Surgical and Radiologic Anatomy最新文献

Purpose: Although both accessory middle cerebral artery (MCA) and accessory anterior cerebral artery (ACA) are not rare anatomical variations, their combination is rare and there are only a limited number of reports of such combinations.

Methods: We report a case of accessory MCA associated with an accessory ACA diagnosed by magnetic resonance angiography (MRA).

Results: A 39-year-old woman visited our hospital because of right facial discomfort. She underwent 1.5-Tesla magnetic resonance imaging and MRA. MRA showed a left accessory MCA originating from the left ACA A1 segment. MRA also showed an accessory ACA that formed a triplicated ACA at its A2 segment.

Conclusion: Careful imaging assessment is important to identify multiple anatomical variations such as an accessory MCA associated with an accessory ACA. In our case, this rare anatomical variation was confirmed by 1.5-Tesla MRA.

Purpose and background: The trigeminal artery is a rare anatomical variant, representing an embryonic vestige of the anastomosis between the internal carotid artery and the posterior circulator system, that can be asymptomatic or could have vast clinical manifestations produced by insufficient flow or by vascular nervous conflicts. This study is an anatomical presentation of 3 trigeminal artery cases observed at Medimar Imagistic Services Constanta.

Methods: The 3 trigeminal artery cases were discovered on a 860 magnetic resonance angiographies (0.35% of cases), made on a GE HD/e 8ch 1.5 T.

Results: In all 3 cases, the arteries were rising from the right internal carotid artery and one from the left internal carotid artery, in 2 cases the origin was on the superior surface, and in one case, on the anterolateral surface, in all 3 cases from C4 horizontal cavernous segment. The artery caliber was between 2.7 mm and 5.1 mm; the artery length was between 26 and 32 mm. Other associated vascular malformations were: partial or total basilar artery hypoplasia, in one case posterior communicant artery agenesis, contralateral vertebral artery hypoplasia, posterior cerebral artery hypoplasia (in 2 cases), and no anastomosis between the P1 segment of the posterior cerebral artery with the posterior communicating artery (one case).

Conclusions: While the trigeminal artery is a rare anatomical variant, it's still a very important vessel situated in the posterior cerebral fossa, which needs to be taken into account in the case of neurosurgical interventions.

Background: The skull base ligaments have been extensively studied in the literature due to their clinical and surgical significance. The posterior petroclinoid fold (PPCNF) and petroclival ligament (PCVL) are two adjacent structures that have barely been studied and are frequently confused. The present study uses an innovative classification system to investigate the PPCNF and PCVL ossification patterns.

Materials: An archive of 164 computed tomography (CT) scans (328 sides) was evaluated. The sexes were distributed as follows: 86 females and 78 males. The mean age was 47.78 ± 15.64 years old. The ossification patterns were classified as follows: Type 0 (no ossification), Type 1 (incomplete ossification), Type 2 (complete ossification). The incomplete ossification was further classified as subtype 1a (ossification from the clival region), subtype 1b (ossification from the petrous region), and subtype 1c (ossification from both regions).

Results: No PPCNF ossification was observed in 72.6% (238/328 sides). Incomplete PPCNF ossification was identified in 25.8% (85/328 sides), and complete ossification in 1.5% (5/328 sides). A male predominance was determined for the PPCNF ossification. No PCVL ossification was observed in 85.4% (280/328 sides). Incomplete PCVL ossification was observed in 8.2% (27/328 sides) and complete ossification in 6.4% (21/328 sides). The age affected the PCVL ossification, with the older patients presenting with ossification. Simultaneous absence of PPCNF and PCVL ossification was observed in 215 sides (65.5%). The coexistence of incomplete PPCNF and PCVL ossified variants was identified in 13 sides (4%). Concomitant complete PPCNF and PCVL ossified variants were detected in 2 sides (0.6%).

Conclusions: The current study presents a detailed description of the PPCNF and PCVL. Knowledge of both structures' ossification is important for anatomists, radiologists, and clinicians due to their close relationship with neurovascular structures.

Purpose: Posterior tibial slope (PTS) influences knee kinetics and kinematics. The purpose of this study was to investigate morphology and variation within a sample of the black and white male and female population.

Method: 480 randomly selected lateral knee radiographs were included. The anterior tibial cortex angle (ATC), proximal anatomical tibial axis angle (PTAA) and the posterior tibial cortex angle (PTC) were measured using ImageJ 1.53e software. Between group differences (black male and females, white males and females) were analysed using one-way ANOVA.

Results: Significant differences between the three different angles (p = 0.0001, F = 50.68) but no between group differences for the individual angle measurements (ATC, PTAA, PTC) between ethnicity and sex. For ATC, the angles between groups ranged from 14.20 + 2.81 degrees (Females Black), 14.62 + 3.6 degrees (Male Black), 15.18 + 3.68 degrees (Male White) to 15.54 + 3.21 degrees (Females White). For PTAA, the angles between groups ranged from 10.37 + 2.59 degrees (Females Black), 10.61 + 3.27 degrees (Male Black), 10.68 + 3.27 degrees (Male White) to 10.83 + 3.27 degrees (Females White). For PTC, the angles between groups ranged from 6.07 + 3.13 degrees (Females White), 6.13 + 3.7 degrees (Male White), 6.35 + 2.67 degrees (Females Black) to 6.62 + 3.16 degrees (Male Black).

Conclusion: This study could not establish differences in posterior tibial slope angles between males and females and ethnicity. Significant differences between ATC, PTAA and PTC angles were observed and PTC angles were smaller when compared to PTAA and ATC angles. The ATC angles ranged between 13.18 and 16.57 degrees, the PTAA angles ranged 9.38-11.87 degrees and the PTC angles ranged between 5.03 and 7.62 degrees for all groups.

Purpose: The main objective of this study was to conduct a radioanatomical study of the osteo-myo-cutaneous scapulo-dorsal pedicled flap.

Methods: A radiological study was performed to study the anatomical variations of the dorsal scapular pedicle (origin, course of the deep branch of the dorsal scapular artery (DSA) in relation to the medial border of the scapula, perforators from the superficial branch of the DSA). Perforators from the superficial branch of the DSA were also identified on anatomical subjects, and their cutaneous vascular territory was determined.

Results: The DSA originated from the transverse cervical artery in 95% of cases. The deep branch of the DSA was in an anterolateral position relative to the medial border of the scapula in 70% of cases, and in an anteromedial position in 30%. In most cases, between 1 and 2 perforators arised from the superficial branch of the DSA. The mean size of the cutaneous vascular territory arising from the perforators of the superficial branch of the DSA was 7.8cmx8.5 cm.

Conclusion: When mandibular reconstruction with this flap is considered, a preoperative CT angiogram could ensure that the transverse cervical vessels have been preserved, and determine the position of the deep branch of the DSA relative to the medial edge of the scapula.

Purpose: As digital education is encroaching on the traditional method, it is important to get, the feedback of medical students. The current study has been proposed to investigate the perception of first-year MBBS students, regarding the use of 3D atlas for gross anatomy study as adjunct along with cadaveric dissection.

Methods: The feedback of 91 first-year MBBS students, regarding the incorporation of a 3D atlas in the dissection lab along with traditional cadaveric dissection was collected. A self-structured questionnaire, along with a consent form, was made available via Google forms and the responses were analysed.

Results: 97% of students agreed that the orientation and understanding of different anatomical structures improved for dissection with 3D atlas usage along with cadaveric dissection and enhanced peer discussion. The majority of students agreed that the usage of the 3D atlas created enthusiasm and motivation toward anatomy learning and encouraged them to participate actively in the lab. Some suggestions by the students like the free availability of the app for anywhere and anytime usage, lesser number of students for each batch, and the conduction of substage viva on a 3D atlas, etc. may be tailored as per institutional infrastructure.

Conclusions: The results of the study validate that the use of a 3D atlas along with dissection is an effective method of teaching anatomy. The current analysis will provide feedback for future decisions to incorporate 3D learning tools for gross anatomy in dissection labs. The authors believe that it is a useful tool that merits inclusion in anatomy.

Purpose: The challenges of spinal surgery can be overcome by deeply understanding the anatomical and surgical complexities of the region through the use of model simulators. This study investigates the impact of digitally designed simulators, specifically lumbar spinal models with abnormal curvature, on preoperative planning and their effectiveness as training tools. The study addresses challenges in spine surgery, such as unique deformities, classification issues, and associated abdominal structure abnormalities.

Methods: Twenty life-sized lumbar spine models exhibiting lateral curvature, intervertebral rotation, asymmetry in spinal segments, and disc abnormalities were 3D printed for 20 trainees to practice pedicle screw placement across five levels. A detailed survey evaluated the residents' views on the anatomical realism of the model and its surgical application, focusing on screw sizes, procedure duration, placement accuracy, materials, and surgical techniques. The study emphasized understanding the anatomical bone structure, identifying lumbar spinal curvature, decision-making, pedicle placement, the development of surgical strategies, and the educational value of the simulator. It rated their understanding on a scale from 1 to 5, where 1 indicates very low understanding and 5 signifies extremely high understanding.

Results: Post-practice surveys revealed that the primary challenge for residents was determining the correct direction for pedicle screw placement, with the model's loss of resistance being perceived as less realistic. Despite this, the simulated environment was found to be beneficial, with realistic procedural steps. Significant differences emerged in residents' perceptions regarding the identification of scoliosis levels (3.5), imitation of bone tissue (4.30), anatomical positioning of the pedicle start (3.55), and preparation for posterior deformity correction (4.7). The model proved to be an effective teaching tool, particularly in enhancing manual skills for pedicle screw placement (4.9), preparation for deformity correction (4.7), explaining surgery to patients and their families (4.8), and potentially reducing surgery time (4.6).

Conclusion: The scoliotic model received high ratings for its appropriateness in screw placement, earning a 'very good' evaluation (4.2). Notably, its contribution to learning pedicle screw placement was rated very positively (4.7), highlighting its effectiveness as a valuable training tool. Scoliotic models play a crucial role in helping orthopedists understand patient-specific deformities and enhance preoperative preparation, ultimately contributing to improved surgical outcomes.

Purpose: The purpose of this case report is to present an anatomical variation of the radial artery observed in anatomical practice and to discuss its clinical significance.

Methods: During the dissection of the right upper limb of a Chinese adult male, a high-position variation of the right radial artery with the absence of the radial recurrent artery was found.

Results: The variant branch of the right radial artery originates from the brachial artery and arises medially in the upper one-third of the arm. According to previous literature, we refer to it as the brachioradial artery. During its course down to the wrist in the same arm and forearm, no radial recurrent artery or other branches were observed.

Conclusions: We report an atypical variation of the radial artery, namely a unilateral brachioradial artery accompanied by the absence of branches on the same side. This variation may impede procedures such as puncture, vascular access establishment, and surgical operations. Understanding and analyzing this atypical variation of the radial artery is important in clinical practice.

Purpose: The sigmoid sinus (SS) is a major surgical landmark. The paramastoid process (PMP) occurs rarely. Inferior diverticula of the SS were not found or reported previously. We aimed to determine the incidence and detailed anatomy of such morphology of the SS.

Methods: Archived angioCT files of 25 males and 25 females were used. The morphology of the SS was checked on planar sections and by three-dimensional volume renderings.

Results: In 3 female cases (6%), inferior paramastoid diverticula of the SS (PMDSSs) were found, two on the right and one on the left. They were all protruding on the inferior side of the jugular process of the occipital bone. Their heights and inner diameters were, respectively, 9.94/11.01 mm, 8.21/4.85 mm and 5.97/8.72 mm. A high jugular bulb was also found on that side in each case. Each PMDSS had a thin or dehiscent bottom. They were closely related to condylar veins, the occipital artery, the vertebral artery and its venous plexus.

Conclusion: The PMDSS should not be mistaken as a PMP to avoid surgical lesions of the SS. The PMDSS is an unexpected landmark in the suboccipital region.

Objective: This study explored the surgical technique and clinical application of the dorsal metacarpal cutaneous branch flap of the radial digital artery of the index finger.

Methods: Through the anatomical dissection of 10 hand specimens, we examined the origin and characteristics of the artery and its branches towards the hand dorsum. Furthermore, the soft tissue defects of the index finger in 12 patients admitted to our hospital between 2017 and 2021 were surgically repaired using the dorsal metacarpal cutaneous branch flap of the radial digital artery of the index finger.

Results: The radial digital artery of the index finger had two types of origins: 70% (14 sides) were derived from the main artery of the thumb, and 30% (6 sides) were derived from the superficial palmar arch. The artery emitted 2 to 4 cutaneous branches from between the origin point and the head of the second metacarpal bone to the skin at the first dorsal interosseous muscle, with a cutaneous branch outer diameter of approximately (0.55 ± 0.01) mm, supplying the skin on the dorsum of the radial side of the hand. Clinical outcomes showed successful flap survival, without any arterial or venous vascular crises. Follow-up examinations at 1 to 3 years postoperatively showed that the skin flap had good blood supply, texture, elasticity, a natural and aesthetic appearance, and no swelling. The protective sensation was recovered and there was no need for secondary repair surgery.

Conclusion: The dorsal metacarpal cutaneous branch flap of the radial digital artery is a safe, reliable option for index finger tissue repair, maintaining palm skin integrity and demonstrating positive clinical efficacy.