Tubbs, R. Shane

Anomalies in the course and drainage of the Inferior Vena Cava (IVC) may complicate normal functioning, correct diagnosis, and therapeutic interventions within the abdomen. Development of the IVC occurs during the 4th to 8th week of gestation, and due to its developmental complexity, there are many opportunities for malformations to occur. Although most IVC anomalies are clinically silent and are usually discovered incidentally on abdominal imaging, aberrations may be responsible for formation of thrombosis, back pain, and anomalous circulation of blood to the heart. In this review, we will discuss the most common variations and abnormalities of the IVC, which include the posterior cardinal veins, the subcardinal veins, the supracardinal veins, persistent left IVC, IVC duplication, situs inversus, left retroaortic renal vein, left circumaortic renal collar, scimitar syndrome, and IVC agenesis. For each abnormality outlined above, we aim to discuss relevant embryology and potential clinical significance with regards to presentation, diagnosis, and treatment as is important for radiologists, surgeons, and clinicians in current clinical practice. Clin. Anat. 27:1234–1243, 2014. © 2014 Wiley Periodicals, Inc.

Standard cutaneous innervation maps show strict midline demarcation. Although authors of these maps accept variability of peripheral nerve distribution or occasionally even the midline overlap of cutaneous nerves, this concept seems to be neglected by many other anatomists. To support the statement that such transmedian overlap exists, we performed an extensive literature search and found ample evidence for all regions (head/neck, thorax/abdomen, back, perineum, and genitalia) that peripheral nerves cross the midline or communicate across the midline. This concept has substantial clinical implications, most notably in anesthesia and perineural tumor spread. This article serves as a springboard for future anatomical, clinical, and experimental research. Clin. Anat. 28:96–100, 2015. © 2014 Wiley Periodicals, Inc.

Hilton's Law, put forth 150 years ago, is well known and frequently taught in anatomy courses. We critically analyzed the complex description of associated muscular, cutaneous, and articular innervations in order to assess the general applicability of Hilton's Law. We applied rules for interpretation of the Law extrapolated upon but based on Hilton's original writings, and excluded obscure supplementary clauses not considered as part of the Law. We found the Law, as originally written and as we interpreted with some latitude, to be reliable and applicable to all cranial and peripheral nerves. Hilton's Law is a powerful springboard to understand articular anatomy and pathophysiology. Clin. Anat. 548–555, 2014. © 2013 Wiley Periodicals, Inc.

Alfred W. Adson was a pioneer in the field of neurosurgery. He described operations for a variety of neurosurgical diseases and developed surgical instruments. Under his leadership the Section of Neurological Surgery at the Mayo Clinic was established and he functioned as its first chair. Adson's contributions to the understanding of spinal and spinal cord tumors are less well known. This article reviews related medical records and publications and sets his contributions in the context of the work of other important pioneers in spinal tumor surgery at the time.

The human cutaneous sensory map has been a work in progress over the past century, depicting sensory territories supplied by both the spinal and cranial nerves. Two critical discoveries, which shaped our understanding of cutaneous innervation, were sensory dermatome overlap between contiguous spinal levels and axial lines across areas where no sensory overlap exists. These concepts define current dermatome maps. We wondered whether the overlap between contiguous sensory territories was even tighter: if neural communications were present in the peripheral nerve territories consistently connecting contiguous spinal levels? A literature search using peer‐reviewed articles and established anatomy texts was performed aimed at identifying the presence of communications between sensory nerves in peripheral nerve territories and their relationship to areas of adjacent and non‐adjacent spinal or cranial nerves and axial lines (lines of discontinuity) in the upper and lower limbs, trunk and perineum, and head and neck regions. Our findings demonstrate the consistent presence of sensory nerve communications between peripheral nerve territories derived from spinal nerves within areas of axial lines in the upper and lower limbs, trunk and perineum, and head and neck. We did not find examples of communications crossing axial lines in the limbs or lines of discontinuity in the face, but did find examples crossing axial lines in the trunk and perineum. Sensory nerve communications are common. They unify concepts of cutaneous innervation territories and their boundaries, and refine our understanding of the sensory map of the human skin. Clin. Anat. 27:681–690, 2014. © 2013 Wiley Periodicals, Inc.

Although the ulnar nerve is closely associated with the triceps brachii muscle, the literature does not normally describe it as supplying this muscle. However, recent research has examined the ulnar nerve in the upper arm and identified branches supplying the medial head of the triceps brachii muscle. This study aims to expand upon this research by describing the course and incidence of these branches in a larger sample size. We examined 50 specimens in 25 cadavers. Ulnar innervation of the medial head of the triceps brachii was identified in 14 specimens (28%). The mean distance of the ulnar nerve branch midpoint was 26% along a line between the surgical neck and an epicondyle line, with a range of 11–39%. Innervation of the triceps brachii muscle by the ulnar nerve has important clinical and surgical implications. Clin. Anat. 26:1028–1030, 2013. © 2013 Wiley Periodicals, Inc.

By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his residency training and a hiatus to further his clinical interests and intellectual curiosity, he traveled to Europe and met with a variety of surgeons, physiologists, and scientists, who likely laid the groundwork for Cushing's increased interest in peripheral nerve surgery. Returning to The Johns Hopkins Hospital in 1901, he began documenting these surgeries. Patient records preserved at Yale's Cushing Brain Tumor Registry describe Cushing's repair of ulnar and radial nerves, as well as his exploration of the brachial plexus for nerve repair or reconstruction. The authors reviewed Harvey Cushing's cases and provide 3 case illustrations not previously reported by Cushing involving neurolysis, nerve repair, and neurotization. Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor.

Object A review of the literature has revealed scant data related to neurosurgical treatment of gravid patients. The authors reviewed their experience with the neurosurgical treatment of pregnant women to better characterize the optimal management strategies for intracranial pathological entities in this population. Methods Between July 1969 and July 2005, 34 patients with documented pregnancy and concomitant intracranial pathological entities were treated at the authors' institution. The average age of the gravid patients at presentation was 27 ± 6 years. Twelve patients harbored vascular and 14 patients harbored neoplastic lesions. Four gravid patients suffered from traumatic intracranial hemorrhage, 2 had primary intracerebral hemorrhage, and 2 had hydrocephalus. The medical records of these patients were reviewed to assess the outcome for the mothers and fetuses. Results Nineteen pregnant patients (56%) underwent a neurosurgical procedure after induction of general anesthesia. Of these, 14 (74%) underwent craniotomies for clipping/resection of their lesion, 2 (10%) underwent stereotactic biopsies, and 3 (16%) underwent CSF shunting procedures. Three patients (9%) delivered by cesarean section followed by their neurosurgical procedure, and 5 (15%) underwent therapeutic abortion preoperatively to allow for radiation therapy early in their pregnancy (4 of these patients underwent surgery prior to their therapeutic abortion). Eleven patients (32%) were treated nonoperatively while pregnant, and 3 of these received their treatment after delivery. There was no operative maternal mortality or permanent morbidity. The fetuses did not suffer from any complications related to the mother's neurosurgical procedure. Conclusions Based on the authors' experience and a review of the literature, surgery for intracranial lesions in pregnant patients is generally well tolerated by both mother and fetus. Preoperative delivery by cesarean section of term or near-term babies is reasonable. Some patients treated conservatively may deteriorate and require an operation.

Object The suprascapular nerve may become entrapped as it travels deep to the suprascapular ligament, necessitating decompression. The present study was performed to verify the feasibility of a minimally invasive, endoscopically assisted technique for decompressing the suprascapular nerve in the supraspinous fossa. Methods The authors performed dissection and decompression of the suprascapular ligament using an endoscopically assisted technique via a 3-cm skin incision in 10 adult cadavers (20 sides). Measurements were also made of the depth from the skin to the suprascapular ligament. Results A mean depth of 4 cm was necessary to reach the suprascapular ligament from the skin surface. With the authors' approach, no obvious injury occurred to the suprascapular or other vicinal neurovascular structures (such as the spinal accessory nerve and suprascapular vessels). Conclusions The results of this cadaveric study demonstrate that access to the suprascapular nerve can be obtained endoscopically via a small suprascapular incision. This approach obviates a large incision, entry into the glenohumeral joint, and reduces the risk of spinal accessory nerve injury in the posterior cervical triangle, or atrophy of the trapezius or supraspinatus muscles from a standard larger dissection. To the authors' knowledge an endoscopically assisted approach to decompressing the suprascapular nerve as it courses deep to the suprascapular ligament has not been reported previously.