Tag Archives: surgery

Donor vessels

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The traces of the middle meningeal artery (MMA) can be observed on dry skulls. For this reasons, it is often investigated in paleoneurology. The vessels run between the two layers of dura mater, along with the endosteal (periosteal) layer which is adherent to the inner surface of the skull. The MMA display connections with other vascular networks, but it is largely independent of the cerebral vascular system. Apparently, in adults there is only scarce or absent blood flow in MMA at rest, and activation may be triggered by thermal stress or other emergency responses (see Bruner et al. 2011). In a recent paper, Niknejad and colleagues (2018) test the possibility of using the MMA as a donor vessel in cerebrovascular bypass procedures, as an alternative to the superficial temporal artery (STA) which is standardly used for this purpose. The authors performed cadaveric dissections on 12 specimens and compared size, diameter and feasibility of both the MMA and the STA for the bypass to the middle cerebral artery. Their results confirmed that the MMA can be a suitable donor vessel. The premise of the donor potential of the MMA is based on its dispensability. Nevertheless, the authors note that the MMA may play an important role in case of the moyamoya disease, in which conditions MMA forms an important collateral network. In addition, this study provides valuable empirical data on the MMA morphology. Authors were able to identify three main branches in all specimens, with the dominant anterior petrosquamosal branch in all the cases. The diameter of the MMA was measured at its ostium and was 2.4 mm in average.

Stáňa Eisová

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Modelling brain-skull interface

Precise computational modelling of the brain-skull interface is necessary for the prediction, prevention and treatment of acquired brain-injuries. The brain-skull interface comprises complex layers including the osseous cranial tissues, meninges, sub-arachnoidal space and tissues, cerebrospinal fluid (CSF), pia mater and the gray and white cerebral matter. While the tissue properties of the brain-skull interface are known, there is no consensus on how these layers interact during head impact.  To generate computational models of the brain-skull interface with greater accuracy, knowing the boundary conditions or constraints is necessary. Previous experimental studies have relied on modelling the deformation of the brain-skull interface using neural density targets (NDTs) implanted into the cadaver brain, collecting information on tissue displacement during front and rear impact in motor vehicle crash-tests.

Wang et al. (2018) utilized computational bio-mechanics and finite element analysis (FEA), placing nodes in the 3D model in close approximation to the position of the experimental NDTs. Four hypotheses of the brain-skull interface were modeled, each approach placing different boundary conditions to model deformation during simulated head impact. All analyses were validated against previous experimental studies. Results showed that how the brain-skull interface was modeled appreciably affected the results. The 3D model showing the closest agreement with the experimental data, included all tissues of the brain-skull interface, allowed for displacement without separation of the skull and brain tissues, and strongly corresponded with known neuroanatomy. This 3D model indicated that non-linear stress-strain associations between brain and skull tissues best matched experimental results. Further, this 3D model could be closely predicted using an Ogden Hyperviscoelastic Constitutive model which did not over- or under-estimate deformations during head impact. The risks of over- and under-estimating head impact during motor vehicle accidents has implications for vehicle construction and prevention of serious brain trauma during accidents. Ultimately, a better understanding of the interaction between layers of the brain-skull interface can produce more accurate predictions of the likely impact during motor vehicle accidents and prevent violent head injury. Extrapolation of this research into paleoneurology could allow investigations into the structural interaction between the brain and braincase, testing if the resistence of brain-skull tissues during deformation evolved in human species as primary adaptations or secondary adjustments such as allometric responses.

 

Alannah Pearson


A History of Surgery

The Chirurgeon’s Apprentice is a popular blog on the website of medical historian Dr Lindsey Fitzharris who received her doctorate from University of Oxford in medical, technology and science history. Dr Fitzharris discusses the apt naming of the blog with the word ‘chirurgeon‘ the first historical reference to a practitioner of surgery. The website illuminates the often grisly but fascinating historical developments in Medicine and Surgery with focus on the Victorian era and the rapidly developing techniques and methods occurring in all scientific disciplines at this time.  Under the Knife is a well-researched and often darkly humorous video series delivered by Fitzharris where each episode details different aspects of the history of Surgery and Medicine. Dr Lindsey Fitzharris is also the author of a recent book The Butchering Art about the Victorian surgical pioneer Jospeh Lister and the development of antiseptic practices.

Alannah Pearson