The pancreas exhibits a uniquely intricate vascular architecture characterized by frequent and clinically significant morphological variations. These variations—impacting both arterial supply and venous drainage—are critical determinants in surgical planning, radiologic interpretation, and interventional outcomes. This comprehensive review examines the full spectrum of pancreatic vascular anatomy, with particular emphasis on embryological development, imaging manifestations, and surgical relevance. Key arterial structures, including the superior and inferior pancreaticoduodenal arteries (SPDAs and IPDAs) and the dorsal pancreatic artery (DPA)—are explored in detail alongside accessory branches. On the venous side, focus is placed on the gastrocolic trunk (GCT) of Henle, the uncinate and centro-inferior pancreatic veins, and the dorsal pancreatic vein (DPV). The review highlights that arterial aberrations, such as a DPA originating from the superior mesenteric artery (SMA), or duplicated patterns of the IPDA, as well as venous anomalies such as variant drainage of the GCT or the centro-inferior pancreatic vein, have substantial implications during pancreaticoduodenectomy, distal pancreatectomy, and transplantation procedures. With advances in multidetector computed tomography (MDCT), magnetic resonance angiography (MRA), and three-dimensional (3D) modeling, high-risk vascular variants can now be accurately mapped preoperatively, facilitating safer and more effective minimally invasive and robotic-assisted surgeries. In conclusion, the recognition and understanding of pancreatic vascular variations are imperative for optimal surgical and interventional management. This review underscores the importance of multidisciplinary collaboration among surgeons, radiologists, and anatomists, which will allow them to integrate detailed anatomical knowledge into clinical workflows, ultimately improving patient outcomes in pancreatic procedures.

Purpose: This evidence-based systematic review with meta-analysis aims to synthesize the inferior mesenteric artery (IMA) variants including their origin level, branching patterns, and morphometric characteristics. Materials and methods: The study adhered to the latest guidelines. Four online databases were used for the systematic review, and studies that reported the prevalence of IMA variants were considered eligible for inclusion. A statistical meta-analysis was conducted using R programming software with a random-effects model to calculate the pooled prevalence of the variants. Results: Twenty-three (23) studies were included in this analysis. The IMA typically originated at the 3rd lumbar vertebra (L3) level, occurring in 70.16% of cases. The most common branching pattern of the IMA was bifurcated, indicating a pooled prevalence of 63.89%. This predominant pattern involved the IMA bifurcating into the left colic artery (LCA) and a common trunk for both the superior rectal artery (SRA) and the sigmoid artery (SA), with a pooled prevalence of 46.09%. The IMA trifurcation and tetrafurcation had pooled prevalences of 27.35% and 11.62%, respectively. The diameter of the IMA had a pooled mean of 41.41 mm, and the distance from the IMA’s origin to the LCA had a pooled mean of 40.67 mm. Conclusions: This review of existing literature delineates the IMA levels of origin, branching patterns, and morphometric characteristics. A comprehensive understanding of the surgical anatomy of this vessel is imperative during colorectal cancer procedures. Consequently, surgeons operating in this anatomical region must possess an in-depth knowledge of typical and variant anatomical structures.

Background: The arcuate foramen (AF), an osseous foramen, is probably formatted from the ossification of the posterior atlanto-occipital membrane. When this morphologically ossified variant exists, it encloses the vertebral artery (VA) third segment (V3). This close relationship may cause compression to the VA with concomitant vertebrobasilar insufficiency, vertigo, headaches, or neck pain. In the published literature, no studies investigate the abovementioned potential compression pattern. The present study examines the AF ossification pattern (complete or partial type) and the variable VA diameter at the atlantal part (V3), concluding a potential risk for VA compression after correlating the relative diameters (AF and VA diameters). Materials and Methods: One hundred and fifty dried first cervical vertebrae (atlases) and one hundred fifty computed tomography (CT) scans were obtained for the present study. The presence of a complete or incomplete AF was evaluated, and when present, its diameter was measured. To correlate these findings with the vessel, 50 computed tomography angiographies (without AF presence) were obtained to measure the V3 segment diameter. Results: Out of the total 600 (N = 600) sides, 111 sides had incomplete AF (18.2%), and 67 sides had complete AF (11.1%). The AF mean diameter was 6.41 (1.12) mm. The diameter of the V3 segment ranged between 5.0 and 6.0 mm; therefore, three morphological stenosis patterns were identified. A low risk of compression (over 6.0 mm) was identified in 61.2% (N = 109 sides), a moderate risk (between 5.0–6.0 mm) was observed in 29.2% (N = 52 sides), and a high risk (under 5.0 mm) was recorded in 9.6% (N = 17 sides). There was no statistically significant correlation regarding sexes and age for the potential compression patterns. Conclusions: The present study revealed the morphological stenosis pattern of the AF to the V3 segment. The variation had a high risk of compression to the vessel in 9.6% of sides, indicating that it is not infrequent. Knowledge of these details is essential for clinicians when investigating vertebrobasilar insufficiency.

The vascular anatomy of the stomach is both complex and highly variable, with direct implications for oncologic, bariatric, esophageal, and interventional procedures. This comprehensive review combines anatomical, radiological, and surgical evidence on arterial and venous variations in the stomach. The left gastric artery, traditionally the first branch of the coeliac trunk, often shows variants such as a direct aortic origin or association with an abnormal left hepatic artery. The right gastric artery most frequently arises from the proper hepatic artery, but its origin can vary significantly. The gastroepiploic arteries exhibit diversity in their origin, size, and connection patterns, with occasional duplication or absence. Additional vessels, including the posterior gastric artery and the short gastric arteries, also contribute to variations in arterial supply. Venous drainage largely follows the arterial pattern. The left and right gastric veins and the gastroepiploic venous arcade are major routes, while variants of the left gastric vein and the gastrocolic trunk (Henle’s trunk) contribute to complexity through different convergence patterns. These vascular variations have significant clinical implications, as they impact the safety of D2 lymphadenectomy, the risk of ischemic complications during laparoscopic sleeve gastrectomy, the success of gastric conduit formation in esophagectomy, and the effectiveness of transarterial embolization for upper gastrointestinal bleeding. Preoperative vascular mapping with multidetector computed tomography angiography and 3D reconstruction reliably defines individual anatomy, allowing for customized surgical planning and reducing operative risks. Recognizing both common and rare gastric vascular variants is essential for safe and effective surgical and endovascular management of gastric disease.

Background/Objectives: Variations in the course of the maxillary artery (MA) relative to the lateral pterygoid muscle (LPM) pose critical challenges in surgical, anesthetic, and interventional procedures involving the infratemporal fossa (ITF). These variations can increase the risk of hemorrhage, nerve injury, or incomplete anesthesia. The present study aimed to elucidate the topographic relationship between the MA and LPM by combining high-resolution radiological imaging with a comprehensive analysis of anatomical literature. Materials and Methods: A retrospective review of 250 brain computed tomography angiographies (CTAs), totaling 500 sides, was conducted to classify the MA course as lateral (superficial), medial (deep), or intramuscular. Additionally, a systematic review and meta-analysis of 32 eligible studies—including 5938 arteries—was performed following PRISMA 2020 and Evidence-Based Anatomy (EBA) guidelines. Study quality and risk of bias were assessed using the Anatomical Quality Assurance (AQUA) tool. Results: In the imaging cohort, the MA coursed lateral to the LPM in 64.2% of sides, medial in 29.6%, and through the muscle fibers in 6.2%. A rare temporalis-traversing variant was identified in 3.0% of cases. Bilateral symmetry was observed in 77.6% of patients. Meta-analytic findings indicated a pooled prevalence of 79.6% for the lateral course, 19.9% for the medial course, and 0.01% for the intramuscular course. Cadaveric studies and Asian populations showed a higher incidence of lateral variants, while imaging-based studies more frequently detected medial and transmuscular paths. Conclusions: While the MA most often follows a lateral course relative to the LPM, clinically significant variation—including medial, intramuscular, and temporalis-traversing routes—exists. These variants complicate access during maxillofacial surgery, TMJ procedures, and regional anesthesia. Findings emphasize the importance of individualized preoperative vascular mapping to improve procedural safety and outcomes in the ITF.

The treatment of central nervous system (CNS) autoimmune diseases has evolved from broad immunosuppression toward targeted disease-modifying therapies (DMTs). While current DMTs effectively control inflammatory activity in many patients, unmet needs remain, including persistent compartmentalised CNS pathology, limited tissue penetration, and the cumulative burden of chronic therapy. Chimeric antigen receptor (CAR) T-cell therapy represents a novel “living” immunotherapy capable of antigen-specific cellular depletion. Although currently approved only for B-cell malignancies, CAR T-cells are increasingly being explored in CNS autoimmunity leveraging their capacity for autonomous cytotoxicity and expected access to immune cells within protected CNS niches following a potentially single intervention. In this review, we examine CAR T-cells in the context of CNS-autoimmunity, we outline principles derived from oncologic applications, assess current DMTs, their limitations and side effects, and define parameters where CAR T-cells may offer added value. We discuss biological and practical requirements for broader clinical application, as currently they are investigated only for the very severe and refractory cases where all alternative treatments have failed. We further review the plasticity of CAR constructs, distinguishing clinically advanced platforms from early proof-of-concept approaches. Finally, we summarise clinical experience from 15 patients with CNS autoimmunity treated with CAR T-cells and review ongoing or planned trials that include such patients. We conclude that CAR T-cell therapy remains investigational for severe, treatment-refractory disease, with future applicability dependent on demonstrable efficacy, safety, cost, and feasibility beyond existing DMTs.