Bendik Skinningsrud

Variations in the Arterial Blood Supply to the Penis and the Accessory Pudendal Artery: A Meta-Analysis and Review of Implications in Radical Prostatectomy

Purpose: The aim of this meta‐analysis was to analyze the available literature and provide comprehensive data on the prevalence and variations of the accessory pudendal artery and the 3 types of penile blood supply, including type 1—internal pudendal artery only, type 2—internal pudendal artery and accessory pudendal artery, and type 3—accessory pudendal artery only. Materials and Methods: We performed an extensive search of the major databases and identified 23 studies in a total of 4,945 patients suitable for inclusion in this meta‐analysis. Studies eligible for inclusion included cadaveric, imaging or intraoperative studies. Extracted data were pooled into a meta‐analysis with a random effects model using MetaXL, version 5.0 (EpiGear International, Sunrise Beach, Queensland, Australia). The chi‐square test and Higgins I2 statistics were used to assess heterogeneity among included studies. Results: Our findings revealed that the most common type was type 1 with a pooled prevalence estimate of 61.9%, followed by types 2 and 3 with a pooled prevalence estimate of 32.8% and 5.4%, respectively. In our analysis of the accessory pudendal artery the vessel was present in 28.5% of patients. When present, unilateral accessory pudendal arteries were most common (pooled prevalence estimate 72.5%) or they were present on the right or the left side (pooled prevalence estimate 48.0% or 52.0%, respectively). They most commonly originated from the obturator artery and the inferior vesical artery (pooled prevalence estimate 48.9% and 29.6%, respectively). The most common type was apical accessory pudendal arteries (pooled prevalence estimate 60.9%). Conclusions: A penile blood supply originating at least in part from an accessory pudendal artery represents more than a third of cases. Based on the anatomical findings when an accessory pudendal artery is present, we advocate attempted preservation of the vessel during radical prostatectomy to best maintain the penile arterial blood supply, especially in patients with type 3 or in older patients with type 2.

Systematic reviews versus narrative reviews in clinical anatomy: Methodological approaches in the era of evidence-based anatomy: Systematic versus Narrative Reviews

Two main types of review articles with distinct characteristics and goals are commonly found in the scientific literature: systematic reviews and narrative (also called expert or traditional) reviews. Narrative reviews are publications that describe and discuss the state of science on a specific topic or theme from a theoretical and contextual point of view with little explicit structure for gathering and presenting evidence. Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesizing the results of primary research studies using an explicit methodological approach. With the recent rise of evidence‐based anatomy, important questions arise with respect to the utility of narrative reviews in clinical anatomy. The goal of this perspective article is to address the key differences between narrative and systematic reviews in the context of clinical anatomy, to provide guidance on which type of review is most appropriate for a specific issue, and to summarize how the two types of reviews can work in unison to enhance the quality of anatomical research and its delivery to clinicians and anatomists alike. Clin. Anat. 31:364–367, 2018.

Development of the human pancreas and its vasculature — An integrated review covering anatomical, embryological, histological, and molecular aspects

OBJECTIVES The aim of this study was to provide a comprehensive overview of the clinically relevant anatomical and histological aspects of the development of the human pancreas, with emphasis on the vascularization of the gland. METHODS A comprehensive search on the relevant aspects of pancreatic biology was performed through the main electronic databases up to August 2017. Data from all relevant articles was gathered, analyzed and included in this narrative review. RESULTS This review outlines the main topics on embryology, anatomy, histology, and molecular biology of the microcirculation of the human pancreas. The first part describes in detail the development of the pancreas synthesizing anatomical knowledge with findings of novel molecular studies. The second and third parts give information on the organization of arterial and venous pancreatic circulation. The final part summarizes the most important findings concerning pancreatic microcirculation. All parts taken together create a comprehensive and up-to-date description of the development and organization of the blood supply to the human pancreas. CONCLUSIONS Detailed knowledge on the physiological development of the pancreas and anatomy of its blood supply play a key role in understanding the pathophysiology of various pancreatic disorders and is crucial for developing novel therapies for pancreatic disorders.

An original micro-CT study and meta-analysis of the internal and external anatomy of maxillary molars-implications for endodontic treatment: Morphology of Maxillary Molars

The aim of this work was to conduct a radiological micro‐CT study and meta‐analysis to determine the morphological features of the root canal anatomy of the maxillary molars. The radiological study included micro‐CT scans of 110 maxillary first molars and 98 maxillary second molars. To identify articles eligible for inclusion in our meta‐analysis, PubMed, Embase, and Web of Science were search comprehensively. The following data were extracted: study type (cadaveric, intraoperative or imaging), Vertucci types of canal configuration, presence/number of canals, roots, apical foramina, apical deltas, and inter‐canal communications. The mesiobuccal root was the most variable with respect to canal configuration, type I being the most common configuration followed by type II and type IV. Type I was the most common canal configuration in the distobuccal and palatal root. Regarding the number of canals in the maxillary first and second molars, one canal was most prevalent in all roots of the three molars, except for the mesiobuccal root of maxillary first molar, in which two canals were most prevalent. The most prevalent number of roots in all maxillary molars was three. Knowledge of endodontic anatomy determines the parameters of root canal treatment and significantly affects the probability of success. It is therefore especially important to know the morphology of the root canal system in order to perform endodontic treatment correctly. Clin. Anat. 31:838–853, 2018.

Internal and external morphology of mandibular molars: An original micro-CT study and meta-analysis with review of implications for endodontic therapy: Morphology of Mandibular Molars

The aim of this radiological micro‐CT study and meta‐analysis was to determine the morphological features of the root canal anatomy of the mandibular molars. The radiological study included micro‐CT scans of 108 mandibular first, 120 mandibular second, and 146 mandibular third molars. For our meta‐analysis, an extensive search was conducted through PubMed, Embase, and Web of Science to identify articles eligible for inclusion. Data extracted included investigative method (cadaveric, intraoperative, or imaging), Vertucci type of canal configuration, presence/number of canals, roots, apical foramina, apical deltas, and intercanal communications. In the mesial roots of mandibular molars, the most frequent Vertucci type of canal configuration was type IV, except for the mandibular third molar where type I was most common. Type I was most common in the distal root. There were usually two canals in the mesial root and one in the distal root. Two was the most common number of roots, and a third root was most prevalent in Asia. One apical foramen was most common in the distal root and two apical foramina in the mesial root. Intercanal communications were most frequent in the mesial root. Knowledge of the complex anatomy of the mandibular molars can make root canal therapy more likely to succeed. We recommend the use of cone‐beam computed tomography before and after endodontic treatment to enable the root anatomy to be accurately described and properly diagnosed, and treatment outcome to be assessed. Clin. Anat. 31:797–811, 2018.

Prevalence of the petrosquamosal sinus and its clinical significance: a radiological study and meta-analysis

OBJECTIVE The petrosquamosal sinus (PSS) is clinically important as it represents a potential hemorrhagic hazard during neurosurgical procedures. This double-approach radiologic study and meta-analysis aimed to assess the imaging characteristics of the PSS on computed tomography (CT) and systematically analyze its prevalence to improve imaging accuracy and assist in neurosurgical management. METHODS The retrospective radiologic study included CT scans of 388 patients aged 18 years or older. All patients with any visible intracranial pathologies or history of head trauma were excluded. To identify articles eligible for inclusion in our meta-analysis, an extensive search was conducted through PubMed, Embase, ScienceDirect, Web of Science, and CNKI. Data extracted included investigative method, prevalence of the PSS among subjects, ethnicity, gender, side, laterality, and mean diameter. The extracted data were pooled into a meta-analysis with a random-effects model. RESULTS The radiologic study showed that the PSS was visualized in 25.5% of the sides examined, that it was slightly more common among females (27.5%) than males (23.8%) and on the left (21.7%) than the right (29.4%). Its mean diameter was 1.14 ± 0.58 mm. The meta-analysis revealed that the overall prevalence of the PSS in the population is 11.1%, that it is more common in females (27.4%) than males (17.6%), and that a unilateral PSS is more common (78.2%) than a bilateral one (21.8%). CONCLUSIONS As a PSS is present in about one tenth of the population, it is important to consider the possibility that it is present when undertaking neurosurgical procedures and to assess preoperative CT scans to avoid complications.

Congenital absence of the palmaris longus muscle: A meta-analysis comparing cadaveric and functional studies

The aim of our paper was to provide comprehensive data on the prevalence of absence of palmaris longus muscle (PLM) and its anatomical characteristics and conduct two separate meta-analyses comparing cadaveric and functional studies while identifying variation among different ethnic groups. An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included prevalence of absence of PLM among subjects, ethnicity, laterality, side, and gender. Our main findings revealed that the absence of PLM is more frequently reported in functional studies. Moreover, functional tests likely overestimated the absence of PLM and recommend future studies to assess the validity of functional tests and use an imaging assessment prior to excluding the use of a palmaris longus tendon graft in patients in whom a function test identified the absence of PLM.

The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery

PURPOSE Corona mortis is a highly variable vascular connection between the obturator and external iliac or inferior epigastric arteries or veins located behind the superior pubic ramus in the retropubic space (space of Retzius). Due to the significant variation in this collateral circulation, detailed anatomical knowledge of the corona mortis is vital to enhance the prevention of possible iatrogenic errors in hernia repair and other pubic surgical procedures. The aim of our meta-analysis was to provide comprehensive data on the prevalence, anatomical characteristics, and ethnic variations of the corona mortis vessel. METHODS An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included investigative method, prevalence of the corona mortis vessels among hemi-pelvises (overall, arterial only, venous only, and combined), distance from the corona mortis to pubic symphysis, and assessment of gender, side, laterality, and ethnicity subgroups. RESULTS A total of 21 studies (n=2184 hemi-pelvises) were included in the meta-analysis. The overall prevalence of the corona mortis in hemi-pelvises is high (49.3%). A venous corona mortis is more prevalent than an arterial corona mortis (41.7% vs. 17.0%). The corona mortis is more common in Asia (59.3%) than in Europe (42.8%) and North America (44.3%). CONCLUSIONS As a corona mortis is present in an about half of all hemi-pelvises, it is important to consider the possibilities of its presence when undertaking surgical procedures and plan accordingly to avoid injuries. All surgeons operating in the retropubic region should have a thorough understanding of the anatomical characteristics and surgical implications of a corona mortis.

Large prospective validation and cultural adaptation of the Polish version of the Swiss Spinal Stenosis Questionnaire for patients with lumbar spinal stenosis

OBJECTIVE The aim of this prospective cohort study was to translate, validate and perform a cultural adaptation of the Polish version of the Swiss Spinal Stenosis Questionnaire (P-SSSQ), a disease-specific questionnaire for assessing symptom severity, physical function and satisfaction with treatment in patients with lumbar spinal stenosis (LSS). MATERIAL AND METHODS Patients were prospectively recruited at two orthopedic centres in Krakow, Poland, between January 2011 - October 2016. During the interview, each patient completed the P-SSSQ, SF-36 Health Survey, and a demographic data questionnaire. After translation, cross-cultural adaptation, and pilot testing, assessment was made of the internal consistency, test-retest reliability, construct validity, and responsiveness of the P-SSSQ subscales. RESULTS Finally, 171 consecutive patients were included in the study. Cronbachs alpha and ICC values were above 0.8 for all three subscales of the P-SSSQ. The symptom severity domain was highly negatively correlated with physical functioning and bodily pain of SF-36, with Pearson correlation coefficients of -0.68 and -0.63, respectively. The physical function domain was highly negatively correlated with physical functioning (r = -0.62). The satisfaction subscale was also highly negatively correlated with the change in the symptom severity (r = -0.61) and physical function scale (r = -0.65). CONCLUSIONS The proposed version of the P-SSSQ showed excellent measurement properties and can be considered validated for use in Polish. It is easy to understand, quick to complete, and the psychometric properties of the original version are maintained.