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BACKGROUND: The genitofemoral nerve is the most variable nerve of the lumbar plexus in terms of its course and bifurcation, and therefore it must be taken into consideration during extended pelvic lymph node dissection. Its borders, during robotic, laparoscopic or open radical prostatectomy for intermediate or high-grade prostate cancer, have long been defined and must be respected; the genitofemoral nerve represents the extended pelvic lymph-node dissection lateral boundary, and the fact that it may vary from case to case puts its integrity at risk. MATERIALS AND METHODS: For the first time, we report genitofemoral nerve branching pattern data obtained from extended pelvic lymph node dissection during videolaparoscopic radical prostatectomy. We also propose a further sub-classification to identify the exact genitofemoral nerve bifurcation point in correlation with the injury risk. RESULTS: Our results show the prevalence of a genitofemoral nerve originating as a single trunk which divides into two branches, and highlight how this condition occurs at the external iliac artery upper third in more than 75% of cases. Furthermore, at the femoral canal inlet, the genitofemoral nerve two branches were mainly seen lying laterally and below the external iliac artery, or in the middle of the external iliac artery and external iliac vein. CONCLUSIONS: Better understanding of the genitofemoral nerve course and bifurcation points deduced from the extended pelvic lymph node dissection, which are, in any case, applicable to all major pelvic surgery, would prove helpful in avoiding iatrogenic nerve injuries during extended pelvic lymph node dissection.

BACKGROUND: The basal vein of Rosenthal (BVR) is a venous structure in the deep cerebral venous system. It plays an important role in cerebral haemorrhages, particularly subarachnoid haemorrhages and perimesencephalic haemorrhages. The aim of this study was to evaluate the BVR’s anatomical and functional classification and its role in various clinical situations. AIM OF THE STUDY: The review was conducted from its inception up to 27 September, 2024. It was made according to the PRISMA Statement 2020 and using the following databases: Scopus, Pubmed and Web of Science. Studies were considered eligible if they provided precise data and information on the anatomical variation of the basal vein of Rosenthal. The quality assessment was assessed using the Newcastle-Ottawa Quality Assessment Scale. MATERIALS AND METHODS: A total of 12 articles, the studies behind which were conducted in different countries, were included. Data on the classification of the basal vein of Rosenthal, surgical or radiological, and the outcome, mainly haemorrhagic, were reported. BVR type b or c correlates with increased venous fragility and an outcome of idiopathic haemorrhage. CONCLUSIONS: The anatomical classification of the BVR highlights the importance of careful surgical planning and prophylactic measures while providing valuable insights into idiopathic cerebral haemorrhages.

Background Pregnant women with neuromuscular diseases (NMDs) often display respiratory muscle impairment which increases the risk for pulmonary complications (PCs). The aim of this study was to identify pregnant NMDs patients with pulmonary risk factors and to apply in these women non-invasive ventilation (NIV) combined with mechanical insufflation-exsufflation (MI-E) in the peri-partum period. Methods We conducted a multicenter observational study on women with NMDs undergoing cesarean section or spontaneous labor in a network of 7 national hospitals. In these subjects we applied a protocol for screening and preventing PCs, and we evaluated PCs rate, maternal and neonatal outcome. Results Twenty-four patients out of the 94 enrolled pregnant women were at risk for PCs and were trained or retrained to use NIV and/or MI-E before delivery. After delivery, 17 patients required NIV with or without MI-E. Despite nine out of the 24 women at pulmonary risk developed postpartum PCs, none of them needed reintubation nor tracheostomy. In addition, the average birth weight and Apgar score were normal. Only one patient without pulmonary risk factors developed postpartum PCs. Conclusion This study showed the feasibility of applying a protocol for screening and treating pregnant NMDs women with pulmonary risk. Despite a PCs rate of 37% was observed in these patients, maternal and neonatal outcome were favorable.

A systematic and narrative literature review was performed, focusing attention on the anatomy of the area located at the junction of the sphenoid and the basal portion of the temporal bone (petrous bone, petrous apex, upper petro-clival region) encircled by the free edge of the tentorium, the insertion of the tentorium itself to the petrous apex and the anterior and posterior clinoid processes that give rise to three distinct dural folds or ligaments: the anterior petroclinoid ligament, the posterior petroclinoid ligament and the interclinoid ligament. These dural folds constitute the posterior portion of the roof of the cavernous sinus denominated “the oculomotor triangle”. The main purpose of this review study was to describe this anatomical region, particularly in the light of the relationships between the anterior margin of the free edge of the tentorium and the above-mentioned components of the sphenoid and petrous bone.

Persistent Primitive Hypoglossal Artery (PPHA) is a developmental anomaly of the brain superficial arterial circulation and is classified as a condition of carotid-vertebrobasilar anastomosis persistence caused by lack of reabsorption of the vascular network running on the hindbrain surface between the 4th and 5th embryonic week. It has an incidence between 0.03 and 0.9%, it is the second most frequent seen persistence of carotid-vertebrobasilar anastomoses after the trigeminal artery (TA), representing 85% of all persistent vestigial arteries (0.1–0.6%). Here a case of Persistent Primitive Hypoglossal Artery (PPHA) is reported being detailed in its morphological and clinical aspects. The patient, a 55-year-old female patient with high cardiovascular risk without specific symptoms presents at radiological morphological examination with an anomalous bifurcation of the ICA which gives rise to the ICA itself, which ascends without collateral branches up to the carotid foramen in the cranial base, and to an accessory artery, which enters the hypoglossal canal on the contour of the great occipital foramen, as a PPHA. A comprehensive embryologic analysis of this anatomical variant is offered and clinical awareness on it raised in view of a more informed an effective realization of it in daily clinical practice.

First described during an anatomical dissection in 1889 (Batujeff1889), with its first angiographic description dating back to 1961 (Begg 1961), PPHA may occur in association with aneurysms (Nakamura et al. 2000) and its well-known association with the ipsilateral vertebral artery agenesia (VA) seems to play an ischemic role in the event of inflow reduction in ICA, which alone supplies vascularisation on its own side (Zhang et al. 2016). CASE REPORT A 55-year-old female patient referred to our Cardiology Outpatient Service with a high cardiovascular risk (i.e. smoking, high cholesterol levels) without specific symptoms: since atherosclerosis, as is currently known, is multi-district disease, there is a tendency shared between radiologists and cardiologists to perform a single exam to study both the coronaries and epiaortic vessels, thus benefiting from a single administration of contrast medium. The multi-slice CardioSync CT Scan (Siemens Somatom Volume Zoom) for the study of coronary arteries and epiaortic vessels after riodine non-ionic contrast medium administration was used: the volume rendering reconstruction (Fig. 1) of the epiaortic vessels shows an anomalous bifurcation of the ICA, which gives rise to the ICA itself, which ascends without collateral branches up to the carotid foramen in the cranial base, and to an accessory artery, which enters the hypoglossal canal on the contour of the great occipital foramen, as a PPHA. The arteries of the sixth branchial arch contribute to the formation of the two primitive pulmonary arteries with their proximate portion, while there is no scientific agreement on the role of the artery of the fifth branchial arch (Klostranee & Krings 2022). b. Vascular anomalies The most common vascular anomalies of the vessels of the neck (Fig. 5) include the common origin of the brachiocephalic trunk and leftCommon Carotid Artery (CCA), the aberrant right subclavian artery, also called arteria lusoria, the ICA aplasia or hypoplasia; ICA is embryologically divided into 7 segments (I - cervical, II - ascending petrosus, III - horizontal petrosus, IV - ascending cavernous, V - horizontal cavernous, VI - clinoid and VII - terminal): ICA hypoplasia is frequently seen close to the bifurcation (segment I) (Kathuria et al. 2011), while the aplasia is observed at carotid foramen (segment II, with canal of reduced caliber or even absent) (Given et al. 2001).

The aim of this paper is to investigate the implications of Challenge-Based Learning programs on entrepreneurial skills, and on the mindset and intentions of university students, through a quantitative approach. Resorting to an original database, we analyzed the pre- and post-levels of entrepreneurial skills, mindset and intention of 127 students who attended a Challenge-Based Learning program. Results show a positive and significant effect of Challenge-Based Learning programs on the entrepreneurial mindset and skills - that is, financial literacy, creativity, and planning - of the students.