Folia morphologica最新文献

Background: Anatomical variants such as the precondylar tubercle (PCT) and third occipital condyle (TOC) are rare bony projections located at the anterior margin of the foramen magnum. Though often asymptomatic, they can have clinical relevance in radiological and surgical contexts. Despite growing interest in these traits, their presence in European skeletal collections remains poorly documented.

Materials and methods: This study examined 126 crania from the historical collection curated at the Museum of Anthropology "Giuseppe Sergi" (MGS), Sapienza University of Rome. Biological profiles were reassessed using standard anthropological methods for sex determination and age estimation. Macroscopic evaluation focused on the presence of PCT and TOC, as well as associated traits such as bipartite hypoglossal canals.

Results and discussion: Eight crania presented PCTs; of these, two also exhibited TOC. In the latter specimens, the absence of postmortem damage allowed confident exclusion of fusion with the atlas or axis, suggesting an incidental occurrence and likely asymptomatic condition. Two specimens with PCT also displayed bipartite hypoglossal canals. Although the sample does not represent a population in the proper sense, these findings align with previously reported frequencies in modern collections and highlight potential developmental origins shared between PCT and TOC.

Conclusions: The identification of PCT and TOC in a curated historical sample contributes to the documentation of rare morphological variants at the craniovertebral junction. These results underscore the relevance of skeletal collections in descriptive anatomy and support future multidisciplinary research integrating clinical, developmental, and evolutionary perspectives.

Background: The common hepatic artery (CHA) is a major vessel supplying the liver, stomach, pancreas, and duodenum. While typically arising from the celiac trunk, its origin, course, and morphometry exhibit considerable variability, which may complicate hepatobiliary and pancreatic surgery, liver transplantation, and interventional procedures. This study aimed to comprehensively assess the anatomy and morphometry of the CHA using computed tomography angiography (CTA), with attention to clinically relevant variations.

Materials and methods: A retrospective analysis was performed on 73 consecutive patients (41 females, 32 males). Each CHA was reconstructed in three dimensions using dedicated software, and its origin, length, diameter, cross-sectional area, and departure angle were measured at standardized points.

Results: The CHA most commonly originated from the celiac trunk (93.2%), with aberrant origins from the superior mesenteric artery (5.5%) and aorta (1.4%). The median distance from the celiac trunk to CHA origin was 35.73 mm, and the median CHA diameter at its origin was 5.55 mm. Proximal to the bifurcation into the proper hepatic and gastroduodenal arteries, the median CHA diameter and cross-sectional area were 5.54 mm and 23.48 mm², respectively.

Conclusions: Although the CHA typically arises from the celiac trunk, clinically significant variants, including superior mesenteric artery, and aorta-derived CHAs, necessitate preoperative recognition to avoid vascular injury during pancreaticoduodenectomy or hepatic resection. The morphometric data presented provide valuable guidance for endovascular procedures, catheter and graft selection, and arterial reconstruction planning, underscoring the importance of routine preoperative vascular mapping with CTA in hepatobiliary and pancreatic surgery.

Background: The obturator artery (OA) and obturator vein (OV) often exhibit anatomical variations, particularly in their origins. Corona mortis (CMOR) is a well-known type of anatomical variation; however, few studies have reported the distribution of OA after it passes through the obturator canal (OC). This case reports an abnormal OA and OVs that formed a CMOR without passing through the OC.

Materials and methods: Variations were observed in an 81-year-old Japanese man during a gross-anatomical dissection course for students at Tokai University of Medicine in 2023.

Results: The left OA branched from the external iliac artery via the inferior epigastric artery, coursing toward the OC with the obturator nerve (ON); however, only the ON emerged from the canal. The left OV originated in the public and internal obturator regions as OV1 and OV2, each exiting the OC separately. Furthermore, OV1 and OV2 branched and converged with the external iliac vein to form OV3 and OV4. The muscles normally supplied by OA were instead distributed by branches of the left medial circumflex femoral artery (MCFA) and femoral artery.

Conclusions: This is the first report of the OA and OVs not passing through the OC. Understanding the course of these vessels is essential for procedures such as pelvic lymph node dissection and endovascular aneurysm repair involving unilateral internal iliac artery interruption. The branches of the MCFA and femoral artery observed in this case may contribute to further studies on the vascular anatomy of the pelvic system.

Background: The great auricular nerve (GAN) is the largest cutaneous branch of the cervical plexus, playing a crucial role in head and neck surgeries, including aesthetic procedures, migraine treatment, and parotid gland interventions. Despite its clinical importance, anatomical descriptions of GAN remain inconsistent across studies.

Materials and methods: This systematic review aims to provide a comprehensive, evidence-based analysis of GAN anatomy. A systematic search was conducted across major electronic databases to identify original studies reporting morphometric and branching data on GAN. Studies that were review articles, case reports, letters to the editor, conference abstracts, or performed on animals were excluded. The methodological quality of the included studies was assessed using the Anatomical Quality Assurance (AQUA) Tool developed by the Evidence-Based Anatomy Working Group.

Results: This review was registered in the PROSPERO database, ID CRD420251005988. This part of the review included 21 studies, encompassing 745 dissected GANs (512 cadaveric and 233 intraoperative observations). During its course, GAN divides into multiple branches supplying the mastoid region, posterior two-thirds of the auricle, lobule, parotid gland, and overlying skin. Several anatomical landmarks were identified for GAN localization, and their distances to notable parts of GAN anatomy were recorded and analyzed.

Discussion and conclusions: This review provides the most comprehensive synthesis of GAN anatomy to date. Given its high clinical relevance, especially in surgical procedures and nerve grafting, precise anatomical knowledge is essential to minimize iatrogenic injuries. However, due to variability in study methodologies and reporting quality, further high-quality anatomical studies are needed to refine surgical guidelines.

Background: The inferior mesenteric artery (IMA) serves as the primary blood supply for the hindgut, extending from the distal transverse colon to the rectum. Variations in the anatomy of the IMA are well-documented, and numerous classification systems have been developed to describe these anatomical differences. These variations can involve differences in the origin, course, and branching patterns of the IMA. The present study aimed to analyze the anatomy of the IMA with respect to the available classification systems in the literature.

Materials and methods: Results from 74 consecutive patients who underwent abdominal computed tomography angiography (CTA) were evaluated.

Results: The most common vertebral level of departure of the IMA was found to be the body of the L3 vertebra. The most common IMA type according to the Zhang classification was found to be Type IA, which occurred in 25 of the studied patients (35.71%). The most common IMA type according to the Zebrowski classification was found to be Type B (n = 26; 41.27%), followed by Types C and H (n = 14; 22.22%). The most common order of departure of the branches of the IMA was found to be the left colic artery (LCA) followed by the common departure of the sigmoid trunk and superior rectal artery (SRA). The median diameter of the IMA at its origin was found to be 3.49 mm (LQ = 3.09; HQ = 3.70) in females and 3.74 mm (LQ = 3.44; HQ = 4.05) in males (p = 0.01).

Conclusions: The results of the present study demonstrate that the most comprehensive but also specific classification system of the IMA was the McSweeney classification. It is hoped that the results of the present study may be useful to physicians performing various gastrointestinal and endovascular procedures, such as laparoscopic ligation of the IMA or embolization procedures.

Background: The brachioradialis muscle (BRM), among the extensor muscles of the forearm, is positioned most laterally and marks the beginning of the lateral extensor group of the forearm.

Materials and methods: The study was based on 100 human fetuses of both sexes (47♂ and 53♀), aged between 20 and 34 weeks of gestation. The fetuses, preserved in 10% buffered formalin solution, underwent conventional anatomical dissection to expose the lateral group of forearm extensors. Photographic documentation of the muscles in situ was analyzed using an optimized digital imaging system and subjected to statistical evaluation (including Student's t-test and nonlinear estimation).

Results: For most of the parameters examined, no statistically significant differences were identified with respect to sex or laterality. The greatest variability was observed in muscle surface area and tendon width at mid-length. Derivatives of linear parameters were calculated to determine the rate of increase of these functions, confirming a faster growth rate in the proximal portion of the muscle compared with the distal portion of the BRM. These results corresponded with developmental patterns previously reported for upper limb musculature.

Conclusions: 1) The variability of the brachioradialis muscle (BRM) in the human fetus is minimal. 2) The BRM shows no sex- or side related (laterality) except for the morphometric parameters with the greatest overall variability (i.e., the largest mean-median differences and highest SDs) which are: tendon width at mid-length and muscle surface area. 3) BRM development follows a proximal-distal growth pattern, similar to other upper-limb muscles.

Background: The left coronary artery (LCA) typically terminates by bifurcating into left anterior descending (LAD) and circumflex (Cx) branches, collectively forming a critical component of coronary circulation. Despite relevancy in coronary angiography interpretation and preoperative planning, description of standard and aberrant LCA branching pattern rates is often restricted to small-scale studies. Therefore, this study aimed to provide a comprehensive analysis of the prevalence of LCA branching patterns.

Materials and methods: A systematic review was conducted by searching major databases and relevant anatomical journals. Studies that provided quantitative data on LCA branching patterns were selected for inclusion. A total of 85 studies met the criteria, which encompassed a total of 23,421 LCAs. Data on LCA branching patterns rates, continent in which the study took place, and study methodology (imaging versus dissection) were extracted and analyzed via meta-analysis.

Results: The pooled prevalence of absent LCA was 0.40%, single LCA branch (aberrant Cx origin while LCA continued as LAD) was 0.03%, LCA bifurcation was 68.77%, trifurcation was 26.77%, tetrafurcation was 1.01%, and pentafurcation was < 0.01%. Subgrouping based on methodology revealed differing LCA bifurcation rates as seen in imaging studies (75.79%) versus dissection studies (64.22%) (Q = 15.91, p < 0.01). Subgrouping based on continent in which the study took place revealed significant heterogeneity (Q = 29.26, p < 0.01).

Conclusions: The LCA exhibits variable branching patterns, and understanding the prevalence of LCA branching patterns can support imaging interpretation and preoperative planning for coronary circulation interventions.

Background: The application of artificial intelligence (AI) in medicine has been a strong trend in recent years. Many generative tools have a model that processes a text command (so-called "prompt") and generates a response in the form of text (e.g. ChatGPT) or an image (e.g. Midjourney, DALL-E). Due to the wide availability, these tools are often used without proper supervision for educational purposes. The aim of this study was to assess the state-of-the-art use of AI-based generative tools in creating an image-based anatomical atlas using only images created by AI.

Materials and methods: The author's provided anatomical prompt into the Midjourney and individual images were made for each of the eight organ systems - digestive, facial, genitourinary, respiratory, skeletal, muscular, circulatory, and neurological. The systems were divided into two sections: a general sketch of body system (BS) and a detailed description of one of their representative structures (DS). The authors selected two of the highest images for each collection, correspondingly. The obtained data was assessed qualitatively depending on the presence of a specific structure, a physiological alteration, or the presence of an additional AI hallucination. Obtained results were compared with The Federative International Programme for Anatomical Terminology - Terminologia Anatomica 2nd version (TA2) and statistically analyzed using the chi-square test of independence (two-sided α = 0.05, β = 0.2) to evaluate the relationship of image complexity and the categories studied.

Results: A total of 12126 general BS and 2503 specific DS items according to TA2 were obtained and analyzed. As for the presence of structures, they were generally present in 17.3% (n = 2094), absent in 53.3% (n = 6462) and the generated scenery did not allow a clear assessment of the presence of a structure in 29.4% (n = 3570). Only 7.0% (n = 553) of the current structures were in physiological order. However, 6.0% (n = 471) of the particular items were classed as AI hallucinations. When comparing BS and DS findings, the tool significantly outperformed DS in all categories: structural presence (21.7% BS vs 40.3% DS; p < 0.001), physiological order (4.6% BS vs 15.5% DS; p < 0.001), and AI imagination (6.3% BS vs 4.9% DS; p = 0.034).

Conclusions: The current state-of-the-art of anatomy based on generative tools does not allow for the high-quality application of AI to generate anatomical atlases. Especially, inexperienced users may unknowingly cultivate inconsistent scientific understanding. The results obtained are expected to improve in the future due to the continuous addition of annotations to libraries and the improvement of algorithms, nevertheless more research is required.

Background: The brachial artery is a key vessel supplying the upper limb, and its anatomical variations can have significant clinical implications. One of the most common variations of this vessel is a high division of the brachial artery. This can occur at various levels of the arm and lead to the formation of a brachioradial artery, a brachioulnar artery, or their superficial variants.

Materials and methods: The study was based on the analysis of a case observed during a routine autopsy of a 64-year-old woman, conducted as part of the Normal Anatomy course for medical students at the Department of Normal and Radiological Anatomy of the Medical University of Lublin.

Results: The analysis revealed an atypical course of the arteries in the left upper limb. The brachial artery divided at the level of the upper third of the arm, 2 cm below the lower border of the teres major muscle, giving rise to the brachioradial artery and the brachioulnar artery. The common interosseous artery branched off from the brachioulnar artery in the cubital fossa. The vascular course in the right upper limb was confirmed as typical.

Conclusions: A high division of the brachial artery is a relatively common anatomical variation, occurring in 10.05% of the population, and therefore requires special attention during surgical and diagnostic procedures. Its most frequent variant is the division of the brachial artery into a brachioradial artery and a brachioulnar artery. The presence of this variation can affect the efficacy and safety of procedures such as angiography, vascular surgeries, or reconstructive surgeries. Further research should aim to standardize the descriptions of anatomical variations in upper limb arteries and establish a unified nomenclature system.

Background: A comprehensive anatomical understanding of the azygos venous system, and of the courses and branching patterns of major arteries and their possible variations, is essential for accurate diagnosis, effective management of vascular conditions, and for safe surgical or interventional procedures. Detailed preoperative assessment and recognition of such vascular morphologies and anomalies play a pivotal role in minimizing intraoperative risks and preventing postoperative complications.

Case report: Four concurrent variations of the vessels were identified in a ninety-eight-year-old Korean female cadaver during routine dissection for an anatomy class. The main trunk of the azygos vein (AV) bifurcated at the level of L1 and rejoined at the level of T10. During its ascent on the left side, the intercostal veins drained directly into the AV without forming the hemiazygos or accessory hemiazygos veins. The right common carotid artery exhibited severe kinking just inferior to the level of T1. The first branch of the right internal iliac artery was the obturator artery rather than the umbilical artery. Furthermore, the inferior gluteal artery (IGA) and the internal pudendal arose from a common trunk and bifurcated below the pelvic diaphragm. We observed a rare looped artery in the left internal iliac region connecting the posterior division of the internal iliac artery to the proximal portion of the IGA.

Conclusions: This case highlights that various rare vascular anomalies may coexist in a single individual; anatomist, surgeons, and other clinicians should be aware of this possibility during dissection and surgical procedures.