Pediatric high-grade gliomas are a devastating subset of brain tumors, characterized by their aggressive pathophysiology and limited treatment options. Among them, H3 K27-altered diffuse midline gliomas (DMG) of the brainstem stand out due to their distinct molecular features and dismal prognosis. Recent advances in molecular profiling techniques have unveiled the critical role of H3 K27 alterations, particularly a lysine-to-methionine mutation on position 27 (K27M) of the histone H3 tail, in the pathogenesis of DMG. These mutations result in epigenetic dysregulation, which leads to altered chromatin structure and gene expression patterns in DMG tumor cells, ultimately contributing to the aggressive phenotype of DMG. The exploration of targeted therapeutic avenues for DMG has gained momentum in recent years. Therapies, including epigenetic modifiers, kinase inhibitors, and immunotherapies, are under active investigation; these approaches aim to disrupt aberrant signaling cascades and overcome the various mechanisms of therapeutic resistance in DMG. Challenges, including blood–brain barrier penetration and DMG tumor heterogeneity, require innovative approaches to improve drug delivery and personalized treatment strategies. This review aims to provide a comprehensive overview of the evolving understanding of DMG, focusing on the intricate molecular mechanisms driving tumorigenesis/tumor progression and the current landscape of emerging targeted interventions.

Background: Facial synkinesis is characterized by involuntary co-contraction of facial muscles during voluntary movements, impairing both function and aesthetics following facial paralysis. It affects approximately 21% of individuals following Bell's palsy, with symptoms such as involuntary eye closure when smiling. While the pathophysiology remains unclear, therapeutic options range from conservative approaches like botulinum toxin to surgical interventions. A bibliometric analysis offers insights into research trends, key contributors, and knowledge gaps in this field. Materials & Methods: A systematic search was conducted in the Scopus database up to July 2024, identifying 100 most-cited articles on facial synkinesis. Articles were categorized as basic science (BSc), clinical (CL), or review articles, with additional data extracted on study focus, journal type, citation metrics, and authorship. Statistical analyses included Pearson's χ² and Wilcoxon rank sum tests. Results: The articles spanned 1952–2020, with the highest publication frequency in 2017. Clinical studies constituted 76%, focusing on conservative treatments (35%), diagnostics (28%), and surgical interventions (19%). Plastic surgery and ENT journals accounted for 76% of publications. The most-cited article, published in neurology (1975), investigated electrophysiologic diagnostics. Citation metrics revealed a mean citation count of 38.3 and a median publication year of 2010. The 50 newer articles demonstrated a trend toward surgical management of synkinesis. Conclusions: This bibliometric analysis highlights the evolution of research on facial synkinesis, emphasizing the predominance of clinical studies, focus on conservative treatments and gaps in basic science research. Further research is needed to fill knowledge gaps to improve outcomes for affected patients.