Anatomia, Volume 4, Issue 1 (March 2025) – 4 articles

Background: The dorsal scapular nerve (DSN) and the long thoracic nerve (LTN) exhibit variable anatomical pathways, which may contribute to upper back pain and impaired scapular movement in affected patients. This study investigates these variations to enhance clinicians’ diagnostic and surgical approaches. Methods: The bilateral cervical regions of 32 formalin-embalmed donors (64 sides) were dissected to document the origin of the DSN, the relationship with the scalene muscles of the DSN, and anatomical connections between the DSN and LTN. Measurements of the distance between the mastoid process and the piercing point of the DSN to the scalene muscle were obtained with digital calipers. Additional measurements were obtained from the medial border of the scapula at two specific locations: the scapular spine (zone 1) and the midpoint between the scapular spine and the inferior angle of the scapula (zone 2). Results: The DSN demonstrated four distinct cervical spinal nerve root origins and five unique scalene muscle piercing patterns. The average distance between the DSNs’ scalene muscle piercing point and the mastoid process was 94.87 ± 10.09 mm, with significantly greater distances observed in male donors compared to female donors (p < 0.001). Connections between the DSN and LTN were identified in 65.2% of the examined cervical regions. The mean distance of the DSN from the medial border of the scapula at zone 2 was significantly greater than at zone 1 (p < 0.001). Conclusions: The anatomical variation findings and classification of the DSN provide valuable insights, offering guidance for conducting clinical procedures of the scalene and rhomboid musculature in a way that minimizes the risk of iatrogenic injury. The documented variations may also assist in the diagnosis and management of DSN-related pathologies such as DSN neuropathy. Full article

Background: Clinical-surgical procedures in the thoracic outlet can be challenging due to the proximity of neurovascular structures to the subclavian vein. Methods: During a routine anatomical dissection in an undergraduate medical study at Paracelsus Medical University, Nuremberg, a novel anatomical finding was observed in an ethanol–glycerin embalmed, 79-year-old female body. In addition to the standard measurements, hematoxylin eosin staining of relevant vessels was performed Results: A nerve branch separating from the brachial plexus at the C6 spinal nerve traversed inferiorly and passed through a fenestration of the subclavian vein in the lateral section, rejoining the lateral cord of the brachial plexus. In addition, hypoplasia of the right-sided internal carotid artery (ICA) and a left-sided internal jugular vein (IJV) hypoplasia were detected. At the left venous angle of the left IJV, a venous saccular aneurysm was found. The ectopic origin of the left ascending pharyngeal artery originated from the initial segment of the left ICA. Also, Langer’s axillary arches were observed bilaterally in the same subject. Conclusions: The anatomical findings in the specimen do not provide a direct symptomatic correlation or functional relevance comparable to clinical observations. Nevertheless, it is important to highlight this discovery as a potential clinical reference for future studies. Full article

Background: Endovascular treatment of venous disease is introducing new therapeutic options in neuroradiology. These procedures are technically challenging and require extensive physician training. Currently, training is mainly conducted on animal models, which presents drawbacks such as ethical concerns and anatomical differences from human vascular architecture. There is no training model that simulates treating intracranial venous disease using original instruments in a real angiography suite. Methods: This work presents the development of a venous system model for endovascular training simulations for integration into the existing Hamburg ANatomical NEurointerventional Simulator (HANNES) for arterial interventions. Results: The manufacturing process established at HANNES and the material used for the arterial vascular models were successfully transferred to the larger 3D-printed vein models. The application test was conducted in a real angiography suite with original instruments by an experienced neurointerventional physician to evaluate the system in terms of geometric mapping, flow, haptics and probing. Conclusion: This newly developed model provides a first approach to simulate an endovascular intervention in the venous system within the HANNES environment. Future expansions might include specific treatment simulations for conditions such as arteriovenous malformations, dural arteriovenous fistulas, sinus vein thrombosis and hydrocephalus. Full article

Background: Peripheral nerve surgeries require extensive practice to address anatomical variability and effectively manage neuropathy symptoms. While these procedures are increasingly performed by other surgical specialists, neurosurgeons bring unparalleled expertise in the central and peripheral nervous systems. Microscopic surgical techniques are essential for minimally invasive procedures, and cadaver-based education provides an invaluable medium for trainees to practice these techniques. However, few papers address these concepts in tandem. This study explores lesser-known peripheral nerve entrapments, highlights minimally invasive microscopic approaches, and advocates for cadaver-based training. Methods: Willed cadavers were embalmed through approved methods by the state anatomical board. For each decompression procedure, a 1–2 cm keyhole incision was made. Further methods are described in each nerve entrapment surgery below. Exploratory sessions with wider incisions were conducted either before or after the minimally invasive procedure to review anatomy or assess procedural success, respectively. Results: Neurosurgical medical education using cadavers allows trainees to practice techniques and enhance their skillset. Cadavers provide a valuable medium for exploring the relevant anatomy and visualizing the correct procedural steps after minimally invasive surgeries. Using microscopes for the procedures further facilitates detailed anatomical observation and technique refinement. Conclusions: Here, we show that cadaver-based medical education offers a realistic and controlled environment for exploring anatomical variability and refining surgical techniques. This method allows for a visual, mental, and tactile understanding, while performing minimally invasive procedures with a microscope on cadavers further enhances trainees’ proficiency, precision, and confidence, equipping them with the skills needed for improved surgical outcomes. Full article