The embryological development of the cerebral vasculature is very complex. Historical and also more recent studies based on human embryos, comparative anatomy and cerebral angiographies allowed us to better understand this vasculature development. The knowledge and understanding of such embryological development are important for physicians interested in neurovascular pathologies. Indeed, all vascular variants and almost all vascular pathologies, such as aneurysms, dolichoectasia, atherosclerosis, and neurovascular conflicts could be explained by an alteration during the embryological life. There are also many variants of these vascular structures present in normal developed adults, which are variably associated with pathological entities. Understanding the process which leads to the development of the normal cerebral arterial system in humans is, therefore, very important to have a better knowledge of the possible clinical and surgical implications of these anomalies. In this paper, we review the embryological development of the cranio-facial arterial vasculature from its beginning at approximately days 21–50 of intrauterine life, with pictures illustrating each developmental phase.

Background/Objectives: Retained epidural catheter fragments are an infrequent but clinically relevant complication of neuraxial anesthesia. Optimal management remains undefined, with limited evidence guiding treatment selection or risk stratification. This systematic review synthesized individual patient data to compare treatment strategies, examine surgical outcomes, and determine predictors of intervention. Methods: A systematic review was conducted across six databases in accordance with PRISMA guidelines (PROSPERO: CRD420025638305). Adult cases of retained epidural catheter fragments were included. Functional outcomes were standardized using modified MacNab, McCormick, and Therapy–Disability–Neurology (TDN) scores. Predictors of surgery and detectability were assessed using univariate and multivariate logistic regression models with Firth correction. Results: Forty studies comprising 51 patients were included. Conservative management was chosen in 23 cases (45%); 39.1% (n = 9) ultimately required delayed surgery due to symptom onset during follow-up. Surgical removal (n = 28, 55%) was safe and yielded excellent outcomes in 95.8% of cases. Fragment length was significantly associated with increased odds of surgery (OR = 1.05, 95% CI: 1.01–1.10, p = 0.04), while catheter material was associated with surgery in univariate analysis (OR = 2.49, 95% CI: 1.08–9.00, p = 0.03). An MRI demonstrated the highest diagnostic accuracy (AUC = 0.859, cutoff = 70 mm catheter length), outperforming CT (AUC = 0.611) and X-ray (AUC = 0.533). Across all patients, 84.3% achieved “Excellent” recovery per MacNab, with no neurological deterioration in any surgical case. Conclusions: Surgical removal of retained epidural catheter fragments is safe and effective in symptomatic patients. Conservative management is viable for asymptomatic cases under structured surveillance. Catheter material and fragment length may dictate imaging selection and treatment decisions.

Background/Objectives: The concept of frailty has been recognized as an important issue which can influence postoperative outcomes. We aimed to investigate the influence of frailty on clinical and radiological outcomes in patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative spine disease. Methods: A single-center, retrospective cohort study was conducted involving 408 patients in whom 506 expandable interbody devices were implanted. The patients were grouped into vulnerable/frail versus well/fit according to the Canadian Frailty Index. Results: The frail patients were older and had a larger number of fused segments (3.0 vs. 2.4 segments, p = 0.009). In the univariate analysis, the frail patients were more likely to experience a postoperative adverse event (AE) until discharge (OR 1.89, 95% CI 1.22–2.92; p = 0.004), three (OR 1.57, 1.07–2.3; p = 0.021), and 12 months postoperatively (OR 3.77, 1.96–7.24; p < 0.001). Following the multivariable logistic regression analysis, frailty remained an independent risk factor for postoperative AEs at 12 months (OR 3.44, 95% CI 1.69–6.99; p = 0.001). Conclusions: Frailty negatively influenced the rate of AEs until 12 months, while the odds of having a favorable outcome at any time remained unaffected in patients undergoing posterior spinal fusion with TLIF. Future efforts are needed to evaluate whether preoperative medical optimization or prehabilitation may positively impact patient outcomes.

Whole-spine epidural abscesses (WSEAs) are rare infections with potentially devastating neurological sequelae. As common treatment guidelines remain absent, this study aims to describe the management and resulting outcomes of WSEAs through an institutional case series and systematic literature review. What are the optimal management strategies for WSEAs based on current evidence? We retrospectively analyzed a series of WSEAs treated at our tertiary spine center (2009–2024) and conducted a systematic review using PubMed, Ovid, and Web of Science (1990–2024). Data on patient demographics, clinical presentation, bacteriology, diagnostics, treatment strategies, and outcomes were extracted. Statistical analyses included multivariate and risk-factor analysis. We identified 48 patients (mean age 54 years, 69 % male), including four from our institutional series. Staphylococcus aureus was the most common pathogen (67 %). Five patients (10.4 %) received only conservative antibiotic treatment, primarily those with mild neurological deficits or severe comorbidities. Surgical intervention was performed in 43 patients (89.6 %), mainly utilizing skip-laminectomies (68.8 %) with catheter-based epidural irrigation. Favourable outcomes were comparable between surgical (86.1 %) and conservative (80.0 %) treatment (p = 0.567). Initial neurological status strongly correlated with neurological outcome (Spearman's ρ = 0.563, p = 0.0001). Both surgical and conservative approaches can achieve favourable outcomes in selected WSEA cases. The strong correlation between initial and final neurological status emphasizes the importance of early diagnosis and targeted intervention. Skip-laminectomies with catheter-based irrigation appear effective while minimizing surgical morbidity. Conservative treatment may be considered in neurologically intact patients under close surveillance. Larger multicenter studies are needed to establish reliable treatment algorithms.

Study Design: Retrospective cohort study. Objectives: To evaluate the frequency, risk factors, and impact of incidental durotomy on adverse events and outcomes after TLIF with expandable interbody spacers. Methods: We reviewed 433 consecutive patients treated by TLIF using expandable titanium interbody implants (ALTERA®, Globus Medical Inc) on 538 levels between December 2018 and September 2023. Patients with incidental durotomy (ID) and cerebrospinal fluid leakage were compared to patients without ID, focusing on patient-specific and surgery-related factors, adverse events, clinical outcomes (MacNab criteria), and radiological outcomes at discharge, 3, and 12 months. Results: The ID rate was 9.0% (39/433 patients). Patients with ID had lower BMI (26.1 ± 5.2 vs 28.0 ± 5.3 kg/m ² , P = .03), longer surgery duration (358 ± 132 vs 305 ± 128 minutes, P = .01), and extended hospital stays (14.7 ± 12.8 vs 10.9 ± 8.2 days, P < .01). More postoperative adverse events (51.3% vs 28.7%, P = .004) with higher severity (28.2% vs 13.2% moderate to severe, P = .019) occurred at discharge. No differences were found in outcomes at 3 or 12 months. ID patients showed higher risks for impaired wound healing (adjusted OR, 4.39; 95% CI, 1.90-10.2; P = .001) and pulmonary embolism (adjusted OR, 3.52; 95% CI, 1.13-10.9; P = .029). Conclusions: Incidental durotomy was associated with longer surgery time, hospital stays, and increased early postoperative complications. While not affecting mid-to-long-term outcomes, ID increased risks for wound healing difficulties and pulmonary embolisms.