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Torul, Damla/0000-0003-2323-606X WOS: 000457681400005 PubMed: 29763338 Accidental displacement of dental implants into the anatomical spaces is a rare complication that may be accompanied by tissue damage, functional disturbance, psychological distress, and medicolegal conditions. The aim of this report is to present an unusual case of a dental implant that displaced into the mandibular canal and to highlight the importance of adequate preoperative planning and surgical knowledge.

Kidney laceration following blunt trauma is responsible for up to 3% of trauma cases. The risk factors associated with renal injury are attributed to the risks of mechanical injury. However, anatomical variations that may accelerate the insult of injury are poorly documented. This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. The curvature of the spine, shown on CT imaging, revealed a reduced retroperitoneal space around the left kidney. This case explores lumbar scoliosis as a risk factor for kidney laceration. We hypothesise that this increased risk is associated with asymmetry of the spine and reduced anatomical space in the retroperitoneum. Patients with lumbar scoliosis may be considered a high-risk category for renal injury, following low-impact trauma.

Objective The aim of this retrospective study was to describe the sonographic appearance of the posterior brain anatomy in normal fetuses at 11 to 14 weeks of pregnancy and to determine the fetal outcome when one of the posterior brain anatomical space is not recognized. Methods Two groups of patients were included in the study: a control group of consecutive 311 healthy fetuses with a normal sonogram and a study group of 21 fetuses with absence of one of the three posterior brain spaces. In each fetus, images of the mid-sagittal view of the fetal face and brain at 11 to 14 weeks of gestation were obtained. Results In all fetuses with absence of one of the three posterior brain spaces, a severe anomaly, including open spina bifida, cephalocele, Dandy–Walker complex, and chromosomal aberrations, was associated. Conclusion Our study indicates that the sonographic finding characterized by the absence of one of the three posterior brain spaces seems to facilitate not only the detection of open spina bifida, as previously reported, but also of other neural tube defects, such as cephalocele, and is an important risk factor for cystic posterior brain anomalies, and/or chromosomal abnormalities. Thus it seems a poor prognostic finding for major fetal abnormalities. © 2015 John Wiley & Sons, Ltd.

ObjectiveAn increasing number of human in vivo magnetic resonance imaging (MRI) studies have focused on examining the structure and function of the subfields of the hippocampal formation (the dentate gyrus, CA fields 1 − 3, and the subiculum) and subregions of the parahippocampal gyrus (entorhinal, perirhinal, and parahippocampal cortices). The ability to interpret the results of such studies and to relate them to each other would be improved if a common standard existed for labeling hippocampal subfields and parahippocampal subregions. Currently, research groups label different subsets of structures and use different rules, landmarks, and cues to define their anatomical extents. This paper characterizes, both qualitatively and quantitatively, the variability in the existing manual segmentation protocols for labeling hippocampal and parahippocampal substructures in MRI, with the goal of guiding subsequent work on developing a harmonized substructure segmentation protocol.MethodMRI scans of a single healthy adult human subject were acquired both at 3 T and 7 T. Representatives from 21 research groups applied their respective manual segmentation protocols to the MRI modalities of their choice. The resulting set of 21 segmentations was analyzed in a common anatomical space to quantify similarity and identify areas of agreement.ResultsThe differences between the 21 protocols include the region within which segmentation is performed, the set of anatomical labels used, and the extents of specific anatomical labels. The greatest overall disagreement among the protocols is at the CA1/subiculum boundary, and disagreement across all structures is greatest in the anterior portion of the hippocampal formation relative to the body and tail.ConclusionsThe combined examination of the 21 protocols in the same dataset suggests possible strategies towards developing a harmonized subfield segmentation protocol and facilitates comparison between published studies. published

The paravascular pathway, also known as the "glymphatic" pathway, is a recently described system for waste clearance in the brain. According to this model, cerebrospinal fluid (CSF) enters the paravascular spaces surrounding penetrating arteries of the brain, mixes with interstitial fluid (ISF) and solutes in the parenchyma, and exits along paravascular spaces of draining veins. Studies have shown that metabolic waste products and solutes, including proteins involved in the pathogenesis of neurodegenerative diseases such as amyloid-beta, may be cleared by this pathway. Consequently, a growing body of research has begun to explore the association between glymphatic dysfunction and various disease states. However, significant controversy exists in the literature regarding both the direction of waste clearance as well as the anatomical space in which the waste-fluid mixture is contained. Some studies have found no evidence of interstitial solute clearance along the paravascular space of veins. Rather, they demonstrate a perivascular pathway in which waste is cleared from the brain along an anatomically distinct perivascular space in a direction opposite to that of paravascular flow. Although possible explanations have been offered, none have been able to fully reconcile the discrepancies in the literature, and many questions remain. Given the therapeutic potential that a comprehensive understanding of brain waste clearance pathways might offer, further research and clarification is highly warranted.

A few cases of accidental displacement of mandibular molar or fragment of tooth into adjacent anatomical spaces, during surgical interventions have been reported. This report describes a unique case of swelling with extra oral skin fistula in mandibular body region caused by unrecognized displacement of a lower first molar root into buccal space. The possible causes for such incident along with the complications which may occur, and the techniques used to prevent the risk of accidental displacement of tooth and roots, during extraction are discussed. The importance of recognizing this complication and actions to be taken after recognizing it are highlighted.

This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms. Parous sheep underwent the dissection of the rectovaginal septum, followed by the insertion of an implant with or without four anchoring arms, both designed to fit the ovine anatomy. The anchoring arms were put in place using a trocar and an "outside-in" technique. The cranial arms were passed through the obturator, gracilis, and adductor magnus muscles. The caudal arms were fixed near the sacrotuberous ligament, through the coccygeus muscles. This technique allows for the mimicking of surgical procedures performed in women suffering from pelvic organ prolapse. The anatomical spaces and elements are easily identified. The most critical part of the procedure is the insertion of the cranial trocar, which can easily penetrate the peritoneal cavity or the surrounding pelvic organs. This can be avoided by a more extensive retroperitoneal dissection and by guiding the trocar more laterally. This approach is designed only for experimental testing of novel implants in large animal models, as trocar-guided insertion is currently not used clinically.

Парадуоденальний, або groove панкреатит, рідкісний тип фокального хронічного запалення підшлункової залози, що переважно вражає ‘‘борозну‘‘ –анатомічний простір між дорсокраніальною частиною головки підшлункової залози, дванадцятипалою кишкою та загальною жовчною протокою. В літературі зустрічається під такими синонімами: дуоденальна дистрофія гетеротопічної підшлункової залози, панкреатична гамартома дванадцятипалої кишки, міоаденоматоз. Спірним залишається питання патогенезу парадуоденального панкреатиту. Основними етіопатогенетичними факторами захворювання є анатомічні особливості протокової системи підшлункової залози та підвищення в'язкості панкреатичного соку, які призводять до хронічного персистуючого запалення в ділянці ‘‘борозни‘‘ з наступним втягненням в патологічний процес головки підшлункової залози, двадцятипалої кишки та термінального відділу холедоха. Тяжкість диференціації groove панкреатиту з пухлинами періампулярної ділянки створює певні діагностичні труднощі для клініцистів та патоморфологів, що вимагає проведення операційного лікування для верифікації остаточного діагнозу. Дане повідомлення описує основні етіологічні, патофізіологічні та морфологічні зміни, які виникають при парадуоденальному панкреатиті.

Anatomically, the groin serves as the conduit for structures that are traversing between the abdominopelvic cavity and the lower extremity. It houses many delicate and vital neurovascular components that should be protected when surgically exploring this area. Such structures include the femoral vessels and their tributaries, as well as branches of the lumbar plexus. What makes the groin unique, however, are its anatomical spaces. Knowledge of the inguinal canal, the femoral triangle, the femoral sheath, and the femoral canal and their contents must preface any intention to surgically explore the groin. In this chapter, we provide an illustrative review of the anatomy of the groin, highlighting surgically important structures, spaces, and variations.

For decades, in situ hybridization methods have been essential tools for studies of vertebrate development and disease, as they enable qualitative analyses of mRNA expression in an anatomical context. Quantitative mRNA analyses typically sacrifice the anatomy, relying on embryo microdissection, dissociation, cell sorting, and/or homogenization. Here, we eliminate the tradeoff between quantitation and anatomical context, using multiplexed in situ hybridization chain reaction (HCR) to perform accurate and precise relative quantitation of mRNA expression with subcellular resolution within whole-mount vertebrate embryos. Gene expression can be queried in two directions: read-out from anatomical space to expression space reveals co-expression relationships in selected regions of the specimen; conversely, read-in from multidimensional expression space to anatomical space reveals those anatomical locations in which selected gene co-expression relationships occur. As we demonstrate by examining gene circuits underlying somitogenesis, quantitative read-out and read-in analyses provide the strengths of flow cytometry expression analyses, but by preserving subcellular anatomical context, they enable iterative bi-directional queries that open a new era for in situ hybridization.SUMMARYMultiplexed in situ hybridization chain reaction (HCR) enables quantitative multidimensional analyses of developmental gene expression with subcellular resolution in an anatomical context.

Vertebral artery (VA) identification within the suboccipital triangle is a key step in craniocervical junction surgery. Often VA exposition at this level is arduous (space-occupying lesions, previous surgery); to identify VA more proximally may prove useful in complex cases. An alternative triangle is present just below the suboccipital one, where VA can be easily controlled; we named it the inferior suboccipital triangle (IST). The aim of the study is to identify IST anatomical relations and VA space orientation and evaluate its practical utility in surgery. An anatomical study was performed on ten sides of five injected cadaverdic specimens. Relevant anatomical data were databased. The IST is limited superiorly by the inferior oblique muscle, inferolaterally by the posterior intertransversarii muscle and inferomedially by the C2 lamina; VA at this level has a vertical course with a slight medial to lateral direction (mean 10.8°) and minor posterior to anterior inclination (mean 3.4°). VA within the IST has a constant course without significant loops or kinkings; periarterial venous plexus is less represented at this level. The IST measures an average of 1.89 cm2, and VA at this level has an average length of 98 mm. IST is a significantly large anatomical space where the VA course is rather regular, and its length is sufficient for vascular proximal control purposes. Periarterial venous plexus is less evident at this level, easing the surgical exposure. VA exposition within the IST can be used as an alternative option when space-occupying lesions, scars and stabilisation devices make arterial dissection hazardous in more cranial V3 segments.

Modeling subject-specific shape change is one of the most important challenges in longitudinal shape analysis of disease progression. Whereas anatomical change over time can be a function of normal aging; anatomy can also be impacted by disease related degeneration. Shape changes to anatomy may also be affected by external structural changes from neighboring structures, which may cause non-linear pose variations. In this paper, we propose a framework to analyze disease related shape changes by coupling extrinsic modeling of the ambient anatomical space via spatiotemporal deformations with intrinsic shape properties from medial surface analysis. We compare intrinsic shape properties of a subject-specific shape trajectory to a normative 4D shape atlas representing normal aging to separately quantify shape changes related to disease. The spatiotemporal shape modeling establishes inter/intra subject anatomical correspondence, which in turn enables comparisons between subjects and the 4D shape atlas, and also quantitative analysis of disease related shape change. The medial surface analysis captures intrinsic shape properties related to local patterns of deformation. The proposed framework simultaneously models extrinsic longitudinal shape changes in the ambient anatomical space, as well as intrinsic shape properties to give localized measurements of degeneration. Six high risk subjects and six controls are randomly sampled from a Huntington’s disease image database for quantitative and qualitative comparison.

The pterygopalatine fossa is a well-protected region of the skull base, and surgical access for resection of tumors growing in this region can be challenging. Historically, the approach to this anatomical space has been an open transmaxillary technique. This results in disruption of the anterior and posterior walls of the maxillary sinus and numerous postoperative morbidities. More recently, improvements in endoscopic sinus surgery instrumentation and techniques have led to the advent of minimally invasive surgical approaches to the skull base. The use of endoscopes allows for improved visualization and surgical manipulation, as well as reduced postoperative comorbidities. We discuss a graduated, minimally invasive approach to the pterygopalatine fossa.

Functional magnetic resonance imaging (MRI) data are usually registered into standard anatomical space. However, standard atlases, such as LPBA40, the Harvard–Oxford atlas, FreeSurfer, and the Jülich cytoarchitectonic maps all lack important detailed information about small subcortical structures like the substantia nigra and subthalamic nucleus. Here we introduce a new subcortical probabilistic atlas based on ultra-high resolution in-vivo anatomical imaging from 7T MRI. The atlas includes six important but elusive subcortical nuclei: the striatum, the globus pallidus internal and external segment (GPi/e), the subthalamic nucleus, the substantia nigra, and the red nucleus. With a sample of 30 young subjects and carefully cross-validated delineation protocols, our atlas is able to capture the anatomical variability within healthy populations for each of the included structures at an unprecedented level of detail. All the generated probabilistic atlases are registered to MNI standard space and are publicly available.

The left atrial medial isthmus (or alternative isthmus) is an anatomical space located between the right inferior pulmonary vein and the medial part of the mitral annulus. This area may be used clinically for transcatheter ablation of arrhythmogenic substrate and accessory pathways. The purpose of

The authors proposed to evaluate the quantity of anatomical intracranial reserve according to morphometric measurements in axial projection by means of helical computer tomography data of bitemporal distance, width of the tentorial opening, diameter of the foramen magnum and mutual correlation of these parameters in points. This method showed a high accuracy (92%) and predictive value (85%) in determination of terms and volume of complex treatment of 140 victims with craniocerebral injury, 120 patients with primary tumors of the brain and 110 patients with acute disorder of cerebral circulation.

Calot's triangle is an anatomical landmark of special value in cholecystectomy. First described by Jean-Francois Calot as an "isosceles" triangle in his doctoral thesis in 1891, this anatomical space requires careful dissection before the ligation and division of the cystic artery and cystic duct during cholecystectomy. The modern definition of the boundaries of Calot's triangle varies from Calot's original description, although the exact timing of this change is not entirely clear. The structures within Calot's triangle and their anatomical relationships can present the surgeon with difficulties, particularly when anatomical variations are encountered. Sound knowledge of the normal anatomy of the extrahepatic biliary tract and vasculature, as well as understanding of congenital variation, is thus essential in the prevention of iatrogenic injury. The authors describe the normal anatomy of Calot's triangle and common anatomical anomalies. The incidence of structural injury is discussed, and new techniques in surgery for enhancing the visualisation of Calot's triangle are reviewed. © .

the most common procedures performed in oral and maxillofacial surgery units with low rates of complications and morbidity [1–3]. Most frequently confronted complications are fracture of tuberosity, tooth root fracture, perforation of the maxillary sinus, prolapse of the buccal fat pad, and displacement of the roots or tooth into the maxillary sinus [3–5]. According to the literature, a few cases of accidental displacement of molars into adjacent anatomical spaces, such as the infratemporal fossa, the pterygomandibular space, the maxillary sinus, the buccal space, or the lateral pharyngeal space, during surgical interventions have been reported [3, 5, 6]. However this is the first reported case of maxillary third molar displaced into pterygopalatine fossa. The aim of this case report is to identify potential risk factors and to gather information on the prevention and treatment of this complication.

INTRODUCTION: Odontogenic infections are the most commonly encountered orofacial infections, which may spread into the adjacent anatomical spaces along the contiguous fascial planes, leading to involvement of multiple spaces which can progress to life-threatening situations. MATERIALS AND METHODS: A prospective study was carried out on 100 consecutive cases of odontogenic infections treated at our institute over a period of 18 months by surgical intervention and intravenous antibiotics. Morphologic study of the isolates and antibiotic sensitivity testing was performed. RESULTS: Caries was the most frequent dental disease (53.27%), and the mandibular first molar was the most frequently involved tooth (41.9%) associated with the etiology of odontogenic infections. A total of 158 spaces were involved in 100 patients. In subjects with single space odontogenic infections (n = 61), submandibular space was most commonly affected (44.26%) followed by buccal space (27%). In subjects with multiple space infections (n = 39), submandibular space (30.19%) was most frequently involved followed by buccal space (17.92%). In the aerobic group/microaerophilic group, 17 different species were isolated in a total of 102 aerobic isolates. A total of 18 species were identified in 65 anaerobic isolates sampled. CONCLUSION: Amoxicillin possess antimicrobial activity against major pathogens in orofacial odontogenic infections, but β-lactamase production has restricted the effectiveness of amoxicillin against the resistant strains of Staphylococcus aureus, Bacteroides, Prevotella and Porphyromonas. For the management of orofacial infections, the use of amoxicillin/clavulanate and clindamycin is recommended because of stability against β-lactamases.

The detection of fetal anomalies has improved in the last years as a result of the generalization of ultrasound pregnancy screening exams. The presence of a cystic imaging in the fetal pelvis is a relatively common finding, which can correspond to a real congenital cystic lesion or result from the anomalous liquid accumulation in a whole pelvic organ, mainly the urinary bladder, the uterus, or the vagina. In selected cases with poor prognosis and/or inconclusive echographic findings, magnetic resonance may bring additional information in terms of the characterization, anatomical location, and real extension of the pathology. This pictorial essay describes the normal pelvic fetal anatomy, as well as the most common pelvic cysts. It also describes the causes of an anomalous distension of the whole pelvic organs detected in utero, with emphasis on prenatal magnetic resonance imaging exams. Moreover, it proposes practical teaching points to reduce the differential diagnosis of these lesions based on the sex of the fetus, the division of the pelvis in anatomical spaces, and the imaging findings of the pathology. Finally, it discusses the real utility of complementary MRI.

Three-dimensional atlases of subcortical brain structures are valuable tools to reference anatomy in neuroscience and neurology. In the special case of deep brain stimulation (DBS), the two most prominent targets are the subthalamic nucleus (STN) and the internal part of the pallidum (GPi). With the help of atlases that define their position and shape within a well-defined stereotactic space, their spatial relationship to implanted deep brain stimulation (DBS) electrodes may be analyzed on a single-subject level and in group studies. One standard approach to define such atlases is to manually segment structures on MR data of large cohorts and coregister them to a standard anatomy template. Other approaches include using histological stacks that are again co-registered to the template. However, most of the atlases derived in this fashion show a substantial descripancy to the anatomy that is defined by the template itself. Here, an algorithm that automatically segments the template itself by simultaneously using its T1, T2, proton density and T2 relaxometry modalities is introduced. Based on a low number of manually placed point fiducials within each structure, this three-level algorithm was able to robustly segment subcortical anatomical structures. The first level consisted of a multimodal region-growing algorithm that intended to increase the number of sample points for robustness reasons. The second level computed Mahalanobis distances from each voxel in the brain to the multimodal intensity distribution of first level points set and thus assigned target structure similarity values to each voxel. Finally, the third level assigned each super-threshold voxel to one of the subcortical structures in a winner- takes-all fashion based on second level probability maps. The algorithm was able to segment the STN, the pallidum and the red nucleus directly on the MNI template. The algorithm was not able to automatically segment the internal and external parts of the pallidum. However, given the practical importance of the GPi, a second version of the atlas was defined in high resolution by manual segmentation. To maintain a maximally possible observer-independence, this process was largely informed by automatically generated probability maps described above. We argue that the resulting atlas is a valuable tool to define DBS target structures within standard anatomical space. Furthermore, the atlas may additionally be used as an anchor-point to co-register more detailed (e.g. histological) atlases into standard space. Both the automated and manual versions of the atlas will be made publicly available under an open license.

Our aim was to describe our experience of retrieval of accidental displacements of upper and lower molars into neighbouring anatomical spaces. Thirteen patients were evaluated retrospectively in terms of age, sex, affected side, jaw (mandible or maxilla), surgeon's experience, whether the extracted teeth had erupted, which portion of the tooth or teeth was displaced, the anatomical space into which the fragment was displaced, postoperative complaints, timing of the retrieval, type of anaesthesia, and surgical approach. There were no significant differences in sex, affected side, which part of the tooth was displaced, whether the extracted teeth had erupted, type of anaesthesia, or timing of retrieval. We conclude that this condition should be treated, although follow-up alone may be an option. The intraoral lingual pouch approach for complications of mandibular third molars and the intraoral Caldwell-Luc operation for those in the maxilla could be successful options for retrieval.

Objectives Venous malformation (VM) is the most common symptomatic low-flow vascular malformation, which predominantly occurs in the head and neck region. The aim of this paper was to evaluate the results of endovascular sclerotherapy of voluminous VM, when the lesion is either ≥15 cm in maximum diameter or the lesion invades more than one anatomical space, in the head and neck region using absolute ethanol under digital subtraction angiography (DSA) guidance. Methods A total of 23 patients with head and neck VMs between October 2005 and December 2008 were retrospectively reviewed. All patients received direct puncture ethanol sclerotherapy under DSA guidance. Follow-up assessments were performed at 3–25 months after therapies were completed, and complications were reported in some cases. Results All patients were satisfied with the results of therapy. Seventeen patients (73.9%) achieved excellent responses and six patients (26.1%) achieved good responses in magnetic resonance imaging assessments. Minor complications developed during the procedures, all of which were successfully managed with full recovery during follow-ups. Serious complications such as acute pulmonary hypertension, cardiovascular collapse and pulmonary embolism were not encountered. Conclusion It is concluded that sclerotherapy with absolute ethanol under DSA guidance is an important alternative therapy for voluminous and extensive VM, as the procedure is reasonably safe and offers good therapeutic results.

Relating structural connectivity with functional activity is fundamentally important to understanding the brain's physiology. The thalamocortical system serves as a good model system for exploring structure/function relationships because of its well-documented anatomical connectivity. Here we performed functional and structural magnetic resonance mapping of the human thalamocortical system using intrinsic brain activity and diffusion-weighted imaging. The accuracy of these imaging techniques is tested by comparison with human histology registered to common anatomical space and connectional anatomy derived from nonhuman primates. In general, there is good overall concordance among structural, functional, and histological results which suggests that a simple model of direct anatomical connectivity between the cerebral cortex and the thalamus is capable of explaining much of the observed correlations in neuronal activity. However, important differences between structural and functional mapping results are also manifest which suggests a more complex interpretation and emphasizes the unique contributions from structural and functional mapping.

CT and MRI are commonly used in the evaluation of patients with suspected orbital disease. Many different diseases may present within this small anatomical space. The purpose of this article is to present a diagnostic strategy based on a compartment model. Localizing pathology to sinus, bone, extraconal space, muscle cone, intraconal space, optic nerve, globe or lacrimal fossa allows significant reduction in the number of differential diagnoses as these compartments contain different tissues which disease may involve or arise from. Certain diseases may also present in multiple compartments. Common diseases which might present in one or multiple compartments will be discussed.

The advantages of a new, dynamic sonar technology in open stereotactic microsurgery are demonstrated by means of three surgical procedures for deep-seated vascular malformations that are not easy of access. With this method, targets can be aimed at without using rigid, obstructive pointing devices as in conventional stereotaxy. On the contrary, it is possible to take advantage of preformed anatomical spaces reaching the lesion most carefully by means of light-weight, free-hand on-target instruments. The spatial information, correlated with a CT data set, is displayed in real time with an accuracy of +/- 1 mm. Additional image data from MR and digital angiography can be used interactively.

Damage to the inferior alveolar nerve is a relatively infrequent complication in dental practice. When root canal treatment of a lower molar or premolar surpasses and/or overextends beyond the apical foramen and invades the periapical zone, the foreign material introduced within such a sensitive anatomical space may mechanically or even chemically affect the inferior alveolar nerve. We describe a case of endodontic treatment of a permanent right lower first molar in which the sealer cement overextended in large amounts and damaged the right inferior alveolar nerve. The condition reverted a few months after the surgical removal of the material. Evaluation of the removed material, using powder x-ray diffraction and scanning electron microscopy with coupled dispersive energy spectroscopy, showed it to consist of calcium tungstate (scheelite [CaWO4]) and zirconium oxide (baddeleyite [ZrO2]), which were chemical components of the sealer cement.

The accurate mapping of functional magnetic resonance imaging (fMRI) activations to anatomical structures is critical for fMRI studies of brain organization. In the commonly used functional space analysis method, functional images are realigned to a functional reference image and processed in low-resolution functional space. The average functional activations are then projected into high-resolution anatomical space for visualization. Here, we describe a new technique, anatomical space analysis (ASA), whereby low-resolution functional images are first coregistered and resampled directly into high-resolution anatomical space with all subsequent data processing performed in high-resolution space. A major advantage of ASA is that minor scanner sampling instabilities and small head movements can increase spatial resolution by providing multiple samples of the relationship between functional and anatomical space. Both simulations and analyses of real fMRI data show that ASA improves the precision, objectivity and reproducibility of functional brain mapping.

The connectivity architecture of the human brain varies across individuals. Mapping functional anatomy at the individual level is challenging, but critical for basic neuroscience research and clinical intervention. Using resting-state functional connectivity, we parcellated functional systems in an "embedding space" based on functional characteristics common across the population, while simultaneously accounting for individual variability in the cortical distribution of functional units. The functional connectivity patterns observed in resting-state data were mapped in the embedding space and the maps were aligned across individuals. A clustering algorithm was performed on the aligned embedding maps and the resulting clusters were transformed back to the unique anatomical space of each individual. This novel approach identified functional systems that were reproducible within subjects, but were distributed across different anatomical locations in different subjects. Using this approach for intersubject alignment improved the predictability of individual differences in language laterality when compared with anatomical alignment alone. Our results further revealed that the strength of association between function and macroanatomy varied across the cortex, which was strong in unimodal sensorimotor networks, but weak in association networks.

Intracerebral tumors of the insular lobe are quite frequent, however treatment of patients with this pathology still remains a challenging and controversial issue of neurosurgery. First of all, this is associated with the localization of tumors in the area of eloquent anatomical structures: M1--M2 segment of the middle cerebral artery, lenticulostriate arteries, basal ganglia, and internal capsule, which causes a high rate of postoperative complications in these patients. Most insular tumors are amenable for resection with a reasonable rate of postoperative complications, although most of the surgery-related complications resulting in substantial deficits are due to lesions of eloquent anatomical structures located in this compact anatomical space. Therefore, the aim of this work was to analyze the literature regarding the issues of clinical presentation, diagnosis, and aspects of surgical treatment of insular tumors.Внутримозговые опухоли островковой доли мозга встречаются нередко, однако лечение пациентов с данной патологией является сложной, противоречивой проблемой нейрохирургии. Прежде всего это связано с расположением опухолей в зоне, окруженной важнейшими анатомическими образованиями (М1-М2 сегмент средней мозговой артерии, лентикулостриарные артерии, базальные ганглии, внутренняя капсула), в результате чего частота послеоперационных осложнений у данной категории больных остается высокой. Цель нашей работы - анализ литературы, касающейся вопросов клинической картины, диагностики и аспектов хирургического лечения внутримозговых опухолей островковой доли.

Background In nonsurgical facial rejuvenation, autologous fat and dermal fillers have become an effective method to achieve symmetry and balance of the midface. Nonsurgical techniques that target the dynamic anatomical relationships existing in the midface can improve rejuvenation outcomes in this commonly augmented region. Objectives The authors described techniques for fat compartment and potential space volumization of the midface via a standardized and reproducible technique. They placed emphasis on access to anatomical spaces and compartments within the midface. Methods In 11 hemifacial cadavers, hyaluronic acid filler homogenized with red dye was injected via 3 midfacial ports that were anatomically designed to access the superficial fat compartments, deep fat compartments, or traverse the prezygomatic space. Specimens were dissected in a layered fashion to analyze relationships between the injected filler and midfacial anatomy. We have described 4 site-specific procedural techniques and created a video containing anatomical renderings of each targeted viaduct accompanied by technique demonstrations. Results We found that Beut techniques 1 through 4 can be performed through 3 midfacial viaducts. Port placement 1.5 cm inferolateral to the alar base in the nasolabial crease created a medial midface viaduct, suitable for access to the deep medial cheek fat, medial superficial fat compartment, premaxillary space, and adjacent superior nasolabial cheek compartment. Port placement within the nasojugal groove provided a middle midface viaduct to access the middle superficial fat compartment and medial suborbicularis oculi fat (SOOF). Port placement 1.5 cm inferolateral to the lateral canthus created a lateral midface viaduct to approach the pre-periosteal fat, prezygomatic space, lateral SOOF, and infraorbital fat compartment. Conclusions Our findings indicate that anterior and lateral cheek projection, V-deformity correction, rhytid softening, and tear trough effacement can be achieved through the midfacial viaducts. Systematic assessment and site-specific nonsurgical rejuvenation of the midface may lead to increased safety, accuracy, and technique reproducibility in this commonly injected region.

The authors of the manuscript “Volumizing Viaducts of the Midface: Defining the Beut Techniques” reveal their mastery of fat compartments and anatomical spaces by providing a comprehensive approach to midface rejuvenation.1 The discussion will focus on the ports, techniques, and concepts inherent in the authors’ approach to facial augmentation. The authors’ technique is a noteworthy departure from earlier attempts at midface rejuvenation that relied on en bloc repositioning of soft tissue. Rather than visualizing the midface as “malar fat,” the authors view the midface as a set of independent compartments and spaces, each of which contributes to overall morphology. Their use of ports or viaducts is a direct extension of this concept. Three ports enable access to the compartments and spaces that may require augmentation. This approach to facial rejuvenation by augmentation specifically addresses shape, support, and structure prior to augmentation of folds and creases. The authors suggest this approach improves the final dynamic result. In addition, augmentation of key regions as a preliminary step may decrease the volume required to improve some creases. The example of deep cheek fat augmentation and the nasolabial crease supports an approach directed primarily at support and secondarily at creases and wrinkles. This approach may also help to limit one of the most common unsolved problems in facial augmentation: prolonged refractory edema. If one dissects either the nasolabial crease or the vermillion white roll carefully under high power magnification, large lymphatic vessels will be noted to travel parallel within these structures. This is in keeping with the concept that creases do not occur sporadically nor in an arbitrary manner, but rather form over subsurface structures, including lymphatic vessels. Malar edema after injection of the nasojugal crease is …

The pelvis is a complex anatomical space enclosed by rigid, bony walls that encompass crucial vessels, nerves, ligaments and viscera. Resection within its narrow confines poses the risk of permanent damage to bowel, bladder, and sexual function, and subsequent deleterious effect on patients’ health and quality of life. In this chapter we describe the anatomy of the pelvis in detail, with a discussion of pelvic fascial planes, precise dissection, optimal total mesorectal excision and extended resections in the treatment of rectal and anal cancers.

The oral cavity and pharynx are anatomical spaces defined by soft and hard tissue structures. These structures act as an aerodigestive tract, and the shape of these spaces changes during speech, swallowing, and respiration. Surgical resection of tumors in oropharynx causes tissue defects and various problems, such as disturbance of mastication, deglutition, and articulation, leading to a decreased quality of life. Thus, there is a need for a reconstructive or regenerative approach to restore lost tissues and prevent postoperative complications. In oropharynx, the reconstructive approach is a mainstay of treating surgical defects so far, and there are few references in the literature regarding the regenerative approach. The reconstructive approach using free flaps has advantages in immediate covering of tissue defects without xenobiotic rejection. However, there exist problems such as the stretching ability in free flaps due to the difference of tissue characteristics. Thus, the regenerative approach should also be evolving in oropharynx.

Extra-articular elbow arthroscopy has to be considered as the evolution of the elbow surgery to a mini invasive endoscopically assisted surgery developed by the recent advance of the elbow arthroscopy. Various pathologies, such as lateral epicondylitis, ulnar nerve entrapment, distal Biceps tendon rupture, synovial cysts, or olecranon bursitis have been treated arthroscopically. Extra-articular pathologies can be treated through an intra-articular endoscopic approach. The true endoscopic extra-articular technique is proced through a real anatomical space or inside a space of work created de novo by the surgeon. The difficulty of using endoscopy in extra-articular pathologies of the elbow is related to the vasculo-nervous structures sourrounding the articulation wich are directly subject to potential injury. Elbow extra-articular endoscopy must be considered as a difficult and sometimes dangerous procedure reserved to experimented elbow arthroscopic surgeons. Those techniques are yet to demonstrate their superiority in term of results and security compare to the open techniques.

Although anesthesia and post-operative analgesia are associated with specific morbidity, regional anesthesia is not systematically given during groin hernia surgery. The goals of this work were to determine the anatomical bases of safe ilio-inguinal (II)-hypogastric anesthesia that can be prolonged into the post-operative period and to validate this technique on anatomical preparations and in clinical situations. We studied the courses of the ilio-hypogastric (IH) and II nerves in 33 halves of 20 embalmed adult cadavers. The intermediate portion of the IH and II nerves, located between the transverse and the internal oblique muscles, were found to be suitable for a simultaneous block with a single injection. We assessed the feasibility of injecting a percutaneous infiltration into this space by injecting a dye before dissection. In 75% of cases, we observed percutaneous coloring of the nerves, confirming that this site was suitable. To guide the infiltration, the points where the nerves passed through the transverse and the internal oblique muscles were located from the iliac crest and anterior and superior iliac spine, respectively. The nerve trunks were grouped for over 5 cm in a cell-fat layer running between these two deep muscles. It was possible to position a micro-catheter in this anatomical space to allow repeated injections. The results of this anatomical study were used to modify the technique so that it could be used to provide regional anesthesia in five patients operated on for hernia. Post-operative pain was very effectively controlled in four cases with no complications.

Minor surgical procedures to the inner (mucosal) aspect of the lower lip may occasionally cause numbness of the overlying skin. This study was designed to find, by means of dissection and computerized three-dimensional reconstruction, why surgical interference with nerve fibres in the deep aspect of the lip can cause neurological deficit in the superficial layers. Thirteen cadaveric lips were examined by dissection under a surgical microscope (9 lips) or serial sectioning and computerized three-dimensional reconstruction (4 lips). Muscle mass, minor labial salivary glands and nerve fibres were identified and traced. Three patterns of mental nerve distribution were seen on dissection and two on computerized reconstruction; these latter corresponded to two of the patterns seen on dissection. Fibres passing close to the labial minor salivary gland mass were seen to travel towards the superficial aspect of the lip, terminating in the dermis. It is clear that there is no safe anatomical space for minor surgical procedures to the inner (mucosal) aspect of the lower lip if avoidance of cutaneous numbness is an important consideration. However, we describe a technique that may minimize the possibility of cutaneous numbness.

The level of fit and fill of a stem in the host femur is the most critical factor for the mechanical stability and success of the prosthesis. It would be useful to have a simulation tool able to investigate the anatomical compatibility of a new implant in a large library of femoral anatomies in the early phases of the design process. In order to realise this tool, it is necessary to develop an automatic method for the positioning of the stem in a database of anatomies. The aim of this study was to develop and evaluate a method for the automatic positioning of the stem geometry in the anatomical CT dataset. Two different strategies were considered: a completely automatic registration technique and a semi-automatic method based on an anatomical referencing. The two procedures were compared to the manual positioning obtained by an expert surgeon in a set of nine CT datasets. For both methods in each femur the positioning and the orientation of the stem were good. The results showed a better level of fitting for the automatic method, while the shift of the hip joint centre was lower for the anatomical referencing technique. However, the anatomical referencing method requires a higher computational effort without being significantly better than the automatic method. For this reason, the automatic method should be chosen to develop the automatic positioning of a stem in a database of anatomies.

The muscles groups around the knee have an antigravity role and offer knee stabilization during standing position and stability in a variety of different positions. They can be classified based on their anatomic location as well as on their function. The muscles of the thigh and lower leg are comprised of compartments defined as distinct anatomical spaces bordered by fascia or bone. The knowledge of the anatomical bounders of the compartments is important especially in describing the extension of the soft tissue tumors (e.g., extra- or intracompartmental). The anterior compartment of the thigh is represented by the quadriceps muscle, the sartorius, and the tensor fascia latae. The posterior compartment includes the hamstring muscles (the semitendinosus, the semimembranosus, and the biceps femoris). The medial compartment contains the gracilis and the adductor muscles. The gastrocnemius muscles are included together with the soleus muscle in the superficial posterior compartment of the lower leg.

Background . Thoracic outlet syndrome (TOS) is one of the most poorly understood syndromes. Neurogenic TOS is found in 95% of cases. The described anatomical spaces transform and evolve into ‘entrapment spaces’. The aetiology is unclear. This study was based on the observation by a single surgeon that there appeared to be a high incidence of anatomical abnormalities in patients with neurogenic TOS. Objective. To attempt to clearly define anatomical anomalies causing TOS. Methods . The records from a prospectively maintained computer database of 219 patients submitted for surgery over a 10-year period (1999 - 2009) were reviewed. A substudy was done on the patients operated on over the last 4 years (n=63) in whom details of the intraoperative anatomical findings were meticulously recorded. Results. Over the last 4 years, the surgical findings in the last 63 patients (67 operations) revealed a significant number of anatomical abnormalities believed to be responsible for the nerve compression. Brachial plexus anomalies were found in 99% of the patients – the majority comprised the postfixed configuration. In addition, 58% had a soft-tissue anomaly, 27% had a bony anomaly and 3% had other abnormalities. The majority had combinations of these abnormal findings. Conclusion . These findings strongly suggest that there is usually an identifiable anatomical cause, typically the brachial plexus, for the symptoms of TOS. We strongly recommend that the supraclavicular approach be used in order to define anatomical aberrations. Brachial plexus configuration anomalies causing TOS have not been emphasised previously. Further detailed recordings of these findings may help us better understand the aetiology of this poorly defined syndrome.

The pelvic floor is a complex interrelated structure of muscles, ligaments, and fascia with multiple functions. These functions concern support of visceral organs, maintaining continence, facilitating micturition and evacuation, as well as forming part of the birth canal. This multifunctional unit has connections to the bony pelvis, to organs, and to the extensive fibroelastic network in the fat-containing anatomical spaces.

The main goal of our dynamic 3D computer-assisted reconstruction of a metallic retrobulbar foreign body following orbital injury with ethmoid bone involvement was to use 3D-information obtained from standard computed tomography (CT) data to explore and evaluate the nasal cavity, ethmoidal sinuses, retrobulbar region, and the foreign body itself by simulated dynamic computed visualization of the human head. A foreign body, 10 x 30 mm in size, partially protruded into the posterior ethmoidal cells and partially into the orbit, causing dislocation and compression of the medial rectus muscle and inferior rectus muscle. The other muscles and the optic nerve were intact. Various steps were taken to further the ultimate diagnosis and surgery. Thin CT sections of the nasal cavity, orbit and paranasal sinuses were made on a conventional CT device at a regional medical center, CT scans were transmitted via a computer network to different locations, and special views very similar to those seen on standard endoscopy were created. Special software for 3D modeling, specially designed and modified for 3D C-FESS purposes, was used, as well as a 3D-digitizer connected to the computer and multimedia navigation through the computer during 3D C-FESS. Our approach achieves the visualization of very delicate anatomical structures within the orbit in unconventional (non-standard) sections and angles of viewing, which cannot be obtained by standard endoscopy or 2D CT scanning. Finally, virtual endoscopy (VE) or a 'computed journey' through the anatomical spaces of the paranasal sinuses and orbit substantially improves the 3D C-FESS procedure by simulating the surgical procedure prior to real surgery.

Interindividual topographical variability of cytoarchitectonically defined somatosensory areas 3a, 3b, and 1 was analyzed in the standard anatomical format of a computerized brain atlas. T1-weighted magnetic resonance images were obtained from 10 postmortem brains. The brains were serially sectioned at 20 mcm, sections were stained for cell bodies, and areas 3a, 3b, and 1 were defined with an observer-independent cytoarchitectonic technique. After correction of the sections for deformations due to histological processing, the 3-D reconstructed histological volumes of the individual brains and the volume representations of the cytoarchitectonic areas were adapted to the reference brain of a computerized atlas. Corresponding areas were superimposed in the 3-D space of the reference brain. These population maps describe, for each voxel, how many brains have a representation of one particular cytoarchitectonic area. Each area's extent is very variable across different brains, but representations of areas 3a, 3b, and 1 in >/=50% of the brains were found in the fundus of the central sulcus, its caudal bank, and on the crown of the postcentral gyrus, respectively. Volumes of interest (VOIs) were defined for each area in which >/=50% of the brains have a representation of that area. Despite close spatial relationship of areas 3a, 3b, and 1 in the postcentral gyrus, the three VOIs overlap by

The meaning and usefulness of the phrase "an anatomical space" are questioned. The concept of anatomical space is examined from historical, developmental, and topographical viewpoints. The validity of the idea and usage of the term "potential space" is discussed. The criterion of Haines (1991) is adopted, that only "spaces" or "cavities" that are lined with a "mesothelial" layer and that can repeatedly be opened up without tissue damage should be considered "true potential spaces." A plea is made that all other anatomical "spaces" be designated "compartments."

Effective local regional control for solid tumor malignancies is dependent upon prerequisite surgical excision with negative margins. Invasion of contiguous adjacent structures, particularly in anatomical spaces of limited size, may preclude the surgical goal of histologically negative margins. From a historical perspective, the invasion of vascular structures in the pelvis has proved to be a significant limitation in achieving local regional disease control with surgical resection. In recent years, advances in the field of vascular surgery have caused us to reassess the historical criteria of resectability when blood vessels are focally invaded by malignancy. En bloc resection of adjacent vessels has been reported primarily with head and neck extirpations and increasingly with hepatobiliary and pancreatic lesions. In many cases, where the local vasculature is invaded or impinged by the tumor, venous structures are often ligated while arteries are bypassed with an appropriate conduit. In pelvic exenterative surgery, significant morbidity from chronic limb edema and deep venous thrombosis may result from the ligation of larger veins. This is especially the case when multiple major venous structures such as the common and the external iliac vein, as well as the hypogastric vein, are all simultaneously interrupted. To the best of our knowledge, there is no prior report examining venous reconstruction using the femoral vein for pelvic exenterative surgery requiring major iliac artery and venous resection. Herein we describe a case of a complex vascular reconstruction after pelvic exenterative surgery in a patient with recurrent rectal cancer invading multiple adjacent contiguous structures, including the iliac vessels.

Positron emission tomography (PET) is valuable for assessing the biochemistry and physiology of the human brain. A computerised brain atlas has been developed which allows demonstration of anatomical regions of PET images and manipulation of these images into a standardised anatomical space. Once the images are in this standardised three-dimensional space it is possible to make comparisons between individuals and groups of individuals. We describe the use of this atlas in the generation of a set of mean reference images using methionine PET images of normal volunteers.

International audience; INTRODUCTION:Cerebral arteriovenous shunts (CAVS) in the pediatric population cannot be compared to those in adults as they present different anatomical, physiological, and pathological characteristics concerning the arterial and venous vasculature and the cerebrospinal fluid physiology. These lesions develop in a maturing brain, of which expression is difficult to assess, with a potential for recovery different from that in adults.DISCUSSION:Their impact on the brain will be different in the antenatal period, in neonates, in infants, and in children, with variable symptoms according to each age group. We review different classifications of pediatric CAVS (according to the anatomical space in which they develop, their type and architecture, and the age at which they reveal), describe their evolution, and discuss the current role of endovascular treatment in the management of these vascular lesions.

The compartment syndrome is a condition characterized by a raised hydraulic pressure within a closed and non expandable anatomical space. It leads to a vascular insufficiency that becomes critical once the vascular flow cannot return the fluids back to the venous system. This causes a potential irreversible damage of the contents of the compartment, especially within the muscle tissues. Gluteal compartment syndrome (GCS) secondary to hematomas is seldom reported. Here we present a case of a 51-year-old patient with history of a non-Hodgkin lymphoma who underwent a bone marrow aspiration from the posterior iliac crest that had excessive bleeding at the puncture zone. The patient complained of increasing pain, tenderness, and buttock swelling. Intraoperative pressure validation of the gluteal compartment was performed, and a GCS was diagnosed. The patient was treated with a gluteal region fasciotomy. The patient recovered from pain and swelling and was discharged shortly after from the hospital. We believe clotting and hematologic disorders are a primary risk factor in patients who require bone marrow aspirations or biopsies. It is important to improve awareness of GCS in order to achieve early diagnosis, avoid complications, and have a better prognosis.

Continuous attention has been developed on the anatomical variations of the axilla in anatomist and surgeon due to their clinical importance. The axillary region is an anatomical space between the lateral part of the chest wall and the medial aspect of the upper limb. During the routine dissection of embalmed cadavers, we found variant muscular slip originating from the lateral border of tendinous part of the latissimus dorsi and continuing 9 cm more crossing the axilla. And then, it inserted into the superior margin of the insertion of the pectoralis major. We considered this muscular variation as axillary arch muscle. Correct identification of the relevant anatomy and subsequent simple surgical division is curative, paying special attention to anatomical variations in this region and its clinical importance due to its close relationship to the neurovascular elements of the axilla.

The accidental tooth displacement into adjacent anatomical spaces is rare but potentially serious complication of impacted third molar extraction. A few cases of accidental displacement of third molars into anatomical spaces, such as the infratemporal fossa, the pterygomandibular space, the maxillary sinus, or the lateral pharyngeal space, during surgical interventions have been reported. In this paper, a case of a mandibular third molar accidentally displaced into the submandibular space in a 24-year-old male patient is presented. Delayed presentation resulted in infection and trismus which were controlled by antibiotic therapy and the displaced tooth recovered under general anesthesia.