Surgical and Radiologic Anatomy最新文献

Abstract

Intracranial arterial anatomy is lacking for most mammalian and non-mammalian model species, especially concerning the origin of the basilar artery (BA). Enhancing the knowledge of this anatomy can improve animal models and help understanding anatomical variations in humans. We have studied encephalic arteries in three different species of birds and eight different species of mammals using formalin-fixed brains injected with arterial red latex. Our results and literature analysis indicate that, for all vertebrates, the internal carotid artery (ICA) supplies the brain and divides into two branches: a cranial and a caudal branch. The difference between vertebrates lies in the caudal branch of the ICA. For non-mammalian, the caudal branch is the origin of the BA, and the vertebral artery (VA) is not involved in brain supply. For mammals, the VA supplies encephalic arteries in two different ways. In the first type of organization, mostly found in ungulates, the carotid rete mirabile supplies the encephalic arteries, the caudal branch is the origin of the BA, and the VA is indirectly involved in carotid rete mirabile blood supply. The second type of encephalic artery organization for mammals is the same as in humans. The caudal branch of the ICA serves as the posterior communicating artery, and the BA originates from both VAs. We believe that knowledge of comparative anatomy of encephalic arteries contributes to a better understanding of animal models applicable to surgical or radiological techniques. It improves the understanding of rare encephalic variations that may be present in humans.

Background

There is currently no information on positional changes in the brachial nerve plexus during prenatal growth. The subclavian–axillary artery passing through the medianus nerve ansa is considered a good landmark for evaluating the height of the plexus.

Materials and methods

We used histologic sections from 9 embryos and 17 fetuses (approximately 6–15 weeks of gestational age) to identify the height of the ansa by referring to the level of the rib and the glenohumeral joint.

Results

The nerve ansa was usually (23 plexuses) observed at the level of the first and/or second ribs. However, it was sometimes observed above the first rib, at a distance equal to or more than an intercostal width (7 plexuses). In the latter group, the ansa was usually located below the glenohumeral joint. Thus, the joint was located higher than the first rib, although the upper extremities were in the anatomic position for all specimens. The left–right difference in the height of the plexus corresponded to or was less than the width of the first intercostal space. Despite the synchronized growth between the thorax and shoulder girdle, the brachial plexus showed a considerable variation in comparative height; the range corresponded to twice of an intercostal width. Whether the nerve plexus is located high or low is determined at an early developmental stage and is maintained during the later growth stages.

Conclusion

The high-positioned plexus might cause nerve injury at delivery, followed by a glenohumeral joint deformity because of the fragility without fixation in the thorax.

Purpose

Replaced posterior cerebral artery (PCA), defined as a hyperplastic anterior choroidal artery (AChA) supplying all branches of the PCA, is an extremely rare anatomical variation. To the best of our knowledge, there are only a few reports of replaced PCA.

Methods

Herein, we report a case of replaced PCA diagnosed by digital subtraction angiography.

Results

A 76-year-old woman visited a neurosurgical clinic because of headache and vertigo. Magnetic resonance imaging and magnetic resonance angiography incidentally revealed a left internal carotid artery aneurysm. She was referred to our hospital for further examination and treatment of the unruptured intracranial aneurysm. Left internal carotid angiography revealed a paraclinoid aneurysm. We also incidentally found an anomalous hyperplastic AChA distal to the aneurysm. This hyperplastic AChA supplied not only the AChA territory but also the entire PCA territory. No vessels that could be a normal AChA or posterior communicating artery were identified along the left internal carotid artery. Vertebral angiography demonstrated that the left PCA was not visualized. With these findings, we diagnosed anomalous hyperplastic AChoA in this case as replaced PCA.

Conclusion

Careful imaging assessment is important to identify replaced PCA. Both direct findings of a hyperplastic AChA course and perfusion territory and indirect findings of the absence of the original PCA are useful in the diagnosis of replaced PCA.

Background

The ventral enclosure of the thyroid cartilage by a collapsed hyoid bone (CHB) is poorly encountered in previous research. It was aimed to observe whether or not these malformations could be found and detailed anatomically in a consistent lot of computed tomography (CT) files.

Methods

Two hundred archived CT angiograms were explicitly observed for the CHB anatomical variant.

Results

Different possibilities of CHB were found in 6/200 cases, five males and one female. The symmetrical overlap of the thyroid cartilage by the hyoid body was found in one male case. In three cases, two males and one female, there was asymmetrical overlapping due to tilted hyoid bones. In one male case with such asymmetrical CHD, an ossified anterior longitudinal ligament was noted: the tips of the superior horns of the thyroid cartilage reached lateral to it, thus being retropharyngeal. A different male case had a lowered hyoid with a greater horn fused to the superior horn of the thyroid cartilage, with an interposed ossified triticeal cartilage. In the last male case, the right greater horn collapsed laterally to an ossified triticeal cartilage fused with the thyroid cartilage's superior horn.

Conclusions

The CHB is an undeniable anatomical possibility of an atavism that alters conventional anatomical and surgical landmarks. Different anatomical components of the hyoid bone can descend uni- or bilaterally.

Introduction

Fraser syndrome, named after George Fraser, is an autosomal recessive disorder showing a highly variable interfamilial phenotypic variation, with malformations ranging from minor symptoms to lethal anomalies like renal agenesis, incompatible with survival. Limb reduction defects have not been reported to be associated with it.

Case presentation

A 21-year-old primigravida presented to the antenatal outpatient department with a level two targeted anomaly scan report suggestive of severe oligohydramnios with suspected renal agenesis. The cranial vault bones were compressed, and orbital globes and lenses could not be visualized. Renal agenesis was confirmed due to sleeping adrenals sign, non-visualization of the urinary bladder, and Doppler of renal arteries. A detailed examination of the fetal head in the sagittal section showed the absence of an eye globe and lens, arousing suspicion of Fraser syndrome. After pregnancy termination, a complete fetal autopsy was done to look for any additional findings.

Conclusion

Patients who have a syndromic mix of acrofacial and urogenital abnormalities with or without cryptophthalmos should be evaluated for Fraser syndrome, which can be diagnosed by clinical examination and perinatal autopsy.

Background

The splenic artery, an essential component of abdominal vascular anatomy, exhibits significant variations with clinical implications in surgical and radiological procedures. The lack of a standardized classification system for these variations hinders comparative studies and surgical planning. This study introduces the IPALGEA classification system, based on computed tomography angiography (CTA) findings, to address this gap.

Methods

A retrospective analysis was conducted on 302 patients who underwent CTA at a tertiary university hospital between August 2021 and January 2022. The study focused on the evaluation of splenic artery variations, including the origin, course, terminal branching patterns, and the relationship between the inferior polar artery and the left gastroepiploic artery. The IPALGEA classification was developed to standardize the reporting of these variations.

Results

The study highlighted a significant prevalence of splenic artery variations, with the most common pattern being a superior course relative to the pancreas. The IPALGEA classification effectively categorized these variations, emphasizing the relationship between the inferior polar artery and the left gastroepiploic artery. The findings revealed that the bifurcation distance of the celiac trunk varied significantly between genders and that the presence of an inferior polar artery correlated with a shorter hilus distance.

Conclusion

The IPALGEA classification offers a comprehensive and standardized approach to categorize splenic artery variations. This system enhances our understanding of abdominal vascular anatomy and has significant implications for surgical and radiological procedures, potentially reducing surgical complications and improving patient outcomes.

Purpose

This study aimed to conduct a bibliometric analysis of trends in the description items within the literature published from 2019 to 2021 with "maxillary sinus septum" in the title or subtitle.

Methods

Electronic data from PubMed (MEDLINE), Google Scholar, and ScienceDirect were searched from 2019 to 2021. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to select 21 of 243 articles and examined their studies. Statistical calculations from data recorded by the authors were performed using the Chi-square, Mann–Whitney, and independent tests. Significance was set at P < 0.05.

Results

The number of articles decreased annually. The highest number of publications was from Asia (64.3%), accounting for 71.4% of publications. The features of the septum were described for eight items, with one septum (70.14%) mentioned significantly more frequently, followed by on one side (65.89%) or the right side (62.22%). Location was mentioned significantly more frequently in the middle (55.22%) and for those aged 45 years and older (50.38%). No significant differences were observed in prevalence, age, height, or width between sexes; the patients’ ages ranged from 18 to 90 years. Septa were significantly more prevalent in dentulous (45.38%) and partially edentulous (48.58%) patients, with significantly more patients exhibiting buccopalatal orientation (82.39%).

Conclusions

This study focused primarily on anatomical features using CBCT examination, and analyses of male–female differences and the origin of the sinus septum are necessary for the future.

Purpose

Occipital Neuralgia (ON) is defined as a unilateral or bilateral pain in the posterior area of the scalp occurring in the distribution area or areas of the greater occipital nerve (GON), lesser occipital nerve (LON), and/or third occipital nerve (TON). In the present study, the purpose was to show the possible importance of the triangular area (TA) in nerve block applied in ON by measuring the TA between GON, TON, and LON.

Methods

A total of 24 cadavers (14 males, 10 females) were used in the present study. The suboccipital region was dissected, revealing the points where the GON and TON pierced the trapezius muscle and superficial area, and the point where the LON left the sternocleidomastoid muscle from its posterior edge and was photographed. The area of the triangle between the superficial points of these three nerves and the center of gravity of the triangle (CGT) were determined by using the Image J Software and the results were analyzed statistically.

Results

The mean TA values were 952.82 ± 313.36 mm² and 667.55 ± 273.82 mm², respectively in male and female cadavers. Although no statistically significant differences were detected between the sides (p > 0.05), a statistically significant difference was detected between the genders (p < 0.05). The mean CGT value was located approximately 5 cm below and 3-3.5 cm laterally from the external occipital protuberance in both genders and sides.

Conclusion

In ON that has more than one occipital nerve involvement, all occipital nerves can be blocked by targeting TA with a single occipital nerve block, and thus, the side effects that may arise from additional blocks can be reduced. The fact that there was a statistically significant difference according to the genders in the TA suggests that different block amounts can be applied according to gender.

Purpose

The anatomical position of the lingula is clinically very important to prevent injuries during sagittal split ramus osteotomy. Our study aims to evaluate the localisation of the lingula by cone beam computed tomography (CBCT) and to compare the localisation of the lingula between malocclusion, gender, and lingula types.

Methods

A retrospective study was conducted to evaluate the shape and location of the lingula using CBCT. A total of 250 CBCT images were included in this study. The lingula was classified as nodular, assimilated, truncated, or triangular type. Six defined distances from the top of the lingula were measured: anterior border of the ramus (L-A), posterior border of the ramus (L-P), internal oblique ridge (L-IOR), mandibular notch (L-N), and distal surface of the mandibular second molar (L-M2) and occlusal plane (L-OP). The measured distances were compared between gender, malocclusion, and lingula types.

Results

The most common type of lingula was nodular (32.4%). The L-N, L-P, L-M2, and L-OP distances between genders were statistically higher in male patients than in female patients. The L-IOR, L-M2, and L-OP distances exhibited statistically significant differences found between malocclusions. No statistically significant difference was found when the distances of the lingula to the anatomical points were compared between the lingula types.

Conclusion

These variations in positioning of the lingula depending on the dysmorphoses are developing towards a systematic 3D examination before any mandibular osteotomy to precisely visualize the position and shape of the lingula.