Background: The treatment of spheno-orbital meningiomas (SOMs) requires extensive bone resections, creating significant defects in a complex geometrical space. Bone reconstruction represents a fundamental step that optimizes long-term aesthetic and functional outcomes. In recent years, 3D printing technology has also been exploited for complex skull base reconstructions, but reports remain scarce. Methods: We retrospectively analyzed four consecutive patients who underwent SOM resection and one-step 3D PEEK customized reconstruction from 2019 to 2023. A systematic review of 3D printing customized implants for SOM was then performed. Results: All patients underwent a frontotemporal craniotomy, removal of SOM, and reconstruction of the superolateral orbital wall and pterional region. The aesthetic outcome was extremely satisfactory in all cases. No orbital implant malposition or infectious complications were documented. Eleven papers were included in the literature review, describing 27 patients. Most (23) patients underwent a single-stage reconstruction; in three cases, the implant was positioned to correct postoperative delayed enophthalmos. Porous titanium was the most used material (16 patients), while PEEK was used in three cases. Prosthesis malposition was described in two (7.4%) patients. Conclusions: Single-step reconstruction with a personalized 3D PEEK prosthesis represents a valid reconstruction technique for the treatment of SOMs with good aesthetic outcomes.

Purpose: Intraoperative neurophysiological monitoring (IONM) has become an essential tool in neurosurgery, yet its application in pediatric cerebrovascular pathology remains scarcely documented. This paper aims to evaluate current evidence regarding the use of IONM in pediatric vascular neurosurgery and to present an institutional experience with AVM and cavernoma surgery performed with intraoperative neuromonitoring. Methods: A scoping review of literature was conducted and a 13-year retrospective pediatric institutional case series was reported, including 8 AVMs and 4 cavernomas operated with IONM. Results: Only five studies met the inclusion criteria, mostly consisting of case reports or small series, confirming the paucity of literature in this field. Reported experiences consistently described IONM as useful for detecting ischemia, guiding subcortical dissection, identifying safe brainstem or cortical entry zones, and supporting functional preservation. In the institutional series, IONM enhanced surgical resection safety by guiding temporary clipping in AVMs, facilitating identification of eloquent pathways during nidus dissection, and assisting in cortico-subcortical mapping in cavernoma surgery. Conclusions: Despite limited published evidence, our institutional experience supports the value of IONM as a technically feasible and potentially useful adjunct in pediatric vascular neurosurgery. For these malformations characterized by a high degree of surgical complexity, intraoperative neuromonitoring may further expand the armamentarium available to surgeons.

Objectives: Among the spectrum of spinal injuries, Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) occupies a unique and challenging position. SCIWORA presents diagnostic and therapeutic challenges due to its broad clinical and radiological heterogeneity. While most children recover favorably with conservative treatment, a subset may require surgery based on imaging findings. The findings underscore the need for standardized diagnostic criteria, MRI-based classification systems, and evidence-based treatment algorithms to improve consistency in care and long-term neurological outcomes. Methods: A systematic search of PubMed, Cochrane, Scopus, and Embase databases was performed through June 2025 following PRISMA guidelines. Inclusion criteria encompassed studies of pediatric SCIWORA (age < 18 years) reporting demographics, clinical and radiological features, management, and outcomes. Results: Sixty studies encompassing a total of 848 pediatric patients were included. The mean patient age was 9.33 years (±2.52), with a slight male predominance. The most common trauma mechanisms were road traffic accidents (40.3%), sports injuries (22%), and falls (18.8%). MRI findings were available in 399 cases: 46% had intraneural lesions (Type IIb), 39% showed no abnormality on MRI (Type I, or “real SCIWORA”), 9% had combined lesions (Type IIc), and 6% had extraneural abnormalities (Type IIa). Neurological severity at presentation was primarily ASIA Grade A (46.25%), but follow-up data showed substantial improvement, with ASIA E (normal function) increasing to 49.78%. Overall, 66.2% of patients experienced neurological improvement, while 33.8% remained stable. Conservative treatment was employed in 95.41% of cases. Only 4.59% underwent surgery, which was typically reserved for MRI-positive lesions demonstrating spinal instability or compression. Conclusions: Pediatric SCIWORA remains an uncommon but potentially devastating injury, with an outcome highly dependent on MRI findings and initial neurological status. This systematic review aims to clarify the contemporary understanding of pediatric SCIWORA, delineating “real” SCIWORA from other SCIWORA-like entities, and synthesizing the latest evidence regarding epidemiology, mechanisms, clinical presentation, MRI findings, and management in children.

A 64-year-old patient presented with signs and symptoms of intracranial hypertension. Imaging studies revealed superior sagittal sinus thrombosis, chronic left transverse sinus (TS) thrombosis and a Cognard type IIA + B dural arteriovenous fistula (dAVF) of the left TS.^1-5 Endovascular treatment was performed through arterial (ascending pharyngeal artery) and venous injection (left TS catheterization via right jugular puncture), enabling selective transvenous closure of the fistulous point with coils and Squid liquid embolic agent. At 6-month follow-up, angiography demonstrated the development of a new Cognard type I dAVF with fistulous points at the torcular Herophili, likely due to angiogenic remodeling induced by the persistence of the TS stenosis. Given the absence of cortical venous reflux and the patient's asymptomatic status, conservative management was chosen. Subsequent angiography 6 months later showed disease progression to a Cognard type IIB, along with complete occlusion of the right TS. The torcula was still opacified by the fistula, but no longer contributed to cerebral venous drainage, which had predominantly shifted anteriorly via the lateral mesencephalic vein toward the cavernous sinus and pterygoid plexuses, and through emissary and diploic veins. Endovascular treatment via the right transjugular vein was unsuccessful due to occlusive stenosis of the distal right TS. The patient underwent microsurgical exclusion of the dAVF. The torcular was disconnected from the straight sinus using a titanium clip, and a deep arterial feeder was coagulated (Video 1). Postoperatively, the patient developed a cerebrospinal fluid leak, which resolved after ventriculoperitoneal shunt placement. This case underscores the importance of multimodal treatment options in managing complex dAVFs.