Does the use of oral contraceptives or hormone replacement therapy offer protection against the formation or rupture of intracranial aneurysms in women?: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to carry out a systematic review of the literature with meta-analysis to evaluate the effect of using oral contraceptive and hormone replacement therapy as a protective factor in the formation of intracranial aneurysms and subarachnoid hemorrhage. METHODS: This is a systematic review of the literature with meta-analysis, using PubMed and Embase as databases and the PRISMA method. Case-control and cohort studies published until December 2022 were included in this review. RESULTS: Four studies were included in this review; three of which were eligible for meta-analysis. Regarding the use of oral contraceptive and the development of subarachnoid hemorrhage, there was a lower risk of aneurysm rupture with an odds ratio 0.65 (confidence interval 0.5-0.85). In the analysis of patients using hormone replacement therapy and developing subarachnoid hemorrhage, there was also a lower risk of aneurysm rupture with an OR 0.54 (CI 0.39-0.74). Only one article analyzed the formation of intracranial aneurysm and the use of hormone replacement therapy and oral contraceptive, and there was a protective effect with the use of these medications. oral contraceptive: OR 2.1 (CI 1.2-3.8) and hormone replacement therapy: OR 3.1 (CI 1.5-6.2). CONCLUSION: The use of hormone replacement therapy and oral contraceptive has a protective effect in intracranial aneurysm rupture and formation.

Middle fossa triangles - A step-by-step dissection.

Background: The anatomy and surgical approach to the cavernous sinus and the middle fossa can constitute a considerable challenge, specially for young surgeons. Although their surgical explorations have gone through a popular phase in the past, to this date, they remain an uncomfortable subject for many neurosurgeons. The aim of this paper is to systematically review its anatomy and multiple corridors through a step-by-step dissection of the middle fossa triangles, providing a roadmap for surgeons. Methods: A step-by-step dissection of the cavernous sinus was performed in two fresh-frozen cadavers aiming to describe the anatomy of ten different middle fossa triangles, demonstrating the feasibility of the use of their spaces while surgically approaching this area. Results: The intradural opening of the roof of the cavernous sinus was obtained by dissection of clinoidal, carotid-oculomotor, supratrochlear, optic-carotideal, and oculomotor triangles, allowing an expanded superior view. On the counterpart, the extradural exploration of the lateral wall through the middle fossa floor peeling exposed the infratrochlear, anteromedial, and anterolateral triangles. The middle fossa floor itself was the door to approaching posterior fossa through anterior petrosectomy. The dissection of each individual triangle can be amplified exponentially with exploration of its adjacents, providing broader surgical corridors. Conclusion: The cavernous sinus still remains far from an "every man's land," but its systematic study based on direct approaches can ease the challenges of its surgical exploration, allowing surgeons to feel more comfortable with its navigation, with consequently benefit in the treatment of patients.

Does the use of oral contraceptives or hormone replacement therapy offer protection against the formation or rupture of intracranial aneurysms in women?: a systematic review and meta-analysis

SUMMARY OBJECTIVE: The aim of this study was to carry out a systematic review of the literature with meta-analysis to evaluate the effect of using oral contraceptive and hormone replacement therapy as a protective factor in the formation of intracranial aneurysms and subarachnoid hemorrhage. METHODS: This is a systematic review of the literature with meta-analysis, using PubMed and Embase as databases and the PRISMA method. Case-control and cohort studies published until December 2022 were included in this review. RESULTS: Four studies were included in this review; three of which were eligible for meta-analysis. Regarding the use of oral contraceptive and the development of subarachnoid hemorrhage, there was a lower risk of aneurysm rupture with an odds ratio 0.65 (confidence interval 0.5-0.85). In the analysis of patients using hormone replacement therapy and developing subarachnoid hemorrhage, there was also a lower risk of aneurysm rupture with an OR 0.54 (CI 0.39-0.74). Only one article analyzed the formation of intracranial aneurysm and the use of hormone replacement therapy and oral contraceptive, and there was a protective effect with the use of these medications. oral contraceptive: OR 2.1 (CI 1.2-3.8) and hormone replacement therapy: OR 3.1 (CI 1.5-6.2). CONCLUSION: The use of hormone replacement therapy and oral contraceptive has a protective effect in intracranial aneurysm rupture and formation.