Surgical and Radiologic Anatomy最新文献

Purposes: The middle hepatic artery (MHA)-the arterial supply to segment 4-is variably defined and frequently under-reported, despite clear implications for transplantation, hepato-pancreato-biliary surgery, and intra-arterial oncologic therapies. We conducted an evidence-based systematic review and meta-analysis to estimate the prevalence and origins of the MHA and to summarize its surgical relevance.

Methods: Following evidence-based anatomy principles and the PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar. Proportion meta-analyses employed random effects and small-study effects were assessed with DOI plot and LFK index.

Results: Fifteen studies (n = 3,819) were included. The pooled prevalence of an identifiable MHA was 81.15% (95% CI 64.70-93.40). The most common origins were the left hepatic artery (LHA) (47.86%, 95% CI 37.09-58.73) and right hepatic artery (RHA) (43.87%, 95% CI 34.85-53.07). Less frequently, the MHA originated from the common hepatic artery (CHA) (8.99%, 95% CI 0.00-32.68), and rarely from a replaced RHA (0.58%), proper hepatic artery (0.28%), or replaced LHA (0.06%). Across studies, the MHA consistently supplied segment 4; rare extensions to segments 2/3 were reported.

Conclusions: An MHA can be identified in most individuals, usually originating from the LHA or RHA. Due to inconsistent terminology across studies, standardized language distinguishing a hilar MHA from intrahepatic A4 branches is necessary. Routine preoperative arterial mapping and the preservation or reconstruction of the MHA should be considered in liver transplantation, pancreatoduodenectomy, and selective intra-arterial therapies to reduce ischemic and biliary complications.

Greek has shaped anatomical terminology for over two millennia, providing much of the lexical foundation of the Terminologia Anatomica. Despite this profound legacy, modern Greek anatomical nomenclature remains only partially aligned with the latest Terminologia Anatomica 2, characterized by outdated expressions, multiple synonyms, and inconsistent adoption in medical education and clinical practice. In contrast, countries with coordinated, evidence-based national standards achieve greater clarity and enhance clinical safety. In Greece, the persistence of obsolete or ambiguous terms creates academic barriers and poses clinical risks, including misinterpretation of diagnostic findings and surgical errors. This review traces the historical contribution of Greek to international nomenclature, evaluates the current state of Greek anatomical terminology, and uses global examples to propose a plan for modernization. Key recommendations include forming a national multidisciplinary committee, systematically cross-mapping Greek terms to Terminologia Anatomica 2, standardizing terminology in education and licensing, and creating a multilingual open-access database. These efforts would preserve Greece's linguistic heritage while ensuring accuracy, clarity, and international compatibility in modern medical communication.

Purpose: Understanding gender-based foot morphological differences is critical for ergonomic footwear design. This study investigated these variations in young adults using photogrammetric and plantar pressure analysis.

Methods: We analyzed 200 healthy participants (100 males, 100 females; aged 19-21 years) through digital photogrammetry and RSscan Footscan pressure mapping. Key parameters included foot length (FL), ball width (BWF), hallux valgus angle (HVd), lateral foot angle (LdF), and Clarke's Index for arch classification. Plantar pressure distribution was assessed across 10 anatomical zones.

Results: We revealed significant gender disparities: males had longer (26.6 vs. 25.2 cm) and wider feet (10.2 vs. 9.1 cm), while 75% of participants exhibited HVd (5.1°-6.3°), with no gender difference. Dynamic Clarke's Index showed 80% had high arches, correlating with lower BMI (p < 0.001). Pressure analysis highlighted higher midfoot loading (37.8-41.2 cm²) and medial forefoot pressure in HVd cases. Females predominantly wore smaller shoes (sizes 36-38), whereas 89% of males wore sizes 42-44. BMI influenced midfoot pressure (r = 0.3) and arch height, with flat arches linked to higher BMI. Foot asymmetry (38%) and HVd prevalence underscored the need for gender-specific shoe designs.

Conclusion: It emphasize prioritizing ergonomic footwear to mitigate pressure imbalances, HVd progression, and asymmetry, particularly in high-BMI individuals. This dual-method approach provides actionable insights for biomechanical applications and footwear customization.

Purpose: This study aimed to (1) investigate the prevalence of the nerve to vastus medialis within the adductor canal, (2) characterize the anatomical features of the canal, and (3) assess correlations between canal characteristics and anthropometric data. Additionally, the number and motor entry points of femoral nerve branches supplying the anterior thigh muscles were examined.

Methods: Thirty-two lower limbs (16 fresh-frozen cadavers) were dissected. The adductor canal was identified, and its proximal and distal ends were measured from the anterior superior iliac spine (ASIS). Prevalence of the nerve to vastus medialis within the canal was recorded. Motor entry points of femoral nerve branches were identified and measured along a reference line from the ASIS to the center of the tibiofemoral joint using a measuring tape. Correlations between adductor canal anatomy and height, weight, body mass index, and thigh length were analyzed using Pearson's or Spearman's correlation tests.

Results: The nerve to vastus medialis was located within the adductor canal in 34.38% of cases. The mean canal length was 7.20 ± 2.86 cm, corresponding to 55-71% of the ASIS-to-knee distance. Distances to the canal's proximal and distal ends correlated significantly with height and thigh length (r = 0.421-0.653, p < 0.05). Femoral nerve branches to each anterior thigh muscles ranged from one to five.

Conclusion: Anatomical variation in the nerve to vastus medialis may influence outcomes of adductor canal procedures. Knowledge of canal location and motor entry points may assist clinicians in performing adductor canal blocks or surgical interventions.

Purpose: Cerebral arterial fenestration is a common occurrence. However, fenestration of the middle cerebral artery (MCA) is uncommon. It is usually observed in the proximal M1 segment and has a small slit-like configuration. We herein report a case of a relatively large semicircular fenestration located in the mid M1 segment of the right MCA.

Methods: Magnetic resonance imaging (MRI), including magnetic resonance angiography (MRA), was performed in a 66-year-old man presenting with left homonymous hemianopia for the evaluation of suspected cerebrovascular disease. The MR machine was a 3-Tesla scanner, and MRA was performed using the standard three-dimensional (3D) time-of-flight technique.

Results: MRA demonstrated fenestration in the mid M1 segment of the right MCA. The fenestration appeared in a relatively large semicircular configuration. The superior limb took a semicircular course and was thinner than the inferior limb, and no perforating branches arising from either limb were clearly identified.

Conclusion: Fenestration of the MCA is thought to result from incomplete fusion or partial persistence of the arterial plexus during embryological development and is therefore typically small, slit-like, and located in the proximal M1 segment. However, the morphology observed in this case was markedly different. To our knowledge, only a few similar cases have been reported in the English-language literature.

A 50-year-old patient admitted for a subarachnoid hemorrhage underwent a successful surgical clipping of two aneurysms involving the anterior communicating artery and the supraclinoïd and ophthalmic segments of the right internal carotid artery. The analysis of the vertebrobasilar system through the brain computed tomography angiography and 3D modeling revealed a double origin of the right superior cerebellar artery from the basilar artery and the posterior cerebral artery. Two channels arose separately from the basilar artery and the P1 segment of the right posterior cerebral artery then merged distally to form the main trunk of the right superior cerebellar artery. To the best of our knowledge, this is the first time such a variant is reported.

Objective: To uncover the positional relationship between the lateral pterygoid plate (LPP) and foramen ovale (FO) in an adult population.

Methods: The 500 normal subjects (250 males and 250 females), who underwent cranial computed tomography scans were included into the study.

Results: Four configurations regarding FO location types were determined: the lateral type in 347 sides (34.7%), medial type in 115 sides (11.5%), the direct type in 412 sides (41.2%), and the far type in 126 sides (12.6%). The frequencies of these types were affected by sex (p < 0.001), but not side (p = 417). The most common configuration was the direct type (47.4%) in females and the lateral type (41.8%) in males. The antero-posterior and medio-lateral diameters of FO were measured as 7.35 ± 1.98 mm and 4.08 ± 1.26 mm, respectively. The antero-posterior diameter was greater in the lateral type compared to the medial and direct types (p = 0.003). The medio-lateral diameter was greater in the lateral type compared to the direct type (p < 0.001). The pterygoalar and pterygospinous bars were observed in 24 sides (2.4%) and 18 sides (1.8%), respectively. The positional relationship between FO and LPP was statistically different between presence and absence of the pterygoalar bar (p = 0.001), but not between presence and absence of the pterygospinous bar (p = 0.512). In FOs with the pterygoalar bar, the far type was seen significantly less common.

Conclusions: The incidence of the far type was 12.6%; thus, a neurosurgeon can reach FO relatively easily by tracing the base of LPP backward in more than 80% of the population.