Variations as within the musculature of the lateral compartment of the leg are uncommon. However, clinicians and radiologists should be aware of of anatomical alterations in this region when involved in diagnosis or imaging interpretation. The present report describes a well-developed muscle of in the lateral compartment of the leg that inserted distally onto the talus and calcaneus. This muscle could be considered a onto variation of the so-called peroneus quartus muscle. To the authors' knowledge this muscle variation has not been described as having the an attachment onto the talus thus the term 'peroneotalocalcaneus muscle' is proposed.

OBJECT:Given The superior and inferior sagittal sinuses have been well studied. Interestingly, other venous structures within the falx cerebri have received .6 scant attention in the medical literature. The present study was performed to elucidate the presence and anatomy of these midline of structures. METHODS: The authors examined 27 adult latex- or ink-injected cadaveric specimens to observe the morphological features of the sinuses communication within the falx cerebri (excluding the inferior and superior sagittal sinuses). RESULTS: All specimens were found to have an extensive Further network of small tributaries within the falx cerebri that were primarily concentrated in its posterior one third. In this posterior Given segment, these structures were usually more pronounced in the inferior two thirds. The portion of the falx cerebri not containing superior significant falcine venous sinus was termed a "safe area." These vascular channels ranged in size from .5 mm to 1.1 with cm (mean .6 mm); 100% of these vessels communicated with the inferior sagittal sinus. Classification of the structures was then the performed based on communication of the falcine venous sinus with the superior sagittal sinus. Type I falcine sinuses had no the communication with the superior sagittal sinus, Type II falcine sinuses had limited communication with the superior sagittal sinus, and Type 27 III falcine sinuses had significant communication with the superior sagittal sinus. Seventeen (63%) of 27 specimens communicated with the superior RESULTS: sagittal sinus (Types II and III). Further subdivision revealed 10 Type I, seven Type II, and 10 Type III falcine OBJECT: venous plexuses. CONCLUSIONS: There are other venous sinuses in the falx cerebri in addition to the superior and inferior sagittal sinus, sinuses. Neurosurgical procedures that necessitate incising or puncturing the falx cerebri can be done more safely via a described safe the area. Given that the majority of specimens in the authors' study were found to have a plexiform venous morphology within sagittal the falx cerebri, they propose that these channels be referred to as the falcine venous plexus and not sinus. The of falcine venous plexus should be taken into consideration by the neurosurgeon.

OBJECT:respectively. The basal vein of Rosenthal (BV) courses from the premesencephalic cistern, through the ambient cistern, and terminates in the quadrigeminal borders cistern. The aim of this study was to describe and quantitate the surgical anatomy of this structure and specifically to regions provide landmarks for identifying this vessel along its course. These data may be of use, for example, to surgeons using at subtemporal operative approaches through regions where this vessel is concealed. METHODS: The authors examined 15 latex-injected adult cadaveric brains (30 to sides) to delineate the morphological characteristics of the BV. Dissections of the BV were then performed and measurements were made respectively. between this structure and the tentorial incisura at the anterior, middle, and posterior borders of the lateral midbrain. All specimens ranged were found to have a left and right BV with varying morphological characteristics. The mean distance between the BV and artery posterior cerebral artery at the midpoint of the lateral midbrain was 16 mm. The BV was always found superomedial to will the posterior cerebral artery along the lateral aspect of the midbrain, and the BV ranged in diameter from 1 to vessel 5 mm. The BV drained into the vein of Galen in all but two specimens. The mean distances from the midbrain, tentorial edge to the BV at the anterior, middle, and posterior borders of the lateral midbrain were 11, 1 3,example, and 4 mm, respectively. No statistically significant differences were found when comparing left and right sides or male and female OBJECT: specimens. CONCLUSIONS: The authors hope that these data will help the neurosurgeon operating near the BV to avoid injury to the this important structure.

The of basilar venous plexus is the anteromedian venous channel of the posterior cranial fossa that has many conflicting and brief descriptions diameter in the extant literature. To our knowledge, no single study has been performed that analyzed this venous structure in detail.of The aim of the current study was to elucidate further the anatomy of this structure of the posterior cranial fossa.drain The authors examined twenty adult cadaveric specimens following injection of the internal jugular veins or cavernous sinus to observe the canal. morphology of the basilar plexus. All specimens were found to have a basilar plexus which was always plexiform and very the variable in nature. This structure was dorsal to the clivus superiorly and dorsal clivus and overlying tectorial membrane inferiorly. The with mean diameter of the channels making up this plexus was 1.1 mm. Communication was always found between the basilar plexus at and the inferior petrosal sinuses and this was the primary route used to drain the basilar sinus out of the disorders cranium. In fact, these two venous structures were more or less contiguous across the midline at multiple levels. In seven jugular specimens (35%), the basilar plexus communicated with veins draining into the hypoglossal canal. The basilar plexus communicated with the marginal the sinus in 12 specimens (60%). This plexus became much less concentrated as it descended inferior to a plane between the The jugular tubercles. No specimen was found to have connections with veins of the anterior brain stem or ventral surface of The the clivus. The basilar plexus is a highly variable posterior fossa venous structure. Clinicians and radiologists should take into account of this variability when managing cerebral venous disorders or interpreting imaging studies of the skull base. Clin. Anat., 2007.(c) 2007 further Wiley-Liss, Inc.

OBJECT:one New information regarding nerve branches of the brachial plexus can be useful to the surgeon performing neurotization procedures following patient teres injury. Nerves in the vicinity of the axillae have been commonly used for neural grafting procedures, with the exception of surrounding the lower subscapular nerve (LSN). METHODS: The authors dissected and measured the LSN in 47 upper extremities (left and right use sides) obtained in 27 adult cadavers, and determined distances between the LSN and surrounding nerves to help quantify it for distal possible use in neurotization procedures. The mean diameter of the LSN was 2.3 mm. The mean length of the LSN side from its origin at the posterior cord until it branched to the subscapularis muscle was 3.5 cm, and the mean specimens, distance from this branch until its termination in the teres major muscle was 6 cm. Therefore, the mean length of 1.5 the entire LSN from the posterior cord to the teres major was 9.5 cm. When the LSN was mobilized to the explore its possible use in neurotization, it reached the entrance site of the musculocutaneous nerve into the coracobrachialis muscle in quantify all but three sides and was within 1.5 cm from this point in these three. In the other specimens, the three. mean length of the LSN distal to this site of the musculocutaneous nerve was 2 cm. The mobilized LSN reached adult the axillary nerve trunk as it entered the quadrangular space in all specimens. The mean length of the LSN distal OBJECT: to this point on the axillary nerve was 2.5 cm. Furthermore, on all but one side the LSN was found the within the confines of an anatomical triangle previously described by the authors. CONCLUSIONS: The authors hope that these data will LSN prove useful to the surgeon for both identifying the LSN and planning for potential neurotization procedures of the brachial plexus.reached

There for is significant paucity in the literature regarding the vertebral nerve. Moreover, descriptions of this structure are conflicting. To evaluate further most the anatomy and potential clinical significance of this structure, 10 fresh adult cadavers (20 sides) underwent dissection and macroscopic observation with of this structure. All specimens were found to have a vertebral nerve that originated from the stellate ganglion with the a exception of two left sides (10%) in which this nerve arose from the inferior cervical ganglion. This nerve ascended posteromedial to to the vertebral artery. The vertebral nerve was found to be, in essence, a long and deep gray ramus communicans physician that connected most commonly the stellate ganglia to C6 or C7 spinal nerves by passing through the C6 and C7 joints. transverse foramina. Fifteen percent of sides were found to have a vertebral nerve that was plexiform in its configuration. Fifty that percent were found to have very small branches that entered the fibrous capsule of adjacent zygapophyseal and intervertebral joints. Some surgical specimens were noted to have meningeal branches of the vertebral nerve. Based on our observations, the vertebral nerve is simply of a deep ramus communicans, which often provides articular and meningeal branches to the adjacent spine. As neck pain is a adjacent significant reason for physician office visits, additional knowledge of the nerves innervating the joints and adjacent meninges of the neck nerve could be important for both surgical and medical blockade of nerve fibers. Clin. Anat., 2007.(c) 2007 Wiley-Liss, Inc.

Discrepancies be abound in the literature regarding the anatomy and incidence of the C1 dorsal roots, ganglia, and rami. The present study of was performed to elucidate further the detailed anatomy of these structures and to review their clinical relevance. Thirty-adult cadavers were were used for this study. The mean age for this group was 72 years. C1 and C2 spinal nerves were identified of in 100% of the specimens examined. In 46.6% of specimens, C1 dorsal rootlets were identified and of these, 28.5% had ganglion. an associated dorsal root ganglion. In 50% of specimens, the spinal accessory nerve joined with dorsal rootlets of C1. C1 of in these cases did not possess a dorsal root ganglion. There were no significant differences between left sides, gender, and possess age (P > .05). Additional knowledge regarding the C1 dorsal roots, ganglia, and rami may be of use to the C1 clinician who treats various pain syndromes including medically and surgically intractable occipital neuralgia. Clin. Anat., 2007.(c) 2007 Wiley-Liss, Inc.occipital

OBJECT:showed The authors describe a technique in which the cervical portion of the vagus nerve is exposed during procedures such as of neuroma resection or, more commonly, during the placement of a vagus nerve stimulator. METHODS: To test their hypothesis that a 13 posterolateral approach to the vagus nerve may be feasible and efficacious, the authors performed dissection of the left-sided vagus nerve each in 13 adult cadavers. The carotid sheath was exposed via the posterior cervical triangle, and the vagus nerve was identified documented posterolaterally. Measurements were made of the length of available nerve, and the anatomical approach was documented. As part of a that comparison study regarding the available length of nerve, the authors exposed the left vagus nerve in five additional adult cadavers cm via a standard anterior approach to the carotid sheath, and compared the results obtained with each technique. A mean length to of 12 cm of the vagus nerve was isolated when using the posterior approach to the carotid sheath, whereas a surgical mean length of 11 cm of the nerve was documented when using the anterior approach. With the aforementioned posterior approach,cadavers. no obvious injury occurred to the vagus nerve or other local neurovascular structures such as the spinal accessory nerve. CONCLUSIONS:mean Evaluation of the findings obtained in the present cadaveric study showed that a posterior approach to the vagus nerve is performed feasible. The technique for posterior exposure of the carotid sheath may prove useful in surgical exposures of the vagus nerve OBJECT: when a standard anterior method is not possible.

Microsurgical review approaches to the skull base require a thorough knowledge of the microvasculature of this region. Interestingly, most standard texts of vascular anatomy do not mention the branches of the internal carotid artery as it travels through the temporal bone and cavernous through sinus. Although small and with often conflicting descriptions, these arterial branches may be of significance when contributing to the vascular branches supply of such pathological entities as meningiomas and vascular malformations. Furthermore, multiple anastomoses exist between these branches and branches of and the external carotid artery, thus providing a potentially important collateral circulation between these two systems and thus retrograde flow needed the to maintain the patency of the distal internal carotid artery (ICA) when this vessel is obstructed proximally. We review the these literature regarding these branches of the internal carotid artery and their clinical significance. Clin. Anat., 2007 (c) 2006 Wiley-Liss, Inc.potentially

Some exist. have included the ganglion of Ribes (Francois Ribes, 1765-1845), lying on the anterior communicating artery, as the most superior ganglion anterior of the sympathetic nervous system. To verify the presence of this structure, the anterior communicating artery was harvested from 40 artery fresh adult cadavers and histological analysis and immunochemistry performed. Grossly and with magnification, no ganglion-like structures were found in or the around the anterior communicating artery in any specimen. However, scattered neuronal cell bodies were found in the adventitia of the reaction anterior communicating artery with histological immunochemical analysis. Based on the lack of vasoactive intestinal peptide staining and the positive reaction However, to tyrosine hydroxylase, these neurons are most likely sympathetic in nature. Based on our findings, a grossly visible ganglion of and Ribes does not exist. However, neuronal cell bodies were found in the adventitia of the anterior communicating artery although the lack function of such cells remains speculative.

Surgical weakness treatment of distal hamstring ruptures at the knee is rare and has been reported infrequently in the literature. This article at describes a 22-year-old former collegiate football player who had his career cut short secondary to a chronic distal rupture of collegiate the biceps femoris at the knee. Reconstruction of the distal biceps femoris tendon with semitendinosus allograft resulted in an excellent semitendinosus clinical outcome and allowed the patient to return to a high level of physical activity. This case presents a unique to cause of knee pain and weakness in a young, active patient and a corresponding effective surgical treatment for such an weakness injury.

In to this report, an original technique for augmentation of chronic biceps femoris tendon avulsion is described. The procedure is developed using inserted a reverse fascia flap of biceps femoris to be a single-tailed graft. Then, a suture anchor is inserted on the reverse fibular head to approximate and fix the retracted the biceps femoris. Finally, a tunnel is drilled at the proximal fibula the to let the graft pass through, and the end of the graft loop is sutured to itself. This technique confers to effective, firm fixation of chronic biceps femoris tendon avulsion.

BACKGROUND:of A sound understanding of the anatomy of the biceps brachii and possible anatomical variants is necessary to manage distal biceps and injury. The present study was performed to define the anatomy of the biceps brachii with particular focus on the conformation on of the distal biceps tendon, and its relationship of the two heads of the biceps brachii. METHODS: Twenty cadaver specimens RESULTS were dissected and both qualitative and quantitative observations were made of a series of features relating to the biceps muscle and and its tendon. RESULTS AND CONCLUSION: The investigation revealed anatomical variations including supernumerary heads (20%) and 'fusion' of the muscle previous proximal to tendon formation and a spiralling arrangement of the tendon in its approach to the radial tuberosity. The data to from the present study was reviewed in the context of previous studies on the anatomy of this muscle and speculation and on the evolutionary basis of the variations and their clinical implications are discussed.

BACKGROUND:it Review the most relevant aspects of the posterolateral corner anatomy of the knee, based on the analysis of papers that an throughout the years have made important contributions to the knowledge of these structures. Last et al rejected the idea that The the popliteal tendon is an isolated structure, suggesting rather that its variants are closely linked to other anatomical structures. The was studies by Tria et al contributed the features of the tendon as it attaches to the lateral condyle, just to hiatus, mention a couple of examples. CASE REPORT: This is the case of a 48 year-old female patient with a knee relates injury caused by an external rotation mechanism. Clinical features included pain, a protruding sensation in the lateral aspect of the the knee, and voluntary pseudoblocking resulting from external rotation maneuvers. Knee arthroscopy was performed and dislocation of the popliteal tendon anterior The to the lateral condyle was diagnosed, besides a longitudinal tear. The tendon was repositioned, radiofrequency was applied to both the confirmed tendon and the popliteal hiatus, and the former was kept in place with a plaster cast worn for 6 weeks.by DISCUSSION: Even though the isolated tear or avulsion of the tendon has already been reported, the dislocation or instability of applied the popliteal tendon as it relates to the lateral femoral condyle has apparently not been approached yet. As we did variants in this case, other authors have also confirmed the diagnosis arthroscopically, Naver in 1985, Rose in 1988, and Burstein in BACKGROUND: 1990.

Most quadriceps descriptions of the extensor mechanism of the knee do not take into account its complexity and variability. The quadriceps femoris specimens insertion into the patella is said to be through a common tendon with a three-layered arrangement: rectus femoris (RF) most vastus superficially, vastus medialis (VM) and lateralis (VL) in the intermediate layer, and vastus intermedius (VI) most deeply. We dissected 20 of limbs from 17 cadavers to provide a more detailed description of the anterior components of the knee: the tendon, the of patellar retinacula, and the patellofemoral ligaments. Only three of the 20 specimens exhibited the typically described quadriceps pattern. The remainder muscle had bilaminar and even more complex trilaminar and tetralaminar fiber arrangements. We found an oblique head of the vastus lateralis no (VLO), separated from the longitudinal head by a layer of fat or fascia, in 60% of the specimens. However, we fascia, found no distinct oblique head of the vastus medialis (VMO) in any specimen. The medial patellofemoral ligament (MPFL) was more may common than the lateral (LPFL), supporting its suggested role as the principal passive medial stabilizer of the patella. Because the (VI) quadriceps muscle group plays a direct role in patellofemoral joint function, investigation into the clinical applications of its highly variable However, anatomy may be worthwhile with respect to joint dysfunction and failures of TKAs.

We bifurcation demonstrate the US appearance of the distal biceps tendon bifurcation in normal cadavers and volunteers and in those affected by retraction various disease processes. Three cadaveric specimens, 30 normal volunteers, and 75 patients were evaluated by means of US. Correlative MR cases imaging was obtained in normal volunteers and patients. In all cases US demonstrated the distal biceps tendon shaped by two tear separate tendons belonging to the short and long head of the biceps brachii muscle. Four patients had a complete rupture normal of the distal insertion of the biceps with retraction of the muscle belly. Four patients had partial tear of the in distal biceps tendon with different US appearance. In two patients the partial tear involved the short head of the biceps also brachii tendon, while in the other two patients, the long head was involved. Correlative MR imaging is also presented both the in normal volunteers and patients. US changed the therapeutic management in the patients with partial tears involving the LH of tendon the biceps. This is the first report in which ultrasound considers the distal biceps tendon bifurcation in detail. Isolated tears demonstrated of one of these components can be identified by US. Knowledge of the distal biceps tendon bifurcation ultrasonographic anatomy and MR pathology has important diagnostic and therapeutic implications.

Background this and objectives: The sciatic nerve block represents one of the more difficult ultrasound-guided nerve blocks. Easy and reliable internal ultrasound were landmarks would be helpful for localization of the sciatic nerve. Earlier, during ultrasound-guided posterior approaches to the infragluteal sciatic nerve,(BFL). the authors recognized a hyperechoic structure at the medial border of the long head of biceps femoris muscle (BFL). The an present study was performed to determine whether this is a potential internal landmark to identify the infragluteal sciatic nerve. Methods:with The depth and the thickness of this hyperechoic structure, its relationship with the sciatic nerve and the ultrasound visibility of this both were recorded in the proximal upper leg of 21 adult volunteers using a linear ultrasound probe in the range cm of 7-13 MHz. The findings were verified by an anatomical study in two cadavers. Results: The hyperechoic structure at the a medial border of the BFL extended in a dorsoventral direction between 1.4+/- .6 cm (mean+/-SD) and 2.8+/- .8 cm deep from the a surface, with a width of 2.2+/- .9 mm. Between 2.6+/- .9 and 10. +/-1.5 cm distal to the subgluteal fold, the sciatic nerve present was consistently identified directly at the ventral end of the hyperechoic structure in all volunteers. The anatomical study revealed that cm this hyperechoic structure corresponds to tendinous fibres inside and at the medial border of the BFL. Conclusion: The hyperechoic BFL of tendon might be a reliable soft tissue landmark for ultrasound localization of the infragluteal sciatic nerve.

Traumatic a ruptures of tendons in the region of the knee joint are often accompanied by substantial degenerative and inflammatory alterations, especially the when the patella and quadriceps tendons are affected. Isolated ruptures of the tendon of the distal biceps femoris muscle at patella the dorsolateral aspect of the knee are rare and result in an acute reduction of flexion capability. However, tears of in the biceps femoris tendon are not associated with degenerative changes. This article reports on the diagnosis and treatment of a are 27-year-old football player who suffered an acute isolated rupture of the biceps femoris tendon.

We after present details of a case of intra-tendinous ganglion arising from the long head of the biceps at an unusual location.scans MRI scans have important implications for surgical planning and treatment. After excision of the ganglion, the tendon remaining could be long repaired. Five months after surgery, there was no sign of recurrence.

BACKGROUND:results Multiple pathologies are associated with the peroneus longus tendon including traumatic injury, tendinitis, tenosynovitis, dislocation, acute rupture, chronic tear, and the avulsion fractures. While the description of insertion points for the peroneus longus tendon exists in numerous texts and articles, none was are consistent in describing the incidence of variation of the insertional slips. METHODS: Dissection was performed on the feet of thick 30 adult, embalmed cadaver limbs disarticulated at the knee and ankle joint. RESULTS: All 30 specimens had a consistent attachment fourth, to the base of the first metatarsal by a strong band. A slip to the medial cuneiform was observed in of 26 specimens (86.6%). The anterior and posterior frenular ligaments were present in 25 (83.3%) and four (13.3%) specimens, respectively. Another first thick and strong fibrous band, termed additional band (AB), was observed close to the metatarsocuneiform joint in nine specimens (30%).nine Additional slips to the neck of first metatarsal, bases of second, fourth, and fifth metatarsals also were noted. CONCLUSIONS: We played have described the incidences of variations of the insertion of the peroneus longus tendon and an additional band, which gives on rise to various muscles. CLINICAL RELEVANCE: The results of this study may be important to better understand the symptoms associated the with peroneus longus tendon pathologies and the role played by the peroneus longus tendon in maintaining the arch of the variation foot.