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Recent studies have revealed that there is existence of a specific waste clearance pathway in the brain, coined the glymphatic system. This case report demonstrates supportive finding of drainage of Gadolinium and waste products released after Laser Interstitial Thermal Therapy via perivenous routes and a paradural lymphatic system. These findings provide further evidence of interstitial fluid drainage along the perivenous spaces in accordance with a glymphatic system theory.

Background Psoriatic arthritis (PsA) is a systemic chronic inflammatory disease associated with psoriasis. Neuropathic pain is defined as pain which is produced by a primary lesion or dysfunction of peripheral or central nervous system. Objectives The aim of this study is to investigate the neuropathic pain component of chronic joint pain in psoriatic arthritis and to detect its correlation with disease activity and functional capacity. Methods During the patients9 routine outpatient clinic visit, we gain information about patients9 demographics. We used Pain Detect questionnaire to detect neuropathic pain component, Visual Analogue Scale for joint pain, Disease Activity Score 28-Joint (DAS28) for disease activity evaluation and Health Assessment Questionnaire (HAQ) for functional capacity evaluation. Results There were 48 PsA patients and 34 control patients in this study. Mean age was 52 (21–79), mean BMI is 27.5 kg/m2 (20.8–53) and mean disease duration was 5 year in PsA group. Mean age was 54 (20.8–53), mean BMI was 27.6 kg/m2 (20.8–53) in control group. Neuropathic pain component was positive in 22.9% of PsA and negative in 45.8% of PsA and unclear in 31.2% of PsA group. In control group, neuropathic pain component was positive in 35.3% of patients and negative in 41.2% of patients and unclear in 23.5% of patients. Mean pain detects score was 13 in PsA and 14 in control group. There was no statistically important difference between the PsA and control group9s neuropathic pain prevalence (p=0.601) and mean PD score (p=0.24). Mean DAS 28 score was 3.5 (1–3.56) and mean HAQ score was 0.65 (0–2.05) in PsA group. There was a statistically important positive correlation between the PD score and HAQ score in PsA patients (Ro=0.460, p=0.001). In addition, there was a statistically unimportant positive correlation between the PD score and DAS28 score in PsA patients. There was a statistically unimportant positive correlation between the PD score and HAQ score in control group (Ro=0.411, p=0.016). Conclusions We detected neuropathic pain component in 22.9% of PsA patients but there was no difference between the PsA group and control group. Diagnosis of concomitant neuropathic pain by Pain Detect Questionnaire may be useful for pain management in PsA patients. Disclosure of Interest None declared

Aim: The purpose of the present study was to investigate functional responses and nitric oxide synthase activity in the corpus cavernosum of young control, middle-aged control and middle-aged non-insulin dependent diabetic rats. Methods: The animal groups were treated with ascorbic acid. Results: Acetylcholine-mediated endothelium-dependent relaxation of cavernosal tissue was significantly attenuated from a maximum of 58.0 ± 4.1% (1 mmol, n = 10) in young rats to 44.3 ± 1.6% in aged-matched controls (P

SummaryA decision-analysis model was constructed to assess total direct health care costs of four current first-line treatment options for mild-to-moderate bleeding episodes in haemophilia patients with inhibitors in Turkey: recombinant activated Factor VII (rFVIIa); high-dose Factor VIII; prothrombin complex concentrate (PCC); and activated PCC (aPCC). Resource utilisation was based on a retrospective analysis of 105 bleeding episodes treated during the period January 1996 to December 2002. Clinical outcomes were derived from a combination of the retrospective patient data and literature review, both validated by an expert panel of Turkish haematologists. rFVIIa was more effective and resolved bleeds more quickly than any of the alternatives. rFVIIa and PCC were associated with similar direct treatment costs that were relatively lower than those compared with the other options. Given the better efficacy, rFVIIa should be considered the preferred treatment option in the management of haemophilia patients ...

Trochlear nerve palsy has been based on head trauma, various inflammatory and infectious disorders, vascular diseases and neoplasms. In many cases cause of the nerve palsy unclear. We examined in relationship of the superior cerebellar artery (SCA) with the trochlear nerve in 35 cadaveric brains. The trochlear nerves were in contact with main trunk of the SCAs or its branches in all hemispheres. The anatomic relationships between the SCA and the trochlear nerve were observed in this study.

The proximity of the vertebral artery (VA) to the odontoid process makes it vulnerable to injury during surgery. Knowledge of the quantitative anatomy of the VA groove is therefore necessary. In this study we assessed the spatial relationship between the VA and the odontoid process on cadavers by direct measurement and in patients by CT angiography. Our goal was to measure the distances from the VA and vertebrobasilar junction to the odontoid tip. The VA and odontoid process of 10 craniocervical cadavers ("cadavers") and of 20 patients were evaluated and average measurements obtained. The measured parameters were: (i) distance from the right VA to the odontoid tip (right VA-odontoid tip); (ii) distance from the left VA to the odontoid tip (left VA-odontoid tip), and (iii) distance from the vertebrobasilar junction to the odontoid tip (vertebrobasilar-odontoid tip). On the cadavers, the right VA-odontoid tip distance was 11.55mm, the left VA-odontoid tip was 11.02mm, and the vertebrobasilar junction-odontoid tip distance was 24.55mm. In patients, using CT angiography, the right VA-odontoid tip distance was 11.47mm and the left VA-odontoid tip distance was 11.50mm. The VA-odontoid tip distance is important in anterior odontoid approaches. Since the odontoid process may be in close contact with the VA, the relationship between them should be evaluated preoperatively in all candidates for odontoid surgery using three-dimensional CT angiography.

Methylxanthines (theophylline, theobromine and caffeine) are widely used as central nervous system stimulants and caffeine is used in the treatment of apnea in newborns. Plasma therapeutic concentration of caffeine is around 110 microM. Caffeine diffuses the blood brain barrier easily, increasing oxygen consumption in neurones and leading to cell death. In the present study, 4-7-day-old rats were used to obtain cerebellar granular cell cultures. Caffeine was used 50, 150, 250 and 350 microM concentrations and the most toxic dose for it was found to be 350 microM. Death cell scores were 0.9+/-0.63 for control, 1.1+/-0.63 for 50 microM, 0.89+/-0.47 for 150 microM (P0.05 for both), 3.84+/-0.8 for 250 microM (P=0.024) and 6.2+/-0. 86 for 350 microM (P=0.001) caffeine concentrations. The role of voltage-dependent calcium channels in caffeine-induced neurotoxicity was tested with the doses of 100 and 200 microM nimodipine 45 min before or after the 350 microM caffeine. Both doses of nimodipine after caffeine administration were found to be ineffective in blocking neurotoxicity. Doses administered 45 min prior to caffeine, reduced death cell score to 0.89+/-0.23 (P=0.000) for 100 microM nimodipine and 2.35+/-0.96 (P=0.000) for 200 microM nimodipine administration into the cultures. A dose-dependent manner of nimodipine in ischemic states is well-known. In the light of these results, nimodipine may be used in the treatment of newborn apneas together with caffeine to prevent neurotoxic side effects of high or repeated doses of it.

To study the prevalence of the usage of herbal medicines among cancer patients.This study was carried out between October 1, 2009 and May 31, 2011, by using face-to-face interviews with cancer patients attending oncology departments (clinics and outpatient clinics, chemotherapy units). A special questionnaire was filled in during the interviews.Of the patients 68.2% reported usage of herbal medicines, 66% stated that their usage of herbal medicines was based on the media and the Internet as a source and 64% stated that they received information about herbal medicines from relatives and friends. Only 24% of herbal medicines users had consulted or discussed their use with a physician.In Turkey, especially among cancer patients, there is a high prevalence of complementary and alternative medicine (CAM) usage and the most commonly used form of CAM is herbal medicines. This prevalence has also been found to be high in our research as well. Due to the probable side effects and potential drug interactions of herbal agents, all cancer patients should be asked about their use of herbal medicines.

Review on MIR125B2 (microRNA 125b-2), with data on DNA, on the protein encoded, and where the gene is implicated.

Review on MIR125B1 (microRNA 125b-1), with data on DNA, on the protein encoded, and where the gene is implicated.

Review on MIR125A (microRNA 125a), with data on DNA, on the protein encoded, and where the gene is implicated.

To retrospectively evaluate the management and clinicopathologic predictors of outcome of adenoid cystic carcinoma (ACC) patients treated and followed at our Department.Data on 41 patients treated between 2000 and 2006 at the University of Istanbul, Institute of Oncology, were reviewed. Factors affecting recurrence, distant metastasis and survival were evaluated.There were 22 (53.6%) major salivary and 19 (46.3%) minor salivary gland tumors. Eighteen patients (43.9%) had solid histologic type tumor. Twenty-one (51%) patients had perineural invasion and 28 (68.2%) high grade tumors. Sixteen (39%) patients had stage I disease, 12 (29.1%) stage II and 13 (31.5%) stage III. Thirty-two patients (78.4%) had radical and 9 (21.9%) partial resection. Thirty-one patients (75.6%) received adjuvant postoperative radiotherapy (RT). Eight patients (19.5%) suffered locoregional relapse and 9 (21%) distant metastases. Two patients (4.8%) died from ACC and 7 (17%) from other causes. The median follow-up was 48 months (range 24-60). Disease free survival (DFS) at 2 and 3 years were 78% and 58%, respectively. Overall survival (OS) at 2 years and 3 years were 87% and 80%, respectively. Median time to locoregional relapse and distant metastasis was 28 and 32 months, respectively. Seven of 9 patients with distant metastasis had solid tumor subtype. Distant metastasis occurred more frequently in patients with tumors of major salivary glands (66%). Sites of distant metastasis were lung alone (n=5), bone alone (n=2) and 2 patients had both lung and bone metastasis. There was no statistically significant relationship between clinical T stage and solid histology with locoregional relapse (p0.05). Surgical resection type and perineural invasion were significant prognostic factors for locoregional relapse (p=0.03). T stage (p=0.001), grade (p=0.02) and solid histology (p=0.003) were prognostic factors associated with DFS. Prognostic factors associated with OS were grade (p= 0.001), clinical T stage (p=0.02), solid histology (p=0.01), radical excision (p=0.04) and perineural invasion (p=0.001).ACC is a neoplasm in which early diagnosis is important because it is a slow-growing tumor producing diffuse invasion. Distant metastasis and locoregional relapse can be predicted by solid histologic subtype, high grade, type of surgery, perineural invasion and tumor stage. The most frequent sites of metastasis are lung and bone.

Unilateral chewing habit is common in dentate popula- tions. It may initiate a hypertrophy process in the lateral pterygoid muscles compared with the nonused sides. We hypothesized that the lateral pterygoid muscles of the affected sides would be larger in volume than those of the nonaffected sides in subjects with unilateral chewing habit. Because analysis of medical images in accordance with the rules of modern stereology enables precise unbiased esti- mates of muscle volume, and magnetic resonance imaging (MRI) is a criterion standard as an imaging modality for the analysis of muscles because of its excellent soft-tissue resolution, we estimated lateral pterygoid muscle volume both at right and left sides using stereologic techniques (Cavalieri principle) by means of MRI. The MRI-estimated volumes of both the inferior and the superior heads of the lateral pterygoid muscle at the chewing side were significantly greater than the opposite side when compared. This finding may assist in the interpretation of lateral pterygoid muscle and tempo- romandibular jointYrelated problems in maxillofacial surgery clin- ics. This investigation has also demonstrated that systematically sampled MRI slices through the lateral pterygoid muscle can be used to obtain unbiased estimates.

To study the prevalence of Behçet's disease (BD) in a rural area of Western Turkey.This study was conducted in seven villages in the rural Havsa region which has a total population of 5727. The physicians and medical students visited every household and distributed a questionnaire on the symptoms of rheumatic disorders. One of the questions was whether they had ever suffered from mouth ulcers. If the response was affirmative the proband was examined by a rheumatologist and a dermatologist for other symptoms. The individuals with true aphthous ulcerations had pathergy tests and were invited to the hospital for ophtalmic examinations.Of the 5203 individuals who participated in this survey, 4861 were 10 years or older. 124 out of 190 individuals who responded positively to the question regarding the presence of mouth ulcers had true aphthous ulcerations. 115/124 underwent a pathergy test and 4 showed positive reactions without any other stigmata of BD, except for folliculitis in one. Among the individuals with a negative pathergy test, 2 had acneiform skin lesions and 1 a genital ulcer. No individual exhibited any ocular symptoms or findings characteristic for BD. Only 1 person with aphthous ulceration, folliculitis and a positive pathergy test was considered to have BD.In this survey, the prevalence of BD was found to be 2: 10,000 (95% confidence interval 0 to 4.3: 10,000). This figure is lower than what has been reported in four previous studies from different regions in Turkey. This finding might be due to ethnic distribution and geographical differences.

Introduction: Our goal was to investigate the effects of arsenic sulfur (AsS) on the detrusor smooth muscle reactivity. Material and Methods: AsS (100 ppm µg/g) in drinking water was administered for 2 weeks to two groups of female Wistar rats. The contractile responses of urinary bladders to electrical field stimulation, carbachol, ATP and KCl, and the relaxant responses to ATP, adenosine and isoproterenol were examined. Urinary bladder strips were collected for light microscopic examination. Results: Our results demonstrate that oral inorganic AsS exposure induced enhanced contractile and reduced relaxant responses in rats. We hypothesize that AsS is involved in deficiencies of isolated urinary bladder in rats. Conclusion: These functional and morphological changes may be important as an intermediate link in urinary bladder oncogenesis induced by AsS.

Background Isotretinoin, a retinoid indicated for the treatment of severe cystic acne, has been associated with adverse effects,including musculoskeletal symptoms. Reported here is a case of bilateral sacroiliitis related to isotretinoin use. Isotretinoin may cause sacroiliitis development or trigger it in healthy people. We advise rheumatologists to be aware of this side effect. Objectives Isotretinoin, a retinoid indicated for the treatment of severe cystic acne, has been associated with adverse effects,including musculoskeletal symptoms. Reported here is a case of bilateral sacroiliitis related to isotretinoin use which completely resolved following discontinuation of the medication. Methods A 18 year old man was treated for acne affecting the back and face with oral isotretinoin. He had no previous medical problems apart from the onset with puberty of severe acne vulgaris of the face and back. Isotretinoin was commenced 10 weeks later he experienced back and sacroiliiac pain, restricting his participation in sporting activities. There was no history of psoriasis, uveitis or inflammatory bowel disease. The patient was taking no other medications. On examination he had decrease lomber schober,sacroiliac tenderness. MRI showed moderate to severe relatively symmetrical sacroiliitis with moderate joint effusions and florid bone marrow oedema in the anterosuperior aspect of the sacroiliac joints. The isotretinoin was ceased and the patient responded to slow release naproxen 1000 mg daily and physiotherapy. Eight weeks later he was free of symptoms. A repeat MRI performed 10 weeks later showed no evidence of sacroiliitis – no effusions, synovitis or abnormal one marrow signal. Results Bilateral symmetrical sacroiliitis can be seen in seronegative spondyloarthropathies. The patient had no infectious conditions capable of initiating reactive arthritis and lacked both a history and symptoms of inflammatory bowel disease psoriasis, uveitis, conjunctivitis or peripheral arthritis inconsistent with ankyilosing spodylitis, enteropathic arthropathies and psoriatic arthropathy. Synovial and/or bone inflammatory symptoms may develop in closely related conditions featuring acne or acral pustules. These symptoms may appear spontaneously or be triggered by isotretinoin. Previous cases of sacroiliitis in patients treated with isotretinoin for acne have not been able to conclusively attribute the condition to either isotretinoin or the patients9 acne. We report here that isotretinoin treatment is usually used in acne treatment, may cause sacroiliitis development or trigger it in healthy people. We advise rheumatologists to be aware of this side effect. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5208

WOS: 000209846404189

Background Radiologic determination of pediatric femoral fracture rotation has been debated. Measuring the antetorsion angle of the fractured femur by computed tomography and comparing it with the opposite side has been the method of choice for this purpose. However, no simple method for direct measurement of femoral fracture rotation exists in the literature. In this study, our aim was to test a mathematical method of measuring the axial plane malrotation from direct roentgenograms. Materials and methods A pediatric femoral shaft fracture model was produced. The bone was secured to a wooden frame that allowed the distal part of the fracture to rotate around an axis. Radiographs were taken at known intervals of rotation ranging from the neutral position to 60° external rotation and to 60° internal rotation in 5° increments of rotation. Five independent, blinded observers measured the radiographs and calculated the fracture rotation according to a standard formula. Calculated rotation values were compared with known rotation values. Results Calculated rotation values were close to actual rotation values throughout the arc of rotation. The mean absolute error of five observers for all measurements of external and internal rotation was 3.97° (±0.83). The correlation coefficient between calculated and actual rotation values was 0.9927. The interobserver intraclass correlation coefficient for calculated rotation was 0.997. Conclusions Absolute error and correlation coefficient values indicate that this method is accurate and reliable in determining the fracture rotation.

Transoral yaklasım, alt clivus, kraniyoservikal bileske, üst servikal lezyonlariçin tercih edilen bir yöntemdir. Yaklasımın endike oldugu durumla arasında, çesitliekstra ve intradural lezyonlar sayılabilir. Bu çalısmanın amacı, transoral yaklasımplanlanan hastalarda, olası a. vertebralis ve a. basilaris yaralanmalarını önlemekamacıyla, transoral yaklasımdaki vasküler yapılar ile kranioservikal bileske kemikyapıları arasında detaylı anatomik bilgiyi saglamak, ölçümler yapmak ve güvenlidegerleri tespit etmektir.Nörosirürjikal cerrahi tekniklerin anatomik çalısmalarda kullanılmasıçalısmanın kalitesini arttıracagı gibi, pratik uygulamada daha basarılı olunmasınısaglar. Çalısmamızda ilk basmakta, 60 adet atlas ve 20 adet axis'de ölçümleryapılmıstır. Atlas'da, arcus anterius'un kalınlıgı ortalama 7,0 ± 1,2 mm bulunmus,massa lateralis'ler arasındaki uzaklık ise ortalama 16,1 ± 1,5 mm, axis'de ise, koronalplanda dens axis'in genisligi ölçülmüs ve ortalaması 9,8 ± 0,8 mm bulunmustur. kincibasamakta ise; 10 adet kadavrada ölçümler yapılmıstır. Koronal planda dens axis'ingenisligi ölçülmüs ve ortalaması 10,1± 1,4 mm bulunmus, odontoid rezeksiyonu içinalınması gerekli olan arcus anterius genisligi (minimum turlama genisligi ) ölçülmüsve ortalaması 10,8 ± 1,1 mm bulunmustur. Üçünçü basamakta;10 adet kadavradayapılan ölçümlerde, vasküler yapılarla ilgili ölçüm sonuçlarının oldukça genis biraralıkta oldugu saptanmıstır. Söyle ki, apex dentis ile sag a. vertebralis arasındakiuzaklık ortalama 19,8 ± 1,7 mm iken sol a. vertebralis arasındaki uzaklık ortalama18,3 ± 0,8 mm olarak, apex dentis ile a. basilaris'in bifurkasyonu arasındaki uzaklıkortalama 24,5 ± 1,4 mm olarak bulunmustur. Benzer sekilde, atlas'ın arcus anterius'uile sag ve sol a. vertebralis arasındaki uzaklıgın ortalamaları sırasıyla 22,2 ± 1,5 mmve 21,3 ± 1,2 mm'dir, Ayrıca yapılan ölçümlerde atlas'ın arcus anterius'u ile a.basilaris'in bifürkasyonu arasındaki uzaklık ortalama 27,2 ± 1,2 mm olarakbulunmustur. Transoral yaklasımda, cerrahi yaklasım için güvenli alanlar budegerlerdir.Çalısmamızdan kemik yapılar ile vasküler yapılar arasında elde ettigimizsonuçların çesitliligine dayanarak, transoral cerrahide ameliyat öncesinde çesitligörüntüleme yöntemleri ile her hastanın damarlarının yerlesiminin anatomik olarakbelirlenmesi, önemli bir komplikasyon olan vasküler zedelenmeyi ve buna ikincilolarak görülebilecek morbidite ve mortalite riskini azaltacaktır.Anahtar sözcükler: Transoral yaklasım, a. vertebralis, a. basilaris, atlas, axis. Transoral approach is a preferred method for inferior clival region,craniocervical junction, and superior servical region lesions. The indications fortransoral resection of the odontoid process include various intradural and extradurallesions. The aim of this study was to determine detailed anatomical information aboutvascular structures and osseous components of craniocervical junction, to reducepossible arteria vertebralis and arteria basilaris injuries, and to show safety zones forthis approach.Using neurosurgical methods on anatomical studies provides increased qualityand successful practice. On the first step of the study sixty dried adult atlas andtwenty axis vertebrae were were evaluated anatomically. The bony drilling depth(BDD) was 7,0±1.2mm, maximum bony drilling diameter (MBDD) was 16,1±1.5mm,and the widest odontoid diameter (WOD) on coronal sections was 9,8±0.8mm. Onthe second step ten cadaver were evaluated, the distance between the two edges ofC1 anterior ring removal for odontoid resection (MDD) was 10,8 ±1.1 mm, and thewidest odontoid diameter on coronal sections (WOD) was 10,1±1.4mm. On the thirdstep vascular measures made in cadavers were determined in a broad spectrum.While the distance between dentis apex and right arteria vertebralis was measured19,8 ± 1,7 mm, the distance between dentis apex and left arteria vertebralis was 18,3± 0,8 mm. The distance between dentis apex and arteria basilalis was measured 24,5± 1,4 mm. Similarly, the distance of atlas arcus? anterior to the right arteria vertebralisand the left arteria vertebralis were measured respectively 22,2 ± 1,5 mm and 21,3 ±1,2 mm. Subsequently, the distance between atlas arcus? anterior and arteriabasilalis was measured 27,2 ± 1,2 mm. These findings have marked safety zones fortransoral approach.Various evidences found from vascular and skeleton anatomy on the studyshowed us imaging of the patients? vascular anatomy before transoral surgeryprevents vascular lesions, which was reduced not only secondary morbidity but alsomortality.Keywords: Transoral approach,vertebral artery, basilar artery, atlas, axis. 61

A. superior cerebelli ve dalları, bifurcatio basilaris, n. trigeminalis, angulus pontocerebellaris, pineal bölge, clivus ve cerebellum'un üst bölümüne yönelik cerrahi girişimler gibi operasyonlar sırasında operasyon bölgesinde bulunmaktadır ve zarar görebilir. A. superior cerebelli'nin dağılım paterni günümüzde net olarak ortaya konmuş değildir. Bu çalışmada a. superior cerebelli'nin yapısını ayrıntılarıyla tanımlamayı ve tartışmalı konulara ışık tutmayı amaçlıyoruz. Bu çalışma 60 yetişkin kadavrasında yapılan rutin otopsilerden elde edilen 120 hemispherium cerebelli üzerinde yapıldı. A. carotis interna ve a. basilaris'lerden kanule ederek damarları renklendirilmiş latex ile doldurduktan sonra beyinler formaldehid solüsyonu içerisinde fikse edildi. Bütün diseksiyonlar cerrahi diseksiyon mikroskopu kullanılarık yapıldı. 120 hemispherium cerebelli'nin tamamında a. superior cerebelli gözlendi. Bunların 92 tanesi tek kök halinde başlarken, 27 tanesi iki kök (duplikasyon), bir tanesi ise çok nadir görülen bir varyasyon olarak üç kök (triplikasyon) halinde başlıyordu. Tek kök halinde başlayan damarlardan biri ve duplikasyon tipinde başlangıç gösteren iki damarın rostral kökleri a. cerebri posterior'dan ayrılıyordu. Bunların dışında kalan diğer a. superior cerebelli'ler a. basilaris'den ayrılmaktaydı. A. cerebelli superior'ların segmentasyon paterni incelendi. Tek bir kök halinde başlayan a. superior cerebelli'lerde rostral ve caudal köklerine ayrılıyorlardı. Rostral köklerden ayrılan dallar genellikle cortex cerebelli'nin medial bölümünü beslerken, caudal köklerden ayrılan dallar lateral bölümlerini beslemekteydi. A. superior cerebelli'nin dalları olan perforator arterler, precerebellar arterler ve kortikal arterler incelendi. Perforator arterler fossa interpeduncularis, pedunculus 56cerebellî'ler ve meseneephalon'un posterior bölümünde dağılırken, precerebellar arterler cerebellomesenceprtalie fissür içerisinde a. superîor cerebelii ve/veya dallarından ayrılarak cerebellum'un iç kısımlarını ve özelliklede nucleus dentatus'u besliyordu, Kortikal arterler vermian, hemisferîk ve marginal dallarına ayrılıyordu. %35 oranında marginal arter varlığı gözlendi. A, superior cerebelii bölgedeki kraniai sinirler olan n, ocuiomotorius, n. trochlearis ve n. trigeminus ile yakın ilişki halindeydi, A, superior cerebelii veya caudal köklerinin yedi hemisferde n, trigeminus ile temas halinde olduğu gözlendi. Bütün cerebellum'larda az veya çok a, superior cerebelli dağılım paterni farklılıklar gösteriyordu, A. superior cerebelli'ye ait değişik varyasyonlar gözlemlendi. Bu durumun farkında olunmasının cerrahi girişimlere çok büyük katkısı olacaktır. Anahtar kelimeler: A. superior cerebelli, cerebellum, n. ocuiomotorius, n. trigeminus, n, trochlearis, vasküier anatomi The superior cerebellar artery ör its branehes are exposed in surgical approaehes to the basılar bifurcatio, trigeminal nerve, cerebellopontine angle, pineai region, divus, and the upper part of the cerebelium, The vaseularization pattem of the superior cerebeliar artery is stili a controversiai subject The study aimed to provide detailed information about superior cerebeliar arteries and to shed light on the îssues, which have not adequately discussed. 120 cerebeliar hemispberes frorn 60 adult cadavers were examined. Brains were obtained in routine autopsies. Internal carotid and basılarwere cannulated and înjected with colored latex. Then, the brains were embalmed in formaîdehyde, The dissections were carried out using a surgical microscope, The superior cerebellar artery (SCA) was present in eaoh of the 120 hemispheres, While the ninety-two of superior cerebellar arteries (SCAs)as a single trunk, twenty-eightas duplicate trunks and öne arose as tripiicate trunk as a very rare varîation. öne soiitary trunk and two rostrai trunks of two duplicate vessels arose from the posterior cerebral artery. The remainder arose from the basüar artery, The segmentatîon pattern of SCAs were examined. The SCAs arisîng as a single trunk bifurcated into a rostrai and a caudai trunk, corresponding to the trunks formed by a duplicate origin, Usually the rostrai trunk supplied fhe medial and the caudai trunk supplied the lateral parts of the cerebellar cortex. The SCA gave off perforating, precerebeilar, and cortical arteries. Thesewere examîned. The perforating arteries suppiied the interpeduncular fossa, the cerebral peduncles and the posterior parts of the mesencephaion, The precerebeilar branehes arose wîthin thecerebellomesencephalic groove and supplied the innerof the cerebellum and dentate nucleus. The corticai branches were divided into vermian, hemispheric, and margina! arteries. We found the ratio of rnargînal arteries as 35%. Süperler cerebellar artery hasreiatîonship with the oculomotor nerve, trochlear nen/e and the trîgernina! nerve. Seven SCAs ör caudal trunks were in contact with the trigeminal nerve, in cerebelium, more ör the vascularization pattern of the SCAs were different. Different variations of SCA were examined, Therefore, awareness of this fact will provide a great contribution to surgical interventtons. Key words: Cerebeilum, superior cerebellar artery, vascular anatomy, oculomotor nerve, trigeminai nerve, trochlear nerve. 68

ÖZET Orbita ve orbita içi yapıları anatomik olarak tanımlamaya yönelik kadavra çalışmalarının az sayıda olması klinik anatomi açısından bir eksiklik oluşturmaktadır. Lateral orbitotomi, orbita lateraline yerleşmiş birçok kitlenin çıkarılması amacıyla lateral orbita duvarı boyunca uygulanır. Bu çalışmada kadavradan elde edilen 10 adet orbita örneği lateral orbitotomi yaklaşımıyla incelenerek bölge anatomisi ve anatomik yapıların birbirleriyle ilişkileri değerlendirildi. Bu amaçla diseksiyon işlemi tabakalara ayrılarak gerçekleştirildi, ayrıca lateral yaklaşımla karşılaşılacak olan yapıların lokalizasyonunda kolaylık sağlayabilecek, m. rectus superior, m. rectus lateralis ve göz küresi arasında yer alan üçgen bir alan tanımlandı. Orbita içindeki yapılardan, ekstraoküler kaslar, n. opticus, n. abducens, pars orbitalis glandula lacrimalis, ganglion ciliare ve a. centralis retinae'ye ait ölçümlerin yanısıra, tanımalanan üçgen saha esas alınarak elde edilen ölçümler de bu çalışmada gerçekleştirildi. Ayrıca gözlenen varyasyonlar değerlendirildi. Orbita anatomisinin tabakalar halinde tanımlanması, bu bölge anatomisinin tanımlanmasında kolaylık sağladı. Yapılan ölçümlerin bir kısmı literatürle uyumlu bulunurken bir kısmı da ilk defa bu çalışmada elde edildi. Buna ek olarak bir kadavrada glandula lacrimalis'i innerve eden çift n. lacrimalis ve bir kadavrada da n. oculomotorius'dan anulus tendineus communis'in lateral kompartmanına (Oculomotor foramen) girmeden ayrılan ramus superior ve ramus inferior dalı dışında burada üçüncü bir dal verdiği ve bu dalın m. levator palpebrae superioris'i inneve ettiği görüldü. Anahtar sözcükler: Orbita, lateral orbitotomi, mikrodiseksiyon, anatomi ABSTRACT Lack of sufficient amount of cadaver studies to demonstrate the orbit and the structures within the orbit results in a deficiency in clinical anatomy. Lateral orbitotomy along the lateral orbital wall is performed to excise masses located in the lateral part of the orbit. In this study, regional anatomy and releationships between anatomical structures are investigated on ten orbit specimens from cadavers. The dissection of the region of interest was performed in a layer-by-layer fashion and a triangle bounded by the superior rectus muscle, lateral rectus muscle and the globe is defined to enable easy localization of the structures during lateral approach. Among the intraorbital structures, various measurements are performed on extraocular muscles, optic nerve, abducent nerve, orbital part of the lacrimal gland, the ciliary ganglion and the central retinal artery. Additional measurements are performed using the defined triangle and variations are documented. Layer- by-layer dissection made the identification of the structures easy. While some of the measurement data are in agreement with some of the published data, other data are unique. In one cadaver two lacrimal nerves innervating the lacrimal gland are found and in another cadaver oculomotor nerve, just before going through the lateral compartment of the common tendinous ring, gave off a third branch, in addition to superior and inferior branchs, which then innervated the levator palpebrae superioris muscle. Key words: Orbit, lateral orbitotomy, microdissection, anatomy 677