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Background: Medial fasciocutaneous flaps, which are based on the femoral artery from the thigh region, are used for wide inguinal, scrotal, vaginal, perineal, leg, head and neck defect reconstructions in injured human patients. Within this regard, anatomical knowledge about perforating and cutaneous branches of the femoral artery is important for the surgeons.Materials and Methods: In the present study, vascular pedicles of the medial thigh perforator flap based on the femoral artery were investigated according to anatomical and surgical landmarks. Human Caucasian preserved cadavers of 15 adults (13 males, 2 females; age range 55-82 years: 30 sides, bilaterally) that were previously formalin fixed were subjected to our analytical examinations. Micro dissections were performed under 4× loop magnification while representing the perforating branches of the femoral artery after filling by coloured latex injection via the external iliac artery.Results: The size and length parameters of these branches which appeared around the apex of the femoral triangle were evaluated. The mean size of the perforating branch at the point of origin was 0.14 cm and the mean size of the cutaneous branch at the point of origin was 0.09 cm, the mean length of the pedicle was 4.74 cm and the mean length of the cutaneous branch was 3.30 cm, respectively. Location of the perforating and the cutaneous branches were also determined according to the surgical landmarks such as the anterior superior iliac spine, inguinal ligament, pubic tubercle and interepicondylar line.Conclusions: The pedicle of the medial flap should locate up to 25 cm from the anterior superior iliac spine so as to preserve the vascular structures. Exact location of this artery helps the surgeons to perform anastomosis in an easier and safer manner during surgical operations. [ABSTRACT FROM AUTHOR]

The saphenous flap is a fasciocutaneous flap generally used for knee and upper third of the leg coverage. Due to various descriptions of the saphenous flap, such as venous, sensory, and free flap, the origin and distributing characteristics of the saphenous artery are important for plastic surgeons. The aim of this cadaveric study was to evaluate the anatomical features of the saphenous flap. The pedicles of the saphenous flap were dissected under 4× loop magnification in thirty-two legs of 16 formalin-fixed adult cadavers. The findings of this anatomic study were as follows: Descending genicular artery originated from the femoral artery in all of the cases. The first musculoarticular branch, which arose from descending genicular, to the vastus medialis muscle existed in all dissections. The second branch was the saphenous artery which seperately originated from the descending genicular artery in all of the cases. At the level of origin the mean diameter of the saphenous artery was found to be 1.61 mm. The muscular branches to the anterior or posterior sides of the sartorious muscle existed in all of the dissections. Two vena comitantes and a saphenous nerve were accompanying the saphenous artery in all cadavers. The mean distance between the origin of the artery and interepicondylar line of tibia was 115 mm. The muscular branches of the saphenous artery to the gracilis muscle were encountered 6.66% of the cases. The cutaneous branches numbered between one and four, and arose 3.5 to 9.5 cm from the site of origin of the saphenous artery. The distal end of the saphenous artery reached approximately 122 mm distally to the knee joint in all cases. Due to variations of the arterial anatomy and limited number of anatomic studies of the saphenous flap, we studied the topography and anatomy of the saphenous artery for increasing reliability of the saphenous flap. [ABSTRACT FROM AUTHOR]

Brain balance changes have been recognised in migraine, but cerebellar function between or during attacks has been assessed only in a few studies. Previous studies have indicated that migraine affects cerebellar function. In the present study we aimed to evaluate the hemicerebellar volume changes of patients with migraine without aura (MWoA). Volumetric changes of cerebellar hemispheres were evaluated in terms of asymmetry using stereological methods on magnetic resonance images (MRI) retrospectively. Nineteen patients with MWoA and 18 age- and gender-matched control subjects were included in the study. MRIs were analysed by using the point-counting approach of stereological methods by Cavalier's principle. There was no statistically significant cerebellar atrophy or hemicerebellar asymmetry between the MWoA and control subjects. There was no cerebellar atrophy or asymmetry between the MWoA and age-matched control group. The stereological evaluation of cerebellar asymmetry and atrophy in humans is important for both clinicians and anatomists. The technique is simple, inexpensive, and reliable. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Alzheimer's disease (AD) is the most common cause of dementia and, as previous studies have indicated, degenerative changes in the cerebellum occur in AD. It is well known that the cerebellum does not have a symmetric morphology and some pathological disorders, such as schizophrenia, epilepsy, autism and alcoholism, can cause asymmetrical changes in the cerebellum. In this study, we aimed to evaluate whether or not patients with AD show cerebellar asymmetry. We also intended to depict the probable volumetric asymmetry by using a stereological technique. MATERIALS AND METHODS: The study evaluated the volumetric measurements of each cerebellar hemisphere by applying a stereological method to MR images. This age- and gender-matched study was composed of 15 patients with probable AD and 14 healthy subjects (controls). MR images were analyzed by using the point-counting approach, holding to Cavalieri's principle. RESULTS: Although there was significant cerebellar atrophy in AD patients, the study showed no statistically significant cerebellar asymmetry according to age and gender, both in the study and control groups (p > 0.05). CONCLUSIONS: There was no difference in cerebellar asymmetry associated with age and gender between the AD patients and control subjects. The stereological evaluation of cerebellar asymmetry correlating with gender is of importance to both clinicians and anatomists. The technique is simple, inexpensive, reliable and unbiased. [ABSTRACT FROM AUTHOR]

Objective: To compare whether there are any differences between the 3 methods used for measure area of foramen magnum (FM) in skulls., Methods: The FMs of 150 skulls were examined. Antero-posterior diameter, transverse diameter were measured using by Vernier caliper. The area of the FM was calculated by using 2 different formulas as described previously by Radinsky and Teixeira.The authors also applied stereological assessment method for estimating the surface area of FMs. The area was calculated 3 times manually using stereological point grid system for each skull.The authors compared the mean surface area of FMs obtained from each of these 3 methods estimating surface area of FMs whether there were any significant differences in between their results., Results: The mean areas of the FMs estimated according to Teixeria formula, Radinsky formula, and Cavalieri stereological method were respectively as follows: 790.47 ± 99.86 mm, 783.66 ± 99.34 mm, and 748.06 ± 100.19 mm. The authors observed significant differences (P < 0.05) in between the mean surface areas of FMs obtained from each of these 3 methods used for estimating the area., Conclusion: There were significant differences (P < 0.05) in between the mean surface areas of FMs obtained from each of these 3 methods used for estimating the area.

Anatomic variability and anastomosis of the angular artery of the facial artery with the other arteries are important for both anatomists and surgeons. In particular, the angular artery is a significant landmark in dacryocystorhinostomy. Because of variations on anatomy of the angular artery, there are limited numbers of anatomic studies on the flaps of facial region. Hence, the aim of the cadaveric study was to evaluate the anatomic features of the angular artery in detail to help surgical procedures.The artery was represented under ×4 loop magnification in 32 sides of 16 formalin-fixed adult cadavers. The angular artery's position, diameter, and branch patterns relevant to the nose arterial supply were evaluated. The facial artery ended symmetrically in 10 (62.5%) of the cadavers. The facial artery was terminated as angular artery in all of the cases. The types of the angular artery were as follows: classical angular type in 8 cases (25.0%), nasal type in 15 cases (46.9%), alar type in 4 cases (12.5%), and labial type in 5 cases (15.6%) on the facial halves. We studied the topographic anatomic features of the angular artery for increasing reliability of the flaps on the region. The angular arterial anatomic details are critical and essential for surgical cosmetic and functional results.

Cerebellum is responsible to higher cognitive functions and delicate motor activity. Because of its significance, cerebellum may play a major role in cognitive, behavioral, and psychiatric diseases. Therefore, the investigations on cerebellum may be contributed to the future researches so as to solve reasons of the diseases. The rabbit brain relatively larger than the rat and mouse brain and the individual evaluation of its subdivisions are rather easy. There are no data on cerebellar volume of rabbits in literature. Thus, the study presents microscopic volume calculation of rabbits' cerebellum using the stereological method. The mean (SD) calculated volume of the cerebellum in the rabbit brain was found to be 0.69 (0.03) cm3. The individual microscopic volume estimation of an animal subject can be achieved by Cavalier method. Researchers believed that the findings and the applied method in this study may be useful for the scientists.

The application of stereologic techniques to the analysis of the nervous system has greatly contributed to the evaluation of the normal and pathological anatomy of the aging brain. Currently, the hippocampus still holds secrets about the aging process. Experimental researches on hippocampus morphology may contribute to the future researches. This study presents the volume and weight of left hippocampus using a stereological technique on light microscope. The mean weight of the encephalon without cerebellum was 6.1 ± 0.1 g. The mean weight and the volume of the hippocampus were (mean ± SD) 0.28 ± 0.02 g and 0.28 ± 0.02 cm3, respectively. The mean coefficient of error for the stereological volume estimation of the hippocampus was 0.03. The individual volume estimation of the subjects may be achieved by the Cavalieri method. Investigators believed that the findings and the applied technique in this study may be useful for clinicians.

The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Discoid lateral meniscus is a rare disorder and its association with other variations in the knee joint has been reported. The anterior intermeniscal ligament has also been described as connecting the anterior convex margin of the lateral meniscus to the anterior horn of the medial meniscus. In the normal population, it was observed at 53-94%. Although the functional properties of the anterior intermeniscal ligament are not yet clarified, two distinct types of the ligament have been described according to their morphological characteristics as cord-like and membranous types. The purpose of this study was to evaluate any possible association between morphologic types of anterior intermeniscal ligament and discoid lateral meniscus. A retrospective study was designed; 20 discoid lateral menisci were operated using routine arthroscopic examination. Upon arthroscopic examination the thickness of the ligament and associated morphological changes were recorded systematically. The cord-like anterior intermeniscal ligament was an associated structure in 15 of the 20 knees with discoid lateral meniscus (75%). Patients with discoid lateral meniscus apparently have cord-like type anterior intermeniscal ligament, thus we conclude that cord-like type of anterior intermeniscal ligament is a frequent accompanying structure to discoid lateral meniscus and may have a potential stabilizing effect on its anterior stability.

Objective: To evaluate cerebellar volume changes and the asymmetry of patients with benign paroxysmal positional vertigo (BPPV)., Methods: The cerebellar hemispheres` volumetric symmetry were evaluated using a stereological method on MR images. The study included 15 patients with BPPV, and 14 age-, and gender-matched control subjects. The cases were admitted to the Departments of Otolaryngology, Neurology, and Neurosurgery in the Faculty of Medicine, Kocatepe University, Afyonkarahisar, Turkey with the complaint of vertigo between January 2004 and December 2008., Results: The right hemi cerebellum volumes of the subjects with BPPV and the controls were measured smaller than the left hemi cerebellar volumes, however, there was no statistically significant quantitative evidence detected in terms of cerebellar asymmetry between sagittal and axial plane estimates in the cases with vertigo. There was statistical significance between the right and left cerebellum in both the patient and control groups (p=0.023), however, the difference did not change according to gender. There were no statistically significant age and gender dependent cerebellar atrophy and asymmetry between BPPV and control subjects., Conclusion: There was no cerebellar atrophy and asymmetry between BPPV and age matched control groups. The stereological evaluation of hemi cerebellar symmetry and atrophy in humans is important for both clinicians and anatomists. The technique is simple, inexpensive, and reliable.

Metastatic tumors presenting as soft tissue lesions are relatively rare, and can be the source of diagnostic confusion both clinically and histopathologically. We present a case of an 82-year-old woman with complaints of painless swelling in the right temporo-occipital junction for 3 months, and with unusual scalp metastasis of thyroid follicular carcinoma. Use of histopathological examinations are significant for determining the tumor type, and arriving at the exact and correct diagnosis.

The use of technology in the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. It has been extensively studied in combination with various techniques for spinal stabilization from both the anterior and posterior approach. Minimally invasive and instrumental approach via posterior fixation is increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar vertebrae. Posterior access to the lumbar disc spaces for posterolateral fusion scan has been technically challenging, frequently requiring the use of an approach surgery for adequate exposure. For successful surgery and suitable instrumental design, adequate anatomical knowledge of the lumbar vertebra is also needed. Anatomic features of lumbar vertebrae are of importance for posterior screw fixation technique. The morphometry of L1-L5 has been studied to facilitate the safe application of pedicle screws. Thus, we aimed to evaluate the morphometric landmarks of lumbar vertebrae such as pedicle, vertebral body, vertebral foramen, intervertebral space height and volume for safe surgical intervention using a posterior fixation approach to offer anatomical supports for lumbar discectomy, stenosis and cases of deformity. The features of the L1-L5 vertebral body, the detailed morphometric parameters of lumbar vertebrae and the intervertebral space were analyzed using computerized tomography scan, magnetic resonance imaging and also dry lumbar vertebrae. Additionally, intervertebral space volumes were measured using stereological methods to ensure safe surgical intervention., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

Migraine is associated with an increased risk of deep white matter lesions and subclinical posterior circulation infarcts. A significant association between deep white matter hyperintensities and cerebral atrophy is true for various neurological diseases; it was not specifically proven in migraine. The aim of this study was to evaluate the cerebellar and cerebral volume and volume ratios for cerebellum using the Cavalieri principle. We also aimed to examine whether migraine with aura causes cerebellar and cerebral atrophy. Twenty three right-handed patients with migraine with aura diagnosed by means of the International Headache Society criteria and 24 age-matched subjects whose only health problem was headache due to rhinosinusitis and tension type headache were included in the study. Measurements of the cerebellar and cerebral volumes as well as cerebellar/cerebral volume ratios were made using Cavalieri's principle by utilizing the point-counting methods. There were no significant differences between the volumes of cerebrum, cerebellum, and the ratio of cerebellum to cerebrum for males (p = 0.05, p = 0.10, and p = 0.64, respectively) and for females (p = 0.18, p = 0.89, and p = 0.24, respectively). Our results suggest that patients with migraine with aura do not have a significant difference in cerebellar and cerebral volumes and cerebellar/cerebral volume ratios compared to the non-migraine group.

Osteochondroma is a benign tumor that is unusual in the maxillofacial region. Anatomy of the region, especially the mandible, is important for surgical intervention for the condylar osteochondroma. The present case report describes evaluation of condylar hyperplasia with emphasis on the advantages and disadvantages of sterolithographic solid model and stereologic techniques for preoperative surgical planning, operation time, and prognosis. Condylar osteochondoma was diagnosed by panoramic radiograph and 3-dimensional computerized tomography (3DCT) as well as histopathologic analysis in a male patient. Before surgery, a stereolithographic model was created and stereologic method was used based upon 3DCT.

The anatomical structure of the maxillary sinus is fundamental to maxillofacial surgery. The presence of septa, located at the inner surface of the maxillary sinus, increases the risk of sinus membrane perforation during sinus elevation for dental implant surgery. The aim of this study was to evaluate the anatomy of maxillary sinus septa.Data in this study was obtained from a total of 205 cases. One hundred and seventy-seven patients were partially edentulous (PE) whereas 28 patients had no teeth. Dental computerized tomography (dental CT) was used in the assessment of 410 sinus segments (205 left and 205 right segments). The prevalence of sinus segments with septa was found to be 145/410. Septa were detected in 91 of the 177 PE cases. There were a total of 26 septa in 18 of the 28 completely edentulous (CE) cases. A total of 165 septa were detected in these segments. The prevalence of septa was 46.4% (26/56) in the CE, and 39.2% (139/354) in the PE segments. Thirty septa were found in the anterior, 110 in the middle and 25 in the posterior region. All detected septa were located mediolateral direction. Their relative position: lateral, middle or medial were also noted. The height measurements of the septa varied amongst the different positions. In view of the fact that septa of various heights and courses can develop in all parts of the maxillary sinus, timely and adequate assessment of the inner aspect of the maxillary sinus is essential to avoid complications during sinus augmentation procedures., (Copyright 2009 Wiley-Liss, Inc.)

Objectives: The protection of microcircular support which is essential for healing gains importance if implant surgery is considered to affect the blood flow. The aim of the study is to establish the artery territories supplying the blood into the oral mucosa in the cadavers and to demonstrate the mucosal delivery pattern and to evaluate the effects of different incision types on the healing in the patients having the implant application., Materials and Methods: The study was planned in two stages as cadaver and clinical investigations. In cadaver investigation, all intra oral vascular territories were shown in ten specimens. The arterial structure and mucosal vascularity of the area were assessed microscopically and macroscopically. With the obtained data, the clinic results were established by making the crestal incision only for Group 1 (n = 30); both crestal and vertical releasing incisions for Group 2 (n = 30) were planned., Results: The results were established anatomically and clinically. In all cases, vascular territories of the mucosa in the maxilla and mandible were evaluated. In stereo microscopic assessment, although vestibule and oral mucosa had rich anastomoses, the crestal line had avascular features. There was no complication in the soft tissues of the cases, performed the vertical releasing incision during the healing period after 8-week follow-up., Conclusion: The vascular richness of the oral mucosal area enables the sufficient healing in the areas of applied flap. According to the alveolar anatomical pattern and the amount of the soft tissue over it, the incisions may be applied horizontally and/or vertically.

Objectives: Age-related volumetric differences in brain anatomy or volumetric brain analyses in many disorders are of interest. Delineating the normal anatomical cerebellar volume is of importance for both the anatomists and clinicians. In the present study, we aimed to evaluate the cerebellar volume using a stereological technique and to determine the possible volumetric asymmetry depending on age and gender., Materials and Methods: Volumetric asymmetry of cerebellar hemispheres was evaluated using stereological method on the magnetic resonance images (MRI) of healthy male and female subjects. Randomly selected individuals (27 males, 27 females) aged between 10-86 years who have normal brain MRI were enclosed in the study. All the subjects were right handed. The individuals were divided into three groups according to age as 18-34 (young), 35-60 (middle aged) and 60-84 (elder) and their MRI images were analyzed. The data set were analyzed by two factor repeated measure analysis., Results: Although the cerebellum was smaller between young and middle aged groups and also middle aged and elder groups, there were no any statistically significant differences between compared groups' mean (P > 0.05). There were not statistically differences according to sex and age groups (P > 0.05)., Conclusions: There was no cerebellar asymmetry between compared groups. The stereological evaluation of cerebellar asymmetry in humans correlate with both gender and age groups is of importance for both clinicians and anatomists. The technique is simple, reliable, unbiased and inexpensive.