Surgical Anatomy of the Lacrimal Excretory System and Lateral Wall of the Nose

Experimental calcaneus fractures were produced by axially loading 18 specimens. Anatomic dissections were performed and documented. Two constant primary fracture lines were identified, dividing the calcaneus in the coronal and sagittal planes. A constant anterolateral fragment was identified, as were three patterns of calcaneocuboid joint fracture involvement. Based on the pathoanatomy and surgical anatomy of the calcaneus, a medial and lateral column classification is proposed. The medial column includes the superomedial fragment. The lateral column includes the calcaneocuboid joint, lateral wall and posterior facet. This concept can help identify fracture displacements and correlate them with a treatment plan.

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Surgical Anatomy of the Guinea Pig Ear

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947508400220 ◽

1975 ◽

Vol 84 (2) ◽

pp. 250-255 ◽

Cited By ~ 22

Author(s):

Richard Asarch ◽

Maxwell Abramson ◽

Ward B. Litton

Keyword(s):

Blood Loss ◽

Guinea Pig ◽

Tympanic Membrane ◽

Round Window ◽

Semicircular Canals ◽

Lateral Wall ◽

Surgical Anatomy ◽

Surgical Approaches ◽

Lateral Canal ◽

Superior Approach

The basic anatomy of the guinea pig ear is outlined as background for a description of two surgical approaches to the guinea pig temporal bone. These approaches provide access to the external, middle, and inner ear without significant blood loss or mortality. The superior approach, made by incision at the superior anterior attachment of the auricle and removing the lateral wall of the epitympanic space, exposes the round window, epitympanum, lateral canal, and external auditory canal, leaving the tympanic membrane intact. The inferior approach through the neck exposes the cochlea, Eustachian canal, horizontal and posterior semicircular canals, tympanic membrane, and ossicles.

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The foramen lacerum: surgical anatomy and relevance for endoscopic endonasal approaches

Journal of Neurosurgery ◽

10.3171/2018.6.jns181117 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1571-1582 ◽

Cited By ~ 2

Author(s):

Wei-Hsin Wang ◽

Stefan Lieber ◽

Roger Neves Mathias ◽

Xicai Sun ◽

Paul A. Gardner ◽

...

Keyword(s):

Multislice Ct ◽

Lateral Wall ◽

Anterior Wall ◽

Surgical Anatomy ◽

Average Height ◽

Endoscopic Endonasal ◽

Average Width ◽

Effective Removal ◽

Adjacent Structures ◽

Vidian Canal

OBJECTIVEThe foramen lacerum is a relevant skull base structure that has been neglected for many years. From the endoscopic endonasal perspective, the foramen lacerum is a key structure due to its location at the crossroad between the sagittal and coronal planes. The objective of this study was to provide a detailed investigation of the surgical anatomy of the foramen lacerum and its adjacent structures based on anatomical dissections and imaging studies, propose several relevant key surgical landmarks, and demonstrate the surgical technique for its full exposure with several illustrative cases.METHODSTen colored silicone-injected anatomical specimens were dissected using a transpterygoid approach to the foramen lacerum region in a stepwise manner. Five similar specimens were used for a comparative transcranial approach. The osseous anatomy was examined in 32 high-resolution multislice CT studies and 1 disarticulated skull. Representative cases were selected to illustrate the application of the findings.RESULTSThe pterygosphenoidal fissure is the synchondrosis between the lacerum process of the pterygoid bone and the floor of the sphenoid bone. It constantly converges with the posterior end of the vidian canal at a 45° angle, and its posterolateral end points directly to the lacerum foramen. The pterygoid tubercle separates the vidian canal from the pterygosphenoidal fissure, and forms the anterior wall of the lower part of the foramen lacerum. The lingual process, which forms the lateral wall of the foramen lacerum, was identified in 53 of 64 sides and featured an average height of 5 mm. The mandibular strut separates the foramen lacerum from the foramen ovale and had an average width of 5 mm.CONCLUSIONSThis study provides relevant surgical landmarks and a systematic approach to the foramen lacerum by defining anterior, medial, lateral, and inferior walls that may facilitate its safe exposure for effective removal of lesions while minimizing the risk of injury to the internal carotid artery.

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The medial wall of the cavernous sinus. Part 1: Surgical anatomy, ligaments, and surgical technique for its mobilization and/or resection

Journal of Neurosurgery ◽

10.3171/2018.3.jns18596 ◽

2019 ◽

Vol 131 (1) ◽

pp. 122-130 ◽

Cited By ~ 6

Author(s):

Huy Q. Truong ◽

Stefan Lieber ◽

Edinson Najera ◽

Joao T. Alves-Belo ◽

Paul A. Gardner ◽

...

Keyword(s):

Cavernous Sinus ◽

Single Layer ◽

Lateral Wall ◽

Anterior Wall ◽

Surgical Anatomy ◽

Medial Wall ◽

Vertical Segment ◽

Anterior Clinoid Process ◽

Endoscopic Endonasal

OBJECTIVEThe medial wall of the cavernous sinus (CS) is often invaded by pituitary adenomas. Surgical mobilization and/or removal of the medial wall remains a challenge.METHODSEndoscopic endonasal dissection was performed in 20 human cadaver heads. The configuration of the medial wall, its relationship to the internal carotid artery (ICA), and the ligamentous connections in between them were investigated in 40 CSs.RESULTSThe medial wall of the CS was confirmed to be an intact single layer of dura that is distinct from the capsule of the pituitary gland and the periosteal layer that forms the anterior wall of the CS. In 32.5% of hemispheres, the medial wall was indented by and/or well adhered to the cavernous ICA. The authors identified multiple ligamentous fibers that anchored the medial wall to other walls of the CS and/or to specific ICA segments. These parasellar ligaments were classified into 4 groups: 1) caroticoclinoid ligament, spanning from the medial wall and the middle clinoid toward the clinoid ICA segment and anterior clinoid process; 2) superior parasellar ligament, connecting the medial wall to the horizontal cavernous ICA and/or lateral wall of the CS; 3) inferior parasellar ligament, bridging the medial wall to the anterior wall of the CS or anterior surface of the short vertical segment of the cavernous ICA; and 4) posterior parasellar ligament, which anchors the medial wall to the short vertical segment of the cavernous ICA and/or the posterior carotid sulcus. The caroticoclinoid ligament and inferior parasellar ligament were present in most CSs (97.7% and 95%, respectively), while the superior and posterior parasellar ligaments were identified in approximately half of the CSs (57.5% and 45%, respectively). The caroticoclinoid ligament was the strongest and largest ligament, and it was typically assembled as a group of ligaments with a fan-like arrangement. The inferior parasellar ligament was the first to be encountered after opening the anterior wall of the CS during an interdural transcavernous approach.CONCLUSIONSThe authors introduce a classification of the parasellar ligaments and their role in anchoring the medial wall of the CS. These ligaments should be identified and transected to safely mobilize the medial wall away from the cavernous ICA during a transcavernous approach and for safe and complete resection of adenomas that selectively invade the medial wall.

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Anatomic Study of Endoscopic Transnasal Approach to Petrous Apex

E3S Web of Conferences ◽

10.1051/e3sconf/202021803016 ◽

2020 ◽

Vol 218 ◽

pp. 03016

Author(s):

Wenyuan He ◽

Qingying Qin ◽

Guxian Wang

Keyword(s):

Skull Base ◽

Sphenoid Sinus ◽

Lateral Wall ◽

Anterior Wall ◽

Surgical Anatomy ◽

Petrous Apex ◽

Transnasal Approach ◽

Long Time ◽

Endoscopic Transnasal Approach ◽

Micro Drill

With the development of Neurosurgery technology, there has been a qualitative leap forward with the appearance of microanatomy, which makes the deep brain tumors which were hard to be achieved in the past, and effectively reduces the mortality of patients. Petrous apex is a cone-shaped part of the anteromedial part of the temporal bone, which is deep. It has been a challenging area for surgical anatomy for a long time. In this paper, fresh adult perfused cadaveric head specimens and dry adult cadaveric head specimens were taken as the experimental objects. The anterior wall of sphenoid sinus and the internal septum of sphenoid sinus were excised under neuroendoscope. The structures of the lateral wall of sphenoid sinus were identified and dissected. The lateral wall of sphenoid sinus and the bone of skull base were opened with micro drill, The meninges were exposed and cut open, and the related structures were dissected, observed and photographed. The experimental results show that it is relatively safe to operate in the range of less than 8mm, and the rock tip can be found accurately. The measurement of the bony structure of the skull base is helpful for the surgeon to judge the course of the internal carotid artery and its adjacent structure.

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