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Biomedical subjects

R Shane Tubbs

Publications and source records attributed to R Shane Tubbs.

At least 91 records · Page 5Linked to original sources
PubMed2006

Approach to the cervical portion of the vagus nerve via the posterior cervical triangle: a cadaveric feasibility study with potential use in vagus nerve stimulation procedures.

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

Aged↗
PubMed2006

Does the ganglion of Ribes exist?

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

Aged↗
PubMed2005

Additional vascular compression of the brachial plexus in a cadaver with a cervical rib: case illustration.

Cervical ribs are uncommon and occur in approximately 0.5-1% of the population. The authors describe a cadaver found to have a cervical rib with further compression by the dorsal scapular artery. This vessel originated from the third portion of the subclavian artery. No other anomalies were found in this specimen. The authors speculate that some cases of symptomatic cervical rib may have an additional vector of compression from a dorsal scapular artery when it arises from the third portion of the subclavian artery. Additional studies aimed at the vascular system may be useful in diagnosis and operative planning for symptomatic patients.

Aged↗
PubMed2005

Long-term follow-up in children with functional hemispherectomy for Rasmussen's encephalitis.

INTRODUCTION: Cerebral hemispherectomy has been performed for over 60 years. Multiple variations of functional hemispherectomy have been performed since its inception by Rasmussen. Long-term follow-up for these variations is lacking in the medical literature. METHODS: We review the long-term follow-up for five children with Rasmussen's encephalitis who underwent a modification of functional hemispherectomy. RESULTS: The length of follow-up for this cohort ranged from 13 to 23 years (mean 15.6 years). All patients experienced immediate and complete elimination of seizures. Only one patient underwent ventriculoperitoneal shunt placement. All patients are capable of ambulating on their own. Many years following their procedures, this cohort of patients remains seizure free.

Adolescent↗
PubMed2005

Occult spinal dysraphism and Pacinian hamartomas.

CASES: The authors report two patients with occult spinal dysraphism who, following histological analysis, were found to harbor associated Pacinian hamartomas. One patient's hamartoma was found in conjunction with their lipomyelomeningocele and the other was combined with a presacral myxopapillary ependymoma associated with a fatty filum terminale. DISCUSSION AND CONCLUSION: We review the literature and believe this to be only the third report of Pacinian hamartomas in association with occult spinal dysraphism. Although Pacinian hamartomas are seemingly rare in conjunction with occult spinal dysraphism, mesodermal elements are often found in this disease entity.

Hamartoma↗
PubMed2005

Spinal cord compression as a result of Rosai-Dorfman disease of the upper cervical spine in a child.

BACKGROUND: Rosai-Dorfman disease is characterized by massive painless cervical lymphadenopathy, but can also include nasal obstruction, tonsillar enlargement, or hearing abnormalities. The disease occurs most often in the third and fourth decades. Most authors have suggested that it represents either an autoimmune disease or a reaction to an infectious agent that has yet to be discovered. Less than 50 cases of central nervous system involvement have been reported. CASE ILLUSTRATION: We report a child with cervical spinal cord compression due to Rosai-Dorfman disease of the cervical spine. PROGNOSIS: This disease has variable outcomes from relatively benign to insidious over decades. Our case is unusual in that the patient was a child and had involvement of the spine with resultant cord compression, a combination that has been reported rarely.

Adolescent↗
PubMed2005

Landmarks for the greater petrosal nerve.

The anatomy of the greater petrosal nerve while within the middle cranial fossa is lacking in the English literature and must be well understood by the surgeon who operates in this area. Twenty-two sides from six female and five male cadavers were examined. Measurements were made between the greater petrosal nerve as it coursed through the middle cranial fossa and surrounding structures such as the arcuate eminence and lateral wall of the middle cranial fossa. Mean distances from the arcuate eminence to the hiatus of the greater petrosal nerve into the middle cranial fossa measured 17.5 mm (SD = 2.2). The length of this nerve within the middle fossa was approximately 10 mm (SD = 2). From the lateral wall of the middle fossa to a midpoint of the greater petrosal nerve mean distances measured 39 mm (SD = 2.4). The mean distance from the foramen spinosum to the exit of this nerve inferior to the trigeminal ganglion measured 7 mm (SD = 1.8). These measurements will hopefully aid the surgeon who wishes to expose or avoid the greater petrosal nerve within the middle cranial fossa.

Aged↗
PubMed2005

Duplication of the occipital condyles.

This article describes an extremely rare case, encountered in the anatomy laboratory, of a skull base found to have duplication of both occipital condyles. In addition, this specimen was noted to have a large bony excrescence near the basion, a small third occipital condyle, a left paracondylar process, elongation of the right styloid process, and a bony septation of both hypoglossal canals. The embryology and clinical implications are discussed.

Adult↗
PubMed2005

Novel surgical approach to the carpal tunnel: cadaveric feasibility study.

Carpal tunnel syndrome is the most common entrapment neuropathy dealt with by the clinician. Multiple techniques have been used to surgically treat this pathological condition and all of these approach the carpal tunnel from the palmar surface of the hand or wrist. We have developed a novel endoscopic approach to the carpal tunnel utilizing a dorsal approach that necessitates a good appreciation of the anatomy of this region. This approach was carried out in 10 hands. Through a single dorsal incision we were able to transect the flexor retinaculum in all specimens without obvious damage to neural or vascular tissues. The microscissors used in our study were found to be too delicate for transection of the flexor retinaculum thus another cutting tool should be considered. Our dorsal approach with visualization of the internal aspect of the flexor retinaculum may obviate many of the complications that are seen with the current techniques used to surgically treat carpal tunnel syndrome such as injury to the median nerve and its branches. Clinical trials are now necessary with prospective randomized studies that will determine which techniques are most efficacious and minimize complications most effectively.

Aged↗
PubMed2005

Unusual attachment of the pectoralis minor muscle.

The authors report a presumably unusual bony attachment of the pectoralis minor muscle in an adult cadaver. The specimen's left pectoralis minor had no attachment to the coracoid process of the scapula but attached directly to the fibrous capsule of the glenohumeral joint. Some have theorized that the coracohumeral ligament represents fibers of the pectoralis minor that attach to this bone in some animals but that has degenerated in man. This case report seems to support this possibility.

Adult↗
PubMed2005

Unusual drainage of the testicular veins.

An unusual drainage of the testicular veins was found during routine cadaveric dissection. Specifically, the lateral division of each testicular vein on both left and right sides was found to drain into the subcostal veins. No other anomalies of the veins of the abdomen were found. Knowledge of the many anomalies that can potentially occur in the abdominal region is necessary in interpretation of images of this anatomical area. Additionally, knowledge of these variations is important surgically; for example, anomalous veins that ought to be ligated during surgery for varicocele go unnoticed and result in recurrence of the varicocele.

Cadaver↗
PubMed2005

Aneurysm of the distal facial artery from a penetrating oral prosthesis.

We report a 94-year-old male who died of pneumonia. During the routine dissection of the head and neck for a gross anatomy course at our institution a mass was noted in the region of the right cheek. Macroscopic and microscopic observation of this mass revealed an aneurysm of the facial artery. A traumatic defect was noted at the apex of the aneurysmal wall related to an intraoral prosthetic clasp that had penetrated the buccinator muscle. Traumatic aneurysms of the face have been caused by blunt trauma to the jaw with or without fracture, surgical manipulation around the teeth and jaw, and following missile injury. Some have described compression of neighboring structures such as cranial nerves and other blood vessels with resultant compromise. We believe our case to be the first report of a facial artery aneurysm in a cadaver and we are unaware of other reports from the literature describing the production of a facial artery aneurysm from a puncture of an intraoral prosthesis through the medially placed buccinator muscle. Although seemingly rare, health care professionals should make efforts to ensure that oral prostheses do not develop sharp or irregular edges that could potentially perforate the lateral oral cavity with potential perforation of the overlying vasculature.

Aged, 80 and over↗
PubMed2005

Unusual finding of the craniocervical junction.

The authors report a rare anomaly of the upper cervical spine. After an automobile accident, an 8-year-old child underwent CT of the head. Imaging showed a bony anomaly of the neck that was further imaged with thin cuts through the atlas and axis. This demonstrated an unfused anterior arch of the atlas and fusion of the odontoid process to the anterior arch of the atlas. Neurologically, the child is normal with no decreased range of motion about the cervical spine. After a review of the literature, this seems to be only the sixth reported case.

Cervical Vertebrae↗
PubMed2005

Contrahentes digitorum muscle.

Variations of the adductor pollicis muscle of the hand are seemingly rare. We describe an unusual finding of this muscle made during the routine dissection of a cadaveric hand as part of our medical school's gross anatomy course. We believe this case report represents persistence of a portion of the contrahentes digitorum in a human hand. As muscle variations may compress the median nerve while in the carpal tunnel, the clinician should be aware of such a variation.

Animals↗
PubMed2005

How PAs live and work.

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Attitude of Health Personnel↗