Surgical and radiologic anatomy : SRA
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Avulsion of nerve roots from the cervical spinal cord has always been considered as an untreatable injury, even by surgeons with expertise in this area. However, numerous experimental studies in animals, as well as a human case report, showed that if continuity is restored between the spinal cord and nerve roots, axons from spinal motor neurons can regrow into the peripheral nerve graft with a subsequent recovery of motor function. The posterior subscapular approach, based on the evolution of the posterolateral approach for removal of the first rib, is the only way to expose the entire brachial plexus from C5 to T1 from the ventral and dorsal roots to the distal nerve trunks. ⋯ Reimplantation of ventral roots into the cord is relatively easy from C5 to C7, more difficult for C8 and problematic for T1, whereas reimplantation of dorsal roots into the cord is easy from C5 to T1. The disadvantages of this approach for exposure of the plexus and nerve root avulsion repair are significant: the surgical technical steps are difficult mainly because of the cervical paraspinal muscle mass, which cannot be easily "elevated and retracted" despite previous descriptions; bleeding from the venous plexus can be excessive as suggested by dissection and our own experience; the stability of the cervical spine may be compromised following extensive laminectomy with total unilateral facetectomy; exposure of the plexus distal to the division of the trunks is difficult; there may be injury to the long thoracic nerve and subsequent winging of the scapula; and pneumothorax. This approach is therefore only applicable in highly selected cases involving multiple avulsed roots with proximal lesions extending as far as the division of the trunks.
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In this study we evaluated the ability of the transmaxillary route to expose the elements of the infratemporal fossa (ITF). Five adult cadaver heads were dissected on both sides, after making a paralateronasal incision. The maxillary branch of the trigeminal nerve served as a superior landmark to progress into the retroantral space and pterygopalatine fossa. ⋯ Access to the foramen ovale was deep (mean 56 mm) and narrow (20 degrees). Our results indicate that the transmaxillary approach is a minimally invasive procedure that gives an appropriate window to the structures of the retroantral space and to the pterygomaxillary fissure and pterygopalatine fossa. Monitoring of the retropterygoid portion of the infratemporal fossa by this route is inadequate.
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The carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy in human. The diagnosis is based on symptoms and on physical examination and is supported by nerve conduction tests. The aim of this study was to evaluate the precision and the valence of ultrasound (US) for CTS. ⋯ These US images and measurements were directly compared with anatomic cross-sections gained from the same wrists at the same level. Our results showed that ultrasound is a very precise method to display the anatomy of the carpal tunnel and of the median nerve and thus the conditions of the median nerve. Significant differences could not be detected for each of these parameters either for the carpal tunnel or the median nerve. (Ultrasound: cross-sectional area of carpal tunnel: 162.4 +/- 29.3 mm2 and of the median nerve: 9.2 +/- 2.4 mm2; anatomy: cross-sectional area of carpal tunnel: 168.4 +/- 31.2 mm2 and of median nerve: 9.4 +/- 2.2 mm2).