Antoaneta Fasova

Background/Objectives: Quantitative MRI data describing the infraclavicular brachial plexus cords together with both axillary vessels remain limited. This study characterized artery-centered cord topography and neurovascular morphometry on 0.55 T MRI and discussed the potential anatomical implications for infraclavicular block. Methods: This prospective cross-sectional imaging study included 100 adults undergoing clinically indicated MRI. One infraclavicular region was analyzed per participant. Within the mid-infraclavicular retropectoral region posterior to the pectoralis minor muscle, the axial T1-weighted image providing the clearest simultaneous visualization of the lateral cord (LC), medial cord (MC), posterior cord (PC), axillary artery (AA), and axillary vein (AV) was selected. The LC, MC, PC, and AV were mapped using a 12-sector clock-face model centered on the AA, and center-to-center intercord, cord-to-AA, and cord-to-AV distances were measured. Results: The LC was most frequently located at 11 o’clock (62%), the MC at 3 o’clock (41%), the PC at 6 o’clock (40%), and the AV at 2 o’clock (71.1%; n = 90). Mean intercord distances were 11.73 ± 3.17 mm (LC-MC), 11.09 ± 2.43 mm (LC-PC), and 8.13 ± 2.83 mm (MC-PC). Mean cord-to-AA distances were 6.33 ± 1.69, 7.36 ± 2.03, and 7.13 ± 1.83 mm for LC, MC, and PC, respectively. In 92 participants with complete cord-to-AV measurements, corresponding means were 17.01 ± 5.01, 9.61 ± 2.90, and 16.54 ± 3.87 mm. Conclusions: At the mid-infraclavicular retropectoral level, 0.55 T MRI demonstrated a structured but non-equidistant neurovascular arrangement. These imaging-derived data provide quantitative anatomical reference information but are not procedural safety margins or predictors of block success.

Background/Objectives: The infraclavicular region contains a complex arrangement of the brachial plexus cords and axillary vessels. Accurate ultrasonographic characterization of these relationships is important for anatomical image interpretation and has direct relevance to ultrasound-guided infraclavicular procedures. This study aimed to evaluate the bilateral topographic distribution and morphometric relationships of the lateral, medial, and posterior cords relative to the axillary artery and axillary vein. Methods: This prospective, multicenter, observational anatomical–ultrasonographic study included 50 adults (25 women and 25 men), each examined bilaterally, yielding 100 potential side-specific examinations. The lateral cord (LC), medial cord (MC), posterior cord (PC), and axillary vein (AV) were mapped using a 12-sector radial model centered on the axillary artery (AA). Center-to-center intercord, cord-to-AA, and cord-to-AV distances were measured. Topographic confidence intervals were estimated using participant-level cluster bootstrap resampling, and bilateral morphometric data were analyzed using linear mixed-effects models. Results: The LC was located in sectors 10–11 in 85/94 examinations (90.4%; 95% CI, 84.4–95.7%), the MC in sectors 2–4 in 84/89 (94.4%; 95% CI, 89.2–98.9%), the PC in sectors 6–7 in 78/83 (94.0%; 95% CI, 88.6–98.8%), and the AV in sectors 4–5 in 95/100 (95.0%; 95% CI, 90.0–99.0%). Mean intercord distances were 11.20 ± 1.18 mm for LC/MC, 7.30 ± 1.61 mm for LC/PC, and 5.70 ± 1.10 mm for MC/PC. Mean cord-to-AA distances were 7.60 ± 0.74, 4.60 ± 0.93, and 6.60 ± 0.91 mm for the LC, MC, and PC, respectively. Mean cord-to-AV distances were 15.50 ± 2.01, 6.60 ± 1.22, and 8.50 ± 1.10 mm, respectively. Mixed-effects models demonstrated significant differences among measurements within each distance family (all p < 0.001), without significant overall side or sex effects. Conclusions: The brachial plexus cords and AV demonstrated a consistent topographic organization around the AA during bilateral mid-infraclavicular ultrasonographic assessment. The MC showed the shortest center-to-center distance to both the AA and AV, and the three cords formed a non-equidistant spatial configuration.

Background/Objectives: Transsphenoidal surgery has become the gold standard for the treatment of sellar and parasellar lesions, but it remains associated with significant anatomical challenges and the risk of intraoperative complications. The limitations of conventional imaging in depicting the complex three-dimensional anatomy of the skull base have led to a growing interest in virtual (VR) and augmented reality (AR) technologies, which offer enhanced spatial visualization, preoperative simulation, and image-guided intraoperative navigation. This systematic review aims to evaluate the current evidence on the role of virtual and augmented reality in transsphenoidal surgical interventions, with a focus on their impact on preoperative planning, intraoperative orientation, surgical outcomes, and neurosurgical training. Methods: A systematic literature search was conducted in accordance with PRISMA 2020 guidelines across PubMed, Scopus, and Web of Science for the period 2015–2025. MeSH terms and free-text keywords related to transsphenoidal surgery, sphenoid sinus anatomy, and VR/AR technologies were combined using Boolean operators. Risk of bias was assessed using RoB 2.0 for RCTs; methodological quality was assessed using the Newcastle–Ottawa Scale for observational studies and AMSTAR 2 for systematic reviews. Clinical, morphometric, and experimental studies evaluating VR/AR applications were included. Data were extracted using a standardized protocol and synthesized through qualitative analysis, with subgroup analysis by technology type (VR vs. AR) and clinical application domain. Results: A total of 218 publications were identified, of which 52 met the inclusion criteria (clinical studies n = 12, simulation and technology studies n = 30, morphological studies n = 10). VR-based three-dimensional reconstructions were consistently associated with improved preoperative spatial orientation and anatomical landmark recognition. AR systems demonstrated a meaningful contribution to intraoperative navigation, with reported reductions in time to target and improved visualization of critical neurovascular structures. VR platforms showed high effectiveness in surgical training, with shorter learning curves and improved technical performance. However, the majority of included studies were small observational cohorts, simulation studies, or expert overviews, with substantial heterogeneity in methodology, technology platforms, and outcome measures, precluding quantitative meta-analysis. Conclusions: Virtual and augmented reality represent clinically promising adjuncts to transsphenoidal surgery, with demonstrated benefits in preoperative planning, intraoperative navigation, and surgical training. These conclusions should be interpreted in the context of a predominantly early-phase and heterogeneous evidence base. Standardized protocols, larger prospective studies, and randomized trials are needed before the integration of VR/AR with navigation systems and artificial intelligence can be established as a routine component of personalized transsphenoidal surgery.

Background: The sphenoid sinus is essential for transsphenoidal surgical accesses to the sellar and parasellar regions because of its anatomic proximity to vital vascular and neurologic structures such as the internal carotid artery, optic nerve, and cavernous sinus. The high degree of morphological variability of the sphenoid sinus has a significant impact on surgical technique and the risk of intraoperative complications. Detailed knowledge of individual anatomy is therefore crucial for the safety and efficacy of transsphenoidal approaches. Objectives: This review aims to conduct a systematic analysis of the current scientific literature on anatomical variations in the sphenoid sinus and their clinical relevance in surgical interventions to the skull base. Special attention is paid to the influence of morphological features on surgical strategies to pathological processes in this area and postoperative outcomes. Materials and Methods: A systematic review of the literature was conducted according to PRISMA 2020 guidelines. The PubMed, Scopus, Web of Science, and Google Scholar databases were searched for the period March 2010 to March 2025. Keywords such as “sphenoid sinus”, “anatomical variations”, “transsphenoidal surgery” and “skull base” were used. Original studies, systematic reviews, and meta-analyses focused on the anatomy, pneumatization, and surgical significance of sphenoid sinus variations are included. Quality and relevance criteria for published material were considered in the selection of articles. Results: The most commonly identified anatomic variations included sellar and lateral pneumaticity, the presence of Onodi cells, multiple and deviated septa, and dehiscence of the posterior wall of the sphenoid sinus and prolapse into its cavity of the internal carotid artery. These variations are associated with an increased risk of intraoperative vascular injury, visual deficit, and postoperative liquorrhea. Accurate preoperative assessment by high-resolution computed axial tomography and magnetic resonance imaging, as well as the use of intraoperative neuronavigation, are critical to reduce surgical risk. Conclusions: Anatomic variations in the sphenoid sinus are an essential factor to consider when planning and performing transsphenoidal surgical accesses. An individualized approach based on detailed diagnostic imaging analysis and neuronavigation technologies contributes to a higher safety of the performed surgical interventions, a better radicality of tumor resection and more favorable postoperative outcomes.