TRANSLATIONAL ANATOMY IN THE 21ST CENTURY - IS ANATOMY REALLY A "DEAD SCIENCE"?

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Background. Translational anatomic research concern, for example, basic surgical research in the disciplines endocrine surgery, plastic surgery with the topic migraine surgery and hernia surgery, all in combination with neuroimaging in the field of ultrasonography and of the Intraoperative Neuromonitoring (IONM). IONM is a basic requirement to avoid laryngeal nerve palsy and to recognize anatomic variants; for migraine surgery recent findings on the pathogenesis of frontal migraine headache support an alternative peripheral mechanism involving compressed peripheral nerves. These disciplines, also in hernia surgery avoiding chronic post-herniorrhaphy pain, therefore, require ultrasonography as an important preoperative neuroimaging-device. Material and Methods. Anatomic variants, such as a non-recurrent inferior laryngeal nerve (nrILN), produced possible explanations for different IONM-signals which would correlate with differences in the anatomic course of the inferior laryngeal nerve. Preoperative ultrasonography was performed to evaluate the presence of a brachiocephalic trunk and the recurrent laryngeal nerve for exclusion or identification of a nrILN; a clear and understandable anatomic mapping of the inguinal region and the spermatic cord sheaths by means of anatomic dissection, ultrasound guided visualisation of all three inguinal nerves are presented; for migraine surgery research, the supratrochlear (STN) and supraorbital nerve (SON) were macroscopically identified and their relationship to the corrugator supercilii muscle (CSM) was investigated by dissection and ultrasonography. Results and Discussion. IONM-signals during thyroid surgery, derived from the vagus nerve were positive if derived proximal to and negative if derived distal to the branching off a nrILN. By ultrasonographic identification of a normal brachiocephalic trunk, a nrILN could be excluded. In frontal migraine patients a new possible compression point of the STN passing through the orbital septum could be identified. Also previously described compression points of both STN and SON could be verified. Osteofibrous channels used by the STN and SON were found constantly. An algorithm for ultrasound visualization of this peripheral, supraorbital neurovascular bundle could be worked out. The anterior-superior iliac spine, pubic tubercle, Camper´s fascia, external oblique aponeurosis, superficial inguinal ring, external spermatic fascia, cremasteric fascia with cremaster muscle fibers, internal spermatic fascia, cremasteric vein (=external spermatic vein=“blue line”), ductus deferens, pampiniform plexus and the inferior epigastric artery are the main surgical landmarks for an open inguinal hernia repair, likewise for ultrasound guided representation Conclusions. IONM and preoperative ultrasonography can be reliable tests in recognizing peripheral nerves and their variants. Translational anatomic research and its application on peripheral nerves, such as IONM and ultrasonography, improves surgical outcomes and therefore individual patient quality of life - from «bench-to-bedside». This is achieved by increasing individualizing, enlightening under-investigated anatomic details and optimizing surgical procedures.