PURPOSE:Chronic subdural hematoma (cSDH) is typically diagnosed on non-contrast brain CT. Embolization of the middle meningeal artery (MMA) has become an increasingly adopted treatment, but pre-procedural assessment of MMA anatomy remains essential because anatomical variations may affect procedural safety. This study evaluated whether three-dimensional (3D) reconstructions from routine non-contrast CT can depict MMA anatomy compared with digital subtraction angiography (DSA), the reference standard. MATERIALS AND METHODS:In this retrospective study, 76 patients (91 MMAs) who underwent both non-contrast CT and DSA were analyzed. The anterior, posterior, and middle branches were assessed. Branch dominance was categorized as Type I (anterior), Type II (posterior), or Type III (mixed), and posterior branch origin as proximal (A), intermediate (B), or distal (C). The Extended-Adachi classification was used for overall anatomical patterns. The foramen spinosum (FS) and MMA tortuosity were also evaluated. Concordance rates between CT and DSA were calculated. RESULTS:On CT, the anterior, posterior, and middle branches were visible in 100%, 94.5%, and 96.7% of cases, respectively. CT-DSA concordance was high for branch identification (91.1%, 85.7%, and 78.0%) and lower for dominance (45.5%) and posterior branch origin (39.3%). Absence of the FS on CT was strongly associated with anatomical variants (3/4 cases). CONCLUSION:3D reconstructions from non-contrast CT allow reliable visualization of the main MMA branches. Assessment of the FS may provide an additional indirect indicator of anatomical variation, although this finding requires confirmation in larger studies. Pre-procedural recognition of MMA variants may help optimize procedural planning and reduce the risk of non-target embolization.

Introduction et objectifs Le pneumothorax est une urgence fréquemment rencontrée dans la pratique médicale. Compressif, il constitue une urgence absolue, dont l’absence de diagnostic ou l’échec du drainage peut rapidement évoluer vers un arrêt cardiorespiratoire. L’exsufflation, le drainage thoracique et la thoracostomie au doigt sont des gestes indispensables à maîtriser pour les professionnels de santé. Cependant, ces gestes techniques, parfois complexes et avec des taux d’échecs rapportés notables (de 17 à 60 %) [1], peuvent entraîner des complications graves [2], [3] et doivent pouvoir être réalisés dans des contextes variés, du box des urgences aux champs de bataille. Ces interventions nécessitent donc un personnel entraîné, capable de les exécuter avec assurance, rapidité et en minimisant la douleur. Les simulateurs « plastiques », bien que disponibles, apparaissent peu réalistes et extrêmement coûteux, ce qui limite leur pertinence. Notre objectif était de concevoir un modèle réaliste de pneumothorax permettant l’entraînement à la réalisation des drainages thoraciques. Matériels, patients et méthodes Le modèle a été développé au sein de l’Institut d’anatomie et de simulation de Toulouse. Sur un cadavre frais, un bouton de gastrostomie 18G a été inséré dans le 4e espace intercostal en position médioclaviculaire. L’incision a été rendue hermétique à l’aide d’une bourse de Vicryl 0. L’hémithorax a d’abord été rincé à l’eau, puis rempli d’air. Résultats La qualité du pneumothorax créé a été contrôlée échographiquement par un radiologue expérimenté [4]. Après anesthésie locale, les gestes d’exsufflation, de drainage thoracique et de thoracostomie ont pu être réalisés sans difficulté. Ces gestes ont pu être réalisés à plusieurs reprises après regonflage de l’hémithorax via le bouton de gastrostomie. Conclusions Le modèle de pneumothorax cadavérique avec bouton de gastrotomie est un modèle réaliste, peu coûteux, réutilisable plusieurs fois et facilement accessible aux médecins en formation dans les laboratoires d’anatomie. Sa diffusion pourrait permettre d’améliorer l’efficience des médecins confrontés à la réalisation de ce geste technique complexe.

PURPOSE:The authors described detailed relevant anatomy for anterior approach of the lumbosacral spine emphasizing all critical structures at risk for surgical injuries. METHODS:Two fresh adult male cadavers were dissected at the Toulouse anatomy department. For each specimen, a step-by-step surgical approach followed by broader anatomical dissection was performed. RESULTS:Results were divided into three compartments: anterior abdominal wall, latero/retroperitoneal space, lumbosacral prevertebral space. Each compartment was analyzed and visually described according to surgical and wider anatomical approach. Each region has critical anatomical structures that need to be well managed during surgery avoiding surgical complications. In the lumbosacral prevertebral space, the vascular anatomy is the most critical point to know to avoid potentially fatal surgical complications for patients. Ureter embedded into the posterior part of the peritoneum is also a critical structure to manage correctly during lumbosacral anterior approach. Different neural structures are also encountered with potential painful complications in case of injury. CONCLUSIONS:In reference to anterior lumbosacral approach, critical structures to manage are peritoneum, ureter, prevertebral venous structures and hypogastric plexus. Their surgical anatomy has to be known and well recognized during surgery. Our surgical then broader anatomical dissections provide pragmatic pictural pedagogic content for teaching surgeons practicing anterior lumbosacral approach.

Purpose: The authors meticulously described the relevant anatomy for the anterior approach to the lumbosacral spine, with a focus on critical structures at risk for surgical injuries. Methods: Using two fresh adult male cadavers, the dissections were carried out at the Toulouse anatomy department. For each specimen, a step-by-step surgical approach was followed by a broader anatomical dissection. Results: The findings were categorized into three compartments: the anterior abdominal wall, lateroretroperitoneal space, and lumbosacral prevertebral space. Each compartment was meticulously analyzed and visually described, considering both surgical and broader anatomical perspectives. Within the lumbosacral prevertebral space, the vascular anatomy emerged as the most crucial point to understand, as it helps avoid potentially fatal surgical complications for patients. Additionally, managing the ureter embedded in the posterior part of the peritoneum is critical during the lumbosacral anterior approach. Various neural structures are also encountered, with the potential for painful complications in case of injury. Conclusions: Surgeons performing the anterior lumbosacral approach must be well-versed in managing critical structures, including the peritoneum, ureter, prevertebral venous structures, and hypogastric plexus. A thorough understanding of their surgical anatomy is essential. Our surgical and broader anatomical dissections offer pragmatic visual content for surgeons practicing the anterior lumbosacral approach.

Purpose Lymph node involvement in cancer of the uterine cervix is a major independent prognostic factor for overall survival. The aim of our study was to examine the lymphatic drainage regions of the different parts of the uterine cervix. Methods An anatomical study of fresh cadavers was conducted by injecting patent blue in the anterior or posterior lip of the uterine cervix and dissecting drainage regions. Furthermore, a retrospective radiological and pathological studies were conducted on patients who were treated for early-stage cancer of the uterine cervix with lymph node involvement. Radiological analysis of pre-therapeutic MRIs and/or pathological analysis of surgical specimens showed the precise location of the tumour. A correlation between the anatomy of the primary lesion site and the lymphatic area involved was established. Results We administered 15 cadaveric injections: 8 in the anterior lip of the uterine cervix and 7 in the posterior one. For 100% of the anterior lip injections, lymphatic drainage was bilateral ileo-obturator ( n = 8/8) combined with bilateral parametrial drainage. For the posterior injections, there was never any ileo-obturator drainage, and 6 of the 7 (75%) posterior injections drained in the posterior uterine serosa. Concerning the clinical study, we included 21 patients. We observed a non-significant tendency towards bilateral lymph node involvement when the tumour of the anterior lip. Conclusion Physiological lymphatic drainage of the uterine cervix presents anatomical specificities, depending on the structure studied, anterior or posterior lip of the cervix. Better knowledge of these specificities should allow personalized surgery for each patient.

The Central Nervous System (CNS) tumor with BCOR internal tandem duplication (ITD) has recently been added as a novel embryonal histomolecular tumor type to the 2021 World Health Organization (WHO) Classification of CNS Tumors. In addition, other CNS tumors harboring a BCOR/BCORL1 fusion, which are defined by a distinct DNA-methylation profile, have been recently identified in the literature but clinical, radiological and histopathological data remain scarce. Herein, we present two adult cases of CNS tumors with EP300::BCOR fusion. These two cases presented radiological, histopathological, and immunohistochemical homologies with CNS tumors having BCOR ITD in children. To compare these tumors with different BCOR alterations, we performed a literature review with a meta-analysis. CNS tumors with EP300::BCOR fusion seem to be distinct from their BCOR ITD counterparts in terms of age, location, progression-free survival, tumor growth pattern, and immunopositivity for the BCOR protein. CNS tumors from the EP300::BCOR fusion methylation class in adults may be added to the future WHO classification.

Parmi les cancers gynécologiques, le cancer de l'ovaire a le plus haut taux de mortalité. L'atteinte ganglionnaire reste un facteur pronostique important [1] avec une morbidité chirurgicale non négligeable. Pourtant le drainage physiologique de l'ovaire est peu étudié dans la littérature ce qui ne permet pas actuellement d'envisager une chirurgie conservatrice telle que le prélèvement du ganglion sentinelle [2]. L'objectif de notre étude était d'évaluer la faisabilité d'une technique innovante [3] pour étudier les territoires de drainage lymphatique de l'ovaire à l'aide d'un module de recirculation sur le modèle cadavérique. Nous avons injecté du bleu patenté dans la corticale de douze ovaires de cadavres « revascularisés » avec le modèle de recirculation Simlife. Nous avons observé en direct la migration du colorant et décrit les territoires de drainage de chaque ovaire. Nous avons observé une coloration des vaisseaux lymphatiques et la migration du colorant dans 100 % des cas. Nous avons mis en évidence une coloration du territoire lomboaortique dans 75 % des cas avec une atteinte préférentielle en latéro-cave (83 % des cas) pour l'ovaire droit et latéro-aortique (50 % des cas) pour l'ovaire gauche, une atteinte iliaque commune a été observée dans seulement 8 % des cas. Dans 57 % des cas, la coloration du territoire lomboaortique était associée à une coloration du ligament suspenseur. Nous n'avons pas observé de coloration pré-cave, pré-aortique ou inter-aortico-cave. Le territoire pelvien était concerné dans 66 % des cas, avec une coloration iliaque externe dans 33 % des cas, et iliaque interne dans 25 % des cas. Cette coloration était systématiquement homolatérale à l'ovaire injecté. Notre étude permet une meilleure compréhension du drainage lymphatique de l'ovaire avec l'utilisation d'une méthode de détection inédite. La poursuite de ces travaux pourrait permettre d'envisager une stadification ganglionnaire moins morbide pour les cancers de l'ovaire à un stade précoce.

Purpose Total elbow arthroplasty for the treatment of patients with severe elbow osteoarthritis is associated with postoperative activity limitations and risk of midterm complications. Elbow denervation could be an attractive therapeutic option for young, active patients. The aim of our study was to assess the feasibility of selective total elbow denervation via 2 anteriorly based approaches. Methods Selective total elbow denervation was performed in 14 cadaver elbows by 2 fellowship-trained elbow surgeons. Lateral and medial approaches to the elbow were used. The length of skin incisions and the minimum distance between them were noted. The number of articular branches identified and their respective distances from the lateral or medial epicondyle of the humerus were recorded. Results The anterolateral and anteromedial approaches allowed for the identification of all mixed and sensory nerves in all 14 cases. The mean number of resultant articular branches per cadaver was 1 for the musculocutaneous nerve, 2 (range, 1-3) for the radial nerve, 1 (range, 1-3) for the posterior cutaneous nerve of the forearm, 2 (range, 1-3) for the ulnar nerve, and 2 (range, 1-3) for the medial antebrachial cutaneous nerve; the collateral ulnar nerve was connected directly to the capsule. The length of the medial and lateral incisions was 15 cm (range, 12-18 cm) and 12 cm (range, 10-16 cm), respectively. The mean minimum distance between the incisions was 7.5 cm (range, 6.7-8.5 cm). Conclusions The findings suggest that selective elbow denervation via 2 approaches is feasible. Copyright (C) 2022 by the American Society for Surgery of the Hand. All rights reserved.

L’anatomie 3D est un mode d’étude indispensable en 2022 pour l’enseignement de l’anatomie. Nous avons démarré un projet transversal au sein de notre université basé sur la reconstruction en 3D de modèles anatomiques exposés dans notre musée. En effet, notre musée expose près de 700 pièces (cires, plâtres, pièces naturalisées) dont les plus anciennes datent de la seconde moitié du 19e siècle. En plus de leur valeur scientifique, ces oeuvres représentent un intérêt historique, patrimonial et culturel indéniable que nous voulons « dépoussiérer », favoriser et faire connaître au delà des murs de la faculté grâce à l’outil numérique. L’objectif de ce projet est la réalisation d’une plateforme collaborative multidisciplinaire autour du musée, faisant se rencontrer des étudiants de tous horizons : médecine, informatique, beaux arts, muséologie, communication, marketing. Le projet se base sur le principe physique de la photogrammétrie pour modéliser des spécimens d’étude en anatomie afin de créer des doubles numériques en 3 dimensions (en particulier de spécimens fragiles et menacés). Le projet consiste dans un premier temps en la création d’une bibliothèque numérique d’objets 3D destinée à l’enseignement et l’étude de l’anatomie (serious game). Les groupes sont composés d’étudiants de différentes écoles et compétences, travaillant conjointement pour le même objectif. Dans un deuxième temps, les étudiants travailleront à développer un musée virtuel accessible sur ordinateur et supports mobiles à partir des modèles disponibles dans la bibliothèque (site internet, QR code), pour rendre ce patrimoine accessible au plus grand nombre, mettant à la fois le fond et la forme des oeuvres. En conclusion, ce projet transforme un musée d’anatomie en plateforme collaborative, multidisciplinaire, moderne, pour faire vivre à la fois l’anatomie et le patrimoine au sein de l’université.

OBJECTIVES:The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the hip joint and the distribution of sensory receptors within its capsule.METHODS:Five electronic databases were queried, with the search encompassing articles published between January 1945 and June 2019. Twenty-one original articles providing a detailed description of sensory receptors around the hip joint capsule (n=13) and its articular branches (n=8) were reviewed.RESULTS:The superior portions of the anterior capsule and the labrum were found to be the area of densest nociceptive innervation. Similar to the distribution of nociceptors, mechanoreceptor density was found to be higher anteriorly than posteriorly. Hip joint capsular innervation was found to consistently involve the femoral and obturator nerves, which supply the anterior capsule, and the nerve to the quadratus femoris, which supplies the posterior capsule. The femoral, obturator, and superior gluteal nerves supply articular branches to the most nociceptor-rich region of the hip capsule.CONCLUSIONS:The femoral and obturator nerves and the nerve to the quadratus femoris were found to consistently supply articular branches to both the anterior and posterior capsule of the hip joint. The anterior capsule, primarily supplied by the femoral and obturator nerves, and the superior labrum appear to be the primary pain generators of the hip joint, given their higher density of nociceptors and mechanoreceptors.LEVEL OF EVIDENCE:Anatomy study, literature review.

The aim of our study was to determine the feasibility of an all-posterior endoscopic resection of enthesopathy via direct midline transtendinous approach with detachment and reattachment of the Achilles tendon (endo-REDMTART). Endo-REDMTART was performed in 10 ankles by two foot and ankle surgeons. Posterolateral and posteromedial portals were utilized. Three accessory, more distal portals were utilized (one posterolateral, one posteromedial, and one midline transtendinous). We measured the quality of the resection of the calcaneal spur and the length of tendon that was able to be reattached to the calcaneus. The procedure was successful in all 10 cases. The mean minimum thickness of resected calcaneal spur was 7 mm (5–9 mm) thick, and the mean anteroposterior distance was 23 mm (20–25 mm). In all 10 cases, the maximum distance between the distal Achilles tendon and calcaneus was 1 mm (0–1 mm), with good tendon–bone contact. The data here suggest that endo-REDMTART is feasible. This procedure provides all of the advantages of endoscopic technique without compromising the efficacy of Haglund deformity resection. No Clinical Trials Registration or IRB is required. Anatomy study; cadaveric dissection.

L'atteinte ganglionnaire des cancers du col de l'utérus est un facteur pronostique majeur et indépendant de survie globale [1]. Plusieurs essais sont en cours dont SENTICOL III [2], pour tenter de diminuer la morbidité liée aux lymphadénectomies pelviennes et ainsi montrer la fiabilité de la technique du ganglion sentinelle dans les stades précoces [2]. Néanmoins, la topographie du drainage lymphatique du col de l'utérus n'a jamais été étudiée d'un point de vue anatomique. L'objectif était donc d'étudier les territoires de drainage lymphatique du col de l'utérus en fonction de la localisation de la tumeur primitive. Une étude anatomique sur cadavres frais a été menée par injection au bleu patenté de la lèvre antérieure du col de l'utérus ou de la lèvre postérieure. Le drainage a ainsi été comparé en fonction des sites d'injection. Parallèlement, une étude rétrospective radiologique a été menée sur des patientes ayant eu un cancer du col de l'utérus de stade précoce. L'analyse des imageries par résonance magnétique (IRM) pré-thérapeutiques a montré la localisation précise de la tumeur. Seules les patientes ayant une atteinte ganglionnaire prouvée à l'analyse anatomopathologique ont été inclues. Une corrélation entre l'anatomie du site de la lésion primitive et son drainage lymphatique a donc été établie pour chaque patiente. Nous avons réalisé 20 injections : 10 sur la berge cervicale antérieure et 10 sur la berge postérieure. Quatre-vingt pour cent (n = 8) des injections antérieures ont montré un drainage lymphatique ilio-obturateur bilatéral associé à un drainage paramétrial bilatéral. Sur 21 patientes inclues, l'étude radiologique a montré une tendance non significative à une atteinte ganglionnaire bilatérale lorsque la tumeur était localisée sur la berge cervicale antérieure. Il s'agit d'une étude anatomique et radiologique du drainage du col de l'utérus jamais décrite auparavant. Une tendance au drainage lymphatique bilatéral est mise en avant concernant la berge cervicale antérieure.

BACKGROUND:Painful shoulders create a substantial socioeconomic burden and significant diagnostic challenge for shoulder surgeons. Consensus with respect to the anatomic location of sensory nerve branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches (ABs) (1) innervating the shoulder joint and (2) the distribution of sensory receptors about its capsule and bursae. MATERIALS AND METHODS:Four electronic databases were queried, between January 1945 and June 2019. Thirty original articles providing a detailed description of the distribution of sensory receptors about the shoulder joint capsule (13) and its ABs (22) were reviewed. RESULTS:The suprascapular, lateral pectoral, axillary, and lower subscapular nerves were found to provide ABs to the shoulder joint. The highest density of nociceptors was found in the subacromial bursa. The highest density of mechanoreceptors was identified within the insertion of the glenohumeral ligaments. The most frequently identified innervation pattern comprised 3 nerve bridges (consisting of ABs from suprascapular, axillary, and lateral pectoral nerves) connecting the trigger and the identified pain generator areas rich in nociceptors. CONCLUSION:Current literature supports the presence of a common sensory innervation pattern for the human shoulder joint. Anatomic studies have demonstrated that the most common parent nerves supplying ABs to the shoulder joint are the suprascapular, lateral pectoral, and axillary nerves. Further studies are needed to assess both the safety and efficacy of selective denervation of the painful shoulders, while limiting the loss of proprioceptive function.

Based on the currently available literature, total denervation of the elbow joint is considered impossible. However, consensus with respect to the anatomic location of sensory branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the elbow joint, as well as the distribution of sensory receptors about its capsule. Four electronic databases were queried, between January 1945 and June 2019. Twenty-one original articles providing a detailed description of the distribution of sensory receptors about the elbow joint capsule (5) and its articular branches (16) were reviewed. The posterior capsule was found to be primarily innervated by the ulnar and radial nerves via combined articular branches and sensory branches of the medial antebrachial cutaneous nerve. The anterior capsule was found to be primarily innervated by a plexus of articular ramifications from muscular branches of mixed nerves (ulnar, musculocutaneous, radial, and median nerves). A higher density of nociceptors and mechano-receptors was identified within the posterior and anterior capsules, respectively. Thorough denervation, via the technique proposed herein, is likely to be sufficient in eliminating pain from degenerative conditions of the elbow joint.

Introduction: The aim of this work was to analyze the transvaginal approach in minimally invasive surgery in terms of anatomical, histopathological and functional characteristics, to show the safety of this surgical approach. Methods: Anatomical study was first conducted by dissection on fresh cadavers of adult women in order to measure the distance between the vaginal incision and the ureters, rectum and hypogastric nerves. In parallel, an anatomopathological study detailed and compared the macroscopic and histological characteristics of the anterior and posterior surfaces of vaginal samples obtained from cadavers and patients in the context of a hysterectomy for benign pathology. Finally, patients who underwent a transvaginal approach nephrectomy or transplantation were retrospectively enrolled for a clinical examination and an evaluation of their sexuality. Results: The anatomical study conducted on seventeen cadavers showed that the posterior vaginal fornix was remote from the major structures of the pelvis such as rectum, ureters, hypogastric plexus, which allowed a safe incision. Mechanical tests further demonstrated that the posterior vaginal fornix was more extensible than the anterior and histological features showed no major vascular or nervous structures. Ten patients were included in the retrospective clinical study. Long-term follow up showed no negative impact on the texture of the vagina or satisfaction from sexual intercourse. Conclusions: Anatomical, histological and functional data supported that transvaginal approach by posterior vagina fornix incision is a minimally invasive surgery that can be performed safely and effectively by a skilled surgeon in cases with a specific surgical indication for this approach. (C) 2020 Elsevier Masson SAS. All rights reserved.

Supra-selective stimulation of the branches destined for the horizontal part of genioglossus muscle (GGh) could be a target of choice in the treatment of mild-to-severe obstructive sleep apnea syndrome. The main aim of our study was to assess a percutaneous method for the three-dimensional localisation of the terminal branches destined to GGh.

Le nerf suprascapulaire (NSS) est le principal nerf assurant l’innervation sensitive de la face postérieure et supérieure de l’épaule. Cependant, la distribution des branches sensitives du NSS reste encore débattue. L’objectif de cette étude était de permettre une description consensuelle de l’anatomie des branches sensitives du NSS. L’hypothèse était que le NSS donnait trois branches sensitives permettant l’innervation de la capsule gléno-humérale postérieure, de la bourse sous acromiale, et des ligaments acromio- et coraco-claviculaires. Les divisions, les courses, et la distribution des branches sensitives du NSS innervant les structures de l’épaule ont été examinées macroscopiquement par la dissection de 37 épaules de 19 cadavres frais âgés en moyenne de 83 ans (74–89). Les 37 NSS donnaient 1 branche sous acromiale médiale (bSAM) et 1 branche sous acromiale latérale (bSAL), et une branche gléno-humérale postérieure (bGHP) à l’épaule. Cette distribution permet une innervation bipolaire - médiale (bSAM) et latérale (bSAL) - de la bourse sous acromiale, des ligaments acromio- et coraco-claviculaire (bSAM), et de la capsule gléno-humérale postérieure (bGHP). Le NSS donne deux branches sous acromiales et une branche gléno-humérale postérieure à l’épaule. Cette distribution permet une innervation bipolaire - médiale et latérale - de la bourse sous acromiale, des ligaments acromio- et coraco-claviculaire, et de la capsule gléno-humérale postérieure.