Background: In this study, we aimed to comparatively evaluate the morphology of internal carotid artery (ICA) bifurcations with and without aneurysms and identify risk factors for aneurysm development that are associated with the bifurcation geometry. Method: In this two-center study, the computerized tomography angiography data of 1512 patients were evaluated. The study included 64 (4.2%) patients with ICA bifurcation aneurysms (ICAbifAn) and patients with anterior circulation aneurysms (non-ICAbifAn). ICA (P1) was defined as the parent artery, and the middle (M1) and anterior (A1) cerebral artery segments were defined as daughter arteries. We measured the diameters of the P1, M1, and A1 and their ratios (BifSR) to identify the risk factors. In addition, we calculated the bifurcation angle in two ways by measuring all angles between the P1 and daughter arteries and compared these two methods. The first method was the angle between the M1 and A1 (α), and the second was the sum of the angles between the P1 and daughter arteries (BifA). Result: A total of 163 patients who met the inclusion criteria were included in this study: 58 patients in the ICAbifAn group and 105 patients in the non-ICAbifAn group. A univariate logistic regression analysis revealed that the P1, BifSR, α, and BifA measurements were significant predictors of aneurysm formation. However, after a multivariate analysis, only the BifA angle retained its significance (OR, 0.911 (0.877–0.946), p < 0.001). In the ROC curve, the optimal BifA threshold for accurately differentiating between an ICAbifAn and non-aneurysmal bifurcation was 210° (area under the curve (AUC), 0.81; sensitivity, 69%; and specificity, 87%). The α angle had an AUC of 0.68. Conclusions: These results suggest that bifurcation geometry plays a significant role in the likelihood of aneurysm formation. We also showed that the BifA was more predictive of aneurysm formation than the α angle.

This study aimed to examine the clinical and morphological characteristics associated with the risk of rupture of internal carotid artery (ICA) bifurcation aneurysms (ICAbifAn) by comparing ruptured and unruptured aneurysms. The two-center observational study included 66 patients with ICAbifAn (4.3%) identified from a database of 1,512 patients with intracranial aneurysms. The following data were collected and evaluated for their association with rupture risk: demo-graphic data, medical history, aneurysm neck and dome size, bottleneck factor, aspect ratio (AR), size ratio, dome projection and localization, ICA (D1), M1, and A1 diameters, and ICA-M1 (β), ICA-A1 (γ), and M1-A1 (α) angles. Sixty ICAbifAn cases were included in the study. Of these, 26 (43.3%) were ruptured aneurysms, and 34 (56.7%) were un-ruptured aneurysms. Patients in the ruptured group were younger than those in the unruptured group (p=0.017). The ruptured group had a smaller α angle (p=0.018) and significantly narrower A1 (p=0.004) and M1 (p=0.005) vessel diameters compared to the unruptured group. Irregular shape (p=0.001), AR>1.7, and a narrow neck (p=0.007) were significant predictors of rupture. Logistic regression analysis revealed that AR, α angle, and M1 and A1 diameters were significant predictors of aneurysm rupture. In receiver operating characteristic (ROC) analysis, an α angle cutoff of 126.2° exhibited a sensitivity of 61.5% and a specificity of 67.7% (area under the curve [AUC]=0.67). A cutoff M1 diameter of 2 mm exhibited a sensitivity and specificity of 61.5% and 76.4%, respectively (AUC=0.71). Additionally, a cutoff A1 diameter of 1.5 mm exhibited a sensitivity and specificity of 73.1% and 71.1%, respectively (AUC=0.75). This study provided insights into the impact of aneurysm and bifurcation geometry on the risk of ICAbifAn rupture, which may also be applicable to more common bifurcation site aneurysms. Simple morphological measurements at the bifurcation region, where instability prevails, may serve as useful indicators for clinicians evaluating the likelihood of ICAbifAn rupture.

Objective : We evaluated the diagnosis, treatment, and long-term results of patients with dural arteriovenous fistula (dAVF), which is a very rare cause of posterior fossa hemorrhage.Methods : This study included 15 patients who underwent endovascular, surgical, combined, or Gamma Knife treatments between 2012 and 2020. Demographics and clinical features, angiographic features, treatment modalities, and outcomes were analyzed.Results : The mean age of the patients was 40±17 years (range, 17–68), and 68% were men (11/15). Seven of the patients (46.6%) were in the age group of 50 years and older. While the mean Glasgow coma scale was 11.5±3.9 (range, 4–15), 46.3% presented with headache and 53.7% had stupor/coma. Four patients (26.6%) had only cerebellar hematoma and headache. All dAVFs had cortical venous drainage. In 11 patients (73.3%), the fistula was located in the tentorium and was the most common localization. Three patients (20%) had transverse and sigmoid sinus localizations, while one patient (6.7%) had dAVF located in the foramen magnum. Eighteen sessions were performed on the patients during endovascular treatment. Sixteen sessions (88.8%) were performed with the transarterial (TA) route, one session (5.5%) with the transvenous (TV) route, and one session (5.5%) with the TA+TV route. Surgery was performed in two patients (14.2%). One patient (7.1%) passed away. While there were nine patients (64.2%) with a Rankin score between 0 and 2, the total closure rate was 69.2% in the first year of control angiograms.Conclusion : In the differential diagnosis of posterior fossa hemorrhages, the differential diagnosis of dAVFs, which is a very rare entity, should be considered, even in the middle and elderly age groups, in patients presenting with good clinical status and pure hematoma. The treatment of such patients can be done safely and effectively in a multidisciplinary manner with a good understanding of pathological vascular anatomy and appropriate endovascular treatment approaches.

Objectives: Post-laminectomy syndrome due to epidural fibrosis (EF) is a common cause of persistent low back pain after lumbar spinal surgery and is challenging for both surgeons and patients. The current experimental study aimed to investigate the effect of dehydrated human amnion/chorion membrane (dHACM) allograft for preventing EF formation following lumbar laminectomy.Methods: Sixteen Sprague–Dawley rats equally divided into two groups underwent lumbar laminectomy. Group A, the control group, underwent lumbar laminectomy with standard closure. Group B, the experimental group, additionally received epidural dHACM allografts during the procedure. After 45 days of follow-up, the rats were sacrificed, and the harvested tissues were histopathologically evaluated for EF.Results: Compared with Group A, Group B showed significantly less EF generation (p < 0.001), implying that dHACM allografts effectively prevent EF. Conclusions: This study demonstrated that dHACM can effectively reduce EF formation after spinal laminectomy in rats.

Aim: Conservative treatment is a safe alternative to surgical treatment in patients with asymptomatic or mildly symptomatic extradural hematoma seen in the pediatric age group. There is still a debate about patient selection criterias. This study highlights the radiological and clinical features of pediatric large EDH patients treated without surgery. Material and Methods: In this retrospective-cohort study, we present a review of the data of 20 pediatric EDH patients treated in Health Sciences University, Bursa Yüksek Ihtisas Training and Research Hospital between 2015 and 2020. This study; includes patients with Glasgow Coma Scale (GCS) 14+ and diagnosed EDH thickness ≥ 15mm in computed tomography (CT), treatment protocol and outcomes. Results: Of the 206 patients diagnosed with EDH, 131 (63,5 %) had an initial GCS ≥ 14. Furthermore, 23 (11,1 %) patients had EDH thickness ≥ 15 mm. 3 patients were excluded from study because of emergent surgery. The number of patients included in the study was 20 and all patients had a GOS score of 5 on at least one -year follow-up. Conclusion: According to our results, conservative treatment is an optimal alternative to surgical treatment in pediatric large EDH patients. However, patient selection and clinical features are very important.