Surgical and radiologic anatomy : SRA
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The minimally invasive lateral retroperitoneal transpsoas approach is a recent technique developed for lumbar interbody fusion and discectomy. The proximity of the retroperitoneal vessels and ventral nerve roots to the surgical pathway increases the risk of injury to these anatomical structures. A precise knowledge of the regional anatomy of the lumbar plexus is required for safe passage through the psoas muscle. Preoperative examination of the axial MRI images will allow the surgeon to observe the neural structures at the operative levels and confirm that abdominal vessels do not obstruct the lateral disc space. The objective of this study was to determine the anatomic position of the ventral nerve roots and the retroperitoneal vessels in relation to the vertebral body in the degenerative spine and to delineate a safe working zone using magnetic resonance imaging (MRI). ⋯ Preoperative planning and safe zone delineation are a simple method to assess the relative position of neural and vascular anatomic structures in relation to the surgical area. This method can help spine surgeons to prevent perioperative complications.
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Venous drainage of the temporal lobe is of great importance in various neurosurgical and combined skull base approaches. The most significant draining vein of the temporal lobe is the inferior anastomotic vein (vein of Labbé). The purpose of this study was to examine the detailed anatomy and variations of the vein of Labbé (VL) from microsurgical perspective. ⋯ Results of this study suggest that careful and thorough evaluation of the VL is of great importance, especially in surgeries combining a subtemporal route with petrosal approaches by sectioning the SPS and the tentorium.
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We conducted this prospective, observational study using ultrasound to describe the neuro-vascular relationships at the femoral crease. In particular, we sought to identify and describe the incidence of vascular structures lying lateral to the femoral artery at this level, and the frequency with which needle insertion would require adjustment to avoid contact with these vessels during femoral nerve blockade (FNB). ⋯ Ultrasound scanning at the femoral crease in preparation for FNB reveals branches lying lateral to the main femoral artery in a significant proportion of patients, presenting a significant risk of needle contact with one of these vessels. The use of ultrasound likely reduces the risk of vascular trauma in this setting.
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The iliac crests are rich sources of cortical as well as cancellous bone. Though the proportions of cortico-cancellous tissue vary along the crest, a detailed morphometric characterization of the osseous tissue along the iliac crest is hard to come across in literature. This paucity of anatomical data on the quantity of cortical and cancellous bone along the iliac blade has prompted this study. ⋯ Strategies for graft harvesting from the iliac crests should be based upon the morphological assessment of the bone at the desired site of harvest.
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The anatomical features of the posterior compartment of the arm seem to provide the basis to raise one of the smallest free muscular flaps, with minimal donor site morbidity: the medial triceps free flap. ⋯ Our findings confirmed the reliability of the MC vessels and their anatomical relationships with the medial head of triceps brachii muscle, which could be harvested as a free flap or as a pedicled flap based on anterograde or retrograde flow. This technique should be safe, yielding mild donor site morbidity, and suitable in regional reconstruction or distant reanimations.