Background: Retroperitoneal surgical corridors, particularly in robotic-assisted partial nephrectomy and donor surgery, require precise knowledge of hilar vascular orientation. The typically described Vein–Artery–Pelvis (VAP) anatomy is often assumed, yet its reliability is poorly quantified. Therefore, the purpose of the present study is to provide a comprehensive radioanatomical map of hilar architecture to enhance surgical safety and predictability. Methods: Contrast-enhanced computed tomography (CT) scans of the abdomen from 200 patients (104 males and 96 females) were evaluated. The anterior-to-posterior sequence of hilar structures, the frequency of early vascular branching, and the presence of accessory vessels were documented and stratified by sex and laterality. Results: The conventional VAP sequence was observed in a minority of cases, occurring in only 32.6% (131 sides). The map identified 37 distinct sequence variants. The most common variants included VAPA (9.0%), AVAP (7.8%), and VAAP (7.0%). Adherence to typical VAP anatomy was significantly lower in males (27.9%) than in females (37.7%). Arterial complexity, characterized by early branching or accessory vessels, was present in 43.2% of sides, with a significantly higher occurrence in males and on the right side. Venous mapping revealed a marked lateral disparity; accessory veins were predominantly right-sided (12.5%), whereas early venous branching was predominantly a left-sided feature (30.0%). Conclusions: Renal hilar architecture demonstrates substantial variability, with the classical VAP configuration representing a minority arrangement. These findings highlight the importance of individualized preoperative imaging assessment and may help anticipate anatomical complexity in retroperitoneal surgery.

Background: Sex estimation represents a pivotal element of forensic anthropological investigation, conventionally dependent on highly dimorphic skeletal components such as the pelvis and skull. The purpose of the current study was to systematically evaluate the diagnostic accuracy of sternal measurements for sex estimation and to identify methodological- or population-based moderators that influence classification performance. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. R programming software was used to perform statistical meta-analysis. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios (LR±), and overall accuracy were calculated using random-effects meta-analysis. Subgroup analyses and meta-regression were performed based on population origin, study design, statistical approach, and measurement protocol. Results: Forty-one studies comprising 293 predictive models were included. The overall pooled sensitivity and specificity were 80.9% (95% CI: 79.7–82.1) and 74.0% (95% CI: 72.4–75.5), respectively, with a mean accuracy of 77.3%. Subgroup analysis revealed that studies involving African populations and imaging-based methods achieved the highest accuracy. Machine learning- and ROC-based methods outperformed traditional discriminant analysis. Combined sternal measurements (manubrium and body) yielded the most robust diagnostic performance (accuracy: 87.3%). Significant heterogeneity (I² > 85%) was observed. Conclusions: Sternal morphometry exhibits a moderate to high degree of diagnostic accuracy in sex estimation and possesses significant forensic importance, especially in situations where more sexually dimorphic features are inaccessible. Nonetheless, variations across populations, the absence of standardized protocols, and methodological heterogeneity constrain its universal applicability.

The infratemporal fossa houses critical neurovascular structures and is frequently accessed in skull base and craniofacial surgery. Ossification of the pterygospinous (PSL) and pterygoalar (PAL) ligaments-forming the pterygospinous (PSB) and pterygoalar (PAB) bars represents a clinically crucial ossified (morphological) variant that may alter surgical access and predispose to nerve entrapment. A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and Evidence-Based Anatomy guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched for studies reporting the prevalence and morphometry of ossified PSL and PAL. Data were synthesized using random-effects models in R software. Sixty-nine studies comprising 54,542 skull sides met the inclusion criteria. The pooled prevalence of PSB was 8.36%, with incomplete ossification (6.89%) more frequent than complete ossification (2.04%). The overall PAB prevalence was 7.85%, also dominated by incomplete forms (5.30%). The combined presence of PSB and PAB was identified in 1.32% of cases. The ossification of the PSL and PAL represents a relatively common morphological variation with significant implications for skull base and trigeminal interventions. These ossified structures may impede cannulation of the foramen ovale, alter local anatomical relationships, and contribute to trigeminal or lingual nerve entrapment, which could lead to unsuccessful or complicated procedures. Routine preoperative imaging using computed tomography or cone beam computed tomography should be considered when approaching the foramen ovale to identify these variants. Additional anatomical and clinical research is warranted to optimize surgical strategies and enhance patient safety in cases involving PSB and PAB.

Persistent left superior vena cava (PLSVC) is the most frequently reported anatomical variant of the thoracic systemic venous system. While its association with congenital heart disease (CHD) is well recognized, its prevalence within CHD populations and its relative occurrence compared with non-CHD cohorts remain incompletely characterized. This study aimed to estimate the pooled prevalence of PLSVC among patients with CHD and to assess its relative frequency compared with that in control populations. A systematic review of PubMed, Scopus, and Web of Science was conducted from database inception to January 2026. Studies reporting the prevalence of PLSVC in CHD cohorts were included. A random-effects meta-analysis was performed, and risk ratios (RRs) were calculated for studies that included both CHD and non-CHD groups. Sixteen studies (n = 37,370) were included. The pooled prevalence of PLSVC in CHD patients was 6.36% (95% CI: 4.70–8.24). Significant heterogeneity was identified (I² = 97.6%). An increased likelihood of PLSVC was observed in CHD populations (RR = 15.34; 95% CI: 5.72–41.14). However, this relative risk is based on a highly limited number of comparative studies (n = 4) and exhibits substantial heterogeneity (I² = 92.47%); thus, it must be interpreted with significant caution. Subgroup analyses did not demonstrate statistically significant differences based on nationality (p = 0.59), study type (p = 0.32) and age group (p = 0.95), while imaging modality was statistically significant (p = 0.01). PLSVC is observed in a notable proportion of patients with CHD, although variability in reported prevalence is substantial and likely influenced by methodological differences across studies. Given its potential implications for catheter-based and surgical procedures, systematic evaluation of thoracic venous anatomy should be considered during the diagnostic and preoperative assessment of patients with CHD.

George Triantafyllou, Daniel Gondorf, Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Vasileios Papadopoulos, Nikolaos Lazaridis, Kostis Gyftopoulos, Maria Piagkou. Anat Cell Biol -0001;0:. https://doi.org/10.5115/acb.26.181

We describe a rare case of LRV pseudo-fenestration in a 68-year-old female identified on contrast-enhanced multidetector computed tomography. Unlike true fenestration, in which a single vessel splits and reunites, this pseudo-fenestration resulted from the convergence of two distinct hilar venous trunks. Multiplanar and three-dimensional reconstructions demonstrated that the left suprarenal vein drained into the superior limb, whereas the left gonadal vein drained into the inferior limb, reflecting a consistent and anatomically meaningful tributary pattern. This configuration is most plausibly explained by incomplete or asymmetric embryological fusion of the cardinal venous system. Accurate preoperative recognition of this variant is clinically important to reduce the risk of iatrogenic injury during laparoscopic donor nephrectomy, adrenal venous sampling, and other retroperitoneal or endovascular procedures.