Surgical and Radiologic Anatomy最新文献

Purpose: A persistent trigeminal artery is the most common persistent carotid-vertebrobasilar anastomosis. Persistent trigeminal artery variants (PTAVs) terminate in the cerebellar arteries without connecting to the basilar artery; of these, the anterior inferior cerebellar artery (AICA) is the most common. AICA duplication is frequently observed. However, to our knowledge, there have been no previous reports of PTAVs associated with duplicated AICAs. Here, we report a case of PTAV as a duplicate AICA, associated with the early bifurcation of the superior cerebellar artery and the aortic arch origin of the vertebral artery.

Methods: The case was diagnosed using digital subtraction angiography.

Results: A 51-year-old woman underwent screening for cerebrovascular disease. She was referred for a catheter angiography because of a suspected dural arteriovenous fistula. Digital subtraction angiography revealed no arteriovenous shunts. A left internal carotid angiogram showed a PTAV terminating into the left AICA. A left vertebral angiogram also showed the left AICA, indicating there were two left AICAs-one arising from the PTAV and the other from the basilar artery. We therefore made a diagnosis of duplicated AICAs. The left posterior inferior cerebellar artery was aplastic, and the left AICA originating from the basilar artery perfused its territory. An angiogram also revealed early bifurcation of the left superior cerebellar artery and an aortic origin of the left vertebral artery.

Conclusion: This report provides evidence that PTAV can occur as a duplicate AICA. Our case also had other anatomical variations. Careful imaging assessments are important for identifying these rare anatomical variations.

Background: This study investigates the anatomy of the superficial palmar branch of the radial artery (SUPBRA) for palmar skin reconstruction. It aims to detail SUPBRA's anatomical features for hand/finger reconstruction and pinpoint reference points for efficient harvesting.

Materials and methods: Nineteen male hand specimens (aged 18-70 years), fixed in 10% formalin, were dissected to study the anatomy of SUPBRA island flap. All measurements such as the external diameter of the SUPBRA, its bifurcation point from the radial artery, length of the SUPBRA pedicle, accompanied by venae comitantes, the number and location of perforators were used analyzed. Two flap techniques based on SUPBRA, the mid-palmar axis and wrist line axis, were studied. SUPBRA flap designs were used in three hand injury cases.

Results: The distance from SUPBRA's origin to the styloid process averaged 9.4 ± 1.1 mm, and its mean diameter was 2.4 ± 1.5 mm. It has not been encountered a pattern with a narrow diameter of 1.1 mm or less, which is considered hypoplastic and unsuitable for a flap due to inadequate nourishment, in SUPBRA. Mean length of the SUPBRA pedicle was 31.0 ± 6.3 mm. The SUPBRA was typically accompanied by two vena comitantes. The location of the musculocutaneous perforators, approximately 10 mm distal to the scaphoid tubercle, suggests that when the SUPBRA flap is designed transversely along the distal wrist crease, the direct cutaneous perforators will play a crucial role in providing adequate blood supply to the flap as a pedicle. Flap sizes ranged from 1.5 × 3.0 mm to 2.5 × 6.5 mm. To obtain a longer pedicle, the flap was designed with a long-skin pattern along the long-axis direction, and the accompanying veins were dissected proximally to the radial artery. All cases confirmed the SUPBRA flap's viability for microvascular anastomosis in the thenar regions.

Conclusion: SUPBRA flap isa valuable option for hand and finger reconstruction,. providing detailed anatomical insights, including its external diameter, bifurcation point from the radial artery, flap length, presence of venae comitantes, and the number and locations of perforators. This flap is particularly suitable for reconstructing palmar defects of the radial digits, palm, and first webspace, and its arterial dimensions and lengths make it well-suited for microvascular anastomosis.

Purpose: To describe a case in which a right replaced posterior cerebral artery (PCA) was associated with an ipsilateral superior cerebellar artery (SCA) type persistent trigeminal artery (PTA) variant.

Methods: A 53-year-old man who had been diagnosed with chronic dissection of the left vertebral artery (VA) 4 months previously underwent follow-up magnetic resonance (MR) angiography using a 3-Tesla scanner.

Results: MR angiography showed a slightly dilated left VA at the terminal segment without interval change. An artery arising from the cavernous segment of the right internal carotid artery (ICA) and continuing to the right SCA without connection to the basilar artery is indicative of the SCA type PTA variant. There was also a large artery arising from the supraclinoid segment of the right ICA and continuing to the right PCA. In addition, a tiny artery arose from the right ICA proximal to the origin of the large artery. There were no tiny arteries arising from the right ICA distal to the origin of the large artery. Therefore, the tiny artery is considered to be a hypoplastic posterior communicating artery and the large artery is considered to be a replaced PCA.

Conclusion: A replaced PCA is an extremely rare variation, from which all branches of the PCA arise from the anterior choroidal artery. The SCA type PTA variant is also rare. This is the first report of a case of a combination of these two variations; however, they had no developmental relationship. Thus, our patient incidentally had two extremely rare ipsilateral variations.

Purpose: We report a case of regression of a 2-year-old girl with bilateral primitive ophthalmic arteries (POAs).

Case report: The patient presented with a headache and had no visual impairment or visual field abnormalities. Magnetic resonance angiography (MRA) revealed arteries originating bilaterally from the cavernous internal carotid artery segments, diagnosed as persistent POAs.

Conclusion: Six months later, MRA revealed decreased origin delineation and five years later, MRA revealed bilateral origin disappearance from the orbit to the periphery.

Background: Bipartite medial cuneiform bone (BMC) is located at the Lisfranc joint of the midfoot, and it represents a rare variant involving two separate ossification centers in the medial cuneiform bone. Although BMC is typically asymptomatic, it can become clinically relevant under conditions of trauma or chronic stress, affecting foot stability.

Case report: The current imaging report describes a 48-year-old female presenting with chronic dorsal midfoot pain, worsened by extended standing and ambulation. Physical examination indicated mild tenderness without swelling or ecchymosis. Magnetic resonance imaging (MRI) revealed a BMC with degenerative changes around the synchondrosis, indicating abnormal weight-bearing stress across the cuneiform segments. The patient underwent conservative management with nonsteroidal anti-inflammatory drugs (NSAIDs) and restricted weight-bearing, leading to a reduction in pain over four weeks. Surgical options, including excision and fusion, were discussed but reserved for potential recurrence and persistence. The present report further explores BMC's anatomical features, including its differentiation from fractures through imaging. BMC's horizontal cleavage plane, well-corticated edges, and distinct articulations differentiate it from a traumatic fracture.

Conclusion: Current literature on managing symptomatic BMC is limited, with treatment options varying from conservative approaches to surgical interventions for persistent symptoms. The present case highlights the importance of considering BMC in the differential diagnosis of midfoot pain or instability. Additionally, it enhances our understanding of the anatomical aspects of BMC and offers valuable insights into its clinical presentation, imaging characteristics, and management strategies.

Purpose: Anatomical research on fetal liver venous systems is scarce. This study presents variations, morphometric, and histogenesis data through cadaveric study which can aid prenatal radiological analysis.

Materials and methods: 10% formalin embalmed 16 fetuses (8-second trimester, 8-third trimester) were utilized. Morphometric and histological evaluation of the umbilical vein, portal sinus, and ductus venosus were done. Variations were noted. Descriptive statistics, ratio, correlation, and regression were used for data analysis.

Result: A positive correlation of morphometric variables with gestational age is observed. An intra-hepatic portal shunt is observed connecting the left hepatic vein and portal sinus. In one case ductus venosus arose from the medial end of portal sinus and is not in continuity with the umbilical vein. Umbilical and portal sinus presents tunica intima, tunica media, and adventitia. There is an increase in smooth muscle fibers in tunica media from the second to third trimester. Ductus venosus consists of three parts- inlet, outlet, and isthmus. The wall of ductus venosus showed tunica intima and tunica adventitia.

Conclusion: This study records the variations of the umbilical vein, portal sinus, and ductus venosus. Knowledge of variations, morphometry, and histogenesis of these veins is essential to distinguish clinical variations from conditions such as agenesis of ductus venosus, persistence of the right umbilical vein, and congenital portal-systemic shunts.

Purpose: Although both accessory middle cerebral artery (MCA) of distal origin and anterior communicating artery (ACoA) duplication are not rare anatomical variations, their combination is extremely rare and there are only a few reports of such combinations.

Methods: We report a case of distal origin accessory MCA associated with ACoA duplication diagnosed by magnetic resonance angiography (MRA).

Results: A 63-year-old man visited another hospital for screening examinations for cerebrovascular disease. He was noted to have a possible intracranial aneurysm at the A1-A2 junction of the right anterior cerebral artery on MRA. He was referred to our hospital for its management. More detailed 3-Tesla MRA volume rendering images revealed ACoA duplication, not an aneurysm. MRA also showed the right distal origin accessory MCA arising from the A2 segment distal to the ACoA duplication.

Conclusion: This rare combination of anatomical variations requires careful imaging assessment. MRA volume rendering images were useful in our case.

Purpose: The foramen tympanicum (FT) is an anatomical variation of the tympanic part of the temporal bone located in the anteroinferior part of the external auditory pore (EAP) and posteromedial to the temporomandibular joint (TMJ). The FT is most often asymptomatic, but it can be symptomatic in rare cases. The prevalence of FT varies widely in the literature. The aim of our study was to determine the radiological prevalence in a European population.

Methods: We retrospectively analyzed the presence of FT in all patients who underwent brain or rock scans from January 2021 to July 2022 in University Hospital. Demographic characteristics such as age and gender were collected. Morphometric measurements on the FT were also carried out manually: axial, sagittal and area calculation. Binomial test, Pearson's Chi2 test or Student's T test were carried out according to the type of analysis.

Results: A total of 2040 patients were included. 145 patients with FT were identified, giving a prevalence of 7.11%. FT were unilateral in 39% and bilateral in 61% of cases (p = 0.008). Women were statistically more likely to have one (p = 0.00002). Higher age was correlated with an increase in the prevalence of FT (p = 0.03). The morphometric measurements did not reveal any differences depending on the side.

Conclusion: This study is the largest series of Computed Tomography (CT) scans on the prevalence of foramen tympanicum. Although rare, every surgeon must keep in mind this anatomical entity to limit the risk during a surgical procedure.

Purpose: The paracondylar process (PCP) is defined as the bony prominence extending from the outer side of the condyles on the outer surface of the occipital bone downwards towards the transverse process of the atlas (TPA). In this case report, the morphometry of the rarely seen PCP and its morphometric data with neighboring structures are evaluated.

Case report and results: Unilateral (right-sided) PCP was observed in the cranium of a Caucasian female. The base of the PCP, located on the outer side of the occipital condyle (OC) and just behind the jugular foramen (JF), was broader than its apex and had a molar shape. The base width was measured as 13.6, and the top width was measured as 8.7 mm. PCP length was measured at 15.2 mm. The base distance of the PCP, which was located very closely with the OC and JF, to these structures was measured as 0.42 and 0.59 mm, respectively. The distance to the spinous process (SP) and mastoid process (MP) of the temporal bone was relatively greater and was measured as 1.07 and 15.5 mm, respectively.

Conclusions: The rare PCP reported, in this case, was well-developed and molar type. It is likely large enough to articulate with the TPA regarding length. However, this could not be shown because the matched atlas could not be found. We believe that supporting the close adjacencies of PCP with OC and JF with metric data may benefit clinicians working in regional surgery.

Introduction: The evolving curricula in medical education have significantly reduced the time allocated for learning and clinically correlating anatomical facts. This has led to noticeable gaps in the anatomical knowledge observed by specialists while training junior residents and is being extensively documented in the literature.

Materials and methods: The descriptive, cross-sectional, questionnaire-based study was conducted online by sharing the questionnaire via e-mail, WhatsApp, and Telegram to institutes across all Indian states and union territories where postgraduate radiodiagnosis courses are offered.

Results: The survey had a predominant response from radiodiagnosis residents belonging to the female gender (53.8%), pursuing MD (83.2%), from final year (43.4%), and from private (58%) institutes. 98% of the residents encountered challenges interpreting radiological images, 89% had no formal training in anatomy during residency, and 59% felt a lack of confidence regarding the human anatomy knowledge required for radiodiagnosis. 91.5% of the residents believe that a short human anatomy posting would significantly improve their radiological reporting skills, and 94% expressed interest in attending workshops or seminars to enhance their knowledge of human anatomy for radiological practice. A standardized curriculum for human anatomy training during the radiodiagnosis residency program is needed for the current period, as 90% of the respondents agreed.

Conclusion: To bolster future radiologists' diagnostic acumen, an enhanced anatomical education within radiodiagnosis residency programs in India is indeed necessary. Implementing structured training programs, incorporating interactive workshops, and leveraging advanced technological tools can significantly bridge knowledge gaps among residents.