Surgical and Radiologic Anatomy最新文献

Purpose: This study utilized cone-beam computed tomography images to assess the potential of maxillary sinus (MS) and piriform aperture (PA) measurements in sex prediction and to identify possible correlations between these structures and the MS ostium.

Methods: A total of 204 images were selected and divided into two groups: 102 for constructing and testing the formula, and 102 for validation. In each subgroup, the images were equally divided for 11 measurements by two examiners in the MS (height, width, length, and total width), PA (height and width), and maxillary ostium diameter.

Results: Significant correlations were found in males and in the total analysis for all measurements of the right MS, while the length of the left MS showed a positive correlation with PA height. In the total analysis, the height of the left MS and the total width along the MS also positively correlated with PA height. When tested, the constructed formula resulted in an accuracy of 82.4%.

Conclusion: Tomographic images proved to be excellent tools for sex prediction, as the measurements described in this study could be reproduced and analyzed in different populations, considering that craniometric characteristics may vary across populations.

Purpose: This study aimed to investigate the relationship between linea alba width and unclosed pediatric umbilical hernias.

Methods: A retrospective chart review was conducted on patients with pediatric umbilical hernias persisting beyond the age of 2, from April 2014 to March 2021. Additionally, data from children who underwent computed tomography (CT) for other conditions or injuries, such as diarrhea or traffic accidents, were collected from April 2010 to March 2022. The width of the linea alba was measured using ultrasonography in pediatric hernia patients and CT in children without umbilical hernias. Measurements were taken at five levels on the axial plane: at the level of the umbilicus and 1.5 cm and 3 cm above and below the umbilicus.

Results: The analysis included 191 children without hernias and 30 patients with unclosed hernias, all aged between 2 and 7 years. The linea alba width was significantly wider in children with unclosed hernias than in children without hernias at all five measurement points (p < 0.05). The disparity was more pronounced below the umbilicus. However, no significant differences in width were observed across different age groups among children without hernias.

Conclusion: Children with umbilical hernias exhibited wider linea albae. It is hoped that these results will contribute to modifications in surgical techniques and enhance understanding of the pathophysiology in patients with umbilical hernias.

Purpose: The aim was to find bony landmarks of the pelvis for the origins and routes of uterine arteries, hoping to improve speed and safety of embolization procedures (leiomyoma, post-partum bleedings…).

Methods: We carried out a study based on the analysis of CT-angiographies in arterial phases of whole-body scans. Two measurements were done per artery, one from the origin of uterine arteries to a first perpendicular line passing through the lowest part of the sacroiliac joint, another one from the beginning of the parametrial segment from a second parallel line passing by the acetabular roof. Mean distances across all these measurements were calculated, as were potential associations with known variables such as anatomical variants, age, parity and any pelvic surgical history.

Results: Two hundred uterine arteries were analyzed. Concerning the origin, 83.5% of uterine arteries were located approximately one centimeter around the first line defined above, with a mean distance of + 4.8 mm. Concerning parametrial segment beginning, 88% were located approximately one centimeter around the second line defined, with a mean distance of only + 3.9 mm above the acetabular roof. Some significant differences were observed in subgroups, notably with a small trend to higher arising of uterine arteries in patients who had at least one childbirth, and expectedly lower arising in distal anatomical variants.

Conclusion: Clear pelvic anatomic landmarks exist and could help the guidance of arteries catheterization, and therefore indirectly lead to faster embolization and optimize procedures safety.

The article "ChatGPT Efficacy for Answering Musculoskeletal Anatomy Questions: A Study Evaluating Quality and Consistency between Raters and Timepoints" assesses the performance of ChatGPT 3.5 in answering musculoskeletal anatomy questions, highlighting variability in response quality and reproducibility. We raise several points that may add further insights into the study's findings. While ChatGPT and other Large Language Models (LLMs) show promise in medical education, several areas require further exploration. We emphasize the importance of using larger question sets and diverse formats, such as multiple-choice questions (MCQs), where ChatGPT has demonstrated more consistent performance in prior studies. Additionally, improvements in artificial intelligence (AI) models and the incorporation of updated anatomical databases could enhance response accuracy. The study also identifies ChatGPT's lack of anatomical specificity as a limitation, which may be addressed by training AI models on specialized anatomy datasets. In conclusion, while ChatGPT is not yet a fully reliable standalone resource, it might serve as a complementary tool when integrated with traditional methods. Further research is needed to optimize AI for anatomy education.

Purpose: Our study aims to determine the position and types of the hyoid bone and to evaluate the morphometry of the hyoid bone and tongue according to sex.

Methods: Our study included cervical Computed Tomography (CT) images of 200 individuals (100 females, 100 males) between the ages of 18 and 84. Using the 3D Slicer software package, hyoid bone position, shape, area, volume and tongue volume measurements were made on these images.

Results: In our study, the position of the hyoid bone was found to be proportionally at the C3 vertebral level in both sexes. The most common hyoid bone was type B, while the least common was type V. Type B rate was statistically higher in females, and type H rate was higher in males (p < 0.05). Participants with type H had statistically higher bone volumes and areas than those with type B (p < 0.05). Differences between bone volumes and areas of other bone types were not statistically significant (p > 0.05). Average hyoid bone volume (females 1575.9 mm³; males 2609.6 mm³), hyoid bone area (females 1519.8 mm²; males 2406.4 mm²), tongue volume (females 66,659.5 mm³; males 83,085.5 mm³) were measured in females and males. A statistically weak negative correlation was found between the participants' ages and hyoid bone areas (rho = -0.162; p = 0.022). A statistically moderate positive correlation was found between tongue volume and hyoid bone volume/area (respectively p < 0.001; rho₁ = 0.658, rho₂ = 0.546).

Conclusion: Hyoid bone volume, hyoid bone area and tongue volume were higher in males than females. As tongue volume increased, hyoid bone volume and hyoid bone area increased. The connection between tongue volume and hyoid bone volume will contribute to dentomaxillary development and surgical procedures, and bone morphology will also be important in different disciplines.

Background: The lower limb venous system, a subject of extensive study due to its high clinical significance on deep vein thrombosis, presents a rare, intriguing, symmetrical variant in this dissection report.

Case report: We present the uncommon and clinically meaningful bilateral persistent sciatic vein (PSV) variant. The developmental variant was symmetrically detected during a dissection of an 81-year-old female donated cadaver. The symmetrical PSV originated from the popliteal vein (PV, merging of the anterior and posterior tibial vein), coursing through the abductor magnus muscle and draining into the common femoral vein after joining the femoral and greater saphenous vein. The enlarged PSV was the developmental variant at the saphenopopliteal junction, while the "typical" PV was hypoplastic as a regressed vessel.

Conclusion: The typical PV was hypoplastic; the enlarged PSV was the lower limb's primitive axial vein that acted as the central (main) drainage vessel. After a thorough literature search, the PSV variant was recorded as having a low prevalence in the general population. The current dissection finding is relatively rare due to its symmetric occurrence. The rare variant is related to Klippel-Trenaunay Syndrome, a congenital vascular malformation. Clinicians must distinguish the primitive axial vein (PSV) from the transformed axial vein (pathology) to avoid complications and iatrogenic injury.

Purpose: Ophthalmic artery (OphA) embryogenesis is a complex process with various origins. We describe herein a case in which the OphA stemmed from the persistent primitive trigeminal artery (PPTA), which has never been reported.

Methods: A man in his 70s was admitted to our hospital following the sudden onset of altered consciousness. A computed tomography (CT) scan revealed a cerebellar hemorrhage, brainstem compression, and hydrocephalus. The patient underwent emergency craniotomy for hematoma evacuation and decompression. Digital subtraction angiography (DSA) was performed 14 days postoperatively to determine the source of the bleeding.

Results: DSA of the right vertebral artery revealed retrograde filling of the left PPTA, originating from the distal two-thirds of the basilar artery (BA) and extending to the cavernous segment of the left internal carotid artery (ICA) as well as a small artery extending from the intermediate part of the PPTA into the orbit and passing through the superior orbital fissure (SOF). DSA of the left common carotid artery showed the typical supracavernous origin of the OphA.

Conclusion: This is the first reported case of double OphAs originating from the ICA and PPTA. It is possible that the OphA traversing the SOF had an anastomosis with the primitive trigeminal artery (PTA) during the embryonic period. Persistence of only the BA side of the PTA results in the OphA originating from the BA, whereas persistence of only the ICA side results in the OphA originating from the meningohypophyseal trunk.

Purpose: The paracentral lobule artery (PLA) is a typically present branch of the distal anterior cerebral artery (ACA), irrigating the homonymous lobule. The PLA origin is either a pericallosal portion of the ACA or a prominent branch of the ACA termed callosomarginal (CMA). In addition to the paracentral lobule, the PLA irrigates the cingulate gyrus in the medial hemispheric surface, and the superior portion of the precentral and postcentral gyri in the lateral hemispheric surface. The present cadaveric case series aimed at establishing previously unreported morphometric estimates of the PLA, including its length according to its site of origin, its supplying branches according to its distribution area, as well as its anastomoses.

Methods: Seventeen colored latex-injected cadaveric heads were studied with a surgical microscope and microsurgical instruments.

Results: The PLA was invariably present and most commonly originated from the A4 (n = 15 hemispheres, 50%) segment of the ACA. Other PLA origins were the CMA (n = 10, 30%), the A3 (n = 5, 16.7%) and the A5 (n = 1, 3.3%) segments. When the PLA originated from the A4, its mean (SD) overall length was 7.6 (17.9) mm and its mean (SD) diameter was 0.88 (0.26) mm. The PLA supplied the paracentral lobule, cingulate gyrus and post central gyrus with a mean (SD) of 28.07 (13.4), 8.53 (4.27), 5.92 (4.4) branches respectively and the precentral gyrus with a median [IQR] of 2 [0-6] branches. The most common anastomoses of the PLA in the medial and the lateral hemispheric surface involved the ipsilateral posterior internal frontal artery and the branches of the middle cerebral artery, respectively. There were no significant differences between sexes or hemispheric sides for the anatomical features of the artery analyzed.

Conclusion: The present study established previously unreported morphometric estimates for the PLA by considering all possible PLA variant origins and morphological variants. Given that variable pathologies have been previously detected in the areas supplied by the PLA, a better understanding of its anatomy can aid surgical planning and approaches.

Purpose: Numerous studies have already reported on the anatomy of the superficial temporal artery (STA) on dissection or imaging, and more specifically on CT angiography. However, few studies have reported on the possible variations that exist between readers in the assessment of certain anatomical parameters. The aim of this study was to investigate the reproducibility of different anatomical measurements of the superficial temporal artery with CT angiography.

Methods: Forty cranial iodine contrast-enhanced CT scans were searched in a retrospective monocentric study. Various anatomical categorical and quantitative measurements (more or less automatic) of the superficial temporal artery were assessed. To evaluate the inter-observer reproducibility of various anatomical measurements of the superficial temporal artery obtained through CT angiography, descriptive statistics, kappa statistics and intraclass correlation coefficients (ICC) were employed.

Results: Eighty STAs were analyzed independently by two readers. The kappa coefficient for determining the mode of STA termination was substantial (kappa = 0.782). The number of loops was mean 0.22 vs. 0.25 (p = 0.981; ICC = 0.701) and the number of kinks was mean 5.68vs5.64 (p = 0.876; ICC = 0.860). No significant difference was found between readers for the determination of the distance of the STA termination to different superficial landmark lines. No significant difference in the orientation angles of the STA and the frontal and parietal branches was found. Semi-automatic measurements of the length of the STA appeared (ICC > 0.7) reproducible whereas semi-automatic measurements (surface, perimeter, short diameter, large diameter) appeared statistically less reproducible (ICC < 0.5). These results must also be interpreted in the light of the spatial resolutions inherent in the CT angiography technique.

Conclusion: The present study provides information concerning the reproducibility of certain anatomical measurements of the superficial temporal artery in CT angiography.

Purpose: The stellate ganglion (SG), or cervicothoracic ganglion, is usually located anterior to the neck of the first rib. Various techniques, such as ultrasonographic imaging and fluoroscopic approaches, are used to assist in the anesthetic blockade of the SG. However, there are reported complications associated with SG block; some patients had medication-related or systemic side effects, and some had procedure-related or local side effects. So, understanding the anatomy of the SG is critical for diagnosis and treatment of nerve block accuracy and to avoid unnecessary nerve damage during surgical procedures. This study aimed to collect data for the gross shape of the SG and histologically investigate these different types.

Methods: The SG from 31 formalin-fixed adult cadavers (59 sides) were studied. The prevalence and shape of the SG were recorded and photographed. Next, the SG for each type was examined histologically.

Results: The SG were classified into four types based on their shape: dumbbell, spindle, star, and inverted L shapes. The frequency of each type was as follows: spindle (47.46%), dumbbell (27.12%), star (23.73%), and L-inverted shapes (1.69%). Each type had a similar number of nerve cell bodies. Interestingly, the inverted-L shaped SG was histologically, discontinuous but grossly fused.

Conclusion: An improved understanding of the SG's macro and microanatomy can help better understand patient presentations and improve clinical and surgical results in procedures performed near this important neck structure.