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Serdar Özgen, T. Glenn Pait and Y. Şsükrü ÇağLar

Object. The goal of this study was to demonstrate the origins, courses, anastomoses, and target tissues of the arterial branches that arise from the V2 segment of the vertebral artery.

Methods. Ten adult cadaveric necks (20 V2 segment specimens) were examined (magnification × 40) after injection of colored silicon. The branches at each cervical level were classified in a new system according to anatomical features and target tissues—anterior, posterior, medial, and lateral. Incidence with which each branch category was observed at each cervical level was calculated.

Anterior branches were observed at C-3 in all 20 V2 segment specimens. The incidence with which the posterior branch was present at C-4 was 45%, whereas the corresponding rates at segments superior and inferior were lower. The medial V2 segment branches were assessed in four subcategories. The anterior spinal artery was present at C-3 in all specimens, whereas the mean incidence at the C4–6 level was 46.7%. The posterior spinal artery was most frequently detected at C-3 (60%). The anterior radicular artery (RA) was present at C-5 in 50% of the specimens, whereas the posterior RA was detected at C-5 in only 35%. Lateral branches were most frequently detected at C-3.

Conclusions. The authors provide detailed anatomical information about the origins, courses, anastomoses, and target tissues of the vessels that arise from the V2 segment. This new classification allows for better understanding of the vasculature of the C3–6 region.

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Serdar Ozgen, Burak O. Boran, Ilhan Elmaci, Ugur Ture and M. Necmettin Pamir

Subarachnoid–pleural fistula is a rare type of cerebrospinal fluid (CSF) fistula, and there are only several cases reported in the literature. The authors describe a 65-year-old male patient in whom a diagnosis of T7–8 disc herniation had been made. He underwent surgery via a right lateral extracavitary approach. Postoperatively he developed progressive respiratory distress and headache. A chest x-ray film revealed a pleural effusion, and computerized tomography (CT) myelography demonstrated a subarachnoidal-pleural fistula at the level at which the herniated disc had been removed. The patient had been managed via a CSF drainage system and a chest tube. He was discharged after relief of symptoms was attained. Subarachnoid–pleural fistulas can be secondary to traumatic injury and surgery, or they can be spontaneous. Patients present with rapidly filling pleural effusion and headache. A diagnosis can be established using CT myelography or myeloscintigraphy. Treatment is conservative, with the placement of a chest tube and insertion of a CSF drainage catheter, and surgical repair should be considered only if the conservative therapy fails.

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Serdar Özgen, Nigar Baykan, I. Varlik Dogan, Deniz Konya and M. Necmettin Pamir

In this report the authors present a case of cauda equina syndrome that developed following induction of spinal anesthesia in a patient who had no apparent preexisting bleeding abnormality. An acute subdural hematoma caused the syndrome and was believed to have resulted from direct vascular trauma during administration of spinal anesthesia or from vascular trauma combined with thrombocytopenia in the postoperative period.

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İlhan Elmacı, Adnan Dağçinar, Serdar Özgen, Gazanfer Ekinci and M. Necmettin Pamir

Diastematomyelia, or split cord malformation, a complete or incomplete sagittal division of the neural axis into halves, is seen in association with many other congenital anomalies. Among these anomalies, intradural spinal teratoma is extremely rare. Diastematomyelia is a well-recognized although unusual clinical syndrome in children, but it is rarely reported in the adult. The authors describe a 42-year-old man who presented with pain and distal left-leg weakness as well as neurogenic claudication for 1 month. The patient underwent radiological examinations, and diastematomyelia and an intradural lumbar teratoma were diagnosed. He underwent surgery and was followed for 1 year. This is the fourth case of an adult who simultaneously presented with diastematomyelia and an intradural teratoma.