Fetal Kadavralarda Nervus Medianus’un Oluşumu, Dallanması ve Anastomozlarının Varyasyonları

Abstract

Amaç: Nervus medianus’un varyasyonları klinik ve cerrahi yaklaşımlar açısından önemlidir. Bu çalışmanın amacı, fetal kadavralarda nervus medianus'un oluşumunu, dallanmasını ve anastomozlarını belirlemektir.

Materyal-Metod: Bu çalışma, Süleyman Demirel Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı laboratuvarında bulunan yaşları 18-40 gebelik haftası arasında değişen ve eksternal anomali ya da patolojisi olmayan 40 (22 dişi, 18 erkek) fetal kadavraya ait 80 üst ekstremite üzerinde gerçekleştirildi. Nervus medianus, n. ulnaris ve n. musculocutaneus’un dalları tanımlanarak bu dalların dağılımı belirlendi. Nervus medianus’un dallanması ve oluşumu ile onun anatomozları incelendi.

Bulgular: Bu çalışmada n. medianus’un 80 üst ekstremitenin 6'sında (%7,5) üç kökten oluştuğu görüldü. Nervus medianus’un, 2 (%2,5) ekstremitede, n. musculocutaneus mevcut olmasına rağmen kolun fleksor komparmanındaki kasları innerve ettiği görüldü. Nervus musculocutaneus’un olmadığı 1 (%1,25) ekstremitede ise n. medianus’un kolun fleksor komparmanındaki kasları innerve ettiği görüldü. Ayrıca 3 ekstremitede (%3,75) n. musculocutaneus ile n. medianus arasında anastomoz saptandı. Son olarak çalışmamızda %3,75 oranında Martin-Gruber anastomozu bulunurken Marinacci anatomozuna rastlanmamıştır.

Sonuç: Bu çalışmada, fetal kadavra diseksiyonu ile n. medianus'un varyasyonları ve anastomozları tanımlandı. Bu varyasyonlar üst ekstremite yaralanmalarında doğru tanı ve tedavi planlamasını olumsuz etkileyecektir. Bu nedenle, n. medianus'un varyasyonları ve anastomozları hakkında yeterli bilgi sahibi olunması, cerrahların bu bölgeye yapılan müdahaleler sırasında iyatrojenik yaralanmalardan kaçınması için yararlı olacaktır.

Keywords

• Fetus
• Marinacci anastomozu
• Martin-Gruber anastomozu
• nervus musculocutaneus
• nervus ulnaris

Variations of Formation, Distribution and Communications of Median Nerve in Fetal Cadavers

Abstract

Objective: Variations of the median nerve (MN) are important for clinical and surgical approaches. In this study, it was aimed to determine the formation, distribution and communication of the MN in fetal cadavers.

Material and Method: This study was carried out on 80 upper extremities obtained from 40 spontaneously aborted human fetuses (22 females, 18 males) aged between 18 and 40 weeks. Median, ulnar and musculocutaneous nerve (MSCN) and their branches were identified and distribution of their branches was determined. The distribution, formation and communications of the MN were examined.

Results: In this study, it was seen that the MN was composed of three roots in the 6 (7.5%) of 80 upper limbs. It was also found that the MN innervated the flexor muscles of the arm in two extremities despite MSCN was present (2.5%). It has also been determined that the MN innervated the flexor muscles of the arm in one extremity where MSCN was absent (1.25%). In addition, communications between the MSCN and the MN was detected in 3 (3.75%) extremities. Finally, in our study, Martin-Gruber communication was found 3.75% while Marinacci communication was not determined.

Conclusions: This study identified variations and communications of the MN by means of fetal cadaveric dissection. These variations will adversely affect the correct diagnosis and treatment planning in upper extremity injuries. Therefore, precise knowledge of the variations and communications of the MN will be useful for surgeons to avoid iatrogenic injuries during surgical interventions in this region. 

Keywords

• Fetus
• Marinacci communication
• Martin-Gruber communication
• Musculocutaneous nerve
• Ulnar nerve

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