IntroductionUnruptured intracranial aneurysms (UIAs) are frequently detected in noninvasive imaging studies such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA). If small, UIAs are observed in these modalities in order to detect growth or shape change, but there are many questions about proper protocol of the follow-up.AimTo assess changes of small (< 7 mm) UIAs dome size and shape in repeated CTA studies as predictors of growth and rupture.Material and methodsOne hundred and ten UIAs (10 posterior circulation) in 70 patients (55 women) were observed, with a cumulative observation time of 333.32 years. Aneurysms’ dome and neck perpendicular dimensions were measured in the first and the last CTA study at least twice with the developed application. Confidence intervals (CI) for measurements and dome shape parameters were calculated. For aneurysms ruptured during follow-up intermediate studies were analyzed. Patients’ clinical information was recorded. The aneurysm growth detection algorithm integrated CI and spatial resolution of the CT scanner.ResultsTwenty-three aneurysms increased in volume, 10 in height and 14 in dome width. Volume increased in 90% of cases of height and 93% of width increase. Posterior circulation aneurysms grew faster than anterior ones (p < 0.003), but calculated time to significant size increase (eT) did not differ between the groups due to higher CI in the posterior circulation. Analysis of eT with Kaplan-Meier curves showed that 75% of growing aneurysms could be detected in the first 3 years of observation. During the follow-up 3 aneurysms bled, and they grew faster than other growing aneurysms. Two of the bleeding aneurysms formed daughter sacs.ConclusionsDome volume assessment is superior to single dimension assessment in aneurysm growth detection. Confidence intervals assessment helps to avoid overestimation of growth. Seventy-five percent of growing aneurysms could be detected in the first 3 years of observation. Daughter sac formation and fast increase in size are strong predictors of aneurysm rupture.

Due to their anatomical location, occipital condylar fractures (OCFs) are usually not observed during traditional autopsies and are therefore considered a rare injury. The aim of this study was to determine the true frequency of OCFs using post-mortem computed tomography (PMCT) in traumatic casualties. We retrospectively analyzed 438 PMCT studies of victims of traffic accidents, falls from height, violence, and low-energy head injuries (324 males and 114 females). OCFs were present in 22.6% of cases ( n = 99), mostly in victims of railway accidents (48.5%, n = 17), falls from height (26.6%, n = 29), cyclists (24%, n = 6), and pedestrians hit by cars (22.5%, n = 29). Isolated OCFs were found in 5.5% of cases ( n = 24), most often in cyclists (12%, n = 3) and pedestrians (9.3%, n = 12) hit by cars. There were no OCFs in the cases of fatalities caused by violence or accidental low-energy head injury. PMCT scans revealed that OCFs are common in high-energy injury fatalities and can be useful for determining the mechanism of trauma more precisely.

BackgroundThe geometry of the vessels is easy to assess in novel 3D studies. It has significant influence on flow patterns and this way the evolution of vascular pathologies such as aneurysms and atherosclerosis. It is essential to develop robust system for vascular anatomy measurement and digital description allowing for assessment of big numbers of vessels.MethodsA semiautomatic, robust, integrated method for vascular anatomy measurements and mathematical description are presented. Bezier splines of 6th degree and continuity of C3 was proposed and distribution of control points was dependent on local radius. Due to main interest of our institution, the system was primarily used for the assessment of the geometry of the intracranial arteries, especially the first Medial Cerebral Artery division.Results1359 synthetic figures were generated: 381 torus and 978 spirals. Experimental verification of the proposed methodology was conducted on 400 Middle Cerebral Artery divisions.ConclusionsIn difference to other described solution all proposed methodology steps were integrated allows analysis of variability of geometrical parameters among big number of Medial Cerebral Artery bifurcations using single application. This allows for determination of significant trends in the parameters variability with age and in contrary almost no differences between men and women.

Our results can help harmonize standards for MT in Poland according to international guidelines.

IntroductionThe ongoing need for dural tenting sutures in a contemporary neurosurgical practice has been questioned in the literature for over two decades. In the past, these sutures were supposed to prevent blood collecting in the potential space between the skull and the dura by elevating the latter. Theoretically, with modern haemostasis and proper postoperative care, this technique should not be necessary and the surgery time can be shortened. Unfortunately, there is no evidence-based proof to either support or reject this hypothesis.Methods and analysisThe systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and The Cochrane Handbook for Systematic Reviews of Interventions. Eight electronic databases of peer-reviewed journals will be searched, as well as other sources. Eligible articles will be assessed against inclusion criteria. The intervention is not tenting the dura and this will be compared with the usual dural tenting sutures. Where possible, ‘summary of findings’ tables will be generated.Ethics and disseminationEthical committee approval is not required for a systematic review protocol. Findings will be presented at international neurosurgical conferences and published in a peer-reviewed medical journal.PROSPERO registration numberCRD42018097089.