Surgical And Radiologic Anatomy[JOURNAL]
Sun
200 papers
Maximizing surgical precision in gracilis muscle reconstruction: anatomical Variants, advanced Imaging, and novel surgical strategies.
Landfald IC, Aragonés P, Dehghani D … +4 more , Coleman J, Adamek J, Kumar YAS, Olewnik Ł
Surg Radiol Anat · 2025 Oct · PMID 41131421 · Full text
BACKGROUND: The gracilis muscle (GM) is a reliable flap in reconstructive microsurgery due to its consistent anatomy and low donor-site morbidity. However, morphological, vascular, and neural variations may complicate su...
BACKGROUND: The gracilis muscle (GM) is a reliable flap in reconstructive microsurgery due to its consistent anatomy and low donor-site morbidity. However, morphological, vascular, and neural variations may complicate surgical planning and outcomes. METHODS: A narrative review was conducted based on anatomical studies, imaging reports, and surgical case series sourced from PubMed and Scopus (up to 2025), with emphasis on anatomical variants, imaging modalities, and reconstructive strategies. RESULTS: Key variants include supernumerary heads, accessory slips, multiple vascular pedicles, and diverse innervation patterns. These factors affect flap design, harvesting, and reinnervation success. Advanced imaging techniques such as CTA, MRA, Doppler ultrasound, and ICG angiography enable precise preoperative mapping. We propose two clinical frameworks—the Gracilis Functional Flap Classification (GFFC) and the Gracilis Innervation-Based Surgical Planning Algorithm (GISPA)—to integrate anatomical variation into individualized surgical planning. CONCLUSIONS: GM anatomical variability significantly influences reconstructive outcomes. The integration of GFFC and GISPA, supported by imaging and emerging technologies, enhances surgical precision and functional results in microsurgical applications.
Cervical rib synostosis with the first rib and an elongated C7 transverse process: a rare variation causing thoracic outlet syndrome.
Triantafyllou G, Melissanidis S, Arkoudis NA … +2 more , Papadopoulos-Manolarakis P, Piagkou M
Surg Radiol Anat · 2025 Oct · PMID 41131401 · Publisher ↗
Morphological variants in the cervical and thoracic regions, although often asymptomatic, can have significant clinical implications when they contribute to conditions such as thoracic outlet syndrome (TOS). We report a...
Morphological variants in the cervical and thoracic regions, although often asymptomatic, can have significant clinical implications when they contribute to conditions such as thoracic outlet syndrome (TOS). We report a rare case of a 39-year-old female patient presenting with vascular TOS. Detailed imaging via high-resolution computed tomography (CT) and magnetic resonance angiography (MRA) revealed a right-sided elongated transverse process (ETP) of the C7 (24.70 mm in length) articulating with a cervical rib (CR), which showed synostosis with the first rib. The coexistence of CR synostosis with the first rib and an ETP of C7 is a rare variation. Three-dimensional CT reconstructions were crucial in visualizing the osseous architecture, while dynamic MRA confirmed vascular compression. While both anomalies have been previously identified as independent contributors to TOS, their simultaneous presence has not been previously documented in symptomatic patients. This unique combination likely exacerbates neurovascular compression, complicating both diagnosis and surgical intervention. Preoperative imaging is crucial for identifying such rare variants and for informing surgical planning. This case highlights the diagnostic and surgical importance of recognizing complex rib and vertebral anomalies using advanced imaging modalities.
Evaluation of gender and age differences in orbital symmetry for mirrored implant feasibility: a multicenter study.
Erdogan Ö, Abdelazeem MH, Osman MF … +4 more , Buyuk C, Yuce F, Barhoma MG, Mohamed S
Surg Radiol Anat · 2025 Oct · PMID 41125982 · Publisher ↗
PURPOSE: This study aimed to evaluate the anatomical symmetry of the left and right orbital cavities to assess the reliability of mirror-image-generated implants for orbital fracture repair, a common approach in reconstr...
PURPOSE: This study aimed to evaluate the anatomical symmetry of the left and right orbital cavities to assess the reliability of mirror-image-generated implants for orbital fracture repair, a common approach in reconstructive surgery. METHODS: In a multicenter retrospective analysis, maxillofacial CT and CBCT images from 78 patients were examined to assess differences in the volumetric and linear dimensions of the right and left orbital cavities. Standardized volumetric and linear measurements in both the coronal and sagittal planes were conducted. Statistical analyses were conducted to determine the significance of differences across gender and age groups. RESULTS: The study population had a mean age of 41.73 years, with 42% male and 58% female patients. No statistically significant differences in the orbital volume were found between the right (24.23 ± 2.62) and left (23.48 ± 2.53) sides (p = 0.219). Coronal plane measurements, including the orbital floor length (D1) and medial wall length (D2), similarly showed no significant differences between the two sides. In the sagittal plane, minor variations were observed, with average differences not exceeding 0.5 mm in most dimensions. Gender-based and age-based subgroup analyses further revealed no statistically significant differences in orbital measurements across groups, supporting the acceptance of anatomical symmetry between the left and right orbital cavities. CONCLUSION: The findings indicate that the left and right orbital cavities can be considered symmetrical with respect to volume and linear measurements, validating the use of mirror-image-generated implants for reconstructive purposes. The minor variations observed in the linear dimensions did not compromise the clinical reliability of this approach, supporting its continued application in orbital fracture repair.
Simultaneous retropharyngeal course of three carotid arteries coexisting with internal carotid coiling: a unique topographical variant.
Karangeli N, Triantafyllou G, Papadopoulos-Manolarakis P … +2 more , Samolis A, Piagkou M
Surg Radiol Anat · 2025 Oct · PMID 41120786 · Publisher ↗
BACKGROUND: Variations (topographical) in the course of the carotid arterial system are well-documented. Still, their clinical significance lies in their potential to alter cervical anatomy and increase the risk of iatro...
BACKGROUND: Variations (topographical) in the course of the carotid arterial system are well-documented. Still, their clinical significance lies in their potential to alter cervical anatomy and increase the risk of iatrogenic injury. Retropharyngeal displacement most often involves the internal carotid artery (ICA), while involvement of the external carotid artery (ECA) or common carotid artery (CCA) is rarely reported. Simultaneous displacement of multiple carotid arteries (CAs) is extremely rare. METHODS: We describe a 40-year-old female patient in whom computed tomography angiography (CTA) revealed an unusual constellation of vascular variants. RESULTS: Both ICAs and the ipsilateral ECA traveled through the retropharyngeal space. Bilateral carotid bifurcations were twisted. The right ICA showed a coiled shape at the level of the styloid process, and both CCAs were found in unusually close proximity to the superior cornu of the thyroid cartilage. No signs of atherosclerosis were seen, indicating a developmental rather than acquired variant. CONCLUSION: This case expands the range of known cervical vascular topographies by showing, for the first time, a tri-arterial retropharyngeal configuration with concurrent ICA coiling. While isolated or bilateral retropharyngeal displacements of the ICA, CCA, or superior thyroid artery have been documented, the presence of three major arteries in this compartment simultaneously seems unprecedented. Recognizing such extreme variants is essential for preventing severe hemorrhage and for guiding surgical and anesthetic planning in the anatomically restricted retropharyngeal region.
Coronary-to-pulmonary artery fistula in a patient with atypical chest pain: case presentation and literature review.
Rusali AC, Lupu CI, Manolache MM … +3 more , Rusali LM, Bordei P, Cojocaru L
Surg Radiol Anat · 2025 Oct · PMID 41120623 · Full text
Coronary artery fistulas are rare anomalies characterized by abnormal communications between a coronary artery and a cardiac chamber, vein, or great vessel. This review explores the pathophysiology, clinical presentation...
Coronary artery fistulas are rare anomalies characterized by abnormal communications between a coronary artery and a cardiac chamber, vein, or great vessel. This review explores the pathophysiology, clinical presentation, diagnostic modalities, and management of CPAFs, with a focus on their hemodynamic implications. A clinical case is presented to illustrate the diagnostic process and decision-making in the management of CPAFs. The patient was admitted into hospital for chest pain and an abnormal flow in the pulmonary artery observed on transthoracic echocardiography in the emergency department. Further investigations revealed the patient had a coronary-to-pulmonary fistula connecting the left anterior descending artery to the pulmonary artery trunk. Myocardial perfusion scan was performed and it demonstrated normal perfusion in the left anterior descending artery territory. Different causes for chest pain were investigated-upper digestive endoscopy revealed peptic ulcer, which was successfully treated. This review underscores the importance of individualized approaches to treatment and highlights the potential for conservative management in selected patients.
Piriformis muscle with three bellies and a sacrotuberous-ligament belly: cadaveric case report and belly-count classification proposal.
Landfald IC, Aragones P, Vázquez T … +1 more , Olewnik Ł
Surg Radiol Anat · 2025 Oct · PMID 41120580 · Full text
INTRODUCTION: The piriformis muscle (PM) contributes to hip stabilisation and external rotation. Given its proximity to the sciatic nerve, PM variability is clinically relevant within deep gluteal syndrome, which encompa...
INTRODUCTION: The piriformis muscle (PM) contributes to hip stabilisation and external rotation. Given its proximity to the sciatic nerve, PM variability is clinically relevant within deep gluteal syndrome, which encompasses non-discogenic entrapments in the subgluteal space. Although numerous variants have been described, the number of discrete bellies is inconsistently reported across studies. CASE REPORT: During routine dissection of a 79-year-old female cadaver, we identified a three-bellied PM. The superior belly arose from the gluteal surface of the ilium near the greater sciatic notch, the middle belly from the anterior sacrum (S2–S4), and the inferior belly from the sacrotuberous ligament. All three bellies converged into a single tendon inserting on the superior surface of the greater trochanter. Morphometry demonstrated distinct dimensions for each belly and for the common tendon. The contralateral side displayed a typical single-bellied PM. CONCLUSION: This report documents a three-bellied configuration of the PM. To standardise concise reporting, we propose a belly-count scheme with four categories: Type 0 absent, Type 1 single belly, Type 2 double belly, and Type 3 multiple bellies (≥ 3). Both the present case and the triple-bellied configuration reported by Koziol et al. fall under Type 3. This scheme is reporting-oriented and preliminary and does not imply prevalence or clinical risk without confirmation in larger series.
Portal vein confluence variants on contrast-enhanced CT: distribution, IMV-confluence distance, and novel patterns in 199 adults.
Mai PT, Hoang VT, Nguyen TTT … +2 more , Vo THT, Le VP
Surg Radiol Anat · 2025 Oct · PMID 41120551 · Publisher ↗
OBJECTIVE: To characterize portal vein (PV) confluence variants on contrast-enhanced CT, quantify the inferior mesenteric vein (IMV)-to-confluence distance by variant, and report previously undescribed configurations. ME...
OBJECTIVE: To characterize portal vein (PV) confluence variants on contrast-enhanced CT, quantify the inferior mesenteric vein (IMV)-to-confluence distance by variant, and report previously undescribed configurations. METHODS: We first labeled variants using an extended 14-type scheme (Prado I-XII plus two new types XIII-XIV). For comparability with prior literature, these were then collapsed to three drainage categories (Thomson I/II/III: IMV → SV, true trifurcation at the SMV-SV junction, IMV → SMV) for distance analyses. RESULTS: After recoding to three drainage categories, the distribution was Type I/II/III = 45.7% (91/199) / 19.1% (38/199) / 34.7% (69/199). Two additional, previously unclassified variants (Types XIII-XIV) were identified on CT in 5/199 patients (2.5%). One case (Type XII, dual IMV) could not be assigned to a single drainage category and was excluded from the three-group comparisons (N = 198). Median IMV-to-confluence distances differed: 17.9 mm (Type I; interquartile range [IQR] 13.3-23.0), 0.0 mm (Type II; IQR 0.0-0.0), and 5.0 mm (Type III; IQR 3.5-7.0) (Kruskal-Wallis χ = 159.12, p < 0.001; N = 198). Group differences were tested with Kruskal-Wallis and Bonferroni-adjusted pairwise Mann-Whitney U; agreement was assessed with Cohen's κ and ICC(2,1). CONCLUSION: Classic PV confluence types predominate, but rare/novel configurations are present. The association between IMV drainage route and IMV-to-confluence distance supports variant-aware preoperative CT review to inform operative planning and patient safety.
An unusual emissary foramen of the temporal bone.
Triantafyllou G, Papadopoulos-Manolarakis P, Suwannakhan A … +1 more , Piagkou M
Surg Radiol Anat · 2025 Oct · PMID 41107613 · Publisher ↗
PURPOSE: Emissary foramina (EF) provide venous connections between intracranial dural sinuses and extracranial venous networks. While common EF are well described, their variants are underrecognized. Identifying unusual...
PURPOSE: Emissary foramina (EF) provide venous connections between intracranial dural sinuses and extracranial venous networks. While common EF are well described, their variants are underrecognized. Identifying unusual EF is clinically important, as they may mimic pathology on imaging, provide routes for infection, or increase bleeding risk during skull base and temporal bone surgery. This study reports a unique EF of the temporal bone detected through imaging. MATERIALS: A retrospective review of a high-resolution computed tomography (CT) scan of a 64-year-old male patient was performed using multiplanar reconstructions and three-dimensional reconstructions (slice thickness: 0.6 mm). RESULTS: A distinct foramen, measuring 3.15 mm in diameter, was identified in the right temporal bone, 9.2 mm superior to the zygomatic arch and 1.4 mm lateral to the middle meningeal artery groove. It was clearly separate from the postglenoid foramen and absent contralaterally. Its topography suggests a venous connection between the extracranial pterygoid venous plexus and intracranial venous channels, resembling but not identical to previously described postglenoid or squamosal foramina. CONCLUSIONS: This case expands the morphological spectrum of temporal bone EF. Recognition of such variants is essential to avoid misinterpretation on imaging, prevent misdiagnosis, and anticipate potential surgical complications such as unexpected bleeding or venous injury. Detailed radiologic evaluation should be emphasized in skull base surgery planning and radiology reporting.
A multilevel variation of the sensory branches of the lumbar plexus with an accessory genitofemoral nerve.
Stoyanov D, Pavlov SP
Surg Radiol Anat · 2025 Oct · PMID 41107602 · Full text
The lumbar plexus is one of the most variable nerve plexuses in the human body. Located posteriorly to the psoas major muscle, it is the origin of several nerves that cross the retroperitoneal space and are responsible f...
The lumbar plexus is one of the most variable nerve plexuses in the human body. Located posteriorly to the psoas major muscle, it is the origin of several nerves that cross the retroperitoneal space and are responsible for the innervation of the lower abdominal wall and a portion of the lower limb. Relative to their anatomical route, these nerves can be divided into several major sections: intrapsoas, retroperitoneal, and distal to the inguinal ligament, and all of those are liable to nerve injury during surgical interventions. Here, we describe a complex variation involving the lateral femoral cutaneous nerve, the femoral branch of the genitofemoral nerve, and the anterior femoral nerve, discovered during a routine dissection in an undergraduate human anatomy course for medical students.
Morphometric analysis of the coracoid process in the Chinese population: clinical strategies for fracture fixation.
Tan Y, Wang X, Tan Z … +2 more , Yu B, Zhang H
Surg Radiol Anat · 2025 Oct · PMID 41087612 · Full text
PURPOSE: The coracoid process presents surgical challenges due to its irregular anatomical morphology, further compounded by a paucity of population-specific morphometric data in the Chinese population. This study aimed...
PURPOSE: The coracoid process presents surgical challenges due to its irregular anatomical morphology, further compounded by a paucity of population-specific morphometric data in the Chinese population. This study aimed to systematically analyze the morphometric characteristics of the coracoid process in the Chinese population and simulate mid-axial screw placement through the vertical portion of the coracoid, thereby providing anatomical guidance for surgical fixation of coracoid base fractures. METHODS: Seven scapular specimens and 12 three-dimensional CT reconstructions were analyzed. Measurements were set the length, width, and thickness of the horizontal portion, the height, width, and thickness of the vertical portion, as well as the length and width of the glenoid cavity. Simulated mid-axial screw trajectories were assessed for angulation relative to the glenoid plane and scapular body plane, and the extreme range of each entry angle was defined. Specimen measurements were compared to the CT data. Entry point distances from anatomical landmarks and screw trajectory lengths were measured. RESULTS: In the scapular specimens, the length of the horizontal portion was 37.94 ± 4.02 mm, with a width of 13.74 ± 1.35 mm and a thickness of 9.40 ± 0.90 mm. The height of the vertical portion was 19.14 ± 1.64 mm, with a width of 24.99 ± 1.30 mm and a thickness of 9.97 ± 1.43 mm. The length of the glenoid cavity was 41.21 ± 4.50 mm, and the width was 29.39 ± 4.12 mm. In the glenoid plane, the screw trajectory angle was 51.33° ± 16.04°, and the extreme range of entry angle was 53.53° ± 6.05°. For the scapular body plane, it was 8.67° ± 6.36° and 63.86° ± 6.36°, respectively. The CT data measurements aligned with those of the specimens except for the extreme range of entry angles (P < 0.05). The optimal entry point was 10 mm lateral to the medial border of the horizontal portion, slightly below the midpoint of its superior-inferior axis, with a trajectory length of about 40 mm. CONCLUSION: This study delineates the anatomical dimensions of the coracoid process in the Chinese population and defines safe parameters for mid-axial screw placement through the vertical portion, including entry point localization, trajectory orientation, and angulation limits. These findings enhance the precision and safety of coracoid-related surgical interventions.
Re-evaluating the 'gonadal ganglion': anatomical insights into intermesenteric ganglia and gonadal innervation.
Yaguchi M, Kawashima T
Surg Radiol Anat · 2025 Oct · PMID 41083886 · Publisher ↗
PURPOSE: “Gonadal ganglion” is occasionally used to describe ganglia at the origin of the gonadal artery that give rise to gonadal branches. To evaluate the anatomical accuracy of this term and clarify the structure of g...
PURPOSE: “Gonadal ganglion” is occasionally used to describe ganglia at the origin of the gonadal artery that give rise to gonadal branches. To evaluate the anatomical accuracy of this term and clarify the structure of gonadal innervation, anatomical examinations of the preaortic plexus and its ganglia were required. METHODS: Thirty-six sides from eighteen elderly cadavers were analyzed to study the anatomical and histological features of gonadal innervation. RESULTS: The intermesenteric plexus was found to form thick bilateral intermesenteric trunks accompanied by a thin preaortic plexus. Paucicellular preaortic ganglia containing only a few ganglion cells were widely distributed throughout the plexus, whereas dense preaortic ganglia (DCGs) were consistently located on each trunk. Although a clear interaction between the preaortic ganglia and both typical and atypical gonadal arteries was noted, several findings raise concerns about the anatomical validity of the term “gonadal ganglion.” First, 10 of 33 (30.3%) typical gonadal arteries lacked a DCG at the artery’s origin. Second, 15 of 40 DCGs (37.5%) contributed to gonadal innervation regardless of the gonadal artery’s origin. Although gonadal branches consistently followed the gonadal artery in the paraaortic region, their association with intermesenteric ganglia or gonadal artery origin in the preaortic region was variable. CONCLUSION: Regardless of their location on the gonadal artery, the surrounding ganglia contribute only a few branches to the gonads but supply many branches to other structures. “Gonadal ganglion” should not be used to describe a ganglion with a single function. If necessary, it should be termed the “aortico-gonadal ganglion”.
Role-based prompting to optimize chatgpt's anatomical assessment.
Sivri I, Ozden FM, Gul G … +2 more , Kaygin E, Colak T
Surg Radiol Anat · 2025 Oct · PMID 41083875 · Publisher ↗
Recent evaluations of ChatGPT’s performance in anatomy education have provided valuable insights into its capabilities and limitations. In response to the article by Singal and Goyal on the use of ChatGPT 3.5 and 4.0 for...
Recent evaluations of ChatGPT’s performance in anatomy education have provided valuable insights into its capabilities and limitations. In response to the article by Singal and Goyal on the use of ChatGPT 3.5 and 4.0 for education on scalenovertebral triangle anatomy, we propose that the “neutral prompt” approach can be further optimized by using role-specific prompts. This approach, already utilized in other medical domains, allows large language models to generate more contextually appropriate and pedagogically useful outputs. We recommend considering the integration of role-specific prompts in future studies assessing AI-based tools in anatomy education, as a means to optimize their reliability and educational value.
A case report of an absence of the left inferior thyroid artery with the thyroid IMA artery compensating.
Xu FB, Yue WB, Yang C
Surg Radiol Anat · 2025 Oct · PMID 41083784 · Publisher ↗
PURPOSE: The inferior thyroid artery is an artery of the anterolateral neck and supplies blood to the thyroid gland and surrounding structures in the neck. Here, we report an anatomical variation of the left inferior thy...
PURPOSE: The inferior thyroid artery is an artery of the anterolateral neck and supplies blood to the thyroid gland and surrounding structures in the neck. Here, we report an anatomical variation of the left inferior thyroid artery in a male cadaver. We aimed to enrich the data on these anomalies, which can have implications for surgical interventions and clinical outcomes. CASE PRESENTATION: During routine neck dissection of a 64-year-old male donor, the inferior thyroid artery was identified bilaterally. On the left side, the inferior thyroid artery was absent and replaced by the thyroid IMA artery. The thyroid IMA artery formed a U-shaped course and gave branches to the lower part of the thyroid gland. In addition, the thyroid IMA artery arose from the brachiocephalic trunk. Furthermore, the branch of the thyroid IMA artery ascended parallel to the left recurrent laryngeal nerve. There was no anatomical variation of the right inferior thyroid artery. CONCLUSIONS: The current study describes a significant anatomical variation as the absence of the left inferior thyroid artery compensated by the thyroid IMA artery. This variation has significant implications for clinical practice and surgical procedures, particularly for surgery in the neck, axilla, and superior mediastinum. Preoperative imaging and surgical panning should be considered to avoid the likelihood of complications during clinical practice and surgery.
Bilateral incomplete mandibular canals: an embryological analysis of their possible etiology.
Rumpansuwon K, Berkban T, Kruepunga N … +8 more , Weerachatyanukul W, Asuvapongpatana S, Chaiyamoon A, Jitaree B, Tubbs RS, Iwanaga J, Senarai T, Suwannakhan A
Surg Radiol Anat · 2025 Oct · PMID 41083728 · Publisher ↗
PURPOSE: This study aims to report a previously undocumented anatomical variation of the mandible and investigate its developmental origin using embryological analysis. METHODS: Anatomical inspection and computed tomogra...
PURPOSE: This study aims to report a previously undocumented anatomical variation of the mandible and investigate its developmental origin using embryological analysis. METHODS: Anatomical inspection and computed tomography were performed on a dried human mandible from a male cadaver of unknown age. Additionally, serial histological sections from a Carnegie Stage 23 human embryo were reconstructed in 3D model to examine the spatial relationships between the developing mandible and surrounding structures. RESULTS: The mandibular canal exhibited breaching of the medial wall into the lingual cortex on both sides. Computed tomography confirmed that the canals originated from the mandibular foramen and gave rise to the mental foramina at the medial third of the mandible. These defects were found along with a left-sided Stafne bone cavity. Embryological analysis revealed a close spatial proximity between the developing mandible, the inferior alveolar nerve, and the salivary glands, supporting the hypothesis that incomplete ossification could result from variant nerve positioning or glandular entrapment. CONCLUSION: This study presents rare anatomical variations of the mandibular canal and their possible developmental mechanism. These findings have implications for radiological interpretation and surgical planning involving the mandible.
Assessment of sellar parameters using computed tomography for a safe endonasal transsphenoidal approach in pituitary surgery.
Akbudak İ, Tekinhatun M, Turmak M … +1 more , Deniz MA
Surg Radiol Anat · 2025 Oct · PMID 41083658 · Publisher ↗
PURPOSE: Endoscopic endonasal transsphenoidal surgery (EETS) is a key treatment for pituitary tumours unresponsive to medication, but it carries risks such as internal carotid artery injury and cavernous sinus haemorrhag...
PURPOSE: Endoscopic endonasal transsphenoidal surgery (EETS) is a key treatment for pituitary tumours unresponsive to medication, but it carries risks such as internal carotid artery injury and cavernous sinus haemorrhage. This study aims to establish safe surgical boundaries by measuring sellar region parameters on computed tomography angiography (CTA) images to enhance EETS efficacy and minimize complications. METHODS: This study involved 460 adult patients who underwent head and neck CTA scanning at our clinic from August 2023 to April 2024. Measurements taken from CTA images included skull base angle (SBA), Anterior Surgical Angle (ASA), Posterior Surgical Angle (PSA), Anterior Distance 1 (AD1), Anterior Distance 2 (AD2), Posterior Distance 1 (PD1), Posterior Distance 2 (PD2), Safe Window Area (SWA), Depth of the Sella Turcica (DST), Intercarotid Distance (ID), Apex Nasi-Sella Turcica Angle (ANSTA), Sella Anterior Wall Thickness (TSAW) and Sella Floor Wall Thickness (TSFW). Sphenoid sinus types were also assessed, with comparisons made between genders and age groups. RESULTS: When comparing genders, median values of SBA, ASA, DST and ANSTA were significantly higher in females, whereas AD1, AD2, PD1, PD2, SWA, ID and TSAW were significantly higher in males (p < 0.05). Moreover, correlation analysis revealed a significant positive correlation between age and PSA, PD1-2, ID, TSAW and TSFW. CONCLUSION: Pre-operative measurement of sella turcica parameters and sphenoid sinus type by radiologists is crucial for neurosurgeons planning EETS for pituitary lesions, potentially reducing complications through a better understanding of surgical anatomy.
Carotid-anterior cerebral artery (ACA) anastomosis (infraoptic ACA): review and proposing additional classification of bilateral type.
Uchino A
Surg Radiol Anat · 2025 Oct · PMID 41083600 · Publisher ↗
PURPOSE: The purpose of this review is (1) to describe variability of the carotid-anterior cerebral artery (ACA) anastomosis (infraoptic ACA) and (2) to propose additional classification of bilateral type. METHODS: The a...
PURPOSE: The purpose of this review is (1) to describe variability of the carotid-anterior cerebral artery (ACA) anastomosis (infraoptic ACA) and (2) to propose additional classification of bilateral type. METHODS: The author reviewed many articles reporting carotid-ACA anastomosis, including the authors’ own previous reports, and analyzed the pattern of anomalous arteries with the presence or absence of the normal A1 segment, with particular attention to bilateral types. The data base used was PubMed. The search terms used were “carotid-ACA anastomosis” and “infraoptic ACA”. RESULTS: There are three major types of unilateral carotid-ACA anastomosis: type 1, bilateral normal A1s are present; type 2, ipsilateral normal A1 is absent but contralateral A1 is present; and type 3, bilateral normal A1s are absent. There was a strong right-sided predominance. The bilateral type is rare, with no significant laterality in size. The author proposed the bilateral type as type 4, with three subtypes: type 4a had bilateral normal A1, type 4b had unilateral A1, and type 4c had no A1. In most cases of the bilateral type, carotid-ACA anastomosis was classified as type 4c. CONCLUSION: Carotid-ACA anastomosis is clinically significant because of its strong association with an aneurysm at the anterior communicating artery complex. And it is also dangerous in surgical operations in the suprasellar region approached via the anterior cranial fossa, such as aneurysm clipping. Because of symmetry, the bilateral type (type 4) may sometimes be overlooked during the interpretation of magnetic resonance angiography and computed tomography angiography.
Investigation of variations in the innervation of the thenar muscles by the median nerve.
Acar E, Yılmaz M, Kıratlıoğlu Y … +3 more , Acar Hİ, Armangil M, Tekdemir İ
Surg Radiol Anat · 2025 Oct · PMID 41068426 · Publisher ↗
INTRODUCTION: This study aims to investigate the anatomical variations in the median nerve and its branches, specifically focusing on their distribution to the muscles and the points at which they enter the muscles. In a...
INTRODUCTION: This study aims to investigate the anatomical variations in the median nerve and its branches, specifically focusing on their distribution to the muscles and the points at which they enter the muscles. In addition, the branching level of the ramus muscularis of the median nerve supplying the thenar muscles was examined to explore potential correlations with carpal tunnel syndrome. Understanding these variations is crucial for minimizing iatrogenic nerve damage during surgical procedures in the carpal tunnel region. METHODS: Dissections were conducted on 15 forearm and wrist specimens, including 8 right-sided cadavers and 7 left-sided cadavers. The muscle branch entry levels into the thenar region were measured, and the nerve was classified according to Lanz's classification system during the opening of the flexor retinaculum. Parameters such as the height of the first branch of the median nerve relative to the z-line (interstyloid line), the relationship of the nerve's muscular branch to the flexor retinaculum, the level of entry of the muscle branch into the muscle (relative to the z-line), muscle length, and the ratio of the entry level of the first branch to muscle length were examined. RESULTS: Four types of median nerve branching were observed according to Lanz's classification. The extraligamentous type was the most common, found in 53% of the specimens. In preligamentous types, the branches emerged on average 13.37 ± 5.69 mm inferiorly, except for those relative to the z-line. The entry level of the muscle branch into the muscle was most frequently located in the upper third of the thenar region. The average length of the thenar region was measured to be 11.40 ± 1.02 mm. The high frequency (53%) of the extraligamentous type in our study aligns with the findings in the general literature. However, the discovery of an additional preligamentous accessory motor branch in 46% of cases is a noteworthy observation, highlighting a higher rate than previously documented. CONCLUSION: These branching patterns suggest the need for careful consideration of accessory branches during surgical procedures in the carpal tunnel region. In particular, during carpal tunnel surgeries, it is recommended to assess the relationship between the motor branch of the median nerve and the flexor retinaculum before releasing it, as variations in branching could have implications for surgical outcomes.
Arthroscopic posterior approaches to the wrist and periscaphoid vascular network: a cadaveric anatomical study.
Koehly A, Pichonnat M, Cognet JM … +4 more , Lepage D, Burnier M, Loisel F, Brumpt E
Surg Radiol Anat · 2025 Oct · PMID 41062815 · Publisher ↗
The aim of our study was to assess the anatomical relationships between wrist arthroscopic portals and the periscaphoid vascular network. Fourteen fresh human cadaver wrists were perfused. Needles were placed in the 3–4,...
The aim of our study was to assess the anatomical relationships between wrist arthroscopic portals and the periscaphoid vascular network. Fourteen fresh human cadaver wrists were perfused. Needles were placed in the 3–4, 6R, midcarpal radial (MCR), midcarpal radial scaphoid (MCRS), and scaphotrapezium-trapezoid (STT) portals. Contrast-enhanced CT scans were performed to analyze the constant arteries, their anatomical relationships, and their distance from the needles. Scaphoid vascularization mainly consisted of a dorsal branch along the dorsal ridge and a palmar branch opposite the waist. Our study highlights the probable and more frequent-than-expected presence of an anterior artery also located at the level of the waist. The STT portal showed the closest proximity to the dorsal branch of the scaphoid. The safe distances from this branch were smaller when using the STT portal compared to the MCRS portal. The dorsal arthroscopic portals commonly used to treat scaphoid nonunions carried a low risk of damaging these branches. The periscaphoid vascular network appears to be more complex and potentially more variable than classically described in the literature.
The lingual-facial-ascending pharyngeal trunk.
Triantafyllou G, Papadopoulos-Manolarakis P, Tudose RC … +3 more , Rusu MC, Tsakotos G, Piagkou M
Surg Radiol Anat · 2025 Oct · PMID 41060391 · Full text
Though small, the ascending pharyngeal artery (APA) is surgically significant due to its proximity to the internal carotid artery (ICA) and supply to critical neurovascular structures. We present a unique arterial varian...
Though small, the ascending pharyngeal artery (APA) is surgically significant due to its proximity to the internal carotid artery (ICA) and supply to critical neurovascular structures. We present a unique arterial variant identified by computed tomography angiography (CTA) in a 52-year-old male. On the left side, the APA originated in common with a short linguofacial trunk (LFT) that further gave rise to the lingual and facial arteries (LA and FA), forming a trifurcated LA-FA-APA trunk. On the right side, an independent LFT was present, with the APA originating separately from the external carotid artery (ECA). CTA with three-dimensional reconstruction is essential for detecting rare vascular configurations and should be part of the preoperative evaluation for head and neck surgeries and endovascular procedures.
The sensory innervation pattern of the ankle: a systematic review.
Hohenberger G, Wittig U, Pretterklieber M … +2 more , Hammer N, Pretterklieber B
Surg Radiol Anat · 2025 Oct · PMID 41053425 · Publisher ↗
PURPOSE: The aim of this systematic review was to summarize the available evidence concerning the sensory innervation of the upper and lower ankle joints. METHODS: A systematic literature search according to the PRISMA g...
PURPOSE: The aim of this systematic review was to summarize the available evidence concerning the sensory innervation of the upper and lower ankle joints. METHODS: A systematic literature search according to the PRISMA guidelines was conducted using the PubMed and Embase databases. The following search algorithm was used: “(innervation ankle joint)” OR “(denervation ankle joint)” OR “(nerve supply ankle joint)”. Human anatomical studies which provided information on the innervation of the ankle joints were included. RESULTS: Ten studies met the inclusion criteria. The number of specimens included averaged 44.8 (range: 5–200). The tibial nerve innervates the posteromedial portion of the capsule of the upper ankle and subtalar joints and the medial-plantar portions of the talocalcaneonavicular joint. The sural nerve mainly supplies the dorso-lateral portion of the upper ankle joint, the dorsal and lateral portions of the subtalar joint and the region directly anterior to the lateral malleolus. Branches of the deep peroneal nerve innervate the anterior portion of the capsule of the upper ankle joint between the tip of the lateral malleolus and reach almost towards the medial malleolus. Innervation by the superficial peroneal nerve has been reported solely with highly variable patterns. The saphenous nerve innervates the joint capsule directly anterior and distal to the medial malleolus and the medial aspect of the capsule of the talocalcaneonavicular joint. Additionally, the accessory deep peroneal nerve may contribute to the innervation. CONCLUSION: The given data provide relevant guidelines for denervation procedures of both the upper and lower ankle joints.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe