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1

An anatomical investigation of the carotid canal

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Naidoo N., Lazarus L., Ajayi N. O., Satyapal K. S.
Folia Morphologica
|
2017
|
tom 76
|
nr 2
Background: The carotid canal (CC) located in the petrous temporal bone transmits the internal carotid artery, internal carotid venous plexus and sympathetic nerve plexus from the neck into the cranial cavity. It is an accessible passage into the cranial cavity and is considered an important anatomical landmark for neurosurgeons. The aim of this study was to investigate the topographical, morphometric and morphological parameters of the CC. Materials and methods: An examination of the CC and related adjacent structures in 81 dry skull specimens was performed. Distribution of sample by sex was 34 females and 47 males, and by race 77 African and 4 Caucasian. The mean age was 50 years (range: 14–100 years). Results: The external opening of the CC was found to be round-shaped, oval-shaped and tear-drop-shaped in 28.4%, 49.4% and 22.2% of the specimens, respectively. (1) Mean diameters [mm]: (a) medio-lateral 7.52 mm and (b) antero- -posterior 5.41mm. Statistically significant difference in the vertical diameter was recorded in the race groups and laterality of the samples. (2) Mean distances [mm] between: (a) medial margins of external opening of CC was 50.03 mm, (b) lateral margins of external opening of CC was 62.73 mm and (c) external openings of CC and foramen lacerum was 15.6 mm. There was a statistically significant correlation between race and location of the opening of external CC in relation to foramen lacerum (viz. postero-lateral, lateral and diagonal, and lateral). Conclusions: The present study corroborated previous reports on the CC; however, the tear-drop shaped external CC opening was a unique finding. The knowledge of the reference measurements pertaining to the CC and its relationship to adjacent structures may postulate a suitable surgical “safe-zone” range within the CC area. (Folia Morphol 2017; 76, 2: 289–294)
2

Determination of the median nerve safe-zone in the carpal tunnel using the distal forearm bony prominences

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Ajayi N. O., Naidoo N., Lazarus L., Satyapal K. S.
Folia Morphologica
|
2014
|
tom 73
|
nr 4
Background: The compression of the median nerve (MN) in the carpal tunnel (CT) is one of the most common aetiologies of entrapment neuropathy syndromes in clinical practice. The aim of this study was to investigate the relationship of the palpable bony prominences of the distal forearm (radial styloid process [RSP] and ulnar styloid process [USP]) with MN in the CT, in order to determine a safe-zone of the MN during carpal tunnel procedures. Materials and methods: This study involved the bilateral dissection of the CT region of 30 adult cadaveric specimens (n = 60). Results: The mean distance between the RSP and USP was 49.34 mm. The mean distance of the MN from the RSP and the USP were 22.44 mm and 26.66 mm, respectively. The mean diameter of the MN within the CT deep to the flexor retinaculum was 5.93 mm. In addition, the MN was located postero-lateral and postero-medial to palmaris longus tendon (PLT) in 78.33% and 21.67% of specimens, respectively. Conclusions: This study found that the MN was located less than 60% of the RSP-USP distance from the RSP. Furthermore, the MN was mostly located postero-lateral to the PLT. Therefore, injection or surgical incision made at/medial to a point 60% of the RSP-USP distance from the RSP will be outside the safe-zone of the MN. The knowledge of this surface anatomical relationship of the MN may be useful during decompression for CT syndrome. (Folia Morphol 2014; 73, 4: 409–413)
3

Coronary artery dominance dependent collateral development in the human heart

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Ajayi N. O., Vanker E. A., Satyapal K. S.
Folia Morphologica
|
2017
|
tom 76
|
nr 2
Background: In obstructive coronary artery disease, coronary collateral arteries serve as alternative conduits for blood flow to the myocardial tissue supplied by the obstructed vessel(s). Therefore, they are a “natural coronary arterial bypass” to the region supplied by the obstructed vessels. This study aims to determine the influence of demographic and morphologic coronary arterial factors on coronary collateral development in coronary arterial obstruction. Materials and methods: The study group was selected from the coronary angiographic records of 2029 consecutive patients (mean age: 59 ± 12 years). Coronary collaterals were graded from 0 to 3 based on the collateral connection between the donor and recipient arteries. The angiograms of the patients (n = 286) with total obstruction of the coronary arteries were selected for analysis. Results: There were no significant association between patients’ age and sex and the formation of excellent collaterals. However, the location of atherosclerotic lesion affected collateral development in the right coronary artery. In addition, the right coronary arterial dominant pattern significantly influenced the formation of excellent coronary collaterals. Conclusions: Coronary collateral arteries are better developed in right dominant pattern. It may be concluded that coronary arterial morphological pattern influences coronary collateral artery development. (Folia Morphol 2017; 76, 2: 191–196)
4

The impact of left main coronary artery morphology on the distribution of atherosclerotic lesions in its branches

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Ajayi N. O., Lazarus L., Vanker E. A., Satyapal K. S.
Folia Morphologica
|
2013
|
tom 72
|
nr 3
Background: Atherosclerotic occlusion of a coronary vessel is the commonest cause of ischaemic heart disease. The distribution of atherosclerotic lesions is not random, with stenoses preferentially situated at branch ostia, bifurcation points, and the proximal segments of daughter vessels. The aim of this study was to determine the effect of the intrinsic anatomical properties of the left main coronary artery (LMCA) on the distribution of atherosclerotic lesions in its branches. Materials and methods: A retrospective review of 170 consecutive coronary angiograms obtained from the cardiac catheterisation laboratories of private hospitals in the eThekwini Municipality area of KwaZulu-Natal, South Africa was performed. The LMCA was absent in 19/170 (11.2%). The remaining angiograms (n = 151) were divided into two groups: normal 63/151 (41.7%) and those with coronary artery disease (CAD) 88/151 (58.3%). The CAD group was sub-divided into proximal 42/88 (47.7%), mixed (proximal and distal) 26/88 (29.6%) and distal 20/88 (22.7%) sub-groups based on the location of atherosclerotic lesions in the branches of the LMCA. Results and Conclusions: The mean length, diameter and angle of division of the LMCA were as follows: Total angiograms: 10.4 mm, 3.8 mm and 86.2°; normal group: 10.5 mm, 3.9 mm and 85.7°, CAD group: 10.2 mm, 3.7 mm and 86.3°; proximal sub-group: 10.9 mm, 3.7 mm and 91.6°, mixed sub-group — 9.8 mm, 3.7 mm and 85° and distal sub-group — 9.1 mm, 3.8 mm and 79.4°, respectively. The vessels with proximally located lesions were recorded to have longer lengths and wider angles of division than vessels with distal lesions. Coronary angiographic delineation of the LMCA anatomy may be predictive of a coronary arterial arrangement that may favour the progression of proximally located lesions. (Folia Morphol 2013; 72, 3: 197–201)
5

The prevalence and clinical importance of an “additional” terminal branch of the left coronary artery

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Ajayi N. O., Lazarus L., Vanker E. A., Satyapal K. S.
Folia Morphologica
|
2013
|
tom 72
|
nr 2
The left coronary artery (LCA) usually divides into two (anterior interventricular artery [AIA] and left circumflex [LCx] artery) or less frequently into the AIA, LCx, and one or more “additional” terminal branch/es (ATBs). These ATBs of the LCA have no unanimity regarding their anatomical nomenclature. There is a lack of common consensus on the criteria used for their definition, and they are also absent from the current Terminologia Anatomica (1998). This study, therefore, aimed to document the prevalence of the ATBs of the LCA, discuss their clinical importance, and propose an anatomical nomenclature. This study was conducted by reviewing 367 coronary angiograms. The termination patterns of the LCA were classified into 3 categories based on the number of their branches, viz. (a) bifurcation 78.2%, (b) trifurcation 20.4%, and (c) quadrifurcation 1.4%, respectively. The presence of an ATB was recorded in 21.8% of the angiograms. The identification of this vessel may be of clinical importance because the extent of its supply may decrease the effect of occlusion of the LCx artery and AIA on the myocardium. The term “left ramus medianus artery” is proposed as the nomenclature for the ATB of the LCA. (Folia Morphol 2013; 72, 2: 128–131)
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