Intimal Hemorrhage of Basilar Artery Induced by Severe Vasospasm Following Subarachnoid Hemorrhage: The Experimental Analysis.

BACKGROUND: Cerebral vasospasm, a serious complication of subarachnoid hemorrhage (SAH), has been extensively studied for its neurochemical and pathophysiologic mechanisms. However, the contribution of inner elastic membrane dissection and subintimal hemorrhage to basilar artery occlusion remains underexplored. This study investigates inner elastic membrane-related changes in the basilar artery after SAH. METHODS: Twenty-four hybrid rabbits were divided into control, sham, and SAH groups, with SAH induced by autologous blood injection. After 2 weeks, basilar artery changes, vasospasm indexes (VSIs), and dissections were evaluated. RESULTS: The SAH group showed significantly higher VSI, with vascular wall thickening, luminal narrowing, convoluted smooth muscle cells, intimal elastic membrane disruption, endothelial cell desquamation, and apoptosis. Some SAH animals exhibited subintimal hemorrhage, inner elastic membrane dissection, and ruptures. Basilar arteries with subintimal hemorrhage had notably higher VSI. CONCLUSIONS: These findings highlight the role of subintimal hemorrhage and inner elastic membrane dissection in basilar artery occlusion post-SAH, offering valuable insights into vasospasm pathophysiology.

Overlooked evidence for transmission deficit of pupillary light reflex can be secondary to trigeminal nerve ganglion degeneration following subarachnoid hemorrhage; preliminary experimental study.

OBJECTIVE: Although the effect of oculomotor and cervical sympathetic networks on pupil diameter is well known; the effect of the trigeminal nerve on pupil diameter has not been investigated yet. This subject was investigated. MATERIALS AND METHODS: Five of 23 rabbits were used as a control group (GI; n = 5); 0.5 ccs saline solution into cisterna magna injected animals used as SHAM (GII; n = 5); autologous blood injected to produce SAH used as the study group (GIII; n = 13) and followed up three weeks. Light-stimulated pupil diameters were measured with an ocular tomography device before, middle, and at the end of the experiment. Considering the sclera area/pupil area ratio index (PRI) as the pupillary reaction area, we used this equation for the pupil's rush to light. Degenerated neuron densities of trigeminal ganglia and pupil diameters compared with the Mann-Whitney U test. RESULTS: The PRI, degenerated neuron density of trigeminal ganglia (n/mm3) were: (2.034 ± 0.301)/(13 ± 3) in GI; (1.678 ± 0.211)/(46 ± 9) in GII; and (0.941 ± 0.136)/(112 ± 21) in GIII. P-values between groups as: p < 0.005 in GI/GII; p < 0.0001 in GII/GIII and p < 0.00001 in GI/GIII. CONCLUSION: Light stimulates the cornea which is innervated by the trigeminal nerves. This experimental study indicates that the pupil remains mydriatic as the cornea is damaged by trigeminal ischemia following SAH and blocks the light flow.

The impact of the right heart cavities echocardiographic features on atrial-high rate episodes.

Atrial high-rate episodes (AHRE) defined as atrial tachy-arrhythmias, detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation, thromboembolism, cardiovascular events, and mortality. Several variables have been researched and identified to predict AHRE existence. The present study evaluated the association between right-heart structural and functional echocardiographic parameters and AHRE in patients with CIEDs and impaired LVEF. This prospective design study included 194 patients with CIED's. The study population was divided into two groups according to presence of AHRE and analyzed the echocardiographic variables which may able to be a predictor of AHRE. Patients was divided into two groups: patients with AHRE (+) and without AHRE (-). The distribution of patients' characteristics according to presence of AHRE was analyzed. The multivariate analysis revealed Age, LAVI, E/Em tricuspid (HR: 1.106, 1.015-1.205% 95 CI; p = 0.022) and RAVI (HR: 1.035, 1.003-1.069 95% CI; p = 0.033) as independent predictors of AHREs. ROC curve analysis indicated that an E/Em tricuspid (AUC: 0.611, 95% CI 0.538-0.680 p: 0.009) and RAVI (AUC = AUC: 0.707, 95% CI 0.637-0.770 p < 0.001) predicted AHREs with a cut-off value of 6.28 and a sensitivity of 53.2% and specificity of 66.7% and a cut-off value of 29.5 mL/m2 with a sensitivity of 72.7% and a specificity of 65.9%, respectively. The main finding of this study was "RAVI" and "E/Emtricuspid ratio" is associated with AHRE. Additionally, "RAVI" and "E/Emtricuspid ratio" is an independent predictor of AHRE existence.

Changes in the Urethral Artery After Experimental Subarachnoid Hemorrhage-Induced Injury of the Pudendal Ganglion and Onuf's Nucleus Junction.

OBJECTIVE: Onuf's nucleus is an anatomical structure essential in the regulation of urogenital functions. Lumbosacral pathologies may cause changes in urogenital circulation due to Onuf's nucleus injury; however, there is limited evidence corroborating the relationship between spinal cord injury and urethral artery changes. MATERIALS AND METHODS: We used 23 sexually mature male rabbits-5 rabbits in the control group (GI), 5 rabbits in the sham group (GII), and 13 rabbits in the experimental group (GIII; received autologous blood transfusion into the T12-L1 subarachnoid space to induce subarachnoid hemorrhage (SAH). The GIII underwent a S1-3 laminectomy after 2 weeks and was decapitated. Histologic specimens were prepared to examine changes in Onuf's nucleus, pudendal ganglion, and urethral arteries. The density of damaged neurons and vasospasm index (VSI) in the urethral artery were evaluated. RESULTS: The mean density of damaged neurons (n/mm3 ) in Onuf's nucleus and pudendal ganglia (S3) and the mean VSI of the 3 groups were as follows-GI: 6 ± 2 per mm3 , 12 ± 4 per mm3 , and 1.63 ± 0.25, respectively; GII: 27 ± 6 per mm3 , 221 ± 62 per mm3 , and 1.97 ± 0.36, respectively; GIII: 154 ± 41 per mm3 , 1890 ± 541 per mm3 , and 3.04 ± 0.95 (P < .05 each for GI/GII, GI/GIII, and GII/GIII). Neuronal damage criteria, such as cytoplasmic condensation and cytoplasmic halo formation, were more prominent in GIII. CONCLUSION: SAH can lead to ischemia of the Onuf's nucleus-pudendal nerve structures due to urethral artery spasm, resulting in urogenital complications.

Overexpression of POFUT1 promotes malignant phenotype and mediates perineural invasion in head and neck squamous cell carcinoma.

Head and neck squamous cell carcinoma (HNSCC) is one of the most aggressive neoplasms, which requires more effective prevention and treatment modalities. Previous studies found that protein O-fucosyltransferase 1 (POFUT1) upregulation promotes carcinogenesis, although the potential roles, underlying molecular mechanisms, and biological implications of POFUT1 in HNSCC were not investigated. In this study, in silico analyses referred POFUT1 as a potential oncogene in HNSCC. Further analysis of tumor and normal tissue samples as well as HNSCC cells with quantitative real-time polymerase chain reaction, Western blot analysis, and immunohistochemistry showed significant overexpression of POFUT1 in HNSCC clinical tumor tissue specimens and cell lines compared to corresponding controls. In vitro investigations revealed that overexpression of POFUT1 promoted phenotypes associated with cancer aggressiveness and its knockdown in HNSCC cells suppressed those phenotypes. Further xenograft experiments demonstrated that POFUT1 is an oncogene in vivo for HNSCC. Immunohistochemical analysis with human clinical samples and cancer cell-dorsal root ganglion ex-vivo coculture model showed that deregulation of POFUT1 is involved in the perineural invasion of HNSCC cells. These results suggest POFUT1 expression as a potential prognostic marker for patients with head and neck cancer and highlight its potential as a target for HNSCC therapy, although more molecular clues are needed to better define the functions of POFUT1 related to HNSCC carcinogenesis.

The Enigma of Basilar Artery Dissections Secondary to Vasospasm following Subarachnoid Hemorrhage; Exploration of the Unknown Effect of Superior Cervical Ganglia: A Preliminary Experimental Study.

BACKGROUND: Life-threatening basilar artery dissection (BAD) can be seen following subarachnoid hemorrhage (SAH), but it is not clear whether subarachnoid hemorrhage causes dissection, or not. This study aims to investigate the relationship between, degenerative changes in the superior cervical ganglia and the dissection rate of the basilar artery. MATERIAL AND METHOD: In this article, after three weeks of experimental SAH, animals were decapitated. 18 rabbits were divided into three groups, according to their vasospasm indexes. The basilar arteries were examined by anatomical and histopathological methods. RESULTS: Basilar dissection with high vasospasm index value (VSI>3) was detected in six animals (G-I, n=6); severe basilar edema and moderate vasospasm index value (VSI>2.4) in seven rabbits (G-II, n=7) and slight vasospasm (VSI<1.5) index value in five subjects (G-III, n=5) was detected. The degenerated neuron densities (n/mm3) of the superior cervical ganglia were detected as 12±4 in G-I, 41±8 in G-II; and 276±78 in G-III. The dissected surface values/lumen values were calculated as (42±1)/(64±11) in G-I; (21±6)/(89±17) in G-II; and (3±1)/(102±24) in G-III. If we look at these ratios as a percentage: 62%in G-I, 23% in G-II, and 5% in G-III. CONCLUSION: Inverse relationship between the degenerated neuron densities (n/mm3) of the superior cervical ganglia and the dissected surface values basilar artery was observed. The common knowledge is that basilar artery dissection may lead to SAH, however, this study indicates that SAH is the cause of basilar artery dissection.

Effect of modified clivoaxial angle on surgical decision making and treatment outcomes in patients with Chiari malformation type 1.

Introduction: Chiari malformation type 1 (CM1), a complex pathological developmental disorder of the craniovertebral junction, is typically characterized by herniation of the cerebellar tonsils from the foramen magnum. Treatment using posterior fossa decompression alone without taking the ventral cervico-medullary compression into consideration may lead to unsatisfactory treatment outcomes. The current study evaluated the utility of the modified clivoaxial angle (MCAA) in assessing ventral compression and also examined its effect on treatment outcomes. Method: This retrospective study included 215 adult patients who underwent surgical treatment for CM1 at one medical center over a 10-year period. The following surgical techniques were used to decompress the posterior fossa: (a) PFD: bone removal only; (b) PFDwD: bone removal with duraplasty; and (c) CTR: cerebellar tonsil resection. The morphometric measurements of the craniovertebral junction (including MCAA) were recorded using preoperative images, and the postoperative clinical status was evaluated using the Chicago Chiari outcome scale (CCOS). Results: MCAA was positively correlated with the CCOS score and also independently predicted treatment outcome. To enable Receiver operating characteristic (ROC) curve analysis of CCOS scores, the patients were divided into three groups based on the MCAA cut-off values, as follows: (a) severe (n = 43): MCAA ≤ 126; (b) moderate (n = 86): 126 < MCAA ≤ 138; and (c) mild (n = 86): MCAA > 138. Group a exhibited severe ventral cervico-medullary compression (VCMC), and their CCOS scores for the PFD, PFDwD, and CTR groups were 11.01 ± 1.2, 11.24 ± 1.3, and 13.01 ± 1.2, respectively (p < 0.05). The CCOS scores increased with widening of the MCAA angle in all surgical groups (p < 0.05). Furthermore, patients with mild MCAA (>138°) exhibited 78% regression of syringomyelia, and this was significantly greater than that observed in the other groups. Discussion: MCAA can be used in the selection of appropriate surgical techniques and prediction of treatment outcomes, highlighting the importance of preoperative evaluation of ventral clivoaxial compression in patients with CM1.

Microsurgical and fiber tract anatomy of the interthalamic adhesion.

OBJECTIVE: The authors of this study aimed to define the microanatomy of the interthalamic adhesion (ITA) using microfiber dissection, magnetic resonance (MR) tractography, and histological analysis. METHODS: Sagittal, coronal, and axial MR images from 160 healthy individuals 2-82 years of age were examined. The relationships between age range and ITA morphology as well as between gender and ITA morphology were evaluated statistically. Among these 160 individuals, 100 who had undergone MR tractography were examined. In this group, the presence of fiber tracts in the ITA and the relationship with ITA morphological types were examined. Thirty formalin-fixed human cadaveric brains were also examined endoscopically, and 6 hemispheres were dissected from the medial to lateral and superior to inferior directions under the microscope. Sections taken from one of the brains with an ITA type 2 with both thalami were examined histologically. Anti-neurofilament antibody was used in the histological examination. RESULTS: Four morphological types of ITA were observed. Type 1 had an adhesion/adherent appearance, type 2 had a bridge/commissure appearance, type 3 showed no adhesion, and type 4 had a double bridge. Tractographic examination revealed that 28% had no fiber tract transition in the ITA, 21% had a significant transition, and 51% had an indistinct transition. Statistically, the presence of the ITA was significantly higher in the pediatric (age) and female (gender) groups. In specimens with ITAs of a bridge/commissure appearance (type 2), fiber tracts showed clear transitions between thalami. In type 1 (adherent/adhesive appearance), fiber tracts were observed within the ITA, but a reciprocal transition was unclear. Dissection showed that these fiber tracts in the ITA reach the nucleus accumbens, caudate nucleus, and frontoorbital region anteriorly and the lateral habenula and posterior commissure posteriorly. Some fibers also joined the ansa peduncularis. In histological studies, axonal fibers moving in the ITA were observed with anti-neurofilament antibody staining. CONCLUSIONS: This is the first study to demonstrate fiber tracts of the ITA through fiber dissection and transillumination techniques as well as radiological and histological study. Statistical data were obtained by comparing the morphological group with age and gender groups. The anatomy of this structure, which has been neglected for many years, was reexamined. This study showed that the ITA has fibers connecting different parts of the brain, in contrast to previous studies suggesting that it was a simple massa.

Supramarginal Gyrus and Angular Gyrus Subcortical Connections: A Microanatomical and Tractographic Study for Neurosurgeons.

Background and Objectives: This article aims to investigate the subcortical microanatomy of the supramarginal gyrus (SMG) and angular gyrus (AnG) using a microfiber dissection technique and diffusion tensor imaging (DTI)/fiber tractography (FT). The cortical and subcortical structures of this region are highly functional, and their lesions often present clinically. For this reason, the possibility of post-surgical deficits is high. We focused on the supramarginal gyrus and the angular gyrus and reviewed their anatomy from a topographic, functional and surgical point of view, and aimed to raise awareness especially for neurosurgeons. Methods: Four previously frozen, formalin-fixed human brains were examined under the operating microscope using the fiber dissection technique. Four hemispheres were dissected from medial to lateral under the surgical microscope. Brain magnetic resonance imaging (MRI) of 20 healthy adults was examined. Pre-central and post-central gyrus were preserved to achieve topographic dominance in dissections of brain specimens. Each stage was photographed. Tractographic brain magnetic resonance imaging of 10 healthy adults was examined radiologically. Focusing on the supramarginal and angular gyrus, the white matter fibers passing under this region and their intersection areas were examined. These two methods were compared anatomically from the lateral view and radiologically from the sagittal view. Results: SMG and AnG were determined in brain specimens. The pre-central and post-central gyrus were topographically preserved. The superior and medial temporal gyrus, and inferior and superior parietal areas were decorticated from lateral to medial. U fibers, superior longitudinal fasciculus II (SLF II), superior longitudinal fasciculus III (SLF III), arcuat fasciculus (AF) and middle longitudinal fasciculus (MdLF) fiber groups were shown and subcortical fiber structures belonging to these regions were visualized by the DTI/FT method. The subcortical fiber groups under the SMG and the AnG were observed anatomically and radiologically to have a dense and complex structure. Conclusions: Due to the importance of the subcortical connections of SMG and AnG on speech function, tumoral lesions and surgeries of this region are of particular importance. The anatomical architecture of the complex subcortical structure, which is located on the projection of the SMG and AnG areas, was shown with a DTI/FT examination under a topographic dominance, preserving the pre-central and post-central gyrus. In this study, the importance of the anatomical localization, connections and functions of the supramarginal and angular gyrus was examined. More anatomical and radiological studies are needed to better understand this region and its connections.

The role of ONSD in the assessment of headache associated with Chiari malformation type 1.

Background: Cough associated headache is the most common symptom in Chiari malformation type 1 (CM1). However, its pathophysiology and treatment are not clear. The aim of this study was to investigate the relationship between optic nerve sheath diameter (ONSD), an indicator of intracranial pressure, and headache and to investigate its predictive value on postoperative outcome. Methods: In symptomatic CM1 patients, craniovertebral junction morphometric measurements and ONSD measurements were made from preoperative MR images, and headache intensities and characteristics were evaluated. After different surgical procedures, the clinical characteristics of the patients were evaluated according to the Chicago Chiari Outcome Scale, the change in headache intensity was assessed and the relationship with ONSD was evaluated. Results: Preoperative headache intensity was significantly correlated with ONSD measurement (p < 0.01). Modified clivoaxial angle and ONSD were independent predictors of postoperative clinical outcome (p < 0.01). The procedure that achieved the greatest surgical enlargement of the foramen Magnum stenosis provided the best clinical outcome. Postoperative reduction in headache intensity and ONS diameter were correlated (p < 0.01). Conclusion: The fact that ONSD is found to be wide in the preoperative period in CM1 patients indicates that the intracranial pressure is permanently high. This diameter increase is correlated with headache and is a valuable guide in the selection of the appropriate treatment method.

New surgical technique for non-missile trauma hemostasis as a result of sewing needle.

Traumas are the most important cause of mortality in the pediatric population. Bleeding is an important complication, especially in traumatic brain injuries with coagulation problem addition. Low-velocity penetrating brain injuries may be caused by sewing needles, nails, and knives. There are few studies in the literature for this injury type. This study presented a surgical technique and treatment to increase hemostasis in a 2-year-old patient after a sewing needle injury.

Enterococcus gallinarum group meningitis after transanal migration of the ventriculoperitoneal shunt: a pediatric case report.

In the literature, only 11 Enterococcus gallinarum group meningitis has been reported so far. The Enterococcus gallinarum group was shown for the first time in a pediatric patient presenting with meningitis after bowel perforation, a complication of a ventriculoperitoneal shunt. A 30-month-old male patient presented with vomiting and fever, with the ventriculoperitoneal shunt distal catheter protruding from the anal orifice. The patient was diagnosed with intestinal perforation and meningitis. Enterococcus gallinarum group bacterial yield in cerebrospinal fluid culture. A total of 6 weeks of intravenous antibiotic treatment was given in the hospital. After the treatment, the patient was re-ventriculoperitoneal shunt and was discharged. Among the shunt complications, meningitis with intestinal perforation is rare. It should be kept in mind that meningitis in such patients may be caused by very rare microbiological factors such as Enterococcus gallinarum group. Antibiotherapy should be given according to the culture result. Then planning should be made for a permanent shunt.

New experimental finding of dangerous autonomic ganglia changes in cardiac injury following subarachnoid hemorrhage; a reciprocal culprit-victim relationship between the brain and heart.

OBJECTIVE: The vagal, stellate, and cardiac ganglia cells changes following subarachnoid hemorrhage (SAH) may occur. This study aimed to investigate if there is any relation between vagal network/stellate ganglion and intrinsic cardiac ganglia insult following SAH. MATERIALS AND METHODS: Twenty-six rabbits were used in this study. Animals were randomly divided as control (GI, n = 5); SHAM 0.75 cc of saline-injected (n = 5) and study with autologous 1.5 cc blood injection into their cisterna magna(GIII, n = 15). All animals were followed for three weeks and then decapitated. Their motor vagal nucleus, nodose, stellate, and intracardiac ganglion cells were estimated by stereological methods and compared statistically. RESULTS: Numerical documents of heart-respiratory rates, vagal nerve- ICG, and stellate neuron densities as follows: 276 ± 32/min-22 ± 3/min-10.643 ± 1.129/mm3-4 ± 1/mm3-12 ± 3/mm3 and 2 ± 1/cm3 in the control group; 221 ± 22/min-16 ± 4/min-8.699 ± 976/mm3-24 ± 9/mm3-103 ± 32/mm3 and 11 ± 3/cm3 in the SHAM group; and 191 ± 23/min-17 ± 4/min-9.719 ± 932/mm3-124 ± 31/mm3-1.542 ± 162/mm3 and 32 ± 9/cm3 in the SAH (study) group. The animals with burned neuro-cardiac web had more neurons of stellate ganglia and a less normal neuron density of nodose ganglia (p < 0.005). CONCLUSION: Sypathico-parasympathetic imbalance induced vagal nerve-ICG disruption following SAH could be named as Burned Neurocardiac Web syndrome in contrast to broken heart because ICG/parasympathetic network degeneration could not be detected in classic broken heart syndrome. It was noted that cardiac ganglion degeneration is more prominent in animals' severe degenerated neuron density of nodose ganglia. We concluded that the cardiac ganglia network knitted with vagal-sympathetic-somatosensitive fibers has an important in heart function following SAH. The neurodegeneration of the cardiac may occur in SAH, and cause sudden death.

The Effects of Necrostatin-1 on Cerebral Vasospasm- Induced Subarachnoid Hemorrhage.

AIM: In this study, we investigated the effects of necrostatin-1 (NEC-1) on subarachnoid hemorrhage (SAH)-induced vasospasm in a rat model. MATERIAL AND METHODS: 59 male Wistar albino rats were randomly divided into six groups: control (group 1), sham (group 2), decapitation one hour after SAH (group 3), decapitation 48 hours after SAH (group 4), NEC-1 given 15 minutes before SAH and decapitation one hour after SAH (group 5), and NEC-1 given 24 hours after SAH and decapitation 48 hours after SAH (group 6). NEC-1 (1 uq) was administered intracisternally in dimethyl sulfoxide (DMSO) (2.6 uq). After decapitation, the cross-sectional areas and wall thicknesses of basilar arteries were determined histopathologically using stereological methods. RESULTS: NEC-1 administered before SAH had a statistically significant preventive effect on vasospasm following SAH. Arterial wall thicknesses were found to be significantly increased in the SAH without NEC-1 groups but not in the control group, the sham group or the NEC-1 groups. CONCLUSION: The results of this study show that NEC-1 can prevent vasospasm in rats and has cytoprotective effects. Further studies are needed for the clinical use of this agent.

A New Technique in Surgical Management of the Giant Cerebral Hydatid Cysts.

OBJECTIVES: In hydatid disease, the central nervous system is affected approximately in 2% to 3% of patients. Surgical management in these patients is important. To develop a surgical technique to avoid the formation of great volume of cavity after hydatid cyst removal and prevent complications associated with brain collapse and cortical convolution. PATIENTS AND METHODS: In 2 patients, hydatid cysts were delivered by this new technique. A balloon filled with 150 cc of sterile air/distilled water was placed in the cavity until the balloon filled the entire cavity. Air/distilled water evacuation was continued at a rate of 20 cc/d and, after a week, eventually, the balloons were removed RESULTS:: All cysts were delivered without rupture. Neurologic outcomes were good. No complications were observed related to usage of the system such as balloon rupture, evacuation problems, and infection. CONCLUSION: The authors believe that the balloon insertion technique may be a useful method to prevent brain collapse, cortical convolution, and complications associated with this condition. Further technical refinements of the system are needed for better results.