OBJECTIVE: Craniocervical dissections are among the most common causes of stroke in people aged under 50 years, which is why it is essential to clarify, diagnose, and treat them as quickly as possible. Dissections usually occur spontaneously due to bleeding into the vessel wall. The affected segments are usually the motion segments of the internal cerebral artery (C1 segment) and the vertebral artery (V3 segment). Clinically, there is head and/or neck pain and neurologic symptoms, which can vary according to the localization of the dissection.
CONCLUSIONS: Pathognomonic is the detection of an intramural hematoma due to bleeding into the vessel wall. This can best be detected by magnetic resonance imaging (MRI) in native, fat-saturated T1 sequences (black-blood sequence). In addition, contrast-enhanced angiography should be performed using MRI or, alternatively, computed tomography (CT). As there is an increased risk of embolic or hemodynamically induced strokes, prophylactic treatment should be initiated immediately; it remains a case-by-case decision whether antiplatelet agents or oral anticoagulants are chosen for this purpose.
UNASSIGNED: KLINISCHES PROBLEM: Dissektionen der hirnzuführenden Gefäße gehören zu den häufigsten Ursachen eines Schlaganfalls bei Personen unter 50 Jahren, weswegen eine schnellstmögliche Abklärung, Diagnostik und Therapie essenziell sind. Sie entstehen meistens spontan durch Einblutung in die Gefäßwand. Betroffen sind in der Regel die Bewegungssegmente an der A. cerebri interna (C1-Segment) und an der A. vertebralis (V3-Segment). Klinisch kommt es zu Kopf- und/oder Nackenschmerzen sowie neurologischen Symptomen, die sich entsprechend der Lokalisation der Dissektion unterscheiden können. EMPFEHLUNG FüR DIE PRAXIS: Pathognomisch ist der Nachweis eines intramuralen Hämatoms durch Einblutung in die Gefäßwand. Dieses lässt sich am besten in der Magnetresonanztomographie (MRT) in nativen, fettgesättigten T1-Sequenzen (Black-Blood-Sequenz) nachweisen. Zusätzlich sollte eine kontrastmittelgestützte Angiographie am besten in der MRT, alternativ in der Computertomographie (CT), erfolgen. Da ein erhöhtes Risiko für embolisch oder hämodynamisch bedingte Schlaganfälle besteht, sollte unmittelbar eine prophylaktische Therapie eingeleitet werden; dabei bleibt es eine Einzelfallentscheidung, ob hierfür Thrombozytenfunktionshemmer oder orale Antikoagulanzien gewählt werden.

UNASSIGNED: We aimed to analyze the variability of the permanent trigeminal artery (PTA) and its relationship with cerebrovascular disease.
UNASSIGNED: To analyze the variability of the PTA and its relationship with cerebrovascular disease by using the terms \"primitive trigeminal artery\", \"persistent primitive trigeminal artery\", \" persistent trigeminal artery variant\", \"PPTA\", \"PTAV\", \"carotid- basilar anastomoses\", \"carotid-vertebrobasilar anastomoses\", \"persisting embryonic vessels\" were used as keywords, and the English-language literature related to PTA and cerebrovascular diseases published in PubMed, EMBAS, and Web of Science databases from 2000 to 2022 were searched by using \"subject terms + free words\". A meta-analysis of the collected data was performed using stata14.0 statistical software to assess the relationship between the immortal trigeminal artery and cerebrovascular-related diseases.
UNASSIGNED: A total of 1908 relevant articles were initially retrieved for this study. Ten papers were initially screened according to the inclusion and exclusion criteria, while the literature was then read one by one to exclude duplicates, reviews, case reports, and conference abstracts, and six papers were finally included for meta-analysis. The six papers included in this paper were all cross-sectional studies with 39,355 subjects, of which 206 subjects had PTA, with a variation rate of approximately 0.52%, including 77 males and 129 females, 117 left-sided variants and 87 right-sided variants. In contrast, of the 206 subjects with a PTA, 52 had cerebrovascular disease, with an overall prevalence of approximately 25.24%.
UNASSIGNED: The PTA could influence the development of cerebrovascular disease.

There is a lack of data regarding the safety and effectiveness of implanting the Pipeline Embolization Device with Shield technology (PED-Shield) compared with the previous generation of Pipeline (PED-Flex). This retrospective single-center study aimed to compare treatment outcomes between the PED-Shield and PED-Flex for treating unruptured internal carotid artery aneurysms. The PED-Flex was used in 62 procedures (67 aneurysms, 59 patients) and the PED-Shield in 53 procedures (59 aneurysms, 58 patients). The mean aneurysm diameter was significantly lower in the PED-Shield group than in the PED-Flex group (11.9 ± 7.0 mm vs. 15.2 ± 6.9 mm, p < 0.001). At the 12-month follow-up, the complete angiographic occlusion rate was 72.1% and 72.3% in the PED-Flex and PED-Shield groups, respectively (p = 0.9808). Limited to aneurysms larger than 10 mm, 70.6% and 68.0%, respectively (p = 0.8175). The incidence of more than three high signal intensity areas on diffusion-weighted imaging after treatment was significantly lower in the PED-Shield group than in the PED-Flex group (27.7% vs. 67.7%; p < 0.001). Limited to aneurysms larger than 10 mm, 41.1% and 69.6%, respectively (p < 0.0117). Symptomatic ischemic complications occurred within 30 days of four PED-Flex procedures (6.5%) and one PED-Shield procedure (2.0%) (p = 0.2315). Limited to aneurysms larger than 10 mm, 1.8% and 3.2%, respectively (p = 0.6677). The incidence of mRS score worsening at 6 months was 3.2% and 1.9% in the PED-Flex and PED-Shield groups, respectively (p = 0.6534). The PED-Shield can achieve outcomes equivalent to or better than the PED-Flex. Further large-scale studies are warranted to confirm our findings.

The parapharyngeal space, a complex fascial compartment within the head and neck region, encompasses crucial anatomical structures including blood vessels and nerves. Tumors occurring within this space are rare, with the majority being benign in nature. Surgical intervention remains the primary treatment modality; however, managing parapharyngeal space tumors poses significant challenges due to their intricate anatomical configuration. Conventional open surgical approaches have been associated with significant tissue damage and a high prevalence of postoperative complications. Recently, advancements in anatomical studies and surgical techniques have led to significant progress in understanding parapharyngeal space anatomy and improving surgical management. This article aims to provide a comprehensive overview of these developments.
摘要: 咽旁间隙是头颈部复杂的筋膜间隙，其内包含血管、神经等重要解剖结构。发生于咽旁间隙的肿瘤少见，以良性病变为主，手术是主要治疗方法。由于解剖结构复杂，咽旁间隙肿瘤手术具有挑战性。传统咽旁间隙肿瘤手术以开放入路为主，手术创伤大、术后并发症发生率高。随着解剖研究的深入和手术技术的发展，近年咽旁间隙解剖和手术入路研究取得一定进展，本文将围绕这一主题进行综述。.

BACKGROUND: Vascular calcifications, primarily in the aorta and its proximal branches, are commonly observed among subjects with impaired bone health. In this study, we sought to determine if a comparable association holds true for the calcifications in the intracranial internal carotid arteries (IICA), in general and also for particular calcification patterns.
METHODS: A consecutive series of ischemic stroke patients were prospectively enrolled into the study, where computed tomography angiography source images were used to determine the presence and type of IICA calcifications, and dual-energy X-ray absorptiometry was used to determine the bone mineral density in the left femoral neck region. IICA calcifications were categorized as none, intimal, medial, and mixed types based on previously validated classification schemes. Their relationships with femoral bone T-scores were evaluated by bivariate and multivariate analyses.
RESULTS: Femoral neck T-score was highest among patients without any vascular calcifications (n=65), when compared to the bone density measures among patients with any type of calcification (n=185) (p<0.001). After adjustment for age, gender, vascular risk factors, and serum biomarkers related to bone health, the T-score remained significantly associated only with the pattern of intimal calcification [OR 0.63 (0.42 - 0.95), p=0.028].
CONCLUSIONS: Our findings suggest that the intracranial vasculature, in particular the internal carotid arteries, is not immune to the interplay between suboptimal bone health and vascular calcifications. This association was most robust for an intimal type of IICA calcification pattern, while no such relationship could be demonstrated for other types of vascular calcifications.

OBJECTIVE: To report an unusual absent right common carotid artery with embryological and clinical emphasis.
METHODS: A 63-year-old female with a multilobulated anterior communicating artery saccular aneurysm was referred to our center for definite treatment. An analysis of her carotid system on CTA and DSA with 3D modeling was performed to assess the embryology of an absent right common carotid and its association with aneurysm development.
RESULTS: Cerebral angiogram demonstrated an absent right common carotid artery and separate origin of the internal and external right carotid arteries arising from the brachiocephalic trunk.
CONCLUSIONS: Absence of the common carotid artery is an uncommon anatomical variant, usually asymptomatic and commonly associated with other vascular abnormalities. It is important to be familiar with the association between this anatomical variant given its hemodynamic stress, high risk of stroke, and aneurysm formation.

A 50-year-old male patient with a history of transcranial surgery and subsequent radiotherapy for a pituitary adenoma presented with repetitive pulsatile nasal bleeding. A right cavernous segment pseudoaneurysm was discovered on the angiogram, and the patient failed the balloon occlusion test. A Papyrus (Biotronik, Berlin, Germany) stent graft, which is approved for coronary interventions, was successfully deployed over a coaxial guiding system during the emergent treatment of the false aneurysm. The patient tolerated the procedure well and nasal bleeding did not recur after the procedure. At one-year angiographic follow-up, the stent graft was patent and there was no evidence of recanalization of the false aneurysm.

Moyamoya disease (MMD) is a cerebrovascular disorder that is predominantly observed in women of East Asian descent, and is characterized by progressive stenosis of the internal carotid artery, beginning in early childhood, and a distinctive network of collateral vessels known as \"moyamoya vessels\" in the basal ganglia. Additionally, a prevalent genetic variant found in most MMD cases is the p.R4810K polymorphism of RNF213 on chromosome 17q25.3. Recent studies have revealed that RNF213 mutations are associated not only with MMD, but also with other systemic vascular disorders, including intracranial atherosclerosis and systemic vascular abnormalities such as pulmonary artery stenosis and coronary artery diseases. Therefore, the concept of \"RNF213-related vasculopathy\" has been proposed. This review focuses on polymorphisms in the RNF213 gene and describes a wide range of clinical and genetic phenotypes associated with RNF213-related vasculopathy. The RNF213 gene has been suggested to play an important role in the pathogenesis of vascular diseases and developing new therapies. Therefore, further research and knowledge sharing through collaboration between clinicians and researchers are required.

Stylocarotid artery syndrome (SAS) is a rare variant of Eagle\'s syndrome that may lead to transient ischemic attack or stroke. The underlying pathophysiological mechanism involves compression of the internal carotid artery by an elongated styloid process (ESP), potentially resulting in vascular occlusion or dissection. An ESP exceeding 2.5 cm is deemed elongated, with a length of 3.0 cm considered clinically significant. Although the prevalence of ESP ranges from 4.0% to 7.3%, symptomatic cases are rare; symptoms are present in only approximately 4.0% of individuals with an ESP. Unlike the typical symptoms of Eagle\'s syndrome, SAS may not cause pharyngeal discomfort, the sensation of a foreign body in the throat, dysphagia, or facial pain. This absence of characteristic symptoms as well as the development of central nervous system symptoms often leads patients to seek care from neurologists instead of otolaryngologists, increasing the likelihood of misdiagnosis or underdiagnosis. We herein report a unique case of ischemic stroke caused by SAS and present a literature review on cases of SAS-associated ischemic stroke published in the past decade. The reporting of this study conforms to the CARE guidelines.

Blood blister-like aneurysms (BBAs) are rare and challenging intracranial aneurysms. They pose significant diagnostic and surgical risks due to their delicate walls. Accounting for a small percentage of intracranial aneurysms, BBAs are pathologically pseudoaneurysms, often resulting from arterial dissection, with a high tendency to rupture. This report underscores the critical nature of BBAs by reviewing a case in which subarachnoid hemorrhage caused by a BBA rupture was difficult to diagnose with conventional imaging. We highlight the efficacy of three-dimensional (3D) high-resolution vessel wall imaging (VWI) in discerning the subtle vascular abnormality of BBAs. The integration of the black-blood imaging technique within VWI provides superior contrast between the aneurysm and surrounding tissues, facilitating clearer visualization of the aneurysmal wall. The use of 3D T1-weighted imaging provides intricate details of the vessel wall including its contrast enhancement, which is crucial for a comprehensive assessment of a ruptured aneurysm. This case is consistent with the existing literature, supporting the role of VWI in the identification of ruptured BBAs, an area with limited but growing information on its diagnostic value. VWI is precise and accurate in the preoperative diagnosis of BBAs, emphasizing its potential to improve patient management and outcomes, especially in conditions with high risks of morbidity and mortality.