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.

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.

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.

Aim: Aneurysmal subdural hematoma (anSDH) is an uncommon condition associated with significant mortality risk. This study focused on the relationship between morphology and the perianeurysmal environment by comparing aneurysm location and clinical outcomes. Material and Methods: A total of 486 patients with aneurysmal subarachnoid hemorrhage were retrospectively analyzed for accompanying subdural hematoma (SDH) cases. Demographic information, rebleeding, discharge, and 6 months of the modified Rankin scale scores (favorable and unfavorable) were recorded. The aneurysms were divided into 3 groups: internal carotid artery (ICA), anterior cerebral artery (ACA), and middle cerebral artery (MCA). Other parameters included aneurysm morphology, SDH width, intracerebral hematoma (ICH) volume, the presence of intraventricular hematoma, and distance to the subdural space. Results: Concomitant SDH was detected in 19 (3.9%) patients. Aneurysms were located in the ICA, 10 (52.6%); MCA, 8 (42.1%); and ACA, one (5.3%). The mean size was 9.5±4.3 mm, and there was a significant difference in aneurysm size between the ICA and MCA (p=0.025). In six supraclinoid aneurysms (posterior communicating and anterior choroidal arteries), the aneurysm dome was in the inferior lateral projection. No significant differences were observed between patients with favorable and unfavorable modified Rankin scale in terms of clinical and aneurysm morphological characteristics, except for increased ICH volume (p=0.020) and shift effects (p=0.030). Conclusion: The size and dome projection of ICA supraclinoid segment aneurysms may be important risk factors for SDH. We also believe that aneurysm localization may have a limited impact on clinical outcomes in the context of SDH.

Aim: Cigarette smoking is a common addictive manner and one of the greatest threats to health. Nicotine is one of the main components of cigarette. The aim of this study was to reveal the effect of cotinine which is an active metabolite of nicotine, on peripheral nerve injury in rats. Material and Methods: We studied 42 male adult albino-Wistar rats that were divided into three groups with simple randomization method. Group 1 were given Cotinine® (C-5923-sigma) intraperitoneally, at a dose of 0.3 mg/kg/day for 21 days. Group 2 were given ethyl alcohol, the solvent of Cotinine in the same way, dose and period. Group 3 were subjected to sciatic nerve compression injury by a clip, which has a closing pressure of 50 gr/cm2. Group 1 and 2 were subjected to the same type of injury at the end of 21 days. Four weeks later after trauma, both three groups were sacrificed and injured sciatic nerve sections are taken for histopathological analysis. Results: It was observed that cotinine aggravated the traumatic degeneration and as privileged caused to fibrosis. In the Schwann cells of thick-myelinated fibers exhibited higher grades of degeneration and mitochondrial augmentation. According to the multiple comparison results, the number of Wallerian degenerations in the trauma group was significantly lower than in both the drug-control (p=0.016) and drug (p<0.001) groups. This situation was estimated as a response to oxidative stress. Conclusion: This study reveals that peripheral nerve regeneration after traumatic injury may be affected negatively in smokers.

Background: SARS-CoV-2 is more contagious than other viruses among populations. Pregnant women are particularly susceptible to respiratory pathogens and severe pneumonia. Material and Methods: Thirty-two pregnant women who were diagnosed with COVID-19 disease by PCR test in our hospital between March 2020 and June 2020 were included in this study. Patients’ complaints, comorbid disorders, general physical conditions, radiological, laboratory characteristics, treatment results, and maternal and fetus health were recorded retrospectively. Results: The mean age of the patients was 26.6 years. Pregnancy-induced hypertension was evident in 2 patients (6.2%), preeclampsia in 1 patient (3.1%), asthma in 1 patient (3.1%). Mostly detected complaints were cough (34.4%) and fatigue (31.3%). The most frequent abnormal laboratory findings were high fibrinogen level (80.9%), high D-dimer level (71.4%), high CRP level (58.1%). Lymphopenia was found in 15.6% of patients. The maternal and fetal mortality rate was 0%. The rate of improvement in laboratory values in response to the treatment was as follows respectively; sodium (92.3%), lymphocyte count (80%), LDH (62.5%), CRP (61.1%), D-dimer (25%). None of the patients developed spontaneous abortion. Cesarean delivery was performed in 15.6% of patients. 5 newborns were negative for the COVID-19 PCR test two times. Conclusions: Mostly detected complaints in pregnancy patients with COVID-19 disease were cough and fatigue. While evaluating the treatment response, the improvement in sodium level may be more valuable than the improvement in acute phase reactants. The prognosis was quite good in mothers and children treated for this disease. The vertical transition of the disease could not be demonstrated.