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1

Surgical observartion of the agenesis of the foramen of Magendie

100%

Tubbs R. S.

Folia Morphologica

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2006

|

tom 65

|

nr 2

174-177

We report a young girl who presented with headache and back pain. Dynamic MRI revealed no cerebrospinal egress from the median aperture (Foramen of Magendie) of the fourth ventricle and syringomyelia. A posterior cranial fossa exploration was performed and agenesis of the median aperture was observed. Following surgical penetration of the posterior aspect of the fourth ventricle and at the most recent follow-up examination, this patient’s syringomyelia had resolved, as had her symptoms. Agenesis of the foramen of Magendie may be a rare cause of inhibition of normal cerebrospinal egress from the fourth ventricle with resultant syringomyelia.

2

A partially ossified falx cerebri

51%

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

Folia Morphologica

|

2014

|

tom 73

|

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)

3

The most common anatomical sites of arterial injury in the extremities: a review of 75 angiographically-proven cases

51%

Shakeri A. B., Tubbs R. S., Shoja M. M.

Folia Morphologica

|

2006

|

tom 65

|

nr 2

116-120

The incidence of vascular injury has increased worldwide. In an attempt to quantitate the specific arteries most commonly involved in the extremities, we reviewed 75 patients with extremity trauma who were evaluated with angiography (DSA, digital subtraction angiography). The majority of these injuries were related to motor vehicle accidents (93.3%). The mean age of these patients was 28.16 ± 11.14 years, 94.7% of these patients being male. The ratio of upper to lower extremity arterial trauma was 12 to 86. A total of 99 arterial injuries were detected angiographically. Simultaneous injuries to two and three extremity arteries were identified in 13.3% and 9.3% of patients respectively. The most common arteries injured were the anterior tibial, femoral, peroneal, and popliteal arteries. Associated fractures were present in 86.7% of patients. These data may prove useful to the clinician who evaluates post-traumatic injuries of the extremities.

4

Fat herniation through the canal of Schwalbe

51%

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

Folia Morphologica

|

2014

|

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)

5

Macro/micro observational studies of fibres maintaining the biceps brachii tendon in the bicipital groove: application to surgery, pathology and kinesiology

51%

Singh R., Singla M., Tubbs R. S.

Folia Morphologica

|

2015

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tom 74

|

nr 4

Background: There is controversy over the nature of tissues covering the bicipital groove protecting the biceps brachii tendon from dislocation/subluxation causing shoulder pain. Recent researches on cadaveric dissection and histological studies have changed the old concept of the transverse humeral ligament covering the bicipital groove to tendinous fibres of the subscapularis or interdigitating fibres of the subscapularis and supraspinatus. The change has not been incorporated into standard text books of anatomy. Therefore, the aim of the study is to support the new or old concept. Materials and methods: Eighteen embalmed shoulders were dissected to determine the nature of the tissues over the bicipital groove. Tissues from 4 shoulders were processed and 16 histological slides were examined for fibre types. Theoretical analysis of ligament and tendon has also been carried out. Results: The dissection study revealed that the tissues over the bicipital groove were tendinous fibres of subscapularis/interdigitating fibres of the subscapularis and supraspinatus and fibrous expansions from the posterior lamina of the pectoralis major. This was supported by the histological slides which showed the signatures of collagen fibres with the characteristics of tendinous fibres. Conclusions: No separate anatomical entity such as the transverse humeral ligament was detected in this study. Thus present study supports the view that the tissues covering the bicipital groove were formed by tendinous rather than ligamentous fibres. (Folia Morphol 2015; 74, 4: 439–446)

6

A previously undescribed variant of the confluence of sinuses

51%

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

Folia Morphologica

|

2017

|

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)

7

Ectopic arachnoid granulation involving a rare intracranial venous sinus variant

51%

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

Folia Morphologica

|

2017

|

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)

8

Quantitative anatomy of the posterior cricoid region

51%

Tubbs R. S., Wilson T., Salter E. G., Oakes W. J.

Folia Morphologica

|

2005

|

tom 64

|

nr 4

237-239

The anatomy of the posterior cricoid cartilage region was examined to obtain a better quantitative understanding of this region. The mean height and width of the posterior cricoid cartilage in the midline measured 24.5 mm and 25 mm respectively. The mean distance between the fibres for the left and right posterior cricoarytenoid muscles was 5 mm at the midpoint of the posterior cricoid cartilage. The height of these muscles averaged 19 mm for left sides and 20 mm for right sides. The mean distances from the midpoint and superior midline of the posterior cricoid cartilage to the inferior laryngeal nerve were 14 mm and 15 mm respectively for left sides and 17 mm and 18 mm respectively for right sides. It is hoped that these data will be of use to clinicians performing invasive procedures in this area.

9

An unusual muscle of the wrist with potential compression of the ulnar nerve

51%

Hill M. L., Shoja M. M., Salter E. G., Tubbs R. S.

Folia Morphologica

|

2006

|

tom 65

|

nr 2

178-180

During routine cadaveric dissection of the upper extremity an unusual muscle was discovered arising from the tendon of the flexor carpi ulnaris and inserting into the muscle belly of the flexor digiti minimi. The muscle’s course was superficial to the ulnar nerve and artery in Guyon’s canal. We review the literature regarding such muscle variations and discuss the potential for compression of the ulnar nerve by such muscles.

10

Unilateral agenesis of the facial artery with compensation by a giant transverse facial artery

51%

Tubbs R. S., Salter E. G., Oakes W. J.

Folia Morphologica

|

2005

|

tom 64

|

nr 3

During routine dissections carried out in the course of our medical gross anatomy work, an unusual structure was found unilaterally on the left side of an adult male cadaver. Upon investigation, this was determined to be a hugely dilated transverse facial artery. Also noted was the complete absence of the ipsilateral facial artery. To our knowledge, this is the first report of complete agenesis and not simply diminution of the facial artery with compensatory enlargement of the transverse facial artery.

11

Severe bilateral atrophy of the spinati muscles in a cadaver

51%

Tubbs R. S., Salter E. G., Oakes W. J.

Folia Morphologica

|

2005

|

tom 64

|

nr 3

During the routine dissection of a 62-year-old male cadaver, bilateral atrophy of the supra and infraspinatus muscles was observed. The suprascapular nerves, cervical spinal cord and surrounding muscles were found to be normal. We propose that, in the face of normal histology and other normal shoulder girdle muscles and normal nerves, this case represents an instance of Parsonage-Turner syndrome. To our knowledge, this is the first report of bilateral spinati atrophy in a cadaver.

12

A rare variation of the posterior cranial fossa: duplicated falx cerebelli, occipital venous sinus, and internal occipital crest

51%

Shoja M. M., Tubbs R. S., Khaki A. A., Shokouhi G.

Folia Morphologica

|

2006

|

tom 65

|

nr 2

171-174

Folds of the meningeal layer of the dura mater, the falx cerebri and tentorium cerebelli, traverse the vertebrate intracranial cavity and thus compartmentalise the brain. The falx cerebelli, another dural fold, is found in the posterior cranial fossa and attaches to the inferior aspect of the tentorium cerebelli and to the internal occipital crest. We present a case of a duplicated falx cerebelli, occipital venous sinus and internal occipital crest that was detected upon routine dissection of a male cadaver. Since haemorrhage of a dural venous sinus can be a fatal complication of posterior cranial fossa surgery, knowledge of venous sinus variations in this region may prevent unpredictable complications during intracranial procedures.

13

Type I split cord malformation with an unusual bony morphology

51%

Shokouhi G., Tubbs R. S., Shoja M. M.

Folia Morphologica

|

2007

|

tom 66

|

nr 1

Variations in the configuration of the bony septum found in patients with split cord malformations are rare. We report the seemingly rare occurrence of a midline bony septum that ended posteriorly as a fully formed bony spinous process. We speculate that this variation is due to misplaced mesodermal cells associated with the primitive endomesenchymal tract during approximately the third week of foetal life. The clinician that manages these patients may wish to consider this rare morphology and avoid excessive manipulation of such a process, which could potentially injure an underlying hemicord.

14

Accessory venous sinus of Hyrtl

51%

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

Folia Morphologica

|

2007

|

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.

15

A rare variation of the inferior alveolar artery with potential clinical consequences

45%

Khaki A. A., Tubbs R. S., Shoja M. M., Shokouhi G., Farahani R. M.

Folia Morphologica

|

2005

|

tom 64

|

nr 4

345-346

Variations of the inferior alveolar artery are seemingly quite rare, especially with regard to its origin from the maxillary artery. We present an unusual case of an inferior alveolar artery that originated from the external carotid artery. To the best of our knowledge, our case is one of only two reports of the inferior alveolar artery arising from the external carotid artery. The clinician who deals with the mandibular region should be aware of such a variation in the arterial architecture.

16

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

45%

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

Folia Morphologica

|

2009

|

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)

17

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

45%

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.

18

Aortic bifurcation angle as an independent risk factor for aortoiliac occlusive disease

45%

Shakeri A. B., Tubbs R. S., Shoja M. M., Nosratinia H., Oakes W. J.

Folia Morphologica

|

2007

|

tom 66

|

nr 3

Recently, there has been interest in potential geometric risk factors that might result in or exaggerate atherosclerosis. The aortic bifurcation is a complex anatomical area dividing the high pressure blood of the descending abdominal aorta into the lower limbs and pelvis. The distribution of the bifurcation angle and any asymmetry, its relation with age and its possible contribution to the risk of aortoiliac atherosclerosis are presented here. Statistical analysis was performed by SPSS version 11.0 using, Fisher’s exact test, the Pearson and Spearman correlation tests and logistic regression analysis. The p value was set at 0.05. No correlations were found between age, bifurcation angle and angle asymmetry in the Pearson test (p > 0.05). Logistic regression analysis revealed that the bifurcation angle, but not its asymmetry, gender or age, was a significant and independent risk factor for aortoiliac atherosclerosis (model r² = 0.662, p = 0.027). With additional study these results may have implications regarding risk factors for aortoiliac atherosclerosis. To our knowledge, this study is the first of its kind to indicate the potential of such an important geometric risk factor for atherosclerosis at the aortic bifurcation.

19

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

45%

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

Folia Morphologica

|

2007

|

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.

20

Enamel matrix derivative Emdogain as an adjuvant for a laterally-positioned flap in the treatment of gingival recession: an electron microscopic appraisal

45%

Lafzi A., Farahani R. M., Tubbs R. S., Roushangar L., Shoja M. M.

Folia Morphologica

|

2007

|

tom 66

|

nr 2

Enamel matrix derivative (EMD), such as Emdogain®, has been suggested for the improvement of wound healing in periodontal surgical therapy. The present qualitative study seeks to illustrate the ultrastructural changes associated with a human gingival wound at 10 days after the application of EMD as an adjunct to a laterally-positioned flap in a patient with gingival recession. An otherwise healthy patient, who had been suffering from bilateral gingival recession defects on teeth #23 and #26, was studied. One defect was treated with a laterally-positioned flap, while the other was treated with a combination of EMD and a laterally-positioned flap. Ten days after the operation gingival biopsy specimens were obtained from the dentogingival region and examined using a transmission electron microscope. A considerable difference was found in both the cellular and extracellular phases of EMD and non-EMD sites. The fibroblasts of EMD site were more rounded with plump cytoplasms and euchromatic nuclei. A well-developed rough endoplasmic reticulum and numerous mitochondria could be detected. In contrast, the fibroblasts of non-EMD site were of flattened spindle-like morphology. While the signs of apoptosis could rarely be detected at EMD site, apoptotic bodies and ultra-structural evidence of apoptosis (crescent-like heterochromatic nuclei and dilated nuclear envelopes) were consistent features at non-EMD site. The extracellular matrix at EMD site mainly consisted of well-organised collagen fibres, while non-EMD site contained sparse and incompletely-formed collagen fibres. Coccoid bacteria were noted within the extracellular matrix and neutrophils at non-EMD site. It seems that EMD may enhance certain features of gingival wound healing, which may be attributable to its anti-apoptotic, anti-bacterial or anti-inflammatory properties.

Ograniczanie wyników

Surgical observartion of the agenesis of the foramen of Magendie

A partially ossified falx cerebri

The most common anatomical sites of arterial injury in the extremities: a review of 75 angiographically-proven cases

Fat herniation through the canal of Schwalbe

Macro/micro observational studies of fibres maintaining the biceps brachii tendon in the bicipital groove: application to surgery, pathology and kinesiology

A previously undescribed variant of the confluence of sinuses

Ectopic arachnoid granulation involving a rare intracranial venous sinus variant

Quantitative anatomy of the posterior cricoid region

An unusual muscle of the wrist with potential compression of the ulnar nerve

Unilateral agenesis of the facial artery with compensation by a giant transverse facial artery

Severe bilateral atrophy of the spinati muscles in a cadaver

A rare variation of the posterior cranial fossa: duplicated falx cerebelli, occipital venous sinus, and internal occipital crest

Type I split cord malformation with an unusual bony morphology

Accessory venous sinus of Hyrtl

A rare variation of the inferior alveolar artery with potential clinical consequences

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

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

Aortic bifurcation angle as an independent risk factor for aortoiliac occlusive disease

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

Enamel matrix derivative Emdogain as an adjuvant for a laterally-positioned flap in the treatment of gingival recession: an electron microscopic appraisal