The presence of a persistent median artery (PMA) has been implicated in the development of compression neuropathies and surgical complications. Due to the large variability in the prevalence of the PMA and its subtypes in the literature, more awareness of its anatomy is needed. The aim of our meta-analysis was to find the pooled prevalence of the antebrachial and palmar persistent median arteries. An extensive search through the major databases was performed to identify all articles and references matching our inclusion criteria. The extracted data included methods of investigation, prevalence of the PMA, anatomical subtype (antebrachial, palmar), side, sex, laterality, and ethnicity. A total of 64 studies (n = 10,394 hands) were included in this meta-analysis. An antebrachial pattern was revealed to be more prevalent than a palmar pattern (34.0% vs. 8.6%). A palmar PMA was reported in 2.6% of patients undergoing surgery for carpal tunnel syndrome when compared to cadaveric studies of adult patients in which the prevalence was 8.6%. Both patterns of PMA are prevalent in a considerable portion of the general population. As the estimated prevalence of the PMA was found to be significantly lower in patients undergoing surgery for carpal tunnel syndrome than those reported in cadaveric studies, its etiological contribution to carpal tunnel syndrome is questionable. Surgeons operating on the forearm and carpal tunnel should understand the anatomy and surgical implications of the PMA and its anatomical patterns.

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Extensive pneumatisation of the sphenoid bone-anatomical investigation of the recesses of the sphenoid sinuses and their clinical importance

BACKGROUND AND PURPOSE: The internal cerebral vein begins at the foramen of Monro by the union of the thalamostriate and the anterior septal veins. The lateral direct vein is its other major tributary. Numerous researchers have reported differences in internal cerebral vein branching patterns but did not classify them. Hence, the objectives of this study were to evaluate the anatomy of the internal cerebral vein and its primary tributaries and classify them depending on their course patterns using CTA.MATERIALS AND METHODS: Head CTAs of 250 patients were evaluated in this study, in which we identified the number and termination of the anterior septal vein and the lateral direct vein. The course of the lateral direct vein and its influence on the number of thalamostriate veins and their diameters and courses were assessed. The anterior septal vein-internal cerebral vein junctions and their locations in relation to the foramen of Monro also were evaluated. RESULTS:We classified internal cerebral vein branching patterns into 4 types depending on the presence of an extra vessel draining the striatum. Most commonly, the internal cerebral vein continued further as 1 thalamostriate vein (77%). The lateral direct veins were identified in 22% of the hemispheres, and usually they terminated at the middle third of the internal cerebral vein (65.45%). The most common location of the anterior septal vein-internal cerebral vein junction was anterior (57.20%), with the anterior septal vein terminating at the venous angle.CONCLUSIONS: Detailed knowledge of the anatomy of the deep cerebral veins is of great importance in neuroradiology and neurosurgery because iatrogenic injury to the veins may result in basal nuclei infarcts. A classification of internal cerebral vein branching patterns may aid clinicians in planning approaches to the third and lateral ventricles.

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Introduction : This study aimed to determine what anatomical variants of the Circle of Willis (CoW) and the middle cerebral artery(MCA) are observed in patients with acute M1 occlusion and whether their prevalence differs from that described as “normal” in anatomy textbooks. Methods : We have performed a retrospective assessment of radiological examinations of patients with stroke due to middle cerebral artery M1 segment occlusion. All patients underwent mechanical thrombectomy from January 2015 until March 2021. The anatomy of the CoW was assessed on initial CT‐angiography and DSA. Branches of the MCA were observed on control DSA after recanalization. Results : A total of 100 patients were included in the analysis (58 females and 42 males, mean age: 71.6 +/‐ 13.9). Fully complete CoW was observed in 19% of patients. A total of 10% of patients had an incomplete anterior portion of CoW. In the incomplete anterior portion subgroup, the most common variation was the absence of anterior communicating artery (6% of total hemispheres), followed by the absence of one A1 (3% of total hemispheres). An incomplete posterior portion of CoW was identified in 79% of the patients. The absence of posterior communicating artery (PCoA) was observed in 59 patients. Sixteen patients had adult‐type PCoA, 3 patients had transitional‐type PCoA and 21 patients had fetal‐type posterior cerebral artery (PCA). In the subgroup of patients with fetal‐type posterior circle, 5 patients had no P1 segment of PCA. Anterior temporal branch of MCA was observed in 45% of the patients. Middle cerebral artery bifurcation was found in 80% of hemispheres, and trifurcation in 20%. In the bifurcation subgroup, 26% of MCAs had a dominating upper branch and 18% had a dominating lower branch. A duplicate MCA was observed in one hemisphere. Conclusions : In comparison to normal anatomy described in anatomy textbooks, the population of patients suffering from ischemic stroke due to M1 occlusion had a lower proportion of complete and closed CoW. A foetal type PCoA was observed to be prevalent (21%) in patients suffering from acute M1 occlusion. Detailed anatomical knowledge of anatomical variants of CoW in patients undergoing mechanical thrombectomy is essential for clinicians performing intravascular interventions and may aid procedure planning.

Introduction Spinal artery aneurysms associated with previously undiagnosed coarctation of the aorta in adults are exceptionally rare. Aortic coarctation often results in aberrant collateral circulation with hyperdynamic flow. Abundant and fragile collaterals provide favourable conditions for spinal artery aneurysm formation, growth and rupture. There are very few reports of spinal artery aneurysms associated with coarctation of the aorta in the literature, with even less describing current endovascular methods of their treatment. Management of such lesions is especially challenging due to aberrant anatomy and the presence of collaterals. We describe a case of a 67‐year old woman with a previously unrecognized coarctation of the aorta who presented a ruptured radicular artery aneurysm. The patient was treated with endovascular embolization using microcoils. Methods Case report. Results A 67‐year old female presented to the emergency room with severe bilateral lower extremity paresis. Patient’s history was significant of hypertension, ischemic heart disease, atrial fibrillation and a previous subarachnoid hemorrhage of an unknown cause. An initial computed tomography scan done at an outside hospital showed a spinal canal hemorrhage at the cervical level and was suspicious for vascular malformation of cervical spine. Diagnostic angiogram via radial approach revealed a previously undiagnosed coarctation of the aorta. The examination showed an extensive network of collaterals between both subclavian arteries and thoracic aorta. A spinal artery aneurysm was identified as the source of the hemorrhage. At the C7/Th1 level on the left side a dilated radicular artery providing collateral blood flow to the left subclavian artery was detected, with an irregularly shaped lobulated aneurysm (11×7 mm) on its course. The following day endovascular embolization of the aneurysm was performed. Both radial arteries were punctured. On the left side, a pigtail catheter was placed in the left subclavian artery, and on the right side, a 5F guiding catheter was placed in the left vertebral artery. A balloon catheter was introduced to the left vertebral artery and advanced to the branching point of the radicular artery with the aneurysm on its course. Functional test was performed and upon balloon inflation no neurological deterioration was observed. The radicular artery feeding the aneurysm was accessed with a microcatheter. Embolisation was performed and microcoils were deployed in the radicular artery proximal to the aneurysm site. A control angiogram via left subclavian showed retrograde inflow into radicular artery from which the anterior spinal artery branched off. Conclusions As our case demonstrates, spinal and radicular artery aneurysms induced by aortic coarctation are complex entities and pose a unique surgical and medical challenge. Treating the aneurysm should be prioritized in cases of subarachnoid hemorrhage. Transradial approach for interventional procedures can avoid anatomic restrictions posed by coarctation.