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R. Shane Tubbs, Elizabeth C. Tyler-Kabara, Alan C. Aikens, Justin P. Martin, Leslie L. Weed, E. George Salter and W. Jerry Oakes

. Plast Reconstr Surg 87 : 911 – 916 , 1991 Francel TJ, Dellon AL, Campbell JN: Quadrilateral space syndrome: diagnosis and operative decompression technique. Plast Reconstr Surg 87: 911–916, 1991 8. Horiguchi M , Koizumi M , Isogai S , Sekiya S : [Bilateral absence of the quadrangular space of the axilla.] Kaibogaku Zasshi 67 : 38 – 43 , 1992 , 1987 (Jpn) Horiguchi M, Koizumi M, Isogai S, Sekiya S: [Bilateral absence of the quadrangular space of the axilla.] Kaibogaku Zasshi 67: 38–43, 1992, 1987 (Jpn

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Ricardo L. L. Dolci, Leo F. S. Ditzel Filho, Carlos R. Goulart, Smita Upadhyay, Lamia Buohliqah, Paulo R. Lazarini, Daniel M. Prevedello and Ricardo L. Carrau

satisfactorily low. Access is achieved through the quadrangular space (QS), which was named the “front door of Meckel's cave.” 25 Entry into this space is limited medially and inferiorly by the internal carotid artery (ICA). Therefore, this technique, in combination with transcranial approaches, gives the skull base surgeon the potential to access 360° of Meckel's cave. Injury to the ICA is one of the most disastrous complications that can occur during microscopic transsphenoidal surgery or EEAs. 12 , 16 An ICA injury can lead to death, postoperative pseudoaneurysm or

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Jayme Augusto Bertelli, Paulo Roberto Kechele, Marcos Antonio Santos, Hamilton Duarte and Marcos Flávio Ghizoni

abducted and externally rotated ( Fig. 1 ). All the nerves and vessels in the axilla were dissected. After skin incision and subcutaneous tissue separation, the latissimus dorsi tendon was identified. The axillary nerve was located over the subscapularis muscle and its relationship with surrounding structures was studied. This location corresponded to the entrance of the quadrangular space. Branches of the axillary nerve were documented. The latissimus dorsi tendon and the teres major muscle were detached from the humerus and the divisions of the axillary nerve were then

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R. Shane Tubbs, Charles A. Khoury, E. George Salter, Leslie Acakpo-Satchivi, John C. Wellons III, Jeffrey P. Blount and W. Jerry Oakes

explore its possible use for neural grafting or neurotization, it reached the entrance site of the musculocutaneous nerve into the coracobrachialis muscle in all but three cadaver sides and was within 1.5 cm from this point in these three. In the other specimens the mean length of the LSN distal to this site of the musculocutaneous nerve was 2 cm. The mobilized LSN reached the axillary nerve trunk as it entered the quadrangular space in all specimens. The mean length of the LSN distal to this point on the axillary nerve was 2.5 cm. The LSN was found to lie within the

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R. Shane Tubbs, W. Jerry Oakes, Jeffrey P. Blount, Scott Elton, George Salter and Paul A. Grabb

defined as that portion of nerve that originates from the posterior cord of the brachial plexus and ends before entering the quadrangular space. The quadrangular space is bound by the teres minor superiorly, the teres major inferiorly, the long head of the triceps medially, and the surgical neck of the humerus laterally. Our examinations included measurements and observations of the distance that the AN traveled into the triangle from the apex of the coracoid process of the scapula, the diameter of the portion of AN within the triangle, and the relationship and distance

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R. Shane Tubbs, Martin M. Mortazavi, Mohammadali M. Shoja, Marios Loukas and Aaron A. Cohen-Gadol

the SAN could be used for radial nerve branches to the triceps brachii muscle and the axillary nerve at its exit from the quadrangular space. Because recovery of even minimal function can be significantly important to patients with paralyzed limbs, and because often the injuries that traumatized the nerves also damaged ipsilateral donor nerves, in the current study we aimed to identify a novel method of upper limb neurotization in which the contralateral SAN could be used. Methods For this study, 10 adult cadavers ranging from 54 to 89 years of age (mean 78

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H. Carson McKowen and Rand M. Voorhies

shoulder resulting in injury to the axillary nerve. 6 All of these cases had a precipitating traumatic event; however, Cahill 3 reported a spontaneous form of axillary neuropathy resulting from entrapment of the nerve in the quadrilateral space. The quadrilateral or quadrangular space is the anatomical compartment bounded by the teres major and minor muscles, the long head of the triceps, and the neck of the humerus. Through these confines run the posterior humeral circumflex artery and the axillary nerve. Cahill 3 appropriately named the disease the “quadrilateral

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Jacques J. Morcos

anterior petrosectomy (Kawase approach, whether performed endoscopically or not) is needed from the subtemporal approach to resect the posterior fossa component of a tumor. This is sometimes true, but often times not, as others and I have experienced. The petrous apex may have been already totally eroded. A similar phenomenon applies to the anterior endonasal approach. The widened quadrangular space lateral to the cavernous carotid artery is a path to the middle fossa, and with appropriate instrumentation, may allow resection of soft tumors well into the Meckel cave, a

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Wei-Hsin Wang, Stefan Lieber, Roger Neves Mathias, Xicai Sun, Paul A. Gardner, Carl H. Snyderman, Eric W. Wang and Juan C. Fernandez-Miranda

facilitates lateral mobilization of the ICA to access to the medial petrous apex, and medial mobilization of the ICA when access to the middle cranial fossa is needed. The “quadrangular space” has been described as the “front door” to Meckel’s cave. 6 In a more recent study, the authors defined the “strut of the quadrangular space,” which actually corresponds to and is more accurately defined as the lingual process of the sphenoid bone. 2 Removal of the lingual process is key to open this space, which provides access to the middle cranial fossa, specifically to the

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Scott L. Zuckerman, Ilyas M. Eli, Manish N. Shah, Nadine Bradley, Christopher M. Stutz, Tae Sung Park and John C. Wellons III

T he axillary nerve is the terminal branch of the posterior cord of the brachial plexus, receiving fibers from cervical nerve roots C-5 and C-6. 29 After exiting the axillary fossa posteriorly, it passes through the quadrangular space with the posterior circumflex humeral artery, then winds around the surgical neck of the humerus deep to the deltoid. It then divides into 2 branches: posterior and anterior. The posterior branch innervates teres minor and posterior deltoid muscles and gives rise to the superior lateral brachial cutaneous nerve. The anterior