This is the first atlas to depict in high resolution images the fine structure of the spinal canal, the nervous plexuses, and the peripheral nerves in relation to clinical practice. It is relevant to regional anesthesiologists, interventional pain physicians, neurologists, orthopedists, neurosurgeons, reconstructive surgeons, and physiatrists. It contains more than 800 images of unsurpassed quality, few of which have ever before been published, including scanning electron microscopy images of neuronal ultrastructures, macroscopic sectional anatomy, and three-dimensional images reconstructed from patient imaging studies. The editor, Dr. Miguel Reina, an internationally renowned clinician-researcher in anesthesiology and anatomy, heads one of the few research groups in the world capable of producing such an atlas. Over the years, with his colleagues and collaborators, he has developed an extensive and unique collection of superb images which will form the basis for the atlas. Dr. Reina is assisted by the special participation of Dr. Admir Hadzic, one of the most respected and well known regional anesthesiologists in the world, and has assembled top authorities from the United States, Spain, Denmark, The Netherlands, Sweden, China, Japan, and Australia to contribute. The atlas is organized by anatomical region. Each image is accompanied by detailed text that guides readers through the depicted anatomy and provides synoptic evidence-based, clinically relevant information for the practitioner. A final section considers the great potential for the innovative application of scanning electronic microscopy and three-dimensional image reconstruction to clinical practice.
Part I. Human Peripheral Nerve.- 1. Ultrastructure of Myelinated and Unmyelinated Axons.- 2. Macrophages, Mastocytes, and Plasma Cells.- 3. Ultrastructure of the Endoneurium.- 4. Ultrastructure of the Perineurium.- 5. Ultrastructure of the Epineurium .- 6. Origin of the Fascicles and Intraneural Plexus.- 7. Macroscopic View of the Cervical Plexus and Brachial Plexus.- 8. Anna Carrera, Francisco Reina.- 9. Macroscopic View of the Lumbar Plexus and Sacral Plexus.- 10. Cross-sectional Microscopic Anatomy of the Sciatic Nerve and its Dissected Branches.- 11. Cross-sectional Microscopic Anatomy of the Sciatic Nerve and Paraneural Sheaths.- 12. Computerized Tomographic Images of Unintentional Intraneural Injection.- 13. Ultrasound View of Unintentional Intraneural Injection.- 14. Histologic Features of Needle-Nerve and Intraneural Injection Injury as Seen on Light Microscopy.- 15. Structure of Nerve Lesions after “In Vitro” Punctures.- 16. Scanning Electron Microscopy View of In Vitro Intraneural Injections.- 17. Injection of Dye Inside the Paraneural Sheath of the Sciatic Nerve in the Popliteal Fossa.- 18. High-Definition and Three-Dimensional Volumetric Ultrasound Imaging of the Sciatic Nerve.- Part II. Component of the Spinal Canal.- 19. Spinal Dural Sac, Nerve Root Cuffs, Rootlets, and Nerve Roots.- 20. Ultrastructure of Spinal Dura Mater.- 21. Ultrastructure of the Spinal Arachnoid Layer.- 22. Three-Dimensional Reconstruction of Spinal Dural Sac.- 23. Three-dimensional Reconstruction of Spinal Epidural Fat.- 24. Ultrastructure of Human Spinal Trabecular Arachnoid.- 25. Ultrastructure of Spinal Pia Mater.- 26. Ultrastructure of Spinal Subdural Compartment: Origin of Spinal Subdural Space.- 27. Unintentional Subdural and Intradural Placement of Epidural Catheters.- 28. Ultrastructure of Human Spinal Nerve Roots.- 29. Three-dimensional Reconstruction of Cauda Equine Nerve Roots.- 30. Spinal Nerve Root Lesions after “In Vitro” Needle Puncture.- 31. Nerve Root Cuff Lesions after “In Vitro” Needle Puncture and Model of “In Vitro” Nerve Stimuli Caused by Epidural Catheters.- 32. Ligamentum Flavum and Related Spinal Ligaments.- 33. The Ligamentum Flavum.- 34. Subarachnoid (Intrathecal) Ligaments.- 35. Displacement of the Nerve Roots of Cauda Equina in Different Positions.- 36. Nerve Root and Types of Needles Used in Transforaminal Injections.- 37. Three-Dimensional Visualization of Spinal Cerebrospinal Fluid and Cauda Equina Nerve Roots, and Estimation of a Related Vulnerability Ratio.- 38. Ultrastructure of Nerve Root Cuffs: Dura-Epineurium Transition Tissue.- 39. Ultrastructure of Nerve Root Cuffs: Arachnoid Layer–Perineurium Transition Tissue at Preganglionic, Ganglionic, and Postganglionic Levels.- 40. Spinal Cord Stimulation.- 41. Ultrastructure of Dural Lesions Produced in Lumbar Punctures.- 42. Injections of Particulate Steroids for Nerve Root Blockade: Ultrastructural Examination of Complicating Factors.- 43. Nerve Root and Types of Needles Used in Transforaminal Injections.- Part III. Materials.- 44. Needles in Regional Anesthesia.- 45. Catheters in Regional Anesthesia.- 46. Epidural Filters and Particles from Surgical Gloves.- Part IV. Research Techniques.- 47. Three-dimensional Reconstruction of Spinal Cerebrospinal Fluid, Roots, and Surrounding Structures.- 48. Cerebrospinal Fluid and Root Volume Quantification from Magnetic Resonance Images.- 49. Scanning Electron Microscopy.- 50. Transmission Electron Microscopy.
Miguel Angel Reina, MD, PhD
Department of Clinical Medical Sciences and Institute of Applied Molecular Medicine
School of Medicine
University of CEU San Pablo
Department of Anesthesiology
Madrid-Montepríncipe University Hospital