Surgical and Radiologic Anatomy最新文献

Purpose: As the popularity and the usage of the artificial intelligence (AI) tools is increasing in medical education, it is important to critically evaluate these resources and confirm their reliability. The current study proposes to assess the reliability and effectiveness of ChatGPT 3.5 and 4 for gross anatomical information on scalenovertebral triangle.

Methods: ChatGPT versions 3.5 and 4 AI tools were used to explore the anatomical information on scalenovertebral triangle eight times on different days. The responses were qualitatively compared to the actual anatomy of the region and comments were made by the authors for each response.

Results: The replies given by ChatGPT were not appropriate (either incorrect, partially correct or incomplete) in any of the conversations. There was no major difference between the accuracy of responses, while comparing ChatGPT 3.5 and 4. Almost three out of four times, ChatGPT confused scalenovertebral triangle with scalene or interscalene triangle.

Conclusions: None of the responses provided by ChatGPT 3.5 and 4 across all eight instances aligned even once with the standard anatomical description of the scalenovertebral triangle. A novice medical student may not be able to judge the difference between correct and incorrect, consequently may wrongly interpret the anatomy. So cautious planning and educator check is important while it is used. Further development and modifications of this AI tool are required to increase its potential to be used in medical education and healthcare.

The branches of the external carotid artery can show variation, and common trunks are occasionally found. Because the common trunks such as the thyrolingual, linguofacial, and thyrolinguofacial trunks are formed from two or all of the superior thyroid artery, lingual artery, and facial arteries, maxillofacial trunks are extremely rare. We report a rare case with the maxillofacial and thyrolingual trunks identified by three-dimensional computed tomography angiography.

Background: The external carotid artery (ECA) branching pattern has been extensively studied in the current literature. However, its topographical variability has been barely reported. The aim of the current study was to assess the ECA in relationship with the styloid process (SP) and the mandible.

Materials: 100 computed tomography angiograms were randomly selected and retrospectively investigated on the neck region for the ECA course in relation to the SP and the mandible.

Results: A retrostyloid course of the ECA was identified on 18 sides (9%). Six patients had a bilateral retrostyloid ECA, and six patients had a unilateral variant. The side and sexes did not affect the prevalence of this variant. The elongated SP or variable ossification of the stylohyoid chain did not affect the retrostyloid course. The ECA retromandibular course of type 1 (straight course deep to the ramus of the mandible) was identified in 30.5%, type 2 (lateral retromandibular loop) in 20%, and type 3 (lateral retromandibular loop behind the ramus of the mandible) in 45.5%. The side and sexes did not affect the prevalence of this variant.

Conclusions: Our study enhances the current knowledge on the ECA topography. Both variants investigated in the current study, displace the ECA into the parapharyngeal space. Knowledge of these anatomic variations are of importance preoperatively to avoid iatrogenic injuries.

Purpose: The tibialis posterior (TP), flexor digitorum longus (FDL), and flexor hallucis longus (FHL) are muscles that contribute to the stability of foot and ankle movements, playing a crucial role in achieving optimal gait. However, a comprehensive examination of the anatomical characteristics and histological variances of each muscle has not been conclusively established.

Methods: A total of 10 un-embalmed cadavers were dissected, and muscles from each cadaver were consistently harvested from the musculotendon junction. The ratio of collagen and elastic fibers was assessed through three immunohistological analyses, focusing on distinct histological characteristics in type I (slow twitch) and type II (fast twitch) fibers. Additionally, Ultrasonography was utilized to compare and analyze the thickness, fascicle angle, and muscle fiber length of each muscle.

Results: Concerning the relative proportion of elastic fibers to collagen, the TP exhibited the highest collagen content (21.9 ± 0.30%, mean ± standard deviation), while the FHL had the highest elastic fiber proportion (48.4 ± 0.44%). The TP predominantly comprised slow type muscle fibers (36.88 ± 0.83%), whereas the FHL contained a higher density of fast type muscle fibers (32.46 ± 4.02%). US analysis indicated that the thickness of the TP was relatively greater (2.0 ± 0.2 mm) compared to the FDL (1.2 ± 0.1 mm) and FHL (1.1 ± 0.1 mm). Additionally, the fascicle length was notably longer in the TP (25.6 ± 4.1 mm).

Conclusion: Our anatomical and histological findings indicate that the tibialis posterior (TP) is the thickest with a significant physiological angle and a high collagen content. This characteristic enables the TP to provide stability by transmitting a constant force to the calf. On the other hand, the flexor hallucis longus (FHL) exhibits the highest elastic fiber content, confirming its ability to exert instantaneous, swift, and powerful force.

Introduction: The aim of the present meta-analysis was to provide the most up-to-date and evidence-based results regarding the morphometric properties of the lumbar vertebrae.

Methods: Medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, and Cochrane Library were searched through.

Results: The results of this meta-analysis were established based on a total of 1481 patients. New results were established in 27 categories for each lumbar vertebra separately. The findings from this study reveal that the width of the spinal canal progressively increases towards the lower end of the lumbar spine (L1 = 22.04 mm, L5 = 26.46 mm). Additionally, the transverse processes exhibit a similar trend, widening as they approach the lower lumbar vertebrae (L1 = 68.08 mm, L5 = 85.91 mm). The pedicle height decreased from L1 to L4, with an increase observed at L5 (14.73 mm). No significant differences were observed between the measurements of the left and right pedicles.

Conclusion: The presented results provide physicians with normative morphometric data on the lumbar vertebrae. Having adequate knowledge of the anatomy of the lumbar vertebrae may be of immense use for surgeons performing various spinal surgeries, such as pedicle screw fixation, percutaneous endoscopic transforaminal discectomy, or lumbar disc replacement.

Purpose: Knowledge of a large communication between posterior circumflex humeral and deep brachial arteries, although infrequent, it is important to avoid damage during a Leechavengvongs procedure or used as recipient artery in free flaps for upper limb reconstruction.

Methods: A dissection of a latex-injected cadaver revealed the presence of a large communication between the posterior circumflex humeral and deep brachial arteries. Furthermore, this communicating artery was observed during a Leechavengvongs procedure. A comprehensive review of the existing literature on the anatomical variations of the posterior circumflex humeral and deep brachial arteries was conducted.

Results: A communicating artery between the posterior circumflex humeral and deep brachial arteries was identified during a routine dissection. This communicating artery establishes a posterior collateral pathway of substantial caliber between the axillary and the brachial arteries. Given its oblique trajectory posteriorly along the humeral shaft, this artery is susceptible to injury during a posterior approach to the humerus. Despite the existence of numerous anatomical variations involving the posterior circumflex humeral and deep brachial arteries, this communicating artery has not been previously described in the literature. Additionally, we report this anatomical variation crossing the surgical field during a Leechavengvongs procedure.

Conclusion: Our findings suggest that a large communicating artery between the posterior circumflex humeral artery and the deep brachial artery has the potential to cross the surgical field and become a source of risk during a posterior approach to the arm. It can also be used as recipient artery in free flaps for upper limb reconstruction.

Purpose: The current meta-analysis aimed to investigate the extensor digitorum brevis manus (EDBM) muscle variability by calculating the pooled prevalence of all published variants. After considering the pooled prevalence, these variants were classified based on their insertion and relationship with the extensor indicis (EI) muscle and/or tendon. The origin of the variants, neural and arterial supply, and the terminology of the EDBM variants were further investigated.

Materials: The systematic review was conducted according to the guidelines proposed by the Evidence-Based Anatomy Workgroup and PRISMA 2020. Four databases were searched using several keyword combinations. The included studies were statistically meta-analyzed using the R programming language. The EDBM pooled prevalence was calculated, as were subgroup analyses of a few parameters.

Results: Thirty-one studies met our inclusion criteria, with a total sample of 9686 hands. The EDBM pooled prevalence was estimated at 1.96% (95%CI 1.42-2.58). The EDBM's most common insertion was via a distinct tendon to the index finger, coexisting with the typical EI tendon (0.38% pooled prevalence). The origin, innervation, and arterial supply of EDBM have not been studied systematically.

Conclusions: The EDBM variant can be considered infrequent, with a pooled prevalence of 1.96%. Particular attention should be given to the muscle's insertion and relationship with the EI muscle and tendon. Knowledge of the EDBM morphological variability is adequate for hand and reconstructive surgeons to avoid confusion intraoperatively and misdiagnosis preoperatively.

Purpose: This radiologic work aimed to display the alteration in the crista galli (CG) morphology in the pediatric population with advancing age.

Methods: This pediatric examination consisted of computed tomography images of 180 subjects (90 males / 90 females) aged 1-18 years. The width (CGW), height (CGH) and length (CGL) of CG were measured, and its morphological types were noted.

Results: CGW, CGH and CGL were measured as 4.34 ± 1.38 mm, 12.13 ± 3.36 mm and 13.03 ± 2.75 mm, respectively. CGH (p < 0.001) and CGL (p < 0.001) increased with advancing age, but CGW (p = 0.069) did not vary. Three configurations regarding morphological types of CG were observed as follows: the tear-drop type in 83 CGs (46.10%), the tubular type in 64 CGs (35.60%), and the ossified type in 33 CGs (18.30%). Three configurations related to Keros classification were determined as follows: Type 1 in 31 CGs (17.20%), Type 2 in 116 CGs (64.50%), and Type 3 in 33 CGs (18.30%). CG shape types (p = 0.455) and Keros types (p = 0.801) did not correlate with sex. CG pneumatization was found in six (3.3%) children.

Conclusions: CGL increased, but did not alter significantly after infancy period. CGW did not correlate with pediatric ages, but CGH increased with advancing age up to prepubescent period. The incidence of Type 1 decreased with advancing age, but the incidence of Types 2 and 3 increased, especially from the late childhood period. All pneumatized CGs were observed after late childhood period.

Background: Multi-slice spiral computed tomography (CT) angiography (MSCTA) has become the primary non-invasive image technique for evaluating cephalic and cervical vascular anatomy, especially vascular variant such as persistent carotid-basilar anastomosis. Persistent proatlantal intersegmental artery (PPIA) is an example of a rare persistent carotid-basilar anastomosis that deserves to be featured through this imaging technic.

Purpose: The aim of this study is to explore the imaging characteristics of the PPIA using MSCTA and to assess its clinical significance. Furthermore, the study seeks to propose a novel classification system predicated on the posterior circulation blood supply.

Materials and methods: This retrospective analysis evaluated the imaging and clinical data of 11 patients diagnosed with a PPIA using MSCTA.

Results: The incidence of the PPIA was found to be 0.01%. Classification based on the origin of the PPIA identified two cases (18.2%) as type I and nine cases (81.8%) as type II. This study introduced a novel classification system for PPIA, which is based on the posterior circulation blood supply, encompassing the persistent artery, vertebral artery, and posterior communicating artery. Among the 11 patients with PPIA, there were 11 instances of ipsilateral vertebral artery agenesis, three cases of contralateral vertebral artery hypoplasia, one case of contralateral vertebral artery agenesis, two cases of persistent artery hypoplasia, and two cases of basilar artery hypoplasia. Furthermore, the study identified two patients with aneurysms, one with cerebral infarction, and one with a Pulmonary Arteriovenous Fistula.

Conclusion: The proposed classification system for PPIA enhances the understanding of posterior circulation blood supply, which is vital for pre-interventional and pre-surgical imaging assessments. In PPIA cases, the ipsilateral vertebral artery is consistently hypoplastic, and the PPIA predominantly serves the posterior fossa's vascularization in about 75% of cases.