Post-traumatic cerebral venous sinus thrombosis (ptCVST) often remains underdiagnosed due to the non-specific nature of clinical signs, commonly mimicking severe traumatic brain injury (TBI) manifestations. Early recognition of this rare and potentially life-threatening complication is crucial for the effective management of severe TBI patients in Intensive Care. The present study reports the case of a 66-year-old male who was transferred to the emergency department due to moderate TBI. Initial emergency brain computed tomography (CT) scans revealed certain traumatic lesions, not necessitating any urgent neurosurgical intervention. During his stay in an Intensive Care Unit (ICU), multiple transient episodes of intracranial pressure (ICP) values were managed conservatively, and through placement of an external ventricular drain. Following a series of CT scans, there was a continuous improvement of the initial traumatic hemorrhagic findings despite his worsening clinical condition. This paradox raised suspicion for ptCVST, and a brain CT venography (CTV) was carried out, which showed venous sinus thrombosis close to a concomitant skull fracture. Therapeutic anticoagulant treatment was administered. The patient was discharged with an excellent neurological status. To date, there are no clearly defined guidelines for medical and/or surgical management of patients presenting with ptCVST. Therapy is mainly based on intracranial hypertension control and the maintenance of normal cerebral perfusion pressure (CCP) in the ICU. The mismatch between clinical and imaging findings in patients with TBI and certain risk factors raises the suspicion of ptCVST.

An arteriovenous shunt involving the cavernous sinus can be a direct carotid-cavernous fistula (CCF; in which the internal carotid artery communicates with

Decompressive craniectomy (DC) is a vital intervention for severe traumatic brain injury (TBI), especially in refractory intracranial hypertension. While effective in lowering intracranial pressure (ICP), its impact on long-term functional outcomes and survival with disability remains debated. This study aimed to analyze clinical outcomes for TBI patients who underwent DC at a Greek tertiary hospital and identify prognostic factors. This retrospective study included 144 patients who underwent DC from 2014 to 2024. Univariate analyses evaluated associations with early and late outcomes and in-hospital mortality. Exploratory multivariable logistic regression models were also constructed. The mortality rate was 41%, with 32.4% of patients achieving a favorable early outcome and 31.4% achieving a favorable late outcome. Both age and initial neurological status were significantly associated with early and late outcomes (p ≤ 0.01). Abnormal pupillary response was significantly associated with unfavorable outcome and in-hospital mortality in a univariate analysis. In exploratory multivariable models, older age and lower Glasgow Coma Scale–Pupils (GCS-P) scores were independently associated with unfavorable early and 12-month outcomes and in-hospital mortality. Treatment during the coronavirus disease 2019 (COVID-19) pandemic period was associated with higher in-hospital mortality, an association that may reflect pandemic-related healthcare system pressures rather than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Larger multicenter studies are needed to develop and validate reliable prognostic models.

Background/Objectives: Intracranial arachnoid cysts (ACs) may be congenital, primary, or secondary due to trauma. These cysts are benign, contain cerebrospinal fluid (CSF), and are classified based on location, size, and their clinical symptomatology. They are uncommon lesions in children, rarely leading to severe mass-effect neurological symptomatology. Methods: The present report describes a 30-month-old female presenting with quadriparesis. An emergency magnetic resonance imaging (MRI) study revealed the presence of a primary intracranial arachnoid cyst of the posterior cranial fossa, exerting significant pressure on the medulla oblongata and the cervical portion of the spinal cord, displacing them dorsally, with a remnant diameter of 2.5 mm. Results: This benign malformation located in a crucial area might have been complicated by severe neurological deterioration and required prompt intervention, so the patient underwent a suboccipital craniectomy in a sitting position, along with a neurosurgical procedure, which established a lasting communication channel between the cyst and the basal cisterns. This led to a favorable outcome. Conclusions: Up to the present report, postoperative complete resolution of quadriparesis secondary to a posterior cranial fossa arachnoid cyst has not been reported. At present, no therapeutic modality has been established as the definitive standard of care for pediatric ACs, and their management raises a great deal of controversy among neurosurgeons. The narrative literature review of the present study integrates the various perspectives regarding ACs and their possible treatment approaches that are currently available.