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1

Musculocutaneous and median nerve connections within, proximal and distal to the coracobrachialis muscle

100%

Loukas M., Aqueelah H.

Folia Morphologica

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2005

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tom 64

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nr 2

101-108

During dissection of the brachial plexus variations have frequently been observed in the formation and further ramification of the cords to form the musculocutaneous and median nerves (MCN and MN). The present study was undertaken to localise the connections (the communication pattern) of the MN and the MCN with respect to the point of entrance of the MCN to the coracobrachialis muscle. A total of 129 formalin-fixed cadavers were dissected for this purpose. For simplicity we classified the communication patterns as Types I, II, III and IV. In 82 (63.5%) of 129 cadavers 119 communications were found to be present. We were able to identify 4 different patterns of communication. Type I (54 communications, 45%): the communications were proximal to the point of entry of the MCN into the coracobrachialis, Type II (42 communications, 35%): the communications were distal to the point of entry of the MCN into the coracobrachialis, Type III (11 communications, 9%): the MCN did not pierce the coracobrachialis and Type IV (9 communications, 8%): the communications were proximal to the point of entry of the MCN into the coracobrachialis and additional communication took place distally. Precise knowledge of variations in MCN and MN communications may prove valuable in traumatology of the shoulder joint, as well as in plastic and reconstructive repair operations.

2

A case of an accessory testicular artery

100%

Loukas M., Stewart D.

Folia Morphologica

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2004

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tom 63

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nr 3

Dissection of an adult male cadaver revealed the presence of an accessory left testicular artery in addition to the normal right and left testicular arteries. In this case the accessory left testicular artery originated from the ventrolateral wall of the descending aorta. The origin was located between the superior mesenteric artery and the left renal vein. The accessory artery continued to course from the aorta laterally toward the superior ventral portion of the left kidney and then passed ventrally to the kidney on its course inferiorly to the pelvic region. Communication was observed between the accessory left testicular artery and the left renal artery. This variation of gonadal vasculature is of interest from the point of view of its embryogenesis, and possible clinical significance.

3

A partially ossified falx cerebri

81%

Zandian A., Clarke P., Tubbs R. S., Loukas M.

Folia Morphologica

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2014

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tom 73

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nr 3

During a routine faculty prosection of the head and neck region of an adult female cadaver, a partial ossification of the falx cerebri was found. Ossification of other dural areas or regions of the body were not found. In addition, the brain and remaining organs appeared to be grossly normal. Reports of partial ossification of the falx cerebri are still rare and while certain pathologies such as nevoid basal cell carcinoma syndrome typically present with ossification of the falx on radiographs, the causal relationship of such an abnormality remains unclear. (Folia Morphol 2014; 73, 3: 363–365)

4

Anatomical variations of the superficial and deep palmar arches

81%

Loukas M., Holdman D., Holdman S.

Folia Morphologica

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2005

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tom 64

|

nr 2

78-83

The use of radial arteries as an arterial bypass conduit is an invasive procedure which is becoming popular among various medical centres. The greatest risk associated with harvesting the radial artery is ischaemia of the soft tissues of the hand. In this study we dissected 200 hands derived from 100 formalin-fixed cadavers in order to identify arterial patterns that will allow safe removal of the radial artery for use in bypass procedures. A complete superficial palmar arch (SPA) was found in 90% of the cases and divided into 5 types, while the remaining 10% possessed an incomplete palmar arch. Types of SPA are designated by the letter S. In type S-I (40%), the SPA is formed by anastomosis of the superficial volar branch of the radial artery to the ulnar artery. Type S-II (35%) is formed entirely of the ulnar artery. Type S-III (15%) is formed by anastomosis of the ulnar and median arteries. Type S-IV (6%) is formed by anastomosis of the ulnar, radial, and median arteries and Type S-V (4%) is formed by a branch of the deep palmar arch (DPA) communicating with the SPA.DPA was identified in all specimens and classified into three types, all designated by the letter D. Type D-I (60%) is formed by anastomosis of the deep volar branch of the radial artery and the inferior deep branch of the ulnar branch. Type D-II (30%) is formed by anastomosis of the deep volar branch of the radial artery and the superior deep branch of the ulnar artery. Type D-III (10%) is formed by anastomosis of the deep volar branch of the radial artery with both deep branches of the ulnar artery. This data could provide an important source of information for vascular surgeons harvesting radial arteries.

5

Fat herniation through the canal of Schwalbe

81%

Cesmebasi A., Abel N., Tubbs R. S., Loukas M.

Folia Morphologica

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2014

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tom 73

|

nr 4

The authors report a case of fat herniation through the canal of Schwalbe noted in a female cadaver during abdominopelvic dissection. Perineal hernias are rare hernias, and herniations through the hiatus of Schwalbe represent a rare posterior lateral perineal hernia. While these hernias are extremely rare, anatomists and surgeons should be aware of them, and the clinical significance and manifestations which may occur with these hernias. (Folia Morphol 2014; 73, 4: 504–506)

6

A case of atypical insertion of the levator scapulae

81%

Loukas M., Louis R. G. J., Merbs W.

Folia Morphologica

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2006

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tom 65

|

nr 3

232-235

Anatomical variations in the musculature of the spine have the potential to cause functional and postural abnormalities, which in turn could lead to chronic myofascial and skeletal pain. We present a unilateral case of a 71-year-old Caucasian female in which the left levator scapulae muscle gave rise to an accessory head that inserted, by way of a flat aponeurotic band, to the ligamentum nuchae, the tendon of the rhomboideus major and the superior aspect of the serratus posterior superior muscle. The innervation was provided by a branch of the dorsal scapular nerve. By exerting unilateral traction on the vertebrae and surrounding musculature, this unusual variation might have resulted in clinical consequences including scoliosis and movement abnormalities of the head and neck as well as myofascial pain syndrome.

7

A previously undescribed variant of the confluence of sinuses

81%

Tardieu G. G., Oskouian R. J., Loukas M., Tubbs R. S.

Folia Morphologica

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2017

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tom 76

|

nr 2

An 8-year-old female with a history of chronic headaches and uncertain papilloedema was found to have a variant of the posterior intracranial dural venous sinuses on magnetic resonance imaging assessment of the brain. Magnetic resonance venography included in the imaging revealed a circular formation of the confluence of sinuses and absent right-sided transverse sinus. The confluence of sinuses is a highly variable structure; however, to the authors’ knowledge, a circular confluence of sinuses variant has not been reported in the literature. (Folia Morphol 2017; 76, 2: 316–318)

8

Ectopic arachnoid granulation involving a rare intracranial venous sinus variant

81%

Umeh R., Loukas M., Oskouian R. J., Tubbs R. S.

Folia Morphologica

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2017

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tom 76

|

nr 2

Arachnoid granulations are hypertrophied arachnoid villi, which extend from the subarachnoid space into the venous system and aid in the passive filtration and reabsorption of cerebrospinal fluid. These macroscopic structures have been described in various locations, with the transverse and sigmoid sinuses seen as normal variants on imaging. Here we present the occurrence of an enlarged arachnoid granulation at the foramen rotundum where a variant intracranial venous sinus was identified during routine dissection. Variations, such as the one described herein, should be recognised by those who operate or interpret images of the skull base. (Folia Morphol 2017; 76, 2: 319–321)

9

A case of a bilateral accessory digastric muscle

81%

Loukas M., Louis R. G., Kapos T., Kwiatkowska M.

Folia Morphologica

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2005

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tom 64

|

nr 3

Abnormalities of the anterior belly of the digastric muscle are rare but have received increased attention by radiologists in recent years in an attempt to avoid confusion with submental cysts or enlarged submental lymph nodes on CT or MR images. We present a case of bilateral accessory digastric muscles which fuse (partially) with the midline raphe of the mylohyoid muscle. Fibres from the right accessory anterior digastric muscle proceeded to decussate and join the mylohyoid muscle and the contralateral insertion of the digastric muscle. Embryological development and possible clinical consequences are discussed.

10

A case of an anomalous cricothyroid artery

81%

Loukas M., Louis R. G., Cruz G. S.

Folia Morphologica

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2004

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tom 63

|

nr 3

The cricothyroid artery typically originates as a branch of the superior thyroid artery and courses medially to reach the median cricothyroid ligament. Anatomical variations of this pattern are not well documented in the literature. We present a case in which the left cricothyroid artery originated from the left superior thyroid artery near the superior border of the thyroid cartilage and coursed medially to pierce the thyroid lamina. This variation was found during a routine anatomy dissection at the American University of the Caribbean School of Medicine. The possible clinical implications and their relevance to emergency airway management procedures are discussed.

11

Sternalis muscle: a mystery still

81%

Loukas M., Bowers M., Hullett J.

Folia Morphologica

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2004

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tom 63

|

nr 2

Despite intensive anatomical research during the last century, anatomical structures or variations of these structures may still cause confusion or even iatrogenic injury. A matter of debate is the sternalis muscle. We present a review of the literature of the sternalis muscle with special emphasis on its clinical anatomy.

12

Accessory venous sinus of Hyrtl

81%

Tubbs R. S., Loukas M., Shoja M. M., Oakes W. J.

Folia Morphologica

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2007

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tom 66

|

nr 3

Variations of the intracranial venous sinuses are important to the surgeon during intraoperative procedures and to the clinician during imaging interpretation. We report a male cadaver found to have a rare venous sinus variation. In all likelihood, this sinus corresponded to the rarely reported accessory venous sinus of Hyrtl. The sinus was approximately 5 mm in width and traveled from the sphenoparietal sinus anteriorly to the veins, draining into the foramen spinosum (i.e. the middle meningeal veins) posteriorly. No other variations or obvious pathology were identified intracranially or extracranially. Knowledge of such a venous variation may be of use to the clinician.

13

Morphometric and volumetric analysis of the middle cerebral artery in human fetuses

71%

Gielecki J., Zurada A., Kozlowska H., Nowak D., Loukas M.

Acta Neurobiologiae Experimentalis

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2009

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tom 69

|

nr 1

The morphometrical and volumetrical changes of the middle cerebral artery (MCA) during the fetal period of development were analyzed by digital-image analysis system (DIAS). Examinations were performed on 304 MCAs from 152 brains of human fetuses ranging from the 12th to 40th weeks of gestation. MCAs were analyzed with respect to its branching from the internal carotid artery and its division into the main cortical branches. No statistically significant differences were found between the mean values of the diameter, length and volume of the left and right M1 segments of the MCAs in all studied age groups.

14

An interrupted inferior vena cava in a situs inversus: a case report and review of the literature

71%

Loukas M., Strike D. R. G., Tubbs R. S., Tarneja N., Shoja M. M.

Folia Morphologica

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2009

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tom 68

|

nr 3

Situs inversus with interrupted inferior vena cava is an uncommon anatomic variant found in the abdominal and thoracic viscera. In this report, we present a 59-year-old woman with this variation, found during gross anatomical dissection. While this type of variation has been variable, in the present case the hepatic veins drained directly into a very short (2.2 cm) inferior vena cava. The infrarenal component of the inferior vena cava was present and drained into the azygos and hemiazygos veins. Clinical considerations of this variant anatomy are of interest, as they may present in patients as pathology on cross sectional imaging. (Folia Morphol 2009; 68, 3: 184–187)

15

A retroesophageal right subclavian artery orginating from the left aortic arch - a case report and review of the literature

71%

Loukas M., Giannikopoulos P., Fudalej M., Dimopoulos C., Wagner T.

Folia Morphologica

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2004

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tom 63

|

nr 1

The retroesophageal right subclavian artery is an anatomical abnormality encountered by anatomists and pathologists and recently interventional cardiologists and thoracic surgeons have also come across this phenomenon. We report a case of a retroesophageal right subclavian artery arising from a normally located left aortic arch in a young male autopsied in the Department of Forensic Service of Warsaw Medical University. In addition to the aforementioned anomaly, the presence of a right non-recurrent inferior laryngeal nerve was noticed. The possible embryonic development of these branching patterns and their clinical significance is discussed.

16

Retroscalenic course of the transverse cervical artery with the suprascapular artery travelling through the suprascapular notch

71%

Tubbs R. S., Shoja M. M., Shokouhi G., Loukas M., Oakes W. J.

Folia Morphologica

|

2007

|

tom 66

|

nr 1

Variations involving the cervical portion of the vagus nerve are seemingly very rare. We report an adult male found to harbour a right cervical vagus nerve that crossed anterior to the right common carotid artery to terminate in the lateral aspect of the thyroid gland. A very small continuation of this nerve was found to continue distally into the thorax. Histologically, this part of the vagus nerve did not contain ganglion or other cell bodies. There were no heterologous inclusions (thyroid, parathyroid, thymus, salivary gland or branchial cleft remnants) present. Although grossly there was a connection into the thyroid gland, this was not observed histologically. No signs of trauma were found to the ipsilateral neck region. We hypothesise that this variation is due to entanglement between the thyroid gland and cervical vagus nerve during development. This rare variation might be considered by the clinician who operates in the cervical region or interprets imaging of the neck. To our knowledge, a vagus nerve with the above described morphology has not been described.

17

A complex dural-venous variation in the posterior cranial fossa: a triplicate falx cerebelli and an aberrant venous sinus

71%

Shoja M. M., Tubbs R. S., Loukas M., Shokouhi G., Oakes W. J.

Folia Morphologica

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2007

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tom 66

|

nr 2

Variations of the dural folds and the dural venous sinuses are seldom reported in the extant medical literature. Such variations in the posterior cranial fossa may be problematic in various diagnostic and operative procedures of this region. We report our observation of an extremely rare variation of the falx cerebelli and posterior cranial fossa venous sinuses encountered upon dissection of a young male cadaver. In this specimen the falx cerebelli was duplicated with dimensions of 45.3 × 5.1 mm and 49.8 × 5.3 mm for the right and left falces respectively. The distance between the two falces was 3.2, 4.5 and 7.8 mm at their proximal, middle and distal thirds. An accessory small falx (31.8 × 2 mm) was also found approximately 3.4 mm lateral to the right falx cerebelli and blended with the lateral surface of the right falx cerebelli. There was only one occipital venous sinus (diameter, 2.5 mm) and no marginal sinus was detected. At the right floor of the posterior cranial fossa (posterolateral to the foramen magnum) an additional dural venous sinus was found, which connected the terminal portion of the right sigmoid sinus to the occipital and right transverse sinuses via one medial and two lateral branches respectively. We believe that such a complex dural-venous variation in the posterior cranial fossa has not previously been reported. Neurosurgeons and neuroradiologists should be aware of such variations, as these could be potential sources of haemorrhage during suboccipital approaches or may lead to erroneous interpretations of imaging of the posterior cranial fossa.

18

Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia

61%

Loukas M., El-Sedfy A., Tubbs R. S., Louis R. G. J., Wartmann C. T., Curry B., Jordan R.

Folia Morphologica

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2006

|

tom 65

|

nr 4

337-342

Important structures involved in the pathogenesis of occipital headache include the aponeurotic attachments of the trapezius and semispinalis capitis muscles to the occipital bone. The greater occipital nerve (GON) can become entrapped as it passes through these aponeuroses, causing symptoms of occipital neuralgia. The aim of this study was to identify topographic landmarks for accurate identification of GON, which might facilitate its anaesthetic blockade. The course and distribution of GON and its relation to the aponeuroses of the trapezius and semispinalis capitis were examined in 100 formalin-fixed adult cadavers. In addition, the relative position of the nerve on a horizontal line between the external occipital protuberance and the mastoid process, as well as between the mastoid processes was measured. The greater occipital nerve was found bilaterally in all specimens. It was located at a mean distance of 3.8 cm (range 1.5–7.5 cm) lateral to a vertical line through the external occipital protuberance and the spinous processes of the cervical vertebrae 2–7. It was also located approximately 41% of the distance along the intermastoid line (medial to a mastoid process) and 22% of the distance between the external occipital protuberance and the mastoid process. The location of GON for anaesthesia or any other neurosurgical procedure has been established as one thumb’s breadth lateral to the external occipital protuberance (2 cm laterally) and approximately at the base of the thumb nail (2 cm inferior). This is the first study proposing the use of landmarks in relation to anthropometric measurements. On the basis of these observations we propose a target zone for local anaesthetic injection that is based on easily identifiable landmarks and suggest that injection at this target point could be of benefit in the relief of occipital neuralgia.

19

A retrotracheal right subclavian artery in association with a vertebral artery and thyroidea ima

61%

Loukas M., Louis, Jr. R. G., Gaspard J., Fudalej M., Tubbs R. S., Merbs W.

Folia Morphologica

|

2006

|

tom 65

|

nr 3

236-241

The retro-oesophageal right subclavian artery is an anatomical abnormality encountered by anatomists and pathologists and, more recently, interventional cardiologists and thoracic surgeons with an incidence of 0.2–2% in the population. We report a case of a retrotracheal right subclavian artery which originated distally along the left aortic arch and coursed between the trachea and the oesophagus. Additionally, the aortic arch gave rise to a common trunk, which subsequently bifurcated to yield to a right vertebral artery and a left thyroidea ima, replacing the left inferior thyroid artery. Consequently the right and the left recurrent laryngeal nerves were found to recur normally. The possible embryonic development of these branching patterns and their clinical significance is discussed.

20

The anatomy of the tendon of infundibulum

61%

Loukas M., Dimopoulos C., Barczak A., Kordula J., Wagner T., Fudalej M.

Folia Morphologica

|

2001

|

tom 60

|

nr 4

281-284

The heart, as we know, is a muscular tissue supported by collagenous structures forming the fibrous skeleton of the heart. A structure by the name of the tendon of infundibulum appeared in the literature with no definite information about its structure or even its existence. The tendon of infundibulum was described as a strip of fibrous tissue structure situated between the aortic root and pulmonary trunk. Our study involved 30, formalin fixed, adult human hearts ranging from 18 to 81 years. Classical macroscopic anatomical methods were applied to observe macroscopically all the connections between the aorto-pulmonary trunk, together with serial transverse histological sections, through roots of the aorta and pulmonary trunk, using eosin-hematoxylin and van Gieson staining. All the hearts seemed to encompass many fascial bands attended by connective tissue. However these fascial bands are not concrete structures and cannot be termed tendons. In our investigation we have been unable to demonstrate macroscopically or histologically any structure which could be significantly approximating to the initial description of the literature. However, as far as we are able to judge, the term tendon of infundibulum has erroneously been introduced into many medical textbooks since the literature cannot still prove its existence.

Ograniczanie wyników

Musculocutaneous and median nerve connections within, proximal and distal to the coracobrachialis muscle

A case of an accessory testicular artery

A partially ossified falx cerebri

Anatomical variations of the superficial and deep palmar arches

Fat herniation through the canal of Schwalbe

A case of atypical insertion of the levator scapulae

A previously undescribed variant of the confluence of sinuses

Ectopic arachnoid granulation involving a rare intracranial venous sinus variant

A case of a bilateral accessory digastric muscle

A case of an anomalous cricothyroid artery

Sternalis muscle: a mystery still

Accessory venous sinus of Hyrtl

Morphometric and volumetric analysis of the middle cerebral artery in human fetuses

An interrupted inferior vena cava in a situs inversus: a case report and review of the literature

A retroesophageal right subclavian artery orginating from the left aortic arch - a case report and review of the literature

Retroscalenic course of the transverse cervical artery with the suprascapular artery travelling through the suprascapular notch

A complex dural-venous variation in the posterior cranial fossa: a triplicate falx cerebelli and an aberrant venous sinus

Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia

A retrotracheal right subclavian artery in association with a vertebral artery and thyroidea ima

The anatomy of the tendon of infundibulum