Surgical and Radiologic Anatomy最新文献

Purpose: - As a potential cause of compression resulting in neuropathic pain or using to secure coxal bone procedure, the proximity of sciatic nerve against coxal bone inside the infra-piriform foramen was unclear.

Methods: - This systematic review focused on the relationship between pelvic bone and sciatic nerve based on PRISMA methodology.

Results: - A total of 26 studies involving 4,813 lower limbs were included in the meta-analysis. The variations of the sciatic nerve in relation to the piriform muscle were described in 14.5% of cases. The variation involving division of the sciatic nerve in the pelvis, with the common fibular nerve passing over the piriformis muscle and the tibial nerve passing through it, was never observed. However, a variation in which the sciatic nerve divided in the pelvis, with its two terminal branches (the common fibular nerve and the tibial nerve) passing separately under the piriformis muscle, was described in 0.81% of cases.

Conclusion: - There was no data available to analyse the distance between the sciatic nerve and the coxal bone as it exited the pelvis.

Purpose: Our hypothesis was that some differences exist among the corresponding groups of the perforating arteries (PAs), which could have important implications in radiology, neurology, and neurosurgery. To test the hypothesis, we performed a detailed study of these vessels.

Methods: The vasculature of 22 cerebral hemispheres was injected with a 10% India ink and gelatin. After fixation, all the perforators were microdissected under the stereoscopic microscope. The PAs territories were examined as much as possible. The remaining 4 hemispheres were injected with methylmethacrylate to obtain the vascular casts.

Key findings: The PAs are very rarely absent on one side (7.8%, and 11.6%; p < 0.01). They range from 0 to 12 in number (mean, 3.22), and between 0.06 and 1.32 mm in diameter (mean, 0.31 mm) (p = 0.022 each). They originate from the parent arteries (46.2-100.0%), either solely or by common stems (0.0-65.4%), or along with certain pial vessels (0.0-69.3%), with significant correlation among them (p < 0.029, p = 0.001, p = 0.038). Larger and smaller PAs are distinguished. An occlusion of the larger common stems could cause a massive central hemispheric, or a larger thalamic or paramedian brain stem infarction, associated with certain symptoms and neurologic signs. An obturation of both PAs and pial arteries could result in a combined deep and peripheral ischemia. The smaller PAs mostly nourish the hypothalamus and optic structures. Close proximity of the PAs and aneurysms or arteriovenous malformations could complicate surgical or endovascular interventions.

Conclusion: Knowledge of the PAs microanatomic similarity and differences, including their supplying regions, can help in understanding neurologic signs following their occlusion. This is also important in neuroradiologic diagnostics, and for safe neurosurgical and endovascular interventions.

Purpose: Variations in the branching pattern of the aortic arch are highly diverse and are often encountered incidentally during routine computed tomography angiography scans. This study aimed to determine the prevalence of variations in aortic arch branching patterns in the Turkish population using computed tomography angiography (CTA) images.

Methods: CTA images of 1000 patients (500 males, 500 females) who presented to the radiology clinic for various indications between May 2018 and June 2024 were evaluated. The branching variations of the aortic arch were classified into seven main types. The relationship between aortic arch branching pattern variations and sex was assessed using the Chi-square test.

Results: A normal branching pattern (Type 1) was observed in 853 of the 1000 cases, while variations were found in 147 cases. The most common variation was Type 2, in which the brachiocephalic trunk and the left common carotid artery originate from a common trunk, observed in 8.3% of cases. This was followed by Type 3 variation, where the left vertebral artery arises directly from the aortic arch, seen in 4.1% of cases. The third most common variation was Type 4, observed in 1.3% of cases, which involves both the Type 2 branching pattern and the left vertebral artery originating directly from the aortic arch. Type 6 variation, defined as an aberrant right subclavian artery, was seen in 0.8% of cases, while Type 7 (mirror image) variation was observed in 0.1%. Type 5 variation was not detected in any case. Apart from these classifications, a variation in which the left inferior thyroid artery originated directly from the aortic arch was detected in one female patient.

Conclusion: There was no statistically significant difference between sexes in the distribution of aortic arch branching pattern variations (p = 0.067). Patients with aortic arch variations are at increased risk of bleeding and ischemia during thoracic surgery. Awareness of aortic arch variations is particularly important in patients scheduled for thoracic surgery or interventional radiological procedures, as it helps reduce potential risks.

Purpose: Maxillary third molars (MTMs) are frequently utilized as donor teeth in autogenous tooth transplantation (ATT). This study aimed to characterize and grade MTMs' CBCT features to inform ATT operation.

Methods: This retrospective CBCT analysis evaluated 800 MTMs from 537 patients regarding tooth morphology, root canal configuration, and impaction status. A CBCT-based binary complexity grading for MTM autotransplantation was established, and its clinical relevance to the operative difficulty of ATT and its adjunctive procedures (root canal treatment, RCT) was analyzed in 26 ATT cases using both a subjective five-point scale and operation time.

Results: Predominant characteristics of MTMs included: 1-rooted morphology (65.63%), Vertucci's Type-I canal configuration (76.17%), root canal curvature 10°-30° (35.44%), and non-impaction status (77.75%). Mean root length was 10.66 ± 1.56 mm, canal length 16.95 ± 1.79 mm, crown-to-root ratio 1:1.8, and maximum root cross-sectional area (CSA) 60.21 ± 13.08 mm². Significant clinical relevance (p < 0.05) was found between atraumatic tooth extraction and root number, impaction direction, and depth of MTMs; between recipient-site preparation and cervical buccolingual width, mesiodistal width, root number, and maximum root CSA; between RCT and the canal configuration and curvature; and between ATT operation time and impaction depth and root number.

Conclusions: MTM CBCT characteristics exhibit significant anatomical variation and are relevant to ATT complexity. The CBCT-based binary complexity grading for MTM autotransplantation predicts procedural difficulty and would facilitate comprehensive preoperative evaluation for ATT.