Which vacuum phenomenon is more predictive for future junctional disorders?: Intradiscal or Intrafacet?

Recent spine studies focused on identifying whether intradiscal vacuum phenomenon (VP) was associated with spinal instability. However, none of them reported a direct association between VP and spinal instability following fusion for degenerative lumbar spine disorders (DSDs), namely junctional disorders. In the present study, we aimed to evaluate whether the VP was predictive for junctional disorders in patients who underwent short-segment lumbar decompression and fusion for DSDs at a tertiary spine center. We retrospectively reviewed prospectively collected database of patients who underwent short-segment decompression and fusion for DSDs. Pre-operative sagittal and axial computed tomography (CT) scans were evaluated in terms of intradiscal and intrafacet VP at all lumbar levels, respectively. Each VP was scored as 1 point. Then, the total VP score was calculated as the sum of intradiscal VP score and intrafacet VP score. Then, we analyzed the possible predictivity of VP for junctional disorders at final follow-ups of the patients operated for short-segment lumbar decompression and fusion. Patients with junctional disorders had significantly higher total and intrafacet VP scores compared to those without junctional disorders. Total VP score had an OR of 1.217 (p = 0.014) and intrafacet VP score had an OR of 1.465 (p = 0.008). The ROC analysis depicted that the cut-offs value for total and intrafacet VP scores to predict junctional disorders following short-segment lumbar decompression and fusion were 1.5 points and 0.5 point, respectively. Vacuum phenomenon could be associated with junctional disorders in patients who underwent short-segment lumbar decompression and fusion for DSD. Intrafacet VP was more important than intradiscal VP in predicting junctional disorders. Proper surgical planning including the evaluation of both intrafacet and intradiscal VP at all lumbar levels is crucial to decrease the likelihood of junctional disorders.

Risk Factors for Intracranial Aneurysm Rupture: A Clinical Case Series and Systematic Review of the Literature.

AIM: To evaluate the patients who underwent surgery for an anterior communicating artery (AcomA) aneurysm at our institution. We analyzed our case series and systematically reviewed the literature to identify factors that could predict the rupture of an intracranial aneurysm in patients with AcomA aneurysms or any intracranial aneurysm. MATERIAL AND METHODS: We conducted a cross-sectional analysis of prospectively collected data from patients who underwent surgery for AcomA aneurysms at a single institution between January 2014 and May 2023. Predictors for the rupture of intracranial aneurysm were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Pubmed and MEDLINE databases. RESULTS: Younger age (odds ratio (OR): 0.957, 95% confidence interval (CI): 0.920-0.995, p = 0.028), presence of a daughter sac (OR: 3.209, 95% CI: 1.095-9.408, p = 0.034), and ever-smoking (OR: 0.357, 95% CI: 0.137-0.930, p = 0.035) were significant predictors of increased risk of rupture in patients with AcomA aneurysms. Several aneurysm- and patient-related risk factors for rupture of intracranial aneurysms were retrieved via the literature analysis. CONCLUSION: Younger age, ever-smoking, and presence of a daughter sac increased the risk of AcomA aneurysm rupture. A systematic literature review revealed several more aneurysm- and patient-related risk factors for rupture of the intracranial aneurysms. Our results could aid neurosurgeons during their decision-making process when treating patients with unruptured intracranial aneurysms.

The perforating branches of the P1 segment of the posterior cerebral artery.

The perforating branches of the P1 segment of the posterior cerebral artery are vulnerable to injury. Because of their close proximity to the basilar artery, the vulnerability occurs especially during surgical interventions for vascular pathologies such as basilar apex aneurysms. Therefore, extensive knowledge of the microsurgical anatomy of this area is mandatory to prevent poor post-operative outcomes. We microscopically examined 28 P1 segments obtained from 14 adult fresh cadaver brains (6 silicone injected, 8 freshly examined). The P1 segments ranged between 2.8mm and 12.2mm (mean 6.8mm) in length with a mean outer diameter of 1.85 mm (range 0.8-4.5mm). All 94 thalamoperforating branches identified in 27 P1 segments (mean 3.35 branches per segment) arose from the postero-superior aspect of P1 and were the most proximally originating branch in nearly all specimens (96.4%). In addition in 28 P1s, 12 short circumflex arteries (42.8%; mean 0.42 branches per segment), 16 long circumflex arteries (57.1%; mean 0.57 branches per segment) and 10 medial posterior choroidal arteries (35.7%; mean 0.35 branches per segment) were identified and all originated from the posterior or postero-inferior surface of the P1 segment. When the P1 segment had more than one type of branch, it was the short circumflex arteries that were always more proximal in origin than the others. The medial posterior choroidal arteries were always more distal in origin. All three branches were not observed together in any of the P1 segments. The findings in this, and future, anatomical studies may help to reduce the post-surgical morbidity and mortality rates after surgery for posterior circulation aneurysms.

There are no estrogen and progesterone receptors in cerebral cavernomas: a preliminary immunohistochemical study.

BACKGROUND: Literature consistently mentions that pregnancy and hormonal therapy probably increase the bleeding rate and seizure expression of cerebral cavernomas. Either increased hormonal activity or embryogenesis related abundant expression of some growth factors such as VEGF, bFGF, and placental growth factor during pregnancy were proposed to initiate angiogenic process and vascular proliferation in cavernomas, thereby increasing their bleeding rate and seizure expression. METHODS: To reveal whether estrogen and/or progesterone have direct effect on cerebral cavernomas, their receptor expressions were studied immunohistochemically in recently excised 12 cerebral cavernomas. RESULTS: Study showed no expression of either estrogen or progesterone receptors in cerebral cavernomas even the staining worked well in positive control tissues of infiltrative ductal carcinoma. CONCLUSIONS: Aggressive behavior of cerebral cavernomas during pregnancy is a commonly proven observation and attributed to some hormonal effects. However, this effect seems not related to effect of estrogen or progesterone on cavernoma tissue via receptor binding.