Surgical and radiologic anatomy : SRA
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The minimally invasive transpsoas approach can be employed to treat various spinal disorders, such as disc degeneration, deformity, and lateral disc herniation. With this technique, visualization is limited in comparison with the open procedure and the proximity of the lumbar plexus to the surgical pathway is one limitation of this technique. Precise knowledge of the regional anatomy of the lumbar plexus is required for safe passage through the psoas muscle. The primary objective of this study was to determine the anatomic position of the lumbar plexus branches and sympathetic chain in relation to the intervertebral disc and to define a safe working zone. The second objective was to compare our observations with previous anatomical studies concerning the transpsoas approach. ⋯ We observed some differences concerning the safe working zone in comparison with other cadaveric studies. The small number of cadaveric specimens used in anatomical studies probably explains theses differences. The minimally invasive transpsoas lateral approach was initially developed to reduce the complications associated with the traditional procedure. The anatomical relationships between the lumbar plexus and the intervertebral disc make this technique particularly risky a L4L5. Alternative techniques, such as transforaminal interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior interbody fusion (ALIF) should be used at this level.
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In France, "article critique" became a particular teaching method in the second part of the medical curriculum. It approaches a reading exercise of scientific medical papers similar to that of journal club. It could be compared to reviewing a paper as performed by reviewers of a scientific journal. ⋯ For the youngest students, the lack of medical knowledge aroused the curiosity. Their enthusiasm to learn new medical subjects remained full. The authors would insist on the requirement of rigorous lessons about evidence-based medicine and IMRaD structure and on a necessary companionship of the students by the teachers.
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To clarify the oriented classification, relationships, and variations of the abducens nerve and provide a detailed description of its microsurgical anatomic features. ⋯ The vulnerability of the abducens nerve results from diverse factors. The inferolateral trunk, which arises from the intracavernous segment of carotid artery (also called the artery of the inferior CS), is an important landmark for finding the abducens nerve and sympathetic nerve. Variations of the abducens nerve are not rare. Keeping variations of the nerve in mind is important during skull base operations and transvenous endovascular interventions. Understanding the relationship of the abducens nerve with adjacent structures will help us in preparing for safe surgery.
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The resection of the superomedial angle of the scapula in snapping scapula syndrome is associated with potential risk of injury to the suprascapular nerve. The aim of the present study was to determine the distance of site of resection on the upper border of the scapula from the suprascapular notch during arthroscopic resection of the superomedial angle using standard superior Bell's and medial portals at the middle of medial border. ⋯ Our study suggests that during arthroscopic resection using superior Bell's portal and medial portal, suprascapular notch hence the suprascapular nerve would have safe margin of more than 10 mm from the resection site on upper border in 85.9% cases and would be vulnerable to injury in 14% cases. The procedure would be safer in patients with a wider scapula.
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Image interpretation during ultrasound guided interscalene nerve blocks might be difficult and misleading due to rare anatomical variations of the sternocleidomastoid muscle. ⋯ As this muscle crosses at a level, where ultrasound guided interscalene blocks are performed, this unusual structure might lead to misinterpretation of the confusing ultrasound image, resulting in misguided needle positioning and consecutive inefficiency of the block technique.