Surgical neurology international最新文献

{"title":"Chronic subdural hematoma: Clinical experience and recurrence risk factors in a Mexican neurosurgery residency training program.","authors":"Aurelio Ponce-Ayala, José de Jesús Gutiérrez-Baños, Rafael Mendizabal-Guerra, Mauricio Ivan Rodriguez-Pereira, Juan Carrizales-Rodriguez","doi":"10.25259/SNI_71_2025","DOIUrl":"10.25259/SNI_71_2025","url":null,"abstract":"<p><strong>Background: </strong>Chronic subdural hematoma (CSDH) recurrence remains a challenge, with risk factors still debated.</p><p><strong>Methods: </strong>A retrospective review of 185 CSDH cases surgically treated at Hospital Juárez de México (2014-2019) was conducted. Recurrence was defined as clinical deterioration with radiological re-expansion. Demographic, clinical, imaging and perioperative variables were analyzed statistically (<i>P</i> < 0.05).</p><p><strong>Results: </strong>The cohort included 145 males (78.4%) median age of 55 years. Head trauma was present in 75.7%. Hematomas were mostly chronic (69.2%), with 49.18% showing heterogeneous density. The surgical approaches used were single burr-hole (4.3%), double burr-hole (10.8%), and craniotomy (84.9%). Recurrence occurred in 16 cases (8.4%), primarily within a week. The significant risk factors for recurrence included thrombocytopenia (<130,000/uL, <i>P</i> = 0.001) and prolonged partial thromboplastin time (>38.6 s, <i>P</i> = 0.005). Craniotomy had lower recurrence (7%) than burr-holes (<i>P</i> = 0.053).</p><p><strong>Conclusion: </strong>Thrombocytopenia and coagulopathy increase recurrence risk in CSDH. Craniotomy may reduce recurrence compared to burr-hole techniques. Further studies are needed to optimize surgical management.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"181"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminated and migratory sparganosis in the central nervous system: A case report and literature review of combined spinal and intracranial involvement.","authors":"Prasert Iampreechakul, Korrapakc Wangtanaphat, Chonlada Angsusing, Sunisa Hangsapruek, Punjama Lertbutsayanukul, Nitat Kiathirannon, Samasuk Thammachantha, Adisak Tanpun, Surasak Komonchan","doi":"10.25259/SNI_146_2025","DOIUrl":"10.25259/SNI_146_2025","url":null,"abstract":"<p><strong>Background: </strong>Central nervous system (CNS) sparganosis is an exceptionally rare parasitic infection caused by the larvae of <i>Spirometra</i> species. Its migratory nature and nonspecific clinical presentation often lead to misdiagnosis, posing significant diagnostic and therapeutic challenges. While CNS involvement typically affects either the brain or spinal cord, disseminated cases involving both regions are exceedingly rare.</p><p><strong>Case description: </strong>We report the case of a 34-year-old woman who initially presented with progressive low back pain and paraparesis. She was diagnosed with spinal sparganosis following surgical resection and histopathological confirmation. Despite an uneventful postoperative recovery, she developed progressive headaches 3 years later. Magnetic resonance imaging revealed intracranial lesions, and subsequent surgery confirmed sparganosis in the cisterna magna. One year after brain surgery and ventriculoperitoneal shunt placement, the patient experienced progressive headaches accompanied by confusion. Under the initial misdiagnosis of brain abscess, she was inadvertently treated with intravenous metronidazole for 2 months, resulting in symptomatic improvement. However, a review of imaging demonstrated extensive CNS involvement, including the supratentorial, infratentorial, and upper cervical regions. In addition, there was clear evidence of parasite migration through the cribriform plate into the frontal lobe, highlighting the disseminated and migratory nature of CNS sparganosis.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic complexity and disseminated nature of CNS sparganosis, underscoring the importance of early surgical intervention and histopathological confirmation. The unexpected clinical response to metronidazole raises the possibility of its adjunctive role in symptom modulation, although its antiparasitic efficacy remains unproven. Given the risk of asymptomatic dissemination and recurrence, long-term follow-up with serial imaging is essential. Clinicians should maintain a high index of suspicion for sparganosis in endemic regions to improve diagnostic accuracy and patient outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"189"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unexpected turn: Posterior reversible encephalopathy syndrome following microsurgical resection of a brain arteriovenous malformation.","authors":"Tarek El Halabi, Mohamad El Houshiemy, Sarah Kawtharani, Bader Ali, Louna Ftouni, Houssein Darwish, Ahmad Beydoun","doi":"10.25259/SNI_88_2025","DOIUrl":"10.25259/SNI_88_2025","url":null,"abstract":"<p><strong>Background: </strong>Cerebral arteriovenous malformations (AVMs) are rare congenital vascular anomalies, often presenting with intracranial hemorrhage or seizures. Posterior reversible encephalopathy syndrome (PRES) is a distinct neurological condition characterized by vasogenic edema, primarily affecting posterior brain regions and typically associated with hypertensive crises, eclampsia, or immunosuppressive therapies. However, its occurrence following neurosurgical interventions is exceptionally rare. This case report documents the first instance of PRES following the resection of a Spetzler-Martin grade I frontal AVM, emphasizing the importance of early recognition and management of this rare complication.</p><p><strong>Case description: </strong>A 27-year-old woman underwent navigation-assisted resection of a right frontal AVM. The procedure was uneventful; however, in the immediate postoperative period, she experienced a generalized tonic-clonic seizure, agitation, dysconjugate gaze, and altered consciousness. Brain magnetic resonance imaging revealed diffuse high fluid-attenuated inversion recovery signal abnormalities in the brainstem, cerebellum, thalami, basal ganglia, and cerebral hemispheres, consistent with central PRES. The patient was managed with supportive care, resulting in a full clinical and radiographic recovery within 3 weeks. Follow-up imaging confirmed the resolution of PRES-related changes, and she remained seizure-free after antiseizure medication tapering.</p><p><strong>Conclusion: </strong>This case underscores the critical importance of early neuroimaging in evaluating unexpected postoperative neurological symptoms. Recognizing central PRES and its atypical radiographic patterns enables timely diagnosis and appropriate management, avoiding unnecessary interventions. The pathophysiology likely involves postoperative endothelial dysfunction and disrupted autoregulation. This report underscores the importance of considering PRES in postoperative neurological complications and calls for further research into its mechanisms and optimal management.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"176"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral arteriovenous malformations classification systems in comparison with Spetzler-Martin: A comparative review.","authors":"Mohamad M Assker, Ahmed M Youssef, Saeed A S Mohammed, Noor M Akar, Mohammed A Hashim, Narjis Kadhim, Noor Al-Saadi, Mostafa H Algabri, Mustafa J Shukur, Mustafa Ismail, Ahmed Muthana, Samer S Hoz","doi":"10.25259/SNI_140_2025","DOIUrl":"10.25259/SNI_140_2025","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous malformations (AVMs) are complex vascular anomalies requiring classification systems to guide treatment and predict outcomes. This review evaluates multiple AVM classification systems, including the widely used Spetzler-Martin Grading System (SMGS), emphasizing their importance in neurosurgery for improving clinical decision-making and communication.</p><p><strong>Methods: </strong>We conducted a literature search using Google Scholar, PubMed, and Scopus to gather information on AVM classification systems. Our inclusion criteria involved articles that referenced a well-established classification system with at least two components. Radiological, surgical, and clinical outcomes systematically categorized nine distinct AVM grading systems. The review focuses on comparing the advantages and limitations of different AVM classification systems to the SMGS.</p><p><strong>Results: </strong>A review of 33 articles highlights the evolution of AVM classification systems, with the SMGS as a foundation for surgical outcomes. Systems such as the Pollock-Flickinger and Pittsburgh AVM scale improve radiosurgery predictions, while Lawton-Young adds factors for surgical precision. Specialized scores refine grading for specific cases, and simplified systems like Spetzler-Ponce enhance usability in unique contexts.</p><p><strong>Conclusion: </strong>AVM classification systems, including Spetzler-Martin, Pollock-Flickinger, and Lawton-Young, provide critical insights into treatment and prognosis. While Spetzler-Martin effectively predicts surgical outcomes, systems like Lawton-Young enhance accuracy by incorporating additional factors but may face challenges in clinical application due to complexity. Continued refinement and validation are essential to improve predictive accuracy, optimize patient care, and connect research with clinical practice.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"173"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an artificial intelligence-based convolutional neural network for sellar barrier classification using magnetic resonance imaging.","authors":"Lautaro Ezequiel De Bartolo Villar, Matias Baldoncini, Alvaro Campero, Mickaela Echavarria Demichelis","doi":"10.25259/SNI_303_2025","DOIUrl":"10.25259/SNI_303_2025","url":null,"abstract":"<p><strong>Background: </strong>This study aims to develop an artificial intelligence (AI) model using convolutional neural networks and transfer learning to classify sellar barriers as strong, mixed, or weak based on magnetic resonance imaging (MRI). Accurate classification is essential for surgical planning in endoscopic endonasal approaches for pituitary adenomas, as variations in the sellar barrier can lead to complications such as cerebrospinal fluid leaks.</p><p><strong>Methods: </strong>The dataset consisted of 600 MRI images of sellar barriers obtained from coronal sections and evenly distributed among the three classes. The EfficientNetB0 architecture was employed, leveraging transfer learning to optimize performance despite the small dataset. The model was implemented and trained on Google Colab using TensorFlow, with techniques such as dropout and batch normalization to improve generalization and reduce overfitting. Performance metrics included accuracy, recall, and F1-score.</p><p><strong>Results: </strong>The AI model achieved a classification accuracy of 96.33%, with individual class accuracies of 98% for strong barriers, 95% for mixed barriers, and 96% for weak barriers. These results demonstrate the model's high capacity to accurately classify sellar barriers and identify their specific characteristics, ensuring reliable preoperative assessment.</p><p><strong>Conclusion: </strong>The proposed AI model significantly enhances the preoperative classification of sellar barriers, contributing to improving surgical planning and reducing complications. While the \"black box\" nature of AI poses challenges, integrating explainability modules and expanding datasets can further increase clinical trust and applicability. This study underscores the transformative potential of AI in neurosurgical practice, paving the way for precise and reliable diagnostics in managing pituitary lesions.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"174"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary intraosseous cavernous hemangioma of the clivus in a pediatric patient: A case report and review of the literature.","authors":"Jessica Branco, Samuel Sequeira Lemos, Vitor Oliveira, Claudia C Faria","doi":"10.25259/SNI_1125_2024","DOIUrl":"10.25259/SNI_1125_2024","url":null,"abstract":"<p><strong>Background: </strong>Primary intraosseous cavernous hemangiomas (PICH) of the skull are rare, benign, vascular tumors mainly found in adults' calvarium. Affection of the clivus has been reported, with the most frequent clinical presentation being headaches followed by cranial nerve compromise. In the pediatric population, it has only been described once and was treated with surgery and radiation.</p><p><strong>Case description: </strong>A 14-year-old previously healthy female presented with episodes of right lingual fasciculations. The investigation of these signs with brain magnetic resonance imaging (MRI) revealed a large clival contrast-enhancing lesion. The patient underwent an endoscopic endonasal biopsy. The histologic findings were consistent with the diagnosis of cavernous hemangioma. She started treatment with propranolol, with serial MRIs showing lesion stability. The last follow-up MRI, 4 years after diagnosis, revealed a mild decrease in the volume of the lesion, and she remains asymptomatic.</p><p><strong>Conclusion: </strong>We report the first clival PICH in a pediatric patient, managed without surgery and radiotherapy and treated with propranolol. We present neuro-imaging findings at diagnosis and during follow-up and a brief review of the literature on the topic.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"171"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult-onset giant mediastinal neuroblastoma.","authors":"Ali Alkhaibary, Mohammed Abdulrazaq Alharbi, Sami Khairy","doi":"10.25259/SNI_800_2024","DOIUrl":"10.25259/SNI_800_2024","url":null,"abstract":"<p><strong>Background: </strong>Neuroblastoma is a neurogenic tumor typically diagnosed in children <5 years of age. It arises from immature neural crest cells of the medulla of the adrenal gland or, less commonly, along the paravertebral sympathetic chain. We hereby report a patient with adult-onset giant mediastinal neuroblastoma.</p><p><strong>Case description: </strong>A 34-year-old female presented with mid-thoracic back pain radiating to the ribs for 1 month. The neurological examination showed decreased sensation at the left T6-T12 dermatomes. Radiological imaging revealed a giant left mediastinal paravertebral soft-tissue lesion. The patient underwent a posterolateral thoracotomy and resection of the lesion. The histopathological sections were compatible with mediastinal neuroblastoma (Differentiating subtype).</p><p><strong>Conclusion: </strong>Adult-onset neuroblastoma has been rarely reported in the literature. The present article discusses the clinicoradiological features of an adult patient with giant mediastinal neuroblastoma.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"170"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of flow-diverting stents in the treatment of ruptured intracranial artery dissections.","authors":"Muhammad Omar Afridi, Stephen Joseph Sozio, Sudipta Roychowdhury, Gaurav Gupta, Emad Nourollah-Zadeh, Hai Sun, Arevik Abramyan, Sri Hari Sundararajan","doi":"10.25259/SNI_1062_2024","DOIUrl":"10.25259/SNI_1062_2024","url":null,"abstract":"<p><strong>Background: </strong>Flow-diverting stents have rapidly become widespread as the preferred treatment for intracranial aneurysms. They function by optimizing blood flow within the parent vessel to reduce shear stress in the aneurysm, facilitating thrombus formation within the aneurysm, and providing a scaffold for endothelialization and vascular remodeling. Early literature indicates this mechanism also applies to the treatment of ruptured intracranial aneurysms and unruptured intracranial artery dissections, demonstrating favorable occlusion rates. We highlight a novel application of flow-diverting stents in the treatment of ruptured intracranial artery dissections.</p><p><strong>Case description: </strong>A retrospective chart review was performed of two adult patients suffering from ruptured middle cerebral artery dissections, in which a Flow Re-direction Endoluminal Device X (FRED X stent, Microvention^™, USA) was deployed across the dissection. Utilizing both the flow diverting and vascular remodeling properties of the FRED X stent, both patients achieved hemostasis, maintenance intraluminal patency, and ultimately resolution of hemorrhage without any treatment-related complications. Short-term follow-up revealed no bleeding recurrence.</p><p><strong>Conclusion: </strong>Flow-diverting stents show promise as a viable option for managing ruptured intracranial artery dissections. However, further prospective studies are recommended to evaluate their efficacy and long-term outcomes comprehensively.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"172"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of repetitive transcranial magnetic stimulation in traumatic brain injury: A systematic review and meta-analysis of randomized controlled trials.","authors":"Abdulsalam Mohammed Aleid, Mohmmed Saud AlShammri, Saud Nayef Aldanyowi, Awn Abdulmohsen Alessa, Abdulmonem Ali Alhussain, Abbas Al Mutair","doi":"10.25259/SNI_926_2024","DOIUrl":"10.25259/SNI_926_2024","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is an injury resulting from external force exerted directly or indirectly on the skull. This is presently the major cause of mortality and disability among youth globally. Repetitive transcranial magnetic stimulation (rTMS) was proposed for the treatment of various neurological disorders such as TBI. We conducted the current systematic review and meta-analysis to investigate the efficacy of rTMS in TBI patients.</p><p><strong>Methods: </strong>We conducted our database searching on PubMed, Scopus, and Web of Science from inception till August 2024 to look for articles that fulfil our aim. The search strategy was based on two main keywords: \"Transcranial magnetic stimulation\" AND \"Traumatic brain injury.\" We conducted the pooled analysis of continuous variables using standardized mean difference (SMD) due to difference in measurement scales.</p><p><strong>Results: </strong>Seven randomized controlled trials were included. A statistically significant improvement in cognitive function was observed after rTMS compared to control group with SMD of 0.7 (95% confidence interval [CI]: 0.25, 1.14, <i>P</i> = 0.002) with non-significant heterogeneity, and pain with SMD of -0.57 (95% CI: -1.02, -0.11, <i>P</i> = 0.01), I² = 64%, <i>P</i> = 0.04. However, no difference was observed between the two groups regarding depression with SMD of -0.1 (95% CI: -0.54, 0.35, <i>P</i> = 0.67).</p><p><strong>Conclusion: </strong>The use of rTMS is associated with improved cognitive functions and reduction in pain. No effect was observed regarding depression but future studies are still warranted in this important clinical field.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"175"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical insights: A comprehensive anatomical study of Heubner's recurrent artery.","authors":"Gervith Reyes Soto, Julio Cesar Pérez Cruz, Vladimir Nikolenko, Andreina Rosario Rosario, Tshiunza Mpoyi Chérubin, Abuzer Güngör, Carlos Castillo Rangel, Manuel De Jesus Encarnacion Ramirez","doi":"10.25259/SNI_81_2025","DOIUrl":"10.25259/SNI_81_2025","url":null,"abstract":"<p><strong>Background: </strong>The recurrent artery of Heubner (RAH) was first described by Johann Heubner in 1872 and later named by H.F. Aitken in 1909. It is the largest medial lenticulostriate artery from the anterior cerebral artery (ACA). Originating from the A1, A2, or ACA-anterior communicating artery junction, it supplies key brain structures like the caudate nucleus and anterior hypothalamus, with variations in origin and course among individuals.</p><p><strong>Methods: </strong>We studied 15 human brains (5 females and 10 males), ensuring no neurological disease or damage to the anterior communicating complexes. Brains were fixed in 10% formalin for a month and then injected with red-colored latex for vascular visualization. Dissections were performed using a Zeiss OPMI surgical microscope, and detailed notes and images were captured for analysis.</p><p><strong>Results: </strong>RAH was identified in 28 of 30 hemispheres, with 11 exhibiting double arteries. RAH origin is located approximately 1-4 mm from the anterior communicating artery (ACOM). The most common origins were the juxtacommunicating, A2, and A1 segments. Trajectories observed included \"L,\" inverted \"L,\" oblique, and sinuous, with oblique being the most common. Variations included the absence of RAH replaced by an accessory middle cerebral artery in some cases.</p><p><strong>Conclusion: </strong>The RAH shows significant anatomical variability, originating from different ACA segments or the frontopolar artery, with four main trajectory types. Understanding these variations is critical for neurosurgical planning, as preserving the RAH can prevent neurological deficits. Gender differences in origin and trajectory were noted, influencing surgical approaches and outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"158"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}