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Radiologic and anatomic evaluation of the anterior sacral foramens and nerve grooves.

STUDY DESIGN: The present study evaluated the anterior sacral foramen using plain radiographs and projected the positions of S1-S3 anterior sacral foramen and corresponding nerve root groove on the posterior aspect of the sacrum. OBJECTIVES: To evaluate the plain radiographs of anteroposterior, inlet, and outlet views regarding the sacral foramen, and to determine quantitatively the location of the anterior sacral foramens on the posterior aspect of the sacrum. SUMMARY OF BACKGROUND DATA: Injury to the sacral nerve roots associated with posterior sacral screw placement remains a potential hazard. Few studies regarding the evaluation of the anterior sacral foramen and its projection on the posterior sacral surface are available. METHODS: Six bony pelves were harvested from preserved cadavers. The superior aspects of the sacral alae, the openings of the anterior and posterior foramens of S1-S2, were marked by outlining them with K-wires. Anteroposterior, inlet, and outlet plain radiographs were taken. The bony sacra were further disarticulated from the above six pelvic specimens. K-wires were drilled through the sacra to project the dimensions of the anterior foramens and nerve grooves of S1-S3 onto the posterior sacral surface. The dimensions between the perimeter of the projection and the corresponding posterior foramen were measured. RESULTS: The plain radiographs show that the shape and relative position between the anterior and posterior foramens vary with different projections. It was believed that outlet projection is the best view of plain and radiographs in the evaluation of the sacral foramens and corresponding pedicles. The approximate boundaries of the anterior sacral foramens' projections were 6 mm superior, 10 mm lateral, 3 mm inferior, and 3 mm medial to the corresponding margins of the posterior foramens. CONCLUSIONS: The outlet projection is the most useful view in plain radiographs for the evaluation of sacral foramens and pedicles. Quantitative data of the anterior sacral foramen's anatomic position on the dorsal aspect of the sacrum may be helpful in the sacral pedicle screw placement.

Aged↗

Morphometric analysis of the foramen magnum in German shepherd dogs (Alsatians).

In this study, a total of 32 skulls from German Shepherd (Alsatian) puppies were used. These animals were divided into two groups and examined individually. Group 1 included the puppies of between 43-60 days old. Group 2 included the puppies of between 61-107 days old. We based our study on the changes in shape and size of the foramen magnum and the correlation of normal craniometric measurements in the German Shepherd puppies. In group 1, a maximum width of the foramen magnum of 15.55 mm, a height of the foramen magnum of 14.38 mm and a foramen magnum index of 92.67 were observed. In group 2, a maximum width of the foramen magnum of 17.49 mm, a height of the foramen magnum of 16.34 mm and a foramen magnum index of 93.51 were measured. A high positive correlation was found between the maximum width and height of the foramen magnum, the maximum width of the occipital condyles, the maximum width of the bases of the jugular processes, the skull height, the height of the occipital triangle, the skull length from prosthion to basion and the skull length from prosthion to the caudal borders of the occipital condyles. A negative correlation was observed between the width and height of the foramen magnum and indices. Although there was no relation between the foramen magnum index and the age of the animals, an important difference was found between groups 1 and 2. A negative correlation was observed between the foramen magnum index and the rate of increase in the cranial volume. In all the animals examined, the dorsal bone of the foramen magnum was closed, therefore any extension or dorsal notch was not seen. Such an extension or dorsal notch of the foramen magnum in the German Shepherd puppies may therefore be the result of a pathological condition.

Aging↗

Morphometric analysis of the foramen magnum in Pekingese dogs.

The size and shape of the foramen magnum were studied in skulls from 75 adult and 5 juvenile Pekingese dogs. After maceration of the skulls, the height, width, and area of each foramen magnum were measured, and various skull indices were determined. The shape of the foramen varied from ovoid to rectangular and had a dorsal notch in all but 2 skulls. Prolapse of cerebellum or brain stem through the enlarged opening was prevented by a fibrous membrane covering the dorsal notch. Mean +/- SD area of the foramen was 138.1 +/- 26.1 mm2; its mean total height was 15.0 +/- 2.9 mm, and its mean maximal width was 13.3 +/- 1.1 mm. Statistically, variability in the area of the foramen was mainly correlated with total height of the foramen, including the dorsal notch. Total height of the foramen was not correlated with age or gender. The degree of dysplasia, notch index, and occipital index of each foramen magnum were determined. To allow a more accurate evaluation of the morphology of the foramen, the foramen magnum index, defined as the ratio between the maximal width and the total height of the foramen, was also computed. Mean +/- SD foramen magnum index was 91.8 +/- 17.1 in the adult Pekingese dogs. Foramen magnum index was not significantly correlated with age, but was significantly larger in male than in female dogs.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗

Bulboventricular foramen size in infants with double-inlet left ventricle or tricuspid atresia with transposed great arteries: influence on initial palliative operation and rate of growth.

Bulboventricular foramen obstruction may complicate the management of patients with single left ventricle. Bulboventricular foramen size was measured in 28 neonates and infants greater than 5 months old and followed up for 2 to 5 years in those patients whose only systemic outflow was through the foramen. The bulboventricular foramen was measured in two planes by two-dimensional echocardiography, its area calculated and indexed to body surface area. One patient died before surgical treatment. The mean initial bulboventricular foramen area index was 0.94 cm2/m2 in 12 patients (Group A) in whom the foramen was bypassed as the first procedure in early infancy. The remaining 15 patients underwent other palliative operations but the bulboventricular foramen continued to serve as the systemic outflow tract. There was one surgical death. Six (Group B) of the 14 survivors developed bulboventricular foramen obstruction during follow-up (mean initial bulboventricular foramen area index 1.75 cm2/m2). The remaining eight patients (Group C) did not develop obstruction during follow-up and had an initial bulboventricular foramen larger than that in the other two groups (mean initial bulboventricular foramen area index 3.95 cm2/m2). All patients with an initial bulboventricular foramen area index less than 2 cm2/m2 who did not undergo early bulboventricular foramen bypass developed late obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

Anatomic variations of foramen ovale.

OBJECTIVES: Foramen ovale is of great surgical and diagnostic importance in procedures like percutaneous trigeminal rhizotomy for trigeminal neuralgia, transfacial fine needle aspiration technique in perineural spread of tumour and electroencephalographic analysis for seizure. This study presents the anatomic variations in dimensions, appearance and number of foramen ovale. METHODS: We studied 35 dried human skulls available in the Department of Anatomy, Manipal college of Medical Sciences, Pokhara, Nepal. Variations in appearance and number of foramen ovale were noted. Length and width of foramen ovale was measured. Comparison with other races and differences between right and left sides were also discussed. RESULTS: Out of 70 sides in 35 adult skulls, mean length and width of foramen ovale was 7.46+/-1.41 mm and 3.21+/-1.02 mm on right side and 7.01+/-1.41 mm and 3.29+/-0.85 mm on left side. Shape of foramen ovale was typically oval in 43, (22 on right, 21 on left) almond shape in 24 (Fig.1, arrowhead; 11 right, 13 left), round in 2(1 right, 1 left) and slit-like in 1(Fig.1, arrow). Bilateral oval foramen was observed in 15 and bilateral almond was in 7. Out of 70 sides in 35 adult skulls 3 (2 left, 1 right) sides had spine on the margin of the foramen (Fig.2, arrow), 3 (2 left, 1 right) had tubercle protruding from the margin (Fig. 3, arrow), 2 (1 left, 1 right) sides had bridge like bony spur dividing the foramen into two compartments(Fig. 2, arrowhead), 9 (5 left, 4 right) had bony plate on the margin of foramen ovale (Fig. 4, arrow). Variant foramen ovale was observed in 24.2%. CONCLUSION: Anatomical variations in size and shape of foramen ovale could be explained by developmental reasons. Considering the immense surgical and diagnostic importance of foramen ovale, this study was worthwhile.

Adult↗

A morphometric analysis of the foramen magnum region as it relates to the transcondylar approach.

BACKGROUND: The transcondylar approach is being increasingly used to access lesions ventral to the brainstem and cervicomedullary junction. Understanding the bony anatomy of this region is important for this approach. The purpose of this study was to conduct a morphometric analysis of the hypoglossal canal (HC), occipital condyle (OC) and the foramen magnum (FM) as it pertains to the transcondylar approach. METHODS: 50 dry skulls provided 100 hypoglossal canals, 100 occipital condyles and 50 foramina magna. Twenty one parameters were analyzed. They were: length of the HC, diameter of the intra- and extracranial ends of the HC, angle of the HC to the sagittal plane, distance of the HC from the posterior, anterior and inferior margins of the OC, antero-posterior and transverse diameter of the OC, presence of condylar foramen, distance of HC from the jugular foramen intra- and extracranially, distance of HC from basion, opisthion, carotid canal and jugular tubercle. The anteroposterior and transverse diameters of the FM were measured and a FM index was calculated by dividing the AP diameter of the FM by the transverse diameter. The angle of the long axis of the occipital condyles to the sagittal plane was measured. Protrusion of the occipital condyle into the foramen magnum was noted. Where applicable, the measurements were made separately for the right and left side. FINDINGS: The average length of the hypoglossal canal in this study was 12.6 mms. The hypoglossal canal makes an angle of 49 degrees to the sagittal plane. In 30% of the dry skulls studied, the HC was divided into two by a bony septum. The distance of the intracranial end of the HC from the posterior margin of the OC was 12.2 mms. The average anteroposterior length of the occipital condyle was 23.6 mms and the transverse diameter was 14.72 mms. The occipital condyle made an angle of 60 degrees to the sagittal plane. In 20% of the skulls studied the occipital condyle protruded into the foramen magnum. The condylar foramen was absent on the right side in 4 skulls and on the left side in 16 skulls. The average anteroposterior length of the foramen magnum was 33.3 mms and the width was 27.9 mms. When the foramen magnum index was > 1.2, the foramen was found to be ovoid. Forty six percent of the skulls studied exhibited an ovoid foramen magnum. CONCLUSIONS: The occipital condyle is frequently being drilled to expose lesions ventral to the brainstem. From our study, it is evident that the occipital condyle can be safely drilled for a distance of 12 mms from the posterior margin before encountering the hypoglossal canal. In 20% of the skulls the occipital condyle protrudes significantly into the foramen magnum. Wide and sagittally inclined occipital condyles, medially protruberant occipital condyles along with a foramen magnum index of more than 1.2 will require much more extensive bony resection than otherwise. With the availability of recent imaging techniques, it is possible to anticipate the extent of bony resection required in an individual case by using the above mentioned morphometric features.

Cadaver↗

Anatomic characteristics of the infraorbital foramen: a cadaver study.

PURPOSE: The aim of this study was to document the variability in the position of the infraorbital foramen with relation to the facial midline, infraorbital rim, supraorbital notch, and maxillary teeth. MATERIALS AND METHODS: Forty-seven cadavers (94 sides) were dissected, exposing the infraorbital foramen, supraorbital foramen, and orbital floor bilaterally. Measurements made included (A) distance between the infraorbital foramen and inferior orbital rim; (B) distance of the infraorbital foramen from the facial midline; (C) distance of the supraorbital foramen from the facial midline; (D) distance between the infraorbital foramen and supraorbital foramen. Means, standard deviations, and ranges were determined, and statistical differences were calculated between the left and right orbits and sexes by use of an unpaired sample t-test (P < .05). RESULTS: In men, the mean distance between the infraorbital foramen and the inferior orbital rim was 8.5 +/- 2.2 mm. In women, this was 7.8 +/- 1.6 mm. The distance between the infraorbital foramen from the facial midline was 27.7 +/- 4.3 mm in males and 26.2 +/- 3.2 mm in females. The mean distance between the infraorbital foramen and supraorbital notch in males was 43.3 +/- 3.1 mm and in females was 42.2 +/- 2.4 mm. The average distance of the supraorbital notch from the midline was 26.5 +/- 3.5 mm in males and 26.3 +/- 3.3 mm in females. There were no statistically significant differences between the left and right sides or between sexes. The maxillary tooth most commonly found in the same vertical plane as the infraorbital foramen was the first premolar. Multiple ipsilateral foramina were found in 15% of cadavers. CONCLUSION: These anatomic characteristics may have important implications for surgical and local anesthetic planning.

Cephalometry↗

Anatomic variations of the infraorbital foramen.

The aims of this study were to locate the infraorbital foramen and to determine the frequency and location of any accessory foramen, which may be troublesome during anesthetization of this region. In 45 cadavers, the infraorbital foramen was dissected according to classic principles for location. The line between the angulus oculi medialis and the angulus oculi lateralis was divided into three equal pieces, and a second line was drawn downward, perpendicular to the point uniting the internal and medial thirds. The position of the infraorbital foramen was determined in relation to that line and the infraorbital margin. For the right and left sides, the infraorbital foramen was found to be on that line in 75.6% and 68.9% of the specimens, respectively. The infraorbital foramen was 10.9 mm and 8.3 mm under the infraorbital margin in men and women, respectively. Regarding accessory foramen, 119 crania and 229 maxilla were observed (a total of 467 infraorbital foramen), and it was found that single accessory foramen were present in 11.5% of specimens and double accessory foramen were present in 1.28% of specimens. In 79.6% of specimens with single accessory foramen, the accessory foramen was superior and medial to the main opening. These results are helpful in decreasing anesthetic complications.

Anesthesia↗

[Univentricular heart with left morphology with permeable atrio-ventricular valves. Study of the bulbo-ventricular foramen with color echo-Doppler. Importance for the surgical repair].

INTRODUCTION AND OBJECTIVES: Bidimensional and color-coded Doppler echocardiography were used to study 19 patients with univentricular heart, permeable atrioventricular valves, muscular bulbo-ventricular foramen and an anterior rudimentary chamber. We evaluated the influence of the foramen upon the size of the great vessels, and in consequence the most appropriated surgical techniques. MATERIAL AND METHODS: The foramen was measured in two projections at the end of the systolic period, and its area was calculated, according to the body surface, with the formula S = pi (D1/2 x D2/2). Indexes lower than 2 cm2/m2 were considered as restrictive. We studied 19 patients that presented a mean age of 11 +/- 12 years (range 1 day-39 years). The patients were classified in two groups. Group A: patients who had transposition of the great vessels (13 cases). Group B: patients who had normal connection of the great vessels (6 cases). Each group was classified in two subgroups: subgroup 1, patients who presented a restrictive foramen, and subgroup 2, patients who presented a normal foramen. In this study, we evaluated the associated cardiac anomalies. RESULTS: Group A. Thirteen cases. The index value for the whole group was 2.47 +/- 1.18 cm2/m2. The first subgroup included 6 cases with a restrictive foramen, 2 patients presented pathology of the arch. Four patients had a pressure gradient between the ventricle and the rudimentary chamber beyond 20 mmHg. The index of this subgroup was 1.68 +/- 0.39 cm2/m2, the median was 1.7. Seven cases, with a normal foramen, were included in the second subgroup, six of them had pulmonary valve stenosis, and the other one had undergone a pulmonary artery bandage 2 months before. Only one patient had a gradient pressure at the foramen beyond 20 mmHg. The index for this second subgroup was 3.34 +/- 0.83 cm2/m2. GROUP B: Six patients with normal connection of the great vessels were included. The index was 1.56 +/- 1.17 cm2/m2. The first subgroup included 3 cases with a restrictive foramen. The index was 0.72 +/- 0.29 cm2/m2 (range 0.41-1) and the median was 0.75. Pressure gradient between the ventricle and the rudimentary chamber was greater than 20 mmHg. Three patients with a normal foramen were in the second subgroup and here, the index was under normal limits 2.4 +/- 0.52 cm2/m2 (range 2.1-3), the median was 2.1. One patient underwent a pulmonary artery bandage two months before. CONCLUSIONS: Bulbo-ventricular foramen size/body surface index may exert an influence on the size of the vessel connected to the rudimentary chamber. The index vary in a negative way with the evolution time, or in those cases with transposition of the great vessels after a pulmonary artery bandage. Whenever the foramen is restrictive, the pulmonary artery or the aorta have a smaller diameter and the pressure gradient between the ventricle and the rudimentary chamber rises.

Adolescent↗

Location of the vertebral artery foramen on the anterior aspect of the lower cervical spine by computed tomography.

Axial computed tomography scans were performed on 14 cadaveric cervical spines to determine the location of the vertebral artery foramen on the anterior aspect of the lower cervical spine. The best scan through the vertebral artery foramen from each level at C3-C6 was selected. Measurements of the vertebral artery foramen included the foramen depth, foramen width, interforaminal distance, the distance from the anterior border of the transverse foramen to the anterior border of the transverse process, the distance from the posterior border of the transverse foramen to the posterior border of the lateral mass, and the distance from the medial border of the vertebral artery foramen to the lateral border of the vertebral body. The results show that the average transverse foramen width was 5.5 +/- 0.4 mm at C3, 5.7 +/- 1.0 mm at C4, 5.9 +/- 0.7 mm at C5, and 5.7 +/- 0.7 mm at C6. The average transverse foramen depth and average interforaminal distance gradually increased from C3 to C6. The distance from the anterior border of the vertebral artery foramen to the anterior border of the transverse process gradually increased from C3 (1.2 +/- 0.4 mm) to C6 (2.7 +/- 0.8 mm) as well. The average distance between the medial border of the transverse foramina and the lateral border of the vertebral body for C3-C6 ranged from 1.8 to 2.2 mm. The average distance between the anterior borders of the vertebral artery foramina and the anterior border of the vertebral body gradually decreased from C3 (8.4 +/- 1.4 mm) to C6 (7.0 +/- 1.6 mm). This study suggested that the lateral border of the vertebral body may be a reliable landmark during anterior cervical decompression. The vertebral artery foramen should be free of violation if vertebrectomy or subtotal vertebrectomy is performed medial to the lateral border of the vertebral body.

Aged↗

Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors.

STUDY DESIGN: In Study 1 the authors measured the vertical and sagittal dimensions of the intervertebral foramen in dried lumbar vertebrae. In Study 2 the dimensions of the intervertebral foramen were measured in fresh cadaveric spines in which the soft tissues forming the foraminal walls were preserved. OBJECTIVES: To investigate whether disc narrowing, or other factors related to the morphometry of lumbar vertebrae, may predispose to foraminal stenosis. SUMMARY OF BACKGROUND DATA: Predisposing factors to foraminal stenosis have been little investigated. Previous studies suggested that narrowing of the disc space might cause a reduction in the foraminal dimensions; however, it is not clear whether such a reduction is to such an extent as to compress the nerve root within the foramen. METHODS: In Study 1 the vertical and sagittal dimensions of 160 intervertebral foramens were measured on dried white spines. Measurements were performed in the presence of a normal height of the disc space, obtained using a silicone rubber disc, and repeated in the same specimen after disc removal. Foraminal dimensions were then related to the sagittal diameter of the spinal canal and the pedicle length. In Study 2, the authors evaluated the dimensions of 50 intervertebral foramens of fresh cadaveric spines, in which the soft tissues forming the foraminal walls and the nerve root were preserved. In specimens showing normal or slightly decreased disc height, the foraminal dimensions were measured before and after disc excision. RESULTS: In Study 1 the reduction in the foraminal height after disc removal was, on average, 6.5 mm (P < 0.0001). In both Studies 1 and 2 the sagittal dimensions of the foramen were not significantly reduced after disc removal. No significant difference was found in Study 1 in the sagittal dimensions of the foramen between specimens showing normal or degenerated facet joints. In Study 2 a compression of the nerve root within the foramen was found in one specimen, showing a concomitant central stenosis at multiple levels. A significant correlation was found between the sagittal diameters of the foramen and the sagittal diameter of the spinal canal and the pedicle length. CONCLUSIONS: Narrowing of the disc space significantly reduces the vertical diameter of the foramen but has no significant effects on its sagittal dimensions. In contrast, the sagittal dimensions of the foramen are strictly related to the sagittal diameter of the spinal canal and the pedicle length. These results suggest that in patients with developmental or combined stenosis of the central spinal canal, a concomitant foraminal stenosis is likely to be present, or at least should be suspected.

Adult↗

Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention.

BACKGROUND AND PURPOSE: Paradoxical embolism through a patent foramen ovale is a recognized cause of stroke, but clinical predictors, recurrence rate, and prevention of brain infarcts in patients with patent foramen ovale have not been determined. We reviewed transesophageal echocardiographic records to ascertain echocardiographic predictors and optimal prophylaxis for patent foramen ovale-related infarcts. METHODS: A patent foramen ovale was identified in 74 patients during 615 transesophageal echocardiograms by color Doppler or saline contrast during a 60-month period. On the basis of final clinical situation, the patients were divided into the following groups: group 1, infarct with patent foramen ovale a likely cause (n = 16); group 2, infarct with patent foramen ovale an unlikely cause (n = 23); and group 3, no infarct (n = 35). Transesophageal echocardiograms were reviewed to assess patent foramen ovale characteristics and associated cardio-embolic sources without knowledge of clinical details or group assignment. Follow-up after a patent foramen ovale-related infarct was obtained by telephone or written correspondence in 15 of 16 group 1 patients. RESULTS: Atrial septal aneurysms were more common in group 1 (38%) compared with group 2 (10%) and group 3 (8%) (P = .02). Contrast right-to-left shunting occurred in 88% of group 1 (P = .06) and 86% of group 2 (P = .07) compared with 60% of group 3. Prevention of recurrence in subjects with presumed patent foramen ovale-related brain infarcts varied. Aspirin was usually chosen after initial brain ischemia. Warfarin and patent foramen ovale closure were usually reserved for subjects with symptoms of brain ischemia while taking aspirin or those who required warfarin or cardiac surgery for other indications. No recurrent infarcts occurred in 15 patients during a mean follow-up period of 28 months. CONCLUSIONS: Atrial septal aneurysm and right-to-left shunt may be predictive of a patent foramen ovale that predisposes a patient to stroke. Aspirin may provide sufficient infarct prophylaxis after initial ischemia. Warfarin and surgical correction should likely be reserved for those in whom aspirin is not effective or those who require warfarin or cardiac surgery for other reasons until prospective studies are available.

Adult↗

Foramen arcuale: anatomical study and review of the literature.

OBJECT: The neurosurgical literature is lacking information on the so-called foramen arcuale. When this foramen is present, the vertebral artery (VA) travels through it after exiting the transverse foramen of the atlas and prior to entering the cranium. METHODS: The authors performed a study in 60 cadavers to determine the incidence of the foramen arcuale and ascertain morphometric information on its anatomy. In specimens in which the foramen arcuale was observed, the authors studied the relationship between it and the VA. The authors identified a foramen arcuale in 5% of specimens. The mean length and thickness of the osseous struts that converted the groove for the VA into the foramen arcuale were 7.0 and 2.0 mm, respectively. The mean area of the identified foramina was 14.2 mm2. The mean area of the ipsilateral C-1 transverse foramina was 18 mm2 in specimens with a foramen arcuale. The mean measurements of the proximal, intraforaminal (foramen arcuale), and distal diameter of the V3 segment of the VA at the level of the foramen arcuale were 6, 4, and 5 mm, respectively. In all specimens the authors noted that the intraforaminal part of the V3 segment was grossly compressed. CONCLUSIONS: The authors found that the foramen arcuale may compress the V3 segment of the VA. Based on their postmortem study, however, they cannot conclude that compression at this location results in symptomatic VA insufficiency. Based on their review of the literature, it seems that symptomatic compression of the VA at this location may be alleviated in some patients with decompressive procedures.

Cadaver↗

The morphology and morphometry of the so-called "meningo-orbital foramen" in humans.

The so-called meningo-orbital foramen creates an additional link between the orbit and the cranial cavity. This bony canal, not always present in the human skull, contains a branch from the middle meningeal artery, providing an accessory blood supply to the orbit. This vessel, like the foramen, is characterised by great variability. Although older textbooks of basic anatomy suggested that it was a rare occurrence, some current data indicate a more frequent incidence of this foramen. These discrepancies were verified in our research. 92 orbits were studied on 46 macerated human skulls (25 male and 21 female). Although the incidence of the meningo-orbital foramen in the material as a whole was 28%, the foramen in female skulls was observed to be 40.5%, compared to 18% in male skulls. This difference was statistically significant. A double foramen was encountered in three orbits, and in one orbit there was a triple foramen. This means that in the material as a whole multiple foramina were observed in 4% of cases. Two measurements were taken to determine the localisation of the meningo- orbital foramen. The minimal distance between the supraorbital notch (or foramen) and the meningo-orbital foramen was 35.0 (28-44) mm. The minimal distance from the cross-point of the entrance to the orbit and the fronto-zygomatic suture was (21.3-35.5) mm. This indicates that the meningo-orbital foramen can lie near an operating field in some surgical interventions through the lateral orbital wall.

Female↗

[Studies on the foramen vesalius in the Japanese juvenile and adult skulls].

Foramen Vesalius is known to be an inconstant foramen, which appears in the anteriomedial side of the foramen ovale. The foramen Vesalius is classified into the open type and the closed type. We studied the frequencies and the types of foramen Vesalius in Japanese by examining 20 juvenile skulls from 3 months to 8 years old and 400 adult skulls from 18 to 91 years old. Of the 20 juvenile skulls, 11 skulls (55.00%) had foramen Vesalius. Of the 400 adult skulls, 87 skulls (21.75%) had foramen Vesalius; 69 (21.50%) in 321 male and 18 (22.78%) in 79 female skulls. No remarkable differences were observed in the ratio between the male and the female, and between the left side and the right side. Among the 69 adult male skulls, the foramen Vesalius was bilateral in 52 skulls (75.36%) and unilateral in 17 (24.64%); among the 18 adult female skulls, it was bilateral in 13 (72.22%) and unilateral in 5 (27.78%). The ratio of the closed type was slightly higher than that of the open type in both sexes and in both sides; however, no remarkable differences were observed. The skulls with one foramen Vesalius were most frequent; those with two followed it and those with 3 foramen Vesalius were least frequent. No remarkable differences were observed in the number of foramen Vesalius between the sexes and the sides.

Adolescent↗

Morphological characteristics of the infraorbital foramen and infraorbital canal using three-dimensional models.

Infraorbital nerve blocking through the infraorbital foramen and infraorbital canal is used to anesthetize the lower eyelid, upper lip, lateral nose, upper teeth and related gingivae. For this, it is important to know the position of the infraorbital foramen, structures around the foramen, and the direction of the injecting needle related to the angle of the infraorbital canal. Many reports have described the anatomical location of the infraorbital foramen; however, not many have described the angle of the infraorbital canal and those structures around the infraorbital foramen that help the physician visualize the correct direction of the needle. Dried skulls of 42 Korean subjects (27 male and 15 female) were studied to analyze structures around the infraorbital foramen. The morphology of the infraorbital canal was also investigated using three-dimensional models. Structures around the infraorbital foramen were classified into four types according to the existence of a distinct tuberosity above the infraorbital foramen, and the degree of prominence of the canine fossa. Types I and II have a tuberosity above the infraorbital foramen, whereas types III and IV have no distinct tuberosity. Types I and III have a prominent canine fossa, whereas this is less prominent in types II and IV. We analyzed the skulls based on the angle of the infraorbital canal to the median plane. We compared the left and right sides and analyzed differences between the sexes, the three canal shapes, and the four structure types around the infraorbital foramen. Type IV was the most common in this series (38%). The infraorbital canal could be classified into three morphologies: 'tube-like' (69%), 'funnel' (25%) and 'pinched' (6%). The mean angle of the infraorbital canal relative to the median plane was 12 degrees , and the angle relative to the Frankfurt plane was 44 degrees . The mean angle between the infraorbital canal and the Frankfurt plane was 4 degrees larger in males than in females in this series of Korean subjects. The operator of the infraorbital nerve block should pay attention towards directing the needle upward at an angle of about 44 degrees for avoiding nerve damage and consider the different angles of the canal according to the individual's sex.

Analysis of Variance↗

Normal fetal foramen flap and transatrial Doppler velocity pattern.

To define the normal size of the foramen ovale and the transatrial Doppler velocity pattern in the fetus, we examined foramen ovale size, foramen flap angle, and motion in 48 consecutive normal human fetal ultrasound studies. The maximal foramen diameter was similar in size to aortic root diameter at all gestational ages, differing by no more than 1.0 mm in any study. Attachment angle at the junction of the foramen with the rim of the foramen varied from 30 degrees to 50 degrees; at least a 30-degree angle was present at some point in the cardiac cycle in all studies. A redundant flap, defined as flap reaching greater than one half of the way across to the left atrial free wall, was observed in only three (6%) fetuses. Seventeen patients had transatrial Doppler velocities recorded with sample volume placed in the trough of the foramen flap on the left atrial side of the foramen ovale. A triphasic pattern was evident in systole with predominantly right-to-left flow in all fetuses. A biphasic pattern was present in diastole with bidirectional flow in all fetuses; this is toward the left atrium in early diastole and toward the right atrium in late diastole. Maximal right-to-left velocity ranged from 15 to 40 cm/sec (mean, 23 cm/sec) and was always less than or equal to mitral A wave velocity. Maximal left-to-right velocity ranged from 5 to 20 cm/sec (mean, 13 cm/sec). These data indicate that normal foramen ovale size is similar to aortic diameter, and foramen flap angle should reach 30 degrees or greater.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗

Patent foramen ovale: paradoxical connection to migraine and stroke.

PURPOSE OF REVIEW: In this article we aim to elucidate the relationship between patent foramen ovale, cryptogenic stroke and migraine. RECENT FINDINGS: Small observational and case-control studies indicate that patients with cryptogenic stroke have a higher incidence of patent foramen ovale. Prospective trials could not show a higher stroke recurrence risk with isolated patent foramen ovale. The combination of patent foramen ovale and atrial septal aneurysm might carry a higher recurrence risk. Secondary prevention with acetylsalicylic acid is as effective as oral anticoagulation, but carries a lower bleeding risk. Whether patent foramen ovale closure prevents recurrent strokes is under investigation. Case-control studies and retrospective analyses indicate comorbidity between patent foramen ovale and migraine, in particular migraine with aura. Recent retrospective studies indicate a reduction in migraine frequency after patent foramen ovale closure (intended for stroke prevention). These studies, however, have major methodological limitations. Therefore patent foramen ovale closure cannot be recommended for the prevention of migraine with aura. SUMMARY: At present routine percutaneous closure of isolated patent foramen ovale cannot be recommended for patients with cryptogenic stroke. Patent foramen ovale closure should not be used for the prevention of migraine.

Heart Septal Defects, Atrial↗