Who really needs a Metaverse in anatomy education? A review with preliminary survey results.

The term Metaverse ("meta" defined as beyond, transcendence or virtuality, and "verse" meaning universe or world) denotes a "virtual reality space" for anatomy teaching. To ascertain how many anatomists are familiar or are using this adjunct in teaching, we conducted a short survey at the 2022 annual meeting of the American Association of Clinical Anatomists (AACA). Interestingly, only six respondents (9.4%) had used a Metaverse for teaching anatomy. Moreover, the vast majority of attendees were anatomy educators or basic science faculty, but not practicing physicians/surgeons or other actively practicing health care professionals; a group where this technology has been used much more commonly. The present manuscript was authored by anatomy educators, practicing physicians and other actively practicing health care professionals with backgrounds in diverse medical fields, that is, anatomists, medical doctors, physician assistants, dentists, occupational therapists, physical therapists, chiropractors, veterinarians, and medical students. Many of these authors have used or have been exposed to a Metaverse in the clinical realm. Therefore, the aim of the paper is to better understand those who are knowledgeable of a Metaverse and its use in anatomy education, and to provide ways forward for using such technology in this discipline.

A comprehensive study of the abdominal ganglia part 2: Aorticorenal ganglia.

Investigation into reports of pain treatment for abdominal cancer and abdominal pain syndromes revealed the lack of human studies on some of the abdominal sympathetic ganglia. Recent studies on renal artery denervation therapy as treatment for resistant hypertension has made the aorticorenal ganglia of particular importance. The aim of this study was to investigate the location, morphology, interconnections, and histological nature of aorticorenal ganglia. We dissected nine abdominal cavities and harvested 37 aorticorenal ganglia. Hematoxylin and Eosin, and Masson's staining techniques were used to study the histological structure. Additionally, ganglia harvested from five individuals were stained with immunohistochemical techniques to test for tyrosine hydroxylase activity. All aorticorenal ganglia were located in proximity to the renal artery, and the majority were close to the vessel origin. Identification of multiple aorticorenal ganglia was the norm, and ranged from 2 to 4 on the left and 1 to 3 on the right. While the pattern of aorticorenal ganglia seemed to be unique in each individual case, the interconnections between these and other ganglia were vast. The aorticorenal ganglia shared direct connections with the celiac, gonadal, inferior mesenteric, and first lumbar sympathetic trunk ganglion. Contributions from the greater, lesser, and least thoracic splanchnic nerves were also observed. While the results of our study may not have direct clinical implications in isolation, the vast number of interconnections with the other abdominal ganglia may cause complications in procedures such as celiac ganglion block. In addition, aorticorenal innervation interruption may lead to hypotension.

The Critical Appraisal Tool for Anatomical Meta-analysis: A framework for critically appraising anatomical meta-analyses.

The hallmark of evidence-based medicine is the meta-analysis (MA). For much of its rich history, the field of anatomy has been dominated by descriptive, cadaveric studies. In the last two decades, quantitative measurements and statistical analyses have frequently accompanied such studies. These studies have directly led to the publication of anatomical MAs, which have ushered in the exciting field of evidence-based anatomy. Although critical appraisal tools exist for clinical MAs, none of them are specifically tailored for anatomical MAs. Therefore, the purpose of this article is to provide a framework by which clinical anatomists and others can critically appraise anatomical MAs using the Critical Appraisal Tool for Anatomical Meta-analysis (CATAM). Using a running example from a recently published MA, we show how to use the CATAM rubric in a step-by-step fashion. Each scored section of the CATAM rubric is summated into a total score (maximum 50 points). This score is then referenced to a conversion chart, which assigns a qualitative value to the MA in a range from "very good" to "poor." Future studies can investigate the interrater reliability of the instrument, and possibly subject the CATAM rubric to a Delphi panel. As anatomical MAs become more commonplace at surgical grand rounds and journal clubs in academic medical centers throughout the world, we hope that the CATAM rubric can help facilitate meaningful discussions about the quality and clinical relevance of anatomical MAs.

A comprehensive review of the great auricular nerve graft.

The great auricular nerve (GAN) is a superficial branch of the cervical plexus that innervates parts of the mandible, auricle, and earlobe. Over the past 30 years, the GAN has become the nerve graft donor of choice for many surgeons for reconstructing injured facial nerves. In this review, we discuss the anatomy and function of the GAN, while focusing on surgical landmarks and the characteristics that make it a suitable nerve graft donor. In addition, we present and summarize published case reports on use of the GAN for grafting. We hope that this review will provide surgeons with an up-to-date and concise reference.

An evidence-based approach to learning clinical anatomy: A guide for medical students, educators, and administrators.

The amount of information that medical students learn is voluminous and those who do not use evidence-based learning strategies may struggle. Research from cognitive and educational psychology provides a blueprint on how best to learn science subjects, including clinical anatomy. Students should aim for high-cognitive learning levels as defined in the SOLO taxonomy. Using a real-world example from a modern clinical anatomy textbook, we describe how to learn information using strategies that have been experimentally validated as effective. Students should avoid highlighting and rereading text because they do not result in robust learning as defined in the SOLO taxonomy. We recommend that students use (1) practice testing, (2) distributed practice, and (3) successive relearning. Practice testing refers to nonsummative assessments that contain questions used to facilitate retrieval (e.g., flashcards and practice questions). Practice questions can be fill-in, short-answer, and multiple-choice types, and students should receive explanatory feedback. Distributed practice, the technique of distributing learning of the same content within a single study session or across sessions, has been found to facilitate long-term retention. Finally, successive relearning combines both practice testing and distributed practice. For this strategy, students use practice questions to continue learning until they can answer all of the practice questions correctly. Students who continuously use practice testing, distributed practice, and successive relearning will become more efficient and effective learners. Our hope is that the real-world clinical anatomy example presented in this article makes it easier for students to implement these evidence-based strategies and ultimately improve their learning. Clin. Anat., 2018. © 2018 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

A comprehensive review of the anterior fontanelle: embryology, anatomy, and clinical considerations.

PURPOSE: Fontanelles are a regular feature of infant development in which two segments of bone remain separated, leaving an area of fibrous membrane or a "soft spot" that acts to accommodate growth of the brain without compression by the skull. Of the six fontanelles in the human skull, the anterior fontanelle, located between the frontal and parietal bones, serves as an important anatomical diagnostic tool in the assessment of impairments of the skull and brain and allows access to the brain and ventricles in the infant. METHODS: Using a standard database search, we conducted a review of the anterior fontanelle, including its embryology, anatomy, pathology, and related surgical implications. CONCLUSIONS: The diagnostic value of the anterior fontanelle, through observation of its shape, size, and palpability, makes the area of significant clinical value. It is important that clinicians are aware of the features and associated pathologies of this area in their everyday practice.

Five common clinical presentations in the elderly: An anatomical review.

Elderly patients face distinct health challenges and have an increased demand for specific medical procedures. As the aging population continues to increase, age-associated conditions such as congestive heart failure, hip fractures, spine degeneration, dementia, and airway compromise will increase in prevalence and procedures to correct these conditions will be increasingly performed. A clear understanding of the clinical anatomy of these diseases and procedures is imperative for anatomists and clinicians alike in order to best treat patients and continue to advance aging research and better teach future medical practitioners about the specific anatomy often involved in this group. The aging process mirrors in a variety of ways the common pathologies of the elderly, but it is key to draw the distinction between normal aging and pathology, particularly for congestive heart failure and dementia, in the clinical setting. This article aims to review the common presentations or procedures of the elderly and how the normal aging process is associated with the anatomy of these conditions or complications. Clin. Anat. 30:168-174, 2017. © 2017 Wiley Periodicals, Inc.

Hip fractures in the elderly-: A Clinical Anatomy Review.

As elderly populations rise worldwide, the amount of hip fractures have continued to increase and result in substantial medical burdens in many countries. This increase goes hand-in-hand with an increase in surgical procedures to correct hip fractures. The medical burden imparted by hip fractures and their corrective surgeries necessitate a clinically relevant understanding of the hip joint including the vascular, neural, and musculoskeletal structures directly associated with and neighboring the joint. It is critical to appreciate how the normal hip anatomy is disrupted by a fracture and how this disruption is heavily influenced by the fracture's location. The effects of advancing age on the integrity of the hip joint and the risk of hip fractures further complicate hip anatomy. Consequentially, normal hip anatomy, aging and the pathology introduced by fractures play major roles in how hip fractures are approached surgically. This article aims to review the clinically relevant anatomy of the healthy hip joint, age-related changes that influence the joint, hip fractures, and corrective surgeries for hip fractures. Clin. Anat. 30:89-97, 2017. © 2016 Wiley Periodicals, Inc.

Can blockage or sacrifice of the middle meningeal artery lead to hydrocephalus?

BACKGROUND: The middle meningeal artery (MMA) is often sacrificed during neurosurgical procedures in the region of the pterion. This maneuver, herein, is hypothesized to be a potential reason for the development of postoperative hydrocephalus by injuring the vascular supply to the arachnoid granulations near the vertex of the skull, and thus disrupting their ability to allow for transfer of CSF from the subarachnoid space to the venous system. MATERIALS AND METHODS: To test this theory, the middle meningeal artery was isolated at the skull base and injected with India ink. Next, the superior sagittal sinus was opened and the arachnoid granulations inspected. RESULTS: All specimens demonstrated ink within the arachnoid granulations indicating that their blood supply is completely or at least partially via the middle meningeal artery. This finding with an illustrative case of surgical cautery of the middle meningeal artery at the skull base with subsequent development of hydrocephalus supports our hypothesis of potential role of iatrogenic MMA injury causing hydrocephalus. CONCLUSIONS: Our cadaveric study shows that the blood supply of the arachnoid granulations of the superior sagittal sinus is via the middle meningeal artery. Additional cases of postoperative hydrocephalus following middle meningeal artery sacrifice are needed to support our hypothesis.

Woven coronary arteries: A detailed review.

A woven coronary artery is a rare congenital vascular variation that involves the separation of the artery into several thin channels, which later merge distally to form a single lumen. This mesh of intertwining small vessels may occur anywhere along the vessel and may be present in multiple coronaries. Although generally a benign incidental finding, there have been reported cases of associated ischemia, thrombus and atherosclerotic plaque formation and complications with cardiac intervention procedures. In this review, we have analyzed and compiled all the reported data pertaining to woven coronary arteries and highlighted its relevance to clinical practice.

Meningeal relationships to the spinal nerves and rootlets: a gross, histological, and radiological study with application to intradural extramedullary spinal tumors.

INTRODUCTION: Juxtapositional tumors of the spinal nerve roots have been noted to not only interact with the roots at various vertebral levels, but also differ among patients. Therefore, the aim of the current study was to elucidate the potential for variation among the relationships of the meningeal layers at different nerve levels. METHODS: In 20 unembalmed adult cadavers and five fetal specimens, the spinal nerve roots from the cervical, thoracic, and lumbar regions were harvested with their associated meningeal layers and subjected to microdissection, histological analysis, or radiological imaging using 9.4-T MRI. RESULTS: As the nerve rootlets passed from the cord, they received their root sheath covering from the pia. After crossing the subarachnoid space to reach the apertures in the dura, they received two additional looser sheaths, an outer from the dura and an inner from the arachnoid. The pia mater always ended proximal to the arachnoid, and the pia and arachnoid layers extended more distally along the roots with caudal descent. Although the dorsal and ventral roots generally exited through separate dural openings, a single dural opening was also observed, often in the lower spinal regions. Thin intradural septations almost always separated the dorsal and ventral rootlets. The left and right sides frequently differed within individuals. CONCLUSIONS: On the basis of our study, variations of the meninges surrounding the spinal nerve roots are common, but themes do exist. Such data support surgical observations of the different interactions between tumors in these regions with surrounding neural tissues.

The fibular collateral ligament of the knee: a detailed review.

The fibular collateral ligament (FCL) is one of the larger ligaments of the knee. The FCL, along with the popliteus tendon, arcuate popliteal ligament, and joint capsule, make up the posterolateral corner of the knee. Recently, there has there been an increased awareness and research on the structures of the posterolateral corner of the knee, particularly the FCL. Studying the detailed structure of the FCL may provide a better understanding that can lead to better diagnosis and treatments following injury. Therefore, this article reviews the FCL, which appears to be the primary restraint to varus rotation but is poorly oriented to resist external rotation of the knee.

Symmetric corticospinal excitability and representation of vastus lateralis muscle in right-handed healthy subjects.

The purpose of this study was to determine the size and location of the representations of the anterior thigh muscles on the human motor cortex in the dominant and non-dominant hemispheres. Motor-evoked potentials (MEPs) induced by transcranial magnetic stimulation were recorded from the right and left vastus lateralis (rVL, lVL) muscles. A total of ten right-handed healthy volunteers participated in the study. In a single session experiment, we investigated VL muscle corticospinal excitability (motor threshold, MEP size, short interval intracortical inhibition, intracortical facilitation) and cortical representation (map area, volume, and location) in the dominant and non-dominant hemispheres. The motor threshold, MEPs, and intracortical excitability did not differ significantly between the hemispheres (P > 0.05). Furthermore, no difference between sides was found in the location of VL motor representation (mediolateral and anteroposterior axis) or in map area and volume (P > 0.05). Vastus lateralis muscle corticospinal excitability and cortical map were symmetrical in right-handed subjects. Future studies on patients with unilateral lower extremity injuries could examine side-to-side plastic reorganization in corticomotor output and map location in both hemispheres.

Morphometry of the fibular collateral ligament: anatomic study with comprehensive review of the literature.

There is no consensus in the literature related to the morphology, bony attachments, and variations of the fibular collateral ligament (FCL) of the knee. Our purpose was to investigate FCL morphology and to review reports in the literature regarding this structure. Seventy knees from formalin-fixed, adult cadavers were dissected and a digital caliper was used to measure FCL length, width, distance from proximal attachment to articular surface (PA→AS), and distance from distal attachment to articular surface (DA→AS). The mean (SE) length and width of all FCLs was 48.3 (1.1) mm and 4 (0.16) mm, respectively. The mean (SE) PA→AS and DA→AS of all FCLs was 22 (0.8) mm and 24.8 (1) mm, respectively. We found a direct relationship between the PA→AS and DA→AS distances (Spearman rho = 0.527, P = 0.002) and this association was independent of age and sex. Two FCL variations were found: a bifurcate ligament with two distal bands and a trifurcate ligament with three distal bands, all of which attached to the fibular head. Our literature review revealed that only 2/10 cadaveric FCL morphology studies reported variations similar to the current study. Further, there was variability in the reported location of the FCL proximal attachment. When combining our data with these studies, 105/219 FCLs directly attached to the apex of the lateral epicondyle (LE), 10/219 to a fovea posterior to the LE, and 104/219 posterior and proximal to the LE. These data may have implications related to FCL injury and repair.