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Pulei, A, Obimbo M, ONGETI K, Kitunguu P, Inyimili M, Ogeng’o J.  2012.  Surgical significance of brachial arterial variants in a Kenyan population. Abstract

Knowledge of the variant anatomy of the brachial artery is important in radial arterial grafts for coronary bypass, percutaneous trans-radial approach to coronary angiography, angioplasty and flap surgery. These variations show ethnic differences but data from black populations are scarce. This study therefore describes the course in relation with median nerve, level and pattern of termination of brachial artery in a black Kenyan population. Methods: This was a cadaveric dissection study of 162 upper limbs at the Department of Human Anatomy University of Nairobi, Kenya. The brachial artery was exposed entirely from the lower border of teres major to its point of termination. The course in relation to the median nerve and the level of termination were recorded. The results were analyzed using SPSS version 17.0 for Windows. Results: 72.2% of the brachial arteries followed the classical pattern described in Gray’s Anatomy. Superfi cial brachioradial and superficial brachial arteries were present in 12.3% and 6.1% of the cases respectively. Brachial artery terminated at the radial neck in 79% of the cases, radial tuberosity (8.6%), and proximal arm (11.1%), mid arm (1.2%). Pattern of termination was either a bifurcation into the radial and ulnar arteries (90.1%) or trifurcation into radial, ulnar and common interosseous arteries (9.3%). We also report a case of trifurcation of the brachial artery into the profunda brachii, radial and ulnar arteries (0.6%). Conclusion: Variations of the brachial artery in its relationship with the median nerve, level and pattern of termination are common. These may complicate arm surgical exposures, fl ap and vascular surgery. Pre-operative angiographic evaluation is recommended.


Kiboi, JG, Kitunguu PK, Angwenyi P, Mbuthia F, Sagina LS.  2011.  Predictors of functional recovery in African patients with traumatic intracranial hematomas. Abstract

Head injury is a critical public health problem responsible for up to 50% of fatalities among trauma patients and for a large component of continuing care among survivors. Intracranial hematomas are among the most common clinical entities encountered by any neurosurgical service and have a very high mortality rate and extremely poor prognosis among traumatic brain injuries. The purpose of this study was to investigate reliable factors influencing the functional outcome of the patients with traumatic intracranial hematomas (ICHs). A retrospective analysis was conducted of consecutive patients presenting at the Kenyatta National Hospital between January 2000 and December 2009. Following ethical approval, the records of patients admitted to the neurosurgical unit and diagnosed with traumatic ICH were retrieved and reviewed. The outcome measure was the Glasgow Outcome Scale (GOS) score at discharge. Data were collected in preformed questionnaires, and the coding and analysis were carried out using SPSS, version 11.5. Of the 608 patients diagnosed with intracranial hematomas during the study period, there was a clear male predominance, with 89.3% male and 10.7% female patients. Majority of the patients (49%) were aged between 26 and 45 years, whereas 5.6% and 9.4% were younger than age 13 years and older than age 61 years, respectively. The most common cause of injury was assault (48%). Good functional recovery was achieved by 280 (46.1%) of the patients in our series, whereas moderate and severe disability accounted for 27% and 6.9%, respectively. Males were more likely to have functional recovery (46.4%) than were females (43.1%), though this finding was not statistically significant (P = 0.069). The proportion of patients who achieved functional recovery seemed to decrease with increasing age. Patients who were involved in motor vehicle accidents were less likely to have functional recovery (33.7%, P = 0.003) than those who fell (53.6%). There was a statistically significant difference in the proportion of patients who achieved functional recovery, with 65.2% of those who had mild head injury as compared to 46% and 15.1% (P ≤ 0.001) for those with moderate and severe head injury, respectively. Patients who had surgical intervention were more likely to achieve functional outcome (51.2%) as compared to 31.7% in those managed conservatively. Furthermore, the time elapsed from initial trauma to surgery significantly influenced outcome. The type of surgery done was not found to significantly influence patient outcome (P = 0.095). An increased risk of poor outcome occurs in patients who are older than age 61 years, have lower preoperative GCS scores, pupillary abnormalities, and a long interval between trauma and decompression. The findings would help clinicians determine management criteria and improve survival.



Aneurysms of the anterior cerebral and anterior communicating arteries are common and their
microvascular surgical management requires sound knowledge of the normal and variant vascular anatomy.
The purpose of this study was to evaluate variations of the anterior cerebral and anterior communicating
arteries. Methods: Thirty six cadaveric brains (72 hemispheres) were studied by gross dissection for the
pattern of arterial blood supply.
The anterior cerebral artery (ACA) was observed to originate from the ipsilateral internal carotid artery (ICA)
in all the cases studied. The most common type of termination of the ACA was bifurcation into pericallosal
(PerA) and callosomarginal (CMA) arteries with the PerA-CMA junction being supracallosal (60%),
infracallosal (27%) or precallosal (5%). Unique variations observed include an accessory ACA from the
ACoA, ’bihemispheric pericallosal arteries’, intertwining course of the A2 segments of the ACAs and
crossing branches from 1 hemisphere to another. Variations of the ACoA were also observed including
fenestration (26%) and duplication (13%).
The majority of ACA bifurcations, in the current study, were supracallosal suggesting the need for
exploration of the interhemispheric fissure during surgical corrections of distal ACA aneurysms. Further, the
incidence of the callosomarginal artery in this series appears to be at variance with other studies highlighting
the need to standardize the definition of the artery. Anterior communicating artery fenestration was the most
common variation raising concern as this has been shown to compromise collateral flow and predispose to
aneurysm formation

Saidi, H, Kitunguu P, Ogengo JA.  2008.  Variant anatomy of the anterior cerebral artery in Adult Kenyans.


JA, O, P K, H S, Tharao MK.  2007.  Variant Anatomy of the Hepatic Artery in Adult Kenyans..

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