Surgical and Radiologic Anatomy最新文献

Purpose: Fenestrations of posterior cerebral artery are exceedingly rare and, therefore, deserve being reported.

Methods: During an educational dissection, a peculiar anatomical variant of the posterior cerebral artery (PCA) was found.

Results: During an educational dissection targeting the right cerebellopontine angle, a peculiar variant of the right PCA was found. The respective posterior communicating artery inserted posteriorly into the junction of the P1 and P2 segments of the PCA. The P1 segment was thinner than the P2 segment. That junction was superior to the oculomotor nerve and was fenestrated, with a thin postero-medial arm facing the cerebral peduncle, and a larger antero-lateral arm formed by the distal end of the P1 segment and the proximal end of the P2 segment.

Conclusions: To the authors' knowledge, fenestrated P1-P2 junctions of PCA were not found previously by dissection. The evidence presented here recommends such variations not to be ignored.

A 26-year-old patient underwent a successful ablation of Grade 2 diffuse astrocytoma of the right parietal lobe. The postoperative computed tomography angiography with 3D modeling revealed a residual avascular porencephalic cyst. Otherwise, multiple arterial variants have been encountered. First, the left A1 segment was fenestrated, and three A2 segments arose from the anterior communicating artery. The middle A2 segment was dominant and supplied left callosomarginal and both pericallosal territories. The right A2 segment supplied the right callosomarginal territory, while the left A1 was limited to the left orbitofrontal and frontopolar territories. This configuration represents a triplicated anterior cerebral artery with an unusual branching pattern not included in the classification of Baptista. In addition, on both sides, superior cerebellar artery duplication was present, with one arising from the basilar artery and the other from the P1 segment of the ipsilateral posterior cerebral artery. The left lower superior cerebellar artery was early bifurcated. It is the first time such a cerebrovascular configuration has been reported. Because of the several clinical and surgical applications of the anterior cerebral artery and superior cerebellar artery variants, this case report is of utmost interest to anatomists, radiologists, and neurosurgeons.

Purpose: To describe a case of a nonbifurcating cervical carotid artery with remnant of the proximal internal carotid artery (ICA).

Methods: A 47-year-old man with unruptured cerebral aneurysm underwent magnetic resonance (MR) angiography of the neck region and intracranial region. The MR machine was a 3-T scanner. Catheter angiography was performed for the treatment of the aneurysm by coil embolization.

Results: The proximal main trunk of the left external carotid artery (ECA) was absent, and branches arose separately, indicative of a nonbifurcating cervical carotid artery. At the level of the ICA origin, aneurysmal protrusion was found on MR angiography. On catheter angiography, this protrusion was not an aneurysm but a remnant of the proximal ICA.

Conclusion: The configuration of the nonbifurcating cervical carotid artery lacks the proximal ECA; however, segmental agenesis of the proximal ICA forms this rare cervical arterial variation. The present case had remnants of the proximal ICA. We speculate that the ICA channel, except for the origin, was occluded after the development of EC-ICA anastomosis, and a nonbifurcating cervical carotid artery with a remnant of the ICA may have formed. Including our patient, only four cases have been reported in the relevant English-language literature.

Purpose: The present study aimed to evaluate the insertion site of the tibialis anterior tendon three-dimensionally.

Methods: Seventy lower limbs were dissected. The tibialis anterior tendon was dissected to verify the insertion site to the medial cuneiform and the base of the first metatarsal bone. The three-dimensional (3D) territory of the tibialis anterior tendon insertion on the medial cuneiform and the first metatarsal bones was measured on a reconstructed 3D model.

Results: The insertion pattern of the tibialis anterior tendon was classified into three types, the most common being Type I: a single tibialis anterior tendon dividing into two equal-sized bands to the medial cuneiform and base of the first metatarsal bone (57.1%, 40/70 of cases). The 3D territory of the tibialis anterior tendon was larger in the plantar aspect than in the medial side of both the medial cuneiform and the base of the first metatarsal bone. The width of the tendon inserted into the medial cuneiform was wider than that inserted into the first metatarsal bone.

Conclusion: The tibialis anterior tendon was more commonly attached to the plantar part than the medial part in both the medial cuneiform and the base of the first metatarsal bone. This anatomical information will help surgeons perform anatomical reconstruction of the tibialis anterior tendon, reduce further tendon damage in the first metatarsocuneiform joint area and also provide valuable knowledge to improve understanding of hallux valgus pathogenesis.

Introduction: The obturator internus muscle is frequently targeted for injective treatments such as botulinum toxin injections in the management of pain syndromes. However, there are controversies over injective method delivering injection to the muscle.

Method: A method called modified Sihler's method was used to stain the OI muscle in 16 specimens to reveal the intramuscular neural distribution of the muscle.

Result: The greatest intramuscular neural distribution was located on the 2/10-4/10 of the muscle in the medial edge of the obturator foramen (0/0) to the greater trochanter of the femur (10/10).

Conclusion: The result suggests that botulinum neurotoxin should be delivered in the intrapelvic portion of the obturator internus muscle. As most of the extrapelvic portion of the obturator muscle is composed of a tendinous portion, it should be considered unsuitable as an injection site by medical professionals.

Purpose: It remains unclear whether concomitant changes in the thoracolumbar (TL) vertebrae and lumbar plexus roots seen in experimental embryology are present in humans with different vertebral formulas, particularly in humans with 18 TL vertebrae. We thus investigated the human lumbar plexus root changes occurring in spines with an additional TL vertebra (18TL).

Methods: The lumbosacral plexus was macroscopically dissected in TL anomaly cases found in 161 computed tomography examinations. TL anomalies were distinguished as simple abnormalities in total TL count and abnormal TL trade-offs, i.e., exchanges between the last thoracic and first lumbar vertebrae, and were analyzed separately.

Results: One additional TL vertebra (7C_18TL_5S) was observed in 4/159 cases (2.5%), excluding cases with cervical and sacral abnormalities. Different from the unclear shifts of nerve roots in cases with 16TL and 17TL trade-offs, the 18TL trade-off tended to involve a caudal shift at the cranial limit, without event change at the caudal limit. In addition, only one nerve segment shift was reconfirmed with a change in two vertebral segments from 16 to 18 TL vertebrae.

Conclusions: We revealed that concomitant changes in the lumbar plexus roots and vertebrae in humans with 18TL vertebrae may become more pronounced than those in humans with 16 or 17TL vertebrae, by approaching the typical mammalian TL formula (19TL). This study showed that the TL formula can be used to estimate changes in the lumbar plexus roots, which may assist in the planning of nerve-sparing spinal and pelvic surgery.

Purpose: Medical training has undergone many transformations to incorporate diagnostic imaging along side anatomical education. Post-mortem computed tomography (CT) scanning of body donors prior to dissection has been proposed. However, it poses challenges secondary to the embalming process and other post-mortem physiological changes that significantly alter the imaging quality. The purposes of this study were to compare the accuracy of pathology identification on pre- and post-mortem CT scans of body donors and to assess the integration of those scans in a dissection-based course, where these images were overlaid onto body donors using augmented reality (AR).

Methods: Participants in this study included 35 fourth year medical students, 5 radiology residents and 3 radiologists. A convergent, parallel mixed methods design was employed with quantitative measures that included statistical analyses of a double-blinded comparison of pathological lesions recognition, on both image sets, the group responses to a study participant survey and the login access data from imaging repository. The study also included qualitative analysis of post-elective structured interviews.

Results: The double-blinded comparison revealed that staff radiologists can only identify, on post-mortem images, 54.8% of the pathologies that they were able to detect on the pre-mortem scans. Analyses of the surveys and login access data reveal that 60% of radiology residents and 56% of students preferred pre-mortem scans and used those scans more often than post-mortem scans (67 access vs 36, respectively). However, post-mortem scans were significantly preferred when used to overlay onto body donors using AR (p = 0.0047).

Conclusion: These results show that post-mortem imaging can be valuable alongside pre-mortem imaging, as they represent the most concordance between the anatomical structures and pathologies seen on the images and what is being dissected.

Background: Here, we sought to examine the validity and reproducibility of balanced fast field echo (bFFE) for assessing superior petrosal vein (SPV) complex (SPVC) anatomy.

Methods: Preoperative bFFE or equivalent scans and operative videos were studied and directly compared with regard to the individual anatomical features of SPVCs and their relation to the operative field. The anatomical details of the bFFE findings of the non-operated side (group 2) of all 50 patients were then reviewed, including the presence of petrosal-galenic anastomosis, and finally compared to the operated SPVCs (group 1).

Results: A complete correlation between bFFE and intraoperative findings was observed in 62% of cases and had a significant correlation with 3 Tesla magnet strength and higher pixel bandwidth (r_bis = - 0.47; p = 0.005). The sensitivity and specificity of bFFE magnetic resonance imaging were 93.7 and 95.2%, respectively, for detecting an SPV disturbing the operative field, and 97.3% and 95% for a disturbing tributary, respectively. Each group had 50 SPVCs, with a total of 70 and 64 SPVs, 10 and 11 general SPVC configurations, as well as 29 and 28 different individual anatomical variations in groups 1 and 2, respectively. Both groups had 1-3 SPVs with a similar distribution of frequencies [Chi-square (4) = 27.56; p = 0.0145 (Fisher's exact test)]. The similarity of the general configurations was not statistically significant. The same four predominant configurations constituted 80% of the SPVCs in each group. The vein of the cerebellopontine fissure was most frequently found in 86% and 88% of cases, and a petrosal-galenic anastomosis was seen in 38% and 40% of groups 1 and 2, respectively.

Conclusions: Individual SPVC variations are extensive. Good quality bFFE or equivalents are feasible for preoperative SPVC assessments. However, methods improving vascular visualization are recommended.

Purpose: Skin closure disorders in ankle surgery are a recurrent problem not only in traumatology but also in elective surgery. The aim of the study was to describe the anatomical basis of the fasciocutaneous vascularization of the lateral malleolus region to develop a posterior cover flap for the region.

Methods: We dissected ten fresh frozen specimens after arterial injection of an Indian ink preparation and individualized the perforating arteries. Their positions and diameters were collated. Then, the surgical technique was clinically applied for two different cases by transferring the fasciocutaneous flap posterior to the lateral malleolus to cover a loss of skin substance.

Results: There were in average 5 fibular perforators over the last 100 mm of the fibula. The average diameter of the first two perforating arteries was 0.6 ± 0.12 mm and 0.9 ± 0.25 mm, respectively, and the consistency of the latter makes it possible to produce a skin flap with anterior translation. This is an axial flap. Two patients were operated on using this technique. There was no necrosis of the posterior fibular flap and healing was achieved by the third post-operative week.

Conclusion: This study showed the presence of fibular perforating arteries with a high reproducibility of their dissection. This anatomical description served as the basis for the description of a new distal fibular perforating flap.

Purpose: The association of bilateral duplication of the superior cerebellar artery with an origin from the posterior cerebral artery is rare but of great interest to anatomists, radiologists, and surgeons. This article reports bilateral duplicated hypoplastic superior cerebellar arteries, one of which arises from a full-type fetal cerebral artery.

Material and method: A 59-year-old woman admitted to the neurosurgery department for a subarachnoid hemorrhage underwent a brain CTA with 3D reconstruction using «3D slicer 4.11» software. Brain CTA and the 3D model were used to analyze the configuration of the posterior circulation.

Results: CTA images and the 3D model showed an unusual configuration of the posterior circulation. The basilar artery prolonged the left vertebral artery, while the right vertebral artery ended in the right posterior inferior cerebellar artery. On both sides, a full-type fetal posterior cerebral artery and duplicated hypoplastic superior cerebellar artery were observed. Three cerebellar arteries arose from the basilar artery, while the fourth one emerged from the right fetal posterior cerebral artery.

Conclusion: Knowledge of such a configuration of the posterior circulation and others is necessary before radiological and surgical procedures. It helps to understand hemodynamic events, and neurovascular conflicts, improve revascularization procedures, and avoid surgical arterial and nervous injuries.