Chirurgia最新文献

{"title":"Anastomotic Fistula After Upper Gastric Resection for Incarcerated Hiatal Hernia, Successfully Managed via Endoscopic Approach: A Case Report.","authors":"Zharko Spasovski, Maja Avramovska, Stefan Krstevski, Petar Avramovski, Kosta Sotiroski, Stefan Talev, Bozidar Blazevski, Vladimir Stojkovski, Liljana Todorovska, Svetlana Stefanovska, Elena Aleksoska, Elena Ginovska","doi":"10.21614/chirurgia.3417","DOIUrl":"https://doi.org/10.21614/chirurgia.3417","url":null,"abstract":"<p><strong>Introduction: </strong>Acute incarcerated hiatal hernia with gastric perforation is rare and life-threatening condition. The clinical presentation is often atypical, which can delay diagnosis and contribute to high mortality from secondary mediastinitis and peritonitis.</p><p><strong>Case report: </strong>We present the case of a 71-year-old woman initially admitted with suspected acute coronary syndrome. The onset of melena, together with findings on gastroscopy and computed tomography, revealed an incarcerated hiatal hernia with gangrene and perforation of the proximal stomach. Emergency proximal gastrectomy was performed, together with extensive lavage of the abdominal and mediastinal cavities. The postoperative course was complicated by a development of a gastrocutaneous fistula on postoperative day 20, which was successfully managed with endoscopic clip placement. The patient required 31 days of intensive care before being discharged in good general condition.</p><p><strong>Conclusion: </strong>This case underscores the value of a multidisciplinary approach, demonstrating that endoscopic management can provide a feasible alternative to high-risk reoperation for postoperative fistula in a septic patient. Five-year follow-up showed a favorable long-term outcome.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 Ahead of print","pages":"1-7"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Therapy Selection for High-Risk Stage II Colon Cancer.","authors":"Horia Teodor Cotan, Cristina Maria Orlov-Slavu, Alexandra Lazar, Cornelia Nitipir","doi":"10.21614/chirurgia.3196","DOIUrl":"https://doi.org/10.21614/chirurgia.3196","url":null,"abstract":"<p><strong>Background/objectives: </strong>The benefit of adjuvant chemotherapy in high-risk, microsatellite stable (MSS) stage II colon cancer remains controversial. Current guidelines rely primarily on histopathologic risk features, but systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) may provide additional prognostic insight. This study aimed to evaluate the role of preoperative NLR in predicting disease-free survival (DFS) and guiding treatment selection between oxaliplatin-containing and fluoropyrimidine monotherapy regimens.</p><p><strong>Methods: </strong>We retrospectively analyzed 57 patients with high-risk stage II MSS colon cancer who underwent curative resection between 2013 and 2023. Patients were stratified by preoperative NLR (<3 vs. >=3) and received either fluoropyrimidine monotherapy or an oxaliplatin-based regimen (FOLFOX or CAPEOX). Multivariate Cox regression and Kaplan-Meier survival analyses were performed to assess recurrence risk and treatment outcomes.</p><p><strong>Results: </strong>An NLR >= 3 was independently associated with increased recurrence risk (HR: 3.22, 95% CI: 1.97â?\"4.57, p=0.001). Among patients with high NLR, those treated with oxaliplatin-based regimens had a longer median DFS (81 vs. 67 months) compared to monotherapy. In contrast, NLR <3 patients showed excellent outcomes regardless of treatment choice. No grade 4 toxicities were reported.</p><p><strong>Conclusions: </strong>Preoperative NLR is a strong and independent prognostic marker in high-risk stage II MSS colon cancer. Patients with high NLR appear to benefit more from oxaliplatin-containing adjuvant chemotherapy, potentially due to its immunogenic effects. NLR may serve as a simple, cost-effective tool for refining adjuvant therapy decisions in this challenging patient population.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 Ahead of print","pages":"1-10"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Giant Cystic Ectopic Parathyroid Adenoma of the Anterior Mediastinum Mimicking a Mediastinal Tumor: A Diagnostic Challenge.","authors":"Irida Pano, Vasileios Leivaditis, Chrysa Andrikopoulou, Elias Liolis, Christos Sachpekidis, Dimitrios Apostolopoulos, Vasiliki Androutsopoulou, Konstantinos Nikolakopoulos, Ioannis Panagiotopoulos, Artemisia Papadima, Zafeiria Papathanassiou, Efstratios Koletsis, Francesk Mulita","doi":"10.21614/chirurgia.3298","DOIUrl":"https://doi.org/10.21614/chirurgia.3298","url":null,"abstract":"<p><strong>Background: </strong>Ectopic parathyroid adenomas represent an uncommon but clinically significant cause of primary hyperparathyroidism, particularly when located in the mediastinum. Their diagnosis may be challenging, especially in the presence of concomitant thyroid pathology, which can obscure imaging interpretation and lead to misleading localization studies.</p><p><strong>Case presentation: </strong>We report the case of a 63-year-old man who presented with persistent hoarseness and was found to have marked hypercalcemia and elevated parathormone levels consistent with primary hyperparathyroidism. Neck ultrasonography demonstrated multinodular goiter, while dual-tracer technetium-99m pertechnetate and technetium-99m sestamibi scintigraphy with SPECT/CT suggested a functional thyroid adenoma and raised suspicion for a possible parathyroid lesion within the thyroid gland. Fine-needle aspiration with parathormone washout did not confirm an intrathyroidal parathyroid origin. Subsequent cross-sectional imaging revealed a large cystic mass in the anterior superior mediastinum compressing adjacent structures. After medical stabilization with cinacalcet, the patient underwent surgical excision through a right axillary thoracotomy. Intraoperative and biochemical findings confirmed the lesion as the source of excessive parathormone secretion. Histopathological and immunohistochemical examination established the diagnosis of a cystic ectopic parathyroid adenoma. Postoperatively, serum calcium and parathormone levels normalized, and the patient remained free of biochemical evidence of recurrent disease during the available follow-up period.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic complexity of mediastinal ectopic parathyroid adenomas, particularly in patients with coexisting multinodular goiter and inconclusive scintigraphic findings. Clinicians should maintain a high index of suspicion for ectopic parathyroid tissue in cases of unexplained hyperparathyroidism with negative or discordant cervical imaging, as accurate localization is critical for definitive surgical management.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 eCollection","pages":"1-11"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment and Decision-Making in Complex Limb Fracture Management: Limb Salvage Versus Primary Amputation.","authors":"Adele Zacken, Kayaththery Varathan, Yasmin A Sheikey, Uzair Khan, Diana Sabbagh, Ayman El-Zanaty","doi":"10.21614/chirurgia.3390","DOIUrl":"https://doi.org/10.21614/chirurgia.3390","url":null,"abstract":"<p><strong>Background: </strong>Complex limb injuries present a major challenge in trauma and orthopaedic practice due to the severity of tissue damage and the complexity of treatment decisions. Determining whether limb salvage or primary amputation provides the optimal outcome remains controversial.</p><p><strong>Methods: </strong>A structured narrative review was conducted using PubMed, Embase, and Scopus, including studies published between 2008 and 2026, with the literature search performed between October 2025 and February 2026. Keywords included \"limb salvage\", \"primary amputation\", \"mangled extremity\", and \"MESS\" Studies evaluating injury severity scoring systems and clinical outcomes were included.</p><p><strong>Results: </strong>Injury severity scoring systems demonstrated limited predictive accuracy, with MESS sensitivity ranging from 46â?\"72% and specificity between 70 84%. The Lower Extremity Assessment Project (LEAP) study reported comparable functional outcomes between limb salvage and amputation at two-year follow-up. Both approaches were associated with high complication rates, with limb salvage often requiring multiple procedures and prolonged recovery.</p><p><strong>Conclusion: </strong>Injury severity scoring systems should not be used in isolation. Decision-making should prioritise functional outcomes, multidisciplinary assessment, and patient-centred factors within the context of modern reconstructive and rehabilitation advances.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 Ahead of print","pages":"1-7"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Presentation of Synchronous Accessory Breast Carcinoma in Abdominal Wall - A Case Report and Review of the Literature.","authors":"Fatima Arab, Tessa Walton, Caroline Brodie, Michaela Larkin, Aoife Lowery","doi":"10.21614/chirurgia.3385","DOIUrl":"https://doi.org/10.21614/chirurgia.3385","url":null,"abstract":"<p><p>Primary malignancy in accessory breast tissue is an infrequent diagnosis representing less than 1% of all breast cancers and most commonly presents with a palpable mass in the axilla. Furthermore, a concurrent second primary breast cancer found in accessory breast tissue is an extremely rare phenomenon, although reports of these are on the rise. Extra-mammary sites where second primary breast malignancies have been reported include the inframammary fold, the abdomen and even the vulva. When an ectopic immunobreast malignancy is suspected, triple assessment is the standard approach to investigation. However, there are no specific treatment guidelines, and it therefore follows the same guidelines as for pectoral breast cancer. Here, we present a report of a 71-year-old female being treated for a left breast cancer, diagnosed with a concurrent second primary breast carcinoma in the right upper quadrant of the abdominal wall, which was surgically managed with wide local excision and sentinel lymph node biopsy. This case highlights the importance of maintaining a high index of suspicion during assessment of these patients in order to establish the correct diagnosis at an early stage.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 Ahead of print","pages":"1-6"},"PeriodicalIF":1.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency and Semi-Elective Surgical Presentations after Bariatric Surgery at a Regional Non-Index Center: A Real-World Descriptive Group.","authors":"Răzvan Dragoș Boșneagu, Eugen Dumitru, Răzvan Cătălin Popescu, Andrei Dumitru, Adriana Nicoleta Butcaru-Pundiche, Teodor Ștefan Nițu, Irina Nițu, Cornelia Minodora Olteanu, Andrei Cristian Ghioldiș, Mihaela Pundiche","doi":"10.21614/chirurgia.3381","DOIUrl":"https://doi.org/10.21614/chirurgia.3381","url":null,"abstract":"<p><strong>Background: </strong>Post-bariatric complications increasingly reach emergency centers that did not perform the index operation, but real-world data from non-index receiving centers are scarce.</p><p><strong>Methods: </strong>Retrospective, descriptive, episode-level study at a regional emergency center performing no bariatric surgery. We included 45 keyword-identified emergency or semi-elective presentations (March 2021-May 2025) of patients operated elsewhere, recording demographics, index procedure, operation-to-presentation interval, workup, management, diagnosis, and short-term outcomes.</p><p><strong>Results: </strong>Of 45 episodes (33 emergency, 12 semi-elective), 73% involved women; median age 44 years, median BMI 36 kg/m²; SG was the index procedure in 84% (sleeve-type anatomy 89%). The interval exceeded 90 days in 56%. The spectrum was led by biliary/pancreatic disease (27%; 9 of 12 semi-elective), foregut leak/fistula (16%), obstruction/hernia (16%) and foregut stenosis/mucosal/reflux-like disease (22%). Invasive management was used in 80%, intensive care in 20%; 11 episodes (24%) met the severe-course composite and 7 (16%) the narrower high-acuity definition, all in the emergency stream. One in-hospital death occurred (2.2%).</p><p><strong>Conclusions: </strong>The cohort showed two streams: a predominantly biliary, semi-elective stream, invasive but without severe clinical course, and an acute stream carrying all observed severity. Reflux-like symptoms after bariatric surgery may mask structural disease. These proportions describe referral case mix, not incidence.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"394-403"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Indocyanine Green Fluorescence Imaging in Thyroid Surgery: Technical Protocol, Evaluation Window and Interpretation Pitfalls - Single-Centre Experience in a Prospective Series of 42 Cases.","authors":"Dana-Roxana Boanță, Mihaela Mișcă, Valentin Titus Grigorean, Victor Dan Eugen, Iulian Brezean","doi":"10.21614/chirurgia.3337","DOIUrl":"10.21614/chirurgia.3337","url":null,"abstract":"<p><strong>Background: </strong>Postoperative hypoparathyroidism remains the most frequent complication of total thyroidectomy (20-40% transient, 1-4% permanent). Intraoperative NIR imaging with indocyanine green (ICG) is validated for parathyroid gland (PG) perfusion assessment - recognized in the EAES 2023 consensus - but data on practical implementation, temporal parameters and interpretation pitfalls remain limited.</p><p><strong>Aim: </strong>To describe the ICG technical protocol with the Karl Storz IMAGE1 S™ Rubina® system, to quantify the evaluation window (tev) and to systematize the interpretation pitfalls encountered.</p><p><strong>Materials and methods: </strong>Prospective, observational, single-centre study (retrospective analysis of prospectively collected data; enrolment dependent on the intraoperative availability of the ICG preparation, therefore not strictly consecutive), including 42 cases in which intraoperative ICG was used during thyroid surgery (37 women, 5 men; mean age 52.6 years; BMI 27.5 kg/m²), performed between February 2024 and February 2025. Uniform protocol: 5 mg ICG IV (2.5 mg/mL) at approximately 66% of the estimated skin-to-skin time; Vidal Fortuny score (0/1/2). Parameters: time of injection (tinj), fluorescence onset (tf) and ICG evaluation window (tev, from injection to score notation and resumption of surgery).</p><p><strong>Results: </strong>Operative time (tOR): 88.6 +- 30.2 min. Fluorescence onset (tf): 37.5 +- 5.2 sec. ICG evaluation window (tev): 6.4 +- 2.3 min overall; 5.2 +- 1.8 min in standard cases vs 7.8 +- 2.0 min in complex cases (p<0.05). First 21 vs last 21 cases: tev 7.7 vs 5.1 min (D = - 2.6 min; p<0.05). Re-injection in 8/42 cases (19.0%). Perfusion scores: 64.3% score 2, 32.1% score 1, 3.6% score 0. Zero adverse reactions, zero permanent recurrent laryngeal nerve palsy.</p><p><strong>Conclusions: </strong>In this series, NIR/ICG imaging with the Karl Storz IMAGE1 S™ Rubina® system proved feasible and safe. The tev parameter (mean 6.4 min) objectively quantifies the efficiency of the assessment and reflects consolidation of the operator's technique after 15 20 cases. The four documented interpretation pitfalls and the re-injection protocol (19.0%) may provide a replicable technical framework for centres implementing this technology.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"445-452"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare-Associated Infections in General Surgery: Surveillance, Audit, and Evidence-Based Prevention Across the Perioperative Pathway.","authors":"Lucian Ambrosie, Petru Radu Soroceanu, Alin Constantin Pînzariu, Mădălina Maxim, Vlad Ionuț Vlăsceanu, Bogdan-Mihnea Ciuntu, Raoul-Vasile Lupușoru, Gheorghe Bălan, Ioan-Adrian Ciureanu, Ioana Silistraru, Daniel Vasile Timofte","doi":"10.21614/chirurgia.3386","DOIUrl":"10.21614/chirurgia.3386","url":null,"abstract":"<p><p>Healthcare-associated infections (HAIs) remain an important patient-safety problem, and surgical site infection (SSI) is a clinically relevant and measurable perioperative outcome in general surgery. Observed SSI incidence depends on the surveillance definition and the intensity of case finding; approaches restricted to the index admission may miss infections diagnosed after discharge. This structured narrative review critically synthesises current guidance and selected evidence on HAI definitions, surveillance, audit, antimicrobial resistance, and perioperative prevention, with emphasis on general surgical practice. Priority is given to interventions supported consistently by contemporary guidelines and evidence syntheses: appropriate antimicrobial prophylaxis, alcohol-containing skin antisepsis, avoidance of peri-operative hypothermia, aseptic practice, antimicrobial stewardship, and post-discharge case finding. Care bundles can reduce SSI, but their effect depends on the interventions included, adherence, and context; current evidence does not show that larger bundles are inherently more effective. A concise audit dashboard and an adaptable perioperative prevention bundle are proposed. Digital surveillance and artificial intelligence may reduce surveillance workload, but current evidence supports their use as adjuncts requiring local validation and human case confirmation rather than as replacements for established surveillance systems.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"463-471"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolomic Profiling of Plasma Bile Acids in Resectable Gastric Cancer.","authors":"Ștefan Ursu, Răzvan Alexandru Ciocan, Cristina-Paula Ursu, Radu-Cristian Moldovan, Florin Zaharie, Zeno Spârchez, Tudor Moisoiu, Alexandra-Iulia Bărăian, Rodica Sorina Pop, Cătălin Ioan Bodea, Cristina-Adela Iuga, Claudia Diana Gherman, Nadim Al Hajjar","doi":"10.21614/chirurgia.3314","DOIUrl":"https://doi.org/10.21614/chirurgia.3314","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer (GC) is characterized by late-stage diagnosis and a lack of reliable non-invasive biomarkers. This study aims to investigate the plasma bile acid (BA) profile to enhance the understanding of GC metabolism and identify potential diagnostic and prognostic tools.</p><p><strong>Methods: </strong>In a case-control design, 62 GC patients (stages Iâ?\"III) and 70 matched controls were recruited. Using liquid chromatography-tandem mass spectrometry (LC-MS/MS), the concentrations of 48 metabolites in plasma were measured. Statistical analysis included univariate tests, principal component analysis, and linear discriminant analysis (LDA).</p><p><strong>Results: </strong>GC patients showed a significantly lower CA/CDCA ratio and alterations in secondary and conjugated bile acids, including TLCA, GLCA, TDCA, GDCA, and GUDCA, suggesting involvement of the gutâ?\"liverâ?\"microbiome axis. The ability to distinguish between groups was moderate (AUC = 0.731). Furthermore, BA levels were negatively correlated with tumor stage, tumor size, and systemic inflammatory markers (CRP, mGPS), while they were positively correlated with nutritional and hematological markers such as albumin and hemoglobin.</p><p><strong>Conclusions: </strong>Gastric cancer is associated with a distinct circulating BA profile that reflects not only tumor-related metabolic remodeling, but also systemic inflammation, nutritional status, and disease burden. The reduced CA/CDCA ratio and alterations in secondary and conjugated bile acids support the involvement of the gut-liver-microbiome axis in GC biology. Although BA profiling alone showed moderate diagnostic performance, its integration with conventional tumor markers, inflammatory indices, and clinico-pathological parameters may improve multimodal biomarker panels for non-invasive patient stratification, disease assessment, and future prognostic evaluation.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"383-393"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological Variability of the P1 Segment of the Posterior Cerebral Artery: An Anatomical and Angiographic Study with Clinical Correlations.","authors":"Ionuț Bulbuc, Constantin Dina, Constantin Ionescu, Andrei Rusali, Bogdan Marian Caraban","doi":"10.21614/chirurgia.3336","DOIUrl":"https://doi.org/10.21614/chirurgia.3336","url":null,"abstract":"<p><strong>Purpose: </strong>The precommunicating (P1) segment of the posterior cerebral artery (PCA) is a short but clinically important arterial segment whose calibre, length and perforator distribution influence posterior circulation haemodynamics, thalamo-mesencephalic ischaemia and the management of posterior communicating artery (PComA) aneurysms. The aim of this study was to characterize the morphology of the P1 segment in a combined anatomical and angiographic series and to discuss the findings in relation to their clinical implications for radiological interpretation and neurovascular procedures.</p><p><strong>Methods: </strong>A total of 320 cases were evaluated: 20 formalin-fixed brain specimens (10 plastic-injected), 120 CT angiographies (CTA) and 180 MR angiographies (MRA). P1 length, P1 calibre, rightâ?\"left symmetry, hypoplasia, agenesis, fenestration, fetal-type PCA configuration, posteromedial perforator pattern and superior cerebellar artery (SCA) origin were recorded. Quantitative morphometric measurements were performed only on the angiographic datasets. Measurements were reviewed independently by two senior radiologists with consensus adjudication. Rightâ?\"left morphometric comparisons were performed with the Mannâ?\"Whitney U test on independent samples, because individual case identifiers were not available to support paired analysis.</p><p><strong>Results: </strong>Mean P1 length was 7.57 +- 2.24 mm on the right (n = 255) and 7.38 +- 2.19 mm on the left (n = 254). Mean P1 calibre including hypoplastic segments was 1.87 +- 0.59 mm on the right and 1.86 +- 0.57 mm on the left. P1 hypoplasia (calibre < 1 mm) was observed in 51 cases (15.9 %), P1 agenesis in 6 (1.9 %) and P1 fenestration in 3 (0.9 %). Five posteromedial perforator patterns were described using an exploratory framework proposed in this study, with asymmetric patterns representing 59.4 % of cases and an artery of Percheron pattern in 5 cases (1.6 %). The SCA arose from P1 in 25 cases (7.8 %), including 3 contralateral origins.</p><p><strong>Conclusion: </strong>P1 length and mean calibre were broadly symmetric between sides, but clinically relevant variants - hypoplasia, agenesis, fenestration, fetal-type PCA, asymmetric perforator patterns, artery of Percheron, and SCA origin from P1 - were frequent enough to support systematic reporting of the P1-PComA complex on CTA and MRA. The proposed perforator scheme is exploratory and requires external clinical-radiological validation.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"432-444"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}