Surgical and Radiologic Anatomy最新文献

{"title":"A prevalence study of the axiobasilaris muscle.","authors":"Isabella G Damjanovic, Madeline M Damjanovic, Leilanie G Clayton, Jasmine Rockarts, Andrew Palombella, Irena A Rebalka, Logan S W Bale","doi":"10.1007/s00276-026-04008-4","DOIUrl":"10.1007/s00276-026-04008-4","url":null,"abstract":"<p><p>Axiobasilaris is an accessory muscle of the prevertebral region. While historical cases have been described in the late 19th century, to our knowledge, no new reports of this muscular variation have been published since that time period. Visual representation of axiobasilaris is also lacking aside from illustrations produced in 1880 by Gruber. Recording anatomical variations is valuable for both teaching and clinical practice, as variations may be encountered by anatomists in the dissection laboratory and cause implications in the surgical setting. Prevertebral variations such as axiobasilaris are relevant in cases of endoscopic endonasal skull base surgery, trans-oral release and reduction of the cervical spine, as well as cervical corpectomy. From a functional perspective, axiobasilaris is thought to contribute to flexion at the atlanto-occipital and atlanto-axial joints. This study aims to determine the prevalence of axiobasilaris through the dissection of 60 donor cadavers (120 sides). Axiobasilaris was found in five out of the 60 (8.33%) donors dissected in this study; two cases presented as a single unilateral muscle, while three others presented as paired bilateral muscles for a total of eight out of 120 sides (6.67%).</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical anatomy of deep branch of the radial nerve at the Arcade of Frohse: geometric relationships relevant to posterior interosseous nerve entrapment.","authors":"Veeramani Raveendranath, Neethu Sivadasan, Rituraj Majumder, Jayasree Srinivasan, R B Udit Narayan","doi":"10.1007/s00276-026-04003-9","DOIUrl":"10.1007/s00276-026-04003-9","url":null,"abstract":"<p><strong>Purpose: </strong>Posterior Interosseous Nerve (PIN) syndrome results from compressive neuropraxia of the deep branch of the radial nerve (DBRN) at or around the Arcade of Frohse (AOF), manifesting purely as motor deficits. Accurate localization of the nerve remains challenging due to limited surface landmark data. This study aimed to establish reliable geometric surface landmarks to guide clinicians in diagnosing and managing PIN syndrome.</p><p><strong>Methods: </strong>Sixteen upper limb specimens from eight cadavers (7 male, 1 female) underwent standardized dissection. Key measurements were recorded, including lengths of DBRN at various anatomical intervals, nerve width at three points, and distances from bony landmarks (medial and lateral epicondyles) to the AOF. Texture of the proximal and distal arcades of the supinator was also documented.</p><p><strong>Results: </strong>The mean length of DBRN from its origin to AOF was 39.35 ± 7.9 mm. The mean distance from the radio-capitular joint (RCJ) to the AOF was 23.06 ± 4.1 mm, and the mean length within the radial tunnel was 41.59 ± 8.5 mm. DBRN width increased from 1.89 ± 0.69 mm at origin to 3.41 ± 1.05 mm at the AOF, consistent with compressive remodelling. A geometric triangle (\"PIN Triangle\") was defined using the medial epicondyle, lateral epicondyle, and the AOF as vertices, with the lateral epicondyle-to-AOF distance averaging 41.36 mm. The AOF was musculotendinous in 44%, tendinous in 25%, and membranous in 31% of specimens.</p><p><strong>Conclusion: </strong>The PIN Triangle is a scalene triangle defined by the medial epicondyle, lateral epicondyle, and the AOF, with its apex approximately 41 mm distal to the lateral epicondyle, provides a reproducible surface landmark for diagnostic palpation and arthroscopic planning for PIN syndrome.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical impact of C1 transverse process resection on inferior and inferolateral exposure at the craniocervical junction: a cadaveric study.","authors":"Mustafa Eren Yuncu, Berra Bilgin, Erman Guler, Ali Karadag, Necmettin Tanrıover","doi":"10.1007/s00276-026-03996-7","DOIUrl":"10.1007/s00276-026-03996-7","url":null,"abstract":"<p><strong>Background: </strong>Surgical exposure of the craniocervical junction (CCJ) is challenging because of the narrow osseous corridor and complex neurovascular anatomy. Although the far lateral approach is well established, the relative anatomical contribution of sequential osseous modifications used in far lateral surgery remains incompletely understood. This study aimed to provide a stepwise anatomical comparison of retrosigmoid, far lateral, and extended far lateral approaches, focusing on neurovascular exposure before C1 transverse process resection.</p><p><strong>Methods: </strong>Four formalin-fixed, silicone-injected adult human cadaveric heads (eight sides) were dissected. Retrosigmoid, far lateral, and extended far lateral approaches with C1 transverse process resection were sequentially performed. Exposure of the lower cranial nerves (CN), vertebral artery (VA), and inferior surgical corridor was qualitatively assessed under operative microscopy.</p><p><strong>Results: </strong>The retrosigmoid approach provided limited inferior exposure due to the foramen magnum. Far lateral exposure with condylar drilling and C1 laminectomy provided greater inferior reach, allowing visualization of the VA V3 segment and extracranial portions of the lower CNs. Notably, substantial exposure of the jugular foramen-C1 interval was achieved before C1 transverse process resection. Additional C1 transverse process resection mainly enhanced inferolateral working space by permitting wider mobilization of the V3 segment and lower CNs, with only limited additional contribution to caudal exposure.</p><p><strong>Conclusion: </strong>C1 laminectomy is the key step for increasing inferior reach at the CCJ, whereas C1 transverse process resection primarily improves inferolateral maneuverability and VA mobilization. Because substantial exposure is already achieved after condylar drilling and C1 laminectomy, transverse process resection should be applied selectively rather than routinely, particularly in lesions requiring extensive VA mobilization or inferolateral exposure.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiologic analysis of cavum septi pellucidi and cavum vergae in children.","authors":"Adrian Drożdż, Mateusz Gadzała, Tomasz Wojciechowski, Bogdan Ciszek","doi":"10.1007/s00276-026-04002-w","DOIUrl":"10.1007/s00276-026-04002-w","url":null,"abstract":"<p><strong>Purpose: </strong>Cavum septi pellucidi (CSP) and cavum Vergae (CV) are two major midline intracranial fluid collections. They have been in the area of interest for many years because of their variable size during growth. The present study aimed to develop a new classification of CSP, investigate morphometric changes in both the CSP and CV during development, and assess their correlation with well-known cerebral parameters.</p><p><strong>Methods: </strong>We analyzed MRI scans of 201 pediatric patients. We divided the sample of individuals into five age groups with approximately equal sizes, including only T2-weighted sequences. Three different methods of CSP classification, Nopoulos, Tsutsumi, and ours, newly developed, were considered.</p><p><strong>Results: </strong>We have proposed a new classification of CSP based on the relation between the laminae of the cavum. We observed a very strong correlation (rho = 0.91) between CSP width and length (p < 0.001) but negligible correlations between CSP dimensions and the width of the lateral ventricles (rho < 0.1; p = 0.928). The trends indicate a decrease in CSP size with age (p < 0.001). All cases with present CV were found in patients with laminae CSP completely unadherent (type C, p = 0.001). We have reached almost perfect interrater agreement across measurements.</p><p><strong>Conclusions: </strong>We have provided a new classification of CSP. It can be considered in every stage of human development as it is not correlated to cerebral diameters. We confirmed no correlation between the width of CSP and the width of the ventricles and biparietal diameter.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the lingual artery: a scoping review and proposed imaging-informed risk classification for surgical and radiological practice.","authors":"Ingrid C Landfald, George Triantafyllou, Lyubomir Gaydarski, Łukasz Olewnik, Bento João Abreu, Judney Cley Cavalcante, Paloma Aragonés, Marta Pośnik, Yuriy Vasil'ev, Maria Piagkou","doi":"10.1007/s00276-026-03989-6","DOIUrl":"10.1007/s00276-026-03989-6","url":null,"abstract":"<p><strong>Background: </strong>The lingual artery (LA) shows significant morphological and topographical variation that can affect the safety and results of head and neck surgeries, carotid interventions, and free flap reconstructions. Traditional descriptions such as the thyrolingual trunk (TLT), linguofacial trunk (LFT), and thyrolinguofacial trunk (TLFT) do not consider surgical risk assessment or the importance of modern imaging.</p><p><strong>Objective: </strong>To comprehensively review LA origin and course variants, determine their prevalence in cadaveric and imaging datasets, and propose an imaging-informed, anatomy-based risk classification for surgical and radiological use.</p><p><strong>Methods: </strong>A PRISMA Extension for Scoping Reviews (PRISMA-ScR)-aligned scoping review of PubMed, Scopus, and Web of Science (January 2007-May 2025) identified studies reporting LA variants through cadaveric dissection, computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography. Only original studies in English containing primary variant data were included. Prevalence ranges were extracted, and a proposed anatomy-based classification (Classes I-III) was constructed according to branching pattern, shared trunk involvement, proximity to the carotid bifurcation or common carotid artery, and anticipated implications for vascular control. Because standardized clinical outcome data were inconsistently reported across the included studies, the framework should not be interpreted as outcome-validated.</p><p><strong>Results: </strong>Ten eligible studies (n = 1550 ECAs) from Europe, Asia, North America, and Africa were included from cadaveric and imaging datasets. Typical anatomy with independent STA, LA, and FA origins was found in 50.7-90% of cases. LFT occurred in 7.5-24.3%, TLT in 0.6-10.5%, TLFT in 0-2.85%, and aberrant origins from the CCA or carotid bifurcation (ALA) in 0.7-6.6%. In the original course-variant dataset (n = 111 body sides), superficial, submental, and dual-origin variants were each uncommon. CTA provided the most detailed three-dimensional depiction of moderate- and high-complexity variants in the included imaging studies. The proposed classification organizes origin and course variants according to expected procedural complexity and imaging needs.</p><p><strong>Conclusions: </strong>A substantial proportion of patients present with LA variants that may influence surgical planning and intraoperative decision-making. The proposed classification may serve as an imaging-informed, clinically oriented framework for preoperative evaluation and multidisciplinary communication. However, it remains anatomy-based and requires prospective clinical validation before outcome-based application.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental changes in hypoglossal canal morphometry and its anatomical relationships: a CT study in 180 pediatric patients.","authors":"Elif Dilara Topcuoglu, Ayse Silan Kapuci","doi":"10.1007/s00276-026-04006-6","DOIUrl":"10.1007/s00276-026-04006-6","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate age- and sex-related changes in hypoglossal canal (HC) morphology and its anatomical relationships with skull base landmarks in a pediatric population using computed tomography (CT).</p><p><strong>Materials and methods: </strong>Children aged 0-17 years who underwent cranial CT were included. Each age group comprised five males and five females. The HC diameters were measured on transverse and multiplanar reformatted images at the midpoint, as well as at the intracranial and extracranial openings. The HC length was also recorded. The distances between the HC and the clivus cortex, the occipital condyle (OC) and the posterior condylar canal (if present) were evaluated. Inter-observer and intra-observer agreement was assessed in 20% of the sample (36 patients, 72 HCs).</p><p><strong>Results: </strong>A total of 360 HCs from 180 pediatric patients were analyzed using linear mixed-effects models accounting for the non-independence of bilateral measurements. Twelve of 13 measurements demonstrated significant age-related enlargement (FDR q < 0.05), most pronounced in distances from the HC to the clivus and OC, a pattern confirmed by monotonic trend analysis. Age-group comparisons showed a significant omnibus effect for 12 of 13 measurements, with the most pronounced differences observed between the youngest and oldest groups. Twelve of 13 measurements also differed significantly by sex, with consistently smaller dimensions in females (regression coefficients ranging from - 0.30 to -0.93 mm, all FDR q < 0.05) and no significant age-by-sex interaction. In contrast, no measurement showed a significant right-left difference or age-by-side interaction.</p><p><strong>Conclusion: </strong>This CT-based study provides detailed morphometric data on the pediatric HC and its anatomical relationships. The findings demonstrate age- and sex-related developmental changes while preserving bilateral symmetry and may serve as a reference for pediatric skull base imaging and surgery.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerve anastomoses in the upper limb: an up-to-date meta-analysis.","authors":"Dawid Plutecki, Michał Bonczar, Jerzy Walocha, Weronika Chaba-Karnaś, Antonina Nowak, Tomasz Kozioł, Kacper Bąk, Marcel Frankiewicz, Mariusz Trystuła, Mateusz Koziej","doi":"10.1007/s00276-026-04001-x","DOIUrl":"10.1007/s00276-026-04001-x","url":null,"abstract":"<p><strong>Introduction: </strong>There are numerous communicating branches (CB) between the nerves of the brachial plexus. Therefore, the objective of this study was to provide comprehensive data on the prevalence, morphometry, and anatomical classifications of upper extremity anastomoses such as: Martin-Gruber anastomosis (MGA), Marinacci anastomosis (MA), Riche-Cannieu anastomosis (CRA), Berrettini anastomosis (BA), median and musculocutaneous nerves anastomoses (MMA), or radial and lateral cutaneous nerve of forearm anastomosis (RLCA).</p><p><strong>Material and methods: </strong>Major online medical databases such as PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect and Korean Journal Database were searched to gather all relevant studies regarding the anatomical characteristics of these structures. Finally, a total of 189 studies were included in this meta-analysis, based on 23,572 upper extremities.</p><p><strong>Results: </strong>The prevalence of MGA was 20.74% (cadaveric studies), 18.93% (fetal studies), 16.65% (healthy subjects) and 20.37% (patients with carpal tunnel syndrom). The most prevalent was type II of the Oh et al. classification of MGA, occurring in 58.01%, and pattern I of Rodríguez-Niedenführ et al. classification, which resulted in 96.07%. Nevertheless the pooled prevalence of MA was 2.04%. The BA was found in 67.97% (cadaveric studies), 29.07% (fetal studies) and 11.88% (electrophysiological studies).</p><p><strong>Conclusion: </strong>This study represents the most extensive and up-to-date evaluation of nerve anastomoses in upper limb morphometry and anatomy up to date. Its findings provide an important reference for clinicians, particularly surgeons performing procedures in the upper extremities region.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central corneal endothelial morphometry in emmetropic adults aged 20-40 years examined in Valencia, Spain: a retrospective cross-sectional analysis.","authors":"Juan A Sanchis-Gimeno, Josepha Hernandez-Nilo, Jessica Paola Loaiza-Giraldo, Nikolaos Lazaridis, George Triantafyllou, Maria Piagkou, Juan José Valenzuela-Fuenzalida","doi":"10.1007/s00276-026-04007-5","DOIUrl":"10.1007/s00276-026-04007-5","url":null,"abstract":"<p><strong>Purpose: </strong>To provide a descriptive anatomical baseline for central corneal endothelial morphometry and examine cross-sectional associations with recorded sex and age in emmetropic adults examined in Valencia, Spain.</p><p><strong>Methods: </strong>This retrospective cross-sectional secondary analysis included 202 de-identified records from adults aged 20-40 years. The historical research program operated from 2002 to 2012; exact participant-level examination dates were unavailable. Emmetropia required a spherical equivalent from -0.50 to +0.50 D, manifest sphere and cylinder within ±0.50 D, and best-corrected visual acuity of 20/20 or better. We obtained endothelial cell density (ECD), coefficient of variation of cell area (CV), percentage of hexagonal cells (%HEX), and mean cell area (MCA) using Topcon SP-2000P non-contact specular microscopy. We used Welch tests, Hedges' g, and false-discovery-rate correction for sex comparisons; age-adjusted models used HC3 robust standard errors with diagnostic and sensitivity analyses.</p><p><strong>Results: </strong>The sample comprised 106 men and 96 women. Overall values were ECD 2908.1 ± 277.5 cells/mm², CV 32.6 ± 3.7%, %HEX 59.9 ± 6.4%, and MCA 350.2 ± 35.0 µm². No endpoint showed a detectable sex association after multiplicity control or age adjustment. Age was cross-sectionally associated with lower ECD, larger MCA, and modestly lower %HEX, although the %HEX association attenuated in sensitivity analyses. ECD and MCA were strongly inversely correlated (r = -0.803).</p><p><strong>Conclusion: </strong>These device- and sample-specific data provide an anatomical comparator for future studies but are not formal clinical reference intervals or surgical thresholds.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical variations and morphometric characteristics of the common hepatic artery: a computed tomography angiography study in 1347 patients.","authors":"Koray Bingol, Elif Celik","doi":"10.1007/s00276-026-03991-y","DOIUrl":"10.1007/s00276-026-03991-y","url":null,"abstract":"<p><strong>Purpose: </strong>The common hepatic artery (CHA) demonstrates considerable anatomical variability with important implications for hepatobiliary, pancreatic, transplant, and endovascular procedures. This study aimed to evaluate the prevalence, morphometric characteristics, and three-dimensional topographic relationships of CHA variations using computed tomography angiography (CTA) in a large cohort.</p><p><strong>Methods: </strong>This retrospective study included 1347 consecutive patients (604 women, 743 men; mean age 55.1 ± 14.4 years) who underwent abdominal CTA. Hepatic arterial anatomy was classified according to the Hiatt and Song classifications. Morphometric parameters of the celiac trunk, CHA, gastroduodenal artery, and proper hepatic artery, and the three-dimensional relationships of the CHA to adjacent structures, were evaluated using multiplanar reformation, maximum-intensity projection, and volume-rendering techniques. Comparisons were performed according to sex, age group, and variation status.</p><p><strong>Results: </strong>Conventional hepatic arterial anatomy (Hiatt type I) was identified in 64.7% of patients, whereas 35.3% had variant anatomy, most commonly an isolated left hepatic artery variation (13.4%). The CHA originated predominantly from the celiac trunk (97.0%), with hepatomesenteric (2.3%) and direct aortic (0.7%) origins being uncommon. Male patients had significantly larger arterial calibres, and most morphometric parameters increased with age. Variant anatomy was associated with longer CHA, greater celiac trunk-to-CHA distance, wider departure angle, and more frequent retropancreatic, intrapancreatic, and portal/superior mesenteric venous confluence-related courses (all p < 0.001).</p><p><strong>Conclusion: </strong>Hepatic arterial variation is associated with distinct morphometric and topographic characteristics. These population-specific reference data may improve preoperative assessment and support safer hepatobiliary, pancreatic, transplant, and endovascular interventions by improving procedural planning and reducing vascular injury.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal course and variability of the spinal accessory nerve: a cadaveric study with surgical implications.","authors":"Martyna Stasiewicz, Carrie O'Flynn, Collette K Hand, André Toulouse","doi":"10.1007/s00276-026-03994-9","DOIUrl":"10.1007/s00276-026-03994-9","url":null,"abstract":"<p><strong>Purpose: </strong>The spinal accessory nerve (SAN) is most vulnerable to injury along its distal extracranial course in the posterior cervical triangle. While proximal anatomy is well described, distal branching patterns and cervical plexus contributions to trapezius innervation remain poorly defined. This study aimed to characterise distal extracranial SAN branching and cervical plexus contributions and to assess whether proximal configurations predict distal trapezial innervation.</p><p><strong>Methods: </strong>Ten sides from five adult cadavers were dissected from the emergence of the SAN at the posterior border of the sternocleidomastoid muscle (SCM) to its intramuscular termination in the trapezius. Emergence level, SCM branching pattern (Shiozaki classification), cervical plexus communications, loop formations, and distal branching were recorded. Linear morphometric measurements were obtained where feasible.</p><p><strong>Results: </strong>The SAN entered the posterior cervical triangle at variable levels (4.5-8.5 cm from the mastoid). Only Shiozaki Type A and B SCM patterns were identified. Cervical plexus contributions were present in all specimens. An independent cervical branch to the superior trapezius occurred in 6/10 sides, and SAN-cervical loop formation in 2/10 sides. Distal intramuscular branching ranged from two to five terminal branches, with no clear relationship to proximal configuration or measurements.</p><p><strong>Conclusion: </strong>Distal SAN anatomy is highly variable and cannot be predicted from proximal patterns or surface landmarks alone, underscoring the need for meticulous identification of both the SAN and cervical contributions during posterior cervical triangle and trapezius-based surgery.</p>","PeriodicalId":49461,"journal":{"name":"Surgical and Radiologic Anatomy","volume":"48 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}