Microsurgical anatomical landmarks associated with high bifurcation carotid artery surgery and related to hypoglossal nerve.
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Real time ultrasound via the anterior fontanelle in infants is a frequent examination. Six coronal and three sagittal planes are defined and described. These give consistent landmarks with which normal and abnormal anatomy can be correlated. The anatomy was confirmed by cutting and correlating autopsy brains at the same angulation.
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OBJECTIVE: This study analyzed the influence of the acquisition method in image-free computer-assisted total knee arthroplasty (CAS-TKA), and the reproducibility of implant planning using BoneMorphing, a 3D morphometric model obtained by a 3D-to-3D elastic registration of statistical models to sparse point clouds acquired directly on the bone surface with a pointer. MATERIALS AND METHODS: Five surgeons (one expert, four trainees) each performed a CAS-TKA hybrid protocol based on morphometric models and landmarks on a cadaveric knee 10 times. In addition, several additional landmarks were digitized during each acquisition. The reproducibility of the implant positioning and sizing, as determined by an implant planning algorithm with morphometric models, was compared to direct digitization accuracy. RESULTS: Femoral and tibial implant positioning parameters with the hybrid protocol resulted in intra-surgeon standard deviations (SDs) of less than+/-1.4 degrees for rotation and 1.9 mm for translation for all surgeons in all directions except for tibial axial rotation (the only parameter determined by a digitized landmark and not recomputed in the 3D model). The variability in individual landmark digitization varied from 2 to 5 mm SD for certain landmarks, with ranges of 15-25 mm across all surgeons. The comparison study showed an improvement in femoral rotation reproducibility with the morphometric model when using the posterior condylar axis. Tibial implant reproducibility for each method was comparable, with the morphometric model giving better results in well-digitized areas such as the tibial plateau. CONCLUSION: A CAS-TKA protocol based on a deformed statistical model offers reproducible implant positioning. Some landmarks, such as distal condyles, show sufficient reproducibility in the direction of interest, while others, such as the anterior tibial tubercle, can lead to hazardous implant positioning. This should be taken into consideration when designing a CAS-TKA system with bony landmarks. In areas where a sufficient number of points have been digitized with good coverage, such as on the distal and posterior femoral condyles or the tibial plateau areas, the information derived from the 3D model is more accurate and reproducible than that derived from digitization. Good training and a guiding user interface are essential to guarantee coverage quality.
OBJECT: Reports describing surgical landmarks with which to identify the branches of the lumbar plexus found on the posterior abdominal wall are lacking in the English-language literature. METHODS: The authors examined 22 sides from six female and five male cadavers. Measurements were made between the branches of the lumbar plexus and various bone landmarks such as the midline vertebral bodies, supracristal plane--a horizontal line connecting the superior-most aspect of the left and right iliac crests approximating the LA-5 vertebrae--and anterior superior iliac spine (ASIS). The mean distances from the midline and as they emerged through or lateral to the psoas major muscle to the subcostal, iliohypogastric, ilioinguinal, lateral femoral cutaneous, genitofemoral, and femoral nerves, were 5.5, 6, 6.5, 6, 4.5, and 4.5 cm, respectively. At a vertical line through the midpoint between the ASIS and the midline, the subcostal, iliohypogastric, and ilioinguinal nerves were superior to the supracristal plane at mean distances of 8, 4, and 5 cm, respectively. Inferior to the supracristal plane and in a vertical line through a midpoint between the ASIS and the midline, the lateral femoral and femoral nerves were found to have mean distances of 5 and 5.5 cm, respectively. The obturator nerve had a mean distance of 3 cm lateral to the midline. Additionally, the lateral femoral cutaneous nerve had a mean distance of 1.5 cm inferomedial to the ASIS. CONCLUSIONS: A good working knowledge of the locations and anatomy of the nerves of the lumbar plexus on the posterior abdominal wall is necessary for the surgeon who operates in this region. The measurements provided herein will aid the surgeon who wishes to expose or avoid these nerves, thus precluding injury.
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The paper presents the results of comparative studies on the range of active elbow joint motion based on data obtained from 50 physical education students. The measurements were made with both an electrogoniometer and a manual goniometer. An explanation of differences in measurement results has been provided based on an investigation by the photographic method of 3 elbow joints using cadaveric material.
Irritation of neural structures, specifically the brachial plexus outside of the cervical spine is capable of producing pain in the upper extremity. These pain patterns may be similar to pain originating from the cervical spine, presenting a diagnostic challenge. Brachial plexus block is performed at multiple levels, including interscalene, supraclavicular, infraclavicular, and axillary. Interscalene block is frequently utilized by interventional pain management physicians for diagnostic and therapeutic purposes to isolate and manage the brachial plexus as a pain generator. The traditional methods employed in performing interscalene or supraclavicular brachial plexus blocks are associated with multiple disadvantages. A new technique is described to meet five essential requirements encompassing safety, specificity, consistency, reproducibility and a high success rate. Relevant anatomy and proposed technique of brachial plexus block is described. The procedure is performed under fluoroscopy with contrast injection. It is concluded that the proposed technique of brachial plexus block is useful for brachial plexus blockade providing precision and specificity with minimal complications.
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Anatomical landmarks are defined as biologically meaningful loci that can be unambiguously defined and repeatedly located with a high degree of accuracy and precision. The neurocranial surface is characteristically void of such loci. We define a new class of landmarks, termed fuzzy landmarks, that will allow us to represent the form of the neurocranium. A fuzzy landmark represents the position of a biological structure that is precisely delineated, but occupies an area that is larger than a single point in the observer's reference system. In this study, we present a test case in which the cranial bosses are evaluated as fuzzy landmarks. Five fuzzy landmarks (the cranial bosses) and three traditional landmarks were placed repeatedly by a single observer on three-dimensional (3D) computed tomography (CT) surface reconstructions of pediatric dry skulls and skulls of pediatric patients, and directly on four of the same dry skulls using a 3Space digitizer. Thirty landmark digitizing trials from CT scans show an average error of 1.15 mm local to each fuzzy landmark, while the average error for the last ten trials was 0.75 mm, suggesting a learning curve. Data collected with the 3Space digitizer was comparable. Measurement error of fuzzy landmarks is larger than that of traditional landmarks, but is acceptable, especially since fuzzy landmarks allow inclusion of areas that would otherwise go unsampled. The information obtained is valuable in growth studies, clinical evaluation, and volume measurements. Our method of fuzzy landmarking is not limited to cranial bosses, and can be applied to any other anatomical features with fuzzy boundaries.