Masters Degrees (Anatomy)

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An anatomical investigation of intracranial meningiomas.
(2021) Anirudh, Ezra Earl.; Lazarus, Lelika.; Harrichandparsad, Rohen.
Meningiomas are generally benign, highly vascularised, slow-growing tumours arising from the arachnoid cap cells of the arachnoid villi. The clinical presentation of these tumours is usually location dependant due to the vast expanse covered by the meninges. Resection of a meningioma is generally performed after preoperative embolisation. A feeder vessel is selected and embolised in an attempt to reduce excessive blood loss and postoperative complications. However, embolisation requires a sound knowledge of the vasculature of the meninges since these vessels supply portions of the cranial nerves. Literature consulted have investigated anatomical features of meningioma’s; however, there is a scarcity of studies investigating patients specifically referred for preoperative embolisation. Therefore, this study aimed to investigate the anatomical features, namely the location, histology, volume and vascularity of intracranial meningiomas referred for preoperative embolisation. This entailed using Magnetic resonance imaging (MRI), Digital subtraction angiography (DSA), and the histological reports obtained from the data bank at the central regional hospital in Durban, South Africa. A retrospective chart review yielded 103 patients that met the inclusion criteria, of which 98 patients (subset 1) presented with a single meningioma and 5 patients (subset 2) presented with multiple meningiomas. The average age of patients (at the time of diagnosis) was reported within the 40–49-year group and primarily within the female population (subset 1: 67.3%; subset 2: 80%). The benign grade of meningiomas was reported as the most common (70.4%), of which the meningothelial subtype (48%) was predominant. Meningiomas were mostly observed within the supratentorial region (subset 1: 57.2%; subset 2: 91.7%) with almost equal incidences in subset 1 and a majority on the right side in subset 2. Regarding tumour volume, subset 1 revealed the largest meningiomas within the supratentorial region (90.9 cm3), and subset 2 revealed an average tumour volume of 43.9 cm3. In terms of meningioma vascularity, within the supratentorial region, the external carotid arteries were noted to be a common primary feeder vessel, for the skull base region the primary arterial supply is the internal carotid artery. This study provides insight into the anatomical basis of intracranial meningiomas within a select South African population as it has introduced a novel methodology of meningioma vascularity. This may assist endovascular surgeons in assessing the feeder vessel contributions of meningiomas and understand the prevalence of these anatomical parameters in this population.
An anatomical investigation of the sympathetic and parasympathetic contributions to the cardiac plexus.
(2011) De Gama, Brenda Zola.; Satyapal, Kapil Sewsaran.; Partab, Pravesh.; Lazarus, Lelika.
The cardiac plexus is “formed by mixed autonomic nerves” that are “described in terms of superficial and deep components, with the superficial located below the aortic arch and anterior to the right pulmonary artery, and the deep located anterior to the tracheal bifurcation (above the division of the pulmonary trunk) and posterior to the aortic arch” (Standring et al., 2008). This investigation aims to review and update the medial cardiac contributions of the cervical and thoracic sympathetic chains to the cardiac plexus and also the contributions from the vagus nerve and its counterpart, the recurrent laryngeal nerve. This study involved the macro and micro-dissection of 100 cadaveric sides of adult and fetal material. The number of ganglia in a cervical sympathetic chain varied from 2 to 5 in this study. This study confirms previous reports on the location of the two components of the cardiac plexus. The origin of the sympathetic contributions to the cardiac plexus in this study were either ganglionic, interganglionic or from both the ganglion and interganglionic chain of the respective ganglia. The superior cervical cardiac nerve had an incidence of 92% while the middle cervical cardiac nerve had an incidence of 65% in the specimens studied. This study also records a vertebral cardiac nerve that arose from the vertebral ganglion in 39% of the cases. The inferior cervical and cervicothoracic cardiac nerves had incidences of 21%, respectively. This investigation records the thoracic caudal limit of the sympathetic contributions to the cardiac plexus as the T₅ ganglion. The findings in this study indicate the importance of understanding the medial sympathetic contributions and their variations to the cardiac plexus as this may assist surgeons during minimal surgical procedures, sympathectomies, pericardiectomies and in the management of diseases like Reynaud’s Phenomenon and angina pectoris (Kalsey et al., 2000; Zhang et al., 2009).
Anterior synostotic plagiocephaly: a quantitative analysis of craniofacial features using computed tomography.
(2021) Mohan, Nivana.; Lazarus, Lelika.; Madaree, Anil.; Harrichandparsad, Rohen.
Anterior synostotic plagiocephaly (ASP) is caused by the premature fusion of one coronal suture, which results in severe craniofacial asymmetry that can be challenging to correct. The various methods of the surgical procedures, as well as the distinctive facial characteristics of ASP, have been well documented. However, there is a paucity of literature pertaining to the quantitative analysis of the craniofacial features that are affected in ASP. This study used preoperative computed tomography (CT) scans to document and compare the morphometry of the anterior cranial fossa (ACF), orbit, and ear on the ipsilateral (synostotic) and contralateral (non-synostotic) sides in a select South African population of patients diagnosed with ASP. The dimensions of the ACF, orbit and the position of the ear on the ipsilateral and contralateral sides were measured using a set of anatomical landmarks on two-dimensional (2D) CT scans of 18 consecutive patients diagnosed with non-syndromic ASP. The differences between the ipsilateral and contralateral sides were computed and expressed as a percentage of the contralateral side. The findings of this study revealed that there was side-to-side asymmetry in the ACF, orbit, and ear. All ACF parameters decreased significantly (t-test; p<0.001) on the ipsilateral side when compared to the contralateral side, resulting in the volume of the ACF being the most affected (-27.7%). In terms of the orbit, on the ipsilateral side, the length-infraorbital rim (IOR), height, and surface area parameters increased significantly (t-test; p<0.001), with the height being the most affected (24.6%). The remaining orbital parameters (length-supraorbital rim (SOR), breadth and volume) decreased significantly (t-test; p<0.001), with the length-SOR parameter being the most affected (-10.8%). Furthermore, the ipsilateral SOR was noted to be displaced more cranially by an average of 3.89mm from the contralateral SOR. With regards to the position of the ipsilateral ear, it was found to be displaced anteriorly (9.33mm) and caudally (5.87mm) from the contralateral ear. This study augments the existing literature by providing actual values to corroborate the hallmark characteristics of ASP. These measures may help surgeons plan the technique and extent of surgical correction of the affected craniofacial structures during corrective surgery as it will provide them with an indication of the extent of the deformity on the ipsilateral side as compared to the contralateral side. The results of this study have the potential to propose a grading system in ASP patients according to severity of the condition if the sample size is increased.
An anthropometric evaluation of the glenohumeral joint in a South African population.
(2018) Khan, Raeesa.; Satyapal, Kapil Sewsaran.; Lazarus, Lelika.; Naidoo, N.
The glenohumeral joint (GHJ), the most mobile yet unstable joint in the body, is comprised of a large humeral head which fits into the relatively smaller socket formed by the glenoid fossa. While this articulation allows for a wide range of motion, it predisposes the shoulder to injury. There is a paucity of literature on the biomechanics of the GHJ in the South African population. The aim of the study was to evaluate the anthropometric parameters of the GHJ, with emphasis on the coracoid process, glenoid fossa, bicipital groove (BG), long head of the biceps brachii tendon (LHBBT) and the transverse humeral ligament (THL). This study comprised of two subsets (n = 404), viz. (i) anthropometric evaluation of the scapula and proximal humerus [n=324: Scapula – Right (R): 80, Left (L): 84; Male (M): 68, Female (F): 96; Humerii – (R): 80, (L): 80; (M): 68, (F): 96] and (ii) cadaveric dissection of the LHBBT and THL [n=80: (R): 40, (L): 40; (M): 44, (F): 36], both of which focused on morphological and morphometric parameters. Results (i) (a) Shape of glenoid fossa = Type 1 (inverted comma): (R): 16.47%, (L): 10.98%; (M): 20.12%, (F): 7.32%; Type 2 (pear): (R): 14.02%, (L): 15.24%; (M): 18.29%, (F): 10.98%; Type 3 (oval) : (R): 18.29%, (L): 25.00%; (M): 27.44%, (F): 15.85%. (b) Notch type of glenoid fossa: Type 1 (without a notch): (R): 1.83%, (L): 7.32%; (M): 6.71%, (F): 2.44%; Type 2 (with one notch): (R): 46.95%, (L): 43.90%; (M): 59.15%, (F): 31.70%. (c) Mean parameters of coracoid process (mm): Length (CL): (R): 41.74±4.74, (L): 41.50±4.87; (M): 42.07±4.73, (F): 40.74±4.84; Width (CW): (R): 13.27±1.89, (L): 14.18±11.90; (M): 13.05±1.90, (F): 15.07±14.49. (d) Mean parameters of glenoid fossa (mm): Horizontal diameter 1 (HD1): (R): 18.40±3.27, (L): 17.51±2.87; (M): 18.23±3.29, (F): 17.38±2.60; Horizontal diameter 2 (HD2): (R): 24.45±2.88, (L): 23.64±2.63; (M): 24.22±2.74, (F): 23.68±2.83; Vertical diameter (VD): (R): 35.23±3.10, (L): 34.88±3.03; (M): 35.26±3.18, (F): 34.64±2.79. (e) Mean coracoglenoid distance (CGD) (mm): (R): 27.40±8.34, (L): 28.15±3.53; (M): 28.19±7.41, (F): 27.00±3.38 .(f) Mean dimensions of BG (mm): Length: (R): 66.64±9.06, (L): 68.31±11.52; (M): 67.44±9.12, (F): 67.53±12.25; Width: (R): 8.98±1.49, (L): 9.27±1.30; (M): 9.18±1.45, (F): 9.05±1.31; Depth: (R): 7.73±1.31, (L): 7.20±1.18; (M): 7.43±1.29, (F): 7.53±1.24. (ii) (a) Mean parameters of the LHBBT (mm): Length: (R): 81.99±21.28, (L): 79.73±17.27; (M): 79.82±19.66, (F): 82.14±19.03; Width: (R): 4.28±1.31, (L): 4.67±1.43; (M): 4.35±1.17, (F): 4.63±1.60. (b) Mean parameters of the THL (mm): Length: (R): 20.91±5.24, (L): 21.19±6.36; (M): 21.52±5.71, (F): 20.48±5.92; Width: (R): 16.65±6.92, (L): 16.63±7.49; (M): 16.83±6.65, (F): 16.40±7.84. In this study, Type 3 (oval) was observed to be most prevalent shape of the glenoid fossa, which corroborated the findings of previous studies. Type 2 (with one notch) was found to be the predominant notch type, differing from the literature reviewed. The mean VD, HD1, HD2, CL and CGD were larger in male individuals, while female individuals presented with larger means of CW. Both BG length and depth were increased on the right side; with the latter yielding a statistically significant difference thus suggesting that an increased depth is a common finding in the right side of individuals. Although the BG length and depth were noted to be greater in female individuals, male individuals presented with larger widths. The mean length and width of the THL were markedly smaller than those reported in previous studies. Any variation from the normal musculoskeletal composition of the GHJ is fundamental to understand rotator cuff disease, tendinitis and shoulder dislocation. This study may provide clinicians and biomechanical engineers with reliable anthropometric reference parameters of the GHJ for the design of prosthesis and may also act as diagnostic tools of degenerative pathology.
Developmental changes of the facial skeleton from birth to 18 years within a South African cohort: a computed tomography study.
(2021) Niemann, Kristen.; Rennie, Carmen Olivia.; Lazarus, Lelika.
Introduction: The facial skeleton or viscerocranium has been recently noted as a method for age estimation as its development is influenced not only by the developing paranasal air sinuses and tooth eruption, but also the individual’s ancestry particularly population specific normative data. This study aimed to investigate the developmental changes of the facial skeleton in males and females from birth to 18 years within the South African population with African ancestry to estimate age. The facial skeleton was assessed according to five regions viz: - orbital, nasal, midfacial, maxillary and mandibular. Methods and materials: A retrospective study which consisted of 239 computed tomography (CT) scans of subadult individuals (0–18 years of age) of African ancestry (128 males; 111 females) was conducted. The scans were obtained from an online server utilised by a private medical facility in the eThekwini Muncipality. The DICOM images were viewed from an online Picture Archiving and Communication Systems server using Infinitt software (version 5.0.1.1) which is the standard software used by the practitioners. Linear parameters in the horizontal, sagittal, and vertical planes assessed the development of the viscerocranial regions. Results: a) Development: Most of the viscerocranial regions experienced a rapid increase in growth between 0–5 years of age viz: orbital (orbital height and width: 0–5 years; lateral orbital wall distance: 0–3.75 years), midfacial (zygomatic arch distance: 0–3.75 years), nasal (aperture height and width: 0–5 years); maxilla (length: 0–3.75 years), mandibular (mandible width: 0–5 years). Thereafter growth continued to increase at a slower rate in the orbital width (0.61–0.8 mm/year in females; 0.56–0.76 mm/year in males), lateral orbital wall distance (1.1 mm/year in females; 1 mm/year in males), zygomatic arch distance (1.6 mm/year in females; 1.8 mm/year in males), nasal aperture width (0.45 mm/year in females; 0.4 mm/year in males) and height (0.63 mm/year in females; 0.77 mm/year in males), maxillary length (0.7 mm/year in females; 0.81 mm/year in males), mandible width (1.1 mm/year in females; 1.5 mm/year in males) and mandible head widths (right: 0.42 mm/year in females, 0.49 mm/year in males; left: 0.52 mm/year in females, 0.68 mm/year in males). Additionally, in the orbital region, the orbital width underwent two periods of rapid growth i.e., 0–5 and 10–18 years of age, whilst the anterior interorbital distance noted no significant increase after 7.5 years of age. xiv b) Sexual dimorphism: Males displayed overall larger measurements than females in all the parameters, except for the anterior interorbital distance and the zygomatic arch lengths (ZAL) on the right and left, as females displayed larger measurements. Although these differences were not statistically significant (p>0.05). The only measurements which displayed statistically significant differences between males and females were the left orbital height (p = 0.048), nasal aperture height (p = 0.048) and the mandible width (p = 0.05), in which males displayed larger measurements than females. c) Age estimation: The measurements which displayed the strongest correlation to age were the ZAD (r = 0.8842, p<0.001), ZAL (right: r = 0.8929, p<0.001; left: r = 0.8656, p<0.001) and the mandible width (r = 0.8444, p<0.001). Formulas were derived for the measurements which could be used to estimate age. Discussion and conclusion: The findings from this study have outlined the development of the viscerocranium in subadult individuals with African ancestry. This study discussed the correlation between the development patterns of each viscerocranial region with age. The data from this study can be a useful addition to the existing data on the skeletal developments of subadult South African individuals. Forensically the development of formulas for subadult individuals could be utilised in the age estimation of skeletal remains.
Scaphocephaly in a select South African population: a morphometric analysis of the cranial fossae and ventricular access points.
(2021) Bisetty, Vensuya.; Lazarus, Lelika.; Madaree, Anil.; Harrichandparsad, Rohen.
Scaphocephaly is a cranial deformity that results from premature fusion of the sagittal suture and is characterized by an elongated and narrowed skull. Patients with this condition present with varying clinical features including frontal bossing and occipital protrusion. This study comprised two subsets, analysing different aspects related to this cranial deformity. Most morphological and morphometrical studies in patients with scaphocephaly focus on the cranial vault. Literature on the morphometry of the cranial base and its fossae in these patients is sparse. Therefore, the first subset aimed to analyse and compare the morphometry of the cranial fossae in patients with scaphocephaly. Due to varying cranial morphology among patients with these deformities, ventricular access using conventional techniques is often a challenge. Although ventricular access may not be frequently required in paediatric scaphocephalic patients, it is vital that an ideal location of the access points be established for safe ventricular catheterization. Accordingly, the second subset aimed to document the morphometry of Kocher’s and Frazier’s points in scaphocephalic patients using known craniometric and surface anatomical landmarks. Dimensions of the anterior, middle and posterior cranial fossae (ACF, MCF and PCF) were measured using select anatomical landmarks on computed tomography (CT) scans of 24 consecutive patients diagnosed with scaphocephaly between 2014 and 2020, and 14 non-affected/ normal paediatric patients selected as controls. Parameters of Kocher’s and Frazier’s points were measured in relation to known cranial surface anatomical landmarks on scans of the scaphocephalic patients utilized in subset 1. The study found that ACF and PCF are most affected in scaphocephalic patients, with elongation along the anteroposterior (AP) plane (lengths) (ACF, p=0.041 and PCF, p=0.018). Minimal changes were observed in the transverse plane (widths) in scaphocephaly versus non-affected/normal controls. Regarding subset 2, Kocher’s point was located between 91.6mm and 140mm posterior to the nasion, and between 20.5mm and 34.6mm lateral to the midline in patients with scaphocephaly. Frazier’s point was located between 60.9mm and 82.8mm superior to the inion, and 25.9mm and 41.4mm lateral to the midline. Parameters measured in the AP plane were found to be more affected than those measured lateral from the midline. This study contributes to the literature by providing novel morphometric data based on a select South African population. Data obtained could aid craniofacial surgeons in understanding which cranial fossa is most affected in scaphocephaly and to what extent, to decide on the most appropriate method of treatment. Additionally, the study concluded that the traditional landmarks used for ventricular access are relatively unreliable in scaphocephalic patients. This study provides data for neurosurgical consideration regarding ventricular catheterization procedures in patients with scaphocephaly.
Trigonocephaly in a select South African population: A morphometric analysis utilising specific anatomical cranial landmarks.
(2024) Barnes, Courtney; Lazarus, Lelika.; Madaree, Anil.
Trigonocephaly is a congenital abnormality that is caused by the premature fusion of the metopic suture. A triangular shaped forehead, shortening of the anterior cranial fossa (ACF), hypotelorism, narrowing of the bitemporal region, and widening of the occipitoparietal region are some of the cranial and facial deformities that patients with trigonocephaly present with. Literature on the morphometry of the ACF and cranial base is scarce in patients with trigonocephaly; most studies focus on the morphometric changes that occur to the entire cranium rather than the cranial base. Therefore, this study aimed to investigate the morphometric changes that occurred to the ACF and orbits in trigonocephaly patients and to determine whether compensatory growth of the middle and posterior cranial fossae (MCF and PCF) was evident via volumetric assessment. Additionally, the identification of various cranial parameters in order to assess the severity of patients with trigonocephaly remains controversial. Thus, this study also aimed to describe an improved grading system in the assessment of trigonocephaly within a select South African population. Dimensions of the ACF and of the orbits, and volumetric assessment of all three cranial fossae were measured using specific anatomical cranial landmarks on preoperative computed tomography (CT) scans of 15 patients with a radiographic confirmed diagnosis of non-syndromic, isolated trigonocephaly between 2012 and 2023, and eight non-affected age-matched pediatric patients were selected as the control group. ACF dimensions in younger and trigonocephaly patients who were classified as severe, were observed to be larger compared to control patients, whilst in older and trigonocephaly patients who were classified as severe, ACF dimensions were observed to be smaller compared to control patients. MCF volume showed significance (p=0.050), whilst ACF and PCF volumes, respectively showed no significance (p=0.170 and p=0.821) when trigonocephaly patients were compared to controls. Additionally, maximum compensatory growth occurred in the PCF compared to the MCF in trigonocephaly patients. The overall dimensions of the orbit showed no significance between trigonocephaly and control patients. However, significant findings were observed in the correlation analysis between the interorbital distance and other orbital parameters and ACF angles when trigonocephaly patients were compared to control patients. Furthermore, more complex orbital morphologies were observed in trigonocephaly patients in younger age groups, compared to less complex orbital morphologies which were observed in older age groups. This study provides novel morphometric and morphological data within a specific South African population. The data obtained could further assist craniofacial surgeons by providing a relationship between the degree of severity and choice of surgical intervention. Additionally, the orbital data obtained could indicate to surgeons the morphological changes that occur in the orbits, and provide an insight into the evolution of the deformity in pediatric patients with trigonocephaly in order to obtain as near to normal orbital features.

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