Surgical And Radiologic Anatomy[JOURNAL]
Sun
200 papers
Endovascular management of femoral artery duplication with a proposed anatomical classification.
Shoja MM, Khoury RE, Asha A … +4 more , Bystrom P, Weiss R, Jacobs CE, Schwartz LB
Surg Radiol Anat · 2026 Apr · PMID 41934500 · Publisher ↗
PURPOSE: Duplication of the femoral artery (FA) is an exceedingly rare anatomic variant, and its implications for endovascular therapy are poorly defined. We report endovascular revascularization for chronic limb-threate...
PURPOSE: Duplication of the femoral artery (FA) is an exceedingly rare anatomic variant, and its implications for endovascular therapy are poorly defined. We report endovascular revascularization for chronic limb-threatening ischemia (CLTI) in a duplicated FA and propose a classification system for these duplications. METHODS: An 80-year-old woman presented with lower extremity CLTI and underwent computed tomographic angiography (CTA) followed by endovascular treatment of the FA stenosis. In addition, previously published reports of FA duplication were reviewed to characterize anatomic patterns and inform a classification system. RESULTS: Computed tomographic angiography demonstrated a duplicated left FA with critical serial stenoses of the internal limb and severe disease near the distal confluence. Selective angiography confirmed two diminutive, parallel FA limbs with occlusion at the adductor canal near their coalescence and collateral reconstitution of the popliteal artery. The diminutive internal limb was successfully cannulated and used to traverse the occlusion. Orbital atherectomy followed by balloon angioplasty restored inline flow with minimal residual stenosis, resulting in durable limb salvage. CONCLUSION: A duplicated FA can complicate endovascular recanalization because of the diminutive caliber of the arterial limbs. We identified five patterns of FA duplication in the literature. Type 1 represents partial duplication of the FA distal to the origin of the deep femoral artery, with subsequent reunion proximal to the adductor hiatus, a pattern similar to that observed in our patient. Including the present report, only 21 cases of type 1 FA duplication have been reported in the literature since the early nineteenth century.
Ultrasound assessment of deep fascia of lower limbs in children: an anatomical study.
Katolicka T, Quittkova A, Pirri C … +4 more , Stecco C, Katolicky J, Safarova M, Machac S
Surg Radiol Anat · 2026 Apr · PMID 41934479 · Publisher ↗
PURPOSE: The deep fascia plays a crucial role in musculoskeletal function, yet little is known about its characteristics in children. The current literature lacks reference values for deep fascia thickness in healthy ped...
PURPOSE: The deep fascia plays a crucial role in musculoskeletal function, yet little is known about its characteristics in children. The current literature lacks reference values for deep fascia thickness in healthy pediatric populations, making assessing alterations in pediatric disorders difficult. This study aims to provide baseline measurements of deep fascia thickness in the lower limbs of healthy pediatric subjects using ultrasound and establish pilot reference data for future clinical applications. METHODS: This cross-sectional study included 21 healthy children aged 3–9 years. Ultrasound imaging was performed using a 17 MHz linear probe at two standardized locations on fascia lata and crural fascia. A modified imaging protocol ensured feasibility for pediatric subjects. Measurements were analysed using ImageJ, with inter-rater reliability assessed via the Intra-Class Correlation Coefficient (ICC). Statistical analyses, including correlations with age and BMI, were conducted using Jamovi software (p < 0.05). RESULTS: The mean fascia lata thickness was 0.802 ± 0.140 mm (anterior) and 1.34 ± 0.251 mm (lateral). The mean crural fascia thickness was 0.629 ± 0.084 mm (anterior) and 0.644 ± 0.076 mm (lateral). A statistically significant correlation was found only between BMI and lateral crural fascia thickness, whereas no significant correlations with age were observed. Inter-rater reliability was good (ICC 0.893, 95% CI 0.851–0.923). CONCLUSION: This study provides the first reference values for pediatric deep fascia thickness. Lateral regions of fascia lata were thicker than anterior regions, consistent with adult findings. Ultrasound imaging proved to be a reliable and well-tolerated method for pediatric fascia evaluation, supporting its future use in research and clinical assessments.
Evaluation of maxillary sinus septa and predicted Schneiderian membrane perforation risk: a cone beam computed tomography study.
Türker N, Çeçen Erol E, Küçük Kurtgöz M … +1 more , Aktuna Belgin C
Surg Radiol Anat · 2026 Apr · PMID 41934477 · Publisher ↗
OBJECTIVE: This study aimed to characterize the morphology, orientation, and location of maxillary sinus septa in relation to posterior dentition status, and to evaluate the radiographically categorized (predicted) risk...
OBJECTIVE: This study aimed to characterize the morphology, orientation, and location of maxillary sinus septa in relation to posterior dentition status, and to evaluate the radiographically categorized (predicted) risk of Schneiderian membrane perforation using cone beam computed tomography (CBCT). METHODS: CBCT images from 300 individuals with adequate posterior maxillary visualization were retrospectively analyzed. Images with pathologic formations, prior sinus surgery, or fractures were excluded. The presence, orientation (mediolateral or anteroposterior), and location (premolar anterior, premolar–molar, molar posterior, or multiple) of maxillary sinus septa were recorded. Participants were grouped by posterior dentition status (< 2 teeth or ≥ 2 teeth). Perforation risk was assessed radiographically using a modified seven-class system and categorized as low, moderate, or high. No intraoperative confirmation was performed. RESULTS: The mean age of participants was 43.5 ± 13.3 years; 54.7% were male. Septa were mostly mediolateral (91.7%) and located in the premolar region (40.0%). The most frequent predicted risk classes were Class I (33.0%) and Class III (32.7%). Moderate predicted perforation risk was higher in females (p = 0.011), and septum location was significantly associated with predicted perforation risk (p < 0.001). No significant associations were observed between posterior dentition status, septum orientation, and predicted perforation risk. CONCLUSIONS: Maxillary sinus septa exhibit variable morphological patterns and anatomical distributions that may be relevant for preoperative CBCT evaluation during sinus floor elevation. Although perforation risk was assessed radiographically and not confirmed intraoperatively, understanding septal morphology may enhance surgical awareness and inform individualized planning.
Type 4A torcular herophili anatomic variant detected by cerebral digital subtraction angiography: case report.
Casaperalta GL, Medina CAL
Surg Radiol Anat · 2026 Apr · PMID 41931117 · Publisher ↗
The torcular Herophili (TH) presents numerous anatomical variants. Kobayashi proposed a classification of sinus confluence patterns; the case we present is compatible with type 4A, a very rare presentation. In this case,...
The torcular Herophili (TH) presents numerous anatomical variants. Kobayashi proposed a classification of sinus confluence patterns; the case we present is compatible with type 4A, a very rare presentation. In this case, we present the case of a young male patient who came to the clinic with moderate holocranial headache. A brain magnetic resonance imaging (MRI) with contrast was performed, revealing an image suggestive of a developmental venous anomaly in the left parietal region, that's why we decide to perform a digital subtraction angiography (DSA). Although no vascular lesion was found, a torcular anatomical variant was evident. The circumstances and logistics allowed for a detailed description of the lesion, and knowledge of the different variants is essential for accurate radiological interpretation and safe surgical planning in the posterior fossa.
Sampson's artery: anatomical, surgical and radiologic implications.
Sakthi-Velavan S, Gabbard C, Carrico J
Surg Radiol Anat · 2026 Apr · PMID 41920218 · Publisher ↗
PURPOSE: Sampson’s artery (SA), the artery of the round ligament, is a small vessel coursing alongside the round ligament of the uterus. The SA has significant clinical implications, particularly in obstetrics, gynecolog...
PURPOSE: Sampson’s artery (SA), the artery of the round ligament, is a small vessel coursing alongside the round ligament of the uterus. The SA has significant clinical implications, particularly in obstetrics, gynecology, radiology, and general surgery. This study aims to synthesize current anatomical, embryological, and clinical evidence regarding SA and clarify its relevance for surgeons, radiologists, and anatomists. METHODS: A structured search of PubMed and Google Scholar was performed using the terms “Sampson’s artery,” “artery of the round ligament,” and “round ligament artery.” Publications describing anatomical, radiological, embryological, or surgical findings were included without year restriction. Case reports, imaging studies, and reviews were analyzed for anatomic origin, course, variations, and clinical outcomes. A total of 88 articles were retrieved, and 33 met the inclusion criteria. RESULTS: Sampson’s artery most often arises from the inferior epigastric artery or external iliac artery. It anastomoses with a branch of the uterine artery and contributes to the utero-ovarian anastomosis. Its caliber may increase during pregnancy or pelvic pathology, producing collateral flow that can contribute to postpartum hemorrhage, placenta accreta, leiomyoma rupture, or postoperative hemoperitoneum after hernia repair. Radiologically, persistent bleeding after uterine artery embolization frequently involves this vessel. Awareness remains limited among surgeons and trainees. CONCLUSION: Although small, SA has disproportionate surgical and radiologic importance. Awareness of the SA as a possible source of persistent hemorrhage is essential for improving outcomes in pelvic and gynecologic procedures. Comprehensive preoperative planning and refinement of surgical and radiologic approaches can further minimize SA-related complications.
Correction: Anatomical study of the vascularization of the pedicled osteo-myo-cutaneous scapulo-dorsal flap.
Kany A, Verdalle-Cazes M, Vacher C … +4 more , Foy JP, Crampon F, Deneuve S, Nokovitch L
Surg Radiol Anat · 2026 Mar · PMID 41894023 · Publisher ↗
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Morphological study of the zygomaticofacial foramen and its location using the distance cross-localization method.
Ma C, Wang Y, Liu C … +2 more , Guan J, Liu J
Surg Radiol Anat · 2026 Mar · PMID 41894003 · Publisher ↗
PURPOSE: The zygomaticofacial foramen (ZFF) can serve as a landmark for craniofacial procedures and is an ideal site to localize the zygomaticofacial nerve. This study investigated ZFF anatomy in a Chinese sample to: (1)...
PURPOSE: The zygomaticofacial foramen (ZFF) can serve as a landmark for craniofacial procedures and is an ideal site to localize the zygomaticofacial nerve. This study investigated ZFF anatomy in a Chinese sample to: (1) compare findings with existing reports, (2) detail anatomical locations using the distance cross-localization method, and (3) explore distribution characteristics. METHODS: Seventy adult skulls were used to investigate the number and diameter of ZFF and measure the distances from ZFF to the closest point on the orbital rim (D-ZFF-CPR), the medial end of the zygomaticofrontal suture (D-ZFF-meZFS), and the inferolateral orbital rim (D-ZFF-ILO). The distance cross-localization method was employed to localize the ZFF. The identified ZFF location was designated as the center of the injection site for the simulated anesthetic procedure. ZFF within injection regions of varying diameters were then counted to calculate the occurrence rate. RESULTS: Zygomatic bones with one or two ZFF accounted for 87.9% of the total sample. The mean D-ZFF-CPR, D-ZFF-ILO, and D-ZFF-meZFS were 7.13 ± 2.12 mm, 11.66 ± 4.13 mm, and 23.44 ± 4.19 mm, respectively. As the diameter of the injection site increased in the simulated anesthetic operation, the occurrence rate of ZFF at that site increased correspondingly, when the diameter was 20 mm or more, over 97% of ZFF were present in this region. The ZFF were closely concentrated near the orbital rim and widely distributed from the medial end of the zygomaticofrontal suture. CONCLUSIONS: The number, diameter and location of the ZFF show variability and contribute to medical procedures involving the craniofacial region. This study provides an easily applicable method to localize the ZFF with reference to the surrounding anatomical landmarks.
Clinical and surgical implications of emissary venous anatomy.
Supsupin E, Bhosale H, Fabrega M … +5 more , Snow I, Ortiz Cordero R, Guevara Tirado O, Robinson J, Virarkar M
Surg Radiol Anat · 2026 Mar · PMID 41893998 · Publisher ↗
PURPOSE: To review the anatomy and clinical significance of the cranial emissary veins (CEVs) with an emphasis on the posterior fossa pathways, their relevance to neuroradiologic interpretation, and implications for surg...
PURPOSE: To review the anatomy and clinical significance of the cranial emissary veins (CEVs) with an emphasis on the posterior fossa pathways, their relevance to neuroradiologic interpretation, and implications for surgical planning. METHODS: A narrative, imaging-focused review was performed while discussing anatomic descriptions and clinically relevant patterns of CEV appearance on cross-sectional imaging. RESULTS: CEVs are valveless veins that pass through cranial apertures and connect the intracranial venous sinuses and extracranial veins. CEVs play a crucial role in normal cerebral venous drainage, brain thermoregulation, and various pathological states, particularly in high-flow vascular malformations, fistulas, and venous thrombosis. CEVs must be identified and reported before surgeries involving the posterior fossa and mastoid region to avoid complications. CEVs, specifically of the posterior fossa, are a source of complications that may include uncontrollable bleeding and air embolism, venous thrombosis, and venous ischemic and hemorrhagic infarcts. CEVs may also be therapeutically beneficial, as a large mastoid emissary vein (MEV) may provide endovascular access for treating lesions involving the transverse or sigmoid sinus. CONCLUSION: Knowledge of the key CEV anatomy is important for the neuroradiologist to inform preoperative planning and promptly identify their pathologic variations. Beyond neurosurgical procedures, understanding the anatomy of the emissary veins is crucial for reconstructive surgeons operating in the scalp and craniofacial region. Misidentification of this anatomy and injury to these structures can lead to intra-operative and post-operative complications, including bleeding, flap congestion, and even intracranial complications.
Fenestrated giant mastoid emissary vein, a novel finding.
Rusu MC, Tudose RC, Vrapciu AD
Surg Radiol Anat · 2026 Mar · PMID 41893901 · Full text
PURPOSE: To document an extracranial fenestration of the mastoid emissary vein (MEV) and to clarify its drainage pattern and potential procedural relevance. METHODS: A 46-year-old male underwent multidetector CT angiogra...
PURPOSE: To document an extracranial fenestration of the mastoid emissary vein (MEV) and to clarify its drainage pattern and potential procedural relevance. METHODS: A 46-year-old male underwent multidetector CT angiographic evaluation of the cervical carotid system. DICOM data were post-processed in Horos using multiplanar reconstructions and three-dimensional volume-rendered images; morphometric measurements were obtained on the reconstructions. RESULTS: A large left MEV (6.6 mm) exited through a single mastoid foramen situated 2.95 cm postero-supero-medially to the mastoid tip. The vein divided 2.2 mm distal to the foramen into an anterior limb (5.0 mm) and a posterior limb (1.1 mm) that rejoined 2.33 cm inferiorly, forming a long fenestration. Three deep communicating veins connected the fenestrated segment to the suboccipital venous plexus, and the distal MEV continued as the deep cervical vein. CONCLUSION: Extracranial fenestration is a plausible variant of a prominent MEV. Recognition on CT may prevent misinterpretation as vascular duplication or pathology and may influence mastoid, retrosigmoid, and endovascular planning in the mastoid–suboccipital region.
An unusual variant of the anterior cerebral and anterior communicating arterial system: anatomical description with clinical and radiological implications.
Ozturk S, Saglam L, Barburoğlu M … +7 more , Sencer S, Dolen Burak D, Unal TC, Sabancı PA, Aras Y, Sencer A, Aydoseli A
Surg Radiol Anat · 2026 Mar · PMID 41886088 · Publisher ↗
Anatomical variations of the circle of Willis are frequently encountered; however, certain configurations may have significant clinical and hemodynamic implications. Variations involving the anterior cerebral artery and...
Anatomical variations of the circle of Willis are frequently encountered; however, certain configurations may have significant clinical and hemodynamic implications. Variations involving the anterior cerebral artery and anterior communicating artery are particularly relevant due to their role in collateral circulation and their importance during surgical and endovascular interventions. A previously undescribed configuration of the anterior cerebral circulation was identified in a 69-year-old woman who presented with a transient ischemic attack. Magnetic resonance angiography demonstrated complete absence of the left A1 segment and the anterior communicating artery, with a single right A2 segment supplying the medial surfaces of both cerebral hemispheres. This configuration was accompanied by a left-sided fetal-type posterior cerebral artery. No significant stenosis was identified in the carotid or vertebrobasilar systems. This unique arterial arrangement does not correspond to currently available classification systems of anterior cerebral artery and anterior communicating artery variations. From a clinical perspective, reliance on a single A2 segment may limit collateral capacity and increase vulnerability to ischemia affecting bilateral medial frontal regions. Awareness of such variants is essential for accurate radiological interpretation and for informed procedural planning in neurosurgical or endovascular interventions involving the anterior circulation.
Anastomosis of the dorsal pancreatic artery and first jejunal artery forming a pancreaticojejunal arcade: a clinically significant Bühler-type celiac-mesenteric collateral.
Junhua H, Yixin H, Yuechen Z … +3 more , Sijie G, Jiuhong Z, Zhihong L
Surg Radiol Anat · 2026 Mar · PMID 41874726 · Publisher ↗
PURPOSE: Although anastomoses between the dorsal pancreatic artery (DPA) and superior mesenteric artery (SMA) branches are well known, a direct end-to-end DPA–first jejunal artery (FJA) connection has never been describe...
PURPOSE: Although anastomoses between the dorsal pancreatic artery (DPA) and superior mesenteric artery (SMA) branches are well known, a direct end-to-end DPA–first jejunal artery (FJA) connection has never been described. We report this novel vascular variant and evaluate its anatomical and clinical relevance. METHODS: A case of abdominal anatomy. The anatomical characteristics of the celiac trunk (CeT) (including its branches) and the DPA were documented in a 68-year-old male specimen. RESULTS: The DPA originated from the common hepatic artery (CHA) and descended posterior to the pancreas. Typical pancreaticoduodenal (PD) arcades were absent. Instead, the DPA formed a direct end-to-end anastomosis with the FJA, which arose anomalously from the right anterolateral aspect of the SMA, contrary to its typical left‒sided origin. This created a continuous arterial channel between the pancreatic body and proximal jejunum, termed the pancreaticojejunal (PJ) arcade. Unlike previously reported DPA–SMA collaterals limited to the duodenum, this is the first DPA–FJA anastomosis extending celiac–mesenteric collateral flow beyond the ligament of Treitz. CONCLUSION: This PJ arcade represents a functionally significant, Bühler-type foregut–midgut collateral. Its diameter is significantly larger than that of the arc of Bühler, and its inadvertent ligation during pancreaticoduodenectomy or vascular surgery may compromise dual perfusion territories. Preoperative computed tomography (CT) angiography should be considered to identify such variants.
Radial nerve branches to the triceps brachii: cadaveric analysis and surgical implications for neurotization.
Mombellet M, Destrieux C, Samargandi R … +1 more , Bacle G
Surg Radiol Anat · 2026 Mar · PMID 41874693 · Full text
PURPOSE: The radial nerve, originating from C5 to C8 and occasionally T1, is one of the two major nerves in the posterior brachial plexus bundle. Studies on the radial nerve vary regarding the number, arrangement, and em...
PURPOSE: The radial nerve, originating from C5 to C8 and occasionally T1, is one of the two major nerves in the posterior brachial plexus bundle. Studies on the radial nerve vary regarding the number, arrangement, and emergence of its branches. This study aims to clarify the motor branch layout of the radial nerve to identify the optimal branch for neurotization. METHODS: Thirty cadaveric dissections were performed using a posterior approach, spliting the triceps muscle heads. RESULTS: Four distinct motor branches were consistently identified, all emerging before the nerve contacts the radial sulcus. Only the inferior branch to the medial head showed variability, sometimes giving additional branches to the lateral head, sensory branches, or both. CONCLUSION: We recommend the long head branch for neurotization due to its consistent anatomical position and reliability. LEVEL OF EVIDENCE: IV
Evaluation of the relationship between the gonial angle and the pattern of the impacted mandibular third molar by cone beam computed tomography.
Akyol R, Etöz M
Surg Radiol Anat · 2026 Mar · PMID 41874684 · Publisher ↗
OBJECTIVES: This study evaluated the relationship between the gonial angle and the impaction patterns of mandibular third molars (M3Ms) using cone-beam computed tomography (CBCT). The secondary aim was to assess the asso...
OBJECTIVES: This study evaluated the relationship between the gonial angle and the impaction patterns of mandibular third molars (M3Ms) using cone-beam computed tomography (CBCT). The secondary aim was to assess the association between the impaction patterns (Pell & Gregory and Winter classifications) and mandibular ramus dimensions, specifically ramus height (RH) and ramus width (RW). METHODS: A total of 355 impacted M3Ms from 213 patients were retrospectively analyzed. Impaction patterns were classified according to the Pell & Gregory (PG) Ramus/Depth and Winter classification systems. Gonial angle, RH, and RW measurements were performed on standardized panoramic reconstruction images generated from CBCT data. Relationships between morphometric parameters and impaction types were analyzed statistically with a significance level of p < 0.05. RESULTS: There was no significant relationship between PG classifications and the gonial angle. However, a significant association was found between Winter classification and the gonial angle (p = 0.044), with the vertical position exhibiting the highest mean values. Multivariable analysis confirmed a significant gender-specific interaction (p = 0.012), with significance occurring exclusively in males (p = 0.005). RH showed statistically significant differences according to both PG Ramus (p < 0.001) and PG Depth (p = 0.037) classifications, whereas RW did not differ significantly across impaction groups. Additionally, a negative correlation was observed between the gonial angle and both ramus height and width. CONCLUSION: Gonial angle and RH are associated with specific M3M impaction patterns, whereas RW is not a determining factor. These morphometric parameters can guide surgeons in estimating extraction difficulty and planning appropriate surgical approaches.
Sex estimation from sacral anatomy in Turkish adults: a machine learning-based analysis.
Ayturk BG, Keles A, Osmanoglu UO
Surg Radiol Anat · 2026 Mar · PMID 41848882 · Publisher ↗
PURPOSE: The estimation of sex is the first and foremost step in developing a reliable biological identity during the examination of skeletal remains. The purpose of the study is to assess the usability of the sacrum for...
PURPOSE: The estimation of sex is the first and foremost step in developing a reliable biological identity during the examination of skeletal remains. The purpose of the study is to assess the usability of the sacrum for sex determination in a Turkish population through machine learning. METHODS: We performed a retrospective examination of the CT images of 540 individuals. DICOM images, including the sacrum, were obtained from patients aged 18–79 years. The following parameters were measured: Anterior Sacral Length (ASL), Posterior Sacral Length (PSL), Anterior Sacrococcygeal Length (ASCL), Posterior Sacrococcygeal Length (PSCL), Maximum Anteroposterior Diameter (MAPD), and Maximum Transverse Diameter (MTD). Eight different machine learning algorithms were applied for sex estimation. To enhance reliability, fivefold cross-validation was used. RESULTS: Sacral morphometric parameters were statistically significantly higher in males than in females (p < 0.001). Among the algorithms tested, logistic regression achieved the highest classification accuracy for sex at 85%. Based on these results, logistic regression provided the best performance for sex estimation from sacral measurements. Further, the maximum anteroposterior diameter at the sacral base was the most discriminative parameter. CONCLUSION: Based on our analysis shows that the sacrum is a reliable anatomical structure for predicting sex in cases of high sexual dimorphism with an accuracy rate of 85%. The sacrum can serve as a powerful reference for sex estimation in forensic cases and anthropological applications. Furthermore, the resulting morphometric records can be stored as a useful resource for preoperative planning and anatomical evaluation for clinics and regional surgeons.
Posterior interosseous ligament of the ankle: current evidence and knowledge gaps.
Gołek Ł, Landfald IC, Domżalski M … +1 more , Olewnik Ł
Surg Radiol Anat · 2026 Mar · PMID 41848798 · Publisher ↗
BACKGROUND: The posterior interosseous ligament (PIL) of the ankle syndesmosis remains a poorly recognized and inconsistently described structure, despite growing anatomical and biomechanical evidence supporting its rele...
BACKGROUND: The posterior interosseous ligament (PIL) of the ankle syndesmosis remains a poorly recognized and inconsistently described structure, despite growing anatomical and biomechanical evidence supporting its relevance. Historically conflated with the deep component of the posterior inferior tibiofibular ligament (PITFL), the PIL has only recently gained attention as a potentially independent contributor to syndesmotic stability. OBJECTIVE: This review consolidates current anatomical, biomechanical, radiological, and surgical insights into the PIL, clarifies terminological inconsistencies, and evaluates its clinical significance. METHODS: A comprehensive synthesis of cadaveric studies, imaging research, and biomechanical models was undertaken to characterize the morphology, function, detectability, and surgical relevance of the PIL. RESULTS: The PIL is identifiable in up to 80% of cadaveric specimens, though its morphology varies widely. MRI detectability varies depending on protocol and anatomical prominence, and current surgical techniques do not account for its presence. When present in robust forms, the PIL may contribute to rotational and posterior syndesmotic stability, especially in conjunction with PITFL insufficiency. CONCLUSION: The PIL may represent a distinct deep posterior band in a proportion of ankles. However, its constancy, isolated biomechanical contribution and independent clinical relevance remain insufficiently established. Standardised terminology and targeted anatomical, imaging and biomechanical studies are needed.
The fovea capitis femoris as a dynamic surgical landmark: morphometric associations with the femoral inclination angle.
Türkoğlu FN, Akın Saygın D, Alpa Ş … +1 more , Aydın Kabakçı AD
Surg Radiol Anat · 2026 Mar · PMID 41843161 · Publisher ↗
PURPOSE: The fovea capitis femoris (FCF) is widely used as a surgical and radiological landmark of the femoral head; however, its anatomical relationship with the angular geometry of the proximal femur remains insufficie...
PURPOSE: The fovea capitis femoris (FCF) is widely used as a surgical and radiological landmark of the femoral head; however, its anatomical relationship with the angular geometry of the proximal femur remains insufficiently defined. Although the fovea is routinely used as a reference point in femoral head procedures, the influence of the femoral inclination angle (FIA) on its morphology and localisation remains insufficiently defined and underappreciated in clinical practice. This study aimed to comprehensively quantify the morphometric and morphological characteristics of the FCF and to investigate their relationship with proximal femoral parameters, with particular emphasis on the FIA. METHODS: A total of 382 adult dry femurs (75 right, 207 left) were analysed. Femur length (FL), FIA, femoral head area (AHOF), foveal area (AFCF), foveal diameters, depth, shape, and localisation were measured using digital callipers and ImageJ software. Correlation and regression analyses were performed to evaluate relationships among parameters. RESULTS: The fovea was most commonly oval or round and was predominantly located in the postero-inferior quadrant of the femoral head. FIA showed a significant positive correlation with both AFCF (r = 0.162, p < 0.001) and the AFCF/AHOF ratio (r = 0.198, p < 0.001), indicating that larger foveae are associated with greater FIA. FL was correlated with AHOF (r = 0.268, p < 0.001), and AHOF was strongly correlated with foveal size (AFCF: r = 0.529, p < 0.001), demonstrating proportional scaling of the fovea with overall femoral size. Regression analysis further showed that AFCF significantly predicted FIA (FIA = 127.2 + 1.68 × AFCF). CONCLUSION: These findings indicate that FCF morphology reflects the global angular and geometric configuration of the proximal femur and support the clinical relevance of incorporating femoral inclination into radiological assessment and surgical procedures that rely on the fovea as a reference point.
Anatomical variations in the relationship between the sciatic nerve and the piriformis muscle: clinical implications.
Lopez Castellanos F, Feipel V
Surg Radiol Anat · 2026 Mar · PMID 41838178 · Publisher ↗
OBJECTIVES: This study aims to contribute additional comparative anatomical and morphometric data to identify anatomical variations of the sciatic nerve (SN) and its relationship with the piriformis muscle (PM), clarify...
OBJECTIVES: This study aims to contribute additional comparative anatomical and morphometric data to identify anatomical variations of the sciatic nerve (SN) and its relationship with the piriformis muscle (PM), clarify sex-related differences, and attempt to propose anatomical features relevant to understanding piriformis muscle syndrome. METHODS: Dissection of the deep gluteal region was performed on 80 specimens from 40 donors of both sexes. The frequency of SN anatomical variations in relation to the PM was recorded according to Beaton and Anson’s classification and analyzed by sex. Various morphometric measurements were also taken and compared according to sex and anatomical variations. RESULTS: Anatomical variations of the SN (types B, C, and D) were observed in 19.7% of specimens, with no significant sex-related difference in prevalence. The distances between the posterior superior iliac spine and the ischial tuberosity, the posterior superior iliac spine and the upper edge of the greater trochanter, the upper edge of the greater trochanter and the ischial tuberosity, the lateral edge of the SN and the upper edge of the greater trochanter, and the length of the lower limb were statistically greater in male specimens. Female specimens had a statistically greater width of the infra-piriform foramen. The distance between the SN and the greater sciatic notch was statistically larger in type A than in type B variants. CONCLUSION: Variations in the anatomical relationship between the SN and PM are not unusual and should be considered during medical procedures. Morphometric assessment may inform future research on piriformis muscle syndrome management.
Isolated left common carotid artery: steal syndrome and neurological complications.
Chen Q, Lu K, Tang Y … +6 more , Dai L, Che J, Jiang Q, Huang W, Wang W, Wang Y
Surg Radiol Anat · 2026 Mar · PMID 41838163 · Publisher ↗
Isolated left common carotid artery (ILCCA) is a rare cardiovascular malformation. Its core imaging feature is the anomalous connection of the left common carotid artery (LCCA) to the pulmonary artery, rendering it the r...
Isolated left common carotid artery (ILCCA) is a rare cardiovascular malformation. Its core imaging feature is the anomalous connection of the left common carotid artery (LCCA) to the pulmonary artery, rendering it the rarest subtype of right aortic arch malformation. Reversed blood flow in the LCCA has been identified in the vast majority of reported cases. This malformation induces a left-to-right shunt via the common carotid artery and the circle of Willis, which subsequently leads to LCCA-steal syndrome. To date, no studies have reported the composition of this left-to-right shunt nor the neurological complications secondary to LCCA-steal syndrome. This case report elucidates the composition of the left-to-right shunt and the underlying mechanism by which the malformation elicits the steal syndrome.
Characterization of Hyrtl's anastomosis: anatomical types, measurements and fetoplacental correlation.
Motwani R, Mangla M, Palo S … +3 more , Kaliappan A, Bukke N, Chandrupatla M
Surg Radiol Anat · 2026 Mar · PMID 41824063 · Publisher ↗
PURPOSE: Hyrtl’s anastomosis, a vascular connection between the umbilical arteries close to its placental attachment that plays a crucial role in maintaining balanced fetoplacental circulation. Despite its clinical impli...
PURPOSE: Hyrtl’s anastomosis, a vascular connection between the umbilical arteries close to its placental attachment that plays a crucial role in maintaining balanced fetoplacental circulation. Despite its clinical implications, its morphological variations remain underexplored. METHODS: Term placentas collected after delivery were analysed for the presence, type, and location of Hyrtl’s anastomosis. Gross dissection and morphometric analysis were done. The distance between Hyrtl’s anastomosis and cord insertion was measured. RESULTS: Hyrtl’s anastomosis was observed in 56 of 111 placentas (50.5%). Most cases demonstrated a single anastomosis (91.1%), while multiple anastomoses were observed in 8.9%, including two cases of a rare double H-type. The H-type was the most frequent morphological pattern (42.9%), followed by oblique (30.4%), fenestrated (10.7%), coalesced (7.1%), M type (1.8%), and anastomosis between branches (3.6%). The mean distance of Hyrtl’s anastomosis from cord insertion was 14.3 ± 10.2 mm (range: 1.3–70 mm). No significant differences were found in maternal, placental, or neonatal outcomes between groups; however, placental weight showed a stronger correlation with neonatal weight when Hyrtl’s anastomosis was present, suggesting subtle efficiency advantages. CONCLUSION: Morphological heterogeneity in Hyrtl’s anastomosis may affect fetoplacental hemodynamics. Recognising such anatomical variances emphasises the significance of including Hyrtl’s anastomosis assessment into routine antenatal ultrasonography, demonstrating the clinical utility of anatomical knowledge.
Morphology of the accessory band of the semitendinosus tendon (aSTT): meta-analysis and systematic review.
Możdżeń K, Fibiger G, Malczak M … +8 more , Tempski J, Malinowski K, Stolarz K, Łazarz D, Murawska A, Kozioł T, Walocha JA, Pękala P
Surg Radiol Anat · 2026 Mar · PMID 41824062 · Publisher ↗
PURPOSE: The semitendinosus tendon (STT) remains one of the principal autografts in knee ligament reconstruction; however, anatomical variations may significantly influence surgical practice. Among these, the accessory b...
PURPOSE: The semitendinosus tendon (STT) remains one of the principal autografts in knee ligament reconstruction; however, anatomical variations may significantly influence surgical practice. Among these, the accessory band of the semitendinosus tendon (aSTT) has attracted attention because of its potential to complicate graft harvesting, increase the risk of misidentification, and even lead to a change in graft selection or inadvertent transection of the ST tendon. Current reports on the morphology and prevalence of the aSTT are inconsistent, largely due to heterogeneous definitions. This study aimed to systematically synthesize available anatomical evidence on the prevalence, morphology, and fascial connections of the accessory semitendinosus tendon. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Eighteen cadaveric studies comprising 839 knees were included. Qualitative and quantitative data were synthesised using MetaXL 5.3 and Comprehensive Meta-Analysis 4 with a random-effects model. Statistical heterogeneity was assessed using Chi² and I² statistics. RESULTS: The pooled prevalence of the aSTT was 72.2% (95% CI: 59.4-82.2%), with marked regional variation. Prevalence was highest in Europe (91.0%; 95% CI: 60.7-100%), followed by North America (62.4%; 95% CI: 0-100%), and Asia (55.5.2%; 95% CI: 28.9-79.3%). Across studies, the aSTT demonstrated consistent morphometric patterns and characteristic fascial connections. CONCLUSIONS: The accessory semitendinosus tendon represents a frequent anatomical variant with clear regional variability. Awareness of this structure is essential during semitendinosus tendon harvesting for ligament reconstruction, as its presence may influence graft identification, preparation, and surgical planning.
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