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  • By Author: Lott, Robert x
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  • By Author: Oakes, W. Jerry x
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R. Shane Tubbs, Robert G. Louis Jr., Christopher T. Wartmann, Robert Lott, Gina D. Chua, David Kelly, Cheryl Ann Palmer, Mohamadali M. Shoja, Marios Loukas and W. Jerry Oakes

Object

To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression.

Methods

Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs.

Results

The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified.

Conclusions

Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

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R. Shane Tubbs, Randall Lee Murphy, David R. Kelly, Robert Lott, E. George Salter and W. Jerry Oakes

Object

The filum terminale externum (FTE) is the extradural component of the filum terminale internum and little attention has been dedicated to this structure in the literature. The authors theorized that the rare intrasacral ependymomas may originate from ependymal cell collections within the FTE.

Methods

To address this hypothesis, the FTE was dissected and analyzed histologically in 15 adult cadavers. None of the specimens was found to harbor ependymal or other glial cell collections.

Conclusions

The authors found previously undescribed smooth-muscle cells within the FTE. Furthermore, histological analysis identified adipose, nerve, bone, and cartilage cells.