DOCSLIB.ORG

Foramen Magnum Meningiomas: Concepts, Classifications, and Nuances

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Foramen Magnum Meningiomas: Concepts, Classifications, and Nuances Neurosurg Focus 14 (6):Article 10, 2003, Click here to return to Table of Contents Foramen magnum meningiomas: concepts, classifications, and nuances MELFORT R. BOULTON, M.D., PH.D., AND MICHAEL D. CUSIMANO, M.D., PH.D., F.R.C.S.(C) Division of Neurosurgery, St. Michael’s Hospital, and the University of Toronto, Ontario, Canada Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. The authors review the clinical presentation, relevant anatomical details of the foramen magnum region, neuroimaging features, the posterior and posterolateral surgical approaches for resection, and outcomes. Based the experiences of the senior author (M.D.C.) and a review of the literature, they introduce the concept of a “surgical corridor,” discuss the classification of these tumors, and the nuances of care for patients with these challenging lesions. KEY WORDS • meningioma • foramen magnum • craniovertebral junction • skull base • suboccipital craniotomy Meningiomas are slow-growing benign tumors that from the lower third of the clivus, to upper margin of the arise at any location where arachnoid cells reside. Al- body of C-2, laterally from the jugular tubercle to the though meningiomas account for a sizable proportion of upper margin of the C-2 laminae, and posteriorly from the all primary intracranial neoplasms (14.3–19%),46 only 1.8 anterior edge of the squamous occipital bone to the C-2 to 3.2% arise at the foramen magnum.2 Their indolent spinous process. development at the craniospinal junction makes clinical The foramen magnum contains several critical neu- diagnosis complex and often leads to a long interval be- roanatomical and vascular structures of which the surgeon tween onset of symptoms and diagnosis. The sensitivity of must be aware. The neural structures include the cerebel- this region to surgical manipulation has sparked recent lar tonsils, inferior vermis, fourth ventricle, caudal aspect debate as to the most advantageous surgical approach. The of the medulla, lower cranial nerves (ninth–12th), rostral intent of this paper is to provide an overview of the rele- aspect of the spinal cord, and upper cervical nerves (C-1 vant surgical anatomy, clinical features, and nuances of and C-2). The ninth through 11th cranial nerves arise as a the management of foramen magnum meningiomas. We series of rootlets along the anterior medulla, with the introduce the concept of the “surgical corridor” and dis- spinal component of the 11th cranial nerve arising mid- cuss its importance in the management of these challeng- way between the anterior and posterior spinal rootlets of ing lesions. the spinal cord. The spinal accessory rootlets coalesce and ascend rostral to join the ninth, 10th, and the cranial por- tion of the 11th nerve. Together, these nerves exit the skull FORAMEN MAGNUM ANATOMY through the jugular foramen. The 12th cranial nerve exits the medulla more anteriorly than the other lower cranial Several excellent reviews of foramen magnum anatomy 3,10,14–17,29–31 nerves and passes anterior to the ipsilateral VA on its have been published. By definition, foramen course to the hypoglossal canal, located within the superi- magnum meningiomas arise from arachnoid at the cra- or and anterior–most portion of the occipital condyle. niospinal junction. The borders of this zone, as defined 14,17 Major arterial structures located within the foramen by George and George and colleagues range anteriorly magnum include the VAs, PICAs, anterior and posterior spinal arteries, and the meningeal branches of the verte- Abbreviations used in this paper: CSF = cerebrospinal fluid; bral, external, and internal carotid arteries. The VA cours- CT = computerized tomography; GKS = gamma knife surgery; es through the foramen tranversalis until reaching C-1 MR = magnetic resonance; PICA = posterior inferior cerebellar where it curves above the lateral aspect of the posterior artery; QOL = quality of life; VA = vertebral artery. arch and proceeds rostral to pierce the dura mater just Neurosurg. Focus / Volume 14 / June, 2003 1 Unauthenticated | Downloaded 09/24/21 10:09 PM UTC M. R. Boulton and M. D. Cusimano inferior to the lateral edge of the foramen magnum adja- cent to the occipital condyle. Its intradural portion typi- cally gives rise to the posterior spinal artery and PICA, although the origin of the PICA has been reported to vary, arising at, above, or below the foramen magnum.13 CLASSIFICATION OF FORAMEN MAGNUM MENINGIOMAS We describe foramen magnum meningiomas as having originated primarily from within the confines of the fora- men magnum or having secondarily invaded the region but originating elsewhere. We also classify the primary tumors according to their anteroposterior and lateromedi- al orientations. The spinal dentate ligament delineates the anterior and posterior compartments. Most lesions (68– 98%)2 arise anterolaterally; a posterolateral origin is the second most frequent, purely posterior lesions the third, Fig. 1. Illustration of the surgical corridor. A: Normal rela- and least common are entirely anterior. We also classify tionship of brainstem to foramen magnum. oc = occipital condyle; these lesions based on their size relative to that of the fora- cmj = cervicomedullary junction. B–D: As the tumor (T) en- men magnum (small, Ͻ one third the transverse dimen- larges, it displaces the brainstem posteriorly and typically to one sion of the foramen magnum; medium, one third to one side, naturally creating a widened surgical corridor. B: A narrow half its dimension; large, Ͼ one half). corridor of less than 1 cm between the condyle and cervicomed- Most importantly, when managing these lesions, we de- ullary junction. C: Adequate corridor with a 1- to 2-cm distance. D: Large corridor (Ͼ 2 cm) that allows relatively easy access to the fine an avenue that we term the “surgical corridor.” This anterior foramen magnum. is defined as “the space for surgical access to a lesion.” It describes the space that the surgeon will work through to access the lesion. The surgical corridor can be enlarged naturally by a tumor displacing normal structures like the undeniable, and lead to significant and often permanent medulla oblongata in a confined space such as the fora- neurological deficit. Early features of foramen magnum men magnum. Alternatively, one goal of a surgical route meningiomas include occipital headache and upper cervi- such as the transcondylar approach would be to enlarge cal pain, which is often exacerbated by neck flexion or the surgical corridor. Valsalva maneuvers. Classic foramen magnum syndrome In the management of foramen magnum meningiomas, is defined by development of unilateral arm sensory and the surgical corridor involves the space between the later- motor deficits, which progress to the ipsilateral leg, then al margin of the cervicomedullary junction and the medi- the contralateral leg, and finally contralateral upper ex- al aspect of the occipital condyle. The corridor can and tremity. Long tract findings characteristic of upper motor should be assessed on preoperative imaging. In these le- lesions are found paradoxically in the presence of atrophy sions, the corridor represents the view of a lesion that a in the intrinsic muscles of the hands. Later findings surgeon obtains via a posterolateral approach after remov- include spastic quadriparesis and lower cranial nerve pal- ing only the occipital bone and leaving the condyle intact. sies. Slowly progressive lesions such as these allow the We define a corridor as “narrow” if it provides a diameter development of accessory muscles to replace trapezius of access to the tumor of less than 1 cm; “adequate” if it is and sternocleidomastoid function. We therefore highly re- greater than 1 cm but less than 2 cm; and “large” if greater commend that the patient be undressed and the sternoclei- than 2 cm (Fig. 1). Thus, a tumor arising primarily from domastoid and trapezius muscles be closely inspected for the posterior lip of the foramen magnum and extending atrophy. Likewise, the tongue should be inspected at rest laterally has a large corridor of access, whereas one pure- for atrophy and fasciculation. Close attention to sensory ly anterior with no displacement of the cervicomedullary testing of the C-2 dermatome will help establish the diag- junction has a narrow corridor. Most tumors, once ad- nosis. Patients attest to initial sensory disturbances such as vanced enough to produce symptoms, have at least an ade- cold or burning dysesthesias, astereognosis, and anesthe- quate corridor. sia but often do not seek medical attention until intractable pain, motor deficits, or ataxia ensue. Terminal progression includes quadriplegia, an inability to maintain airway pro- CLINICAL PRESENTATION tection with secondary pneumonitis, and ultimately respi- ratory arrest. The clinical presentation of foramen magnum meningi- omas is protean, and the mean length of symptoms prior IMAGING FEATURES to diagnosis is 30.8 months, even in the era of MR im- aging.16 The clinical differential diagnosis includes multi- The role of neuroimaging is to confirm the clinical ple sclerosis, amyotrophic lateral sclerosis, syringomyelia, diagnosis and to allow the planning of a surgical approach. and cervical spondylosis.11,20,36 In a cursory examination Magnetic resonance imaging is the modality of choice for the physician may miss subtle findings early in the stage defining tumors of the foramen magnum because it pro- of the progression, but later symptoms are often advanced, vides high-resolution images of soft-tissue anatomy that is 2 Neurosurg. Focus / Volume 14 / June, 2003 Unauthenticated | Downloaded 09/24/21 10:09 PM UTC Foramen magnum meningiomas not susceptible to degradation by the surrounding skull resect tumor safely because of the sharp contrast between base, a pitfall of CT scanning. Although plain T1-weight- bone and soft tissues. It is sometimes difficult to outline ed MR images demonstrate excellent anatomical detail, bone margins on MR images, and this technique may they provide little discrimination between tumor and brain- overestimate the size of the surgical corridor available for stem because the former may appear isointense, mild- extirpation.
Load more

Recommended publications
  • Gluteal Region-II
    Gluteal Region-II Dr Garima Sehgal Associate Professor King George’s Medical University UP, Lucknow Structures in the Gluteal region • Bones & joints • Ligaments Thickest muscle • Muscles • Vessels • Nerves Thickest nerve • Bursae Learning Objectives By the end of this teaching session Gluteal region –II all the MBBS 1st year students must be able to: • Enumerate the nerves of gluteal region • Write a short note on nerves of gluteal region • Describe the location & relations of sciatic nerve in gluteal region • Enumerate the arteries of gluteal region • Write a short note on arteries of gluteal region • Enumerate the arteries taking part in trochanteric and cruciate anastomosis • Write a short note on trochanteric and cruciate anastomosis • Enumerate the structures passing through greater sciatic foramen • Enumerate the structures passing through lesser sciatic foramen • Enumerate the bursae in relation to gluteus maximus • Enumerate the structures deep to gluteus maximus • Discuss applied anatomy Nerves of Gluteal region (all nerves in gluteal region are branches of sacral plexus) Superior gluteal nerve (L4,L5, S1) Inferior gluteal nerve (L5, S1, S2) FROM DORSAL DIVISIONS Perforating cutaneous nerve (S2,S3) Nerve to quadratus femoris (L4,L5, S1) Nerve to obturator internus (L5, S1, S2) FROM VENTRAL DIVISIONS Pudendal nerve (S2,S3,S4) Sciatic nerve (L4,L5,S1,S2,S3) Posterior cutaneous nerve of thigh FROM BOTH DORSAL &VENTRAL (S1,S2) & (S2,S3) DIVISIONS 1. Superior Gluteal nerve (L4,L5,S1- dorsal division) 1 • Enters through the greater 3 sciatic foramen • Above piriformis 2 • Runs forwards between gluteus medius & gluteus minimus • SUPPLIES: 1. Gluteus medius 2. Gluteus minimus 3. Tensor fasciae latae 2.
    [Show full text]
  • Lab #23 Anal Triangle
    THE BONY PELVIS AND ANAL TRIANGLE (Grant's Dissector [16th Ed.] pp. 141-145) TODAY’S GOALS: 1. Identify relevant bony features/landmarks on skeletal materials or pelvic models. 2. Identify the sacrotuberous and sacrospinous ligaments. 3. Describe the organization and divisions of the perineum into two triangles: anal triangle and urogenital triangle 4. Dissect the ischiorectal (ischioanal) fossa and define its boundaries. 5. Identify the inferior rectal nerve and artery, the pudendal (Alcock’s) canal and the external anal sphincter. DISSECTION NOTES: The perineum is the diamond-shaped area between the upper thighs and below the inferior pelvic aperture and pelvic diaphragm. It is divided anatomically into 2 triangles: the anal triangle and the urogenital (UG) triangle (Dissector p. 142, Fig. 5.2). The anal triangle is bounded by the tip of the coccyx, sacrotuberous ligaments, and a line connecting the right and left ischial tuberosities. It contains the anal canal, which pierced the levator ani muscle portion of the pelvic diaphragm. The urogenital triangle is bounded by the ischiopubic rami to the inferior surface of the pubic symphysis and a line connecting the right and left ischial tuberosities. This triangular space contains the urogenital (UG) diaphragm that transmits the urethra (in male) and urethra and vagina (in female). A. Anal Triangle Turn the cadaver into the prone position. Make skin incisions as on page 144, Fig. 5.4 of the Dissector. Reflect skin and superficial fascia of the gluteal region in one flap to expose the large gluteus maximus muscle. This muscle has proximal attachments to the posteromedial surface of the ilium, posterior surfaces of the sacrum and coccyx, and the sacrotuberous ligament.
    [Show full text]
  • Morphology of the Foramen Magnum in Young Eastern European Adults
    Folia Morphol. Vol. 71, No. 4, pp. 205–216 Copyright © 2012 Via Medica O R I G I N A L A R T I C L E ISSN 0015–5659 www.fm.viamedica.pl Morphology of the foramen magnum in young Eastern European adults F. Burdan1, 2, J. Szumiło3, J. Walocha4, L. Klepacz5, B. Madej1, W. Dworzański1, R. Klepacz3, A. Dworzańska1, E. Czekajska-Chehab6, A. Drop6 1Department of Human Anatomy, Medical University of Lublin, Lublin, Poland 2St. John’s Cancer Centre, Lublin, Poland 3Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland 4Department of Anatomy, Collegium Medicum, Jagiellonian University, Krakow, Poland 5Department of Psychiatry and Behavioural Sciences, Behavioural Health Centre, New York Medical College, Valhalla NY, USA 6Department of General Radiology and Nuclear Medicine, Medical University of Lublin, Lublin, Poland [Received 21 July 2012; Accepted 7 September 2012] Background: The foramen magnum is an important anatomical opening in the base of the skull through which the posterior cranial fossa communicates with the vertebral canal. It is also related to a number of pathological condi- tions including Chiari malformations, various tumours, and occipital dysplasias. The aim of the study was to evaluate the morphology of the foramen magnum in adult individuals in relation to sex. Material and methods: The morphology of the foramen magnum was evalu- ated using 3D computer tomography images in 313 individuals (142 male, 171 female) aged 20–30 years. Results: The mean values of the foramen length (37.06 ± 3.07 vs. 35.47 ± ± 2.60 mm), breadth (32.98 ± 2.78 vs. 30.95 ± 2.71 mm) and area (877.40 ± ± 131.64 vs.
    [Show full text]
  • Lab Manual Axial Skeleton Atla
    1 PRE-LAB EXERCISES When studying the skeletal system, the bones are often sorted into two broad categories: the axial skeleton and the appendicular skeleton. This lab focuses on the axial skeleton, which consists of the bones that form the axis of the body. The axial skeleton includes bones in the skull, vertebrae, and thoracic cage, as well as the auditory ossicles and hyoid bone. In addition to learning about all the bones of the axial skeleton, it is also important to identify some significant bone markings. Bone markings can have many shapes, including holes, round or sharp projections, and shallow or deep valleys, among others. These markings on the bones serve many purposes, including forming attachments to other bones or muscles and allowing passage of a blood vessel or nerve. It is helpful to understand the meanings of some of the more common bone marking terms. Before we get started, look up the definitions of these common bone marking terms: Canal: Condyle: Facet: Fissure: Foramen: (see Module 10.18 Foramina of Skull) Fossa: Margin: Process: Throughout this exercise, you will notice bold terms. This is meant to focus your attention on these important words. Make sure you pay attention to any bold words and know how to explain their definitions and/or where they are located. Use the following modules to guide your exploration of the axial skeleton. As you explore these bones in Visible Body’s app, also locate the bones and bone markings on any available charts, models, or specimens. You may also find it helpful to palpate bones on yourself or make drawings of the bones with the bone markings labeled.
    [Show full text]
  • Vertebral Column
    Vertebral Column • Backbone consists of Cervical 26 vertebrae. • Five vertebral regions – Cervical vertebrae (7) Thoracic in the neck. – Thoracic vertebrae (12) in the thorax. – Lumbar vertebrae (5) in the lower back. Lumbar – Sacrum (5, fused). – Coccyx (4, fused). Sacrum Coccyx Scoliosis Lordosis Kyphosis Atlas (C1) Posterior tubercle Vertebral foramen Tubercle for transverse ligament Superior articular facet Transverse Transverse process foramen Facet for dens Anterior tubercle • Atlas- ring of bone, superior facets for occipital condyles. – Nodding movement signifies “yes”. Axis (C2) Spinous process Lamina Vertebral foramen Transverse foramen Transverse process Superior articular facet Odontoid process (dens) •Axis- dens or odontoid process is body of atlas. – Pivotal movement signifies “no”. Typical Cervical Vertebra (C3-C7) • Smaller bodies • Larger spinal canal • Transverse processes –Shorter – Transverse foramen for vertebral artery • Spinous processes of C2 to C6 often bifid • 1st and 2nd cervical vertebrae are unique – Atlas & axis Typical Cervical Vertebra Spinous process (bifid) Lamina Vertebral foramen Inferior articular process Superior articular process Transverse foramen Pedicle Transverse process Body Thoracic Vertebrae (T1-T12) • Larger and stronger bodies • Longer transverse & spinous processes • Demifacets on body for head of rib • Facets on transverse processes (T1-T10) for tubercle of rib Thoracic Vertebra- superior view Spinous process Transverse process Facet for tubercle of rib Lamina Superior articular process
    [Show full text]
  • CT Evaluation of the Greater Sciatic Foramen in Patients with Sciatica
    337 CT Evaluation of the Greater Sciatic Foramen in Patients with Sciatica Burton A. Cohen 1 Sciatic and lower extremity neurologic symptoms may be from pathologic involvement Charles F. Lanzieri of the sacral plexus or sciatic nerve in the region of the greater sciatic foramen. Twenty­ David S. Mendelson five patients were reviewed who presented consecutively over a 4 year period with Michael Sacher sciatic symptoms secondary to pathologiC changes in the greater sciatic foramen. George Hermann Malignant neoplasm alone (18 patients) and malignant neoplasm associated with infec­ tion (two patients) account for most of these cases. Neurogenic tumors (three patients), John S. Train both benign and malignant, and infection alone (three patients) were less frequent. Jack G. Rabinowitz Although sciatic symptoms usually derive from spinal abnormalities, the evaluation of sciatic symptoms should not be considered complete without CT scanning of the greater sciatic foramen. The importance of computed tomography (CT) of the spine and sacrum in the evaluation of patients with sciatica and lower extremity neurologic symptoms has been well described [1-10]. Pathologic processes may involve the sacral plexus or sciatic nerve, causing lower extremity neurologic or sphincter symptoms by irritation of the long lumbar or sacral nerves. These processes may be occult to plain fi lm or myelographic examination. CT provides an accurate means of evaluating the sacrum and parasacral spaces including the greater sciatic foramen (GSF) [1-3]. Therefore, it is an extremely important technique in the evaluation of sciatic symptoms in those patients with a negative workup for spinal pathology. In the absence of sciatic symptoms, CT is also quite helpful in evaluating the GSF and its structures and in determining the nature and extent of pelvic inflammatory and neoplastiC processes.
    [Show full text]
  • Topographical Anatomy and Morphometry of the Temporal Bone of the Macaque
    Folia Morphol. Vol. 68, No. 1, pp. 13–22 Copyright © 2009 Via Medica O R I G I N A L A R T I C L E ISSN 0015–5659 www.fm.viamedica.pl Topographical anatomy and morphometry of the temporal bone of the macaque J. Wysocki 1Clinic of Otolaryngology and Rehabilitation, II Medical Faculty, Warsaw Medical University, Poland, Kajetany, Nadarzyn, Poland 2Laboratory of Clinical Anatomy of the Head and Neck, Institute of Physiology and Pathology of Hearing, Poland, Kajetany, Nadarzyn, Poland [Received 7 July 2008; Accepted 10 October 2008] Based on the dissections of 24 bones of 12 macaques (Macaca mulatta), a systematic anatomical description was made and measurements of the cho- sen size parameters of the temporal bone as well as the skull were taken. Although there is a small mastoid process, the general arrangement of the macaque’s temporal bone structures is very close to that which is observed in humans. The main differences are a different model of pneumatisation and the presence of subarcuate fossa, which possesses considerable dimensions. The main air space in the middle ear is the mesotympanum, but there are also additional air cells: the epitympanic recess containing the head of malleus and body of incus, the mastoid cavity, and several air spaces on the floor of the tympanic cavity. The vicinity of the carotid canal is also very well pneuma- tised and the walls of the canal are very thin. The semicircular canals are relatively small, very regular in shape, and characterized by almost the same dimensions. The bony walls of the labyrinth are relatively thin.
    [Show full text]
  • The Condylar Canal and Emissary Vein—A Comprehensive and Pictorial Review of Its Anatomy and Variation
    Child's Nervous System (2019) 35:747–751 https://doi.org/10.1007/s00381-019-04120-4 REVIEW ARTICLE The condylar canal and emissary vein—a comprehensive and pictorial review of its anatomy and variation Stefan Lachkar1 & Shogo Kikuta1 & Joe Iwanaga1,2 & R. Shane Tubbs1,3 Received: 6 March 2019 /Accepted: 8 March 2019 /Published online: 21 March 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract The condylar canal and its associated emissary vein serve as vital landmarks during surgical interventions involving skull base surgery. The condylar canal serves to function as a bridge of communication from the intracranial to extracranial space. Variations of the condylar canal are extremely prevalent and can present as either bilateral, unilateral, or completely absent. Anatomical variations of the condylar canal pose as a potential risk to surgeons and radiologist during diagnosis as it could be misinterpreted for a glomus jugular tumor and require surgical intervention when one is not needed. Few literature reviews have articulated the condylar canal and its associated emissary vein through extensive imaging. This present paper aims to further the knowledge of anatomical variations and surgical anatomy involving the condylar canal through high-quality computed tomography (CT) images with cadaveric and dry bone specimens that have been injected with latex to highlight emissary veins arising from the condylar canal. Keywords Posterior condylar canal . Anatomical variation . Anatomy . Cadaver . Skull . Emissary vein Introduction the posterior cranial fossa near or in the jugular fossa (Figs. 3 and 4)[2, 7, 9]. Its contents include the condylar emissary The condylar canal serves as a vital passageway for venous vein, which connects the sigmoid sinus or superior jugular circulation (condylar emissary vein) (Fig.
    [Show full text]
  • Abnormality of the Foramen Spinosum Due to a Variation in the Trajectory of the Middle Meningeal Artery: a Case Report in Human
    THIEME 73 Abnormality of the Foramen Spinosum due to a Variation in the Trajectory of the Middle Meningeal Artery: A Case Report in Human Joel Henrique Ellwanger1 Deivis de Campos1,2 1 Department of Biology and Pharmacy, Laboratory of Histology and Address for correspondence Deivis de Campos, PhD, Departamento Pathology, University of Santa Cruz do Sul – UNISC, Santa Cruz do Sul, de Biologia e Farmácia, Laboratório de Histologia e Patologia, RS, Brazil Universidade de Santa Cruz do Sul, Av. Independência, 2293, Santa 2 Institute of Basic Health Sciences, Post Graduate Program in Cruz do Sul, RS, Brazil (e-mail: [email protected]). Neurosciences, Federal University of Rio Grande do Sul - UFRGS, RS, Brazil J Neurol Surg Rep 2013;74:73–76. Abstract Originating from the maxillary artery, the middle meningeal artery (MMA) is predomi- nantly periosteal irrigating the bone and dura mater. It enters the floor of the middle cranial fossa through the foramen spinosum, travels laterally through a middle fossa bony ridge, and curves over the previous upper-greater wing of the sphenoid, where it in a variable point is divided into frontal and parietal branches. The complex sequence of the MMA development gives many opportunities for variant anatomy. In a Caucasian Keywords cadaver skull of an approximately 35-year-old individual belonging to the didactical ► middle meningeal collection of the Laboratory of Human Anatomy at the University of Santa Cruz do Sul, artery Brazil, it was noted that the right foramen spinosum has an abnormal shape. In this ► anatomic variation report, we discuss an abnormality of the foramen spinosum due to a variation in the ► foramen spinosum trajectory of the MMA.
    [Show full text]
  • A Study on Unusual Foramen in the Middle Cranial Fossa in Adult South Indian Dry Skulls
    Dental Communication Biosc.Biotech.Res.Comm. Special Issue Vol 13 No 8 2020 Pp-100-103 A Study on Unusual Foramen in the Middle Cranial Fossa in Adult South Indian Dry Skulls Danisca. U1, Thenmozhi. M. S2 and Yuvaraj Babu. K3 1Department of Anatomy Saveetha Dental College and hospital, Saveetha Institute of Medical and Technical Sciences, Chennai - 600077, India. 2Department of Anatomy Saveetha Dental College and hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 600077, India 3Department of Anatomy, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 600077 India ABSTRACT Foramen Vesalius is present in anteromedial side of the foramen ovale. It connects the pterygoid plexus with the cavernous sinus and transmits a small emissary vein which drains the cavernous sinus . The main importance of this foramen is that it offers a path for the spread of an infection from the extracranial source to the cavernous sinus. Foramen innominatus is found between foramen spinosum and foramen ovale if present it transmits the lesser petrosal nerve. Neurosurgeons should be very precautious about these unusual foramina.The main aim of this study is to analyse the presence of foramen vesalius and foramen innominatus in the middle cranial fossa. For the present study,30 dry human cranial fossa of unknown sex from the Department of Anatomy, Saveetha Dental College and Hospitals, Chennai was examined. From the study, the incidence of unusual foramina was 23.3%. Foramen vesalius was present in 10% of the total skulls and foramen innominatus was present in 13.3% of the total skulls studied.
    [Show full text]
  • An Up-To-Date Overview of Evaluation and Management
    Translational Research in Anatomy 11 (2018) 5–9 Contents lists available at ScienceDirect Translational Research in Anatomy journal homepage: www.elsevier.com/locate/tria Ureterosciatic hernia: An up-to-date overview of evaluation and T management ∗ Jason Gandhia,b,c, Min Yea Leea, Gunjan Joshid, Noel L. Smithe, Sardar Ali Khana,f, a Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA b Medical Student Research Institute, St. George's University School of Medicine, West Indies, Grenada c Department of Anatomical Sciences, St. George's University School of Medicine, West Indies, Grenada d Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA e Foley Plaza Medical, New York, NY, USA f Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA ARTICLE INFO ABSTRACT Keywords: Ureterosciatic hernia, defined as a suprapiriform or infrapiriform herniation of the pelvic ureter, is the sliding of Ureter the ureters into the pelvic fossa, fovea, or greater or lesser sciatic foramen. This type of hernia is the rarest form Sciatic hernia of pelvic sciatic hernias. It may cause a wide range of cryptic clinical symptoms of pain, obstructive uropathy, Ureteral obstruction sepsis, or renal failure. This condition has been described in terms of involvement in inguinal, femoral, sciatic, Sepsis obturator, and thoracic regions. A high index of clinical suspicion is essential for diagnosis because the hernia Hydronephrosis develops in the pelvic cavity and becomes overlayed by the large gluteal muscle. Since ureterosciatic hernias Renal failure have not been adequately reviewed in the literature due to the limited number of case reports, we aim to aid the clinician's knowledge by discussing the relevant anatomy, classification, clinical symptoms, optional radiology, optional diagnostic instrumentation, and management.
    [Show full text]
  • Gluteal Region and Back of the Thigh Musculoskeletal Block - Lecture 14
    Gluteal region and back of the thigh Musculoskeletal Block - Lecture 14 Objective: ✓ Contents of the gluteal region: 3 Glutei muscles: Gluteus maximus, medius and minimus. Other 5 Small muscles: Piriformis, Obturator internus, Superior gemellus, Inferior gemellus and Quadratus femoris. ✓ Nerves & vessels. ✓ Foramina: 1-GreaterSciaticForamen. 2-Lesser Sciatic Foramen. ✓ Back of the thigh: Hamstring muscles. Color index: Important In male’s slides only In female’s slides only Extra information, explanation Editing file Contact us: [email protected] Contents Of Gluteal Region: Glutei: 1. Gluteus maximus 2. Gluteus medius 3. Gluteus minimus Muscles Small Muscles (Lateral Rotators): 1. Piriformis 2. Superior gemellus 3. Obturator internus 4. Inferior gemellus 5. Quadratus femoris (All from Sacral plexus): 1. Sciatic nerve 2. Superior gluteal nerve 3. Inferior gluteal nerve 4. Posterior cutaneous nerve of thigh Nerves 5. Nerve to obturator internus 6. Nerve to quadratus femoris 7. Pudendal nerve (all from internal iliac vessels) 1. Superior Gluteal vessel 2. Inferior Gluteal vessel Vessels 3. Internal pudendal vessels Greater Sciatic Foramen: Pictures Greater Sciatic notch of hip bone is transformed into foramen by: sacrotuberous(between the sacrum to ischial tuberosity) & sacrospinous (between the sacrum to ischial spine) ligaments. Structures passing through Greater sciatic foramen: Piriformis muscle - (Above piriformis muscle) Superior gluteal nerves and vessels - (Below Piriformis muscle) Inferior Gluteal nerves and vessels Sciatic nerve Posterior cutaneous nerve of thigh (superficialis) Nerve to quadratus femoris Nerve to obturator internus Pudendal Nerve* Internal Pudendal vessels* *go to Lesser Sciatic foramen too Lesser Sciatic foramen: Lesser Sciatic notch of hip is transformed into foramen by Sacrotuberous & Sacrospinous ligaments.
    [Show full text]