Dominik Taterra

The Variable Emergence of the Infrapatellar Branch of the Saphenous Nerve

Abstract The infrapatellar branch of the saphenous nerve (IPBSN) is a cutaneous nerve of the lower limb, which arises distal to the adductor canal. High variability in the emergence, course, branching, termination, and morphometrics of the IPBSN poses an increased risk of injury to the nerve during surgical interventions on the anteromedial aspect of the knee. The aim of this study was to describe the anatomical characteristics of the IPBSN. This study utilized cadaveric (n = 100) and ultrasonography (n = 30) assessments, and meta‐analysis. In the cadaveric study, the presence of IPBSN and its emergence mode in relation to the sartorius muscle (SaM) was determined (type A‐anterior; type B‐posterior; type C‐penetrating the SaM). Ultrasonography examinations were conducted on healthy volunteers to determine the presence and mode of the emergence of the nerve. Finally, from electronic databases searching, all studies reporting the IPBSN emergence data were pooled into a meta‐analysis. The mean distance between the medial border of the patellar ligament (MBPL) and the IPBSN at the level of the patellar apex (PA) was also analyzed in the cadaveric, ultrasonography, and meta‐analysis portions of the study. Six studies (n = 336 limbs), including the present cadaveric study, were pooled into the meta‐analysis of emergence. The most prevalent IPBSN emergence mode was type C (42.9%) followed by type B (41.9%) and type A (15.4%). In the ultrasonography assessment, type A was found to be the most common (82.8%). The mean distance between the MBPL and the IPBSN at the level of the PA was 4.89 ± 0.22 cm, and 5.57 ± 0.91 cm, for the cadaveric and meta‐analysis studies combined, and the ultrasonography assessment, respectively. This multimodality study shows that the most common type of IPBSN emergence is type C. The horizontal distance between the MBPL and the IPBSN at the level of the PA is usually between 4.5 and 5.6 cm. Understanding the anatomy of IPBSN emergence is crucial for orthopedic surgeons to minimize the risks of iatrogenic nerve injury during surgical procedures in the region.

Lateral and posterolateral foraminal variations of the atlas: A meta-analysis

The lateral (LF) and posterolateral (PLF) foramina are anatomical variants of the atlas. Both variants have been implicated in multiple neurological conditions including vertebrobasilar insufficiency, with symptoms such as dizziness, syncope, auditory and visual disturbances and paresis. The aim of this study was to conduct a systematic meta-analysis on the prevalence and anatomical characteristics of the LF and PLF. An extensive search of the major electronic databases was conducted to identify all studies that reported relevant data on the LF and PLF. No date or language restrictions were applied. Data on the prevalence, type (complete and incomplete), side, gender, and laterality of the LF and PLF, when available, were extracted and pooled into a meta-analysis. A total of 33 studies (n=10,190 subjects) were included in the quantitative analysis. The overall pooled prevalences of complete LF and PLF were 2.6% (95%CI: 2.1-3.1) and 1.2% (95%CI:0.6-2.0), respectively, while the overall pooled prevalence of the incomplete LF was 2.7% (95%CI:1.3-4.4) and the incomplete PLF was 0.7% (95%CI:0.0-1.8). When there was a complete PLF, a contralateral PLF (complete or incomplete) was found in 32.8% of cases. The geographical distribution of both variants was variable. The findings of this study provide an evidence-based foundation of anatomical knowledge of the two variants of the atlas. We recommend that physicians consider the possible role of the LF and PLF during the diagnosis of various neurological disturbances, especially in situations when all other possible explanations for the symptoms have been excluded.

The prevalence and morphometry of an accessory spleen: A meta-analysis and systematic review of 22,487 patients

BACKGROUNDnAn accessory spleen (AS) is a lobule of splenic tissue found in ectopic locations. Identification of AS is particularly important in patients with immune thrombocytopenia (ITP) requiring splenectomy as unrecognized AS can later cause refractory symptoms. The AS can also be a source of significant intraabdominal hemorrhage. The aim of this meta-analysis was to systematically analyze the data on the prevalence, number, location, and morphometry of AS.nnnMATERIALS AND METHODSnAn extensive search of the major electronic databases was conducted to identify all studies that reported relevant data on the AS. No date or language restrictions were applied. Data on the study type, the prevalence of AS, location, morphometry and number of AS per patient were extracted from the eligible studies and pooled into a meta-analysis.nnnRESULTSnA total of 81 studies (nxa0=xa022,487 subjects) were included into the quantitative analysis. The overall pooled prevalence of AS was 14.5% (95%CI: 12.4-16.7), while the pooled prevalence of AS in ITP patients was 16.7% (95%CI: 12.1-21.7). The majority of accessory spleens were located in the splenic hilum (62.1% [95%CI:51.5-76.3]). Moreover, 26% of ITP patients with an AS have more than one.nnnCONCLUSIONSnThe findings of this study provide an evidence-based foundation of anatomical knowledge about the AS. Surgeons should take particular caution in identifying an AS, as unnoticed AS during splenectomy can lead to recurrence of hematological diseases or can be a potential source of bleeding in the future.

Prevalence and anatomy of the axillary arch and its implications in surgical practice: A meta-analysis

PURPOSEnThe following research aimed to investigate the prevalence and anatomical features of the axillary arch (AA) - a muscular, tendinous or musculotendinous slip arising from the latissimus dorsi and that terminates in various structures around the shoulder girdle. The AA may complicate axillary lymph node biopsy or breast reconstruction surgery and may cause thoracic outlet syndrome.nnnMETHODSnMajor electronic databases were thoroughly searched for studies on the AA and its variations. Data regarding the prevalence, morphology, laterality, origin, insertion and innervation of the AA was extracted and included in this meta-analysis. The AQUA tool was used in order to assess potential risk of bias within the included studies.nnnRESULTSnThe AA was reported in 29 studies (10,222 axillas), and its pooled prevalence estimate in this meta-analysis was found to be 5.3% of the axillas: unilaterally (61.6%) and bilaterally (38.4%). It was predominantly muscular (55.1% of the patients with the AA), originated from the latissimus dorsi muscle or tendon (87.3% of the patients with the AA), inserted into the pectoralis major muscle or fascia (35.2% of the patients with the AA), and was most commonly innervated by the thoracodorsal nerve (39.9% of the patients with the AA).nnnCONCLUSIONnThe AA is a relatively common variant, hence it should not be neglected. Oncologists and surgeons should consider this variant while diagnosing an unknown palpable mass in the axilla, as the arch might mimic a neoplasm or enlarged lymph nodes.

Incidence, Risk Factors, and Comorbidities of Vocal Cord Paralysis After Surgical Closure of a Patent Ductus Arteriosus: A Meta-analysis

Surgical closure of a patent ductus arteriosus (PDA) is considered standard treatment for symptomatic neonates refractory to medical therapy. Sometimes, iatrogenic injury to the left recurrent laryngeal nerve during the procedure can result in vocal cord paralysis (VCP). This study aimed to estimate the incidence of VCP in patients after surgical PDA closure and to identify any associated risk factors and morbidities associated with VCP in the preterm infant population. A thorough search of the major electronic databases was conducted to identify studies eligible for inclusion into this meta-analysis. Studies reporting data on the incidence of VCP (primary outcomes) or risk factors and morbidities associated with VCP in premature infant population (secondary outcomes) were included. A total of 33 studies (nu2009=u20094887 patients) were included into the analysis. Overall pooled incidence estimate of VCP was 7.9% (95%CI 5.3–10.9). The incidence of VCP after PDA closure was significantly much higher in premature infants (11.2% [95%CI 7.0–16.3]) than in non-premature patients (3.0% [95%CI 1.5–4.9]). The data showed that VCP was most common after surgical ligation and in studies conducting universal laryngoscopy scoping. The risk factors for postoperative VCP in preterm infants included birth weight and gestational age. In addition, VCP was significantly associated with the occurrence of bronchopulmonary dysplasia, gastrostomy tube insertion, and increased duration of mechanical ventilation. Vocal cord paralysis remains a frequent complication of surgical closure of a PDA, especially in premature neonates, and is associated with significant post-procedural complications.

Presence of a foramen arcuale as a possible cause for headaches and migraine: Systematic review and meta-analysis

The foramen arcuale (FA) is an osseous bridge that can be formed on the posterior arch of the atlas, often observed on lateral radiographs of the cervical spine. Currently, there is a lack of studies that systematically review the available literature on the FA and its role in headaches and migraines. Therefore, we conducted an extensive search of the major electronic databases to identify all studies that reported relevant data on patients with versus without FA and prevalence of headaches or migraines. No date or language restrictions were applied. Data on the prevalence, type (complete and incomplete), and laterality of the FA and relationship with headaches or migraines were extracted and pooled into a meta-analysis. There were 168/412 (40.8%) patients with headaches in the FA group compared to 368/1691 (21.8%) patients with headaches in the no FA group (OR 4.68; Pu202f=u202f0.002). The proportion of headaches for complete FA was 73/125 (58.4%) compared with 80/413 (19.4%) for incomplete FA (OR 5.04; Pu202f=u202f0.04). When comparing incomplete FA to no FA, the proportion of headaches was 36/85 (42.3%) vs 65/560 (11.6%), and this was significantly different (OR 6.13; Pu202f=u202f0.009). The proportion of headaches in patients with bilateral FA was 67/132 (50.8%) compared to 80/140 (57.1%) in the unilateral group (OR 1.36; Pu202f=u202f0.72). We performed the first meta-analysis to demonstrate the significant association between FA and headaches, and provided further support for the notion of the clinical relevance of this anatomical variant.

FokI as a genetic factor of intervertebral disc degeneration: A PRISMA-compliant systematic review of overlapping meta-analyses

The association of FokI (rs2228570), a polymorphism of the vitamin D receptor gene, with intervertebral disc degeneration (IDD) has been investigated in a multitude of studies. However, conflicting results of these studies led to emergence of several meta-analyses over the past few years. Despite the increased statistical power, these meta-analyses have failed to provide uniform and conclusive data on the relationship of FokI with IDD. The aim of this study was to present a comprehensive review based on the most up-to-date meta-analyses on the association of FokI with IDD. A comprehensive search of all major databases was conducted to identify meta-analyses investigating relation between FokI and IDD. No date or language restrictions were applied. The Jadad decision algorithm was utilized to evaluate included meta-analyses and identify the one providing the best evidence. A total of 7 meta-analyses (nu202f=u202f2580 original patients), that included six to ten case control studies, analyzed the association of FokI polymorphism with IDD. The meta-analysis of the highest quality supported the notion that overall there is no statistically significant association between FokI polymorphism and IDD. However, the authors showed that Caucasians have a reduced risk of IDD and Hispanics have an increased risk of IDD in the dominant and dominant/homozygous/heterozygous models of FokI polymorphism. While currently there is no evidence of an association between FokI polymorphism and IDD in the general population, ethnic predisposition has been shown.

Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations

BACKGROUNDnCervical ribs (CR) are supernumerary ribs that arise from the seventh cervical vertebra. In the presence of CR, the boundaries of the interscalene triangle can be further constricted and result in neurovascular compression and thoracic outlet syndrome (TOS). The aim of our study was to provide a comprehensive evidence-based assessment of CR prevalence and their association with TOS as well as surgical approach to excision of CR and surgical patients characteristics.nnnMETHODSnA thorough search of major electronic databases was conducted to identify any relevant studies. Data on the prevalence, laterality, and side of CR were extracted from the eligible studies for both healthy individuals and patients with TOS. Data on the type of TOS and surgical approach to excision of CR were extracted as well.nnnRESULTSnA total of 141 studies (nxa0= 77,924 participants) were included into the meta-analysis. CR was significantly more prevalent in patients with TOS than in healthy individuals, with pooled prevalence estimates of 29.5% and 1.1%, respectively. More than half of the patients had unilateral CR in both the healthy and the TOS group. The analysis showed that 51.3% of the symptomatic patients with CR had vascular TOS, and 48.7% had neurogenic TOS. Most CR were surgically excised in women using a supraclavicular approach.nnnCONCLUSIONSnCR ribs are frequent findings in patients with TOS. We recommended counseling asymptomatic patients with incidentally discovered CR on the symptoms of TOS, so that if symptoms develop, the patients can undergo prompt and appropriate workup and treatment.

The pterygoalar bar: A meta-analysis of its prevalence, morphology and morphometry.

PURPOSEnThe pterygoalar (PA) bar is a bony bridge resulting from the partial or complete ossification of a PA ligament. The aim of this meta-analysis was to systematically analyze and provide the most comprehensive data on the prevalence, morphology and topographical anatomy of the PA bar.nnnMATERIALS AND METHODSnA comprehensive search of the major electronic databases (PubMed, Embase, ScienceDirect, SciELO, BIOSIS, and Web of Science) was conducted in order to identify relevant studies. Studies reporting the prevalence, side of occurrence, gender dimorphism and morphometry of the PA bar were included in the current study.nnnRESULTSnA total of 25 articles (nxa0=xa016,168 subjects) were included in the meta-analysis. The overall pooled prevalence of the complete PA bar was 4.4% (95% CI: 3.0-6.0) and of the incomplete was 8.4% (95% CI: 4.6-13.3). The PA bar was most often observed unilaterally, on the left side. Analysis of geographical subgroups revealed considerable differences, with the lowest prevalence rates in Europe for both incomplete and complete PA bars.nnnCONCLUSIONSnConsidering the prevalence and anatomical characteristics of the PA bar, caution is recommended while planning or performing transfacial needle approach to the foramen ovale and when considering a differential diagnosis for nerve compression or entrapment syndromes.