Search Results (269)

Renal venous anatomy is relevant to nephrectomy, living-donor evaluation, and retroperitoneal surgery. Classical descriptions often present a single renal vein on each side, whereas published series show that additional veins, retroaortic and circumaortic courses, and variable hilar tributaries are common. This study describes formation patterns, morphometry, and variants in four separate, non-overlapping methodological series of surgical specimens and imaging examinations, with particular attention to the termination of the posterior primary venous branch, the types of venous anastomosis, and the relation of the vein to the artery at the hilum. We examined 192 adult human kidneys (93 right, 99 left) in four separate methodological series, with no kidney examined by more than one technique: anatomical dissection of nephrectomy specimens (n = 64), methacrylate injection and corrosion casting of nephrectomy specimens (n = 93), contrast-enhanced CT angiography (n = 23), and barium injection with radiography of nephrectomy specimens (n = 12). The kidney was the unit of analysis. Because some right and left kidneys may have originated from the same individual and the pairing structure could not be reconstructed, right- and left-sided findings are reported descriptively, without inferential side comparisons. Each feature was analysed only in the kidneys in which it could be assessed. The four techniques differ in their ability to detect small tributaries and anastomoses, and frequencies pooled across methods are descriptive. Among 122 kidneys assessed for hilar formation, the renal vein was formed of two primary trunks in 76/122 (62.3%; 95% CI 53.4–70.4), three trunks in 34/122 (27.9%), and four trunks in 12/122 (9.8%). The confluence was assessed in 110 kidneys and was intrasinusal in 40/110 (36.4%), juxtahilar in 34/110 (30.9%), and extrarenal in 36/110 (32.7%). A posterior primary venous branch was present in 56/122 (45.9%): 19/50 right (38.0%) and 37/72 left (51.4%); it joined the already formed main trunk in 32/56 and took part in the confluence in 14/56. In 90 kidneys the main vein lay anterior to the artery in 42/90 (46.7%). In the descriptive morphometric summary of 78 veins, mean length was 6.9 cm on the left (range 4.8–12.5) and 2.9 cm on the right (range 1.5–5.5). At least one venous anastomosis was recorded in 77/192 kidneys (40.1%; 95% CI 33.4–47.2; pooled across methods): 45/93 right (48.4%; 95% CI 38.5–58.4) and 32/99 left (32.3%; 95% CI 23.9–42.0). Multiple renal veins were identified in 16/116 assessable kidneys (13.8%), including 14/52 right (26.9%) and 2/64 left (3.1%). A retroaortic left renal vein was seen in 2/42 assessed left veins (4.8%), and a complete circumaortic ring in one left specimen. The renal vein was often formed of more than one primary trunk, a posterior branch was present in about half of the kidneys assessed, and multiple veins predominated on the right, in line with previous surgical and imaging series. The more specific contributions of this material are the posterior-branch termination map, the classification of anastomosis types, and the vein–artery counts at the hilum. The study is anatomical and descriptive. It does not measure surgical outcomes and does not show that additional venous imaging is required in every patient. Full article

This review aims to provide an applied surgical–anatomical synthesis of the buccal fat pad, harmonise the commonly used extension nomenclatures, and summarise the principal neurovascular structures at risk, major clinical applications, and representative pathologies relevant to current surgical practice. A narrative, anatomy-oriented review was conducted using cadaveric, imaging-based (CT/MRI), and surgical literature. The evidence was organised thematically around extension anatomy, fascial boundary planes, neurovascular relationships, and procedure-related surgical risk. Two main extension frameworks, the 4-extension and 6-extension models, were identified, and their correlation improves anatomical orientation and comparability across studies. Key structures at risk include the parotid (Stensen’s) duct, buccal branches of the facial nerve, and the buccal and transverse facial vessels, all of which show variable relationships to the buccal fat pad. Safer surgery depends on accurate plane selection, limited dissection, and gentle mobilisation rather than forceful traction to reduce haemorrhagic and neural complications. The review also outlines clinically relevant pathology, including traumatic herniation or pseudoherniation and tumour or tumour-like lesions involving the buccal fat pad. An integrated applied-anatomical framework of the buccal fat pad, combining extension mapping with neurovascular risk awareness, may improve operative planning and support safer, more predictable aesthetic and reconstructive procedures. Full article

Background: Cervical chylous fistula is a rare but potentially severe complication of laterocervical lymphadenectomy associated with thyroidectomy for thyroid carcinoma with lateral lymph node metastases. It occurs predominantly during level IV dissection in the proximity of the jugulo-subclavian confluence. Injury to the thoracic duct or the right lymphatic duct can generate persistent lymphorrhagia, leading to severe electrolyte imbalances, hypoproteinemia, and lymphopenia. The anatomical variability of the terminal portion of the thoracic duct justifies a comprehensive analysis of prevention and management strategies. Methods: A structured narrative analysis of data on thoracic duct anatomy, cervical compartment classifications, and therapeutic options was performed using a database search paired with citation tracking. Intraoperative identification techniques, ligation methods, and conservative and interventional strategies were critically evaluated. Results: Chylous fistula is mainly associated with left lower lateral compartment dissection (level IV) and cervical reinterventions. Daily drainage output is the central criterion for therapeutic decision-making, operationalized here through a comparative matrix and a stepwise algorithm. Low-output fistulas frequently respond to conservative treatment (hypolipidemic diet, medium-chain triglycerides, octreotide, or negative pressure). High-output fistulas require surgical reintervention with thoracic duct ligation (potentially associated with tissue adhesives or muscle flaps), video-assisted thoracoscopy, or percutaneous embolization. Conclusions: Prevention through systematic anatomical identification of the thoracic duct during level IV dissection, intraoperative verification of its integrity, and the application of a flow-based therapeutic algorithm drastically reduce morbidity and optimize the management of cervical chylous fistula. Full article

Background: Cadaveric dissection remains foundational in anatomy education, while virtual reality (VR) has emerged as a potential complementary or alternative modality. This randomized, curriculum-embedded modified AB/BA crossover study evaluated VR-based versus cadaver-based anatomy tutoring among post-baccalaureate students enrolled in a healthcare master’s program. Methods: Participants completed four weeks of tutoring using one modality followed by four weeks using the alternate modality. Outcomes included embedded written examination scores, cadaver-based practical examination scores, final course grades, and learner perceptions measured through pre-, mid-, and post-intervention surveys. Eighteen students completed the full study. Results: No significant differences were observed between VR-based and cadaver-based tutoring for written examinations, practical examinations, or final course grades (all p > 0.05). Learners rated VR-based tutoring as significantly more helpful at the first and second post-intervention timepoints (p < 0.0001 and p = 0.0020). Confidence was comparable between modalities, while enjoyment was higher for the cadaver lab at the second post-intervention timepoint (p = 0.0120). Conclusions: No statistically significant differences in short-term anatomy learning outcomes were detected between VR-based and cadaver-based near-peer tutoring within a cadaver-based curriculum, and both modalities were successfully delivered by student tutors. While the small sample size limits definitive conclusions, either modality, or a combination of both, may represent a feasible supplemental instruction tool based on institutional resources, space, donor availability, and learner needs without significantly compromising the student experience. Full article

Human anatomy teaching is undergoing a rapid transformation driven by digital innovation, immersive visualization, open multiscale datasets, and changing learner profiles, while donor-based dissection nevertheless remains essential for understanding human anatomical variability and tissue properties and may contribute to students’ professional identity formation when supported by structured reflection. In this narrative review, we synthesize peer-reviewed literature, prioritizing contributions most relevant to current educational practice and governance. We discuss how technology-enhanced resources can extend learning before, during, and after laboratory sessions through manipulable visualization, repetition, and tighter links to imaging and data literacy. We also examine the expanding clinical, research, and innovation roles of donor-based anatomy laboratories and the associated need for explicit governance (biosafety, access control, documentation, and transparency regarding secondary uses). Ethical literacy is treated as a core learning outcome, including inclusive representation, consent and donation law awareness, and critical engagement with plastination and public display. Finally, we consider how attention fragmentation and AI-enabled tools may support personalization and feedback, yet also introduce risks such as automation bias and superficial recognition if not paired with verification and reasoning-based tasks. Overall, the future of human anatomy education lies in purposeful integration of donor-based, digital, immersive, and computational modalities within an adaptive learning ecosystem that serves learners across disciplines while maintaining robust ethical and professional standards. Full article

Background/Objectives: Classical descriptions of median nerve motor anatomy often emphasize muscle-specific destinations, although a single muscular branch may divide to supply several muscles. This can obscure the hierarchical relationship between branch origin and downstream ramification. We therefore quantified the two-dimensional topography of muscular branches arising directly from the median nerve and analyzed each branch origin as a single spatial event linked to its subsequent muscular destinations. Methods: Sixteen fresh, non-frozen right upper limbs from 16 independent adult body donors (8 male and 8 female; mean age, 82.2 ± 9.6 years) underwent standardized dissection. Cartesian coordinates were assigned only to the origin of each first-order muscular branch from the median nerve. Branches were ordered proximodistally and linked to downstream subbranch count and target muscles. Coordinates were normalized to bistyloid distance (RPX) and forearm length (RPY). Donor-clustered bootstrap confidence intervals and mixed-effects models with donor-specific random intercepts summarized spatial variation across branch rank, with the longitudinal association interpreted descriptively because rank was defined proximodistally. Results: Seventy muscular branches generated 274 recorded downstream subbranches and 146 unique branch–muscle associations. Limbs contained a median of 4 muscular branches (range, 2–6), and 32/70 branches (45.7%) supplied two or more target muscles; this proportion includes the anterior interosseous nerve when its origin met the study’s branch-centered definition. The first branch participated in pronator teres innervation in all 16 limbs and was exclusive to that muscle in 11 (68.8%); all five sixth-ranked branches observed in this sample supplied flexor digitorum superficialis. As expected from the ranking definition, increasing branch order was descriptively associated with a more distal origin (β = 0.084; 95% CI, 0.063–0.104) and was associated with a higher normalized transverse coordinate (β = 0.077; 95% CI, 0.050–0.103; p < 0.001). Branch order explained substantially more longitudinal than transverse variance (marginal R², 0.444 vs. 0.183). Conclusions: Proximodistally ranked median nerve branch origins were associated with frequent and variable downstream multi-muscle pathways. The rank–longitudinal coordinate association does not independently establish anatomical reproducibility. Treating the muscular-branch origin as the coordinate-level unit preserves the anatomical hierarchy, prevents pseudoreplication of shared coordinates, and provides an anatomical framework with potential relevance to peripheral nerve surgery; clinical benefits remain untested. Full article

Background: Endovascular treatment of femoropopliteal atherosclerotic disease has evolved from plain balloon angioplasty and routine stenting toward lesion-oriented strategies that combine plaque assessment, selective vessel preparation, antiproliferative drug delivery, and provisional scaffolding. The increasing availability of drug-coated balloons, drug-eluting stents, atherectomy, intravascular lithotripsy, intravascular imaging, and sirolimus-based technologies has improved therapeutic options but has also made device selection more complex. Objective: To synthesize comparative evidence and present a practical lesion-oriented framework for selecting vessel preparation, antiproliferative therapy, and selective scaffolding. Methods: A structured narrative review of contemporary evidence was performed, prioritizing randomized controlled trials, head-to-head comparisons, systematic reviews, meta-analyses, and consensus documents relevant to femoropopliteal intervention. Results: Lesion morphology—particularly length, chronic total occlusion, calcification pattern, popliteal involvement, and in-stent restenosis—strongly influences procedural strategy and durability. Atherectomy and specialty balloons can optimize acute vessel preparation in selected lesions, although consistent long-term superiority has not been demonstrated. Intravascular lithotripsy has the strongest randomized evidence for heavily calcified lesions, reducing flow-limiting dissection and bailout stenting. Paclitaxel-coated balloons remain a central leave-nothing-behind therapy, with contemporary evidence not confirming the previously proposed late mortality signal. Sirolimus-coated balloons have now entered the field with randomized noninferiority data versus paclitaxel through 2 years. Drug-eluting and other contemporary stents remain important when recoil, dissection, or complex anatomy make a purely scaffold-free strategy unreliable. Conclusions: Contemporary femoropopliteal intervention is best approached as a sequence of lesion characterization, selective preparation, antiproliferative therapy, and selective scaffolding. Treatment should be matched to lesion morphology and the final mechanical result, with focal repair or stenting when dissection or recoil compromises flow. Full article

Background: Mature cystic teratomas are some of the most common benign ovarian germ cell tumors and are often discovered incidentally during imaging or surgery. Reports on the gross anatomical relationships for these lesions during body donor dissection are particularly limited. This case study explores an ovarian mass with gross features consistent with a mature cystic teratoma discovered during a routine donor dissection and draws attention to the academic and educational value to be gained from its integration into anatomical instruction. Methods: Routine dissection of an 89-year-old female donor revealed a unilateral, well-encapsulated ovarian mass within the mesosalpinx of the left uterine tube. Gross anatomical relationships to nearby structures were documented photographically. The lesion was measured and examined for distinguishing macroscopic features. Results: The ovarian mass measured approximately 7 × 4 × 5 cm³ and was completely contained within a smooth external capsule. After incision, it was found that the lesion contained profuse sebaceous contents and hair; all findings consistent with a mature cystic teratoma. Direct observation of the mass in situ allowed for analysis of its anatomical relationships with adjacent pelvic organs. This supported assimilation of gross anatomy, embryology, and ovarian pathology during first-year medical education. Conclusions: Discovery of ovarian masses during donor dissection provides a unique opportunity for intact pelvic anatomy education to be integrated with uncommon pathologic findings. Gross documentation of lesions exhibiting characteristics consistent with mature cystic teratomas can enhance anatomical education, while simultaneously contributing a more comprehensive description of these uncommon lesions to the currently limited literature. Full article

Laparoscopic cholecystectomy is among the most frequent abdominal operations worldwide, and its safety has improved across three decades. Major vascular injury nonetheless remains a rare but disproportionately lethal complication, capable of producing hepatic ischaemia, biliary stricture, liver failure and death. Bile duct injury has dominated the safety literature; vascular injury—isolated or, more often, combined with bile duct injury as a vasculobiliary injury—has been treated largely as bleeding to be controlled. This review argues that this framing is mistaken. Drawing on the observational literature, guidelines and emerging technologies, it advances one thesis: outcome depends far less on the vessel or repair technique than on where the injury sits on a predictable, systems-level cascade running from distorted anatomy, through cognitive fixation and unsafe dissection, to delayed recognition and non-expert management. We formalise this as the Vasculobiliary Injury Cascade, a three-phase model—predisposition, injury and trajectory—in which every transition is a defensible point of interruption and the determinants of survival lie disproportionately in the final phase. From it we derive a mechanism-specific account of prevention separating arterial misidentification from portal dissection injury, a three-layer defence integrating anatomical recognition, operative decision-making and technology, and a management approach of early recognition and timely referral rather than improvised repair. Full article

Cross-sectional imaging data for the African white-backed vulture (Gyps africanus) are lacking, and interpretation relies mainly on general avian descriptions and studies in other birds. This preliminary case study evaluated contrast-enhanced computed tomography (CT) for visualising principal coelom structures and their spatial relationships in an adult male G. africanus. Images were assessed using multiplanar and three-dimensional (3D) reconstruction techniques. Soft-tissue images better depicted parenchymal organs and cardiovascular structures, whereas lung-window images improved visualisation of the respiratory system, air sacs, and pneumatised skeletal regions. Maximum intensity projection (MIP) and 3D volume rendering (VR) provided complementary information on vascular anatomy and spatial relationships. The observed anatomical features were generally consistent with established avian anatomy and previous imaging studies in other species. CT provided useful anatomical information in this individual and may support future comparative and clinical imaging studies in G. africanus. However, because only one bird was examined and no complementary anatomical sectioning or dissection was performed, the findings should be regarded as a preliminary case study rather than species-specific anatomical reference data. Full article

Pseudopus apodus is an anguimorph lizard belonging to the order Squamata. Anatomical information on this species remains limited, particularly regarding soft tissues, and has primarily focused on the axial skeleton of both living and fossil specimens. Recently, the anatomy of its coelomic cavity has been described using dissection and multi-detector computed tomography (CT), and its brain has been characterized neuroanatomically by combining ultra-high-resolution magnetic resonance imaging (MRI) with histological analysis using immunofluorescence. In the present study, four specimens (one female and three males) were examined. One male and the female were scanned using a low-field MRI system (0.23 T), whereas all three males were scanned using a high-field MRI system (1.5 T). Both MRI systems enabled the identification of a wide range of hard and soft anatomical structures. Only a few small structures could not be consistently identified with the low-field system, including the thyroid gland, spleen, pancreas, testes, and hemipenes. Despite the lower field strength, small ovarian follicles and the optic nerves were clearly visualized with the low-field MRI system. This study provides the first whole-body MRI anatomical reference for Pseudopus apodus, complements previous CT-based anatomical studies, and offers practical information for the interpretation of MRI examinations in reptiles. Full article

Background: Styloid process abnormalities, classically associated with Eagle syndrome, have increasingly been implicated in cerebrovascular events through mechanical interaction with cervical vessels. Methods: This study combined a structured narrative review of the relationship between styloid process anatomy and internal carotid artery dissection with a single-center retrospective observational cohort. Consecutive patients with acute ischemic stroke were evaluated to identify cases of extracranial internal carotid artery dissection, in whom styloid process anatomy, carotid morphology, and potential mechanical triggers were subsequently assessed. The narrative review was supported by a structured PubMed/MEDLINE search and a PRISMA-style study-selection process. No formal meta-analysis was performed, and the institutional cohort did not include an age- and sex-matched control group. Results: The literature search identified 34 eligible reports for the narrative synthesis. Among 1621 consecutive ischemic stroke admissions, 17 patients (1.04%) had extracranial internal carotid artery dissection. Elongated styloid processes (≥30 mm) were identified in 11/17 patients (64.7%), and carotid tortuosity was present in 10/17 patients (58.8%). Several patients had identifiable mechanical or traumatic precipitating factors. Conclusions: Styloid process elongation and carotid tortuosity were frequently observed in patients with extracranial internal carotid artery dissection. These findings support careful assessment of styloid–carotid anatomy in selected patients with carotid dissection. However, the small sample size, retrospective design, and absence of a control group preclude causal inference and require validation in larger controlled studies. Full article

Background/Objectives: Pterygoid implants are increasingly used to provide distal support in full-arch maxillary rehabilitation, improving biomechanical stability and reducing posterior cantilevers. Despite high reported survival rates, their placement is technically demanding because of the complex anatomy of the pterygomaxillary region and the proximity of critical neurovascular structures. Implant displacement into adjacent deep anatomical spaces is a rare but potentially serious complication. The aim of this report is to describe the management of sequential intraoperative complications involving pterygoid implants—initial migration into the maxillary sinus followed by displacement into the pterygopalatine fossa—and to analyse the technical factors that contributed to them. Case Description: A 68-year-old woman underwent full-arch maxillary rehabilitation with eight implants, including bilateral pterygoid implants. Both pterygoid implants showed progressively decreasing primary stability and migrated into the maxillary sinus. During a salvage attempt, a newly inserted pterygoid implant deviated and was displaced beyond the pyramidal process into the pterygopalatine fossa together with the insertion driver. Cone-beam computed tomography (CBCT) localized the implant—lying medial to the lateral pterygoid plate, anterior to the pterygoid process—and guided a targeted retrieval based on careful blunt dissection, performed in an outpatient setting without general anesthesia or endoscopic assistance. A correctly positioned pterygoid implant was then placed. The anterior implants (insertion torque > 60 N·cm) were immediately loaded; at four months the right pterygoid implant was uncovered, and the left implant retained in the sinus was retrieved and replaced using a trans-sinus technique with elevation of the Schneiderian membrane. Conclusions: This case highlights the importance of accurate, consistent anatomical localization, complete osteotomy preparation, appropriate implant selection, and controlled, torque-monitored insertion during pterygoid implant placement. It also demonstrates that rare displacement of an implant into a deep anatomical space can be safely managed in an outpatient dental setting by experienced clinicians using a structured, image-guided approach. Full article

Background and Objectives: Bile duct injury remains a major safety concern during laparoscopic cholecystectomy, and reliable interpretation of hepatocystic anatomy is fundamental to safe dissection. Artificial intelligence (AI)-based computer vision may support anatomical recognition, critical view of safety (CVS) assessment, and intraoperative decision support. This narrative review synthesized the current evidence, clinical applications, readiness for implementation, and future requirements of anatomy-aware AI during laparoscopic cholecystectomy. Materials and Methods: Five bibliographic databases were searched through 15 August 2026, supplemented by citation tracking and targeted searches. Studies were classified according to clinical task, dataset, reference standard, validation design, performance metrics, real-time capability, human factor assessment, and clinical readiness stage. The evidence base comprised 105 verified references: 50 primary AI reports and 55 contextual or methodological sources; 39 direct model development or evaluation reports were characterized in detail. Results: Investigated applications included landmark detection, semantic segmentation, CVS assessment, safe and hazard zone mapping, multimodal analysis incorporating indocyanine green fluorescence, automated documentation, education, and real-time perceptual prompting. Among the 39 direct reports, 24 remained at the offline proof of concept or internal validation stage, eight achieved temporal, external, or multicenter validation, six demonstrated prospective operating-room feasibility, and one reached post-deployment surveillance. The latter evaluated a surgical-process outcome rather than patient morbidity. Generalizability was constrained by dataset overlap, heterogeneous reference standards and metrics, domain shift, and underrepresentation of difficult cholecystectomy. No included study demonstrated reduced bile duct injury or other patient-level benefit. Conclusions: Despite progression to prospective feasibility and one post-deployment process surveillance report, no included study demonstrated a reduction in bile duct injury or another patient-level outcome. Current evidence supports adjunctive applications in documentation, video triage, education, coaching, and quality assurance, while surgeon-facing deployment requires further multicenter, human factor, and comparative-effectiveness evaluation. Full article

Thoracic endovascular aortic repair is established for complicated type B aortic dissection, but extension of disease toward the aortic arch and involvement of supra-aortic branches may require technically demanding, individualized solutions. We report a multistage endovascular strategy in a 56-year-old man who presented with acute Stanford type B aortic dissection, hypertensive crisis, right renal malperfusion, and bovine arch anatomy. Right renal artery stenting was followed by thoracic endovascular aortic repair because of persistent pain and rapid enlargement of the distal arch. At 1 year, computed tomography angiography (CTA) demonstrated aneurysmal progression with type IA and IB endoleaks. A custom-made fenestrated arch endograft was deployed to preserve the common origin of the brachiocephalic and left common carotid arteries. Device malrotation caused acute bilateral carotid hypoperfusion, which was successfully treated by bailout parallel stenting; one bridging stent migrated to the abdominal aorta. Five months later, distal endograft extension excluded the type IB endoleak, and the migrated stent was retrieved with a snare. Follow-up imaging showed exclusion of both endoleaks, patent carotid vessels, and stable renal function. This case illustrates both the versatility and the procedural hazards of total endovascular arch repair. Meticulous CTA planning, immediate availability of bailout strategies, multidisciplinary expertise, and structured imaging surveillance are essential when treating complex post-dissection arch disease. Full article