia after cervical spine surgery.
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http://dx.doi.org/10.1002/ca.23785DOI Listing
September 2021

Transosseous Veins of the Temporal Bone: Connection Between Middle and Posterior Cranial Fossa Venous Structures.

World Neurosurg 2021 Sep 11. Epub 2021 Sep 11.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies; University of Queensland, Brisbane, Queensland, Australia.

Background: The veins and dural venous sinuses of the skull base are important to understand in terms of imaging findings, diagnoses, and surgery. However, to date and to the best of our knowledge, the transosseous veins of the petrous part of the temporal bone have not been studied.

Methods: Ten latex-injected adult cadaveric specimens (20 sides) were dissected to identify the intraosseous and transosseous veins. The petrous part of the temporal bone was drilled away, and the petrous part of the internal carotid artery and the veins of the middle and posterior cranial fossa adjacent to the petrous part of the temporal bone were exposed.

Results: Transosseous veins traveling through the petrous part of the temporal bone were identified on all 20 sides. In general, these were most concentrated near the anterior and posterior parts of the petrous part of the temporal bone. Most traveled more or less vertically from the petrous ridge and related superior petrosal sinus internally through the petrous part of the temporal bone toward the inferior petrosal sinus or horizontally, uniting the veins of the floor of the middle cranial fossa with the veins of the posterior cranial fossa. These transosseous veins connected the veins in the middle cranial fossa with the veins of the posterior cranial fossa. Most (70%) of these transosseous veins were also found to have small connections to the internal carotid venous plexus.

Conclusions: To the best of our knowledge, previous studies have not reported on transosseous veins of the temporal bone or described their anatomy of connecting the veins of the middle and posterior cranial fossae.
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http://dx.doi.org/10.1016/j.wneu.2021.09.024DOI Listing
September 2021

A rare anatomical variation of the submental artery.

Surg Radiol Anat 2021 Nov 12;43(11):1805-1808. Epub 2021 Sep 12.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA.

The submental artery usually runs anteriorly on the inferior surface of the mylohyoid muscle, giving branches to that muscle and to the anterior belly of the digastric muscle, finally supplying the submental skin. Branches of it often perforate the mylohyoid muscle and enter the sublingual space. During a routine anatomy dissection, we encountered a case in which the main trunk of the submental artery perforated the mylohyoid muscle, where the sublingual artery usually runs. No branches coursed anteriorly to supply the submental skin. To our knowledge, this submental artery variation has not been reported in the English literature. Any surgical procedure in the submandibular area, such as the axial pattern submental local flap, requires knowledge of such arterial variations.
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http://dx.doi.org/10.1007/s00276-021-02830-6DOI Listing
November 2021

The course of the main septum in the sphenoid sinuses - evaluation before the FESS.

Folia Med Cracov 2021 ;61(2):35-51

Department of Radiology, Jagiellonian University Medical College, Kraków, Poland.

The purpose of this study was to determine the course of the main septum (MS) in the sphenoid sinuses in the adult population. Materials and Methods: 296 patients (147 females, 149 males), who did not present any pathology in the paranasal sinuses, were included in this retrospective analysis of the computed tomography (CT) scans. Spiral CT scanner (Siemens Somatom Sensation 16) was used in order to glean the images of the paranasal sinuses, using standard procedure, in the option Siemens CARE Dose 4D, without using any contrast medium. Secondary reconstructions of the sagittal and frontal planes were obtained using multi- plans reconstruction (MPR) tool after obtaining transverse planes in the first instance. R e s u l t s: The course of the MS changed the most often from the anterior to the posterior part of the sphenoid sinuses. Such situation took place in 83.78% of the patients, in 32.43% of whom a clear shift to the lateral side was noticed only in the posterior part of the MS: in 18.24% of the patients to the right side, and in 14.19% of the patients to the left side. In 17.57% of the patients the lateral shift was visible in both anterior and posterior parts of the septum, where in 9.46% of the patients it was from the left side to the right, whereas in 8.11% of the patients the shift took place from the right side to the left. The MS had the shape of the letter 'C' in 22.29% of the cases, and 11.82% had the typical shape of the letter 'C,' and in 10.47% of the patients it paralleled the inverted letter 'C' (upside down). Amongst the types of the MS shifting directions the rarest was the MS that resembled the letter 'S' - 11.48% of the patients. In 5.74% of the cases it looked like the typical letter 'S,' and in 5.74% of the cases it was similar to the inverted letter 'S.' Only 16.22% of the cases had the MS that did not change its course nor its shape and ran medially in the sagittal plane from the anterior to the posterior part of the sinuses. Conclusions: In furtherance of reducing the risk of problems occurring during a surgery in the paranasal sinuses, it is prudent to have a CT scan done in all the patients beforehand, due to the high prevalence of the anatomical variations in the sinuses.
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October 2021

Anatomy education for medical students in a virtual reality workspace: A pilot study.

Clin Anat 2021 Sep 6. Epub 2021 Sep 6.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.

The COVID-19 pandemic has posed a challenge for many medical schools, as they have had to adjust their curricula into an online format. This was particularly problematic for anatomy courses as in person dissections have historically been preferred for providing students with a three-dimensional learning environment. In this study, we aim to share our experience with conducting anatomy lectures for medical student using a virtual reality (VR) workspace. Additionally, we discuss the advantages of using VR and expand on how it may be used to improve students' understanding of anatomy in comparison to various other online lecture formats. To do this, we utilized a post-lecture survey to gain feedback from the medical students that participated in a VR anatomy workspace. We found that many of our participants expressed that having access to their course material from anywhere and anytime via a virtual space, and being able to manipulate anatomical structures by moving and modifying them provided the student with a strong advantage. Although there are still limitations, we hope that our experience will assist other anatomy teachers with improving their lecture methods, especially during the pandemic.
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http://dx.doi.org/10.1002/ca.23783DOI Listing
September 2021

Wrist Extension Does Not Change the Position of the Radial Artery: Cadaveric Study With Application to Arterial Line Placement, and Transradial Neurointerventional Procedures.

World Neurosurg 2021 Aug 30. Epub 2021 Aug 30.

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies; University of Queensland, Australia.

Background: The radial artery is gaining popularity as a vascular access site for neurointerventional procedures. However, recent analyses of wrist position and radial artery anatomy has suggested that the extended position of the wrist is not always necessary. Therefore, the following cadaveric study was performed to verify these findings.

Methods: Twenty adult cadaveric upper limbs underwent dissection of the radial artery. The radial artery was exposed but left in its anatomical position. With the hand supinated, the wrist was extended to 45 degrees and 90 degrees. Observations were then made of any movement of the artery during these ranges of motion. Next, a tension gauge was attached to the radial artery and any tension on the artery measured during the above noted ranges of motion.

Results: During extension of the wrist, none of the radial artery specimens was found to move in any direction. Moreover, an average of only 0.28 N of tension on the artery was found with wrist extension up to 90 degrees. Our cadaveric study found that, contrary to popular belief, extension of the wrist during cannulation of the radial artery does not change the position of the artery nor does it significantly alter the tension on the artery.

Conclusions: These data support several recent clinical studies.
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http://dx.doi.org/10.1016/j.wneu.2021.08.105DOI Listing
August 2021

Extended crossing fibers of the mentalis muscle attaching to the contralateral mandible.

Anat Cell Biol 2021 Sep 1. Epub 2021 Sep 1.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.

Fibers of the facial muscles occasionally extend, cross the midline, and connect to surrounding structures on the contralateral side, perhaps enabling the mouth to make more delicate movements and generate more facial expressions. This case report describes a variant in which the extended fibers of the mentalis crossed the midline and indicates the relationship of these fibers to the surrounding structures. Some of the deepest fibers of the mentalis descended inferomedially and crossed transversely just below the chin prominence to attach to the periosteum of the mandible on the contralateral side. The variation presented in this study shed light on the interactions of the mentalis with the surrounding muscles.
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http://dx.doi.org/10.5115/acb.21.127DOI Listing
September 2021

The potential for facial artery injury during mandibular third molar extraction. An anatomical study using contrast-enhanced computed tomography.

Clin Anat 2021 Nov 5;34(8):1215-1223. Epub 2021 Sep 5.

Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.

The purpose of this study was to evaluate the risk of injury to the facial (FA) and related arteries during mandibular third molar (MTM) extraction using contrast-enhanced computed tomography (CE-CT). CE-CT images of the MTM region were retrospectively reviewed. The area of the MTM was equally divided into three zones in the coronal images from mesial to distal, that is, zone 1, zone 2, and zone 3. The FA, submental artery (SMA), and sublingual artery (SLA) were identified. The distance from the mandible to FA, SMA, and SLA and the diameter of the FA, SMA, and SLA was measured in three zones, respectively. The thickness of the facial soft tissues and width of the mandible were measured at their maximum. The mean distance from the FA to the buccal cortical bone in zone 1, zone 2 and zone 3 was 2.24 mm, 2.39 mm and 1.67 mm, respectively. The SMA and SLA were found to be distal to the mandible. The mean diameter of the FA was 1.26 mm in males and 1.04 mm in females, respectively (p < 0.0001). The distance between the FA and buccal cortical bone of the mandible, and the patients' weight showed moderate correlation in zones 1 and 2. Based on our findings, the FA can be damaged if the surgical invasion reaches the facial soft tissues during MTM surgery. The patients' weight might be a good predictor for FA injury when CE-CT is not available.
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http://dx.doi.org/10.1002/ca.23779DOI Listing
November 2021

Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review.

Neurosurg Rev 2021 Aug 25. Epub 2021 Aug 25.

Department of Anatomical Sciences, St. George's University, St. George's, Grenada.

The sacroiliac joint is a diarthrodial synovial joint in the pelvis. Anatomically, it is described as a symphysis, its synovial joint characteristics being limited to the distal cartilaginous portion on the iliac side. It is a continuous ligamentous stocking comprising interconnecting ligamentous structures and surrounding fascia. Its ligaments, the primary source of its stability, include the anterior, interosseous and dorsal sacroiliac, the iliolumbar, sacrotuberous, and sacrospinous. Structural reinforcement is also provided by neighboring fascia and muscles. Lower back pain is a common presentation of sacroiliac joint disease, the best-established treatments being corticosteroid injections, bipolar radiofrequency ablation, and sacroiliac joint fusion.
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http://dx.doi.org/10.1007/s10143-021-01625-yDOI Listing
August 2021

Clinical anatomy of the inferior labial gland: a narrative review.

Gland Surg 2021 Jul;10(7):2284-2292

Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.

Objective: In this article we review the literature on the inferior labial gland from a clinical and anatomical perspective.

Background: Regardless of its importance in clinical practice, there are no medical literature that comprehensively reviewed the inferior labial gland.

Methods: A database search using PubMed and Google Scholar was conducted. The following keywords were used in the search: "lower labial salivary gland", "lower labial gland", "inferior labial salivary gland", AND "inferior labial gland".

Conclusions: The human labial glands are types of minor salivary gland that continuously secrete small amounts of mucous and serous substances to maintain oral health. The inferior labial glands are innervated by the inferior labial branch of the mental nerve, and the inferior labial branch of the facial artery is the main arterial supply to the lower lip. Although they only have an auxiliary role in saliva production compared to the major salivary glands, minor salivary glands provide a certain amount of lubrication in the oral cavity by the continuous outflow of saliva. The inferior labial gland not only promotes moisturization in the oral cavity but also secretes substances with antibacterial effects, which is important for the function of the oral cavity. A recent study showed that the rate of salivary secretion from the inferior labial glands does not change with age, and in some cases the inferior labial glands are used for diagnosing intractable diseases such as Sjogren's syndrome and cystic fibrosis. In addition, since the inferior labial glands themselves can be the site of cyst and/or neoplasia development, we should be careful to distinguish them from other diseases. Elucidation of the anatomy, physiology, and pathology of the inferior labial glands, is important for understanding human health and diseases.
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http://dx.doi.org/10.21037/gs-21-143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340335PMC
July 2021

Can anatomical feasibility studies drive neurosurgical procedures and reach patients faster than traditional translational research?

Neurosurg Rev 2021 Aug 19. Epub 2021 Aug 19.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA.

Often, surgical techniques are practiced and studied in the anatomy laboratory. Occasionally, new surgical methods are developed with cadaveric anatomical studies. Some cadaveric feasibility studies, if published, might go on to be used by surgeons from around the world for improved patient care. Herein, we review our experience with 37 published anatomical feasibility studies over an 18-year period (2002-2020) and analyze the literature for published examples of surgical application of these same anatomical studies. We found that, for cadaveric anatomical feasibility studies within 7 years of their publication date, approximately 22% will be used in neurosurgery with the clinical applications published. Of these studies awarded clinical citation within 7 years of publication, the median time to that citation was approximately 3.4 years. As the average time for translational research to reach patient care is 17 years, cadaveric anatomical studies in this series reached patient care much sooner than traditional translational research. Cadaveric anatomical studies, based on our experience, can drive neurosurgical procedures.
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http://dx.doi.org/10.1007/s10143-021-01626-xDOI Listing
August 2021

Duplicated Anterior Choroidal Arteries: Literature Review and Clinical Implications.

Cureus 2021 Jul 10;13(7):e16291. Epub 2021 Jul 10.

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA.

The anterior choroidal artery supplies important cerebral structures. One important variation of this vessel is duplication. However, little is reported on this anatomical variant and moreover, the prevalence of such a finding varies widely. Therefore, here, we review the literature regarding duplicated anterior choroidal arteries. Clinicians reviewing imaging of the brain, interventionalists, or neurosurgerons should be knowledgeable of variations of the anterior choroidal artery, including its duplication. A better understanding of this anatomy and embryology can improve diagnoses and patient outcomes following interventional or open neurosurgical techniques.
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http://dx.doi.org/10.7759/cureus.16291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351311PMC
July 2021

Anatomy of the Dorsal Meningeal Artery Including Its Variations: Application to Skull Base Surgery and Diagnostic and Interventional Imaging.

World Neurosurg 2021 Aug 6. Epub 2021 Aug 6.

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Queensland University, Brisbane, Australia.

Background: The blood supply to the skull base is important to surgeons and those performing interventional and diagnostic procedures in this region. However, 1 vessel with a vast distribution in this area, the dorsal meningeal artery (DMA), has had few anatomic studies performed to investigate not only its normal anatomy but also its variations. Therefore the current study aimed to analyze the DMA via cadaveric dissection.

Methods: In 10 adults, latex-injected, cadaveric heads (20 sides), the DMA was dissected using a surgical microscope. This artery and its branches were documented and measured.

Results: A DMA was identified on all sides. In the majority (85%), it was a branch of the meningohypophysial trunk or common stem with either the inferior hypophysial or tentorial arteries and always had branches that traversed the basilar venous plexus. Multiple branches of the DMA were identified and categorized as bony, dural, neural, and vascular.

Conclusions: Surgeons operating at the skull base or clinicians interpreting imaging of this area should have a good working knowledge of the DMA and its typical and variant anatomy.
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http://dx.doi.org/10.1016/j.wneu.2021.07.132DOI Listing
August 2021

A Rare Anatomical Variation of the Lesser Occipital Nerve.

Cureus 2021 Jun 24;13(6):e15901. Epub 2021 Jun 24.

Anatomical Sciences, St. George's University, St. George's, GRD.

The lesser occipital nerve (LON) is a cutaneous branch of the cervical plexus that arises from the second and sometimes the third spinal nerve and innervates the scalp. During routine dissection of the neck, the LON was observed to arise directly from the spinal accessory nerve. The aberrant nerve measured 1.9 mm in diameter and 10.2 cm in length. Although anatomical variations of the LON such as duplication and triplication have been observed, we believe the origination of this nerve directly and exclusively from the spinal accessory nerve is exceedingly rare. The current case adds to the sparse literature on the variations of the LON and might be of interest to clinicians treating neurological conditions or surgeons operating in the area.
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http://dx.doi.org/10.7759/cureus.15901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312764PMC
June 2021

Rare anastomosis between the ascending pharyngeal and vertebral arteries via the hypoglossal canal: A cadaveric case report.

Anat Cell Biol 2021 Sep;54(3):399-403

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.

We present a rare case of external carotid artery-vertebral artery anastomosis via the ascending pharyngeal artery, diagnosed upon cadaveric dissection. The ascending pharyngeal artery gave rise to a branch to the hypoglossal canal, which is a variation of a true persistent fetal hypoglossal artery. Knowledge of persistent carotid-vertebrobasilar anastomoses is important as these fetal vessels can contribute significantly to the posterior cerebral circulation. Only 10 cases of external carotid artery-vertebrobasilar artery anastomoses have been reported to our knowledge, and our case presents the first cadaveric dissection of this rare variation.
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http://dx.doi.org/10.5115/acb.21.093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493013PMC
September 2021

An anatomical and histological study of mental nerve branches to the inferior labial glands.

Surg Radiol Anat 2021 Nov 7;43(11):1801-1804. Epub 2021 Jul 7.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, USA.

Purpose: In this study, we aimed to reveal the detailed anatomy of mental nerve branches to the inferior labial glands.

Methods: Embalmed cadaveric heads were used in this study and the mental nerve branches to the inferior labial glands were dissected. Branches to the glands were then excised for histological observation.

Results: On all sides, the inferior labial glands were innervated by small branches arising from mental nerve branches that innervated the lower lip. No nerve branches to the inferior labial gland crossed the midline. Histological observation found that the tissue to the inferior labial gland were composed primarily of nerve fibers with a small number of surrounding vessels. Histological findings in examined specimens were consistent.

Conclusion: The inferior labial glands were innervated by small branches of the mental nerve to the lower lip.
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http://dx.doi.org/10.1007/s00276-021-02795-6DOI Listing
November 2021

Revisiting the Morphology and Classification of the Paracingulate Gyrus with Commentaries on Ambiguous Cases.

Brain Sci 2021 Jun 29;11(7). Epub 2021 Jun 29.

Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, University Hospital WAM-CSW, 90-549 Łódź, Poland.

The anterior cingulate cortex is considered to play a crucial role in cognitive and affective regulation. However, this area shows a high degree of morphological interindividual variability and asymmetry. It is especially true regarding the paracingulate sulcus and paracingulate gyrus (PCG). Since the reports described in the literature are mainly based on imaging techniques, the goal of this study was to verify the classification of the PCG based on anatomical material. Special attention was given to ambiguous cases. The PCG was absent in 26.4% of specimens. The gyrus was classified as present in 28.3% of cases. The prominent type of the PCG was observed in 37.7% of the total. Occasionally, the gyrus was well-developed and roughly only a few millimeters were missing for classifying the gyrus as prominent, as it ended slightly anterior the level of the VAC. The remaining four cases involved two inconclusive types. We observed that the callosomarginal artery ran within the cingulate sulcus and provided branches that crossed the PCG. Based on Klingler's dissection technique, we observed a close relationship of the PCG with the superior longitudinal fascicle. The awareness of the anatomical variability observed within the brain cortex is an essential starting point for in-depth research.
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http://dx.doi.org/10.3390/brainsci11070872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301833PMC
June 2021

An Ultrasound Evaluation of the Vertebral Artery in Patients With Vertebral Artery Hypoplasia.

Cureus 2021 May 14;13(5):e15020. Epub 2021 May 14.

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA.

Purpose The aim of the current study was to assess and compare Doppler ultrasound findings, especially the resistivity index (RI), among and between patients with vertebral artery hypoplasia (VAH) and normal populations. Material and methods Fifteen consecutive patients with VAH (mean age 54 ± 21 years) and 15 sex-matched controls without VAH (mean age 54 ± 22 years) were selected for the study. The vertebral arteries (VA) were examined with Doppler ultrasound. We also explored each group for sex and age differences (young: age ≤ 50, old: age >50). Results The mean RI (MRI), right RI (RRI), left RI (LRI), non-dominant-side RI, and dominant-side RI were significantly higher in the Case Group than the Control Group. In the Case Group, the affected-side RI (A.RI) was significantly higher than the normal side, while the normal side peak systolic velocity was significantly higher than the affected side. The MRI and A.RI were significantly higher in older patients. We also found a significant negative correlation between the mean diameter (MD) and MRI. MRI and A.RI both correlated positively with age in the Case Group, while left peak systolic velocity decreased significantly with age in the Control Group [p-values < 0.05]. Conclusion The dominant VA had a higher RI in the Case Group than the Control Group. It can therefore be inferred that the dominant VA in patients with VAH does not work completely normally, thus making these patients even more susceptible to vertebrobasilar insufficiency and possible strokes.
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http://dx.doi.org/10.7759/cureus.15020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197781PMC
May 2021

Variant Innervation of the Medial Pterygoid Muscle from the Lingual Nerve.

Kurume Med J 2021 Jul 18;66(2):135-138. Epub 2021 Jun 18.

Seattle Science Foundation.

During a routine dissection of the infratemporal fossa and lateral face, a branch of the left lingual nerve was observed entering the medial pterygoid muscle. Normally, the nerve to the medial pterygoid is a direct branch from the mandibular nerve, with no communications with the lingual nerve. There are many reports involving variations of the mandibular nerve; however, few reports describe lingual nerve variations involving the medial pterygoid muscle. Reconstructive surgeries for cosmesis and trauma, tumor excision, and impacted third molar removal may all damage the lingual nerve and might, as seen in the present case, affect the medial pterygoid muscle. Given the presumed rarity of this variation, we discuss the possible embryological origins as well as the surgical conflicts that may arise with this type of variation.
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http://dx.doi.org/10.2739/kurumemedj.MS662005DOI Listing
July 2021

Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery.

Brain Sci 2021 May 16;11(5). Epub 2021 May 16.

Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland.

The present study aims to provide detailed observations on the cavernous segment of the abducens nerve (AN), emphasizing anatomical variations and the relationships between the nerve and the internal carotid plexus. A total of 60 sides underwent gross-anatomical study. Five specimens of the AN were stained using Sihler's method. An additional five specimens were subjected to histological examination. Four types of AN course were observed: a single nerve along its entire course, duplication of the nerve, division into separate rootlets at the point of contact with the cavernous part of the internal carotid artery (ICA), and early-branching before entering the orbit. Due to the relationships between the ICA and internal carotid plexus, the cavernous segment of the AN can be subdivided into a carotid portion located at the point of contact with the posterior vertical segment of the cavernous ICA and a prefissural portion. The carotid portion of the cavernous AN segment is a place of angulation, where the nerve always directly adheres to the ICA. The prefissural portion of the AN, in turn, is the primary site of fiber exchange between the internal carotid plexus and either the AN or the lateral wall of the cavernous sinus.
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http://dx.doi.org/10.3390/brainsci11050649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156379PMC
May 2021

Microsurgical Anatomy of the Inferomedial Paraclival Triangle: Contents, Topographical Relationships and Anatomical Variations.

Brain Sci 2021 May 4;11(5). Epub 2021 May 4.

Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, 90-752 Łódź, Poland.

The inferomedial triangle is one of the two surgical triangles in the paraclival subregion of the skull base. It is delineated by the posterior clinoid process, the dural entrance of the trochlear nerve and the dural entrance of the abducens nerve. The aim of the present article is to describe the anatomical variations within the inferomedial triangle. Measurements of the triangle's borders and area were supplemented by detailed observations of the topographical anatomy and various arrangements of its contents. Nine adult cadaveric heads (18 sides) and 28 sagittal head sections were studied. The mean area of the inferomedial triangle was estimated to be 60.7 mm. The mean lengths of its medial, lateral and superior borders were 16.1 mm, 11.9 mm and 10.4 mm, respectively. The dorsal meningeal artery was identified within the inferomedial triangle in 37 out of 46 sides (80.4%). A well-developed petrosphenoidal ligament of Grüber was identified within the triangle on 36 sides (78.3%). Although some structures were variable, the constant contents of the inferomedial triangle were the posterior petroclinoid dural fold, the upper end of the petroclival suture, the gulfar segment of the abducens nerve and the posterior genu of the intracavernous internal carotid artery.
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http://dx.doi.org/10.3390/brainsci11050596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147798PMC
May 2021

Duplicated transverse cervical nerve and external jugular vein.

Anat Cell Biol 2021 Sep;54(3):404-406

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.

The transverse cervical nerve arises from anterior rami of the second and third cervical spinal nerves via the cervical plexus. We present a case of a left duplicated transverse cervical nerve with a duplicated external jugular vein in a 72-year-old female cadver. The transverse cervical nerve bifurcated into two branches, ., superficial and deep branches, lateral to the sternocleidomastoid muscle. The superficial branch ran lateral to the duplicated external jugular vein and gave a cutaneous branch to the area below the great auricular nerve and cutaneous branches to the skin of the neck. The deep branch ran medial to the duplicated external jugular vein, joined the anterior branch of the superficial transverse cervical nerve and cervical branch of the facial nerve, and terminated into the skin. This case adds to the growing data on individual variability that should be considered when operating on the anterolateral neck.
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http://dx.doi.org/10.5115/acb.21.071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493021PMC
September 2021

Easy three-dimensional scanning technology for anatomy education using a free cellphone app.

Clin Anat 2021 Sep 3;34(6):910-918. Epub 2021 Jun 3.

Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.

The COVID-19 pandemic has brought difficult times to anatomy educators and medical/dental students. Under normal circumstances, gross anatomy classes give students opportunities to touch and observe human bones and cadaveric tissues, thus enhancing their understanding; such morphology is difficult to learn from textbooks alone. As many studies have shown, three-dimensional (3D) technologies used in online lectures can serve as alternatives to real specimens for providing knowledge of anatomy. However, such technologies are often expensive. The goal of this study was to create 3D anatomy models for online lectures using a free cellphone app. Free application software (Qlone) was used to create 3D anatomical models. The extracranium and intracranium of adult skull, fetal skull, mandible, temporal bone, second cervical vertebra, and ilium were all scanned and exported to the computer in 3D format. A total of 53 anatomical structures were evaluated by nine observers. Although the 53 structures used in this study did not include all the structures that students need to learn, visibility was good/acceptable for most of the 53. The free and simple 3D scanning app used in this study could enable anatomy educators to provide better content to students during online lectures.
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http://dx.doi.org/10.1002/ca.23753DOI Listing
September 2021
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