Comparison of Bypass and Non-Bypass Surgical Treatments for Internal Carotid Artery Blood Blister-Like Aneurysms: A Meta-Analysis of Efficacy, Safety, and Outcomes.

BACKGROUND: The optimal surgical strategy for treating internal carotid artery (ICA) blood blister-like aneurysms (BBAs) has remained unclear. Although some have preferred bypass surgery, others have favored less-demanding surgical methods. The aim of the present meta-analysis was to assess the efficacy, safety, and outcomes of bypass and non-bypass surgical methods when intended as primary treatment of ICA BBAs. METHODS: Studies reporting data on the outcomes of interest for surgically treated patients with ICA BBAs were searched for in the PubMed/MEDLINE, Evidence-Based Medicine Reviews, Cochrane Central, ProQuest, and Scopus databases. The data were analyzed using random effects modeling. RESULTS: Seven observational studies involving 140 patients met the inclusion criteria. The patients treated with bypass surgery, compared with those treated with non-bypass techniques, had lower odds of poor outcomes (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.28-2.02; P = 0.57; I2 = 0%), postoperative vasospasm (OR, 1.73; 95% CI, 0.38-7.92; P = 0.48; I2 = 19%), intraoperative bleeding (OR, 3.37; 95% CI, 0.82-13.90; P = 0.09; I2 = 0%), postoperative bleeding (OR, 1.91; 95% CI, 0.47-7.76; P = 0.36; I2 = 0%), and postoperative recurrence of BBAs (OR, 2.16; 95% CI, 0.54-8.66; P < 0.28; I2 = 0%). No comparison, however, achieved statistical significance. CONCLUSIONS: For surgeons who use both bypass and non-bypass surgical strategies, the 2 methods seemed comparable in terms of the outcomes of interest, although the bypass technique appeared superior. However, comparisons with studies reporting bypass as the uniquely preferred technique have indicated that specialization in, and preference for, the bypass procedure has been associated with more favorable outcomes.

Variability in Wall Thickness and Related Structures of Major Dural Sinuses in Posterior Cranial Fossa: A Microscopic Anatomical Study and Clinical Implications.

BACKGROUND: Regional variability in dural sinus (DS) wall thickness in posterior cranial fossa (PCF) have not been studied in detail yet. OBJECTIVE: To clarify the possible regional variability in DS wall thickness and determine the occurrence and localization of the chordae Willisii (CW) in PCF. METHODS: Fifty-nine human cadaveric DSs of PCF were investigated. A measurement of the DS walls/dura mater/CW thickness of parafin-embedded/hematoxylin-eosin stained axial sections was performed by using Cell Sens Science Imaging Software (Olympus Corporation, Tokyo, Japan). RESULTS: The osseus wall (OW) was the thickest one in the confluens sinuum (CS) and the thinnest one in the jugular bulb (JB) and sigmoid sinus (P < .05). The biggest differences between individual walls were observed in the JB where the superior wall was almost twice as thick as the OW. At the transverse-sigmoid junction, the thickness of the walls was comparable. In the CS and transverse sinuses, the OW was even thicker than the surrounding dura mater. The occurrence and thickness of the CW increased from the JB towards CS and prevailed on the right side. An overall number of the CW in PCF was comparable to that observed in the superior sagittal sinus. CONCLUSION: The present study displayed for the first time the regional variability in the DS walls thickness and occurrence of the CW in PCF. Application of these findings may afford greater freedom in exposure of the DSs or neoplasms adhering to the DSs.

Anatomical study of the roots of cranial parasympathetic ganglia: a contribution to medical education.

A major key to increasing the safety of cranial surgery is a thorough understanding of anatomy. The anatomy of the head is of fundamental interest to dental and medical students early in their studies. Clinically, it is mostly relevant to surgeons who are performing interventions and reconstruction in the maxillofacial region, skull base, and the orbit. However, the level of appropriate anatomical knowledge necessary for general and special medical and surgical practice is still under discussion. This study maps the significant areas and structures of the head that are not normally accessible during dissection courses because of time and difficulties involved in the preparation. The detailed photodocumentation enriched by diagrams provides a view of structures until now only partially documented. Three parasympathetic ganglia are located in hardly accessible areas of the head - inside the orbit, infratemporal fossa, and in the pterygopalatine fossa. No detailed photographs have been found in current anatomical textbooks and atlases in relation to the morphology of fibers (roots) connected to the ciliary, otic, and pterygopalatine ganglia. Therefore, this study focused on the detailed display of sensory, sympathetic, and parasympathetic roots of ganglia to provide relevant photodocumentation and an improvement in human anatomy teaching. This study also confirms that cadaver dissection provides an excellent opportunity for the integration of anatomy and clinical medicine into the early clinical training of undergraduate dental and medical students. We believe this article, because of the details mentioned above, will be beneficial not only for the future anatomical undergraduate but also for postgraduate education.