Browsing by Author "Djulejić, Vuk (8587155300)"

Background/Aim. The radial nerve (RN) is the largest terminal branch of the posterior cord of the brachial plexus. Upon leaving the axilla, the RN moves to the posterior compartment of the arm, where it makes close contact with the humerus. By penetrating the lateral intermuscular septum, RN enters the anterior compartment and, in the very proximity of the lateral epicondyle, divides into two terminal branches. The anatomy of this nerve is characterized by remarkable variability, the knowledge of which is of utmost importance in the fields of orthopedics and traumatology. The aim of the study was to examine the anatomy of the RN, including two parameters: the location and the way the RN divides into terminal branches, with a particular emphasis on the clinical implications of this data. Methods. The research was conducted on 27 cadavers, 15 female and 12 male, with a total of 54 upper extremities. After careful dissection, variations in the location and way of termination of the RN were observed on both the right and left hands. Collected data were then analyzed using Microsoft Office Excel. A classification where the division of the RN into terminal branches above the biepicondylar line (BEL) is defined as type A, while the division of RN below BEL is defined as type B was used. Results. According to the proposed classification, we observed a higher incidence of type A (66.7%) compared to type B (33.3%) in the total sample of 54 extremities. In addition, a higher prevalence of type A was observed in the female population, while a higher prevalence of type B was observed in the male population. There were differences in the distribution of types A and B between the left and right arms, but there were no variations in the way of termination of the RN. Conclusion. The present study showed an important complexity in the domain of RN anatomy with significant clinical implications. With that in mind, it is crucial for every patient that the limits of safe zones be defined while performing surgical procedures in the elbow to protect the RN and its branches from iatrogenic injuries. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Although the general vascular supply of the basal ganglia and internal capsule is well known, precise data are lacking regarding the variations of the vascular territories in the two regions. Twelve hemispheres were studied following an injection of coloured ink into the main cerebral arteries, namely the anterior cerebral (ACA), middle cerebral (MCA), anterior choroidal (AChA) and posterior cerebral artery (PCA). Serial sections of the injected hemispheres were taken in the axial or coronal plane. In 75% of the hemispheres, ACA perforators were seen to supply the inferomedial part of the head of the caudate nucleus and the anterior limb of the internal capsule, as well as the anterior and inferior portions of the putamen and globus pallidus. The MCA vessels perfused the superolateral part of the head and body of the caudate nucleus, the superior part of the entire internal capsule, most of the putamen and part of the globus pallidus. The AChA perforators perfused the medial segment of the globus pallidus, the inferior part of the posterior limb, the retrolenticular and sublenticular portions of the internal capsule, and occasionally its genu. The same segment of the globus pallidus and the inferior part of the genu of the internal capsule were most likely supplied by the perforators of the internal carotid artery. A predominance of ACA territory was noticed in one specimen (8.33%) and a predominance of MCA territory in two specimens (16.67%). The obtained anatomical data may help radiologic determination of perforators involved in ischemic events, as well as a better understanding of the neurological deficits in the same events. © 2015 Elsevier Ltd. All rights reserved.

Although the general vascular supply of the basal ganglia and internal capsule is well known, precise data are lacking regarding the variations of the vascular territories in the two regions. Twelve hemispheres were studied following an injection of coloured ink into the main cerebral arteries, namely the anterior cerebral (ACA), middle cerebral (MCA), anterior choroidal (AChA) and posterior cerebral artery (PCA). Serial sections of the injected hemispheres were taken in the axial or coronal plane. In 75% of the hemispheres, ACA perforators were seen to supply the inferomedial part of the head of the caudate nucleus and the anterior limb of the internal capsule, as well as the anterior and inferior portions of the putamen and globus pallidus. The MCA vessels perfused the superolateral part of the head and body of the caudate nucleus, the superior part of the entire internal capsule, most of the putamen and part of the globus pallidus. The AChA perforators perfused the medial segment of the globus pallidus, the inferior part of the posterior limb, the retrolenticular and sublenticular portions of the internal capsule, and occasionally its genu. The same segment of the globus pallidus and the inferior part of the genu of the internal capsule were most likely supplied by the perforators of the internal carotid artery. A predominance of ACA territory was noticed in one specimen (8.33%) and a predominance of MCA territory in two specimens (16.67%). The obtained anatomical data may help radiologic determination of perforators involved in ischemic events, as well as a better understanding of the neurological deficits in the same events. © 2015 Elsevier Ltd. All rights reserved.

Background: Since the medullary arteries are of a great neurologic and neurosurgical significance, the aim was to perform a detailed microanatomic study of these vessels, as well as of the medullary infarctions in a group of patients. Methods: The arteries of 26 halves of the brain stem were injected with India ink and gelatin, microdissected and measured with an ocular micrometer. Neurologic and magnetic resonance imaging (MRI) examinations were performed in 11 patients. Results: The perforating medullary arteries, averaging 6.7 in number and 0.26 mm in diameter, most often originated from the anterior spinal artery (ASA), and rarely from the vertebral (VA) (38.5%) and the basilar artery (BA) (11.6%). They supplied the medial medullary region. The anterolateral arteries, 4.8 in number and 0.2 mm in size, most often arose from the ASA and PerfAs, and nourished the anterolateral region. The lateral arteries, 2.2 in number and 0.31 mm in diameter, usually originated from the VA and the posterior inferior cerebellar artery (PICA). They supplied the lateral medullary region. The dorsal arteries, which mainly arose from the PICA and the posterior spinal artery (PSA), nourished the dorsal region, including the roof of the 4th ventricle. The anastomotic channels, averaging 0.3 mm in size, were noted in 42.3%. Among the medullary infarctions, the lateral ones were most frequently present (72.8%). Conclusion: The obtained anatomic data, which can explain the medullary infarctions symptomatology, are also important in order to avoid damage to the medullary arteries during neurosurgical and neuroradiologic interventions. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.

OBJECTIVE: Intraventricular surgery requires a detailed knowledge of the microanatomy of the choroid plexus vasculature. METHODS: Twenty choroid plexuses were microdissected, and two additional plexuses were prepared for microscopic examination. RESULTS: The choroid plexus was perfused primarily by the anterior choroidal artery (AChA) and the lateral posterior choroidal artery (LPChA). The AChA, which averaged 650 μm in diameter, most often (in 75% of cases) divided into the medial and lateral trunks, which averaged 450 μm in diameter. The medial trunk gave off the bush-like intrachoroidal branches, whereas the lateral trunk divided into the parallel arteries. The inferior LPChA was present in 50% of the hemispheres, both the inferior and superior LPChAs in 40%, and their common trunk in 10%. In 40%, the LPChA, which averaged 670 μm in diameter, divided into the terminal trunks, with a mean diameter of 490 μm. The anastomoses involving the trunks of the LPChA and other choroidal arteries averaged 310 μm in diameter. All primary intrachoroidal branches of the AChA and LPChA were divided into three groups. The parallel branches, which averaged from 220 to 230 μm in diameter, coursed along the lateral part of the choroid plexus. The tortuous glomus vessels, which averaged 310 μm in size, originated from the AChA (45%), the LPChA (15%), or both (40%). The bush-like vessels, with a mean diameter between 155 and 190 μm, ramified into smaller twigs, up to the intrachoroidal capillaries. CONCLUSION: The data obtained on the microanatomy of the intrachoroidal vasculature may have certain neurosurgical implications.

Background: Only a few articles have been published about the lateral posterior choroidal artery (LPChA), and yet none of them contains data regarding the thalamic branches. Methods: The LPChA and its twigs of the 26 cerebral hemispheres were injected with a mixture of a 10% Indian ink and gelatin. Following fixation in a 10% formaldehyde solution, the vessels were micro dissected under the stereoscopic microscope. In addition, serial cerebral angiograms of the 168 patients were examined. Results: The LPChA, which was commonly singular or double and averaged 0.68 mm in diameter, most often originated from the P2 and P3 segments (76%) of the posterior cerebral artery (PCA). It always gave off the choroidal, pulvinar and typical thalamic branches, occasionally the parahippocampal (4%), hippocampal (8%), peduncular (8%), tegmental (12%), pretectal (4%), lateral geniculate (40%) and medial geniculate twigs (16%), and the forniceal, subependymal (100%), stria terminalis (32%), and caudate twigs (28%). The pulvinar and thalamic branches averaged almost 4 in number and 0.27 mm in diameter. They most often supplied the pulvinar nuclei, and occasionally portions of the mediodorsal, lateral dorsal, lateral posterior, ventral lateral, and the ventral posterior thalamic nuclei. Among the 168 serial cerebral angiograms, one presented the arteriovenous malformation of the LPChA, but no one showed an aneurysm. Conclusions: This is the first description of the LPChA thalamic branches to date. Their microanatomic features are important for understanding the neurologic symptoms following vessels occlusion, for precise radiologic diagnoses, and for safe neurosurgical and endovascular interventions. © 2024 Elsevier Inc.

BACKGROUND: There is limited data in the literature related to the microanatomic features of the perforating branches of the vertebral artery. METHODS: The 44 vertebral arteries and their branches were injected with india ink or a radiopaque substance and examined under the stereoscopic microscope. RESULTS: The perforating arteries were noted to range in number from 1 to 11 (mean, 6.5) and in diameter between 100 μm and 520 μm (average, 243 μm). They arose from the vertebral artery (VA) (54.54%), 8 from the right, the left or both VAs. The anterior spinal artery (ASA), which was singular (81.82%), duplicated (13.64%), or plexiform (4.55%), always gave rise to the perforators. The vascular roots of the ASA were the source of the perforators in 95.45% of the brains. The latter vessels arose from the anterolateral arteries in 50% of the cases. The anastomoses involving the perforators, which were present in 40.91% of the brains, varied in diameter between 100 μm and 350 μm (mean, 169 μm). The perforating vessels gave rise to the side branches in 95.45% of the brains that varied in diameter from 100 μm to 300 μm (average, 161 μm). The perforators usually entered the foramen cecum and the anterior median sulcus, and then continued close and parallel to the raphe of the medulla. The perforators can be compressed by a VA aneurysm, which was found in one among the 71 examined patients with cerebral aneurysms. CONCLUSIONS: The obtained data give additional information about the vascular anatomy of the pontomedullary region. © 2004 Elsevier Inc. All rights reserved.

The lenticulostriate arteries (LSA) and their microanatomy, region of supply and atherosclerosis were examined in 24 microdissected brains, arterial casts, and histological specimens. The LSA ranged from 2 to 12 in number and from 0.10 mm to 1.28 mm in diameter. They always arose from the initial segment of the middle cerebral artery (MCA), often from the MCA leptomeningeal branches (38.24%), and rarely from the insular segment (2.94%). They always originated as individual branches, often (61.76%) with their own common stems. In two hemispheres we found that the LSA supplied either a larger or a smaller portion of the basal ganglia and internal capsule than usual. The number of twigs to the innominate substance (substantia innominata) (3-11), and their diameters (0.07-0.30 mm), has been described for the first time, to our knowledge. Microatheromas were found in two LSA. Data about the LSA microanatomy and territory could form the basis of safer neurosurgery, more accurate neuroimaging evaluation, and precise neurological diagnosis in patients with focal ischemic lesions in the basal ganglia and internal capsule. © 2012 Elsevier Ltd. All rights reserved.

The lenticulostriate arteries (LSA) and their microanatomy, region of supply and atherosclerosis were examined in 24 microdissected brains, arterial casts, and histological specimens. The LSA ranged from 2 to 12 in number and from 0.10 mm to 1.28 mm in diameter. They always arose from the initial segment of the middle cerebral artery (MCA), often from the MCA leptomeningeal branches (38.24%), and rarely from the insular segment (2.94%). They always originated as individual branches, often (61.76%) with their own common stems. In two hemispheres we found that the LSA supplied either a larger or a smaller portion of the basal ganglia and internal capsule than usual. The number of twigs to the innominate substance (substantia innominata) (3-11), and their diameters (0.07-0.30 mm), has been described for the first time, to our knowledge. Microatheromas were found in two LSA. Data about the LSA microanatomy and territory could form the basis of safer neurosurgery, more accurate neuroimaging evaluation, and precise neurological diagnosis in patients with focal ischemic lesions in the basal ganglia and internal capsule. © 2012 Elsevier Ltd. All rights reserved.

Purpose: The purpose of this study was to determine the difference in the concentrations of testosterone, 17-β estradiol and progesterone between female patients with and without ACL rupture and the possible effect of these hormones on generalised joint laxity. Methods: Female subjects with non-contact knee joint injury were included in this study. They were divided into two groups: the examined group, consisting of female subjects with ACL rupture, and the control group, consisting of female patients without ACL rupture. In the next step, the patients from these two groups were paired off on the basis of three factors: the level of professional sports involvement (including the type of sports activity), the side of the body where the injury had occurred (left or right) and the age of the subjects. In the end, there were 12 pairs (24 subjects). The concentrations of sex hormones were established from saliva specimens with the aid of the Salimetrics enzyme immunoassay. Generalised joint laxity was tested with the aid of the “laxity score” according to Beighton, Solomon and Soskolne. Results: Female subjects with ACL rupture had significantly lower concentrations of testosterone (p < 0.01), significantly lower concentrations of 17-β estradiol (p < 0.05) and significantly lower concentrations of progesterone (p < 0.01) than female subjects with intact ACL. Conclusions: Decreased concentrations of testosterone, 17-β estradiol or progesterone may be a risk factor leading to ACL rupture. The concentrations of these hormones do not affect generalised joint laxity. Additional research on a larger group of patients is necessary to further determine the effects of these hormones on generalised joint laxity and ACL ruptures. Young female athletes with lower concentrations of sex hormones are more prone to anterior cruciate ligament rupture which is why they need to reduce their sports activities during the pre-ovulatory phase of the menstrual cycle, when these concentrations are additionally reduced. Level of evidence: III. © 2014, Springer-Verlag Berlin Heidelberg.

Purpose: The purpose of this study is to determine the difference in the concentrations of testosterone, 17-β estradiol and progesterone between male patients with and without ACL rupture, as well as the possible effect of these hormones on generalized joint laxity. Methods: Male subjects with non-contact knee joint injury were included in this study. Two groups were formed: the examined group, consisting of subjects with ACL rupture and the control group consisting of patients without ACL rupture. After this, the patients from these two groups were paired off on the basis of three factors, level of professional involvement in sports (including the type of sports activity), left or right side of the body and the age of the subjects. In the end, there were 29 pairs (58 subjects). The concentration of sex hormones was determined from saliva specimens with the aid of the Salimetrics enzyme immunoassay. The testing of generalized joint laxity was performed with the aid of the “laxity score” according to Beighton et al. Results: Subjects with ACL rupture have highly statistically significantly greater concentrations of testosterone (p < 0.01), statistically significantly greater concentrations of 17-β estradiol (p < 0.05), and a highly statistically significantly greater generalized joint laxity score than subjects with an intact ACL (p < 0.01). Conclusion: Increased concentrations of testosterone or 17-β estradiol may be a risk factor leading to ACL rupture. Also, generalized joint laxity may be a factor leading to ACL rupture, but none of the monitored hormones can be set down as the cause of its existence. Young male athletes with higher concentrations of testosterone and greater hyperelasticity should plan preventive programs of physiotherapy for ACL preservation since they present a vulnerable group susceptible to ACL rupture. Level of evidence: Diagnostic study, Level II. © 2014, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).