Surgical and radiologic anatomy : SRA
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The precise description of the fascia vasto-adductoria (FVA) has become an issue of great surgical and clinical importance. Neurovascular entrapment within the adductor canal (AC) may simulate many clinical conditions for cases presented with medial knee or leg pain and ischemic manifestations of the leg. The aim of the present work is to describe the morphological features of the FVA and to elucidate its neurovascular relations. ⋯ True AC block should be done deep to the FVA to ensure effective SN analgesia. Its site is recommended to be at the distal one cm of the proximal part of the AC which is at a distance of 16-17 cm proximal to the base of patella. The VAM, being an anatomical connection between the VM and AM muscles, is theorized to increase the mechanical efficiency of the VM oblique muscle to maintain the knee extensor mechanism.
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Caudal epidural anesthesia (CEB) is widely used for the prevention of chronic lower back pain, the control of intraoperative analgesia such as genitourinary surgery and labor pain cases in sacral epidural space approach for the implementation of analgesia. CEB is an anesthetic solution used into the sacral canal via sacral hiatus (SH). For optimal access into the sacral epidural space, detailed anatomical landmarks of SH are required. This study aims at exploring the anatomical structures and differences of the SH by using the sacral bone as a guide point to failure criteria for reviewing the caudal epidural anesthesia and improving the criteria for success in practice. ⋯ Single bony landmark may not help in locating the SH because of the anatomical variations. Important anatomical landmarks of the CEB are the sacral cornu, lateral sacral crests, the apex of the SH, the base of the SH, the top portion of the median sacral crest, anteroposterior distance of the sacral canal, intercornual distance, distance of the apex of the SH to the S2 foramina. Depth of hiatus less than 3 mm may be one of the causes for the failure of needle insertion. Surrounding bony irregularities, different shapes of hiatus and defects in dorsal wall of sacral canal should be taken into consideration before undertaking CEB so as to avoid its failure. This guide can be done by considering the points and securing a successful venture.
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Knowledge of the vascular supply associated with the sacrotuberous ligament is incomplete, and at most attributed to a single coccygeal branch. Our aim was to investigate the sacrotuberous ligament vasculature with a focus on its origin and distribution. We dissected 21 hemipelvises (10 male and 11 female). ⋯ Seven specimens demonstrated the superior gluteal artery supplying sacral branches to the proximal superior border of the sacrotuberous ligament. Our study highlights several branches from a variety of origins as the supply to sacrotuberous ligament unlike previous reports stating only one vessel. Our results implicate surgical procedures in and around the area of the gluteal region such as decompressive procedures of the pudendal nerve, as it travels between the sacrotuberous and sacrospinous ligaments.
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To investigate the incidence of foramen arcuale in dry atlas vertebrae which may cause clinical problems. ⋯ The present study provides additional information about the incidence and topography of the atlas vertebrae including foramen arcuale.
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The calcification of the stylohyoid chain (SHC), elongated styloid process (SP), larger SP' angle and its shortened distance of cervical internal carotid artery (CICA) are risk factors for bony compression and the stylocarotid syndrome. ⋯ 3D-CTA was the most appropriate radiological investigation analyzing and measuring SHC (elongated, larger angle, shorter distances with CICA) and identifying types (duplicated, segmented, complete and fractured) resulting from pressures on the CICA. Our study also revealed the pressure on the artery not only arose from the tip of the SP but could also result from types stretching over the artery wall. In those specimens, there is a higher probability of formation of the stylocarotid syndrome due to the long-term pressure on the sympathetic chain around the CICA.